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01-01-2016
Nursing instrument to attend mothers who recently gave birth in primary health care
Revista Brasileira de Enfermagem. 2016;69(2):316-325
Abstract
Nursing instrument to attend mothers who recently gave birth in primary health care
Revista Brasileira de Enfermagem. 2016;69(2):316-325
DOI 10.1590/0034-7167.2016690215I
Views0See moreABSTRACT
Objective:
To build a nursing instrument to attend mothers who have recently given birth in primary health care.
Method:
This is a methodological research developed in five stages: identification of empirical indicators associated with mothers who have recently given birth by reviewing integrative literature; evaluation of empirical indicators by focal group; instrument structuring by categorizing indicators; instrument validation using the Delphi technique; and application and development of diagnostic statements and nursing interventions.
Results:
The instrument comprises identification data on mothers who have given birth recently, on the assessment of their human needs, and on nursing Care items. In the final version, we selected 73 diagnoses and 155 nursing interventions.
Conclusion:
With the completion of this study, nurses will have an instrument for Nursing Care Systematization to attend mothers who have given birth recently in primary health care. Besides, this study will also work as a tool in research and teaching of Obstetric Nursing.
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01-01-2016
Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy
Revista Brasileira de Enfermagem. 2016;69(2):307-315
Abstract
Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy
Revista Brasileira de Enfermagem. 2016;69(2):307-315
DOI 10.1590/0034-7167.2016690214i
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Objective:
to identify nursing diagnoses in intensive care unit (ICU) patients by means of a cross-mapping of terms contained in nursing records with the NANDA-I taxonomy.
Method:
an exploratory, descriptive study with a retrospective analysis of nursing records in 256 medical records of patients that were hospitalized in the general ICU of a hospital in the western border of the state of Rio Grande do Sul. Terms indicating conditions demanding nursing interventions were collected from the records; cross-mapping of these terms with the NANDA-I taxonomy diagnoses was performed and confirmed in a nursing focus group. Data were analyzed through descriptive statistics.
Results:
a total of 832 terms and expressions referring to 52 different diagnoses in 9 of the 13 domains of the NANDA-I taxonomy were identified.
Conclusion:
the present study enabled the identification of nursing diagnoses in patients hospitalized in ICUs, affecting care management, the training process of experts in the area, and information systems.
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01-01-2016
Social network of adolescents under probation from the perspective of public health
Revista Brasileira de Enfermagem. 2016;69(2):298-306
Abstract
Social network of adolescents under probation from the perspective of public health
Revista Brasileira de Enfermagem. 2016;69(2):298-306
DOI 10.1590/0034-7167.2016690213i
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Objective:
to analyze the meaning of the social networks of adolescents who are under probation and to identify the essential components of these networks.
Method:
an exploratory study with a qualitative approach. Twenty-six teenagers, aged 13 to 18, participated in the study. For data gathering, the authors chose semi-structured interviews and network maps. Results: it became evident that social networks are essential for adolescents, with the family in a central position – especially the mothers – as well as the Centro de Referência Especializadode Assistência Social (Center for Specialized Reference of Social Assistance – CREAS) for social promotion and construction of new life projects, away from juvenile offending. However, adolescents reported no ties to health workers.
Conclusion:
the authors observed the need for nurses, as workers in primary health care, to practice in a way that is intersectoral and interdisciplinary, with the aim of strengthening the social networks of adolescents at conflict with the law.
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01-01-2016
Direct cost of dressings for pressure ulcers in hospitalized patients
Revista Brasileira de Enfermagem. 2016;69(2):290-297
Abstract
Direct cost of dressings for pressure ulcers in hospitalized patients
Revista Brasileira de Enfermagem. 2016;69(2):290-297
DOI 10.1590/0034-7167.2016690212i
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Objective:
to identify the average direct cost (ADC) on the direct labor (DL) for nurses and the consumption of materials and solutions used in performing dressings for pressure ulcers (PU) in hospitalized patients.
Methods:
case study, exploratory and descriptive case conducted in a teaching hospital. For six months, 228 dressings were performed for the treatment of PU patients. We calculated the cost by multiplying the time spent by nurses by the DL unit cost, adding to the cost of materials and solutions consumed.
Results:
the dressings ADC of PU corresponds to US$ 19.18 (PUs-category I); US$ 6.50 (PUs-category II); US$ 12.34 (PUs-category III); US$ 5.84 (PUs-category IV); US$ 9.52 (PUs-unclassifiable) and US$ 3.76 (PU suspected deep tissue injury).
Conclusion:
the methodology used can be reproduced in different hospital settings for the development of other studies to expand and complement the knowledge gained.
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01-01-2016
Humanization knowledge of undergraduate nursing students
Revista Brasileira de Enfermagem. 2016;69(2):282-289
Abstract
Humanization knowledge of undergraduate nursing students
Revista Brasileira de Enfermagem. 2016;69(2):282-289
DOI 10.1590/0034-7167.2016690211i
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Objective:
identify the senses and practices representative of humanization in the training of undergraduate nursing students.
Method:
a qualitative study, supported on the national policy of humanization and the concept of social representation. An interview was conducted with 40 undergraduate nursing students from a public institution. ALCESTE software was used for lexical content analysis.
Results:
the sense of humanization is built on the practice and disciplines of social and human sciences. The coordination between theory and practice is representative of humanization, but does not take place in learning experiences. The professor’s participation and teamwork are elements that influence humanization.
Conclusion:
humanization should be reinforced in the training of undergraduate nursing students, using learning-teaching strategies and experiences that make sense to students, including alliances between theory and practice, learning and service, research and care.
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01-01-2016
Prevention of vertical mother-to-child transmission of HIV: care and adhesion provided by couples
Revista Brasileira de Enfermagem. 2016;69(2):275-281
Abstract
Prevention of vertical mother-to-child transmission of HIV: care and adhesion provided by couples
Revista Brasileira de Enfermagem. 2016;69(2):275-281
DOI 10.1590/0034-7167.2016690210i
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Objective:
to unveil the existential movement of a couple when performing vertical HIV transmission prophylaxis.
Method:
qualitative research, using Martin Heidegger’s phenomenological approach. A phenomenological interview was conducted with 14 participants between December/2011 and February/2012 in the outpatient facilities of an university hospital, Brazil. A comprehensive and interpretative heideggerian analysis was developed.
Results:
the couple understands that they have followed the guidance of the health professionals as indicated. By not being able to breastfeed, the woman did not fail to be a mother, but it was also not a complete experience. The senses of the occupation of the couple-being unfolded to the prophylactic treatment and facticity due to the fact of not breastfeeding.
Conclusion:
we indicate the need to rethink care, proposing a working relationship that transcends the impersonal that dictates about what the couple must deal with, enabling their active participation in care decisions and actions.
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01-01-2016
Attitudes and pleasure/suffering in mental health work
Revista Brasileira de Enfermagem. 2016;69(2):266-274
Abstract
Attitudes and pleasure/suffering in mental health work
Revista Brasileira de Enfermagem. 2016;69(2):266-274
DOI 10.1590/0034-7167.2016690209i
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Objective:
to investigate the existence of a relationship between attitudinal profiles and the pleasure/suffering dynamic in workers of Mental Health Services.
Method:
a quantitative, descriptive-analytical, correlational and cross-sectional study conducted in 2014. We used three instruments: characterization questionnaire, Opinions on Mental Illness Scale and Pleasure and Suffering Indicators at Work Scale, answered by 80 workers of the Network for Psychosocial Care of Alfenas, state of Minas Gerais, Brazil.
Results:
Authoritarianism proved to be the predominant profile. As for the pleasure/suffering at work, Gratification was considered adequate, and indicators such as Freedom, Wear and Insecurity were considered moderate critical. There were positive correlations between the most favorable attitudes and pleasure indicators at work. The values of both scales showed a relationship with socio-demographic and professional variables.
Conclusion:
the less favorable attitudes are prevalent and, in spite of suffering being present, these professionals feel gratified about their work.
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01-01-2016
Overweight in young adult students: the vulnerability of a distorted self-perception of body image
Revista Brasileira de Enfermagem. 2016;69(2):258-265
Abstract
Overweight in young adult students: the vulnerability of a distorted self-perception of body image
Revista Brasileira de Enfermagem. 2016;69(2):258-265
DOI 10.1590/0034-7167.2016690208i
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Objective:
To analyze overweight in young adult students from the individual dimension of vulnerability, especially its interpersonal and subjective markers.
Method:
An analytical quantitative study was performed with 560 young adults from 26 schools in a capital city in Northeastern Brazil. After obtaining data to administer specific questionnaires, logistic regression was used to identify markers of individual vulnerability.
Results:
In the bivariate analysis, overweight showed a statistically significant association with self-perception of health, satisfaction with body image and self-perception of overweight, the latter remaining in the final regression model.
Conclusion:
It can be mainly concluded that self-perception of overweight is distorted when compared to one’s actual body weight and, for this reason, young adults are vulnerable to dysfunctional health states. However, it was confirmed that this health condition must be understood in an individual and contextual perspective.
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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
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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
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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
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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
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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
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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
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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
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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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01-01-2016
Pressure ulcer healing with Plenusdermax® Calendula officinalis L. extract
Revista Brasileira de Enfermagem. 2016;69(2):250-257
Abstract
Pressure ulcer healing with Plenusdermax® Calendula officinalis L. extract
Revista Brasileira de Enfermagem. 2016;69(2):250-257
DOI 10.1590/0034-7167.2016690207i
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Objective:
to evaluate the therapeutic benefits of the bioactive extracts of Plenusdermax®Calendula officinalis for pressure ulcer healing.
Method:
an observational cohort study, including 41 patients with a diagnosis of pressure ulcer that was stable in size for more than three months. Patients were evaluated every two weeks, over 30 weeks, for: reduction of the wound area, infection control, types of tissue and exudate, and ulcer microbiology.
Results:
the proportions of patients who were completely healed after 15 and 30 weeks of treatment were 63% and 88%, respectively, and the mean healing time was 12.5±7.8 weeks. No adverse events were observed during treatment.
Conclusion:
the results of the study indicate that bioactive C. officinalis Plenusdermax® is a safe treatment that promotes healing of pressure ulcers.
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01-01-2016
Quality of life assessment for health promotion groups
Revista Brasileira de Enfermagem. 2016;69(2):242-249
Abstract
Quality of life assessment for health promotion groups
Revista Brasileira de Enfermagem. 2016;69(2):242-249
DOI 10.1590/0034-7167.2016690206i
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Objective:
to analyze the use of quality of life assessment (QOL) as a strategy to evaluate the work with health promotion groups in the community.
Method:
cross-sectional, descriptive and analytical study. Participants of two elderly groups (n=46) were individually interviewed to fill the sociodemographic instruments, WHOQOL-BREF and WHOQOL-OLD.
Results:
the participants were women with up to 79 years, who did not live with a partner, with up to four years of study, retired, with individual income of up to a minimum salary. The mean scores on the WHOQOL-BREF were higher on “Social Relations” and lower in the “Environment”. For the WHOQOL-OLD, the highest scores were achieved in facets “Social Participation” (G1) and “Past, Present and Future Activities” (G2), while “Death and Dying” facet obtained lower scores in both groups.
Conclusion:
the assessment of QOL appears to be useful in helping to identify the coordination aspects of life of elderly people that need to be better developed in groups.
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01-01-2016
Transcultural adaptation and validation of the Brazilian version of Treatment Spirituality/Religiosity Scale
Revista Brasileira de Enfermagem. 2016;69(2):235-241
Abstract
Transcultural adaptation and validation of the Brazilian version of Treatment Spirituality/Religiosity Scale
Revista Brasileira de Enfermagem. 2016;69(2):235-241
DOI 10.1590/0034-7167.2016690205i
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Objective:
to perform the translation and transcultural adaptation to Brazilian Portuguese, and analyze the psychometric properties of the instrument Treatment Spirituality/Religiosity Scale (TSRS).
Method:
the sample consisted of 188 nursing students of technical and higher education. The reliability analysis by test-retest was performed one month after the first application of the instrument. To measure the construct validation, a factorial analysis was carried out.
Results:
the Brazilian version of the TSRS consisted of 10 items, with two factors. The reliability by test-retest showed a Kappa coefficient ranging from 0.22 to 0.47, and a global internal consistency Cronbach’s alpha of 0.85.
Conclusion:
the Brazilian version of the TSRS showed satisfactory values of validity and internal consistency, being suitable for use in the national context.
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01-01-2016
Epidemiological characteristics and causes of deaths in hospitalized patients under intensive care
Revista Brasileira de Enfermagem. 2016;69(2):229-234
Abstract
Epidemiological characteristics and causes of deaths in hospitalized patients under intensive care
Revista Brasileira de Enfermagem. 2016;69(2):229-234
DOI 10.1590/0034-7167.2016690204i
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Objective:
to describe the epidemiological and sociodemographic characteristics of patients hospitalized in an ICU.
Method:
an epidemiological, descriptive and retrospective study. Population: 695 patients admitted from January to December 2011. The data collected were statistically analyzed with both absolute and relative frequency distribution.
Results:
61.6% of the patients are male, aged 40 to 69 years, and most of them came from the surgery rooms. The most frequent reason for admission was diseases of the circulatory system (23.3%). At discharge from the ICU, 72.4% of the patients were sent to other units of the same institution, 31.1% to the intermediate care unit, and 20.4% died, of which 24.6% from diseases of the circulatory system. The afternoon shift had 45.8% of the admissions and 53.3% of the discharges.
Conclusion:
the description of the sociodemographic and epidemiological features guides the planning of nursing actions, providing a better quality service.
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01-01-2016
Hospital discharge of premature newborns: the father’s experience
Revista Brasileira de Enfermagem. 2016;69(2):221-228
Abstract
Hospital discharge of premature newborns: the father’s experience
Revista Brasileira de Enfermagem. 2016;69(2):221-228
DOI 10.1590/0034-7167.2016690203i
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Objective:
To describe the father’s experience with his premature child discharge of the Neonatal Intensive-Care Unit and to point out interventions to promote this experience.
Method:
Qualitative research with eight fathers, adopting the Symbolic Interactionism as theoretical reference and thematic narrative research as methodological frame.
Results:
The analysis of data has allowed us to describe the experience of the father from three thematic units: “fatherhood boundaries”, “high responsibility for the child” and “social network and support”.
Conclusion:
The father feels insecure with the idea of taking care of his child at home because of the lack of professional support and the initial contact with the child in the Neonatal Intensive-Care Unit.
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01-01-2016
Nurses from the Mobile Emergency Service: profile and developed activities
Revista Brasileira de Enfermagem. 2016;69(2):213-220
Abstract
Nurses from the Mobile Emergency Service: profile and developed activities
Revista Brasileira de Enfermagem. 2016;69(2):213-220
DOI 10.1590/0034-7167.2016690202i
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Objective:
to characterize the profile and identify the activities developed by nurses from the Mobile Emergency Care Service of a state of southern Brazil.
Method:
an exploratory, descriptive study. Data were collected through a questionnaire with 63 nurses.
Results:
the profile showed a workforce predominantly female, young and having specialized training. The activities were organized in the dimensions of caring, managing and educating, verifying the predominance of the first one. Care actions involved multiple procedures, but the use of the Systematization of Nursing Care (SNC) was not mentioned in the development of care activities. Then, the managerial dimension with a predominance of bureaucratic activities was emphasized. Educational activities were less prominent.
Conclusion:
care actions are the focus of the activities of nurses, predominantly the prescribed institutional care without the use of instruments such as SNC that could contribute to the greater visibility of their professional work.
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01-01-2016
Challenges and leadership imperatives in cooperation with the World Health Organization
Revista Brasileira de Enfermagem. 2016;69(2):207-208
Abstract
Challenges and leadership imperatives in cooperation with the World Health Organization
Revista Brasileira de Enfermagem. 2016;69(2):207-208
DOI 10.1590/0034-7167.2016690201i
Views0When an institution promotes strategic innovations, it starts the rupture with tradition, causing changes and, consequently, altering the expectations and prospects of both their internal clients, as their external clients.The engines of the adopted innovations are driven by a broader view of the organization’s purposes, expanding its borders in terms of breadth and depth, which […]See more -
01-01-2016
Desafios e imperativos de liderança na cooperação com a Organização Mundial da Saúde
Revista Brasileira de Enfermagem. 2016;69(2):207-208
Abstract
Desafios e imperativos de liderança na cooperação com a Organização Mundial da Saúde
Revista Brasileira de Enfermagem. 2016;69(2):207-208
DOI 10.1590/0034-7167.2016690201i
Views0Quando uma instituição promove inovações estratégicas, é colocado em curso o rompimento com a tradição, provocando mudanças e, por consequência, alterando as expectativas e as perspectivas tanto dos seus clientes internos, quanto dos seus clientes externos.Os motores das inovações adotadas são acionados por uma visão ampliada dos fins da organização, alargando suas fronteiras em termos […]See more
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