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ORIGINAL ARTICLE07-19-2024
Validation of an instrument for assessing leprosy care in children and adolescents
Revista Brasileira de Enfermagem. 2024;77(2):e20230344
Abstract
ORIGINAL ARTICLEValidation of an instrument for assessing leprosy care in children and adolescents
Revista Brasileira de Enfermagem. 2024;77(2):e20230344
DOI 10.1590/0034-7167-2023-0344
Views0See moreABSTRACT
Objectives:
to validate the content of an instrument for assessing leprosy care in individuals under 15 years old in the context of Primary Health Care.
Methods:
methodological study of content validation, based on the evaluation of essential and derived attributes in primary care, in the professional version. For data analysis, the Content Validation Index (CVI ≥ 0.8) and Cronbach’s Alpha were calculated.
Results:
a higher percentage of judges among nurses (61.5%) was observed; with a doctorate (46.2%), and engaged in teaching and research (77%). The overall Content Validation Index of the instrument was 0.98. In the analysis of Cronbach’s Alpha of the instrument, the assigned value was 0.717.
Conclusions:
the instrument represents an advancement in the measurement of health evaluation policies and can significantly contribute to improving the quality of care provided to children and adolescents with leprosy.
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ORIGINAL ARTICLE07-19-2024
Validation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
Abstract
ORIGINAL ARTICLEValidation of the Brazilian Version of the Modified Scale for Delineating Advanced Practice Nursing Roles
Revista Brasileira de Enfermagem. 2024;77(2):e20230211
DOI 10.1590/0034-7167-2023-0211
Views0See moreABSTRACT
Objectives:
to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles.
Methods:
this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach’s alpha test, and z-test for proportion comparison were used.
Results:
the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership.
Conclusions:
the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.
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REVIEW07-19-2024
Nursing care for hospitalized older adults – fall accidents versus safe mobility: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230180
Abstract
REVIEWNursing care for hospitalized older adults – fall accidents versus safe mobility: a scoping review
Revista Brasileira de Enfermagem. 2024;77(2):e20230180
DOI 10.1590/0034-7167-2023-0180
Views0See moreABSTRACT
Objectives:
to map the constituent elements of the safe mobility concept present in hospital care for older adults.
Methods:
a scoping review of 35 articles searched in databases and gray literature – BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established.
Results:
none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family).
Final Considerations:
the constituent elements of safe mobility express hospital units’ capacity to guarantee care and protection from fall accidents for hospitalized older adults.
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REVIEW07-19-2024
Drug-resistant tuberculosis: integrative review of nursing care in primary health care
Revista Brasileira de Enfermagem. 2024;77(2):e20230097
Abstract
REVIEWDrug-resistant tuberculosis: integrative review of nursing care in primary health care
Revista Brasileira de Enfermagem. 2024;77(2):e20230097
DOI 10.1590/0034-7167-2023-0097
Views0See moreABSTRACT
Objectives:
to identify, in the scientific literature, the care that should be provided to individuals with drug-resistant tuberculosis by nurses in primary health care.
Methods:
integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. Data collection was conducted in November 2022, across ten databases.
Results:
six studies emphasized that nurses should perform directly observed treatment; two highlighted the importance of integrated care management between tuberculosis and human immunodeficiency virus; two demonstrated comprehensive nursing consultation using the nursing process; one emphasized person-centered care, with discharge planning and improved hospital communication with primary health care services.
Final Considerations:
the care that nurses should provide to individuals with drug-resistant tuberculosis in primary health care, for care resolution, is evidence-based.
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ORIGINAL ARTICLE07-19-2024
Translation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese
Revista Brasileira de Enfermagem. 2024;77(2):e20230060
Abstract
ORIGINAL ARTICLETranslation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese
Revista Brasileira de Enfermagem. 2024;77(2):e20230060
DOI 10.1590/0034-7167-2023-0060
Views0See moreABSTRACT
Objectives:
to translate and cross-culturally adapt the MISSCARE Survey-Ped for use in Brazil.
Methods:
a methodological study proposed by translation, synthesis of translations, back-translation, assessment by a committee of experts and pre-testing with the target population.
Results:
two direct translations of the instrument were carried out, followed by a consensual version between them. This synthetic version was back-translated and analyzed by a committee of five experts in pediatric nursing and patient safety, obtaining a Content Validity Index (CVI) of 0.95 and Cronbach’s alpha of 0.804. The final version was sent for pre-testing with 254 Brazilian pediatric nurses, with 44 (17.3%) analyzing the instrument for understanding (CVI 0.866; Content Validity Ratio (CVR) 0.773), relevance (CVI 0.931; CVR 0.864) and relevance (CVI 0.977; CVR 0.955).
Conclusions:
the MISSCARE Survey-Ped Brasil was considered suitable for application in pediatric nurses’ clinical practice in the country.
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Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
Invisibilidade do trabalho da enfermagem: tecnologia como via de combate
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301pt
Views0Na concepção comum, o trabalho é comumente associado a uma atividade remunerada em uma sociedade mercantil e de direito, refletindo a visão moderna que o limita ao tempo trocado por salário. Essa perspectiva, influenciada pelos princípios da Revolução Industrial, estabelece uma dicotomia entre o trabalho e o tempo fora dele, segmentando a vida em esferas […]See more -
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
Abstract
Invisibility of nursing work: technology as a means of combat
Revista Brasileira de Enfermagem. 2024;77:e77suppl0301
DOI 10.1590/0034-7167.202477suppl0301
Views0In the common conception, work is commonly associated with a paid activity in a commercial and legal society, reflecting the modern view that limits it to time exchanged for wage. This perspective, influenced by Industrial Revolution principles, establishes a dichotomy between work and time outside of work, segmenting life into professional and private spheres. However, […]See more
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ORIGINAL ARTICLE11-27-2023
Incidents in the context of pre-hospital care by ambulances: contributions to patient safety
Revista Brasileira de Enfermagem. 2023;76(5):e20220657
Abstract
ORIGINAL ARTICLEIncidents in the context of pre-hospital care by ambulances: contributions to patient safety
Revista Brasileira de Enfermagem. 2023;76(5):e20220657
DOI 10.1590/0034-7167-2022-0657
Views0See moreABSTRACT
Objectives:
to analyze the occurrence of incidents in the context of mobile terrestrial pre-hospital care.
Methods:
a descriptive research was carried out through the observation of 239 treatments performed by 22 healthcare professionals at the Mobile Emergency Care Service, located in Baixada Fluminense, Rio de Janeiro, Brazil. Fisher’s exact test and chi-square test were used for data analysis.
Results:
the total time dedicated to patient care was 439.5 hours, during which 2386 security incidents were observed. The most notable ones were related to written communication (235), patient identification through bracelets (238), and safety in medication preparation (81).
Conclusions:
the need to promote and implement initiatives aimed at patient safety is evident, with special focus on international safety goals within the scope of mobile pre-hospital care services.
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Saberes do enfermeiro e comunicação terapêutica no hospital
Revista Brasileira de Enfermagem. 2023;76(5):e20220617
Abstract
Saberes do enfermeiro e comunicação terapêutica no hospital
Revista Brasileira de Enfermagem. 2023;76(5):e20220617
DOI 10.1590/0034-7167-2022-0617
Views0See moreRESUMEN
Objetivos:
identificar la correlación entre el conocimiento de los enfermeros y la aplicación de la comunicación terapéutica de los enfermeros en los hospitales.
Métodos:
estudio descriptivo, cuantitativo, correlacional con método de muestreo total. Los encuestados fueron 68 enfermeros que trabajaban en una sala del hospital. Se utilizaron cuestionarios modificados para recopilar datos. Los datos se analizaron mediante el análisis de la prueba de chi-cuadrado de Pearson.
Resultados:
los enfermeros con conocimientos suficientes y pobres tienen una buena aplicación de la comunicación terapéutica. No hubo correlación entre el conocimiento y la aplicación de la comunicación terapéutica.
Conclusiones:
la comunicación terapéutica está influenciada por muchos factores. El conocimiento de los enfermeros debe ser mantenido y mejorado para brindar una atención integral y aumentar la satisfacción del paciente.
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ORIGINAL ARTICLE11-27-2023
Nurses’ knowledge and therapeutic communication in hospital
Revista Brasileira de Enfermagem. 2023;76(5):e20220617
Abstract
ORIGINAL ARTICLENurses’ knowledge and therapeutic communication in hospital
Revista Brasileira de Enfermagem. 2023;76(5):e20220617
DOI 10.1590/0034-7167-2022-0617
Views0See moreABSTRACT
Objectives:
to identify the correlation of nurses’ knowledge with the application of nurses’ therapeutic communication in hospitals.
Methods:
a descriptive quantitative, correlational design with a total sampling method was used in the study. Respondents were 68 nurses working in an inpatient room in one of the general hospitals in western Indonesia. Modified questionnaires were used in data collection. Analysis of the Pearson chi-square test was used in data analysis.
Results:
nurses with sufficient and poor knowledge have a good application of therapeutic communication. There was no correlation between knowledge and the application of nurses’ therapeutic communication.
Conclusions:
therapeutic communication is influenced by many factors, but nurses’ knowledge should be maintained and improved to provide holistic care and increase patient satisfaction.
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Adaptação transcultural da Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) modificada para mães de prematuros no Brasil
Revista Brasileira de Enfermagem. 2023;76(5):e20220497
Abstract
Adaptação transcultural da Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) modificada para mães de prematuros no Brasil
Revista Brasileira de Enfermagem. 2023;76(5):e20220497
DOI 10.1590/0034-7167-2022-0497
Views0RESUMEN
Objetivos:
realizar la adaptación transcultural de la Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) para madres de niños enfermos y/o prematuros al portugués en el contexto brasileño.
Métodos:
se realizó un estudio metodológico que incluyó la traducción del instrumento, síntesis de traducciones, revisión por especialistas, síntesis, reevaluación por especialistas, retrotraducción, preprueba y validación de contenido. El estudio involucró a 19 participantes, incluidos traductores y expertos. Además, 18 madres de la población objetivo fueron incluidas en la preprueba.
Resultados:
las equivalencias de opinión obtenidas por el comité de expertos fueron: semántica (85%), idiomática (89%), cultural (86%) y conceptual (94%). El Coeficiente de Validación de Contenido (CVC) de la escala fue de 0,93 para claridad y comprensión; 0,89 para relevancia práctica; 0,92 para relevancia. El promedio general del CVC fue de 0,91.
Conclusiones:
la escala fue traducida y adaptada al portugués brasileño, lo que mantuvo las equivalencias y confirmó la validez de contenido.
Keywords:Aleitamento MaternoAutoeficaciaEstudo de ValidaçãoPesquisa Metodológica em EnfermagemRecém-Nascido PrematuroSee more -
ORIGINAL ARTICLE11-27-2023
Cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) modified for preterm mothers in Brazil
Revista Brasileira de Enfermagem. 2023;76(5):e20220497
Abstract
ORIGINAL ARTICLECross-cultural adaptation of the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) modified for preterm mothers in Brazil
Revista Brasileira de Enfermagem. 2023;76(5):e20220497
DOI 10.1590/0034-7167-2022-0497
Views0ABSTRACT
Objectives:
to conduct a cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) for mothers of ill and/or preterm infants among Portuguese-speaking mothers in Brazil.
Methods:
a methodological study was completed, including the translation of the tool, synthesis of translations, review by experts, synthesis, reassessment of experts, back-translation, pre-test, and validation of the content. The study involved 19 participants, including a translator and experts. In addition, 18 mothers from the target population were included in the pre-test.
Results:
the equivalences of the opinion obtained by the committee of experts were semantic (85%), idiom (89%), cultural (86%), and conceptual (94%). The content validation coefficient (CVC) on the scale was 0.93 for clarity and understanding; 0.89 for practical relevance; 0.92 for relevance; and the average overall CVC was 0.91.
Conclusions:
the scale was translated and adapted to the Brazilian Portuguese language, which maintained the equivalences and confirmed the content validity.
Keywords:BreastfeedingMethodological Research in NursingPremature NewbornSelf-EfficacyValidation StudySee more -
ORIGINAL ARTICLE11-27-2023
Puerperal women’s satisfaction with the obstetric services received: improvement of an assessment instrument
Revista Brasileira de Enfermagem. 2023;76(5):e20220457
Abstract
ORIGINAL ARTICLEPuerperal women’s satisfaction with the obstetric services received: improvement of an assessment instrument
Revista Brasileira de Enfermagem. 2023;76(5):e20220457
DOI 10.1590/0034-7167-2022-0457
Views0ABSTRACT
Objectives:
to improve an instrument that measures postpartum women’s satisfaction with obstetric care.
Methods:
action research, developed from a preliminary version of an instrument prepared by nurse-midwives working in public services in the Federal District. The analysis of the results of application of instrument carried out in a pilot test, analysis of evidence of instrument validity, literature review, focus group with the instrument’s developers and interview with the target audience were carried out.
Results:
factorial analysis showed three existing factors in the construct. Seven nurses participated, discussing the instrument reformulation, and 20 mothers reported their perceptions about the care received during childbirth, generating five thematic units.
Final Considerations:
instrument improvement occurred through item and response scale reconstruction and reorganization, in addition to application of a pre-test with the target population, resulting in an instrument composed of 13 items.
Keywords:Health Services ResearchParturitionPatient SatisfactionSurveys and QuestionnairesWomen's HealthSee more -
Proposta do diagnóstico de enfermagem “Retorno Venoso Periférico Prejudicado”: formação do conceito
Revista Brasileira de Enfermagem. 2023;76(5):e20220426
Abstract
Proposta do diagnóstico de enfermagem “Retorno Venoso Periférico Prejudicado”: formação do conceito
Revista Brasileira de Enfermagem. 2023;76(5):e20220426
DOI 10.1590/0034-7167-2022-0426
Views0RESUMEN
Objetivos:
desarrollar una propuesta de diagnóstico de enfermería centrada en el retorno venoso.
Métodos:
se trata de un análisis de concepto según el modelo propuesto por Walker y Avant, que se operacionaliza a través de una revisión integradora. El estudio se llevó a cabo de acuerdo con las recomendaciones del protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Resultados:
el análisis de los 131 estudios permitió identificar atributos, antecedentes y consecuencias. El atributo más común fue la disminución del flujo venoso. Los antecedentes encontrados con mayor frecuencia fueron deficiencia valvular estructural y/o funcional, edad avanzada y trombosis venosa periférica. Las consecuencias más comunes fueron edema periférico, úlcera venosa y dolor en la extremidad.
Conclusiones:
el diagnóstico de enfermería formulado fue propuesto como parte del Dominio 4, Actividad/reposo, en la Clase 4, Respuestas cardiovasculares/pulmonares, con ocho características definidoras, cinco factores relacionados, seis poblaciones de riesgo y cuatro condiciones asociadas.
Keywords:Diagnóstico de EnfermagemExtremidade InferiorFormação de ConceitoInsuficiência VenosaProcesso de EnfermagemSee more
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ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
Abstract
ERRATUM
Revista Brasileira de Enfermagem. 2016;69(5):1002-1002
DOI 10.1590/0034-7167.20166905e01
Views0Article “Alcohol and alcoholism: attitudes of nursing students”, with number of DOI: http://dx.doi.org/10.1590/S0034-71672013000100013, published in the journal Revista Brasileira de Enfermagem, v66(1):84-9, page 89 that read:“18. Miranda SP, Vargas D. Satisfação de pacientes de um centro de atenção Psicossocial álcool e drogas com o atendimento do enfermeiro. SMAD, Rev Eletrônica Saúde Mental Alcool Drog 2019;5(2):1-15”.[…]See more -
REVIEW01-01-2016
Research methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
Abstract
REVIEWResearch methodology for nursing and health: a book review
Revista Brasileira de Enfermagem. 2016;69(5):1000-1001
DOI 10.1590/0034-7167-2015-0135
Views1For those interested in nursing and health, the book entitled “Research methodology for nursing and health: from theory to practice”() was released in October 2015, at the 67th Brazilian Congress of Nursing, sponsored by National ABEn. The interest emerged from two organizers: Dr. Maria Ribeiro Lacerda (UFPR) and Dr. Regina Gema Santini Costerano (UNIFRA). Forty-seven […]See more -
Violence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
Abstract
Violence in the workplace in Nursing: consequences overview
Revista Brasileira de Enfermagem. 2016;69(5):996-999
DOI 10.1590/0034-7167-2015-0133
Views0See moreABSTRACT
Objective:
to reflect on the consequences of workplace violence experienced by nursing professionals.
Methods:
this is a reflection paper based on recent publications related to the subject, particularly researches carried out in Brazil and in other countries.
Results:
exposure to workplace violence has been associated with health problems in nursing professionals, which may be physical damage, emotional manifestations, and psychic disorders. It also affects the employee performance, his or her family and social interactions.
Conclusion:
this phenomenon is potentially noxious and costly, for it leads to suffering, illness, absence from work, and even death. This reflection calls attention moreover to the importance of a safe and adequate health care work environment.
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REFLECTION01-01-2016
Construcción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
REFLECTIONConstrucción de la enfermera de práctica avanzada en Catalunya (España)
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0RESUMEN
El desarrollo de la enfermera de práctica avanzada (EPA) ha supuesto un reto para las enfermeras en países como EE.UU., Canadá, Gran Bretaña y Australia, entre otros, y desde hace escasos años está siendo considerada en Catalunya y España como un sistema para desarrollar nuevos roles que aporten eficacia y eficiencia al sistema sanitario. El presente artículo pretende conceptualizar la EPA y los modelos de referencia así como contextualizar y reflexionar sobre la EPA en Catalunya, desde el punto de vista de formación y de la implantación de los denominados nuevos roles de enfermería, asimilándolos a la práctica avanzada.
Keywords:Competencia ClínicaEnfermeríaEnfermería de Práctica AvanzadaPráctica ProfesionalRol de la EnfermeraSee more -
Developing the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
Abstract
Developing the Advanced Practice Nurse in Catalonia
Revista Brasileira de Enfermagem. 2016;69(5):991-995
DOI 10.1590/0034-7167.2016690507
Views0See moreABSTRACT
The development of advanced practice nurses (APN) has proved a challenge for nurses in countries such as the USA, Canada, Great Britain, and Australia among others. It is only in recent years that the system has been considered in Catalonia and Spain as a way to develop new roles to bring effectiveness and efficiency to the health system. From the standpoint of training and implementation of the above-mentioned new nursing roles, the following article aims to conceptualise APN and its reference models, as well as to contextualise and reflect on APN in Catalonia in order to assimilate them into advanced practice.
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International academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
Abstract
International academic mobility in nursing education: an experience report
Revista Brasileira de Enfermagem. 2016;69(5):986-990
DOI 10.1590/0034-7167-2015-0128
Views0See moreABSTRACT
Objective:
report the experience of international academic mobility in Ireland through the program Science Without Borders during undergraduate education in nursing.
Method:
a report of experience presented in chronological order, with a descriptive nature.
Results:
the opportunity to know and be able to discuss questions regarding health and nursing in Ireland allowed the review of concepts and a more reflective perspective regarding nursing practices. Additionally, the exchange promoted personal strengthening regarding the confrontation and solution of problems, development of technical and scientific abilities, improvement of linguistic competences and construction of personality, independence and maturity.
Conclusion:
regarding such constructive and enriching experience that this mobility provides to students, to the governing authorities, to the population and to Brazilian nursing, sharing this experience is expected to serve as encouragement for those who search for new horizons, with the objective of adding knowledge for their personal and professional life.
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Online training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
Abstract
Online training for health professionals in three regions of Brazil
Revista Brasileira de Enfermagem. 2016;69(5):981-985
DOI 10.1590/0034-7167.2016690506
Views0See moreABSTRACT
Objective:
to describe online training experience aimed at professionals working in the public health service in 27 Neonatal and Pediatric Intensive Care Units, and to reflect concerning the training process and possible improvements in this process.
Method:
this is an experience report study about the online training with multidisciplinary content, planned from the situational diagnosis of 27 institutions. The training target set was 10 participants per institution and per module, including the following topics: Indicators of Quality as a Management Tool, Hand Hygiene, Patient Safety, Intravenous Therapy and Patients’ Chart Record.
Results:
a total of 2,071 active students in the modules, with 1,046 approved. The mean of 76 students per module exceeded the target set.
Conclusion:
experience has shown that online training is comprehensive as a potential tool for the professional technical development and digital inclusion. The online learning system becomes weakened if participants are unaware of the technological resources.
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Technologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
Abstract
Technologies in intensive care: causes of adverse events and implications to nursing
Revista Brasileira de Enfermagem. 2016;69(5):972-980
DOI 10.1590/0034-7167.2016690505
Views0See moreABSTRACT
Objective:
to identify the causes of adverse events affecting clients resulting from the use of equipment in intensive care services; to point out the main recommendations for clinical practice to minimize these events and, then, discuss the implications to nursing care.
Method:
integrative and descriptive review on the SciELO, Medline, LILACS, and PubMed databases. Articles were selected based on the inclusion criteria and the structured instrument was applied.
Results:
altogether, 11 articles were selected where three evidence units were outstanding: Equipment failure; inadequate use of equipment; and team failure. Permanent education of professionals; evaluation of production and availability of equipment; and use of checklists are recommended.
Conclusion:
preventing adverse events related to equipment is one of the nursing responsibilities and requires the establishment of defensive barriers to prevent these.
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