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REVIEW10-09-2023
Effects on communication due to face mask use: an integrative review
- Jonathan Grassi
, - Isabel Barreto de Oliveira ,
- Laura Franco Chiriboga ,
- Andréa Alves Maia ,
- Margareth Attianezi , [ … ],
- Aline Neves Pessoa Almeida
Abstract
REVIEWEffects on communication due to face mask use: an integrative review
Revista Brasileira de Enfermagem. 2023;76(4):e20220674
DOI 10.1590/0034-7167-2022-0674
- Jonathan Grassi ,
- Isabel Barreto de Oliveira ,
- Laura Franco Chiriboga ,
- Andréa Alves Maia ,
- Margareth Attianezi ,
- Aline Neves Pessoa Almeida
Views0See moreABSTRACT
Objectives:
to integrate evidence from studies on auditory perceptual and speech production effects in communication situations with face mask use.
Methods:
an integrative literature review, in MEDLINE, Cochrane Library and Embase databases. The guiding question was: what effects on communication (perceptual-auditory and speech production) occur with face mask use?
Results:
searches in electronic databases resulted in 1,478 studies and filtering resulted in 29 final studies.
Conclusions:
mask use has effects on communication, both in perception and speech production, factors that are also related to quality of life, stress and socio-emotional factors. These data can impact on indicators and alerts in favor of adopting strategies to manage mask use, involving speech production and perception when wearing a mask in health services.
- Jonathan Grassi
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10-09-2023
Variabilidade glicêmica e mortalidade em unidades de terapia intensiva oncológicas
Revista Brasileira de Enfermagem. 2023;76(4):e20220812
Abstract
Variabilidade glicêmica e mortalidade em unidades de terapia intensiva oncológicas
Revista Brasileira de Enfermagem. 2023;76(4):e20220812
DOI 10.1590/0034-7167-2022-0812
Views0See moreRESUMEN
Objetivo:
investigar la asociación entre la variabilidad glucémica y la mortalidad en pacientes ingresados en unidades de cuidados intensivos oncológicos.
Métodos:
Se llevó a cabo un estudio de cohorte retrospectivo utilizando una muestra de conveniencia de 30 historias clínicas de pacientes de ambos sexos mayores de 18 años. La variabilidad glucémica se midió utilizando la desviación estándar y la amplitud general. El análisis estadístico se realizó utilizando la curva ROC (receiver operating characteristic) y el área bajo la curva (AUC). El nivel de significancia (α) se estableció en un 5% con un intervalo de confianza (IC) del 95%.
Resultados:
El estudio incluyó a 14 pacientes masculinos (46,67%) con una edad media de 60±15 años. Se recopilaron un total de 1503 muestras de glucemia. El análisis AUC para la desviación estándar no mostró ningún resultado estadísticamente significativo (p = 0,966; IC del 95% = [0,283, 0,726]). Por el contrario, la amplitud general tuvo una asociación estadísticamente significativa con la mortalidad (p = 0,049; IC del 95% = [0,514, 0,916]).
Conclusiones:
Este estudio encontró que la variabilidad glucémica medida por la amplitud general está significativamente asociada con la mortalidad del paciente en unidades de cuidados intensivos oncológicos. Estos hallazgos sugieren que el monitoreo de la variabilidad glucémica puede ser un factor importante en el manejo de pacientes críticamente enfermos en unidades de cuidados intensivos oncológicos.
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10-09-2023
Tradução e validação do Multidimensional Individual and Interpersonal Resilience Measure
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho , [ … ],
- Bernardo de Mattos Viana
Abstract
Tradução e validação do Multidimensional Individual and Interpersonal Resilience Measure
Revista Brasileira de Enfermagem. 2023;76(4):e20220696
DOI 10.1590/0034-7167-2022-0696
- Jéssica Diniz Rodrigues Ferreira ,
- Mariana Figueiredo Miranda ,
- Millena Figueiredo Miranda ,
- Marco Aurélio Romano-Silva ,
- Maria Aparecida Camargos Bicalho ,
- Bernardo de Mattos Viana
Views0See moreRESUMEN
Objetivo:
traducir, adaptar culturalmente y validar el Multidimensional Individual and Interpersonal Resilience Measure para el portugués brasileño.
Método:
después de la traducción inicial, la versión pre-final pasó por rigurosos procedimientos de adaptación cultural. Como resultado, la versión final adaptada fue sometida a un estudio de validez.
Resultados:
los procedimientos de adaptación proporcionaron equivalencia entre las versiones pre-final y original en términos semánticos, idiomáticos, experienciales y conceptuales. Un total de 187 ancianos fueron incluidos en el estudio de validez. El análisis factorial exploratorio (AFE) generó un modelo de cinco factores ((RMSEA = 0,030; TLI = 0,959; X = 151,590 p> 0,05). La versión final mostró adecuada consistencia (α de Cronbach = 0,705) y confiabilidad prueba-reprueba (ICC=0,835). No se encontró correlación estadísticamente significativa entre la resiliencia y las variables sociodemográficas y epidemiológicas evaluadas en este estudio.
Conclusión:
EMRII-BR es un instrumento válido y confiable para medir la resiliencia en ancianos brasileños.
- Jéssica Diniz Rodrigues Ferreira
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10-09-2023
Autocompaixão entre estudantes de enfermagem de uma Universidade Estadual da Indonésia durante a pandemia de COVID-19
Revista Brasileira de Enfermagem. 2023;76(4):e20220585
Abstract
Autocompaixão entre estudantes de enfermagem de uma Universidade Estadual da Indonésia durante a pandemia de COVID-19
Revista Brasileira de Enfermagem. 2023;76(4):e20220585
DOI 10.1590/0034-7167-2022-0585
Views0See moreRESUMEN
Objetivo:
Determinar el nivel de autocompasión e investigar las relaciones entre las variables sociodemográficas y la autocompasión entre estudiantes de pregrado de enfermería en una universidad estatal de Indonesia durante la pandemia de COVID-19
Métodos:
Este estudio utilizó un diseño transversal. Las muestras se seleccionaron mediante una técnica de muestreo aleatorio estratificado proporcional (n=260). Los datos se recopilaron utilizando una versión indonesia de la Escala de Autocompasión, que consta de 6 subescalas: bondad propia, autocrítica, humanidad común, aislamiento, atención plena y sobre identificación. Los datos se analizaron mediante análisis univariado y bivariado.
Resultados:
El 60% de los estudiantes tenían autocompasión moderada. Los estudiantes puntuaron más alto en amabilidad consigo mismos (3,93±1,02) y sobre identificación (3,58±0,94), lo que indica que a menudo intentaban amarse a sí mismos cuando sentían dolor emocional y a menudo se dejaban llevar cuando sucedió algo perturbador. Posteriormente, se encontró una correlación significativa entre la edad y la autocompasión (p<0,05).
Conclusión:
La autocompasión entre los estudiantes de enfermería debe mejorarse por medio de intervenciones como la alfabetización de la compasión, el entrenamiento en atención plena y las técnicas experienciales basadas en la compasión.
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ORIGINAL ARTICLE10-09-2023
Expansion of Psychosocial Care Centers and their relationship with health and human rights
- Antonio José Correa de Pauli ,
- Caíque Rossi Baldassarini ,
- Janaína Cristina Pasquini de Almeida ,
- Jaqueline Lemos de Oliveira ,
- Regina Célia Fiorati , [ … ],
- Jacqueline de Souza
Abstract
ORIGINAL ARTICLEExpansion of Psychosocial Care Centers and their relationship with health and human rights
Revista Brasileira de Enfermagem. 2023;76(4):e20220662
DOI 10.1590/0034-7167-2022-0662
- Antonio José Correa de Pauli ,
- Caíque Rossi Baldassarini ,
- Janaína Cristina Pasquini de Almeida ,
- Jaqueline Lemos de Oliveira ,
- Regina Célia Fiorati ,
- Carla Aparecida Arena Ventura ,
- Jacqueline de Souza
Views0See moreABSTRACT
Objective:
To analyze the factors associated with the expansion of the number of Brazilian Psychosocial Care Centers (CAPS) considering aspects related to the general health scenario and the institutionalization of human rights.
Methods:
An analytical document-based study, developed between February 2020 and May 2022, whose secondary data on the 27 Brazilian capitals were collected on platforms in the public domain, based on the time series from 2015 to 2020. Indicators were listed based on health system infrastructure and quality of life. For data analysis, descriptive statistics, Pearson’s correlation test and Student’s t test were used.
Results:
The capitals that expanded the number of CAPS in the analyzed period were the ones that presented the greatest political-legal framework for the protection of human rights.
Conclusion:
The results suggest that the greater the commitment of governments in favor of human rights, the greater the investment for CAPS expansion.
- Antonio José Correa de Pauli
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ORIGINAL ARTICLE10-09-2023
Prevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people
- Andreia Matos da Silva ,
- Ariane Silva do Carmo ,
- Vicente Paulo Alves ,
- Luiz Sérgio Fernandes de Carvalho
Abstract
ORIGINAL ARTICLEPrevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people
Revista Brasileira de Enfermagem. 2023;76(4):e20220592
DOI 10.1590/0034-7167-2022-0592
- Andreia Matos da Silva ,
- Ariane Silva do Carmo ,
- Vicente Paulo Alves ,
- Luiz Sérgio Fernandes de Carvalho
Views0See moreABSTRACT
Objective:
To identify the prevalence of non-communicable chronic diseases: arterial hypertension, diabetes mellitus, and associated risk factors in long-lived elderly people from three Brazilian regions.
Methods:
This is a multicenter, cross-sectional, and comparative study conducted with elderly people aged 80 years or older.
Results:
Higher prevalence of arterial hypertension were observed among those who use polypharmacy (75.7%), among elderly people aged between 80 and 84 years (33.9%), as well as in elderly people who are overweight (78.2%). The prevalence of diabetes was 24% (RP: 0.76; 95% CI: 0.59-0.98) lower among women compared to men and 2.15 times higher among those who use five or more medications (RP: 2.15; 95% CI: 1.63-2.85).
Conclusions:
In our sample, polypharmacy, body weight, and gender determine the prevalence of non-communicable chronic diseases: arterial hypertension and diabetes mellitus in long-lived elderly people.
- Andreia Matos da Silva
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EXPERIENCE REPORT10-09-2023
Service organization protocol for coping with undergraduate students’ psychological distress: a collective construction
Revista Brasileira de Enfermagem. 2023;76(4):e20220535
Abstract
EXPERIENCE REPORTService organization protocol for coping with undergraduate students’ psychological distress: a collective construction
Revista Brasileira de Enfermagem. 2023;76(4):e20220535
DOI 10.1590/0034-7167-2022-0535
Views0See moreABSTRACT
Objective:
to report on the experience of the elaboration process of a service organization protocol for coping with public undergraduate students’ psychological distress in the countryside of São Paulo.
Method:
experience report on protocol production, an action research product, carried out according to the health care and service organization protocol model, made possible by remote meetings with 33 professionals linked to the management and services of the university’s health and social assistance departments.
Results:
collective protocol production provided an opportunity for an institutional agreement on educational, therapeutic and support actions, to be developed in groups or individually with students, with provision for permanent education with civil servants.
Final considerations:
this experience made it possible to list specific actions to face undergraduate students’ psychological distress, bringing health professionals closer to those in management, promoting the exchange of concepts and practices to re-signify and transform the work developed.
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ORIGINAL ARTICLE10-09-2023
Compliance with central venous catheter infection prevention practices after intervention with simulation
- Thayane Gusmão Pires de Oliveira ,
- Juliana de Oliveira Marcatto ,
- Allana dos Reis Corrêa ,
- Luciano Marques dos Santos ,
- Patrícia Kuerten Rocha , [ … ],
- Bruna Figueiredo Manzo
Abstract
ORIGINAL ARTICLECompliance with central venous catheter infection prevention practices after intervention with simulation
Revista Brasileira de Enfermagem. 2023;76(4):e20220574
DOI 10.1590/0034-7167-2022-0574
- Thayane Gusmão Pires de Oliveira ,
- Juliana de Oliveira Marcatto ,
- Allana dos Reis Corrêa ,
- Luciano Marques dos Santos ,
- Patrícia Kuerten Rocha ,
- Delma Aurélia da Silva Simão ,
- Bruna Figueiredo Manzo
Views0See moreABSTRACT
Objectives:
to assess the effect of an educational intervention based on clinical simulation on nursing professionals’ compliance with practices to prevent peripherally inserted central venous catheter-associated primary bloodstream infections in a Neonatal Intensive Care Unit.
Methods:
a quasi-experimental study, with preand post-intervention assessment with a single group. The population consisted of 41 nursing professionals, with 31 observations being made before and after the intervention. Analyzes were performed using descriptive statistics and the McNemar non-parametric test. A significance level of 5% was adopted.
Results:
after the intervention, there was an increase in compliance with prevention practices of surgical antisepsis and professional hand hygiene, skin antisepsis with chlorhexidine, waiting for the time of the effect of alcoholic chlorhexidine and compliance with the sterile technique.
Conclusions:
the educational intervention showed an effect on increasing compliance with catheter-associated infection prevention practices.
- Thayane Gusmão Pires de Oliveira
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ORIGINAL ARTICLE06-16-2021
Patient participation in care safety: Primary Health Care professionals’ perception
- Pedro Rodrigues Carvalho ,
- Emannuela Sofia Dantas Ferraz ,
- Cristiane Chagas Teixeira ,
- Valéria Bertonha Machado ,
- Ana Lúcia Queiroz Bezerra , [ … ],
- Thatianny Tanferri de Brito Paranaguá
Abstract
ORIGINAL ARTICLEPatient participation in care safety: Primary Health Care professionals’ perception
Revista Brasileira de Enfermagem. 2021;74(2):e20200773
DOI 10.1590/0034-7167-2020-0773
- Pedro Rodrigues Carvalho ,
- Emannuela Sofia Dantas Ferraz ,
- Cristiane Chagas Teixeira ,
- Valéria Bertonha Machado ,
- Ana Lúcia Queiroz Bezerra ,
- Thatianny Tanferri de Brito Paranaguá
Views0See moreABSTRACT
Objectives:
to analyze health professionals’ perception about the meaning and practice of patient involvement in care safety in Primary Health Care.
Methods:
this is an exploratory, qualitative study, developed with 22 professionals in the Federal District, Brazil. A semi-structured interview was conducted between October and November/2018. Content analysis was carried out according to Bardin.
Results:
nurses, physicians, dentists, among others, participated. The following categories emerged: Meaning of patient involvement in care safety; Factors intervening in patient involvement in care safety; Strategies for patient involvement in care safety; Qualification for patient involvement in care safety.
Final Considerations:
the meaning of patient involvement for care safety was associated with co-responsibility and patient-centered care. Professionals’ practice revealed intervening factors and the use of involvement strategies. A gap was identified in training on patient involvement in care safety.
- Pedro Rodrigues Carvalho
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REVIEW03-30-2020
Internet influence on the biopsychosocial health of adolescents: an integratitive review
- Elisabete Zimmer Ferreira ,
- Adriane Maria Netto de Oliveira ,
- Silvana Possani Medeiros ,
- Giovana Calcagno Gomes ,
- Marta Regina Cezar-Vaz , [ … ],
- Janaína Amorim de Ávila
Abstract
REVIEWInternet influence on the biopsychosocial health of adolescents: an integratitive review
Revista Brasileira de Enfermagem. 2020;73(2):e20180766
DOI 10.1590/0034-7167-2018-0766
- Elisabete Zimmer Ferreira ,
- Adriane Maria Netto de Oliveira ,
- Silvana Possani Medeiros ,
- Giovana Calcagno Gomes ,
- Marta Regina Cezar-Vaz ,
- Janaína Amorim de Ávila
Views0See moreABSTRACT
Objectives:
To identify scientific evidence on the influence of internet use on adolescents’ biopsychosocial health.
Methods:
Integrative review, with database search, using the descriptors “internet”, “adolescent health” and “adolescent behavior”. After applying the inclusion and exclusion criteria, 16 articles were selected.
Results:
Knowledge convergence produced for three main themes was demonstrated: “Internet exposure time and possible damages to adolescent health”; “Internet, adolescent and cyberbullying”; and “Internet as a source of information for adolescent health”.
Final considerations:
The network involves an intricate network of interactions, providing varied behaviors and attitudes that reflect on adolescent health. Therefore, it is important to articulate nursing actions with the school community and the family, in order to carry out health education.
- Elisabete Zimmer Ferreira
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REFLECTION07-10-2020
Psychosocial risks and the health of health workers: reflections on Brazilian labor reform
Revista Brasileira de Enfermagem. 2020;73:e20190092
Abstract
REFLECTIONPsychosocial risks and the health of health workers: reflections on Brazilian labor reform
Revista Brasileira de Enfermagem. 2020;73:e20190092
DOI 10.1590/0034-7167-2019-0092
Views0See moreABSTRACT
Objective:
to reflect on the psychosocial risks and their impacts on the health of health workers in light of the Brazilian economic context and Labor Reform.
Method:
reflective study on the Brazilian Labor Reform and its impacts on health of health workers.
Results:
although the changes observed in the labor sphere have contributed to improvements in health and safety policies for, these changes have also contributed to the emergence of new risks arising from work activities, including psychosocial risks, which affect all occupational categories.
Final considerations:
we understand that the Brazilian Labor Reform carried out in 2017 leads to the weakening of labor relations, increases workers’ exposure to risks in the workplace, increases the risk of illness, and opposes the global movement of international organizations aimed at the prevention of aggravation in workers’ health and also at preserving their health.
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REVIEW06-17-2020
The role of the nurse in caring for the critical patient with sepsis
- Maria João Chambel Branco ,
- Ana Paula Mirco Lucas ,
- Rita Margarida Dourado Marques ,
- Patrícia Pontífice Sousa
Abstract
REVIEWThe role of the nurse in caring for the critical patient with sepsis
Revista Brasileira de Enfermagem. 2020;73(4):e20190031
DOI 10.1590/0034-7167-2019-0031
- Maria João Chambel Branco ,
- Ana Paula Mirco Lucas ,
- Rita Margarida Dourado Marques ,
- Patrícia Pontífice Sousa
Views0See moreABSTRACT
Objectives:
to know the nursing interventions in the identification, prevention and control of sepsis in critical patients.
Methods:
integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample.
Results:
nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis.
Final Considerations:
the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.
- Maria João Chambel Branco
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ORIGINAL ARTICLE05-15-2020
Configuration of power relations in physicians and nurses’ professional practices
- Tauana Wazir Mattar e Silva ,
- Isabela Silva Câncio Velloso ,
- Meiriele Tavares Araújo ,
- Aline da Rocha Kallás Fernandes
Abstract
ORIGINAL ARTICLEConfiguration of power relations in physicians and nurses’ professional practices
Revista Brasileira de Enfermagem. 2020;73:e20180629
DOI 10.1590/0034-7167-2018-0629
- Tauana Wazir Mattar e Silva ,
- Isabela Silva Câncio Velloso ,
- Meiriele Tavares Araújo ,
- Aline da Rocha Kallás Fernandes
Views0See moreABSTRACT
Objective:
to analyze the configuration of power relations constituted in and by the knowledge and daily practices of physicians and nurses in an Intensive Care Unit (ICU).
Method:
qualitative study in which data were collected through interviews with physicians and nurses from an ICU of a hospital in Belo Horizonte, Minas Gerais. A semi-structured script was used. Data were analyzed through discourse analysis in a Foucaultian perspective.
Results:
three categories were developed – Professional Identity: self-recognition in the profession; Discipline: individualizing attitudes or collective need?; and Circularity of knowledge and power in the constitution of daily practices.
Final considerations:
the identity, discipline and circulation of power are connected in a continuous movement of subjectivation of the subject, which, in turn, uses discourse as a persuasion strategy to modify the position taken over in different situations thereby causing the circulation of power.
- Tauana Wazir Mattar e Silva
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ORIGINAL ARTICLE02-10-2020
Theater of the Oppressed and bullying: nursing performance in school adolescent health
- Lidiane Cristina da Silva Alencastro ,
- Jorge Luiz da Silva ,
- André Vilela Komatsu ,
- Fabiane Blanco Silva Bernardino ,
- Flávia Carvalho Malta de Mello , [ … ],
- Marta Angélica Iossi Silva
Abstract
ORIGINAL ARTICLETheater of the Oppressed and bullying: nursing performance in school adolescent health
Revista Brasileira de Enfermagem. 2020;73(1):e20170910
DOI 10.1590/0034-7167-2017-0910
- Lidiane Cristina da Silva Alencastro ,
- Jorge Luiz da Silva ,
- André Vilela Komatsu ,
- Fabiane Blanco Silva Bernardino ,
- Flávia Carvalho Malta de Mello ,
- Marta Angélica Iossi Silva
Views0See moreABSTRACT
Objective:
to assess the effects of an intervention based on the Theater of the Oppressed in reducing school bullying.
Method:
a quasi-experimental study with 232 first-year high school students from two public schools in the city of Cuiabá, Mato Grosso State, Brazil. An intervention was performed with the Theater of the Oppressed, a theatrical methodology created by Augusto Boal and inspired by Paulo Freire’s “Pedagogy of the Oppressed”, in which one school composed the intervention group, and another school, the comparison group. Both groups were assessed for involvement in bullying situations before and after intervention. For data analysis, Poisson Regression models with random effect were used.
Results:
intervention group presented a significant decrease in direct victimization (physical and verbal aggression).
Conclusion:
the Theater of the Oppressed represents an important strategy in reducing bullying victimization among school adolescents.
- Lidiane Cristina da Silva Alencastro
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ORIGINAL ARTICLE02-10-2020
Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort
- Lenice de Castro Muniz de Quadros ,
- Luciana de Avila Quevedo ,
- Helen Denise Gonçalves ,
- Bernardo Lessa Horta ,
- Janaína Vieira dos Santos Motta , [ … ],
- Denise Petrucci Gigante
Abstract
ORIGINAL ARTICLECommon Mental Disorders and Contemporary Factors: 1982 Birth Cohort
Revista Brasileira de Enfermagem. 2020;73(1):e20180162
DOI 10.1590/0034-7167-2018-0162
- Lenice de Castro Muniz de Quadros ,
- Luciana de Avila Quevedo ,
- Helen Denise Gonçalves ,
- Bernardo Lessa Horta ,
- Janaína Vieira dos Santos Motta ,
- Denise Petrucci Gigante
Views0See moreABSTRACT
Objective:
To describe the association between common mental disorders and socio-demographic variables, smoking habits and stressful events among the 30-year-old members of a 1982 cohort.
Method:
Mental disorder was analyzed by the Self-Reporting Questionnaire (SRQ-20). Poisson regression was used to analyze the unadjusted and adjusted associations.
Results:
Low level of education and stressful events increased the prevalence of mental disorders for both genders. Lower income for women and unemployment for men also remained associated with CMD.
Conclusion:
It was possible to describe the association between contemporary factors and mental disorders in a young population, to which prevention and control measures, through public policies proposed to the areas of Primary Care, Mental Health and Education, can represent a better quality of life and health.
- Lenice de Castro Muniz de Quadros
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REVIEW12-21-2020
Lean Six Sigma methodology application in health care settings: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190861
Abstract
REVIEWLean Six Sigma methodology application in health care settings: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190861
DOI 10.1590/0034-7167-2019-0861
Views0See moreABSTRACT
Objective:
to analyze the scientific production on the results of Lean Six Sigma methodology in health care institutions.
Methods:
an integrative literature review, with the following question: what are the results in health institutions using Lean Six Sigma and Six Sigma methodology? The search was carried out at MEDLINE, LILACS, BDENF, CINAHL, Web of Science, and Scopus, with no time frame.
Results:
thirty-four articles were included, published between 2005 and 2019, of which 52.9% came from the United States of America. The most commonly found improvements were in hospital institutions and from the perspective of customers and internal processes.
Conclusion:
using Lean Six Sigma methodology proved to be effective in the different health care settings, evidencing a gap in its application regarding people engagement and training.
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