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ORIGINAL ARTICLE06-14-2024
Mid-range theory of the nursing diagnosis Overweight
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
Abstract
ORIGINAL ARTICLEMid-range theory of the nursing diagnosis Overweight
Revista Brasileira de Enfermagem. 2024;77(2):e20230372
DOI 10.1590/0034-7167-2023-0372
Views0See moreABSTRACT
Objective:
To build a mid-range theory for the nursing diagnosis Overweight in adolescents and young adults.
Methods:
A methodological study in the light of the theoretical frameworks of Roy and of Lopes, Silva and Herdman. A total of 3,925 articles were retrieved and assessed using the State of the Art Through Systematic Review software. The final sample consisted of 28 articles.
Results:
The findings converged to 3 essential attributes, 13 antecedents, and 7 consequences. A mid-range theory was built consisting of an illustrated diagram, 11 propositions, and 12 causal relationships.
Final considerations:
From the creation of the theory, it was possible to better understand the nursing diagnosis Overweight within the context of adolescents and young adults. Understanding nursing phenomena contributes to nursing science’s advancement and strengthening.
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ORIGINAL ARTICLE06-14-2024
Cardiovascular Risk and Lifestyle: comparison between teaching workers in Portugal and Brazil
Revista Brasileira de Enfermagem. 2024;77(2):e20230354
Abstract
ORIGINAL ARTICLECardiovascular Risk and Lifestyle: comparison between teaching workers in Portugal and Brazil
Revista Brasileira de Enfermagem. 2024;77(2):e20230354
DOI 10.1590/0034-7167-2023-0354
Views0ABSTRACT
Objective:
Compare Cardiovascular Risk between workers in Brazil and Portugal who work in the teaching context and its relationship with Lifestyle and Common Mental Disorder.
Methods:
Cross-sectional study that compared the cardiovascular health conditions of teaching workers in Manaus (Brazil) and Coimbra (Portugal). The odds ratio between groups was estimated.
Results:
The differences were: Smoking and hypercholesterolemia in participants from Portugal. Hypertension, chronic disease, increased abdominal perimeter, common mental disorder, and absence from work in Brazil. The variables with the greatest effect for high cardiovascular risk were: Country-Portugal [17.273 (95%CI1.538-193.951)], sex-male [61.577 (95%CI5.398-702.469)] and smoking [593.398 (95%CI57.330-6.142.020)].
Conclusion:
The differences in risk between groups showed that participants from Portugal, men, with high blood pressure and/or smokers are the most vulnerable to having a cardiovascular event. There is a need for interventions to promote cardiovascular health in the workplace in both countries.
Keywords:Community-Based Participatory ResearchHeart Disease Risk FactorsLife StyleOccupational HealthUniversitiesSee more -
ORIGINAL ARTICLE06-14-2024
Functional performance assessment scale for children and adolescents with cancer: cross-cultural study
Revista Brasileira de Enfermagem. 2024;77(2):e20230331
Abstract
ORIGINAL ARTICLEFunctional performance assessment scale for children and adolescents with cancer: cross-cultural study
Revista Brasileira de Enfermagem. 2024;77(2):e20230331
DOI 10.1590/0034-7167-2023-0331
Views0ABSTRACT
Objectives:
to describe the methodological process of cross-cultural adaptation of the PlayPerformance Scale for Children to Brazilian Portuguese.
Methods:
methodological study of translation and cross-cultural adaptation in six stages: translation, synthesis of translations, back-translation, evaluation by a committee of judges, evaluation by expert nurses, and pretest. The agreement and representativeness of the items were assessed using the content validity index. A minimum value of 80% agreement was considered.
Results:
all stages of the translation and cross-cultural adaptation process were satisfactory. In the evaluation performed by the committee of judges, all items obtained agreement above 80%. Fifteen pediatric nurses conducted the content validation, suggesting necessary modifications for understanding and application. Thirty children and adolescents with cancer were assessed with the scale for the pre-test.
Conclusions:
the scale was cross-culturally adapted to Brazilian Portuguese. The need for psychometric testing in a consistent sample is emphasized.
Keywords:Cross-Cultural ComparisonNursing Methodology ResearchOncologyPediatric NursingPhysical Functional PerformanceSee more -
ORIGINAL ARTICLE06-14-2024
Meanings attributed to health-related quality of life by caregivers of adolescents with diabetes
Revista Brasileira de Enfermagem. 2024;77(2):e20230314
Abstract
ORIGINAL ARTICLEMeanings attributed to health-related quality of life by caregivers of adolescents with diabetes
Revista Brasileira de Enfermagem. 2024;77(2):e20230314
DOI 10.1590/0034-7167-2023-0314
Views0See moreABSTRACT
Objective:
to interpret the meanings attributed to the health-related quality of life by caregivers of adolescents with type 1 diabetes mellitus.
Methods:
qualitative, descriptive-exploratory study of 14 caregivers of adolescents with diabetes developed at the reference outpatient clinic for endocrine diseases in a city in the state of Paraíba. Interviews were performed between May and September 2021. Inductive thematic analysis of the empirical material, and its interpretation in light of the concepts of health-related quality of life and family functioning were performed.
Results:
the meanings attributed by caregivers to the health-related quality of life of adolescents converged on the feeling of being healthy, healthy eating, satisfactory family income, family involvement in care and effective access to the care network.
Final Considerations:
knowledge of these meanings enables health professionals to develop strategies that meet the unique demands of caregivers experiencing this diagnosis.
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REVIEW06-14-2024
Critical analysis of the scientific production on Jean Watson’s Theory of Human Care
Revista Brasileira de Enfermagem. 2024;77(2):e20230231
Abstract
REVIEWCritical analysis of the scientific production on Jean Watson’s Theory of Human Care
Revista Brasileira de Enfermagem. 2024;77(2):e20230231
DOI 10.1590/0034-7167-2023-0231
Views0See moreABSTRACT
Objectives:
to analyze current scientific production on the use of the theoretical-methodological precepts of Jean Watson’s Theory of Human Care/Clinical Caritas Process.
Methods:
quantitative, exploratory, descriptive study using data from 1979 to 2023 in the Scopus database. Analysis was carried out using VOSviewer software.
Results:
the 73 studies included establish a network of collaboration among 221 authors from 155 institutions in 18 countries, who discuss the development of ethical behavior in nursing staff, through technical improvement, implementation, and validation of instrumental strategies capable of measuring and evaluating the quality of holistic and empathetic care. The Theory of Human Caring contributes to nursing training and care, and Process Clinical Caritas-Veritas is useful for the different possibilities of practice and education.
Conclusions:
it is important to strengthen with more empirical data a nursing work model centered on individual human care, supporting the evolution of scientific nursing knowledge.
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REVIEW06-14-2024
Primary health care professionals’ practice in the face of leprosy: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230207
Abstract
REVIEWPrimary health care professionals’ practice in the face of leprosy: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230207
DOI 10.1590/0034-7167-2023-0207
Views0See moreABSTRACT
Objectives:
to identify Primary Health Care professionals’ practice in the face of leprosy.
Methods:
a scoping review, carried out between November 2022 and January 2023, conducted according to the methodological structure proposed by JBI and checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in six databases and additional literature.
Results:
the sample consisted of 11 articles, published between 2008 and 2022. The findings were synthesized into three categories: Early diagnosis and timely treatment; Physical disability prevention; and Household and social contact surveillance.
Final Considerations:
there is a need to align the practices carried out with those recommended by the Brazilian National Program for Leprosy Control and Elimination, as some were not identified in studies, which implies losses to qualified assistance directed to patient demands, with a view to control and elimination of leprosy.
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ORIGINAL ARTICLE06-14-2024
Validity of the TBApp mobile application for self-care management for people with tuberculosis
Revista Brasileira de Enfermagem. 2024;77(2):e20230195
Abstract
ORIGINAL ARTICLEValidity of the TBApp mobile application for self-care management for people with tuberculosis
Revista Brasileira de Enfermagem. 2024;77(2):e20230195
DOI 10.1590/0034-7167-2023-0195
Views1See moreABSTRACT
Objectives:
to describe the validity process of the TBApp mobile application for self-care management for people with tuberculosis linked to Primary Health Care.
Methods:
methodological research developed with ten expert judges, carried out virtually. The application was assessed in relation to content and technology quality in seven domains (objectivity; structure and appearance; relevance; functionality; reliability; usability; and efficiency), using an instrument with a Likert scale.
Results:
TBApp was considered valid, relevant, functional, reliable and effective by expert judges. The objectives, structure and presentation and relevance domains presented an overall Content Validity Index of 0.93, and the functionality, reliability, usability and efficiency domains presented characteristics and sub-characteristics values greater than 0.80.
Conclusions:
TBApp is a creative and innovative tool that can be used by people with TB and disseminated in the scientific community.
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RESEARCH01-01-2015
Polysomnography assessment of sleep and wakefulness in premature newborns
Revista Brasileira de Enfermagem. 2015;68(6):1109-1115
Abstract
RESEARCHPolysomnography 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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RESEARCH01-01-2015
Learning Incubator: an instrument to foster entrepreneurship in Nursing
Revista Brasileira de Enfermagem. 2015;68(6):1103-1108
Abstract
RESEARCHLearning 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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RESEARCH01-01-2015
Estratégias não farmacológicas para diminuição da ansiedade no cateterismo cardíaco: revisão integrativa
Revista Brasileira de Enfermagem. 2015;68(6):1093-1102
Abstract
RESEARCHEstratégias 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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RESEARCH01-01-2015
Non-pharmacological strategies to decrease anxiety in cardiac catheterization: integrative review
Revista Brasileira de Enfermagem. 2015;68(6):1093-1102
Abstract
RESEARCHNon-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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RESEARCH01-01-2015
Convergence, divergence and diagnostic accuracy in the light of two nursing terminologies
Revista Brasileira de Enfermagem. 2015;68(6):1086-1092
Abstract
RESEARCHConvergence, 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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RESEARCH01-01-2015
Speeches of managers about the policy of the directly observed treatment for tuberculosis
Revista Brasileira de Enfermagem. 2015;68(6):1069-1077
Abstract
RESEARCHSpeeches 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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ORIGINAL ARTICLE11-22-2024
Safe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
Abstract
ORIGINAL ARTICLESafe practices for prevention and management of antineoplastic agent extravasation: development of an educational video
Revista Brasileira de Enfermagem. 2024;77(5):e20240172
DOI 10.1590/0034-7167-2024-0172
Views0ABSTRACT
Objectives:
to develop, validate, and evaluate an educational video on the prevention and management of antineoplastic agent extravasation, aimed at nursing professionals.
Methods:
this methodological study was developed according to Falkembach’s theoretical framework, which outlines five phases in the production of educational video materials: analysis and planning, modeling, implementation, evaluation, and distribution.
Results:
content validation demonstrated agreement above the minimum threshold stipulated. The overall Content Validity Index was 90.8%, and it was 94.2% among the content and technical evaluation judges, respectively. The target audience evaluated the video positively, highlighting the importance of the content, the clarity of the language used, and the understanding of the information pertinent to the topic.
Conclusions:
the video proved to be an appropriate strategy for instructing interventions on the prevention and management of extravasation, with the potential to improve educational practices among nursing professionals.
Keywords:Antineoplastic AgentsEducational TechnologyExtravasation of Diagnostic and Therapeutic MaterialsInstructional Film and VideoNursingSee more -
REVIEW11-22-2024
Telenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
Abstract
REVIEWTelenursing contributions in Primary Health Care in the COVID-19 pandemic context: an integrative review
Revista Brasileira de Enfermagem. 2024;77(5):e20240093
DOI 10.1590/0034-7167-2024-0093
Views1See moreABSTRACT
Objective:
to identify telenursing contributions in Primary Health Care during the COVID-19 pandemic.
Methods:
an integrative literature review, conducted between January and August 2022 in the PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE and SciELO databases. A total of 493 studies was found, 62 were read in full, and of these, 16 were selected. For analysis, a dynamic reading of the studies and synthesis of the main results were carried out.
Results:
the main results highlighted telenursing practice as a challenge for professionals and the population. Among the contributions and positive points and aspects that require improvement, practice showed promise when considered in a post-pandemic scenario.
Final considerations:
through telenursing, the population’s access to Primary Health Care was guaranteed in the face of the COVID-19 pandemic. However, a critical look at current technological advances in healthcare is necessary.
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ORIGINAL ARTICLE11-22-2024
Percepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
Abstract
ORIGINAL ARTICLEPercepções de pessoas com deficiência física sobre acessibilidade e condições sociais: intervenções para enfermagem de reabilitação
Revista Brasileira de Enfermagem. 2024;77(5):e20240005
DOI 10.1590/0034-7167-2024-0005
Views0RESUMEN
Objetivos:
analizar las experiencias de personas con discapacidad física adquirida en cuanto a accesibilidad y condiciones sociales; identificar intervenciones de rehabilitación dirigidas por enfermeras para la accesibilidad y condiciones sociales; determinar indicadores sensibles a la enfermería para mejorar la accesibilidad y condiciones sociales.
Métodos:
estudio cualitativo descriptivo-exploratorio utilizó entrevistas semiestructuradas con personas con discapacidad física adquirida mediante muestreo intencionado en bola de nieve para cumplir con todos los objetivos. El análisis de datos siguió los principios del análisis de contenido de Bardin. Los objetivos 2 y 3 se lograron mediante un enfoque teórico reflexivo.
Resultados:
los 27 participantes informaron desafíos de accesibilidad, que impactan las actividades de la vida diaria y las condiciones sociales. Esto influye en la enfermería de rehabilitación, dando lugar a tres campos de intervención: Evaluar la capacidad para realizar actividades diarias y los factores que influyen; Desarrollar e implementar capacitación para la realización de actividades diarias; Promover la movilidad, la accesibilidad y la participación social.
Consideraciones Finales:
a partir de las experiencias de los participantes, identificamos intervenciones de rehabilitación dirigidas por enfermeras para promover la accesibilidad y condiciones sociales.
Keywords:Acessibilidade ArquitetónicaCondições SociaisEnfermagem em ReabilitaçãoObjetivos de Desenvolvimento SustentávelPessoas com DeficiênciaSee more -
ORIGINAL ARTICLE11-22-2024
Rondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLERondas a beira leito no ambiente hospitalar na perspectiva de equipes multiprofissionais de saúde
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0RESUMEN
Objetivo:
Analizar la configuración de las relaciones de poder entre el equipo multiprofesional en el proceso de rondas de cabecera en el hospital.
Método:
Investigación cualitativa con datos analizados a través del análisis del discurso, basado en el marco teórico de Michel Foucault. De septiembre a diciembre de 2022, realizamos entrevistas y observaciones de campo con el equipo multiprofesional de un hospital de Belo Horizonte, Minas Gerais, Brasil, así como entrevistas cualitativas semiestructuradas con 37 profesionales.
Resultados:
Los participantes señalaron que las experiencias de los profesionales involucrados en las rondas de cabecera dependen de cómo el médico conduce el proceso, y el proceso centrado en el médico dificulta la participación de otros profesionales del equipo.
Consideraciones finales:
La forma en que los hospitales organizan las rondas de cabecera no promueve la articulación del conocimiento de sus profesionales. Además, dificulta la circulación del poder y perjudica el trabajo interdisciplinario en un proceso que mantiene al médico como actor principal de las decisiones clínicas.
Keywords:Conhecimentos, Atitudes e Prática em SaúdeEquipe de Assistência MultidisciplinarHospitaisPrática ProfissionalRelações InterprofissionaisSee more -
ORIGINAL ARTICLE11-22-2024
Bedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
Abstract
ORIGINAL ARTICLEBedside rounds in the hospital environment from the perspective of multiprofessional health teams
Revista Brasileira de Enfermagem. 2024;77(5):e20230493
DOI 10.1590/0034-7167-2023-0493
Views0ABSTRACT
Objective:
To analyze the configuration of power relations among the multiprofessional team in the bedside round process in the hospital.
Methods:
Qualitative research with data analyzed through discourse analysis, based on Michel Foucault’s theoretical framework. From September to December 2022, we conducted interviews and field observations with the multiprofessional team at a hospital in Belo Horizonte, Minas Gerais, Brazil, as well as qualitative, semi-structured interviews with 37 professionals.
Results:
The participants pointed out that the experiences of the professionals involved in bedside rounds depend on how the physician conducts the process, and the physician-centered process makes it difficult for other professionals in the team to participate.
Final considerations:
The way hospitals organize bedside rounds does not promote knowledge articulation for their professionals. It hinders the circulation of power and harms interdisciplinary work in a process that maintains the physician as the main actor in clinical decisions.
Keywords:Health Knowledge, Attitudes, PracticeHospitalsInterprofessional RelationsPatient Care TeamProfessional PracticeSee more -
REVIEW11-22-2024
Transition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
Abstract
REVIEWTransition to family parenting in the face of the first child: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230487
DOI 10.1590/0034-7167-2023-0487
Views1See moreABSTRACT
Objectives:
to identify and summarize the elements that characterize the family transition process in relation to the first child.
Methods:
a scoping review was carried out based on JBI methodology, in six databases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.
Results:
ten articles were included with factors characterizing the transition, such as hindering/facilitating conditions that influence the process, important support structures in adaptation and strategies/responses used in the transition process.
Final Considerations:
elements characterizing the transition process in relation to the first child were identified. However, no theoretical explanation for this was identified. Further research should be carried out to obtain a deeper understanding of this process.
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