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ORIGINAL ARTICLE12-08-2023
Sociodemographic factors associated with suicidal behavior at a federal public university in the Western Brazilian Amazon
Revista Brasileira de Enfermagem. 2023;76:e20230102
Abstract
ORIGINAL ARTICLESociodemographic factors associated with suicidal behavior at a federal public university in the Western Brazilian Amazon
Revista Brasileira de Enfermagem. 2023;76:e20230102
DOI 10.1590/0034-7167-2023-0102
Views0See moreABSTRACT
Objective:
to determine risk factors for suicidal behavior among students and employees of a federal public university in the Brazilian Western Amazon.
Methods:
an analytical cross-sectional study of survey and association between variables with a sample of 475 participants. Statistical analyzes were performed using the Mann-Whitney test, Pearson’s chi-square test, likelihood ratio test or Fisher’s exact test and a logistic regression model. A significance level of 5% was used (p-value< 0.05).
Results:
a higher proportion of suicidal behavior was found in younger participants, females, who had no religion or had one, but were non-practicing, who did not have children and/or had a monthly family income of less than two minimum wages. Lower proportions of suicidal behavior were identified in heterosexuals and/or married or in a stable relationship.
Conclusion:
the study suggests a relationship between sociodemographic factors and suicidal behavior in the studied academic community.
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ORIGINAL ARTICLE12-08-2023
Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care
Revista Brasileira de Enfermagem. 2023;76:e20220785
Abstract
ORIGINAL ARTICLEPolypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care
Revista Brasileira de Enfermagem. 2023;76:e20220785
DOI 10.1590/0034-7167-2022-0785
Views0See moreABSTRACT
Objective:
to identify the prevalence and associations of polypharmacy and potentially inappropriate medication use among older adults with hypertension treated in primary care.
Methods:
a cross-sectional study carried out with older adults with hypertension treated at a Family Health Strategy unit. Data collection included analysis of medical records, interviews and multidimensional assessment of older adults. Socio-demographic information and clinical variables were collected. Statistical analysis was performed by multiple logistic regression.
Results:
polypharmacy prevalence was 38.09%, and potentially inappropriate medication (PIM), 28.57%. There was a significant association between polypharmacy and PIM use, altered sleep and ethnicity. PIM use was associated with polypharmacy, worse family functioning, and absence of a caregiver. Cognitive decline reduces the prevalence of these medications.
Conclusions:
polypharmacy and PIM use among older adults with hypertension represent a problem in this population, especially among the most vulnerable.
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ORIGINAL ARTICLE12-08-2023
Care for older adults with disabilities in Long Term Care Facility
Revista Brasileira de Enfermagem. 2023;76:e20220767
Abstract
ORIGINAL ARTICLECare for older adults with disabilities in Long Term Care Facility
Revista Brasileira de Enfermagem. 2023;76:e20220767
DOI 10.1590/0034-7167-2022-0767
Views0See moreABSTRACT
Objective:
to analyze the constitution of care offered to older adults with disabilities, from Long Term Care Facility professionals’ perspective.
Methods:
this is a discourse analysis based on the post-structuralist framework. Participants in this study are professionals involved in the care for older adults, totaling 14 respondents, 13 women and one man.
Results:
from professionals’ perspective, there is a fine line between caring for older adults with disabilities and maintaining their autonomy. Care in which autonomy is restricted predisposes older adults to a process of dependency.
Final considerations:
caring for older adults with disabilities constitutes the challenge between caring and maintaining independence. Thus, older adult-centered care should be taken as a premise so that their individualities are respected.
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ORIGINAL ARTICLE12-08-2023
Fear of COVID-19 when experiencing pregnancy or childbirth in the pandemic: what are the associated factors?
Revista Brasileira de Enfermagem. 2023;76:e20220755
Abstract
ORIGINAL ARTICLEFear of COVID-19 when experiencing pregnancy or childbirth in the pandemic: what are the associated factors?
Revista Brasileira de Enfermagem. 2023;76:e20220755
DOI 10.1590/0034-7167-2022-0755
Views0See moreABSTRACT
Objective:
to identify factors associated with fear of COVID-19 among women who experienced pregnancy or childbirth during the pandemic.
Methods:
a cross-sectional study, nested within a prospective cohort, using an online survey, from August 2021 to February 2022, based on descriptive data analysis.
Results:
of the 431 participants, 52.8% were postpartum women and 20.1% were pregnant women. With regard to fear of COVID-19, a mean score of 20.46 was obtained (moderate fear). The highest fear scores were present in women whose newborns were admitted to hospital in neonatal critical units (p=0.032), and the lowest among those covered by supplementary health (insurance) (p=0.016).
Conclusion:
among pregnant and postpartum women, high fear of COVID-19 translated into the possibility of having newborns admitted to hospital in a critical unit. The importance of supporting actions to support pregnant/postpartum women’s mental health in relation to COVID-19 or other threats that may influence the neonatal outcome stands out.
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ORIGINAL ARTICLE12-08-2023
A relação entre o nível de conhecimento e o comportamento de prevenção do corrimento vaginal para estudantes de enfermagem
Revista Brasileira de Enfermagem. 2023;76:e20220602
Abstract
ORIGINAL ARTICLEA relação entre o nível de conhecimento e o comportamento de prevenção do corrimento vaginal para estudantes de enfermagem
Revista Brasileira de Enfermagem. 2023;76:e20220602
DOI 10.1590/0034-7167-2022-0602
Views0See moreRESUMEN
Objetivo:
la salud reproductiva de las adolescentes es muy importante. Determinar la relación entre el nivel de conocimientos y la conducta de prevención del flujo vaginal en estudiantes de enfermería.
Métodos:
estudio cuantitativo, transversal, con 155 estudiantes de primer año de una facultad privada de enfermería. Los datos se recopilaron de febrero a marzo de 2022 a través de un cuestionario electrónico.
Resultados:
los participantes con buen nivel de conocimientos correspondieron al 98,1% y los que practican buenas conductas para prevenir el flujo vaginal, el 92,3%.
Conclusión:
un buen conocimiento produce conductas de prevención adecuadas. El resultado de este estudio puede contribuir con reflexiones y referencias para un estudio más profundo de los factores que influyen en el nivel de conocimiento y comportamiento sobre la enfermedad de los genitales y los peligros del flujo vaginal patológico.
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ORIGINAL ARTICLE12-08-2023
The relationship between level of knowledge and vaginal discharge prevention behavior for nursing student
Revista Brasileira de Enfermagem. 2023;76:e20220602
Abstract
ORIGINAL ARTICLEThe relationship between level of knowledge and vaginal discharge prevention behavior for nursing student
Revista Brasileira de Enfermagem. 2023;76:e20220602
DOI 10.1590/0034-7167-2022-0602
Views0See moreABSTRACT
Objective:
Reproductive health in adolescent girls is very important. To determine the relationship between the level of knowledge and the behavior of preventing vaginal discharge among nursing students.
Methods:
a quantitative, cross-sectional study, with 155 first-year female students at a private faculty of nursing. Data were collected from February to March 2022, using an electronic questionnaire.
Results:
98.1% of participants have a good level of knowledge and 92.3% of participants practice good vaginal discharge prevention behavior.
Conclusion:
good knowledge produces appropriate prevention behavior. The result of this study can be used as a contribution of thoughts and references as a more in-depth study of the factors that influence the level of knowledge and behavior about the disease of the genitalia and the dangers of pathological vaginal discharge.
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Nursing experiences in specialized services in child and adolescent mental health: a systematic review of qualitative studies
Revista Brasileira de Enfermagem. 2023;76:e20220550
Abstract
Nursing experiences in specialized services in child and adolescent mental health: a systematic review of qualitative studies
Revista Brasileira de Enfermagem. 2023;76:e20220550
DOI 10.1590/0034-7167-2022-0550
Views0See moreABSTRACT
Objective:
to synthesize evidence from qualitative studies on nursing experiences regarding child and adolescent mental health care in specialized services.
Method:
a systematic review with meta-synthesis of qualitative studies according to JBI guidelines. CINAHL, EMBASE, MEDLINE, LILACS, PSYCinfo, Scopus and Web of Science databases were used. The findings were classified according to the level of reliability and credibility and categorized by similarity between contents.
Results:
229 articles were identified, and five were included in the final sample and organized into the categories: Emotional impact; and Understanding nursing role. The level of evidence found was moderate.
Final considerations:
nursing experiences are permeated by emotional exhaustion, feelings of frustration and difficulty in understanding their professional role. The need for training spaces that qualify this care is highlighted.
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ORIGINAL ARTICLE12-04-2023
Sepsis and COVID-19: outcomes in young adults in intensive care
Revista Brasileira de Enfermagem. 2023;76(6):e20230037
Abstract
ORIGINAL ARTICLESepsis and COVID-19: outcomes in young adults in intensive care
Revista Brasileira de Enfermagem. 2023;76(6):e20230037
DOI 10.1590/0034-7167-2023-0037
Views0See moreABSTRACT
Objective:
to verify sepsis incidence among young adults admitted to intensive care due to COVID-19 and to analyze its association with demographic, clinical and outcome variables.
Methods:
a quantitative, longitudinal, retrospective and analytical study, consisting of 58 adults aged 20 to 40 years in intensive care for SARS-CoV-2. It was carried out in a university hospital, from March 2020 to December 2021, with data collected from electronic medical records.
Results:
sepsis incidence was 65%. Sepsis was associated with acute kidney injury, use of vasoactive drugs and mechanical ventilation, being admitted to the emergency room, severity according to the Simplified Acute Physiology Score III and bacterial pulmonary co-infection, the latter being the most frequent etiology for sepsis.
Conclusions:
there was a high sepsis incidence, with 42% of deaths, which points to the importance of investing in preventive measures, especially in relation to bacterial pulmonary coinfections.
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ORIGINAL ARTICLE12-04-2023
Clinical simulation scenarios for the planning and management of infusion therapy by nurses
Revista Brasileira de Enfermagem. 2023;76(6):e20230019
Abstract
ORIGINAL ARTICLEClinical simulation scenarios for the planning and management of infusion therapy by nurses
Revista Brasileira de Enfermagem. 2023;76(6):e20230019
DOI 10.1590/0034-7167-2023-0019
Views0ABSTRACT
Objective:
to build, evaluate and test two clinical simulation scenarios for the planning and management of infusion therapy by nurses.
Methods:
methodological study, with construction of scenarios based on the NLN Jeffries Simulation Theory and the theoretical model Vessel Health Preservation; evaluation of the scenario design by judges, with calculation of the Modified Kappa Coefficient (MKC); testing scenarios with the target audience. Results: scenarios built for: 1. Patient assessment and vascular device selection; and 2. Identification and management of deep vein thrombosis. In the evaluation by judges, testing of validated scenarios in relation to educational practices and simulation design, the items evaluated presented MKC values ≥ 0.74.
Conclusion:
two evidence-based scenarios related to infusion therapy were constructed, with high levels of agreement among judges regarding their design. In testing with nurses, good results were obtained regarding the design and structuring of educational practice.
Keywords:Educational MeasurementNursing EducationPatient Care PlanningSimulation TrainingVascular Access DevicesSee more -
Sleep quality of nurses who worked in coping with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2023;76(6):e20230007
Abstract
Sleep quality of nurses who worked in coping with COVID-19: an integrative review
Revista Brasileira de Enfermagem. 2023;76(6):e20230007
DOI 10.1590/0034-7167-2023-0007
Views0See moreABSTRACT
Objective:
to analyze sleep quality of nurses who worked coping with COVID-19 in scientific evidence.
Methods:
an integrative review, carried out in seven databases, including studies between December 2021 and June 2022, without language restrictions. The sample consisted of 15 primary studies.
Results:
nurses working in hospital, intensive care, outpatient care and teaching institutions constitute a vulnerable group for sleep disorders: latency, duration, efficiency and quality. The disorders identified involved insomnia at varying levels of severity: daytime dysfunction and morning sleepiness. Night work and low capacity for self-care were determinants of impaired sleep patterns.
Final considerations:
the COVID-19 pandemic contributed to greater vulnerability of nurses to changes in sleep, requiring strategies for risk management and well-being promotion.
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ORIGINAL ARTICLE12-04-2023
Work and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220792
Abstract
ORIGINAL ARTICLEWork and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic
Revista Brasileira de Enfermagem. 2023;76(6):e20220792
DOI 10.1590/0034-7167-2022-0792
Views0See moreABSTRACT
Objective:
To assess the relationship between psychopathological symptoms and the social, clinical, and occupational profile of nurses in the Amazon region of Brazil during the COVID-19 pandemic.
Methods:
A descriptive cross-sectional online study was conducted in 2020 with 261 nurses. The Symptom Assessment Scale-40 was utilized.
Results:
The presence of pre-existing conditions before the pandemic was associated with psychotism (p=0.044). Experiencing constraints and/or violence at work during the pandemic was associated with somatization (p=0.025), and working hours were associated with anxiety (p=0.025). Nurses predominantly exhibited symptoms related to fear (33.7%), tension (34.5%), and a sense that something is wrong in the mind (22.6%).
Conclusions:
A significant association was observed between working hours and anxiety symptoms, the experience of constraints and/or violence at work during the COVID-19 pandemic and somatization symptoms, as well as between pre-existing conditions and psychotism symptoms related to COVID-19.
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ORIGINAL ARTICLE12-04-2023
Sexual behavior according to undergraduate students: perspective of cross-cultural nursing and intersectional framing
Revista Brasileira de Enfermagem. 2023;76(6):e20220786
Abstract
ORIGINAL ARTICLESexual behavior according to undergraduate students: perspective of cross-cultural nursing and intersectional framing
Revista Brasileira de Enfermagem. 2023;76(6):e20220786
DOI 10.1590/0034-7167-2022-0786
Views0ABSTRACT
Objective:
to discuss undergraduate students’ sexual behavior from the perspective of social markers and cross-cultural care proposed by Madeleine Leininger.
Methods:
descriptive-exploratory qualitative research, with a theoretical-philosophical foundation in the Transcultural Theory. Convenience sample was composed of 57 young people from two universities in Rio de Janeiro. The focus groups’ content were analyzed lexically using the IRAMUTEQ software.
Results:
four classes emerged: Young people’s sexual scripts: between the fear of an unplanned pregnancy and the risk of exposure to sexually transmitted infections; Affective relationships: trust in steady sexual partners, apparent sense of security and disuse of condoms; Sexual practices, gender and cultural determinants: distinction in men’s and women’s role; Sexual partnerships, negotiation of condom use and vulnerability to sexually transmitted infections.
Final considerations:
challenges are perceived for the attention to undergraduate students’ sexual health, who verbalized risky sexual behaviors due to sociocultural vulnerabilities.
Keywords:Cross-Cultural NursingIntersectional FramingSexual BehaviorSexually Transmitted InfectionsYoung AdultSee more -
ORIGINAL ARTICLE12-04-2023
Hospital discharge planning in care transition of patients with chronic noncommunicable diseases
Revista Brasileira de Enfermagem. 2023;76(6):e20220772
Abstract
ORIGINAL ARTICLEHospital discharge planning in care transition of patients with chronic noncommunicable diseases
Revista Brasileira de Enfermagem. 2023;76(6):e20220772
DOI 10.1590/0034-7167-2022-0772
Views0ABSTRACT
Objective:
to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases.
Method:
a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews.
Results:
there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition.
Final considerations:
they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.
Keywords:Continuity of Patient CareNurse's RolePatient DischargePatient-Centered CareProcess AssessmentTransitional CareSee more -
ORIGINAL ARTICLE12-04-2023
Psychometric Properties of an Instrument for Assessing University Administrators’ Knowledge on Gender-Based Violence
Revista Brasileira de Enfermagem. 2023;76(6):e20220770
Abstract
ORIGINAL ARTICLEPsychometric Properties of an Instrument for Assessing University Administrators’ Knowledge on Gender-Based Violence
Revista Brasileira de Enfermagem. 2023;76(6):e20220770
DOI 10.1590/0034-7167-2022-0770
Views0ABSTRACT
Objective:
To evaluate the factorial structure of the instrument measuring university administrators’ knowledge of gender-based violence.
Methods:
This cross-sectional methodological study was conducted from August to November 2020 with 101 university administrators. Data on demographic and functional characteristics were collected, and the “QUEST VBG UNIV” instrument was applied. Descriptive analysis was performed, the structure of the questionnaire was assessed using exploratory factor analysis (EFA), and the stability of the factors was verified through ORION and FDI tests.
Results:
Of the original 38 items across the 4 sections of the questionnaire, 19 were retained within 2 factors, with appropriate factor loadings. Factor 1 had an explained variance of 15.69%, and Factor 2 had an explained variance of 9.10%. The reliability was deemed satisfactory (ORION > 0.900, FDI > 0.900).
Conclusions:
The questionnaire presented a valid and reliable factorial structure for measuring knowledge about gender-based violence, thereby representing a suitable option for situational assessments in universities.
Keywords:Factor AnalysisGender-Based ViolencePsychometricsStatisticalValidation StudyWorkplace violenceSee more
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ORIGINAL ARTICLE06-17-2024
Quality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
Abstract
ORIGINAL ARTICLEQuality of life associated with nursing professionals’ individual resources and work
Revista Brasileira de Enfermagem. 2024;77(3):e20230476
DOI 10.1590/0034-7167-2023-0476
Views0See moreABSTRACT
Objectives:
to assess the physical and mental components of nursing professionals’ quality of life and associate them with individual, health and work characteristics.
Methods:
cross-sectional research, with nursing professionals from a university hospital in São Paulo. Own questionnaire and validated instruments were applied.
Results:
the overall quality of life was compromised. The physical component was lower in relation to low family income and among those who perceived greater control/pressure at work, and better for those who practiced physical activity and had support of leader and organization. The mental component was lower in professionals who reported dissatisfaction with work, worse self-rated physical health and were older. Scores for both components reduced due to work-related illnesses, worse work ability and increased daytime sleepiness.
Conclusions:
quality of life was statistically associated with controllable institutional factors and individual resources that, except age, can be promoted.
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ORIGINAL ARTICLE06-17-2024
Giving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
Abstract
ORIGINAL ARTICLEGiving meaning to internalized violence throughout life by older adults living in rural areas
Revista Brasileira de Enfermagem. 2024;77(3):e20230163
DOI 10.1590/0034-7167-2023-0163
Views0See moreABSTRACT
Objectives:
to understand the meanings of violence internalized throughout life by older adults living in rural areas.
Methods:
a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software.
Results:
it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality.
Final Considerations:
older adults living in rural areas internalized the violence suffered in a unique way, and this scenario’s specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.
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ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views0In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
DOI 10.1590/0034-7167.20247702e05
Views0In the article “Educational technologies used to promote self-care for people with diabetes mellitus: integrative review”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 4):e20230049, in the title:Where it read:[…]See more -
REVIEW06-14-2024
Lean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
Abstract
REVIEWLean and/or Six Sigma for process optimization in the perioperative period: an integrative review
Revista Brasileira de Enfermagem. 2024;77(2):e20230431
DOI 10.1590/0034-7167-2023-0431
Views0See moreABSTRACT
Objective:
To analyze the evidence on the influence of Lean and/or Six Sigma for process optimization in the perioperative period.
Methods:
Integrative review carried out in the MEDLINE (PubMed), Web of Science, EMBASE, CINAHL, Scopus and LILACS databases on the use of Lean and/or Six Sigma to optimize perioperative processes. The studies included were analyzed in three thematic categories: flow of surgical patients, work process and length of stay.
Results:
The final sample consisted of ten studies, which covered all operative periods. Lean and/or Six Sigma make a significant contribution to optimizing perioperative processes.
Final considerations:
Lean and/or Six Sigma optimize perioperative processes to maximize the achievement of system stability indicators, making it possible to identify potential problems in order to recognize them and propose solutions that can enable the institution of patient-centered care.
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ORIGINAL ARTICLE06-14-2024
Strategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
Abstract
ORIGINAL ARTICLEStrategies used by nurses regarding underreporting of rural work accidents due to pesticide use
Revista Brasileira de Enfermagem. 2024;77(2):e20230384
DOI 10.1590/0034-7167-2023-0384
Views0See moreABSTRACT
Objective:
To learn the strategies used regarding underreporting of pesticide use in rural areas.
Methods:
A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis.
Results:
The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject.
Final considerations:
Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.
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ORIGINAL ARTICLE06-14-2024
Teoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
Abstract
ORIGINAL ARTICLETeoria de médio alcance do diagnóstico de enfermagem sobrepeso
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
DOI 10.1590/0034-7167-2023-0372
Views0See moreRESUMEN
Objetivo:
Construir una teoría de rango medio para el diagnóstico de enfermería Sobrepeso en adolescentes y adultos jóvenes.
Métodos:
Estudio metodológico a la luz de los marcos teóricos de Roy y de Lopes, Silva y Herdman. Un total de 3.925 artículos fueron recuperados y evaluados utilizando el software State of the Art Through Systematic Review. La muestra final fue de 28 artículos.
Resultados:
Los resultados convergieron en 3 atributos esenciales, 13 antecedentes y 7 consecuencias. Se construyó una teoría de rango medio compuesta por un diagrama ilustrado, 11 proposiciones y 12 relaciones causales.
Consideraciones finales:
A partir de la creación de la teoría, fue posible comprender mejor el diagnóstico de enfermería Sobrepeso en el contexto de adolescentes y adultos jóvenes. La comprensión de los fenómenos de enfermería contribuye para el avance y fortalecimiento de la ciencia de enfermería.
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