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REVIEW05-13-2024
Preditores de nanismo entre crianças de 0 a 24 meses no Sudeste Asiático: Uma revisão do escopo
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
Abstract
REVIEWPreditores de nanismo entre crianças de 0 a 24 meses no Sudeste Asiático: Uma revisão do escopo
Revista Brasileira de Enfermagem. 2024;77(2):e20220625
DOI 10.1590/0034-7167-2022-0625
Views0See moreRESUMEN
Objetivo:
Identificar indicadores de desnutrición crónica entre niños de 0 a 24 meses en el Sudeste Asiático.
Métodos:
Esta revisión de alcance se centró en artículos con diseño de estudio observacional publicados en inglés, entre los años 2012 y 2023 de cinco bases de datos internacionales. Las principales palabras clave utilizadas fueron: “stunting (Desnutrición crónica)” o “growth disorder (Desorden del crecimiento)”, y “newborn (Recién nacido)”, y “predict (Predecir)”, y “Southeast Asia (Sudeste Asiático)”.
Resultados:
De los 27 artículos seleccionados para el análisis final, se encontraron trece indicadores que influyen en la desnutrición crónica en siete países del Sudeste Asiático. Los trece indicadores incluyen el niño, la madre, el hogar, la alimentación inadequada complementaria, la lactancia materna inadecuada, la atención inadecuada, los alimentos de mala calidad, la seguridad de los alimentos y el agua, la infección, la economía política, la salud y la asistencia sanitaria, el agua, el saneamiento y el medio ambiente, y por último el factor sociocultural.
Conclusión:
Todos estos indicadores pueden provocar desnutrición crónica en niños del Sudeste Asiático. Para poder prevenirlo los prestadores de servicios de salud y otros sectores relacionados, necesitan realizar actividades de promoción y prevención de la salud de acuerdo con los indicadores encontrados en este artículo.
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REVIEW05-13-2024
Lean methodology: contributions to improving work processes in health and nursing
Revista Brasileira de Enfermagem. 2024;77(2):e20230322
Abstract
REVIEWLean methodology: contributions to improving work processes in health and nursing
Revista Brasileira de Enfermagem. 2024;77(2):e20230322
DOI 10.1590/0034-7167-2023-0322
Views0ABSTRACT
Objective:
to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects.
Method:
an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively.
Results:
the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod.
Conclusion:
three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste.
Keywords:Cost Efficiency AnalysisCost SavingsEfficiencyOrganizationalProcess OptimizationTotal Quality ManagementSee more -
ORIGINAL ARTICLE05-13-2024
A influência da internet nas escolhas sobre a saúde e o bem-estar dos idosos
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
Abstract
ORIGINAL ARTICLEA influência da internet nas escolhas sobre a saúde e o bem-estar dos idosos
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
DOI 10.1590/0034-7167-2023-0321
Views0See moreRESUMEN
Objetivos:
describir el perfil de los ancianos que acceden a internet para buscar información de salud e identificar los factores que pueden influir en las decisiones de los ancianos sobre su salud a partir de la información recopilada en línea.
Métodos:
391 ancianos respondieron a un cuestionario online sobre hábitos y satisfacción con la información de salud recogida en internet. El procesamiento de datos implicó regresión logística.
Resultados:
la educación superior reduce en un 44% la probabilidad de que un anciano siga las recomendaciones de salud en los sitios web. Sin embargo, las actividades sociales y la salud autopercibida aumentan la posibilidad de seguir las recomendaciones en un 83% y un 71%, respectivamente. La creencia de que internet promueve hábitos saludables aumenta 29,2 veces la probabilidad de que un anciano siga un consejo.
Consideraciones Finales:
conocer el perfil de los ancianos que utilizan internet puede ayudar a los profesionales a formular políticas públicas y construir buenas plataformas de información sobre salud y bienestar.
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REVIEW05-13-2024
Technologies used in the treatment of burn victims in intensive care: a scope review
Revista Brasileira de Enfermagem. 2024;77(1):e20220738
Abstract
REVIEWTechnologies used in the treatment of burn victims in intensive care: a scope review
Revista Brasileira de Enfermagem. 2024;77(1):e20220738
DOI 10.1590/0034-7167-2022-0738
Views0See moreABSTRACT
Objectives:
to analyze the technologies used by the nursing team in the treatment of skin lesions caused by burns in patients under intensive care.
Methods:
this is a scope review conducted on the LILACS, Medline, PubMed, and CINAHL databases without temporal or language restrictions.
Results:
the highlighted technologies included the use of specialized dressings, biological agents such as probiotics and cyanobacteria, as well as negative pressure therapies and enzymes such as papain and collagenase. Some technologies, such as nanocrystalline silver, demonstrated efficacy in infection control.
Final Considerations:
the study identified essential technologies in burn care, emphasizing the need for further research on “soft” technologies. The findings support the promotion of evidence-based nursing care for burn patients in intensive care and enhance knowledge about effective treatments.
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ORIGINAL ARTICLE05-13-2024
The influence of the internet on choices about older adults’ health and well-being
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
Abstract
ORIGINAL ARTICLEThe influence of the internet on choices about older adults’ health and well-being
Revista Brasileira de Enfermagem. 2024;77(1):e20230321
DOI 10.1590/0034-7167-2023-0321
Views0See moreABSTRACT
Objectives:
to describe the profile of older adults who access the internet to search for health information and identify the factors that can influence older adults’ decisions about their health based on information collected online.
Methods:
391 older adults answered an online questionnaire regarding habits and satisfaction with information about health collected on the internet. Data processing involved Logistic Regression.
Results:
higher education reduces by 44% the likelihood of an older adult following the health recommendations on internet sites. However, social activities and self-perceived health increase the possibility of following the recommendations by 83% and 71%, respectively. The belief that the internet promotes healthy habits increases by 29.2 times the probability of an older adult following the advice.
Final Considerations:
knowing the profile of older adults who use the Internet can help professionals formulate public policies and build good information platforms on health and well-being.
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REVIEW05-03-2024
Intervenções de Enfermagem para capacitar o cuidador familiar de uma pessoa com amputação de membro inferior: revisão de escopo
Revista Brasileira de Enfermagem. 2024;77(1):e20230264
Abstract
REVIEWIntervenções de Enfermagem para capacitar o cuidador familiar de uma pessoa com amputação de membro inferior: revisão de escopo
Revista Brasileira de Enfermagem. 2024;77(1):e20230264
DOI 10.1590/0034-7167-2023-0264
Views0See moreRESUMEN
Objetivos:
mapear intervenciones de enfermería que capaciten al cuidador familiar de la persona con amputación de miembro inferior para su rol.
Métodos:
es una revisión de alcance guiada por la metodología del Instituto Joanna Briggs, llevada a cabo en diferentes bases de datos (incluyendo literatura gris).
Resultados:
se tuvieron en cuenta seis estudios publicados entre 2009 y 2021, a saber: intervenciones de asesoramiento y apoyo para pacientes y familiares; intervenciones de apoyo entre iguales realizadas por un par de profesionales certificados; participación de cuidadores o familiares en grupos de apoyo e intervenciones clave para el equilibrio psicológico del paciente y del cuidador familiar. Dos estudios analizaron la importancia de la formación del cuidador y del amputado y del desarrollo de habilidades de afrontamiento. Otro estudio recomendó intervenciones de apoyo informativo para los cuidadores en relación con el cuidado del amputado y su adaptación a la vida hogareña.
Conclusiones:
los resultados de esta revisión permiten identificar recomendaciones/directrices para la práctica y recomendaciones/sugerencias de intervenciones según las necesidades identificadas de los cuidadores familiares de pacientes con amputación de miembros inferiores.
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ORIGINAL ARTICLE05-03-2024
Psychometric properties of the Chilean version of the quality of life questionnaire for multiple myeloma
Revista Brasileira de Enfermagem. 2024;77(1):e20230100
Abstract
ORIGINAL ARTICLEPsychometric properties of the Chilean version of the quality of life questionnaire for multiple myeloma
Revista Brasileira de Enfermagem. 2024;77(1):e20230100
DOI 10.1590/0034-7167-2023-0100
Views0See moreABSTRACT
Objectives:
To evaluate the internal consistency and construct validity of the QLQ-MY20 for assessing the quality of life in multiple myeloma survivors in Chile.
Methods:
This was a cross-sectional study conducted between March 2020 and December 2022. It involved 118 individuals from two public hospitals. The QLQ-C30 and QLQ-MY20 questionnaires were used. Internal consistency was assessed using Cronbach’s alpha(α), and construct validity was evaluated through hypothesis testing (Mann-Whitney and Spearman correlation).
Results:
The average age of participants was 67.2 years (SD=9.2). Internal consistency for the complete scale was α=0.779, for the “disease symptoms” dimension α=0.671, for the “side effects of treatments” dimension α=0.538, and for the “future perspective” dimension α=0.670. Four of the five construct validity hypotheses were confirmed: women, individuals with worse performance status, those with pain, and those with worse fatigue showed more symptoms.
Conclusions:
The Chilean version of the QLQ-MY20 demonstrates adequate internal consistency and construct validity.
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ORIGINAL ARTICLE05-03-2024
Cancer patient satisfaction regarding the quality of information received: psychometric validity of EORTC QLQ-INFO25
Revista Brasileira de Enfermagem. 2024;77(1):e20230358
Abstract
ORIGINAL ARTICLECancer patient satisfaction regarding the quality of information received: psychometric validity of EORTC QLQ-INFO25
Revista Brasileira de Enfermagem. 2024;77(1):e20230358
DOI 10.1590/0034-7167-2023-0358
Views0See moreABSTRACT
Objectives:
to psychometrically validate the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ-INFO25 instrument and identify the domains that influence patients’ perception of the information received.
Methods:
a cross-sectional methodology with cancer patients in a Brazilian philanthropic hospital institution. Sociodemographic and clinical instruments, EORTC QLQ-C30, EORTC QLQ-INFO25 and Supportive Care Needs Survey – Short Form 34 were used. Analysis occurred using Cronbach’s alpha coefficients, intraclass correlation, test-retest and exploratory factor analysis.
Results:
128 respondents participated. Cronbach’s alpha coefficient was 0.85. The test-retest obtained p-value=0.21. In the factor analysis, one item was excluded. Satisfaction with the information received was 74%, with three areas with averages below 70%. In open-ended questions, there was a greater desire for information.
Conclusions:
validity evidence was obtained with instrument reliability, consistency and stability. Respondents expressed satisfaction with the information received.
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ORIGINAL ARTICLE05-28-2021
Cultural adaptation and validation of an instrument about nursing critical thinking skills
Revista Brasileira de Enfermagem. 2021;74(2):e20200720
Abstract
ORIGINAL ARTICLECultural adaptation and validation of an instrument about nursing critical thinking skills
Revista Brasileira de Enfermagem. 2021;74(2):e20200720
DOI 10.1590/0034-7167-2020-0720
Views1See moreABSTRACT
Objectives:
to validate the Nursing Critical Thinking in Clinical Practice Questionnaire regarding cultural aspects and metric properties.
Methods:
a methodological research carried out through cross-cultural adaptation, face and content validity, dimensional construct and known groups validity, test-retest reliability and internal consistency. 511 nurses from four hospitals participated in the study, of which 54 participated in retest.
Results:
the instrument validation for Brazilian Portuguese maintained equivalences, according to the original version. The dimensional validity demonstrated adjustment to the tetrafactorial structure of the original version (GFI=0.69). There were statistically significant differences in critical thinking skills between nurses with graduate degrees and who undertook training, reading articles, developing research and working in an institution with a longer time implementation of the Nursing Process. The instrument showed temporal stability (ICC 073-0.84; p<0.001) and adequate internal consistency (α=0.97).
Conclusions:
the instrument proved to be valid and reliable for the studied population.
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REVIEW07-09-2021
Breast cancer screening in Primary Health Care in Brazil: a systematic review
Revista Brasileira de Enfermagem. 2021;74(3):e20200995
Abstract
REVIEWBreast cancer screening in Primary Health Care in Brazil: a systematic review
Revista Brasileira de Enfermagem. 2021;74(3):e20200995
DOI 10.1590/0034-7167-2020-0995
Views1See moreABSTRACT
Objectives:
to analyze care strategies for breast cancer screening in Primary Health Care in Brazil.
Methods:
this is a systematic review following the Cochrane Collaboration recommendations.
Results:
among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women’s health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%.
Conclusions:
Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.
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ORIGINAL ARTICLE07-30-2021
Curricular reforms in the transformation of nursing teaching in a federal university
Revista Brasileira de Enfermagem. 2021;74(4):e20201242
Abstract
ORIGINAL ARTICLECurricular reforms in the transformation of nursing teaching in a federal university
Revista Brasileira de Enfermagem. 2021;74(4):e20201242
DOI 10.1590/0034-7167-2020-1242
Views1See moreABSTRACT
Objectives:
to discuss the curricular reforms adopted for nursing teaching in Brazil, from 1969 to 2019.
Methods:
historical, qualitative approach using the thematic oral history and document research. 13 interviews were carried out with graduation nursing professors from a federal university in the South of Brazil. The document sources were the political-pedagogical projects of the course and their associated documents. Minayo’s thematic analysis was used.
Results:
nursing curricula delineates the profile of the professional that must be formed and are reviewed in order to be adapted to social and educational changes, showing the scientific and professional potential of the nurse. Curricular reforms consider the quality of nursing formation.
Final Considerations:
the structure of the curriculum and the reforms that took place emerged according to the historical, political, epidemiological and social context demanded from the profession, to attend to the demands of society and to the work market.
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Overview of clinical trial protocols for behavioral insomnia in infants
Revista Brasileira de Enfermagem. 2021;74:e20200769
Abstract
Overview of clinical trial protocols for behavioral insomnia in infants
Revista Brasileira de Enfermagem. 2021;74:e20200769
DOI 10.1590/0034-7167-2020-0769
Views1See moreABSTRACT
Objective:
to describe the overview of clinical trial protocols for behavioral insomnia in infants.
Methods:
an analytical study that reviewed protocols registered with the International Clinical Trials Registry Platform between August and September 2019, aiming to identify the interventions for behavioral insomnia in infants, the comparators, the main primary, secondary outcomes and their respective measurements.
Results:
eleven protocols registered between 2004 and 2018 were included. Nurses were the main coordinators of protocols (45.5%), with proposals using educational technologies, one-to-one and online follow-up consultations. The main outcome was improvement of infant and maternal sleep patterns. Secondary outcomes were anxiety, depression, and parental sexual satisfaction. To measure them, the following were used: sleep diary (54.5%), actigraphy (45.4%), and the Pittsburgh Sleep Quality Interview (36.3%) and Extended Brief Infant Sleep Questionnaire (27.2%) were used.
Conclusion:
the protocols proposed interventions for independent sleep, aiming at quality of sleep for the whole family.
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REVIEW07-09-2021
Nursing care for patients in post-transplantation of hematopoietic stem cells: an integrative review
Revista Brasileira de Enfermagem. 2021;74(3):e20200097
Abstract
REVIEWNursing care for patients in post-transplantation of hematopoietic stem cells: an integrative review
Revista Brasileira de Enfermagem. 2021;74(3):e20200097
DOI 10.1590/0034-7167-2020-0097
Views0ABSTRACT
Objectives:
to analyze the available evidence on the nursing care provided to patients after hematopoietic stem cell transplantation.
Methods:
integrative review with the search for primary studies in four databases and a virtual health library. A broad search strategy was used, including research published in English, Brazilian Portuguese, or Spanish, between 2008 and 2018, totaling a sample of 42 studies.
Results:
the studies were grouped into three categories: multiple nursing care (n=19), first-line care (n=18), and self-management of care (n=5).
Conclusions:
nursing care is critical, comprising patients’ physical, psychological and social aspects. It occurs in hospital and home contexts, mainly involving technical actions and health guidance. The evidence identified provide subsidies for decision-making; however, most studies are of the non-experimental type, indicating the need for conducting intervention research.
Keywords:Bone Marrow TransplantationHematopoietic Stem Cell TransplantationNursing CarePatient Care PlanningProfessional PracticeSee more -
ORIGINAL ARTICLE04-22-2020
Indicators of effectiveness of nursing care in the dimension of patient safety
Revista Brasileira de Enfermagem. 2020;73(3):e20180833
Abstract
ORIGINAL ARTICLEIndicators of effectiveness of nursing care in the dimension of patient safety
Revista Brasileira de Enfermagem. 2020;73(3):e20180833
DOI 10.1590/0034-7167-2018-0833
Views0See moreABSTRACT
Objectives:
to validate nursing care effectiveness indicators of patient safety dimension.
Methods:
quantitative survey, using the electronic Delphi sampli, with 52 participants selected by the Snowball sampling. Eight indicators were evaluated regarding the attributes: availability, reliability, simplicity, representativeness, sensitivity, comprehensiveness, objectivity, cost, utility, stability and timeliness. For validation, the minimum agreement criterion was 70%.
Results:
Cronbach’s alpha (0.942) evidenced the high internal consistency among the attributes. The indicators fall with damage, hip fracture, and postoperative hip fracture, incidents related to equipment, incidents due to failures in patient identification, and pressure injury were validated in all attributes, and those of medication error and hand Hygiene were not validated.
Conclusions:
the validated indicators allow assessment of the effectiveness of hospital nursing care. Unavailability of data is an obstacle to monitoring patient safety.
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ORIGINAL ARTICLE06-01-2020
Prisoners of suffering: perception of women on violence practiced by intimate partners
Revista Brasileira de Enfermagem. 2020;73:e20190219
Abstract
ORIGINAL ARTICLEPrisoners of suffering: perception of women on violence practiced by intimate partners
Revista Brasileira de Enfermagem. 2020;73:e20190219
DOI 10.1590/0034-7167-2019-0219
Views0See moreABSTRACT
Objective:
to describe the perceptions of women, prisoners or partners of imprisoned men who experience/experienced intimate partner violence, and how they cope with this situation.
Method:
a descriptive exploratory study with a qualitative approach conducted with 21 women. Empirical data collected between March and August 2018, through audio-recorded semi-structured interviews, were submitted to thematic content analysis.
Results:
women reported experiencing different forms of violence, which triggered suffering and negative commitment in their lives, far beyond the act itself, especially by the emotional and physical marks and their consequences. They also realize that coping with violence is individual responsibility, lived in the counterpoint between the desire to overcome it and passivity.
Final considerations:
intimate partner violence was uniquely revealed by women as a solitary experience, with permanent consequences in the physical, emotional, patrimonial, sexual and moral spheres, and limited internal and external resources make it difficult to cope with it.
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ORIGINAL ARTICLE06-01-2020
Performance of nurses in the bed management service of a teaching hospital
Revista Brasileira de Enfermagem. 2020;73(4):e20190349
Abstract
ORIGINAL ARTICLEPerformance of nurses in the bed management service of a teaching hospital
Revista Brasileira de Enfermagem. 2020;73(4):e20190349
DOI 10.1590/0034-7167-2019-0349
Views0See moreABSTRACT
Objectives:
to analyze the performance of nurses in the Bed Management service of a public teaching hospital.
Methods:
descriptive, qualitative research inspired by Dubois theoretical model. 32 participants from the bed management unit and care units of a public hospital were interviewed from February to May 2018. Observations and data records from the Bed Management service complemented data collection. Theme/Category-Based Content Analysis was used.
Results:
the performance of nurses was described in three analysis matrices, represented by the categories: acquisition, implementation and maintenance of nursing resources; transformation of nursing resources into nursing service and results of the work of the nurse in Bed Management.
Final Considerations:
understanding the performance of nurses in bed management contributes to the scenario of new practices and different roles that favor visibility and strengthening of the nurse’s identity.
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ORIGINAL ARTICLE04-22-2020
Freedom-deprived women: social representations of prison, violence, and their consequences
Revista Brasileira de Enfermagem. 2020;73(3):e20180781
Abstract
ORIGINAL ARTICLEFreedom-deprived women: social representations of prison, violence, and their consequences
Revista Brasileira de Enfermagem. 2020;73(3):e20180781
DOI 10.1590/0034-7167-2018-0781
Views0See moreABSTRACT
Objective:
To understand the social representations that women deprived of their freedom have of imprisonment, violence, and their consequences.
Method:
An exploratory-descriptive qualitative study with 15 women from a female penitentiary in the State of São Paulo, Brazil. Semistructured interview was used. Data submitted to thematic content analysis and interpreted under Social Representations.
Results:
Categories identified: “Enclosed and abandoned in the prison environment”: loss of contact with relatives, difficulties living in prison, and right to be reinserted into society. “Imprisoned in a cycle of social inequality”: lack of support, access to education and employment opportunities, leading them to engage in new illicit activities and consequent imprisonment.
Final considerations:
The social representations of prisoners suggest that they perceive themselves to be doubly “imprisoned”, either from the objective point of view, as an individual deprived of freedom; or subjective, as citizens who have their rights disrespected and their possibilities of rehabilitation limited by the prison system.
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ORIGINAL ARTICLE08-20-2021
Resilience of family caregivers of children and adolescents in treatment of neoplasms and associated factors
Revista Brasileira de Enfermagem. 2021;74(6):e20190388
Abstract
ORIGINAL ARTICLEResilience of family caregivers of children and adolescents in treatment of neoplasms and associated factors
Revista Brasileira de Enfermagem. 2021;74(6):e20190388
DOI 10.1590/0034-7167-2019-0388
Views0See moreABSTRACT
Objectives:
analyze the level of resilience of family caregivers of children and adolescents hospitalized for cancer treatment and associated factors.
Methods:
cross-sectional study, carried out in 2018, with 62 family caregivers in a university hospital in the state of Rio Grande do Sul, Brazil. The instruments CDRisc-10-Br, SRQ20, PSS-14 and WHOQOL-Bref were used to measure resilience, minor psychological disorders, stress, and quality of life, respectively. Inferential statistics were used.
Results:
female caregivers, married, with one child and who practice some predominated religion. They were classified as having a moderate level of resilience (48.4%); with suspicion for minor psychological disorders (45%) and high level of stress (41%). In terms of quality of life, they were satisfied in the Physical, Psychological and Social Relations domains; and dissatisfied in the Environment domain.
Conclusions:
there were direct weak to moderate correlations between the level of resilience and quality of life and inversely with stress and minor psychological disorders.
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ORIGINAL ARTICLE08-18-2021
Mapping of advanced practice nursing actions in the Family Health Strategy
Revista Brasileira de Enfermagem. 2021;74:e20210228
Abstract
ORIGINAL ARTICLEMapping of advanced practice nursing actions in the Family Health Strategy
Revista Brasileira de Enfermagem. 2021;74:e20210228
DOI 10.1590/0034-7167-2021-0228
Views0See moreABSTRACT
Objectives:
to map advanced practice nursing actions implemented in the Family Health Strategy context.
Methods:
cross-sectional exploratory study carried out with Family Health Strategy nurses. Data obtained in the mapping were compared to the characteristics that define advanced practice nurses and are adopted internationally by using a checklist based on the International Council of Nurses Guidelines.
Results:
the mapping allowed to identify advanced practice nursing actions, such as advanced assessment, judgement, decision-making, and diagnostic reasoning skills and authority to diagnose and prescribe medications, diagnostic testing, and therapeutic treatments. However, evidence found in the educational preparation domain indicated evident fragility, expressed as the low percentage of nurses credentialed with a professional master’s degree.
Conclusions:
the present study showed that nurses in the Family Health Strategy carry out advanced practice nursing actions without the professional master’s degree recommended for credentialing, with pertinent legislation, which requires initiatives to be taken by nursing leaders to overcome this deficiency.
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