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EXPERIENCE REPORT11-27-2023
Implementation of a nursing strategy for self-transcendence in older adults: an experience report
- Jesús Guadalupe Martínez Ramírez
, - Erika Adriana Torres Hernández ,
- Raúl Fernando Guerrero-Castañeda
Abstract
EXPERIENCE REPORTImplementation of a nursing strategy for self-transcendence in older adults: an experience report
Revista Brasileira de Enfermagem. 2023;76(5):e20220745
DOI 10.1590/0034-7167-2022-0745
- Jesús Guadalupe Martínez Ramírez ,
- Erika Adriana Torres Hernández ,
- Raúl Fernando Guerrero-Castañeda
Views0See moreABSTRACT
Objectives:
to report the experience of implementing a nursing strategy to promote self-transcendence in older adults attended at a Primary Health Care center.
Methods:
an experience report on the implementation of a strategy addressing the Theory of Self-Transcendence by nursing to older adults in a primary health unit, in San Luis Potosí, Mexico, from October to November 2022.
Results:
fourteen older adults and three nurses participated. From the expression of feelings, speeches about self-transcendence, spirituality and physical activity promotion, the strategy was satisfactory. Emotional, cognitive and spiritual changes were observed in the different dimensions of the Theory of Self-Transcendence.
Final Considerations:
the nursing strategy on self-transcendence made it possible to identify significant moments that helped to identify the key points in which older adults were; it helped to intervene from a person-to-person care perspective.
- Jesús Guadalupe Martínez Ramírez
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ORIGINAL ARTICLE11-27-2023
Analysis of the development of children discharged from the Neonatal Intensive Care Unit from parents’ point of view
- Lediana Dalla Costa ,
- Késsia Helen Dalmuth ,
- Mayeli Thais Fernandes Vieira ,
- Emanueli Girardi ,
- Gisely Fachinello , [ … ],
- Alessandro Rodrigues Perondi
Abstract
ORIGINAL ARTICLEAnalysis of the development of children discharged from the Neonatal Intensive Care Unit from parents’ point of view
Revista Brasileira de Enfermagem. 2023;76(5):e20220717
DOI 10.1590/0034-7167-2022-0717
- Lediana Dalla Costa ,
- Késsia Helen Dalmuth ,
- Mayeli Thais Fernandes Vieira ,
- Emanueli Girardi ,
- Gisely Fachinello ,
- Ângela Morais da Silva ,
- Jolana Cristina Cavalheiri ,
- Alessandro Rodrigues Perondi
Views0See moreABSTRACT
Objectives:
to analyze the development of children discharged from the Neonatal Intensive Care Unit and how hospitalization interferes with child development, from parents’ point of view.
Methods:
a descriptive-exploratory, documentary and qualitative study, carried out with parents of children discharged from the Intensive Care Unit through a telephone survey and supplementation in medical records. Data were analyzed using Bardin’s tool and discussed according to scientific evidence.
Results:
from parents’ point of view, delay in physical development was not observed, however difficulties in breastfeeding and weight gain were reported. Changes in speech and changes in behavior considered abnormal were also delays in child evolution.
Final Considerations:
from parents’ point of view, changes in speech may be associated with hospitalization in an Intensive Care Unit, while difficulties related to breastfeeding and delays in cognition may be altered by conditions of prematurity and low weight at birth.
- Lediana Dalla Costa
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ORIGINAL ARTICLE11-27-2023
Urinary incontinence in women: assessment with the aid of standardized nursing terminologies NANDA-I and NOC
- Liana Priscilla Lima de Melo ,
- Lívia Maia Pascoal ,
- Isaura Letícia Tavares Palmeira Rolim ,
- Francisca Aline Arrais Sampaio Santos ,
- Floriacy Stabnow Santos , [ … ],
- Alana Gomes de Araújo Almeida
Abstract
ORIGINAL ARTICLEUrinary incontinence in women: assessment with the aid of standardized nursing terminologies NANDA-I and NOC
Revista Brasileira de Enfermagem. 2023;76(5):e20220714
DOI 10.1590/0034-7167-2022-0714
- Liana Priscilla Lima de Melo ,
- Lívia Maia Pascoal ,
- Isaura Letícia Tavares Palmeira Rolim ,
- Francisca Aline Arrais Sampaio Santos ,
- Floriacy Stabnow Santos ,
- Marcelino Santos Neto ,
- Francisca Elisângela Teixeira Lima ,
- Alana Gomes de Araújo Almeida
Views0See moreABSTRACT
Objectives:
to assess urinary impairment in incontinent women with the aid of standardized nursing terminologies NANDA-I and NOC.
Methods:
a cross-sectional study, carried out with 97 women attending the gynecology outpatient clinic of a university hospital. Data collection took place using a form that contained information about NANDA-I diagnoses related to urinary incontinence and NOC Urinary Continence indicators. Statistical analysis was performed to assess the impairment of NOC indicators in the presence of NANDA-I nursing diagnoses.
Results:
diagnosis Mixed Urinary Incontinence was the most prevalent (43.3%), and, in its presence, the most compromised indicators were voids in appropriate receptacle, gets to toilet between urge and passage of urine and empties bladder completely.
Conclusions:
urinary impairment was worse in women with elements of stress and urge urinary incontinence.
- Liana Priscilla Lima de Melo
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REVIEW11-27-2023
Vaccination hesitation in children under five years of age: a scoping review
- Eugênio Barbosa de Melo Júnior ,
- Priscilla Dantas Almeida ,
- Beatriz Mourão Pereira ,
- Paulo de Tarso Moura Borges ,
- Elucir Gir , [ … ],
- Telma Maria Evangelista de Araújo
Abstract
REVIEWVaccination hesitation in children under five years of age: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20220707
DOI 10.1590/0034-7167-2022-0707
- Eugênio Barbosa de Melo Júnior ,
- Priscilla Dantas Almeida ,
- Beatriz Mourão Pereira ,
- Paulo de Tarso Moura Borges ,
- Elucir Gir ,
- Telma Maria Evangelista de Araújo
Views0See moreABSTRACT
Objectives:
to synthesize scientific evidence on vaccine hesitancy in children under five years of age and its associated factors.
Methods:
a scoping review, conducted according to the methodological structure proposed by the JBI. Searches were carried out in the Latin American and Caribbean Center on Health Sciences Information, Scientific Electronic Library Online and PubMed databases, including gray literature. Studies in English, Spanish and Portuguese were included, without temporal delimitation. Editorials, studies that did not address vaccine hesitancy in children under five years of age and were not aligned with the objective and research question were excluded. The sample consisted of 18 articles.
Results:
misinformation, concern about adverse effects, distrust about efficacy, affliction regarding administration simultaneously, and insecurity in relation to the laboratories were the reported reasons.
Conclusions:
strategies are needed to combat the lack of information about immunobiological agents, as misinformation was the main factor in parents’ vaccine hesitation.
- Eugênio Barbosa de Melo Júnior
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ORIGINAL ARTICLE11-27-2023
ICNP® terminological subset for people with diabetic foot ulcer in primary health care
- Halene Cristina Dias de Armada e Silva ,
- Sonia Acioli ,
- Patricia dos Santos Claro Fuly ,
- Silvia Maria de Sá Basilio Lins ,
- Juliana Otaciana dos Santos , [ … ],
- Harlon França de Menezes
Abstract
ORIGINAL ARTICLEICNP® terminological subset for people with diabetic foot ulcer in primary health care
Revista Brasileira de Enfermagem. 2023;76(5):e20220668
DOI 10.1590/0034-7167-2022-0668
- Halene Cristina Dias de Armada e Silva ,
- Sonia Acioli ,
- Patricia dos Santos Claro Fuly ,
- Silvia Maria de Sá Basilio Lins ,
- Juliana Otaciana dos Santos ,
- Danielle Lemos Querido ,
- Alessandra Conceição Leite Funchal Camacho ,
- Harlon França de Menezes
Views0See moreABSTRACT
Objectives:
to elaborate an ICNP® terminological subset for people with diabetic foot ulcers in Primary Health Care.
Methods:
this is a methodological study that followed five steps: 1) Identification of relevant terms for the patients through an integrative literature review and official documents in the area; 2) Mapping of terms identified with ICNP® terms; 3) Construction of statements of nursing diagnoses, outcomes and interventions; 4) Structuring of a terminological subset with the Self-Care Deficit Theory; and 5) Content validity of statements constructed with nurses from a programmatic area in Rio de Janeiro.
Results:
the subset developed is composed of 81 diagnoses/outcomes and 583 nursing interventions, organized into universal, change and development requirements.
Conclusions:
the subset on screen was predominantly composed of statements inserted in self-care requirements related to health changes, reinforcing the importance of quality of life and recovery.
- Halene Cristina Dias de Armada e Silva
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ORIGINAL ARTICLE11-27-2023
Outcomes of Intrauterine Device Insertion by Certified Midwives and Obstetric Nurse Practitioners
Revista Brasileira de Enfermagem. 2023;76(5):e20220286
Abstract
ORIGINAL ARTICLEOutcomes of Intrauterine Device Insertion by Certified Midwives and Obstetric Nurse Practitioners
Revista Brasileira de Enfermagem. 2023;76(5):e20220286
DOI 10.1590/0034-7167-2022-0286
Views0See moreABSTRACT
Objectives:
to evaluate the outcomes of Interval Copper Intrauterine Device (IUD) insertion performed by certified midwives and obstetric nurse practitioners at a Peri-Hospital Birth Center.
Methods:
a cross-sectional study was conducted involving 75 women who underwent IUD insertion between January 2018 and February 2020. Data collection was carried out using medical records and telephone interviews.
Results:
no instances of uterine perforation were observed. Expulsion rates of the devices were 1.3% within 30 to 45 days of use and 5.3% within the first year of use. The follow-up removal rate was 4.0%. The average pain score reported was 4.2 (SD = 3.3). Among those who continued using the device, 93.1% expressed satisfaction.
Conclusions:
the findings demonstrate that IUD insertion by certified midwives and obstetric nurse practitioners is a safe procedure, yielding outcomes comparable to those reported in the existing literature.
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REVIEW11-27-2023
Nursing diagnosis proposal “Impaired Peripheral Venous Return”: concept formation
- Hanna Priscilla da Silva Medeiros ,
- Jéssica Naiara de Medeiros Araújo ,
- Amanda Barbosa da Silva ,
- Rodrigo Assis Neves Dantas ,
- Camila Takáo Lopes , [ … ],
- Allyne Fortes Vitor
Abstract
REVIEWNursing diagnosis proposal “Impaired Peripheral Venous Return”: concept formation
Revista Brasileira de Enfermagem. 2023;76(5):e20220426
DOI 10.1590/0034-7167-2022-0426
- Hanna Priscilla da Silva Medeiros ,
- Jéssica Naiara de Medeiros Araújo ,
- Amanda Barbosa da Silva ,
- Rodrigo Assis Neves Dantas ,
- Camila Takáo Lopes ,
- Allyne Fortes Vitor
Views0See moreABSTRACT
Objectives:
to develop a nursing diagnosis proposal focused on venous return.
Methods:
this is a concept analysis according to the model proposed by Walker and Avant, which is operationalized through an integrative review. The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol recommendations.
Results:
the analysis of the 131 studies allowed identifying attributes, antecedents and consequences. The most common attribute was decreased venous flow. The antecedents most frequently found were structural and/or functional valve deficiency, advanced age and peripheral venous thrombosis. The most common consequences were peripheral edema, venous ulcer and pain in the extremity.
Conclusions:
the formulated nursing diagnosis was proposed as part of Domain 4, Activity/rest, in Class 4, Cardiovascular/pulmonary responses, with eight defining characteristics, five related factors, six at-risk populations and four associated conditions.
- Hanna Priscilla da Silva Medeiros
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REVIEW11-27-2023
Abdominal compressions during cardiopulmonary resuscitation: a scoping review
- Magda Mileyde de Sousa Lima ,
- Maria Aline Moreira Ximenes ,
- Dariane Veríssimo de Araújo ,
- Lívia Moreira Barros ,
- Nelson Miguel Galindo Neto , [ … ],
- Joselany Áfio Caetano
Abstract
REVIEWAbdominal compressions during cardiopulmonary resuscitation: a scoping review
Revista Brasileira de Enfermagem. 2023;76(5):e20220400
DOI 10.1590/0034-7167-2022-0400
- Magda Mileyde de Sousa Lima ,
- Maria Aline Moreira Ximenes ,
- Dariane Veríssimo de Araújo ,
- Lívia Moreira Barros ,
- Nelson Miguel Galindo Neto ,
- Joselany Áfio Caetano
Views0See moreABSTRACT
Objectives:
to map the scientific evidence on the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest.
Methods:
this is a scoping review based on the question: “What is the evidence regarding the use of abdominal compressions during cardiopulmonary resuscitation in patients with cardiac arrest?”. Publications up to August 2022 were collected from eight databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used.
Results:
seventeen publications were included. The identified general population consisted of adults and elderly individuals. The primary outcome revealed significant rates of return of spontaneous circulation. Secondary outcomes indicated a significant improvement in heart rate, blood pressure, oxygen saturation, and other outcomes.
Conclusions:
abdominal compressions have been shown to be beneficial. However, further clinical studies are needed to identify the best execution method and its impacts.
- Magda Mileyde de Sousa Lima
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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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