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01-01-2015
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
Tecnologias 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 […]See more -
01-01-2015
Health technologies for spatial analysis and situational diagnosis of the territories: contributions to nursing
Revista Brasileira de Enfermagem. 2015;68(6):999-1000
Abstract
Health 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 -
01-01-2015
CARTA DE FORTALEZA PARA A ENFERMAGEM BRASILEIRA
Revista Brasileira de Enfermagem. 2015;68(5):961-962
Abstract
CARTA 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 -
01-01-2015
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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01-01-2015
Total Quality Management and hospital nursing: an integrative literature review
Revista Brasileira de Enfermagem. 2015;68(5):945-952
Abstract
Total 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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01-01-2015
Association between fatigue and functional capacity in patients with intermittent claudication
Revista Brasileira de Enfermagem. 2015;68(5):937-944
Abstract
Association 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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01-01-2015
Body mobilization for prevention of pressure ulcers: direct labor costs
Revista Brasileira de Enfermagem. 2015;68(5):930-936
Abstract
Body 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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01-01-2015
The mobilization of nurses for the non-interruption of nursing residence
Revista Brasileira de Enfermagem. 2015;68(5):923-929
Abstract
The 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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ORIGINAL ARTICLE04-09-2020
Factors associated with the discontinuance of outpatient follow-up in neonatal units
Revista Brasileira de Enfermagem. 2020;73(3):e20180793
Abstract
ORIGINAL ARTICLEFactors associated with the discontinuance of outpatient follow-up in neonatal units
Revista Brasileira de Enfermagem. 2020;73(3):e20180793
DOI 10.1590/0034-7167-2018-0793
Views1See moreABSTRACT
Objectives:
to identify predisposing and enabling factors as well as the health needs associated with the discontinuance of outpatient follow-up of newborns who were hospitalized at neonatal intensive care unit.
Methods:
cross-sectional study, using the behavioral model of health services use. The study was composed of 358 mothers and newborns referred to the outpatient follow-up after discharge. Characterization, perception of social support, postnatal depression, and attendance to appointments data were collected, analyzed by the R software (3.3.1).
Results:
outpatient follow-up was discontinued by 31.28% of children in the first year after discharge. In multiple regression analysis, the chance of discontinuance was higher for newborns who used mechanical ventilation (OR = 1.68; 95%CI 1.04-2.72) and depended on technology (OR = 3.54; 95%CI 1.32-9.5).
Conclusions:
predisposing factors were associated with the discontinuance of follow-up; enabling factors and health needs did not present a significant association. Children with more complex health conditions require additional support to participate in follow-up programs, thus ensuring the continuity of care.
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ERRATUM02-26-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(1):e20160061
DOI 10.1590/0034-7167.20247701e03
Views2In the article “Nurses in the labor market: professional insertion, competencies and skills”, with DOI number: , published in Revista Brasileira de Enfermagem, 2017;70(6):1220-6, on page 1225:Include before REFERENCES:[…]See more -
REVIEW12-08-2024
Interventions for Strengthening General Self-Efficacy Beliefs in College Students: An Integrative Review
Revista Brasileira de Enfermagem. 2024;77(1):e20230192
Abstract
REVIEWInterventions for Strengthening General Self-Efficacy Beliefs in College Students: An Integrative Review
Revista Brasileira de Enfermagem. 2024;77(1):e20230192
DOI 10.1590/0034-7167-2023-0192
Views0See moreABSTRACT
Objective:
To assess the evidence regarding the effectiveness of interventions aimed at strengthening self-efficacy beliefs in college students.
Methods:
Integrative Review conducted on the Lilacs, PubMed, CinahL, Cochrane Collaboration Databases, Scopus, and PsycInfo databases. The methodological quality of the studies was assessed using tools proposed by the Joanna Briggs Institute, and the results were analyzed descriptively.
Results:
Out of the 10 selected studies, six demonstrated that interventions aimed at strengthening self-efficacy were effective (Levels of Evidence II and III), and four revealed contrary results (Levels of Evidence I and II). Programs aimed at enhancing self-efficacy should include content on positive mental health, psychoeducation strategies, cover a period of eight to twelve weeks, and consider the completion of homework assignments.
Conclusion:
The synthesis of evidence pointed to pathways for building an effective self-efficacy strengthening program to be implemented in universities.
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ORIGINAL ARTICLE05-13-2024
Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health
Revista Brasileira de Enfermagem. 2024;77(2):e20230246
Abstract
ORIGINAL ARTICLEGeneralized Resistance Deficits in inmates with hypertension: missing resources that limit health
Revista Brasileira de Enfermagem. 2024;77(2):e20230246
DOI 10.1590/0034-7167-2023-0246
Views0See moreABSTRACT
Objective:
to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit.
Method:
qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison.
Results:
13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole.
Final considerations:
knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.
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ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e05
DOI 10.1590/0034-7167.20247702e05
Views2In the article “Educational technologies used to promote self-care for people with diabetes mellitus: integrative review”, with DOI number: , published in Revista Brasileira de Enfermagem, 2023;76(Suppl 4):e20230049, in the title:Where it read:[…]See more -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views2In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
REVIEW07-29-2024
Profile of scientific production on nursing technology construction, validity and application: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(3):e20230452
Abstract
REVIEWProfile of scientific production on nursing technology construction, validity and application: a bibliometric study
Revista Brasileira de Enfermagem. 2024;77(3):e20230452
DOI 10.1590/0034-7167-2023-0452
Views1See moreABSTRACT
Objective:
to analyze the profile of scientific production on nursing technology construction, validity and application.
Methods:
this is a bibliometric study, carried out in six databases, based on the Methodi Ordinatio application, arranged in nine stages. To represent the findings, the VOSviewer® software was used.
Results:
346 studies were identified, obtained from BDENF, CINAHL, EMBASE, LILACS, PubMed/MEDLINE, Scopus and Web of Science. There was a predominance of the English language, and 20% of the authors hold more than 25% of studies. Only two journals account for 25% of studies in the period studied. Twenty-six studies were selected for the InOrdinatio classification. Nursing Process (23%) stood out among the studies. The most produced technology was software (27%), and 50% of works describe construction and validity.
Conclusions:
there is an emphasis on the creation of educational technologies, especially information technology. The data demonstrates opportunities for future research in the area.
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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
Views1See 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 ARTICLE10-21-2019
Permanent education for good practices in the prevention of pressure injury: almost-experiment
Revista Brasileira de Enfermagem. 2019;72(6):1646-1652
Abstract
ORIGINAL ARTICLEPermanent education for good practices in the prevention of pressure injury: almost-experiment
Revista Brasileira de Enfermagem. 2019;72(6):1646-1652
DOI 10.1590/0034-7167-2018-0778
Views0See moreABSTRACT
Objective:
To verify the effectiveness of the educational intervention through the evaluation of nurses’ knowledge about prevention of pressure injury.
Method:
A quasi-experimental study with a single group, carried out with 95 nurses from a teaching hospital in the interior of Minas Gerais, in August and September 2017. As a teaching strategy, the active methodology and hybrid teaching were used, based on the reference of the Method of the Arch of Charles Maguerez. Data were collected from a validated instrument, called the Pieper Knowledge Test, and analyzed by descriptive statistics and Student’s t-test with significance level of p <0.001.
Results:
The mean number of correct answers obtained by the nurses was 78.8% in the pre-test and 88.8% in the post-test, and the difference was statistically significant (p <0.001).
Conclusion:
The educational intervention developed was effective, since it contributed to the improvement of nurses’ knowledge.
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ORIGINAL ARTICLE02-10-2020
Nursing practices in a psychological care center
Revista Brasileira de Enfermagem. 2020;73(1):e20180175
Abstract
ORIGINAL ARTICLENursing practices in a psychological care center
Revista Brasileira de Enfermagem. 2020;73(1):e20180175
DOI 10.1590/0034-7167-2018-0175
Views0See moreABSTRACT
Objective:
To analyze the practices developed by nursing professionals in a Psychosocial Care Center (CAPS).
Method:
A qualitative and evaluative research based on the Fourth Generation Assessment and conducted in a CAPS II of Santa Catarina State in 2014. For data collection, semi-structured interviews, field observation, and data recycling group were used with workers. Constant Comparative Method was used for data analysis.
Results:
Practices aimed at the subject and their clinical, social, prevention, treatment and articulation with the health network were identified. Medication care is a specificity of nursing that aims to promote autonomy and social reintegration. There is a need for greater articulation between the nursing and pharmacy staff, as well as creating spaces for users to talk about medication.
Conclusion:
Nursing practices are focused on biopsychosocial care, aiming to deconstruct care models focused on the disease and symptoms.
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ORIGINAL ARTICLE06-17-2020
Cardiovascular risk factors: differences between ethnic groups
Revista Brasileira de Enfermagem. 2020;73(4):e20180918
Abstract
ORIGINAL ARTICLECardiovascular risk factors: differences between ethnic groups
Revista Brasileira de Enfermagem. 2020;73(4):e20180918
DOI 10.1590/0034-7167-2018-0918
Views0See moreABSTRACT
Objectives:
to compare the metabolic, anthropometric, tobacco and alcohol consumption indicators considered as risk factors for cardiovascular diseases, as well as the demographic and socioeconomic characteristics between indigenous from Rio Negro, Sateré-Mawé, mixed-race/black and white people living in the city of Manaus.
Methods:
a cross-sectional observational study guided by the STROBE tool. There was a sample of 191 adults of both sexes. Anthropometric measurements, blood pressure and biochemical analyzes were performed. Statistical test was applied to cross color/race/ethnicity variable with the investigated variables.
Results:
indigenous had better metabolic and anthropometric indicators related to cardiovascular diseases than mixed-race/black and white, as well as Sateré-Mawé in relation to Rionegrinos (from Rio Negro).
Conclusions:
the main differences were obesity, dyslipidemia, pre-systemic arterial hypertension/systemic arterial hypertension, and increased circumferences, with a worse situation for mixed-race/black people. The findings indicate differences in risk factors between race/color and ethnicity groups evaluated.
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ORIGINAL ARTICLE05-18-2020
Construction and validation of an educational video for human papillomavirus vaccination
Revista Brasileira de Enfermagem. 2020;73(4):e20180900
Abstract
ORIGINAL ARTICLEConstruction and validation of an educational video for human papillomavirus vaccination
Revista Brasileira de Enfermagem. 2020;73(4):e20180900
DOI 10.1590/0034-7167-2018-0900
Views0See moreABSTRACT
Objectives:
to validate an educational video aimed at the adhesion of human papillomavirus vaccination.
Methods:
a methodological study, where the knowledge about the theme and the technology to be constructed in six focal groups was identified; a theoretical framework was set up and the existing videos were uploaded. After that, pre-production, production and post-production were followed. In validation of content, 22 specialists participated, and in appearance, ten adolescents, ten mothers, ten teachers and ten audiovisual professionals. Absolute frequency, Binomial Test, and Content Validity Index were used.
Results:
agreement was satisfactory in most items. Regarding relevance, 20 items had indices above 0.80 among judges. Assessment was positive among girls and mothers. Only three items had indices less than 0.80 among teachers and video professionals.
Conclusions:
the educational video was validated, conferring credibility to contribute to educational actions and improve vaccination indexes.
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08-10-2020
Repercussions of intestinal ostomy on male sexuality: an integrative review
Revista Brasileira de Enfermagem. 2020;73(6):e20190245
Abstract
Repercussions of intestinal ostomy on male sexuality: an integrative review
Revista Brasileira de Enfermagem. 2020;73(6):e20190245
DOI 10.1590/0034-7167-2019-0245
Views2INTRODUCTIONThe intestinal ostomy, also known as stoma and ostomy, consists of an artificial opening, produced surgically, whose purpose is to divert the flow of effluents to the external environment. Such a condition can impact the lives of affected individuals due to transformations that affect human multi-dimensionality, including negative repercussions involving sexuality(–).In the United States of […]See more -
ORIGINAL ARTICLE08-20-2021
Risk of suicide among nursing students
Revista Brasileira de Enfermagem. 2021;74(6):e20200867
Abstract
ORIGINAL ARTICLERisk of suicide among nursing students
Revista Brasileira de Enfermagem. 2021;74(6):e20200867
DOI 10.1590/0034-7167-2020-0867
Views0See moreABSTRACT
Objectives:
to identify the risk and degree of risk of suicide in nursing students of a public institution in the countryside of Pernambuco, Brazil.
Methods:
this was a cross-sectional, quantitative research conducted with 150 students. For data collection, a sociodemographic questionnaire and the instrument, M.I.N.I. – Brazilian version 5.0.0 – Module C – Risk of suicide were used. Statistical analyses were performed with IBM(® )SPSS(®), version 23.
Results:
53.3% of nursing students had a risk of suicide, of which 20.7% had a high risk. Moreover, 22.67% reported previous suicide attempt. It is noteworthy that students without a partner have a higher risk of suicide (56.8%) than those with a partner (29.4%).
Conclusions:
it is perceived the need to develop programs that identify students at risk of suicide in higher education institutions, in order to raise awareness of the problem and implement policies to promote mental health in the academia.
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ORIGINAL ARTICLE06-01-2020
Primary care mental health: nurses’ activities in the psychosocial care network
Revista Brasileira de Enfermagem. 2020;73:e20190104
Abstract
ORIGINAL ARTICLEPrimary care mental health: nurses’ activities in the psychosocial care network
Revista Brasileira de Enfermagem. 2020;73:e20190104
DOI 10.1590/0034-7167-2019-0104
Views0See moreABSTRACT
Objective:
to describe and analyze the role of expert nurses in mental health in the Family Health Strategy.
Method:
a qualitative study, with 20 Basic Health Units nurses of Teresina, Piauí. The information was collected through semi-structured interviews from March to May 2017 and analyzed using the content analysis method.
Results:
it was found that the conceptions of the mental health disease process were based on the biological model, there was little communication between mental health and basic network, nurses did not feel qualified to work mental health and there were few mental health actions in Primary Care.
Final considerations:
it becomes urgent to implement public policies that articulate mental health and Primary Care, raising awareness and continuing education for nurses.
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ORIGINAL ARTICLE03-30-2020
Team-Based Learning: a randomized clinical trial in undergraduate nursing
Revista Brasileira de Enfermagem. 2020;73(2):e20180621
Abstract
ORIGINAL ARTICLETeam-Based Learning: a randomized clinical trial in undergraduate nursing
Revista Brasileira de Enfermagem. 2020;73(2):e20180621
DOI 10.1590/0034-7167-2018-0621
Views0See moreABSTRACT
Objectives:
To compare the knowledge on surgical safety through the team-based learning methodology and lecture classes for undergraduate Nursing students, and evaluate the learning satisfaction with team-based learning.
Methods:
Randomized, controlled, parallel, two-arm, unblinded clinical trial developed in the Faculty of Medicine of a public university in Botucatu, Brazil. The groups included 14 students for team-based learning and 11 students for lecture classes.
Results:
Students’ apprehension of knowledge in the team-based learning group was significantly higher compared to the control group (p<0.002) by considering the pre-test results. After 30 days, there was no significant difference between groups. The experience with the methodology was considered positive among students.
Conclusions:
Team-based learning is an important pedagogic tool available and has proven effective in education and learning with students playing the role of protagonists.
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