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12-04-2023
A cronicidade e o seu impacto na saúde do trabalhador: uma chamada para ações concretas
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
Abstract
A cronicidade e o seu impacto na saúde do trabalhador: uma chamada para ações concretas
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
DOI 10.1590/0034-7167.202376suppl301pt
Views0A relação entre cronicidade e trabalho tem sido uma preocupação crescente na sociedade contemporânea. À medida que o número de doenças crônicas aumenta em todo o mundo, é fundamental compreender como essas condições impactam a saúde dos trabalhadores(). Neste editorial, exploraremos os impactos da cronicidade na saúde do trabalhador, destacando dados da Carga Global de […]See more -
12-04-2023
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
Abstract
Chronicity and its impact on workers’ health: a call for concrete actions
Revista Brasileira de Enfermagem. 2023;76:e76suppl301
DOI 10.1590/0034-7167.202376suppl301
Views0The relationship between chronicity and work has been a growing concern in contemporary society. As the number of chronic illnesses increases around the world, it is critical to understand how these conditions impact workers’ health(). In this editorial, we will explore the impacts of chronicity on workers’ health, highlighting data from the Global Burden of […]See more -
12-04-2023
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
Abstract
General Law on Personal Data Protection and applicability to Nursing
Revista Brasileira de Enfermagem. 2023;76:e20230126
DOI 10.1590/0034-7167-2023-0126
Views0See moreABSTRACT
Objectives:
to reflect on the impacts of the General Personal Data Protection Law on Nursing practice.
Methods:
reflection article, through the intentional collection of materials relating to the topic.
Results:
legislation regulates confidentiality, processing and data sharing, requiring institutional protection measures. The nursing team is responsible for acting preventively, both in care and in the management role, in order to avoid the misuse of the patient’s personal data. The law allows academic research to be carried out as long as the purpose is clear, data collection occurs with an explicit purpose and data is anonymized.
Final Considerations:
although the General Personal Data Protection Law requires greater care in relation to data processing, it is established on precepts of good faith and respect for the rights of the individual, concepts aligned with the nursing code of ethics.
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REVIEW12-04-2023
Supervision of professional nursing practice in Brazil: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20230077
Abstract
REVIEWSupervision of professional nursing practice in Brazil: a scoping review
Revista Brasileira de Enfermagem. 2023;76:e20230077
DOI 10.1590/0034-7167-2023-0077
Views0See moreABSTRACT
Objectives:
to map studies that analyze the audit process of nursing councils.
Methods:
this is a scoping review, anchored in the JBI framework, with the guiding question: what is the evidence of the audit process of legal practice of nursing by class councils (COFEN/COREN system)? The searches were carried out in October and November 2022 without limitation of language and year.
Results:
of the 9 selected studies, all are Brazilian and published from 2014 onwards. Among the topics addressed are the role, challenges, costs and difficulties in nurse auditors’ daily work process, in addition to the contribution of the audit sector in Brazil.
Conclusions:
the studies gathered discuss aspects related to costs, challenges and difficulties, but there is no focus on corrective, disciplinary and educational activities as well as little is said about the audit process, its reporting, referral and outcomes.
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ORIGINAL ARTICLE12-04-2023
Overview of nursing ethics teaching in Brazilian public higher education institutions
Revista Brasileira de Enfermagem. 2023;76:e20220808
Abstract
ORIGINAL ARTICLEOverview of nursing ethics teaching in Brazilian public higher education institutions
Revista Brasileira de Enfermagem. 2023;76:e20220808
DOI 10.1590/0034-7167-2022-0808
Views0See moreABSTRACT
Objectives:
to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions.
Methods:
descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil.
Results:
153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women’s, Children’s, Adolescent’s, Adult’s and Older People’s Health, and Mental Health.
Final Considerations:
the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.
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12-04-2023
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
Abstract
La ética de la atención de enfermería a las personas transgénero
Revista Brasileira de Enfermagem. 2023;76:e20220797
DOI 10.1590/0034-7167-2022-0797es
Views0See moreRESUMEN
Objetivos:
debatir sobre aspectos éticos en la atención de enfermería a personas transgénero.
Métodos:
estudio reflexivo fundamentado sobre los dilemas que se plantean en los cuidados de enfermería a personas transgénero. El relato se ha estructurado en torno a los cuatro principios bioéticos.
Resultados:
la atención sanitaria a las personas trans es compleja, transversal a muchos dispositivos y especialidades y longitudinal en el tiempo por lo que precisa de la actuación coordinada. Existe un marco ético en el que se encuadran los cuidados de enfermería que se precisan en la atención a este colectivo.
Consideraciones Finales:
la enfermera como agente de salud puede asumir diversas líneas generales en la atención a pacientes transgénero. Para ello, se debe brindar formación adicional no solo a los profesionales, también a los estudiantes de enfermería y de las demás ciencias de la salud.
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12-04-2023
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
Abstract
Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari
Revista Brasileira de Enfermagem. 2023;76:e20220759
DOI 10.1590/0034-7167-2022-0759
Views0See moreABSTRACT
Objectives:
to reflect on the ethical dilemmas involved in the care of patients at the end of their lives.
Methods:
this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari.
Results:
discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient’s autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care.
Final Considerations:
issues related to being, stemming from one’s reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.
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01-01-2015
Polysomnography assessment of sleep and wakefulness in premature newborns
Revista Brasileira de Enfermagem. 2015;68(6):1109-1115
Abstract
Polysomnography assessment of sleep and wakefulness in premature newborns
Revista Brasileira de Enfermagem. 2015;68(6):1109-1115
DOI 10.1590/0034-7167.2015680616i
Views0See moreABSTRACT
Objective:
to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters.
Method:
a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours.
Results:
the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002).
Conclusion:
the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.
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01-01-2015
Learning Incubator: an instrument to foster entrepreneurship in Nursing
Revista Brasileira de Enfermagem. 2015;68(6):1103-1108
Abstract
Learning Incubator: an instrument to foster entrepreneurship in Nursing
Revista Brasileira de Enfermagem. 2015;68(6):1103-1108
DOI 10.1590/0034-7167.2015680615i
Views0See moreABSTRACT
Objective:
this study aimed to know the contributions of the Learning Incubator to the process of lifelong education in health.
Method:
this is a qualitative field research whose data was collected from August to December 2014 by the focus group technique. The research had 34 employees of a Teaching Hospital in the central region of the state of Rio Grande do Sul that participated previously in the incubation process.
Results:
from the data encoded by content analysis, three themes were selected: Learning Incubator – welcoming and integrating space; An instigating instrument that enhances possibilities; Continuous and lifelong education strategy.
Conclusion:
the Learning Incubator is an important instrument to foster entrepreneurship in nursing and other health areas due to its capacity of rethinking mechanized practices, to the possibility of instigating new ways of being and acting, and to the ability of creating and developing new ideas based on individual and institutional needs.
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01-01-2015
Estratégias não farmacológicas para diminuição da ansiedade no cateterismo cardíaco: revisão integrativa
Revista Brasileira de Enfermagem. 2015;68(6):1093-1102
Abstract
Estratégias não farmacológicas para diminuição da ansiedade no cateterismo cardíaco: revisão integrativa
Revista Brasileira de Enfermagem. 2015;68(6):1093-1102
DOI 10.1590/0034-7167.2015680614i
Views0See moreRESUMEN
Objetivo:
identificar y revisar los estudios de literatura que abordan las estrategias no farmacológicas utilizadas para reducir la ansiedad en los pacientes que reciben un cateterismo cardíaco.
Método:
revisión integradora. La investigación se llevó a cabo utilizando las bases de datos LILACS, SciELO, Medline (BVS y PubMed) y Scopus. Los estudios se analizaron de acuerdo con sus objetivos, la metodo, los instrumentos utilizados para la evaluación de la ansiedad de los pacientes, y los resultados obtenidos.
Resultados:
la estrategia dirigida más para reducir la ansiedad en los pacientes que recibieron cateterización cardíaca fue la musicoterapia. No se encontró estudio, sin embargo, identificando el momento más adecuado para esta intervención (antes, durante y / o después de este procedimiento). Otras estrategias identificados en esta revisión eran videos educativos, masajes y terapia de palma.
Conclusión:
los resultados sugieren que la ansiedad se puede reducir el uso de estrategias no farmacológicas.
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01-01-2015
Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review
Revista Brasileira de Enfermagem. 2015;68(6):1093-1102
Abstract
Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review
Revista Brasileira de Enfermagem. 2015;68(6):1093-1102
DOI 10.1590/0034-7167.2015680614i
Views0See moreABSTRACT
Objective:
to identify and review the literature on non-pharmacological strategies used for reducing anxiety in patients receiving cardiac catheterization.
Method:
this study was an integrative literature review. The research was conducted using the databases LILACS, SciELO, Medline (through BVS and PubMed) and Scopus. Studies were analyzed according to their objective, method, instruments used for evaluating patients’ anxiety, and the results obtained.
Results:
the most used strategy for reducing anxiety in patients receiving cardiac catheterization was music therapy. However, no study identifying the most appropriate time for this intervention (before, during and/or after the procedure) was found. Other strategies identified in this review were educational videos, massage, and palm therapy.
Conclusion:
the results found suggest that anxiety can be reduced using non-pharmacological strategies.
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01-01-2015
Convergence, divergence and diagnostic accuracy in the light of two nursing terminologies
Revista Brasileira de Enfermagem. 2015;68(6):1086-1092
Abstract
Convergence, divergence and diagnostic accuracy in the light of two nursing terminologies
Revista Brasileira de Enfermagem. 2015;68(6):1086-1092
DOI 10.1590/0034-7167.2015680613i
Views0See moreABSTRACT
Objective:
compare divergences and convergences between the nursing diagnoses established for a case study, in the light of two nursing terminologies.
Method:
a descriptive research was undertaken. The participants were 24 nurses from public teaching hospitals (N=12) and hospital care institutions (N=12) in the Northeast of Brazil.
Results:
in group A (6 faculty members and 6 clinical professionals), 51 diagnoses were established according to NANDA-I: 54.9% of high accuracy, 23.5% zero, 15.7% low and 5.9% moderate accuracy. In group B (6 faculty members and 6 clinical professionals), 43 declarations were established using the ICNP®: 44.2% of zero accuracy, 39.5% high, 16.3% low. Four out of fi ve diagnostic titles of high accuracy in group A and the seven titles in group B converged; divergences were attributed to the number of combinations among the focus, judgment and location axes of the ICNP®.
Conclusion:
a range of titles was observed with different diagnostic inferences and low diagnostic accuracy in both groups.
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01-01-2015
Family caregivers articulating the social network of a child with special health care needs
Revista Brasileira de Enfermagem. 2015;68(6):1078-1085
Abstract
Family caregivers articulating the social network of a child with special health care needs
Revista Brasileira de Enfermagem. 2015;68(6):1078-1085
DOI 10.1590/0034-7167.2015680612i
Views0See moreABSTRACT
Objective:
the study sought to characterize the social network of the child and analyze the role of the family in its creation.
Method:
a qualitative approach was developed through five dynamics (Speaking Map) based on the creative sensitive method, with five groups of families (12 participants) in their homes.
Results:
the critical discourse analysis of the caregivers (grandparents, siblings and neighbors) showed that the mother plays the main role in articulating the social network, with its points being linked by the hospital, primary and rehabilitation care, household, school, etc. Familial care becomes more visible at home and within the community.
Conclusion:
with the insufficient public policy that articulating healthcare facilities for CSHCN in the community, family members shape a social network characterized by a dense and fluid mesh.
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01-01-2015
Speeches of managers about the policy of the directly observed treatment for tuberculosis
Revista Brasileira de Enfermagem. 2015;68(6):1069-1077
Abstract
Speeches of managers about the policy of the directly observed treatment for tuberculosis
Revista Brasileira de Enfermagem. 2015;68(6):1069-1077
DOI 10.1590/0034-7167.2015680611i
Views0See moreABSTRACT
Objective:
to analyze the managers’ speeches about the policy transfer of the directly observed treatment (DOT) for tuberculosis control in the city of João Pessoa, Paraíba, Brazil.
Method:
this is a qualitative study developed in May and June, 2013 through semi-directed interviews with twenty health professionals in five health districts in João Pessoa/PB. The empirical material produced was analyzed according to the theoretical-analytical basis of the French Discourse Analysis by Pêcheux.
Results:
the study demonstrated weaknesses in the conduction and organization of actions in relation to the DOT. It revealed that the lack of knowledge of the managers about this policy has direct implications to the care of tuberculosis patients.
Conclusion:
the management should trace strategic plans to rethink the care practices and thus, reorganize the entire care network to users in order to effectively contribute to user adherence in the fight against tuberculosis.
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01-01-2015
Conceptions of mid-level nursing professionals facing those with a chemical dependency
Revista Brasileira de Enfermagem. 2015;68(6):1063-1068
Abstract
Conceptions of mid-level nursing professionals facing those with a chemical dependency
Revista Brasileira de Enfermagem. 2015;68(6):1063-1068
DOI 10.1590/0034-7167.2015680610i
Views0See moreABSTRACT
Objective:
to describe and understand the conceptions of nursing assistants working in Psychosocial Care Centers for alcohol and drugs (CAPS ad), about the patient with addictions.
Method:
sixteen nursing assistants and technicians from nine of the CAPS ad in São Paulo were interviewed, and data were analyzed using the constant comparative method.
Results:
performing the functions in the CAPS ad enabled the change in staff’s conception from a stigmatizing and prejudiced view, to the concept of chemical dependence as a disease and those who are chemically dependent as patients with comorbidities and family problems, in need of help and treatment.
Conclusion:
professional practice in specialized services for alcohol and other drugs enables changes in the staff’s conceptions about chemically dependent individuals, highlighting the need to include the subject of alcohol and drugs in the school curriculum.
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01-01-2015
Symbolic effects capitalized by nurses from the National Institute of Cancer in Brazil (1980 – 1990)
Revista Brasileira de Enfermagem. 2015;68(2):284-290
Abstract
Symbolic effects capitalized by nurses from the National Institute of Cancer in Brazil (1980 – 1990)
Revista Brasileira de Enfermagem. 2015;68(2):284-290
DOI 10.1590/0034-7167.2015680214i
Views0See moreABSTRACT
Objective:
to describe the strategies of nurses in the National Institute of Cancer to disseminate its scientifi c capital and discuss the symbolic effects capitalized in the fi eld of oncology in the 1980s.
Method:
historical social studies, with primary sources consisting of written documents and oral reports, and as secondary sources, articles and books on the subject, based on the French sociologist Pierre Bourdieu’s concepts of scientifi c capital and habitus.
Results:
it revealed the effective performance of nurses in this Institute on policies of cancer prevention and control and strategies used in the teaching of oncology nursing at the undergraduate level. In conclusion, nursing stands out in this context, through the dissemination of its scientifi c knowledge, as a participant in the construction of a scientifi c fi eld of oncology nursing in Brazil, highlighting the occupation of important social areas.
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01-01-2015
Perception of nursing undergraduate students on self-aging
Revista Brasileira de Enfermagem. 2015;68(2):278-283
Abstract
Perception of nursing undergraduate students on self-aging
Revista Brasileira de Enfermagem. 2015;68(2):278-283
DOI 10.1590/0034-7167.2015680213i
Views1See moreABSTRACT
Objective:
to analyze the perceptions of nursing undergraduate students on their self-aging process.
Method:
qualitative study carried out between August and September, 2011 with 18 nursing undergraduate students of a public university in Salvador, Bahia. The interviews were analyzed by means of the Content Analysis method.
Results:
the following thematic concept was apprehended: Perceptions of nursing undergraduates on their self-aging, which generated two subcategories: A) The “don’t think about it” process; B) The context infl uencing the process.
Conclusion:
undergraduates reveal that the aging process is an intrinsic factor to human development. Family ties, spirituality and physical activity would be key mechanisms toward active aging. However, students also reported that their accelerated and stressed social lifestyles led to inadequate habits, such as the consumption of fast food and alcohol, which become negative infl uences in their aging process.
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01-01-2015
Non-conventional technologies for data collection in Brazilian dissertations and theses
Revista Brasileira de Enfermagem. 2015;68(2):269-277
Abstract
Non-conventional technologies for data collection in Brazilian dissertations and theses
Revista Brasileira de Enfermagem. 2015;68(2):269-277
DOI 10.1590/0034-7167.2015680212i
Views0See moreABSTRACT
Objective:
to characterize non-conventional technologies used for data collection of dissertations and theses available in the Catalog of Theses and Dissertations (CEPEn) of the Brazilian Nursing Association (ABEn).
Method:
this is a documentary research, whose data were collected in the catalogs of theses and dissertations available at the ABEn website, from Volumes XIX to XXI. The indicators collected were: academic level; educational institution; year; qualification of the author; setting; non-conventional technology used; type of technology; association with conventional techniques; methodological design; benefi ts and methodological limitations.
Results:
from a total of 6346 studies, only 121 (1.91%) used non-conventional technologies for data collection, representing the fi nal sample of the study.
Conclusion:
it is concluded that Brazilian Nursing researches still need methodological innovations for data collection.
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01-01-2015
Content analysis of a technology to the nursing diagnostic reasoning
Revista Brasileira de Enfermagem. 2015;68(2):261-268
Abstract
Content analysis of a technology to the nursing diagnostic reasoning
Revista Brasileira de Enfermagem. 2015;68(2):261-268
DOI 10.1590/0034-7167.2015680211i
Views0See moreABSTRACT
Objective:
to undergo a content analysis of a metacognitive strategy of indirect assessment in the pre-encounter with the client.
Method:
methodological study. Agreement and inter-rater reliability index for the criteria: relevance, adequacy, clarity, conciseness and accuracy of a technology to the nursing diagnosis reasoning for novices through an electronic form. The sample consisted of 13 raters. Data were analyzed using descriptive statistics.
Results:
high agreement and inter-rater reliability for 85 items related to data collection stage and the strategy description. Only fi ve items did not reach the validation criteria and must be rewritten.
Conclusion:
indirect assessment of the pre-encounter is relevant to the diagnostic reasoning process, being possible to develop competencies and diagnostic skills in the novice through strategies, proposals on innovative technology in the form of a diagram.
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01-01-2015
Manual for monitoring the quality of nursing home care records
Revista Brasileira de Enfermagem. 2015;68(2):253-260
Abstract
Manual for monitoring the quality of nursing home care records
Revista Brasileira de Enfermagem. 2015;68(2):253-260
DOI 10.1590/0034-7167.2015680210i
Views0See moreABSTRACT
Objective:
to build and validate an instrument aimed at monitoring the quality of nursing records in the Home Care Program (HCP) of a university hospital.
Method:
methodological study involving the elaboration of a manual, whose content was later submitted to six experts for validation, reaching a ≥ 80% consensus. The data collection process was carried out in 2012 by means of a questionnaire comprised of the following issues: nursing evolution, nursing diagnosis, and nursing prescription, and standards for the nursing team recommended by the Regional Nursing Council of São Paulo and by the assessed institution. Manual items were judged according to the following variables: relevance, pertinence, clarity and simplicity.
Results:
of the 39 propositions, 100% achieved ≥ 80% agreement in the relevance, pertinence and clarity variables; 92.3% in the simplicity variable. Sleep/rest, Mobility and Check-out variables did not reach a favorable minimum consensus in the prescribed activities and were improved following suggestions from the experts.
Conclusion:
we believe that the instrument will enable the improvement of the HCP’s work process.
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01-01-2015
Vulnerability of families of elderly citizens cared for by the Family Health Strategy
Revista Brasileira de Enfermagem. 2015;68(2):244-252
Abstract
Vulnerability of families of elderly citizens cared for by the Family Health Strategy
Revista Brasileira de Enfermagem. 2015;68(2):244-252
DOI 10.1590/0034-7167.2015680209i
Views0See moreABSTRACT
Objective:
the present descriptive, exploratory, cross-sectional study aimed to identify the vulnerability of families of elderly citizens cared for by the Family Health Strategy (FHS).
Method:
the research employed home interviews and was developed with a sample of 500 families of aged people cared for by 32 FHS teams in the city of Dourados, MS, Brazil. The Family Development Index (FDI) was adapted in order to classify the families according to their degree of vulnerability.
Results:
the results revealed the presence of multigenerational families with low educational levels among individuals over the age of 20 and high illiteracy rates among elderly citizens. There were 403 families whose vulnerability was acceptable, 95 in severe vulnerability, and two families in a condition of very severe vulnerability. The most critical dimensions of the FDI were the access to knowledge and to work.
Conclusion:
the study identifi ed that there is still a need for further investments that can assist these aged people and their families in the Primary Health Care.
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01-01-2015
The work in prison: reflections on the health of prison officers
Revista Brasileira de Enfermagem. 2015;68(2):235-243
Abstract
The work in prison: reflections on the health of prison officers
Revista Brasileira de Enfermagem. 2015;68(2):235-243
DOI 10.1590/0034-7167.2015680208i
Views0See moreABSTRACT
Objective:
to understand the working conditions of prison offi cers and the repercutions of labor activity on their health.
Method:
qualitative and descriptive research. Data were collected through open interviews with the prison offi cers of a regional prision and the speeches were submitted to content analysis.
Results:
the results showed unsatisfactory working conditions due to poor material resources and neglect of governmental regarding rehabilitation of convicts, resulting in workers’ exposure to psychosocial risks, dissatisfaction, and emotional distress.
Conclusion:
investments on the security of workers may contribute to their health promotion.
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01-01-2015
Mother recognition in the Neonatal Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(2):228-234
Abstract
Mother recognition in the Neonatal Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(2):228-234
DOI 10.1590/0034-7167.2015680207i
Views0See moreABSTRACT
Objective:
analyze the maternal experience in a neonatal intensive care unit, focusing on relations of recognition.
Method:
a qualitative study, built on the perspective of Gadamer’s hermeneutics, based on Honneth’s concept of recognition. In-depth interviews were conducted with 10 mothers of children admitted to a neonatal intensive care unit.
Results:
failures were reported in the process of mother recognition in the unit, with consequent feelings of insecurity and obligation to child care, resulting in fragility of self-esteem.
Conclusion:
interactions with health professionals in the NICU and its standards and protocols cause vulnerabilities and affect maternal recognition and autonomy.
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