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ORIGINAL ARTICLE03-11-2024
Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
Abstract
ORIGINAL ARTICLEEthnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
DOI 10.1590/0034-7167-2023-0350
Views0See moreABSTRACT
Objective:
To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic.
Method:
A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software.
Results:
Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children.
Final considerations:
The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.
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ORIGINAL ARTICLE03-11-2024
Experiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
Abstract
ORIGINAL ARTICLEExperiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
DOI 10.1590/0034-7167-2023-0290
Views0See moreABSTRACT
Objective:
To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery.
Methods:
Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool.
Results:
Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery.
Final Considerations:
Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.
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03-11-2024
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201pt
Views0Recentemente, mais um caso de dano grave associado ao cuidado em saúde foi reportado pela mídia. Uma jovem grávida teve a mão e o punho amputados depois de dar à luz ao terceiro filho em um hospital do Rio de Janeiro(). Após o incidente ocasionado pelo acesso vascular, a mulher apresentou hemorragia e foi reinternada.Os […]See more -
REVIEW03-11-2024
Continuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
Abstract
REVIEWContinuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
DOI 10.1590/0034-7167-2023-0094
Views0See moreABSTRACT
Objectives:
to analyze continuing nursing education actions in the scientific literature in the face of homophobia.
Methods:
an integrative literature review with structured search in June 2022 in eight databases, using the descriptors Nursing Education, Homophobia, Sexual and Gender Minorities. Final sample consisted of six primary studies.
Results:
continuing nursing education actions are supported by strategies such as use of teaching materials, lectures, case studies and focus groups, addressing content such as gender identity issues and affective-sexual orientation, health disparities and their relationship with homophobia in healthcare settings.
Final considerations:
carried out in various healthcare settings, continuing education actions proved to be successful in raising nurses’ awareness in facing homophobia in health services, however, their expansion is necessary to create health spaces that meet the specific needs of these people.
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03-11-2024
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201
Views0Recently, another case of serious harm associated with healthcare was reported by the media. A young pregnant woman had her hand and wrist amputated after giving birth to her third child in a hospital in Rio de Janeiro(). After the incident caused by vascular access, the woman suffered hemorrhage and was readmitted.The harm caused to […]See more -
03-08-2024
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
A enfermagem como protagonista no enfrentamento da hesitação e recusa vacinal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101pt
Views0Desde a década de 1970, o Ministério da Saúde do Brasil instituiu o Programa Nacional de Imunização (PNI), que precedeu o Sistema Único de Saúde e que lhe foi incorporado e fortalecido, devido ao modelo descentralizado aos municípios, mas de comando único ao nível central. Seu objetivo era e ainda é coordenar as ações de […]See more -
03-08-2024
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
Abstract
Nursing as a player in tackling vaccine hesitancy and refusal
Revista Brasileira de Enfermagem. 2024;77:e77suppl101
DOI 10.1590/0034-7167.202477suppl101
Views1Since the 1970s, the Brazilian Ministry of Health established the Brazilian National Immunization Program (PNI – Programa Nacional de Imunização), which preceded the Brazilian Health System and which was incorporated and strengthened due to the decentralized model to municipalities, but under single command at central level. Its objective was and still is to coordinate vaccination […]See more -
02-26-2024
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
Abstract
Nurse Navigator of Cancer Patients: contributions to the discussion on the national stage
Revista Brasileira de Enfermagem. 2024;77(2):e770201
DOI 10.1590/0034-7167.2024770201
Views0The professional practice of patient navigation is incipient in Brazil and, therefore, a broad discussion with various sectors of society is essential, which is the main purpose of this editorial. Shall we start with the story.Patient navigation was defined in 1989 as a community-based service delivery intervention aimed at appropriately promoting access to diagnosis and […]See more
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ERRATUM04-22-2020
ERRATUM
Revista Brasileira de Enfermagem. 2020;73(3):202073n3e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2020;73(3):202073n3e05
DOI 10.1590/0034-7167.202073n3e05
Views0Article “Concept formation of ambience for labor and normal institutionalized delivery”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, 72(Suppl 3):348-59, on page 357:Include after Final Considerations the information:[…]See more -
ORIGINAL ARTICLE04-09-2020
Health promotion in schools: speeches, representations, and approaches
Revista Brasileira de Enfermagem. 2020;73(3):e20180774
Abstract
ORIGINAL ARTICLEHealth promotion in schools: speeches, representations, and approaches
Revista Brasileira de Enfermagem. 2020;73(3):e20180774
DOI 10.1590/0034-7167-2018-0774
Views0See moreABSTRACT
Objectives:
to analyze speeches, representations, and approaches on health and health promotion in schools, materialized in the speech of teachers.
Methods:
a qualitative study, of the case study type, carried out with 17 teachers from the municipal and state educational network. The data were obtained from interviews and analyzed by the Content-Oriented Discourse Analysis.
Results:
medical-sanitary and clinical-biological discourses predominated. Health is represented as the absence of disease, reflecting approaches that prioritize healthy habits and changes in behavior. Problematization of social determinants occurs in projects, in an intersectorial partnership.
Final Considerations:
carrying out projects of health promotion in schools ignores the solidification of partnerships and the construction of new speeches that represent it as quality of life conditioned by social, economic, and cultural factors as well as strategies for the ideological repositioning of those actors who act in this setting.
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ORIGINAL ARTICLE04-09-2020
Nursing work and competence in hemotherapy services: an ergological approach
Revista Brasileira de Enfermagem. 2020;73(3):e20180775
Abstract
ORIGINAL ARTICLENursing work and competence in hemotherapy services: an ergological approach
Revista Brasileira de Enfermagem. 2020;73(3):e20180775
DOI 10.1590/0034-7167-2018-0775
Views0See moreABSTRACT
Objetives:
to analyze the ingredients of the competence that the nurses use in the performance of their work in hemotherapy.
Methods:
qualitative study with 22 nurses, accomplished through documentary study, observation and semi-structured interview, with resources of Atlas.ti software based on the foundations of Historical Materialism Dialectic and Ergology. Performed Content Analysis.
Results:
the domain of specific knowledge of hemotherapy and the time of experience in the area, allied to the motivation of the worker and the ability to work in a team favor the competent action in the work activities. On the other hand, the lack of adequate work conditions, especially in relation to adequate materials, equipment and structure, impairs the work of the nurse in hemotherapy.
Final Considerations:
experience gained is critical to successful decision making. In addition, adequate working conditions, updating of knowledge and ability in teamwork favor a scenario of safe practices.
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ORIGINAL ARTICLE04-22-2020
Happiness as a strength in the promotion of adolescent and adult young health
Revista Brasileira de Enfermagem. 2020;73(3):e20190064
Abstract
ORIGINAL ARTICLEHappiness as a strength in the promotion of adolescent and adult young health
Revista Brasileira de Enfermagem. 2020;73(3):e20190064
DOI 10.1590/0034-7167-2019-0064
Views0See moreABSTRACT
Objectives:
to assess the relation between sociodemographic characteristics of young people associated with the subjectivity of being happy; to evaluate the relationship between the subjectivity of being happy and the perception of health status; to evaluate the relationship between the subjectivity of being happy and the school and family environments and peer groups at school.
Methods:
this is an observational study, with an intentional sample of 1,069 young Portuguese people, with ages varying from 14 to 24, most of them women, attending secondary education. The self-filling questionnaire was used.
Results:
there are statistically significant associations between the subjectivity of being happy and schooling, perception of health status, family APGAR, school and family involvement, absence of problems or teasing by peers at school.
Conclusions:
a positive and holistic care coupled with the potential of obtaining and consolidating healthy lifestyles for young people will enable health professionals to perceive them as agents of individual and social change.
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ORIGINAL ARTICLE04-22-2020
Preventing vertical HIV virus transmission: hospital care assessment
Revista Brasileira de Enfermagem. 2020;73(3):e20190491
Abstract
ORIGINAL ARTICLEPreventing vertical HIV virus transmission: hospital care assessment
Revista Brasileira de Enfermagem. 2020;73(3):e20190491
DOI 10.1590/0034-7167-2019-0491
Views0See moreABSTRACT
Objectives:
assess the implementation of actions to prevent vertical transmission of HIV.
Methods:
a retrospective cohort study conducted in two maternity hospitals in the city of Montes Claros, State of Minas Gerais. All women admitted for childbirth diagnosed with HIV and their respective newborns were included from 2014 to 2017. Data were collected from medical records and analyzed descriptively.
Results:
population consisted of 46 pairs of mothers and newborns. Management was considered inadequate in 30 cases of parturient/postpartum women (65.2%) and 14 cases of newborns (30.4%). The main reasons for inadequate maternal management were lack of pharmacological inhibition of lactation (53.3%) and counseling/consent for HIV testing (43.3%). For newborns, late onsetoffirst dose ofZidovudine (50.0%) and no prescriptionofNevirapine (28.6%).
Conclusions:
important prevention opportunities were missed, pointing to the need for improved care.
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ORIGINAL ARTICLE06-08-2020
Maternal-child nursing care for adolescent mothers: health education
Revista Brasileira de Enfermagem. 2020;73(4):e20180769
Abstract
ORIGINAL ARTICLEMaternal-child nursing care for adolescent mothers: health education
Revista Brasileira de Enfermagem. 2020;73(4):e20180769
DOI 10.1590/0034-7167-2018-0769
Views0See moreABSTRACT
Objectives:
to develop an educational intervention through a game that addresses aspects related to adolescent motherhood and child care.
Methods:
this is an action research based on diagnosis, intervention and apprehension stages.
Results:
the situational diagnosis was based on a literature review on adolescent motherhood and child care. In the intervention stage, the educational game’s first version was elaborated. In the third stage constituted by apprehension, the game was submitted to assessment of interdisciplinary experts. Suggestions of experts were adopted and the game had its second version.
Final Considerations:
the educational intervention in the present study appears a care technology that adds knowledge and practices to the work of nurses in Primary Health Care, focusing on adolescent women and children health care.
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REVIEW06-01-2020
Access of the black population to health services: integrative review
Revista Brasileira de Enfermagem. 2020;73(4):e20180834
Abstract
REVIEWAccess of the black population to health services: integrative review
Revista Brasileira de Enfermagem. 2020;73(4):e20180834
DOI 10.1590/0034-7167-2018-0834
Views1See moreABSTRACT
Objectives:
demonstrate and discuss how the black population’s access to health services occurs
Methods:
integrative literature review with the following question: How does the black population’s access to health services occur? The search was carried out in the Scholar, LILACS and SciELO databases and used the descriptor “access to health services” and the term “population,” resulting in a sample with twelve articles.
Results:
studies show that the difficulty of access is a fundamental factor for the quality of life of people, directly compromising preventive services, especially for women’s health and, in addition, it has significant impact on the illness process of the black population within its particularities.
Final Considerations:
several limiting factors compromise the black population’s access to health services, including institutional and structural factors
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ORIGINAL ARTICLE05-18-2020
Militancy of nurses in the institutionality field: printed media versions
Revista Brasileira de Enfermagem. 2020;73(4):e20180835
Abstract
ORIGINAL ARTICLEMilitancy of nurses in the institutionality field: printed media versions
Revista Brasileira de Enfermagem. 2020;73(4):e20180835
DOI 10.1590/0034-7167-2018-0835
Views0See moreABSTRACT
Objectives:
to analyze nurses’ professional militancy in the institutionality field, presented by the printed media from Bahia State in the 1970s and 1980s.
Methods:
a historical and qualitative research under Social History’s perspective, whose data source was the newspaper A Tarde. The temporal cut-off encompasses milestones such as professional body restructuring and creation.
Results:
the Associação Brasileira de Enfermagem democratization movement was reported in a superficial way, highlighting the struggle for power spaces. With respect to Conselhos Federal e Regional de Enfermagem daBahia, the newspaper notified creation and function of bodies, however, there was no visibility to the newspaper’s performance. Concerning the union, there was political fragility of nurses against the creation and union participation in the fight for labor rights.
Final Considerations:
organization of political action occurred from isolated groups mobilization of professionals who were already traveling in political spaces, not the large mass of professionals.
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ORIGINAL ARTICLE07-06-2020
Prevention of infections associated with peripheral catheters: construction and validation of clinical scenario
Revista Brasileira de Enfermagem. 2020;73(5):e20190390
Abstract
ORIGINAL ARTICLEPrevention of infections associated with peripheral catheters: construction and validation of clinical scenario
Revista Brasileira de Enfermagem. 2020;73(5):e20190390
DOI 10.1590/0034-7167-2019-0390
Views0See moreABSTRACT
Objectives:
to describe the process of construction and content validation of a clinical setting for teaching and learning the recommended practices for preventing bloodstream infection, associated with peripheral venous catheters, for nursing professionals.
Methods:
methodological study of the construction of the scenario based on the National League Nursing Jeffries Simulation Theory, International Nursing Association for Clinical Simulation and Learning, and the Brazilian Health Regulatory Agency. Twelve experts performed content validation. We used to assess the degree of agreement between them, the Content Validity Index, and a descriptive analysis of the suggestions presented.
Results:
all the requirements of the simulated clinical scenario reached an agreement between judges of more than 80% in terms of clarity and relevance.
Conclusions:
the steps adopted in the construction and validation of the clinical scenario proved to be adequate and relevant, and the scenario is suitable for training professionals.
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ORIGINAL ARTICLE12-13-2019
Factors related to quilombola attendance to child follow-up appointments
Revista Brasileira de Enfermagem. 2019;72:9-16
Abstract
ORIGINAL ARTICLEFactors related to quilombola attendance to child follow-up appointments
Revista Brasileira de Enfermagem. 2019;72:9-16
DOI 10.1590/0034-7167-2017-0605
Views0See moreABSTRACT
Objective:
To understand factors interfering with the attendance of quilombola children to growth and development follow-up appointments.
Method:
It is a qualitative research based on Symbolic interactionism, during which 14 mothers of children bellow 1 year-old were interviewed, who attended to the Family Health Unit at Ilha de Maré, Bahia, Brazil.
Results:
Appointment attendance is affected by factors intrinsic to mothers (meaning of child health follow-up; association between appointments and children falling ill; personal issues) and extrinsic factors, related to the service (availability, long waiting time for appointments and its quality).
Final considerations:
An administration prioritizing the service’s organization is required, which can prioritize attendances and the reduction of waiting time, specially given the personal issues that compromise going to the unit.
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ORIGINAL ARTICLE02-02-2022
The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols
Revista Brasileira de Enfermagem. 2022;75(3):e20210153
Abstract
ORIGINAL ARTICLEThe Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols
Revista Brasileira de Enfermagem. 2022;75(3):e20210153
DOI 10.1590/0034-7167-2021-0153
Views0See moreABSTRACT
Objectives:
to identify, classify, and analyze modes of failure in the medication process.
Methods:
evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers.
Results:
207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities.
Conclusions:
the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.
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ORIGINAL ARTICLE07-18-2022
Cultural adaptation and content validity evidence of the Nutritional Literacy Scale Brazilian version
Revista Brasileira de Enfermagem. 2022;75(6):e20210657
Abstract
ORIGINAL ARTICLECultural adaptation and content validity evidence of the Nutritional Literacy Scale Brazilian version
Revista Brasileira de Enfermagem. 2022;75(6):e20210657
DOI 10.1590/0034-7167-2021-0657
Views0See moreABSTRACT
Objective:
To investigate the evidence of content validity and reliability of the Brazilian version of the Nutritional Literacy Scale (NLS) after the cultural adaptation process.
Methods:
Psychometric study of 1,197 users of the National Health Service (Brazilian SUS). The NLS was culturally adapted to Brazilian Portuguese and six items of the original scale were modified to improve its understanding, giving rise to the Brazilian version of the scale named NLS-BR. The analysis of evidence of content validity of the NLS-BR was performed using the Item Response Theory (IRT).
Results:
The final version of the NLS-BR had 23 items and proved to be adequate to assess nutritional literacy in adults assisted by the Brazilian SUS.
Final considerations:
The NLS-BR proved to be of adequate understanding and demonstrated evidence of content validity and reliability for users of the Brazilian SUS.
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ORIGINAL ARTICLE07-01-2020
Perceptions of pharmaceutical services among elderly people on polymedication
Revista Brasileira de Enfermagem. 2020;73(5):e20190305
Abstract
ORIGINAL ARTICLEPerceptions of pharmaceutical services among elderly people on polymedication
Revista Brasileira de Enfermagem. 2020;73(5):e20190305
DOI 10.1590/0034-7167-2019-0305
Views0See moreABSTRACT
Objectives:
Describe the importance of guidelines provided during pharmaceutical consultation about compliance with medication therapy based on interviews with polymedicated elderly patients.
Methods:
A qualitative methodological study carried out during consultations with 40 elderly patients of both genders at the Health Care Center for Elderly Patients and Caregivers. The study used the technique of content analysis, applying a questionnaire with two open questions.
Results:
Two categories and eight subcategories emerged after the transcription of interviews and exhaustive reading of the data. The category “Pharmaceutical consultation as an education instrument for the self-care of polymedicated elderly patients” presented the highest frequency. The subcategory with the highest frequency was “Concern of elderly patients about self-care”.
Final Considerations:
In the case of polymedicated elderly patients, pharmaceutical consultation is an important education instrument which, through the provision of pharmaceutical guidelines, allows the minimization of concerns about pharmacotherapy, contributing to compliance and self-care.
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07-05-2021
Factors associated with urinary tract infection in a Nursing Home
Revista Brasileira de Enfermagem. 2021;74:e20200813
Abstract
Factors associated with urinary tract infection in a Nursing Home
Revista Brasileira de Enfermagem. 2021;74:e20200813
DOI 10.1590/0034-7167-2020-0813
Views1See moreABSTRACT
Objective:
to analyze the factors associated with urinary tract infection occurrence in institutionalized elderly.
Methods:
this is a cross-sectional, analytical, quantitative study with 116 elderly people from a Nursing Home. Urinary tract infection diagnosis was carried out through urine culture and clinical assessment. Demographic data and associated factors were obtained from medical records. Statistical analysis included bivariate analysis and logistic regression models.
Results:
the factors associated with urinary tract infection (p<0.05) were being female; wheelchair user; diaper use; diuretic use; urinary and bowel incontinence; type 1 diabetes; benign prostatic hyperplasia; dehydration.
Conclusion:
this study revealed that it is important to consider non-modifiable factors such as sex and clinical comorbidities; however, dehydration, a modifiable factor, increased the chances of developing urinary tract infections by 40 times among institutionalized elderly and demands greater attention from the health team.
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ORIGINAL ARTICLE07-31-2020
Social and obstetric inequalities and vaccination in pregnant women
Revista Brasileira de Enfermagem. 2020;73:e20190099
Abstract
ORIGINAL ARTICLESocial and obstetric inequalities and vaccination in pregnant women
Revista Brasileira de Enfermagem. 2020;73:e20190099
DOI 10.1590/0034-7167-2019-0099
Views0See moreABSTRACT
Objectives:
to analyze the association of socioeconomic level and obstetric characteristics with vaccine registration of pregnant women.
Methods:
cross-sectional study, performed with 480 women in puerperal. Vaccination of pregnant women was considered a dependent variable and as independent variables were age, skin color, education, steady union, paid work, and number of prenatal consultations. Association between variables was verified by the Poisson’s regression model.
Results:
from 480 pregnant women’s health cards, 10.63% had information on hepatitis B vaccination; 31.46% for tetanus; and 90% of the health cards had not register for influenza. There was an association of paid work and number of prenatal consultations with hepatitis B vaccination.
Conclusions:
lower percentages in absence of vaccination occurred in women who were in the job market and had a higher number of prenatal consultations. This suggests that socioeconomic inequalities may interfere with the vaccination of pregnant women in health services.
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EXPERIENCE REPORT02-25-2022
Production and use of educational technologies in nursing post-graduation
Revista Brasileira de Enfermagem. 2022;75(5):e20210510
Abstract
EXPERIENCE REPORTProduction and use of educational technologies in nursing post-graduation
Revista Brasileira de Enfermagem. 2022;75(5):e20210510
DOI 10.1590/0034-7167-2021-0510
Views0See moreABSTRACT
Objective:
To report, under the light of Gardner’s Theory of Multiple Intelligences, the experience of students with advanced educational practices, involving the production and use of technologies in the postgraduation nursing course of the Universidade Federal de Pernambuco.
Methods:
Experience report of students from the post-graduation nursing program from the Universidade Federal de Pernambuco, about the production of knowledge using educational technology and the application of active methodologies in the teaching-learning process for face-to-face and distance teaching.
Results:
The post-graduate students participated in the educational process in a creative way, both during in-person and distance teaching. They created: domino games, educational videos, parodies, conceptual maps, virtual role-playing, an interactive quiz, among others.
Final considerations:
The experience of the students with the advanced educational practices, including the production and use of technologies in nursing post-graduation showed that the teaching-learning process can be innovative and planned to go beyond traditional methods.
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