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ORIGINAL ARTICLE03-15-2024
Effects of training Community Health Agents on dementia: a quasi-experimental study
- Aline Cristina Ramos Coelho
, - Edmir Batista da Silva Cruz ,
- Helena Zacharias Radicchi ,
- Emanuela Bezerra Torres Mattos ,
- Marcia Maria Pires Camargo Novelli , [ … ],
- Corina Lopes Ribeiro
Abstract
ORIGINAL ARTICLEEffects of training Community Health Agents on dementia: a quasi-experimental study
Revista Brasileira de Enfermagem. 2024;77(1):e20230027
DOI 10.1590/0034-7167-2023-0027
- Aline Cristina Ramos Coelho ,
- Edmir Batista da Silva Cruz ,
- Helena Zacharias Radicchi ,
- Emanuela Bezerra Torres Mattos ,
- Marcia Maria Pires Camargo Novelli ,
- Felipe Granado de Souza ,
- Rubens Goulart ,
- Corina Lopes Ribeiro
Views1See moreABSTRACT
Objectives:
to evaluate the knowledge of Community Health Agents about dementia before and after the training workshop for detecting signs of the disease.
Methods:
a quasi-experimental study with 33 community agents, in which sociodemographic information and knowledge about dementia were collected and assessed using the Alzheimer’s Disease Knowledge Scale before and after the workshop. There were 10 weekly, online, synchronous meetings. The Student’s t-test for related samples was used, and the effect size was calculated.
Results:
while the average score on the initial assessment, using the measurement instrument, was 16.3, it was 21.24 in the final assessment. An increase in the scale score was observed after participating in the workshop, with a value of 4.94.
Conclusions:
it is urgent to invest in the ongoing education of these professionals for greater awareness in the timely detection of dementia cases in primary care and awareness of potentially modifiable factors.
- Aline Cristina Ramos Coelho
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REVIEW03-15-2024
Resources for health literacy among caregivers of prematurely born children: a scoping review
- Ana Clara Gomes Andrade ,
- Giovanna Barbosa Mendes ,
- Mariana Fuentes Mendoza Rodrigues Soares ,
- Suelen Rosa de Oliveira ,
- Luciano Marques dos Santos , [ … ],
- Elysângela Dittz Duarte
Abstract
REVIEWResources for health literacy among caregivers of prematurely born children: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230062
DOI 10.1590/0034-7167-2023-0062
- Ana Clara Gomes Andrade ,
- Giovanna Barbosa Mendes ,
- Mariana Fuentes Mendoza Rodrigues Soares ,
- Suelen Rosa de Oliveira ,
- Luciano Marques dos Santos ,
- Elysângela Dittz Duarte
Views1See moreABSTRACT
Objectives:
to map the available evidence on resources used to promote health literacy among caregivers of prematurely born children during outpatient follow-up.
Methods:
the Joanna Briggs Institute’s scope review protocol was utilized. The search encompassed six databases, incorporating studies from 2012 to 2022.
Results:
the three included publications revealed that the resources employed are: mobile applications, phone calls, individual counseling, videos, educational pamphlets, and group discussions. Implementing an education protocol during the transition home enhances scientifically grounded health promotion rates.
Conclusions:
there is limited literature addressing the health literacy of these caregivers. The nursing team plays a crucial role in health education and in developing resources applicable to these families.
- Ana Clara Gomes Andrade
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ORIGINAL ARTICLE03-15-2024
Health Management of an HIV Testing and Counseling Center: Nursing Contributions
- Patrícia dos Santos Augusto ,
- Camila Pureza Guimarães da Silva ,
- Tânia Cristina Franco Santos ,
- Lilian Dias Ennes ,
- Carolina Fraga Paiva , [ … ],
- Antonio José de Almeida Filho
Abstract
ORIGINAL ARTICLEHealth Management of an HIV Testing and Counseling Center: Nursing Contributions
Revista Brasileira de Enfermagem. 2024;77(1):e20230217
DOI 10.1590/0034-7167-2023-0217
- Patrícia dos Santos Augusto ,
- Camila Pureza Guimarães da Silva ,
- Tânia Cristina Franco Santos ,
- Lilian Dias Ennes ,
- Carolina Fraga Paiva ,
- Antonio José de Almeida Filho
Views0See moreABSTRACT
Objectives:
to analyze the role of nursing in the establishment of an HIV/AIDS Testing and Counseling Center in a Brazilian municipality.
Methods:
a historical study utilizing primary sources, including documents and oral accounts, involving a total of ten participants. The study encompasses the years 1997 and 1998. The research took place at the Testing and Counseling Center in São João de Meriti. Data was collected from March to May 2022.
Results:
nursing made significant contributions through the development of training initiatives led by nurses, who were also responsible for individual and group counseling, as well as HIV testing requests.
Final Considerations:
nursing played a crucial role in the center and in the management of Sexually Transmitted Infections, being involved in all stages of treatment in accordance with current public health policy.
- Patrícia dos Santos Augusto
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ORIGINAL ARTICLE03-15-2024
Is there scientific relevance to the plot of films and documentaries about eating disorders?
- Alessandra Honorio Boroski ,
- Rosane Pilot Pessa ,
- Janaína Cristina Pasquini de Almeida ,
- Jacqueline de Souza
Abstract
ORIGINAL ARTICLEIs there scientific relevance to the plot of films and documentaries about eating disorders?
Revista Brasileira de Enfermagem. 2024;77(1):e20220547
DOI 10.1590/0034-7167-2022-0547
- Alessandra Honorio Boroski ,
- Rosane Pilot Pessa ,
- Janaína Cristina Pasquini de Almeida ,
- Jacqueline de Souza
Views1See moreABSTRACT
Objectives:
to analyze films and documentaries about eating disorders from the last twenty years, identifying the way they approach the topic as well as their relevance for didactic use in teaching the health field.
Methods:
a descriptive study, whose data collection was carried out on the main streaming and video platforms, resulting in the survey of 60 media. Of these, only 25 had audio/subtitles in Portuguese (inclusion criteria). scientific relevance was analyzed considering psychopathological and epidemiological aspects of these disorders. A questionnaire about the plot, characters and descriptive data analysis were used.
Results:
most media were dramas about female teenagers who tried to conform to beauty stereotypes, whose symptoms portrayed converged with current medical diagnostic manuals.
Conclusions:
in practical terms, a classificatory list of 11 media was prepared that could be used as a teaching resource for teaching this topic in the health field.
- Alessandra Honorio Boroski
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REVIEW03-15-2024
Nursing care for parents who have experienced fetal demise: integrative review
- Nycarla de Araújo Bezerra ,
- Cibelle Nayara Sena dos Santos ,
- Adrian Thaís Cardoso Santos Gomes da Silva ,
- Francisca Márcia Pereira Linhares ,
- Sheila Coelho Ramalho Vasconcelos Morais
Abstract
REVIEWNursing care for parents who have experienced fetal demise: integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20220811
DOI 10.1590/0034-7167-2022-0811
- Nycarla de Araújo Bezerra ,
- Cibelle Nayara Sena dos Santos ,
- Adrian Thaís Cardoso Santos Gomes da Silva ,
- Francisca Márcia Pereira Linhares ,
- Sheila Coelho Ramalho Vasconcelos Morais
Views0See moreABSTRACT
Objectives:
to identify scientific evidence regarding nursing care for parents who have experienced grief following fetal demise.
Methods:
an integrative review of original studies was conducted across six databases. The studies were classified according to the level of evidence.
Results:
the qualitative analysis of the nine studies comprising the sample involved thematic categories, exploring the impact of perinatal loss on families, inadequate communication by healthcare professionals, and the importance of a holistic approach in care. The role of the nurse is highlighted in making a positive contribution to the team, emphasizing participation in training and the provision of essential information.
Final Considerations:
grieving affects not only family dynamics but also the social environment, emphasizing the urgency of a more empathetic and comprehensive approach. Care should be holistic, going beyond technical nursing assistance, and addressing the biopsychosocial context of the parents.
- Nycarla de Araújo Bezerra
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ORIGINAL ARTICLE03-15-2024
Cultural adaptation and validity evidence of the Student Nurse Stressor-15 (SNS-15) Scale for Brazil
- Agostinho Antônio Cruz Araújo ,
- Simone de Godoy ,
- Natália Maria Freitas e Silva Maia ,
- Maria Eduarda Bonissoni Trevelin ,
- Kelly Graziani Giacchero Vedana , [ … ],
- Isabel Amélia Costa Mendes
Abstract
ORIGINAL ARTICLECultural adaptation and validity evidence of the Student Nurse Stressor-15 (SNS-15) Scale for Brazil
Revista Brasileira de Enfermagem. 2024;77(1):e20230356
DOI 10.1590/0034-7167-2023-0356
- Agostinho Antônio Cruz Araújo ,
- Simone de Godoy ,
- Natália Maria Freitas e Silva Maia ,
- Maria Eduarda Bonissoni Trevelin ,
- Kelly Graziani Giacchero Vedana ,
- Carmem Beatriz Neufeld ,
- Neyson Pinheiro Freire ,
- Carla Aparecida Arena Ventura ,
- Patricia McAleer ,
- Isabel Amélia Costa Mendes
Views0See moreABSTRACT
Objectives:
to carry out the cultural adaptation and evaluation of validity evidence of the Student Nurse Stressor-15 (SNS-15) Scale for use in Brazil.
Methods:
psychometric study, conducted from the stages of translation, synthesis, back-translation, review by a committee of seven experts, pre-test and evaluation of measurement properties with 32 and 238 nursing students, respectively. Descriptive statistics, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA) were performed. The reliability of the instrument was estimated using McDonald’s Omega (ω).
Results:
EFA subsidized the distribution of the fifteen SNS-15 items into four factors. Using AFC, satisfactory fit indices were achieved (Comparative Fit Index = 0.94; Tucker-Lewis Index = 0.93; Root Mean Square Error of Approximation = 0.06; Standardized Root Mean Square Residual = 0.16) and ω = 0.86.
Conclusions:
the Brazilian version of the SNS-15 presents evidence that confirms its validity and reliability.
- Agostinho Antônio Cruz Araújo
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REVIEW03-15-2024
Use of podcasts for health education: a scoping review
- Fabiola Leticia Damascena Amador ,
- Gabriele Cardoso Gonçalves Alves ,
- Vagner Rogério dos Santos ,
- Rita Simone Lopes Moreira
Abstract
REVIEWUse of podcasts for health education: a scoping review
Revista Brasileira de Enfermagem. 2024;77(1):e20230096
DOI 10.1590/0034-7167-2023-0096
- Fabiola Leticia Damascena Amador ,
- Gabriele Cardoso Gonçalves Alves ,
- Vagner Rogério dos Santos ,
- Rita Simone Lopes Moreira
Views0See moreABSTRACT
Objectives:
to map the scientific evidence related to the characteristics, themes, and outcomes of using health education podcasts aimed at individuals over 18 years of age in intra or extrahospital environments.
Methods:
a scoping review, based on the Joanna Briggs Institute method, conducted in 11 databases, including studies from 2004 to 2022.
Results:
11 studies were selected, categorized, highlighting the characteristics, evaluated outcomes, areas, and conditions of podcast application, indicating it as an effective tool for promoting behavioral change, health promotion, and social interaction, demonstrating its potential to improve well-being, quality of life, and user/client autonomy.
Conclusions:
the use of podcasts proves to be an effective, innovative, and low-cost tool, with a significant social impact, being effective for behavioral change, satisfaction, and social interaction. However, the lack of comprehensive studies on podcast development methodologies represents challenges to be overcome.
- Fabiola Leticia Damascena Amador
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ORIGINAL ARTICLE03-11-2024
Use of an application on the measles vaccine for Warao indigenous refugees in Brazil
- Bárbara Lopes Paiva ,
- Ingrid Bentes Lima ,
- Laura Maria Vidal Nogueira ,
- Ivaneide Leal Ataíde Rodrigues ,
- Samantha Pereira Caldas , [ … ],
- Anderson Raiol Rodrigues
Abstract
ORIGINAL ARTICLEUse of an application on the measles vaccine for Warao indigenous refugees in Brazil
Revista Brasileira de Enfermagem. 2024;77:e20230253
DOI 10.1590/0034-7167-2023-0253
- Bárbara Lopes Paiva ,
- Ingrid Bentes Lima ,
- Laura Maria Vidal Nogueira ,
- Ivaneide Leal Ataíde Rodrigues ,
- Samantha Pereira Caldas ,
- Marizete Lopes Andrade ,
- Arthur da Silva Costa Pedroza ,
- Anderson Raiol Rodrigues
Views1See moreABSTRACT
Objective:
To evaluate the need to develop an application with information about the measles vaccine for Warao indigenous people.
Methods:
This was a quantitative study conducted at the Espaço de Acolhimento Tapanã refugee shelter in the city of Belém, Pará, Brazil. The study sample was selected for convenience. Data were analyzed descriptively using Bioestat 5.0 software.
Results:
Twenty-one Warao indigenous individuals were interviewed. It was identified that 91% (n=20) had lost their vaccination card; 91% (n=20) stated they had lost their vaccination card more than three times, and 91% expressed interest in an application to store their vaccination information.
Conclusions:
The research provided important information for the development of a health application named WaraoMedI (Warao Measles Diversity Indigenous), as well as offered nursing professionals evidence about the challenges Warao indigenous refugees face in self-managing their vaccination information.
- Bárbara Lopes Paiva
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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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