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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views0In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1: Where it read: […]See more -
ERRATUM01-13-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
DOI 10.1590/0034-7167.20247706e06pt
Views0No artigo “Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2024;77(4):e20240126, página 5:Onde se lia:[…]See more -
ORIGINAL ARTICLE01-13-2024
Indicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
Abstract
ORIGINAL ARTICLEIndicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
DOI 10.1590/0034-7167-2024-0204
Views0See moreABSTRACT
Objectives:
to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission.
Methods:
a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher’s exact test, Pearson’s Chi-square, and logistic regression were used.
Results:
the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007).
Conclusions:
three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views0ABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
Keywords:Blood CultureBlood Specimen CollectionHealth Knowledge, Attitudes, PracticeNursing CareQuality of Health CareSee more -
ORIGINAL ARTICLE01-13-2024
Evaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
Abstract
ORIGINAL ARTICLEEvaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
DOI 10.1590/0034-7167-2023-0190
Views0ABSTRACT
Objectives:
to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care.
Methods:
methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory.
Results:
the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit.
Conclusions:
the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.
Keywords:Acquired Immunodeficiency SyndromeComprehensive Health CareHIVPrimary Health CareProgram EvaluationSee more -
ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views0See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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ORIGINAL ARTICLE03-27-2023
Prevalence of characteristics associated with sarcopenia in elders: a cross-sectional study
Revista Brasileira de Enfermagem. 2023;76(2):e20220209
Abstract
ORIGINAL ARTICLEPrevalence of characteristics associated with sarcopenia in elders: a cross-sectional study
Revista Brasileira de Enfermagem. 2023;76(2):e20220209
DOI 10.1590/0034-7167-2022-0209
Views0See moreABSTRACT
Objectives:
to identify the prevalence and characteristics associated with sarcopenia in elders in Primary Health Care Units.
Methods:
cross-sectional study with 384 elders. To evaluate sarcopenia, we measured: strength and muscle mass, and physical performance. The elderly were classified as having: probable sarcopenia; sarcopenia; or severe sarcopenia. The chi-squared test and the multinomial logistic regression method were used.
Results:
the prevalence of probable sarcopenia was 25.52%; of sarcopenia, 11.98%; and of severe sarcopenia, 9.90%. Probable sarcopenia is 1.75 times more prevalent in men; osteoporosis is 2.16 times more prevalent in people with severe sarcopenia; polypharmacy is 1.57 times more likely in individuals with probable sarcopenia; and calf circumference below 31 cm is 2.24 times more likely in patients with sarcopenia and 2.19 times more likely in patients with severe sarcopenia.
Conclusions:
the highest prevalence was of probable sarcopenia, and the characteristics associated with sarcopenia were sex, osteoporosis, polypharmacy, overweight, obesity, and calf circumference.
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ORIGINAL ARTICLE03-27-2023
RESVECH 2.0: cross-cultural adaptation for Brazil, reliability and validity for the evaluation of venous ulcers
Revista Brasileira de Enfermagem. 2023;76(2):e20220185
Abstract
ORIGINAL ARTICLERESVECH 2.0: cross-cultural adaptation for Brazil, reliability and validity for the evaluation of venous ulcers
Revista Brasileira de Enfermagem. 2023;76(2):e20220185
DOI 10.1590/0034-7167-2022-0185
Views0See moreABSTRACT
Objectives:
to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas – RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers.
Methods:
methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach’s alpha and Spearman’s correlation (p<0.05) were used.
Results:
12 nurses and 77 people with 153 venous ulcers participated in the study. The translation was successful, the proposed factor model was validated, and Cronbach ‘s alpha = 0.832 (95%CI, 0.780-0.880) and correlation coefficient (RESVECH 2.0 and PUSH 3.0) = 0.74 were obtained.
Conclusions:
the adaptation of RESVECH 2.0 to Brazilian Portuguese is robust. Reliability and validity show compatibility for use in the country in the evaluation of venous ulcers.
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ORIGINAL ARTICLE03-17-2023
Characteristics of work in primary care identified in the collective exercise of application of the SWOT matrix
Revista Brasileira de Enfermagem. 2023;76(2):e20220443
Abstract
ORIGINAL ARTICLECharacteristics of work in primary care identified in the collective exercise of application of the SWOT matrix
Revista Brasileira de Enfermagem. 2023;76(2):e20220443
DOI 10.1590/0034-7167-2022-0443
Views0See moreABSTRACT
Objective:
to understand how variables strengths, weaknesses, opportunities and threats make it possible to characterize work in Primary Health Care, to collectively propose strategies for systematizing this process with Family Health teams.
Methods:
methodological research, with 23 participants in direct relationship with Primary Care, including representatives of segments: care (work), management and social control. In one of the three pedagogical meetings, the SWOT matrix was used as a tool for organizational work planning.
Results:
applying the matrix resulted in the following thematic categories: Teamwork and regulations: key elements for interprofessionality at work; Continuing Health Education: path to autonomy and participatory management (co-management).
Final considerations:
the study promoted the systematization of teams’ work, through the mobilization of sectors and distribution of tasks, involving professionals in the co-management of the process.
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ORIGINAL ARTICLE03-17-2023
Production and validation of an educational video on the use of the Z-Track Technique
Revista Brasileira de Enfermagem. 2023;76(2):e20220439
Abstract
ORIGINAL ARTICLEProduction and validation of an educational video on the use of the Z-Track Technique
Revista Brasileira de Enfermagem. 2023;76(2):e20220439
DOI 10.1590/0034-7167-2022-0439
Views0ABSTRACT
Objective:
to create and validate an educational video on intramuscular drug administration using the Z-track technique.
Methods:
the Delphi Technique was used to validate the script. PhDs in Nursing and PhDs in Social Communication with experience in the production of educational videos participated in the process. After editing, the video was validated by three nursing professors and assessed by students of the undergraduate nursing program at a public university.
Results:
the video was validated by the examiners with 100% agreement in three rounds for script validation and in two for video validation after editing. The duration of the video was 9 minutes.
Conclusion:
after validation by the examiners, students assessed the video and considered it suitable for learning. We This video is expected to aid in the training of nursing professionals and the enhancement of patient care.
Keywords:EducationInjectionsInstructional Film and VideoIntramuscularNursingValidation StudyVideo-Audio MediaSee more -
ORIGINAL ARTICLE03-17-2023
Professional autonomy in dealing with complications: discourse of obstetric nurses working in planned home births
Revista Brasileira de Enfermagem. 2023;76(2):e20220388
Abstract
ORIGINAL ARTICLEProfessional autonomy in dealing with complications: discourse of obstetric nurses working in planned home births
Revista Brasileira de Enfermagem. 2023;76(2):e20220388
DOI 10.1590/0034-7167-2022-0388
Views0See moreABSTRACT
Objective:
to understand the exercise of professional autonomy by obstetric nurses in dealing with complications in planned home births.
Methods:
this is a qualitative study, supported by the Discourse of the Collective Subject methodological framework, whose data collection took place from January to March 2021, through interviews guided by a semi-structured script, in which seven midwives who are members of a childbirth care collective in northeastern Brazil and who work in the home context participated.
Results:
four central ideas emerged from the collective discourses related to the exercise of professional autonomy by obstetric nurses: shared decisions; theoretical-practical instrumentalization; professional expertise; and teamwork.
Final considerations:
obstetric nurses’ autonomy in the face of complications reflects the safety of planned home births and is based on collective critical thinking, reinforcing this professional’ leading role in obstetrics.
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ORIGINAL ARTICLE03-17-2023
Features of the triggering of the yellow code and factors associated with the occurrence of adverse events
Revista Brasileira de Enfermagem. 2023;76(2):e20220181
Abstract
ORIGINAL ARTICLEFeatures of the triggering of the yellow code and factors associated with the occurrence of adverse events
Revista Brasileira de Enfermagem. 2023;76(2):e20220181
DOI 10.1590/0034-7167-2022-0181
Views0See moreABSTRACT
Objective:
to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team.
Methods:
a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo.
Results:
among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014).
Conclusions:
decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.
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ORIGINAL ARTICLE03-06-2023
The self-care process of community-dwelling older adults during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20220644
Abstract
ORIGINAL ARTICLEThe self-care process of community-dwelling older adults during the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2023;76:e20220644
DOI 10.1590/0034-7167-2022-0644
Views0See moreABSTRACT
Objectives:
to understand the self-care process of community-dwelling older adults during the COVID-19 pandemic.
Methods:
this is an explanatory study with a qualitative approach based on the constructivist Grounded Theory, carried out with 18 community-dwelling older adults. Data collection took place through interviews and content was analyzed through initial and focused coding.
Results:
two categories were obtained: “Building connections to support self-care practices” and “Living with the risk group stigma”. From their interaction, the phenomenon “Performing self-care in old age during the COVID-19 pandemic” emerged.
Final Considerations:
it was possible to identify how older adults’ experiences curing the COVID-19 pandemic had repercussions on their self-care process, being influenced by factors such as information about the disease and the impacts of risk group stigmas.
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EDITORIAL01-01-2015
Health technologies for spatial analysis and situational diagnosis of the territories: contributions to nursing
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
Abstract
EDITORIALHealth technologies for spatial analysis and situational diagnosis of the territories: contributions to nursing
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
DOI 10.1590/0034-7167.2015680601i
Views0In order to establish an organizational basis for work processes in primary health care geared towards a new social practice, it is important to recognize territories and their contexts, as these materialize human interactions, conflicts, health problems and human needs.In the process of recognition and situational diagnosis of territories, technologies for spatial analysis can facilitate […]See more -
EDITORIAL01-01-2015
Tecnologias em saúde para análise espacial e diagnóstico situacional dos territórios: contribuições para a enfermagem
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
Abstract
EDITORIALTecnologias em saúde para análise espacial e diagnóstico situacional dos territórios: contribuições para a enfermagem
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
DOI 10.1590/0034-7167.2015680601i
Views0Para a constituição de uma base organizativa dos processos de trabalho na Atenção Primária à Saúde em direção a uma nova prática social é importante o reconhecimento dos territórios e seus contextos, pois estes materializam as interações humanas, os conflitos, os problemas de saúde e necessidades humanas.Nesse processo de reconhecimento e diagnóstico situacional dos territórios, […]See more -
OFFICIAL DOCUMENT01-01-2015
CARTA DE FORTALEZA PARA A ENFERMAGEM BRASILEIRA
Revista Brasileira de Enfermagem. 2015;68(5):961-962
Abstract
OFFICIAL DOCUMENTCARTA DE FORTALEZA PARA A ENFERMAGEM BRASILEIRA
Revista Brasileira de Enfermagem. 2015;68(5):961-962
DOI 10.1590/0034-7167.2015680527
Views0APRESENTAÇÃOOs participantes do 18º Seminário Nacional de Pesquisa em Enfermagem (SENPE), promovido pela Associação Brasileira de Enfermagem (ABEn) e realizado pela ABEn Seção Ceará, aprovaram, em Sessão Plenária de Encerramento, no dia 03 de junho de 2015, a “Carta de Fortaleza para a Enfermagem Brasileira”. A ABEn vem a público divulgá-la, ao mesmo tempo em […]See more -
Delayed surgical recovery: a concept analysis
Revista Brasileira de Enfermagem. 2015;68(5):953-960
Abstract
Delayed surgical recovery: a concept analysis
Revista Brasileira de Enfermagem. 2015;68(5):953-960
DOI 10.1590/0034-7167.2015680526i
Views0See moreABSTRACT
Objective:
analyze the concept of delayed surgical recovery.
Method:
the Rodgers’ concept analysis provided the procedural mechanisms to guide the study, and an integrative review was performed to achieve the second activity of the model adopted. The PubMed, CINAHL, EMBASE and LILACS databases were selected to search for primary studies.
Results:
sixty-six primary studies were included and served as basis to construct the use and meaning of delayed surgical recovery concept. In the analysis, six attributes were outlined, which are interrelated and underpin the research concept definition. Preliminary experience was identified as the antecedent. The consequences of the concept are expressed through clinical manifestations, re-interventions, dependence on care and reduced quality of life.
Conclusion:
the definition of the concept was constructed, and the antecedents and consequents were identified. The use and meaning of the delayed surgical recovery concept point to the use of the qualifier ‘impaired’ instead of ‘delayed’.
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REVIEW01-01-2015
Total Quality Management and hospital nursing: an integrative literature review
Revista Brasileira de Enfermagem. 2015;68(5):945-952
Abstract
REVIEWTotal Quality Management and hospital nursing: an integrative literature review
Revista Brasileira de Enfermagem. 2015;68(5):945-952
DOI 10.1590/0034-7167.2015680525i
Views0See moreABSTRACT
Objective:
to identify the available evidence in the literature on Total Quality Management in nursing administration.
Method:
integrative literature review of full text articles in Portuguese, English and Spanish, published between 2000 and 2011 in the LILACS, MEDLINE, SciELO and PubMed databases.
Results:
the sample comprises 24 periodical articles grouped by the following thematic categories: Theoretical assumptions; Practical application and Quality indicators. Despite the criticism of models derived from classic administration theories, experiences of success with the deployment of TQM have already marked the health and nursing setting in Brazil.
Conclusion:
Total Quality Management in managing of nursing care has being fully used in some health institutions, while others have adopted several of its principles. Two of the twenty four articles are intervention studies, which characterizes the necessity for clinical research in this area.
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RESEARCH01-01-2015
Association between fatigue and functional capacity in patients with intermittent claudication
Revista Brasileira de Enfermagem. 2015;68(5):937-944
Abstract
RESEARCHAssociation between fatigue and functional capacity in patients with intermittent claudication
Revista Brasileira de Enfermagem. 2015;68(5):937-944
DOI 10.1590/0034-7167.2015680524i
Views0See moreABSTRACT
Objective:
to characterize fatigue and exertion fatigue in patients with intermittent claudication (IC), and to test their association with sociodemographic and clinical variables, walking capacity and level of physical activity.
Method:
forty-nine participants (66.6 years; 70% male) were studied. Validated questionnaires were used to assess fatigue (DUFS), exertion fatigue (DEFS), level of physical activity (BASIC) and walking capacity (WIQ).
Results:
participants had substantial fatigue (DUFS = 20.4+8.8) and substantial exertion fatigue (DEFS = 20.4+10.8). There was an association between the DUFS and marital status (p = 0,008). There was a statically significant association between DEFS with scores of the BASIC (r = .331; p = .02) and among DEFS with WIQ domains – walking distance (r=.359; p = .011) and climbing stairs (r=.331; p = .02).
Conclusion:
patients with IC have fatigue and exertion fatigue. Exertion fatigue might compromise the engagement of these patients in physical activity, one of the main components of IC treatment.
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RESEARCH01-01-2015
Body mobilization for prevention of pressure ulcers: direct labor costs
Revista Brasileira de Enfermagem. 2015;68(5):930-936
Abstract
RESEARCHBody mobilization for prevention of pressure ulcers: direct labor costs
Revista Brasileira de Enfermagem. 2015;68(5):930-936
DOI 10.1590/0034-7167.2015680523i
Views0See moreABSTRACT
Objective:
to calculate the average total cost (ATC) on the direct labor costs (DLC) of nursing professionals in body mobilization of patients for the prevention of pressure ulcers.
Method:
this is a quantitative, exploratory and, descriptive research. We observed 656 preventive mobilizations and we calculated the cost by multiplying the time spent by professionals at a unitary DLC.
Results:
ATC with DLC for each Unit corresponded to: Medical Clinic R$ 5.38 for bed turning, R$ 5.26 for seating positions, R$ 5.55 for walking aid; Surgical Clinic R$ 2.42 for bed turning, R$ 2.30 for seating positions, R$ 2.96 for walking aid and Intensive Care Unit R$ 8.15 for bed turning, R$ 7.57 for seating positions, R$ 15.32 for walking aid.
Conclusion:
the knowledge generated can support management related to costs of human resources needed to efficiently and effectively nursing care.
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RESEARCH01-01-2015
The mobilization of nurses for the non-interruption of nursing residence
Revista Brasileira de Enfermagem. 2015;68(5):923-929
Abstract
RESEARCHThe mobilization of nurses for the non-interruption of nursing residence
Revista Brasileira de Enfermagem. 2015;68(5):923-929
DOI 10.1590/0034-7167.2015680522i
Views0See moreABSTRACT
Objective:
To analyze the strategies employed by nurses to maintain the nursing residence program at the Ophir Loyola Hospital and discuss the potential effects of this interruption on the state of Pará.
Method:
Social-historic research. Data were collected through primary sources, written documents, and oral testimonial; the secondary sources used were manuals and articles that approached the topic in question. The theoretical reference was based on the French sociologist Pierre Bourdieu’s ideas about the concepts of cultural, social, and symbolic capital, in addition to the habitus and field concepts.
Results:
During the nurses’ mobilization there was a strong political influence on the development of the crisis and the interruption of the nursing residence Program at the Ophir Loyola Hospital, with implications for the nurses’ qualifications and the health care delivered to the societyof Pará.
Conclusion:
The analysis showed the prevalence of partisan political interests at the expense of social interests, culminating in the interruption of the nursing residency.
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