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01-01-2015
Low birth weight in a municipality in the southeast region of Brazil
Revista Brasileira de Enfermagem. 2015;68(6):1169-1175
Abstract
Low birth weight in a municipality in the southeast region of Brazil
Revista Brasileira de Enfermagem. 2015;68(6):1169-1175
DOI 10.1590/0034-7167.2015680624i
Views0See moreABSTRACT
Objective:
to identify the prevalence of low birth weight in the city of São Paulo.
Method:
epidemiological cross-sectional study with data collected by means of the Brazilian Live Birth Information System related to births occurred in the city of São Paulo between 2007 and 2013. Maternal, gestational, childbirth, and neonatal variables were analyzed descriptively and by association.
Results:
9.65% (1,342,655) of live births were underweight (mean of 3234.55 grams in the term group and 2312.17 in the pre-term group) with a mean maternal age of 27.53 years old. The risk factors identified include maternal age, not having a partner, low maternal level of education, other race rather than white, pre-term pregnancy, multiple births, low number of prenatal check-ups, and cesarean delivery.
Conclusion:
knowledge of this evidence favors planning the care provided by defining strategies to reduce it and consequently improve maternal and infant health care.
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01-01-2015
Gait speed and cognitive score in elderly users of the primary care service
Revista Brasileira de Enfermagem. 2015;68(6):1163-1168
Abstract
Gait speed and cognitive score in elderly users of the primary care service
Revista Brasileira de Enfermagem. 2015;68(6):1163-1168
DOI 10.1590/0034-7167.2015680623i
Views0See moreABSTRACT
Objective:
to investigate the association between gait speed and the cognitive score of elderly patients enrolled in a Basic Health Unit.
Method:
a quantitative cross-sectional study with 203 elderly, a sample calculated based on the estimated population proportion. Data were collected using a sociodemographic and clinical questionnaire, gait speed test (GS) and the Mini Mental State Examination (MMSE).
Results:
the illiterate patients had a mean MMSE=19.33(±3.7) and GS = 0.76m/s (±0.3); those with low/medium education had a MMSE = 25.43(±2.8) and GS = 0.92m/s (±0.2); and the elderly with higher education had a MMSE = 27.33(±2.9) and GS=1.12m/s (±0.3).There was a weak correlation (R2=00354) between gait speed and cognitive score, with statistical significance (Prob>F = 0.0072) and a positive linear trend.
Conclusion:
the better cognitive score the higher the gait speed; the illiterate elderly were those with lower gait speed, thereby indicating a poorer physical performance.
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01-01-2015
Fluid and dietary restriction’s efficacy on chronic kidney disease patients in hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1154-1162
Abstract
Fluid and dietary restriction’s efficacy on chronic kidney disease patients in hemodialysis
Revista Brasileira de Enfermagem. 2015;68(6):1154-1162
DOI 10.1590/0034-7167.2015680622i
Views0See moreABSTRACT
Objective:
to identify self-care measures to manage fluid and dietary restrictions and assess their effectiveness.
Method:
descriptive-correlational study and cluster analysis with 254 chronic renal failure patients on regular hemodialysis program, handled by hemodiafiltration. We evaluated the effectiveness of self-care by interdialytic weight gain (IWG) and by potassium and phosphorus serum pre-dialysis serum levels.
Results:
several self-care measures were significantly correlated with a lower IWG and a lower level of pre-dialysis phosphorus. Patients most often use measures to reduce salt consumption than measures to restrict potassium and dietary phosphorus. The spouse provides important support dietary management. Subjects who use more often the self-care measure are mostly female, are older, less IWG and have a higher Kt/V.
Conclusion:
these results can contribute to the nursing educational support.
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01-01-2015
Validation of newborn positioning protocol in Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(6):1147-1153
Abstract
Validation of newborn positioning protocol in Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(6):1147-1153
DOI 10.1590/0034-7167.2015680621i
Views0See moreRESEARCH
Objective:
to verify the positioning indications of newborn sand build a standard operating procedure protocol for newborn positioning in Neonatal Intensive Care Unit (NICU).
Method:
for protocol validation, the Delphi technique was used ,in which expert nurses in the field reviewed the proposed procedure.
Results:
we present the results of this validation in a protocol form, to contribute to the discussion about newborn positioning in NICU and standardization of nursing care related to positioning. We evaluated ten indicators, in which there was agreementof100.0% in seven, and of80% in three, above the 60% recommended by the validation technique.
Conclusion:
given the importance of newborn positioning in NICU for its neuromuscular development, this study contributes to the adoption of an evidence-based practice for nursing.
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01-01-2015
Patient safety culture in a bone marrow transplantation unit
Revista Brasileira de Enfermagem. 2015;68(6):1139-1146
Abstract
Patient safety culture in a bone marrow transplantation unit
Revista Brasileira de Enfermagem. 2015;68(6):1139-1146
DOI 10.1590/0034-7167.2015680620i
Views0See moreABSTRACT
Objective:
evaluate the patient safety culture in the perspective of health professionals from a bone marrow transplantation unit of an oncology research center, at a reference hospital for cancer treatment in Santa Catarina, Brazil.
Method:
a quantitative cross-sectional study that used the Safety Attitudes Questionnaire was conducted between August and September 2013. The study analyzed 33 professional surveys. Statistical data analysis used descriptive and inferential statistics.
Results:
among the dimensions analyzed, only “job satisfaction” reached a mean score above 75, considered positive in terms of patient safety culture.
Conclusion:
the dimensions of safety culture present in the survey have to be valued by professionals and managers to allow safe patient care.
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01-01-2015
Job satisfaction of nursing staff in a university hospital
Revista Brasileira de Enfermagem. 2015;68(6):1130-1138
Abstract
Job satisfaction of nursing staff in a university hospital
Revista Brasileira de Enfermagem. 2015;68(6):1130-1138
DOI 10.1590/0034-7167.2015680619i
Views0See moreABSTRACT
Objective:
identify the determinants of job satisfaction of the nursing staff of a public university hospital.
Method:
secondary study with mixed data approach and simple and multiple linear regression. A total of 115 subjects participated in the study, 41 nurses and 74 nursing assistants and technicians. The data collection occurred in 2013 using the QST-Caism questionnaire.
Results:
education, hierarchical level and workplace constitute job satisfaction determinants. However, age, gender, job and work period did not show this relationship. More educated workers held low job satisfaction if exercised not graduated nursing functions.
Conclusion:
graduated workers who perform high school functions are more unsatisfied than those who have high school function and qualification.
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01-01-2015
Medical waste in mobile prehospital care
Revista Brasileira de Enfermagem. 2015;68(6):1122-1129
Abstract
Medical waste in mobile prehospital care
Revista Brasileira de Enfermagem. 2015;68(6):1122-1129
DOI 10.1590/0034-7167.2015680618i
Views0See moreABSTRACT
Objective:
the objective of this study is to identify how Medical Waste (MW) is managed in Mobile Prehospital Care (MPC) services in the state of São Paulo as well as characterize and quantify this waste.
Method:
exploratory and descriptive field study with data collection based on the methodology proposed by the Pan American Health Organization (PAHO), which was conducted over eight consecutive days to identify the production and characteristics of generated waste.
Results:
it was found that the MW management of the MPC is not yet in line with the requirements of RDC 306/04, which could affect the occupational safety of workers, patients, the community, and the environment.
Conclusion:
it is recommended for the health managers to focus on this issue. The lack of studies with regard to MPC also indicates the need for further studies on the waste management.
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01-01-2015
Severe lactational mastitis: particularities from admission
Revista Brasileira de Enfermagem. 2015;68(6):1116-1121
Abstract
Severe lactational mastitis: particularities from admission
Revista Brasileira de Enfermagem. 2015;68(6):1116-1121
DOI 10.1590/0034-7167.2015680617i
Views0See moreABSTRACT
Objective:
to identify characteristics of women who have suffered severe lactational mastitis.
Method:
a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics.
Results:
a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants.
Conclusion:
this study showed that severe lactational mastitis can cause great harm to the woman and the baby.
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01-01-2015
Social representations about religion and spirituality
Revista Brasileira de Enfermagem. 2015;68(4):609-616
Abstract
Social representations about religion and spirituality
Revista Brasileira de Enfermagem. 2015;68(4):609-616
DOI 10.1590/0034-7167.2015680406i
Views0See moreABSTRACT
Objective:
to identify the social representations about the concepts of spirituality and religion of of health teachers.
Method:
exploratory and descriptive study, based on a qualitative approach. 25 subjects participated in it. The following instruments were used to collect data: questionnaire to identify the profile; questionnaire of free association, whose inducing words were religion and spirituality, and an interview based on the scale FICA (Puchalski, 2006).
Results:
the representations about religion and spirituality, for professors, are forged around the faith in God and it gives them meaning and purpose to deal with the challenges of personal and professional living.
Conclusion:
there are still barriers that need to be overcome with a view to a comprehensive care. For this, it is essential to incorporate spirituality in the process in the curricula of health courses.
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01-01-2015
Prevalence and factors associated with smoking among tobacco growers in southern Brazil
Revista Brasileira de Enfermagem. 2015;68(4):603-608
Abstract
Prevalence and factors associated with smoking among tobacco growers in southern Brazil
Revista Brasileira de Enfermagem. 2015;68(4):603-608
DOI 10.1590/0034-7167.2015680405i
Views0See moreABSTRACT
Objective:
identify the prevalence and factors associated with smoking in tobacco growers.
Method:
descriptive, cross-sectional research. Data collection occurred in 2012 through household survey and interviews, including application of a structured instrument and scale Fargeström.
Results:
there were 100 growers included, average age of 46,9 ± 10,8 years; 90(90%) married; 72(72%) white, average family composition 3,7±1,1 people; median number of children 3(1-3), and the average study time 6±2,5. The prevalence of smoking among tobacco growers was 17%, which had less education (p=0.010) and fewer people in the household (p=0.049).
Conclusion:
the prevalence of smoking among tobacco growers was higher than the national average, but the nicotine dependence was low, which can facilitate the smoking cessation process. Highlights the need to implement a program to control smoking among tobacco growers.
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01-01-2015
The family living the child recovery process after hospital discharge
Revista Brasileira de Enfermagem. 2015;68(4):594-602
Abstract
The family living the child recovery process after hospital discharge
Revista Brasileira de Enfermagem. 2015;68(4):594-602
DOI 10.1590/0034-7167.2015680404i
Views1See moreABSTRACT
Objective:
to understand the meaning attributed by the family to its experience in the recovery process of a child affected by an acute disease after discharge, and to develop a theoretical model of this experience. Symbolic interactionism was adopted as a theoretical reference, and grounded theory was adopted as a methodological reference.
Method:
data were collected through interviews and participant observation with 11 families, totaling 15 interviews. A theoretical model consisting of two interactive phenomena was formulated from the analysis: Mobilizing to restore functional balance and Suffering from the possibility of a child’s readmission.
Results:
the family remains alert to identify early changes in the child’s health, in an attempt to avoid rehospitalization.
Conclusion:
the effects of the disease and hospitalization continue to manifest in family functioning, causing suffering even after the child’s discharge and recovery.
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01-01-2015
Multiprofessional residency in health: a document analysis of political pedagogical projects
Revista Brasileira de Enfermagem. 2015;68(4):586-593
Abstract
Multiprofessional residency in health: a document analysis of political pedagogical projects
Revista Brasileira de Enfermagem. 2015;68(4):586-593
DOI 10.1590/0034-7167.2015680403i
Views0See moreABSTRACT
Objective:
To analyze MPRH political pedagogical projects (PPP) developed in the state of São Paulo and identify scenarios that are highly favorable to IPE.
Method:
This was a descriptive exploratory study conducted through document analysis.
Results:
The analysis revealed a heterogeneous scenario regarding the curricula, didactic and pedagogical organization, educational objectives, pedagogical matrices and evaluation systems employed. One of the programs was identified as providing a highly favorable setting for IPE.
Conclusion:
The analysis adequately evaluated IPE in educational settings and found a highly favorable scenario for it, identifying didactic, pedagogical, political and organizational MPRH elements.
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01-01-2015
Beliefs of older adults about their vulnerability to HIV/Aids, for the construction of nursing diagnoses
Revista Brasileira de Enfermagem. 2015;68(4):579-585
Abstract
Beliefs of older adults about their vulnerability to HIV/Aids, for the construction of nursing diagnoses
Revista Brasileira de Enfermagem. 2015;68(4):579-585
DOI 10.1590/0034-7167.2015680402i
Views0See moreABSTRACT
Objective:
to know the beliefs of older adults about their vulnerability to HIV/Aids, and to identify nursing diagnoses.
Method:
a field research implemented in Family Health Units, in João Pessoa, Brazil. The sample included 250 older adults of both genders with data collected from April to July of 2011. A Test of Free Word Association was applied using the term HIV/Aids. A content analysis and cross-mapping of the most frequent terms with the International Classification for Nursing Practice, 2011 were performed.
Results:
202 terms were identified in terms, with an overall frequency of 1156. Of the 202 terms, 16 were more frequent and were used to construct the nursing diagnoses. The diagnoses identified were knowledge about appropriate sexual behavior, ability for partial protection, fear of death and hopelessness.
Conclusion:
understanding these beliefs drew from knowledge about factors related to, vulnerability to HIV/Aids aimed at planning health care actions for this population segment.
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AUTHORS’S ANSWER01-01-2015
AUTHORS’S ANSWER
Revista Brasileira de Enfermagem. 2015;68(4):578-578
Abstract
AUTHORS’S ANSWERAUTHORS’S ANSWER
Revista Brasileira de Enfermagem. 2015;68(4):578-578
DOI 10.1590/0034-7167.20156804r
Views0Dear Dr Levent Tekin, Thank you very much for your relevant considerations about the manuscript.[…]See more -
LETTER TO THE EDITOR01-01-2015
Considerations about the manuscript published
Revista Brasileira de Enfermagem. 2015;68(4):577-577
Abstract
LETTER TO THE EDITORConsiderations about the manuscript published
Revista Brasileira de Enfermagem. 2015;68(4):577-577
DOI 10.1590/0034-7167.20156804c
Views0Re: Chinese auriculotherapy to improve quality of life of nursing team To the Editor,[…]See more -
01-01-2015
Research in nursing and new pathways based on SENPE
Revista Brasileira de Enfermagem. 2015;68(4):571-572
Abstract
Research in nursing and new pathways based on SENPE
Revista Brasileira de Enfermagem. 2015;68(4):571-572
DOI 10.1590/0034-7167.2015680401i
Views1Almost half a century after the beginning of nursing research in Brazil, there is still a need for investment before it can be considered consolidated. The truth of this statement can be seen in the national seminars that discuss research in the field through 17 events that present results and participation of nursing researchers and […]See more
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ORIGINAL ARTICLE11-10-2023
Construction and validity of a storyboard about breast cancer for women deprived of liberty
- Dayze Djanira Furtado de Galiza
, - Lisidna Almeida Cabral ,
- Débora Edith Rocha Lima ,
- Helena Alves de Carvalho Sampaio
Abstract
ORIGINAL ARTICLEConstruction and validity of a storyboard about breast cancer for women deprived of liberty
Revista Brasileira de Enfermagem. 2023;76:e20220436
DOI 10.1590/0034-7167-2022-0436
- Dayze Djanira Furtado de Galiza ,
- Lisidna Almeida Cabral ,
- Débora Edith Rocha Lima ,
- Helena Alves de Carvalho Sampaio
Views0See moreABSTRACT
Objectives:
to build storyboards based on health literacy about breast cancer for women deprived of liberty for later production of videos and e-books.
Methods:
a methodological study, construction and validity of storyboards with 10 expert judges. The Educational Content Validation Instrument in Health and the Suitability Assessment of Materials were used. For validity, an agreement criterion greater than 80% was considered, verified from the Content Validation Index, with 40-100% for suitability.
Results:
the storyboards’ overall Content Validity Index was 0.99, combined with the measurement of suitability of 81% and readability percentage of 73.2, categorizing the material as superior and easy to read.
Conclusions:
the educational technology built proved to be valid and reliable, and can be transformed into an e-book and video to promote self-care for women deprived of liberty.
- Dayze Djanira Furtado de Galiza
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ORIGINAL ARTICLE11-10-2023
Construction and validity of educational technology in audiovisual media on premature newborn care
- Marcelo Victor Freitas Nascimento ,
- Willyane de Andrade Alvarenga ,
- Marcia Teles de Oliveira Gouveia ,
- Herla Maria Furtado Jorge ,
- Marianne Rocha Duarte de Carvalho , [ … ],
- Silvana Santiago da Rocha
Abstract
ORIGINAL ARTICLEConstruction and validity of educational technology in audiovisual media on premature newborn care
Revista Brasileira de Enfermagem. 2023;76:e20220403
DOI 10.1590/0034-7167-2022-0403
- Marcelo Victor Freitas Nascimento ,
- Willyane de Andrade Alvarenga ,
- Marcia Teles de Oliveira Gouveia ,
- Herla Maria Furtado Jorge ,
- Marianne Rocha Duarte de Carvalho ,
- Jackeline Vieira Amaral ,
- Silvana Santiago da Rocha
Views0See moreABSTRACT
Objectives:
to construct and validate an educational video storyboard about care for premature newborns at home.
Methods:
a methodological study, with the construction of an educational video storyboard, validated with 14 judges. Content was selected from scoping review. For data collection, a validated instrument was used. The criterion for validity was agreement greater than 80%, analyzed using the Content Validity Index.
Results:
the storyboard construction was guided by the Cognitive Theory of Multimedia Learning theoretical framework. Construction and validity took place from May to December 2020. The storyboard’s final version lasted 10 minutes, and was validated in terms of objective, structure, presentation and relevance, with a Content Validity Index of 0.9.
Conclusions:
the storyboard of the educational video proved to be valid and adequate for health promotion in developing care for premature newborns at home.
- Marcelo Victor Freitas Nascimento
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11-10-2023
ERRATA
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATA
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04pt
Views0No artigo “Primeira graduada do Mestrado em Enfermagem em Prática Avançada em Oncologia no Chile”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2023; 2023(Suppl 4):e76suppl401, no segundo parágrafo:Onde se lia:[…]See more -
ERRATUM11-10-2023
ERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2023;76(5):e2023n5e04
DOI 10.1590/0034-7167.20237605e04
Views0In the article “First graduate of the Master of Nursing in Advanced Practice in Oncology in Chile”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023(Suppl 4):e76suppl401, in the second paragraph:Where it read:[…]See more -
11-10-2023
Time to act sustainably: Why can’t we wait any longer?
Revista Brasileira de Enfermagem. 2023;76(5):e20220813
Abstract
Time to act sustainably: Why can’t we wait any longer?
Revista Brasileira de Enfermagem. 2023;76(5):e20220813
DOI 10.1590/0034-7167-2022-0813
Views0See moreABSTRACT
Objectives:
to raise reflections on the need for health services and professionals to implement sustainable actions, aiming at their own survival and that of the planet.
Methods:
reflective essay based on international reports regarding the impact of climate change on people’s health and the role of institutions in this context.
Results:
the article focused on three fundamentals: climate change continues to be a threat to the health and well-being of all beings on Earth; the institutions that should contribute to health are great agents of contamination of the environment and emission of gases that aggravate the greenhouse effect; and there are several benefits for health institutions to act sustainably.
Final Considerations:
we cannot wait any longer; we must develop policies and management models aimed at environmentally responsible, economically viable, and socially more collaborative healthcare.
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REVIEW11-10-2023
Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review
- Livia Barrionuevo El Hetti Fuentes ,
- Lucas Gardim ,
- Thaís Oliveira da Silva ,
- André Almeida de Moura ,
- Andrea Bernardes
Abstract
REVIEWApplying Lean Healthcare in the hospitalization and patient discharge process: an integrative review
Revista Brasileira de Enfermagem. 2023;76(5):e20220751
DOI 10.1590/0034-7167-2022-0751
- Livia Barrionuevo El Hetti Fuentes ,
- Lucas Gardim ,
- Thaís Oliveira da Silva ,
- André Almeida de Moura ,
- Andrea Bernardes
Views0See moreABSTRACT
Objectives:
to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process.
Methods:
this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases.
Results:
out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care.
Final Considerations:
although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.
- Livia Barrionuevo El Hetti Fuentes
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11-10-2023
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
A eficácia do uso de livros interativos multimodalidade em enfermagem pediátrica na implementação do programa Merdeka Belajar
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreRESUMEN
Objetivos:
analizar la efectividad del uso de libros interactivos multimodales en enfermería pediátrica sobre los resultados de aprendizaje de los estudiantes en la implementación del Programa Merdeka Belajar.
Métodos:
investigación cuasi-experimental con un diseño de grupo de control posterior a la prueba. En este estudio, la muestra incluyó 52 estudiantes de enfermería del cuarto semestre del Instituto de Ciencias de la Salud Suaka Insan Banjarmasin que recibieron el curso de Enfermería Pediátrica. Fue utilizada la técnica de muestreo total y la prueba t dependiente en el análisis de datos.
Resultados:
el libro interactivo multimodal de enfermería pediátrica fue efectivo en la mejora del logro de aprendizaje de los estudiantes de cuarto semestre con un valor de significancia de 0,015 < 0,05. Hay una diferencia en el valor promedio de los cursos de enfermería pediátrica para la clase A y la clase B, que es de 3,173.
Conclusiones:
el uso de libros multimodales interactivos es muy bueno para que los profesores los apliquen en la enseñanza para ayudar a los estudiantes a comprender el material que están aprendiendo.
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ORIGINAL ARTICLE11-10-2023
The effectiveness of using interactive multimodality books in pediatric nursing in implementing Merdeka Belajar program
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
Abstract
ORIGINAL ARTICLEThe effectiveness of using interactive multimodality books in pediatric nursing in implementing Merdeka Belajar program
Revista Brasileira de Enfermagem. 2023;76(5):e20220599
DOI 10.1590/0034-7167-2022-0599
Views0See moreABSTRACT
Objectives:
to analyzing the Effectiveness of Using Interactive Multimodality Books in Pediatric Nursing on Student Learning Outcomes in Implementing the Merdeka Belajar Program.
Methods:
the research design used a quasi-experimental approach with a posttest control group design. The sample in this study was the fourth-semester nursing students of Institute of Health Science Suaka Insan Banjarmasin who received the Pediatric Nursing course, a total of 52 students. The sampling technique used is total sampling. Data analysis used the dependent t-test.
Results:
the interactive multimodality pediatric nursing book was effective in improving the learning achievement of fourth-semester students with a significance value of 0.015 < 0.05. There is a difference in the average value of pediatric nursing courses for class A and class B, which is 3.173.
Conclusions:
the use of interactive multimodality books is very good for lecturers to apply in teaching to help students understand the material they are learning.
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