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ORIGINAL ARTICLE
Mental health of parents of children and adolescents who require special health care
- Eliana Roldão dos Santos Nonose
, - Rosane Meire Munhak da Silva ,
- Eliane Tatsch Neves ,
- Débora Falleiros de Mello ,
- Adriana Zilly , [ … ],
- Regina Aparecida Garcia de Lima
07-29-2024
Abstract
ORIGINAL ARTICLEMental health of parents of children and adolescents who require special health care
Revista Brasileira de Enfermagem. 2024;77(3):e20230457
07-29-2024DOI 10.1590/0034-7167-2023-0457
- Eliana Roldão dos Santos Nonose ,
- Rosane Meire Munhak da Silva ,
- Eliane Tatsch Neves ,
- Débora Falleiros de Mello ,
- Adriana Zilly ,
- Aline Cristiane Cavicchioli Okido ,
- Regina Aparecida Garcia de Lima
Views0See moreABSTRACT
Objective:
To identify the manifestations presented by parents of children and adolescents who require special health attention that can impact their mental health.
Methods:
exploratory, qualitative research, based on the concept of vulnerability, with data collection carried out through interviews with 18 parents of children and adolescents with special health care needs, hospitalized in the pediatric ward of a hospital in Paraná, between May/2017 and May/ 2018. Data analyzed by inductive thematic analysis.
Results:
parents experienced situations of vulnerability when providing care at home, with repercussions on their mental health, expressed by manifestations of lack of protection, anxiety and depression.
Final considerations:
It is important that health professionals seek to expand actions to promote care and reduce situations that generate threats, insecurities, concerns and damage to the health of parents, which can impact and further weaken care for children and adolescents who need attention especially health.
- Eliana Roldão dos Santos Nonose
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ORIGINAL ARTICLE
Evaluation of software technical quality for collecting data from patients under palliative care
- Jéssica de Fátima Gomes Pereira ,
- Letícia Pontes ,
- Mitzy Tannia Reichembach Danski ,
- Solena Ziemer Kusma Fidalski ,
- Juliana de Oliveira dos Santos , [ … ],
- Edmilson Bezerra Cruz Júnior
07-29-2024
Abstract
ORIGINAL ARTICLEEvaluation of software technical quality for collecting data from patients under palliative care
Revista Brasileira de Enfermagem. 2024;77(3):e20230435
07-29-2024DOI 10.1590/0034-7167-2023-0435
- Jéssica de Fátima Gomes Pereira ,
- Letícia Pontes ,
- Mitzy Tannia Reichembach Danski ,
- Solena Ziemer Kusma Fidalski ,
- Juliana de Oliveira dos Santos ,
- Maria Gorete de Brito Cunha ,
- Mairla Cristina Silva Mota ,
- Edmilson Bezerra Cruz Júnior
Views0See moreABSTRACT
Objectives:
to evaluate software technical quality for collecting data from patients under palliative care.
Methods:
this is methodological technology evaluation research, according to the technical standard International Organization for Standardization/International Electrotechnical Commission 25040-2011, developed from August 2021 to August 2023. Eight nurses and eight information technology professionals participated as judges, who evaluated six quality characteristics and 23 subcharacteristics. Items that reached a percentage of agreement greater than 70% were considered suitable.
Results:
the characteristics evaluated by nurses/information technology professionals received the following percentages of agreement, respectively: functional suitability (94%-84%); reliability (100-70%); usability (89.9-66.8%); performance efficiency (95.8%-86.1%); compatibility (95.8-79.6%); and safety (96%-83.4%).
Conclusions:
the software was considered suitable in quality evaluation to offer support to nurses in collecting patient data under palliative care, with the potential to operationalize the first Nursing Process stage.
- Jéssica de Fátima Gomes Pereira
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ORIGINAL ARTICLE
Sexual counseling for people with acute coronary syndrome: educational video development
- Laura Rizardi dos Santos Andrade ,
- Lanay Dourado dos Anjos ,
- Ana Paula Freitas Aguiar ,
- Edvone Alves de Lima ,
- Erika de Sá Vieira Abuchaim , [ … ],
- Vinicius Batista Santos
07-29-2024
Abstract
ORIGINAL ARTICLESexual counseling for people with acute coronary syndrome: educational video development
Revista Brasileira de Enfermagem. 2024;77(3):e20230416
07-29-2024DOI 10.1590/0034-7167-2023-0416
- Laura Rizardi dos Santos Andrade ,
- Lanay Dourado dos Anjos ,
- Ana Paula Freitas Aguiar ,
- Edvone Alves de Lima ,
- Erika de Sá Vieira Abuchaim ,
- Juliana de Lima Lopes ,
- Camila Tákao Lopes ,
- Vinicius Batista Santos
Views0See moreABSTRACT
Objective:
to assess validity evidence of an educational video on safe sexual activity after acute coronary syndrome.
Method:
study in three phases: video development; content validity analysis by 11 experts; and analysis of validity based on response processes by seven people with coronary disease. The content validity ratio (CVR) was calculated with critical values for the second phase of 0.63 and for the third of 1.0.
Results:
the video addressed the importance of resuming sexual activity and positions that consume less energy, clinical warning signs, the importance of adhering to treatment and a welcoming environment for sexual practice. A CVR above the critical value was obtained with a total of 4 minutes and 41 seconds.
Conclusion:
the educational video brings together adequate content validity evidence and can be used as a tool for patients after acute coronary syndrome.
- Laura Rizardi dos Santos Andrade
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REVIEW
Utilization of local pressure devices in pain management during injections: scoping review
- Jefferson Wildes da Silva Moura ,
- Aline de Souza Bitencourt ,
- Thiago Lopes Silva ,
- Andréia Cristina Feitosa do Carmo ,
- Luciano Marques dos Santos , [ … ],
- Patrícia Kuerten Rocha
07-29-2024
Abstract
REVIEWUtilization of local pressure devices in pain management during injections: scoping review
Revista Brasileira de Enfermagem. 2024;77(3):e20230399
07-29-2024DOI 10.1590/0034-7167-2023-0399
- Jefferson Wildes da Silva Moura ,
- Aline de Souza Bitencourt ,
- Thiago Lopes Silva ,
- Andréia Cristina Feitosa do Carmo ,
- Luciano Marques dos Santos ,
- Patrícia Kuerten Rocha
Views0See moreABSTRACT
Objective:
to map scientific evidence regarding the use of local pressure devices in pain relief during injection procedures in patients.
Methods:
scoping review, following the recommendations of the JBI Manual for Evidence Synthesis and PRISMA-ScR, with searches conducted in the PubMed, EMBASE, CINAHL, LILACS, and PsycINFO databases, without temporal restrictions and with a cutoff date of March 2023.
Results:
a total of 1,514 studies were identified, with 20 articles included in the final sample. The ShotBlocker® device was utilized during subcutaneous and intramuscular injections in children and adults, proving beneficial in reducing pain, anxiety, and fear associated with the procedure.
Final considerations:
the ShotBlocker® is a low-cost, easy-to-use device that can enhance nursing clinical practice during painful procedures. However, studies involving the Brazilian Pikluc® device are scarce. Further research involving both local pressure devices is recommended.
- Jefferson Wildes da Silva Moura
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ORIGINAL ARTICLE
Adaptation strategies for preparing for childbirth in the context of the pandemic: Roy’s Theory
- Letícia Pickler ,
- Margarete Maria de Lima ,
- Ariane Thaise Frello Roque ,
- Laís Antunes Wilhelm ,
- Felice Curcio , [ … ],
- Isadora Ferrante Boscoli de Oliveira Alves
07-29-2024
Abstract
ORIGINAL ARTICLEAdaptation strategies for preparing for childbirth in the context of the pandemic: Roy’s Theory
Revista Brasileira de Enfermagem. 2024;77(3):e20230159
07-29-2024DOI 10.1590/0034-7167-2023-0159
- Letícia Pickler ,
- Margarete Maria de Lima ,
- Ariane Thaise Frello Roque ,
- Laís Antunes Wilhelm ,
- Felice Curcio ,
- Dionara Guarda ,
- Roberta Costa ,
- Isadora Ferrante Boscoli de Oliveira Alves
Views0See moreABSTRACT
Objectives:
to understand the process of adapting to childbirth during the COVID-19 pandemic from the perspective of a group of pregnant women.
Methods:
a qualitative, descriptive-exploratory study was conducted with 23 women. Data were collected between October and December 2021 through documentation and semi-structured interviews, which were analyzed using Minayo’s methodology and Roy’s Adaptation Model.
Results:
various types of stimuli – focal, contextual, and residual – were identified as influencing childbirth preparation. The online group was essential for facilitating pregnant women’s adaptation, offering significant support and generating positive feedback for childbirth preparation.
Final Considerations:
the importance of pregnant women’s groups as a strategy for improving adaptation to childbirth was identified, underscoring the effectiveness of this support among professionals and participants, as well as among pregnant women. This support network strengthened preparation for childbirth during a challenging period like the pandemic.
- Letícia Pickler
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ORIGINAL ARTICLE
Profile of patients in private home care who developed ventilator-associated pneumonia
- Fabiana Schimidt Cezar ,
- Fabiana Camolesi Jacober ,
- Heloísa Amaral Gaspar Gonçalves ,
- Katia Vanessa Cantarini ,
- Claudio Flauzino de Oliveira
07-29-2024
Abstract
ORIGINAL ARTICLEProfile of patients in private home care who developed ventilator-associated pneumonia
Revista Brasileira de Enfermagem. 2024;77(3):e20230146
07-29-2024DOI 10.1590/0034-7167-2023-0146
- Fabiana Schimidt Cezar ,
- Fabiana Camolesi Jacober ,
- Heloísa Amaral Gaspar Gonçalves ,
- Katia Vanessa Cantarini ,
- Claudio Flauzino de Oliveira
Views0ABSTRACT
Objectives:
to analyze the profile and clinical outcomes of patients who developed Ventilator-Associated Pneumonia (VAP) in private home care and to compare the incidence with national data.
Methods:
this was a retrospective study with data collected from July 2021 to June 2022 from patient records at a private clinic. Patients using intermittent ventilation or without ventilatory support were excluded.
Results:
the utilization rate of mechanical ventilation was 15.9%. The incidence density of pneumonia in pediatrics was 2.2 cases per 1000 ventilation-days and in adults was 1.7 cases per 1000 ventilation-days, figures lower than those reported by the National Health Surveillance Agency. There were 101 episodes of pneumonia in 73 patients, predominantly male (65.8%), adults (53.4%), and those with neurological diseases (57.5%). The treatment regimen predominantly took place at home (80.2%), and there was one death.
Conclusions:
patients in home care showed a low incidence and mortality rate from ventilator-associated pneumonia.
Keywords:ArtificialHealth Systems AgenciesHome Care ServicesIntensive Care UnitsPneumoniaRespirationVentilator-AssociatedSee more
- Fabiana Schimidt Cezar
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ORIGINAL ARTICLE
Impact of educational intervention on understanding health recommendations after liver transplantation
Revista Brasileira de Enfermagem. 2024;77(3):e20230132
07-29-2024
Abstract
ORIGINAL ARTICLEImpact of educational intervention on understanding health recommendations after liver transplantation
Revista Brasileira de Enfermagem. 2024;77(3):e20230132
07-29-2024DOI 10.1590/0034-7167-2023-0132
Views0See moreABSTRACT
Objectives:
to evaluate the impact of educational intervention on understanding health recommendations after liver transplantation.
Methods:
randomized and prospective clinical trial, with 68 liver transplant recipients in two institutions. The level of understanding was assessed using a statement agreement scale and the understanding score was classified. Chi-square test was used to compare groups.
Results:
the level of understanding was reasonable in 77.9% of patients, 73.5% in the Control Group and 82.3% in the Intervention Group (p=0.399). For topics covered after educational action, there were more than 80% correct answers regarding nutrition, frequent hydration, usage and function of immunosuppressants. However, there were less than 10% correct answers regarding hand hygiene, contact with animals and crowds of people. The use of the patient’s audio, visual and tactile resources led to improved understanding of skin care (p=0.014).
Conclusions:
the level of understanding acquired regarding health recommendations was only reasonable.
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ORIGINAL ARTICLE
Family refusal of skin donation for transplantation: trends and associated factors
- Karoline de Oliveira Lins Souto ,
- Rafael Rodrigo da Silva Pimentel ,
- Ágata Nunes Brito ,
- Edvaldo Leal de Moraes ,
- Marcelo José dos Santos
07-29-2024
Abstract
ORIGINAL ARTICLEFamily refusal of skin donation for transplantation: trends and associated factors
Revista Brasileira de Enfermagem. 2024;77(3):e20230209
07-29-2024DOI 10.1590/0034-7167-2023-0209
- Karoline de Oliveira Lins Souto ,
- Rafael Rodrigo da Silva Pimentel ,
- Ágata Nunes Brito ,
- Edvaldo Leal de Moraes ,
- Marcelo José dos Santos
Views0See moreABSTRACT
Objectives:
to analyze the trends and factors associated with family refusal of skin donation for transplantation.
Methods:
this cross-sectional study was conducted in the State of São Paulo, with family authorization terms collected from 2001 to 2020. The variables analyzed included year, age, gender, cause of death, and type of institution. Data were analyzed using linear and multiple logistic regression, with the Odds Ratio estimated at p<0.05 for statistical significance.
Results:
1,355 individuals refused skin donation. The trend of refusals decreased between 2001 and 2009 in the age groups of 0-11 years and 12-19 years, but increased in the group aged ≥60 years. This trend continued to decrease in the 0-11 years group from 2010 to 2020, and increased in the 20-40 years group. Males and the age groups of 20-40 years, 41-59 years, and ≥60 years exhibited 27%, 34%, 47%, and 53% lower chances of refusal, respectively.
Conclusions:
there is an urgent need for measures to mitigate the high number of refusals associated with skin donation.
- Karoline de Oliveira Lins Souto
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REVIEW
Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health
Revista Brasileira de Enfermagem. 2020;73(5):e20190370
07-06-2020
Abstract
REVIEWMiddle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health
Revista Brasileira de Enfermagem. 2020;73(5):e20190370
07-06-2020DOI 10.1590/0034-7167-2019-0370
Views0See moreABSTRACT
Objectives:
theoretical validation of the concept of low self-efficacy in health as a nursing diagnosis construct.
Methods:
construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles.
Results:
eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health.
Conclusions:
the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.
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ORIGINAL ARTICLE
Critical thinking in nursing training: evaluation in the area of competence Education in Health
Revista Brasileira de Enfermagem. 2021;74:e20200979
05-24-2021
Abstract
ORIGINAL ARTICLECritical thinking in nursing training: evaluation in the area of competence Education in Health
Revista Brasileira de Enfermagem. 2021;74:e20200979
05-24-2021DOI 10.1590/0034-7167-2020-0979
Views0ABSTRACT
Objective:
To analyze the constitution of critical thinking in nursing training in the approach by competence and the integrated curriculum, considering the evaluation process by capturing its challenges, and proposing overcoming strategies.
Methods:
Qualitative. In the first phase of data collection, interviews were conducted with twenty-four professors, nine preceptors, and fifteen students to reconstruct the profile of competence, and in the second phase, a workshop to validate the profile identified challenges and proposals. The Collective Subject Discourse was used to analyze the interviews and the holistic competence reference in reconstructing the profile.
Results:
The critical thinking is built based on experiences in the world of work, and evaluation is the conductor of reflections towards emancipation.
Final considerations:
It signals the importance of professor training in the learning evaluation and working with the collective construction of subjects to overcome challenges that happen in the changes of training.
Keywords:Competency-Based EducationEmployee Performance AppraisalNursesProfessional CompetenceThinkingSee more -
Impact of clinical supervision on job satisfaction and emotional competence of nurses
- Inês Alves da Rocha e Silva Rocha ,
- Cristina Maria Correia Barroso Pinto ,
- António Luís Rodrigues Faria de Carvalho
07-26-2021
Abstract
Impact of clinical supervision on job satisfaction and emotional competence of nurses
Revista Brasileira de Enfermagem. 2021;74(6):e20210125
07-26-2021DOI 10.1590/0034-7167-2021-0125
- Inês Alves da Rocha e Silva Rocha ,
- Cristina Maria Correia Barroso Pinto ,
- António Luís Rodrigues Faria de Carvalho
Views0See moreABSTRACT
Objective:
To evaluate the impact of implementing the SafeCare clinical supervision model on nurses’ job satisfaction and emotional competence profile.
Methods:
This is a quasi-experimental study, with a sample of 28 nurses from a hospital in northern Portugal. A self-administered questionnaire was applied, used as pre and post-test, which included: sociodemographic and professional characterization; “Job Satisfaction Scale”; and “Veiga Emotional Competence Scale”. We conducted descriptive statistical analysis and the Wilcoxon Test.
Results:
A significant decrease in the nurses’ satisfaction with hierarchical superior was observed in the post-test. No significant differences were found in the nurses’ job satisfaction and emotional competence after the implementation of the SafeCare Model.
Conclusion:
The SafeCare Model needs improvement, suggesting increasing the amount of training time administered to nurses and strengthening the healthcare institution’s link to the Model.
- Inês Alves da Rocha e Silva Rocha
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ORIGINAL ARTICLE
Working conditions and depression in hospital emergency service nurses
Revista Brasileira de Enfermagem. 2020;73:e20180952
07-10-2020
Abstract
ORIGINAL ARTICLEWorking conditions and depression in hospital emergency service nurses
Revista Brasileira de Enfermagem. 2020;73:e20180952
07-10-2020DOI 10.1590/0034-7167-2018-0952
Views0ABSTRACT
Objective:
to analyze the presence, intensity and factors related to working conditions for depressive symptoms in hospital emergency nurses in the east of São Paulo.
Methods:
a descriptive, exploratory, quantitative and qualitative study, which applied psychometric scales and interview script.
Results:
nurses (95.24%) had depressive symptoms by the assessment scales by the observer, most with mild and moderate intensity. Inadequate working conditions led to suffering. Factors that trigger depressive symptoms were: disorganized work; harmful relationship with immediate management; inappropriate physician behavior; aggressions; lack of inputs, infrastructure and human resources; professional devaluation. Identified professionals with depressive symptoms who, because they were unaware of being affected by the disorder, did not seek treatment, continued to perform activities that compromised their physical and mental health, promoting damage to the assistance provided.
Final considerations:
high frequency of depressive symptoms. The precarious work environment negatively influenced the care and development of depressive symptoms.
Keywords:DepressionEmergency NursingHospital Emergency ServicesOccupational HealthWorking ConditionsSee more -
ORIGINAL ARTICLE
Safety of the patient in an emergency situation: perceptions of the nursing team
- Andréa Tayse de Lima Gomes ,
- Marcos Antônio Ferreira Jr ,
- Pétala Tuani Candido Oliveira Salvador ,
- Manacés dos Santos Bezerril ,
- Flávia Barreto Tavares Chiavone , [ … ],
- Viviane Euzébia Pereira Santos
06-27-2019
Abstract
ORIGINAL ARTICLESafety of the patient in an emergency situation: perceptions of the nursing team
Revista Brasileira de Enfermagem. 2019;72(3):753-759
06-27-2019DOI 10.1590/0034-7167-2018-0544
- Andréa Tayse de Lima Gomes ,
- Marcos Antônio Ferreira Jr ,
- Pétala Tuani Candido Oliveira Salvador ,
- Manacés dos Santos Bezerril ,
- Flávia Barreto Tavares Chiavone ,
- Viviane Euzébia Pereira Santos
Views0See moreABSTRACT
Objective:
To know the perception of nursing professionals about the essential aspects to provide safe care to polytraumatized patients in emergency services.
Method:
Descriptive and mixed study, performed with a focus group and projective techniques. The sample was made of seven nursing professionals. Data analysis took place through the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires and SPSS 22.0 softwares.
Results:
Based on the analysis of participants’ speeches, three content partitions emerged in the Descending Hierarchical Classification. 1) Structure: need for changes; 2) The process: safe actions by the nursing team; and 3) Care free from damage as the sought result.
Conclusion:
Patient safety in emergency situations must rely on a proper environment and an organized sector, good conditions to transport patients, use of routines and protocols, identification and organization of the beds.
- Andréa Tayse de Lima Gomes
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ORIGINAL ARTICLE
Practice of breastfeeding in quilombola communities in the light of transcultural theory
- Lucas Amaral Martins ,
- Rafaele Marques de Oliveira ,
- Climene Laura de Camargo ,
- Aline Cristiane de Sousa Azevedo Aguiar ,
- Deisy Vital dos Santos , [ … ],
- Jamile Moreira Machado de Souza
06-24-2020
Abstract
ORIGINAL ARTICLEPractice of breastfeeding in quilombola communities in the light of transcultural theory
Revista Brasileira de Enfermagem. 2020;73(4):e20190191
06-24-2020DOI 10.1590/0034-7167-2019-0191
- Lucas Amaral Martins ,
- Rafaele Marques de Oliveira ,
- Climene Laura de Camargo ,
- Aline Cristiane de Sousa Azevedo Aguiar ,
- Deisy Vital dos Santos ,
- Maria Carolina Ortiz Whitaker ,
- Jamile Moreira Machado de Souza
Views0See moreABSTRACT
Objectives:
to identify factors that interfere with the practice of exclusive breastfeeding in quilombola communities.
Methods:
qualitative research based on the Transcultural Theory proposed by Madeleine Leininger, performed with quilombola mothers. For data collection, we used the semi-structured interview, conducted from June 2018 to January 2019. Content analysis was guided by the interactive model of Miles and Huberman.
Results:
it was revealed that intergenerational cultural myths and customs interfere with breastfeeding practice, and identified the influence of professional nurses on best breastfeeding practices.
Final Considerations:
cultural and intergenerational factors favor early weaning and expose the child to illness.
- Lucas Amaral Martins
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REVIEW
Health care of sexual and gender minorities: an integrative literature review
Revista Brasileira de Enfermagem. 2020;73:e20190192
10-28-2020
Abstract
REVIEWHealth care of sexual and gender minorities: an integrative literature review
Revista Brasileira de Enfermagem. 2020;73:e20190192
10-28-2020DOI 10.1590/0034-7167-2019-0192
Views0ABSTRACT
Objectives:
to describe health care practices aimed at lesbians, gays, bisexuals, transvestites, and transsexuals.
Methods:
an integrative literature review based on systematic steps, in MEDLINE, LILACS AND SciELO databases and/or electronic libraries. It was held from September to November 2018, with articles published between 2012 and 2017, available in full in Portuguese, English, and Spanish, addressing health care to that population group.
Results:
fourteen articles were included. Most of the articles were about the trajectory of individuals within health services and showed limitations and obstacles in the use of these services.
Final Considerations:
there is evidence that factors related to organization of services, attitude of professionals, stigma, and discrimination experienced undermine health care practices. Therefore, it is essential to carry out educational activities in health services and educational institutions.
Keywords:Delivery of Health CareHealth ServicesReviewSexual and Gender MinoritiesTransgender PersonsSee more
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ORIGINAL ARTICLE
Nursing knowledge patterns: nurses’ image and role in society perceived by students
Revista Brasileira de Enfermagem. 2020;73(4):e20180959
06-01-2020
Abstract
ORIGINAL ARTICLENursing knowledge patterns: nurses’ image and role in society perceived by students
Revista Brasileira de Enfermagem. 2020;73(4):e20180959
06-01-2020DOI 10.1590/0034-7167-2018-0959
Views0See moreABSTRACT
Objectives:
to understand high school students’ perception about the nurse’s image and role in society, from nursing knowledge patterns.
Methods:
phenomenographic qualitative study, developed between October 2017 and January 2018, in a public university in the countryside of the state of São Paulo, with eight Interdisciplinary Higher Education Program (Programa de Formação Interdisciplinar Superior) students. The findings were collected through semi-structured interviews and analyzed by the phenomenography framework, supported by rereading nursing knowledge patterns.
Results:
two categories emerged: Perception of nurses’ image, which contemplates their positive and negative characteristics, attributes and place where they operate; and Nurses’ role in society, in which their work is compared with physicians’.
Final Considerations:
despite their essential role in care, subordination to medical knowledge and lack of knowledge of nurses’ functions still reflect their image.
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