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06-01-2015
Elderly families of South of Brazil in the Health Strategy
Revista Brasileira de Enfermagem. 2015;68(3):406-413
Abstract
Elderly families of South of Brazil in the Health Strategy
Revista Brasileira de Enfermagem. 2015;68(3):406-413
DOI 10.1590/0034-7167.2015680305i
Views0See moreABSTRACT
Objective:
to characterize families and health status of the elderly in the Family Health Strategy and to verify the association of family composition with sociodemographic characteristics and health of the elderly.
Method:
population-based study with 215 families and 266 elderly, linked to the Family Health Strategy from a city of Rio Grande do Sul state.
Results:
there was predominance of nuclear family composition, considered as the main source of informal support, families of female elderly (62.6%) and cardiovascular complication. The nuclear structure was signifi cantly associated with female gender (PR = 0.77; p = 0.025) and smoking (PR = 1.35; p = 0.009).
Conclusion:
the results reinforce the need to maintain a network of formal and informal support to the elderly and their families to preserve the independence or to postpone the decline in functional capacity.
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06-01-2015
From real to ideal – the health (un)care of long-lived elders
Revista Brasileira de Enfermagem. 2015;68(3):398-405
Abstract
From real to ideal – the health (un)care of long-lived elders
Revista Brasileira de Enfermagem. 2015;68(3):398-405
DOI 10.1590/0034-7167.2015680304i
Views0See moreABSTRACT
Objective:
to analyze similarities and dissimilarities in the meanings assigned to health care by long-lived elders and nursing professionals in a healthcare setting.
Method:
ethnographic qualitative research, based on the Spradley-McCurdy method and the interpretive anthropology of Geertz and Kleinman. The sample consisted of 20 key informants. Data were collected through participatory observation and ethnographic interviews from March to October 2013 and analyzed in domains, taxonomies and cultural themes.
Results:
Six domains and cultural taxonomies emerged and revealed reasons, attributes, and resources in providing care in relationship to long-lived elders and nursing professionals; fi nally, the following cultural theme emerged: the real to the ideal – the health (un)care of long-lived elders.
Conclusion:
The study showed the distance between the desired and actual health care provided to aged people in the scenario studied.
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06-01-2015
Rescuing the pleasure of playing of child with cancer in a hospital setting
Revista Brasileira de Enfermagem. 2015;68(3):391-397
Abstract
Rescuing the pleasure of playing of child with cancer in a hospital setting
Revista Brasileira de Enfermagem. 2015;68(3):391-397
DOI 10.1590/0034-7167.2015680303i
Views0See moreABSTRACT
Objective:
to dimension spaces and people that act on playing of children with cancer in outpatient treatment.
Method:
qualitative research developed with the creative sensitive method. A total of twenty two family members of seven children with cancer in outpatient treatment at a public hospital in Rio de Janeiro participated of this research. Data were generated in the family members’ homes, from September 2011 to May 2012.
Results:
after the diagnosis of childhood cancer, there was a change of scene and in the people who interact and play with children. Hospital has a central place for it, since children discover the pleasure of playing in this setting.
Conclusion:
the health care professional, especially nurses, who work on hospital care needs, should develop the ability of facilitate playing and therefore, enable care that promotes childhood development.
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06-01-2015
Child Health Surveillance: nurses perspective
Revista Brasileira de Enfermagem. 2015;68(3):384-390
Abstract
Child Health Surveillance: nurses perspective
Revista Brasileira de Enfermagem. 2015;68(3):384-390
DOI 10.1590/0034-7167.2015680302i
Views0See moreABSTRACT
Objective:
to analyze conceptions of nurses on child health surveillance in family health units.
Method:
a qualitative study with thematic analysis of the data, based on the paradigm of Health Surveillance. Interviews were conducted with 13 nurses in a countryside city in the state of Sao Paulo.
Results:
nurses conceived child health surveillance as an active monitoring, which should be comprehensive, identifying risks/vulnerabilities, through multidisciplinary and intersectoral actions that are dependent on maternal involvement. We found partial development of these assumptions in practice, due to diffi culties such as lack of maternal involvement in the proposed actions, lack of time for discussion and adoption of measures in the units and disarticulation between levels and sectors of the city.
Conclusion:
a greater political and technical investment is needed to ensure the adoption of this model in different sectors and levels of care of the city.
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06-01-2015
As diversas faces da Integridade em Pesquisa: por uma Enfermagem íntegra!
Revista Brasileira de Enfermagem. 2015;68(3):375-377
Abstract
As diversas faces da Integridade em Pesquisa: por uma Enfermagem íntegra!
Revista Brasileira de Enfermagem. 2015;68(3):375-377
DOI 10.1590/0034-7167.2015680301i
Views0Recentemente, tivemos oportunidade de participar da 4ª Conferência Mundial de Integridade em Pesquisa, no Rio de Janeiro. Para nós, pesquisadores, docentes, autores, pareceristas e editores científicos de periódicos de Enfermagem foi um evento divisor de águas: de ora em diante precisamos apertar o passo para alcançar as áreas que já têm as questões de Integridade […]See more -
06-01-2015
The many sides of Research Integrity: For Integrity in Nursing!
Revista Brasileira de Enfermagem. 2015;68(3):375-377
Abstract
The many sides of Research Integrity: For Integrity in Nursing!
Revista Brasileira de Enfermagem. 2015;68(3):375-377
DOI 10.1590/0034-7167.2015680301i
Views1We recently had the opportunity to participate in the 4th World Conference on Research Integrity in Rio de Janeiro. For us researchers, professors, authors, reviewers and scientific editors of nursing periodicals, the event was a watershed: From this point forward, we must step up our game and catch up with other areas that already discuss […]See more -
01-01-2015
Professional Master’s Degree: potential contribution to Advanced Practice Nursing
Revista Brasileira de Enfermagem. 2015;68(6):1186-1189
Abstract
Professional Master’s Degree: potential contribution to Advanced Practice Nursing
Revista Brasileira de Enfermagem. 2015;68(6):1186-1189
DOI 10.1590/0034-7167.2015680626i
Views0See moreABSTRACT
A reflection articleabout the contribution of Master’s Degree Programs in Advanced Practice Nursing and the Universal Health Coverage and the Universal Health Access, topicsthat have been discussed by the Pan American Health Organization, and which the Brazilian Nursingrequires not just appropriate, but further studyto reflect in order to define directions for our profession.
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01-01-2015
Concept of family insufficiency in the aged: critical literature analysis
Revista Brasileira de Enfermagem. 2015;68(6):1176-1185
Abstract
Concept of family insufficiency in the aged: critical literature analysis
Revista Brasileira de Enfermagem. 2015;68(6):1176-1185
DOI 10.1590/0034-7167.2015680625i
Views0See moreABSTRACT
Objective:
to identify the attributes of the “family insufficiency” concept of the aged in the literature.
Method:
critical literature analysis.
Results:
family insufficiency is characterized as a complex process of psychosocial interaction, founded mainly on low social support of the aged and impaired family ties. Its antecedents are found in contemporary transformations within the family system, intergenerational conflicts, impaired family relationships and social vulnerability of the family. The consequences of family insufficiency include social vulnerability of the aged, decline of psychological and functional health, lower quality of life and unsuccessful aging. An original theoretical proposal was elaborated for the concept of family insufficiency in the elderly, with the identification of its attributes, antecedents and consequences.
Conclusion:
the findings of this study constitute a theoretical advancement in the Family Insufficiency Syndrome in elderly people and provide data for future field research in developing the concept.
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ERRATUM04-22-2020
ERRATUM
Revista Brasileira de Enfermagem. 2020;73(3):202073n3e05
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2020;73(3):202073n3e05
DOI 10.1590/0034-7167.202073n3e05
Views0Article “Concept formation of ambience for labor and normal institutionalized delivery”, with number of DOI: , published in the journal Revista Brasileira de Enfermagem, 72(Suppl 3):348-59, on page 357:Include after Final Considerations the information:[…]See more -
ORIGINAL ARTICLE04-09-2020
Health promotion in schools: speeches, representations, and approaches
Revista Brasileira de Enfermagem. 2020;73(3):e20180774
Abstract
ORIGINAL ARTICLEHealth promotion in schools: speeches, representations, and approaches
Revista Brasileira de Enfermagem. 2020;73(3):e20180774
DOI 10.1590/0034-7167-2018-0774
Views0See moreABSTRACT
Objectives:
to analyze speeches, representations, and approaches on health and health promotion in schools, materialized in the speech of teachers.
Methods:
a qualitative study, of the case study type, carried out with 17 teachers from the municipal and state educational network. The data were obtained from interviews and analyzed by the Content-Oriented Discourse Analysis.
Results:
medical-sanitary and clinical-biological discourses predominated. Health is represented as the absence of disease, reflecting approaches that prioritize healthy habits and changes in behavior. Problematization of social determinants occurs in projects, in an intersectorial partnership.
Final Considerations:
carrying out projects of health promotion in schools ignores the solidification of partnerships and the construction of new speeches that represent it as quality of life conditioned by social, economic, and cultural factors as well as strategies for the ideological repositioning of those actors who act in this setting.
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ORIGINAL ARTICLE04-09-2020
Nursing work and competence in hemotherapy services: an ergological approach
Revista Brasileira de Enfermagem. 2020;73(3):e20180775
Abstract
ORIGINAL ARTICLENursing work and competence in hemotherapy services: an ergological approach
Revista Brasileira de Enfermagem. 2020;73(3):e20180775
DOI 10.1590/0034-7167-2018-0775
Views0See moreABSTRACT
Objetives:
to analyze the ingredients of the competence that the nurses use in the performance of their work in hemotherapy.
Methods:
qualitative study with 22 nurses, accomplished through documentary study, observation and semi-structured interview, with resources of Atlas.ti software based on the foundations of Historical Materialism Dialectic and Ergology. Performed Content Analysis.
Results:
the domain of specific knowledge of hemotherapy and the time of experience in the area, allied to the motivation of the worker and the ability to work in a team favor the competent action in the work activities. On the other hand, the lack of adequate work conditions, especially in relation to adequate materials, equipment and structure, impairs the work of the nurse in hemotherapy.
Final Considerations:
experience gained is critical to successful decision making. In addition, adequate working conditions, updating of knowledge and ability in teamwork favor a scenario of safe practices.
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ORIGINAL ARTICLE04-22-2020
Happiness as a strength in the promotion of adolescent and adult young health
Revista Brasileira de Enfermagem. 2020;73(3):e20190064
Abstract
ORIGINAL ARTICLEHappiness as a strength in the promotion of adolescent and adult young health
Revista Brasileira de Enfermagem. 2020;73(3):e20190064
DOI 10.1590/0034-7167-2019-0064
Views0See moreABSTRACT
Objectives:
to assess the relation between sociodemographic characteristics of young people associated with the subjectivity of being happy; to evaluate the relationship between the subjectivity of being happy and the perception of health status; to evaluate the relationship between the subjectivity of being happy and the school and family environments and peer groups at school.
Methods:
this is an observational study, with an intentional sample of 1,069 young Portuguese people, with ages varying from 14 to 24, most of them women, attending secondary education. The self-filling questionnaire was used.
Results:
there are statistically significant associations between the subjectivity of being happy and schooling, perception of health status, family APGAR, school and family involvement, absence of problems or teasing by peers at school.
Conclusions:
a positive and holistic care coupled with the potential of obtaining and consolidating healthy lifestyles for young people will enable health professionals to perceive them as agents of individual and social change.
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ORIGINAL ARTICLE04-22-2020
Preventing vertical HIV virus transmission: hospital care assessment
Revista Brasileira de Enfermagem. 2020;73(3):e20190491
Abstract
ORIGINAL ARTICLEPreventing vertical HIV virus transmission: hospital care assessment
Revista Brasileira de Enfermagem. 2020;73(3):e20190491
DOI 10.1590/0034-7167-2019-0491
Views0See moreABSTRACT
Objectives:
assess the implementation of actions to prevent vertical transmission of HIV.
Methods:
a retrospective cohort study conducted in two maternity hospitals in the city of Montes Claros, State of Minas Gerais. All women admitted for childbirth diagnosed with HIV and their respective newborns were included from 2014 to 2017. Data were collected from medical records and analyzed descriptively.
Results:
population consisted of 46 pairs of mothers and newborns. Management was considered inadequate in 30 cases of parturient/postpartum women (65.2%) and 14 cases of newborns (30.4%). The main reasons for inadequate maternal management were lack of pharmacological inhibition of lactation (53.3%) and counseling/consent for HIV testing (43.3%). For newborns, late onsetoffirst dose ofZidovudine (50.0%) and no prescriptionofNevirapine (28.6%).
Conclusions:
important prevention opportunities were missed, pointing to the need for improved care.
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ORIGINAL ARTICLE06-08-2020
Maternal-child nursing care for adolescent mothers: health education
Revista Brasileira de Enfermagem. 2020;73(4):e20180769
Abstract
ORIGINAL ARTICLEMaternal-child nursing care for adolescent mothers: health education
Revista Brasileira de Enfermagem. 2020;73(4):e20180769
DOI 10.1590/0034-7167-2018-0769
Views0See moreABSTRACT
Objectives:
to develop an educational intervention through a game that addresses aspects related to adolescent motherhood and child care.
Methods:
this is an action research based on diagnosis, intervention and apprehension stages.
Results:
the situational diagnosis was based on a literature review on adolescent motherhood and child care. In the intervention stage, the educational game’s first version was elaborated. In the third stage constituted by apprehension, the game was submitted to assessment of interdisciplinary experts. Suggestions of experts were adopted and the game had its second version.
Final Considerations:
the educational intervention in the present study appears a care technology that adds knowledge and practices to the work of nurses in Primary Health Care, focusing on adolescent women and children health care.
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REVIEW06-01-2020
Access of the black population to health services: integrative review
Revista Brasileira de Enfermagem. 2020;73(4):e20180834
Abstract
REVIEWAccess of the black population to health services: integrative review
Revista Brasileira de Enfermagem. 2020;73(4):e20180834
DOI 10.1590/0034-7167-2018-0834
Views1See moreABSTRACT
Objectives:
demonstrate and discuss how the black population’s access to health services occurs
Methods:
integrative literature review with the following question: How does the black population’s access to health services occur? The search was carried out in the Scholar, LILACS and SciELO databases and used the descriptor “access to health services” and the term “population,” resulting in a sample with twelve articles.
Results:
studies show that the difficulty of access is a fundamental factor for the quality of life of people, directly compromising preventive services, especially for women’s health and, in addition, it has significant impact on the illness process of the black population within its particularities.
Final Considerations:
several limiting factors compromise the black population’s access to health services, including institutional and structural factors
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ORIGINAL ARTICLE05-18-2020
Militancy of nurses in the institutionality field: printed media versions
Revista Brasileira de Enfermagem. 2020;73(4):e20180835
Abstract
ORIGINAL ARTICLEMilitancy of nurses in the institutionality field: printed media versions
Revista Brasileira de Enfermagem. 2020;73(4):e20180835
DOI 10.1590/0034-7167-2018-0835
Views0See moreABSTRACT
Objectives:
to analyze nurses’ professional militancy in the institutionality field, presented by the printed media from Bahia State in the 1970s and 1980s.
Methods:
a historical and qualitative research under Social History’s perspective, whose data source was the newspaper A Tarde. The temporal cut-off encompasses milestones such as professional body restructuring and creation.
Results:
the Associação Brasileira de Enfermagem democratization movement was reported in a superficial way, highlighting the struggle for power spaces. With respect to Conselhos Federal e Regional de Enfermagem daBahia, the newspaper notified creation and function of bodies, however, there was no visibility to the newspaper’s performance. Concerning the union, there was political fragility of nurses against the creation and union participation in the fight for labor rights.
Final Considerations:
organization of political action occurred from isolated groups mobilization of professionals who were already traveling in political spaces, not the large mass of professionals.
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ORIGINAL ARTICLE04-09-2020
High-risk areas of leprosy in Brazil between 2001-2015
Revista Brasileira de Enfermagem. 2020;73(3):e20180583
Abstract
ORIGINAL ARTICLEHigh-risk areas of leprosy in Brazil between 2001-2015
Revista Brasileira de Enfermagem. 2020;73(3):e20180583
DOI 10.1590/0034-7167-2018-0583
Views0See moreABSTRACT
Objectives:
to identify high-risk areas of leprosy in Brazil from 2001 to 2015.
Methods:
this is an ecological study of spatial analysis based on Brazilian municipalities. Spatial scan statistics were used to identify spatial clustering and measure the relative risk from the annual detection rate of new cases of leprosy. By criterion based on the Gini index, only secondary clusters were considered.
Results:
spatial scan statistics detected 26 clusters, in which the detection rate was 59.19 cases per 100 thousand inhabitants, while in the remainder of the country it was 11.76. Large part of the cluster area is located in the Legal Amazon. These groups included only 21.34% of the total population, but 60.40% of the new cases of the disease.
Conclusions:
Leprosy remains concentrated in some areas, showing the need for control programs to intensify actions in these municipalities.
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REVIEW04-16-2021
Clinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review
Revista Brasileira de Enfermagem. 2021;74(2):e20190804
Abstract
REVIEWClinical outcomes of patient navigation performed by nurses in the oncology setting: an integrative review
Revista Brasileira de Enfermagem. 2021;74(2):e20190804
DOI 10.1590/0034-7167-2019-0804
Views0See moreABSTRACT
Objective:
to evidence the clinical outcomes of navigation performed by nurses in cancer patients.
Methods:
this is an integrative literature review with collection in MEDLINE via PUBMED, LILACS, Web of Science, Scopus, and CINAHL databases. The final sample consisted of seven studies. The data were analyzed and presented descriptively. Data related to clinical outcomes were compiled and described in full. The Agency for Healthcare Research and Quality categorization was used to assess the level of evidence.
Results:
the clinical outcomes demonstrated were decreased distress, anxiety and depression, improved control and management of symptoms, improved physical conditioning, improved quality and continuity of care, improved quality of life, reduced time to start treatment.
Final considerations:
there is research that shows better clinical outcomes in cancer patients through navigation by nurses across the continuum of health care.
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ORIGINAL ARTICLE12-13-2019
Perceptions and expectations of pregnant women about the type of birth
Revista Brasileira de Enfermagem. 2019;72:41-49
Abstract
ORIGINAL ARTICLEPerceptions and expectations of pregnant women about the type of birth
Revista Brasileira de Enfermagem. 2019;72:41-49
DOI 10.1590/0034-7167-2017-0731
Views0See moreABSTRACT
Objective:
to understand the perceptions and expectations of pregnant women about the type of birth.
Method:
this is a qualitative research, based on the assumptions of the Humanization of Obstetric Care. 15 pregnant women were interviewed twice at the beginning and the end of gestation between October 2015 and May 2016. Data were analyzed according to the method of the Discourse of the Collective Subject.
Results:
the discourses were associated with four themes: Advantages of vaginal birth over cesarean section; Fear and unpredictability of vaginal birth; Importance of the doctor in the definition of the type of birth; and Influence of family and friends in choosing the type of birth.
Final considerations:
according to pregnant women, vaginal birth has more benefit compared to cesarean section. However, during gestation and birth, fear of pain and the unexpected, and medical opinions of friends and family against vaginal birth strongly influence the choice of cesarean section.
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REVIEW09-30-2020
Telenursing in care, education and management in Latin America and the Caribbean: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190317
Abstract
REVIEWTelenursing in care, education and management in Latin America and the Caribbean: an integrative review
Revista Brasileira de Enfermagem. 2020;73:e20190317
DOI 10.1590/0034-7167-2019-0317
Views0See moreABSTRACT
Objective:
Analyze the knowledge generated about telenursing related to the roles of nurses (care, education and management) in Latin America and the Caribbean, based on scientific evidence.
Methods:
Integrative review, for the years 2009 to 2019, in scientific databases from Latin America and the Caribbean. Twelve articles were selected.
Results:
Nine studies focused on care and three on education. The information and communication technology used in the studies was telephony directed toward non-communicable diseases. There were concerns about the remote communication process. With respect to education, two focused on educating health teams and one on educating patients.
Conclusion:
It is necessary to conduct studies on telenursing that generate changes in care practices, explore information and communication technology resources and provide communication training focused on this new care model.
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REVIEW08-14-2020
Nursing practice environment in Primary Health Care: a scoping review
Revista Brasileira de Enfermagem. 2020;73(6):e20190479
Abstract
REVIEWNursing practice environment in Primary Health Care: a scoping review
Revista Brasileira de Enfermagem. 2020;73(6):e20190479
DOI 10.1590/0034-7167-2019-0479
Views0INTRODUCTIONKnowledge and scientific evidence about nursing practice environments (NPE) in the context of Primary Health Care (PHC) is scarce.Policy makers, health and professional organizations have proposed to redesign the health system in PHC with the aim of increasing citizens’ accessibility, improving customer outcomes and maximizing efficiency. […]See more -
ORIGINAL ARTICLE08-19-2019
Interruptions and nursing workload during medication administration process
Revista Brasileira de Enfermagem. 2019;72(4):1001-1006
Abstract
ORIGINAL ARTICLEInterruptions and nursing workload during medication administration process
Revista Brasileira de Enfermagem. 2019;72(4):1001-1006
DOI 10.1590/0034-7167-2018-0680
Views0See moreABSTRACT
Objective:
To investigate the sources and causes of interruptions during the medication administration process performed by a nursing team and measure its frequency, duration and impact on the team’s workload.
Métodos:
This is an observational study that timed 121 medication rounds (preparation, administration and documentation) performed by 15 nurses and nine nursing technicians in a Neonatal Intensive Care Unit in the countryside of the state of São Paulo.
Resultados:
63 (52.1%) interruptions were observed. In each round, the number of interruptions that happened ranged from 1-7, for 127 in total; these occurred mainly during the preparation phase, 97 (76.4%). The main interruption sources were: nursing staff – 48 (37.8%) − and self-interruptions – 29 (22.8%). The main causes were: information exchanges – 54 (42.5%) − and parallel conversations – 28 (22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and from 18.3 to 19.2% (administration) – p≤0.05.
Conclusão:
Interruptions in the medication process are frequent, interfere in the workload of the nursing team and may reflect on the safety of care.
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ORIGINAL ARTICLE06-29-2020
Personal Protective Equipment in the coronavirus pandemic: training with Rapid Cycle Deliberate Practice
Revista Brasileira de Enfermagem. 2020;73:e20200303
Abstract
ORIGINAL ARTICLEPersonal Protective Equipment in the coronavirus pandemic: training with Rapid Cycle Deliberate Practice
Revista Brasileira de Enfermagem. 2020;73:e20200303
DOI 10.1590/0034-7167-2020-0303
Views0See moreABSTRACT
Objective:
to discuss the application of Rapid Cycle Deliberate Practice for attire and unattire training in the context of COVID-19 and structure a practical guide to the application at this juncture.
Methods:
this methodological study described theoretical and practical aspects of the application of a simulation strategy as a technological training tool. An application guide was constructed from the search for evidence from the main health authority bodies in Brazil.
Results:
maximizing time in Deliberate Practice, feedback with evidence and psychological security are the principles of this strategy. The dynamic involves repetition and feedback. The application guide presents the sequence of actions for attire and unattire.
Final considerations:
coping with this pandemic requires appropriate use of personal protective equipment. The authors suggest the Rapid Cycle Deliberate Practice as a technological educational tool for attire/unattire, since it encourages mastery performance.
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REVIEW06-11-2021
Mental health interventions implemented in the COVID-19 pandemic: what is the evidence?
Revista Brasileira de Enfermagem. 2021;74:e20200635
Abstract
REVIEWMental health interventions implemented in the COVID-19 pandemic: what is the evidence?
Revista Brasileira de Enfermagem. 2021;74:e20200635
DOI 10.1590/0034-7167-2020-0635
Views0See moreABSTRACT
Objective:
to map the evidence on mental health interventions implemented during the COVID-19 pandemic.
Method:
this scoping review was carried out in the MEDLINE/PubMed, SCOPUS, Web of Science, PsycINFO, and Science Direct databases and in the medRxiv, bioRxiv, and PsyArXiv preprints servers using the descriptors “Covid-19”, “coronavirus infection”, “coronavirus”, “2019-nCoV”, “2019 novel coronavirus disease”, “SARS-CoV-2”, “health personnel”, “general public”, and “mental health”.
Results:
eight articles were selected and categorized into mental health interventions for the population, among which mental health interventions were for people diagnosed with suspicion/confirmed COVID-19 and mental health interventions for health professionals.
Conclusion:
telemonitoring, virtual games and strategies focused on social support and muscle relaxation techniques, characterized as non-pharmacological and low-cost, were shown as interventions, which, since they are effective, need to be encouraged and included in mental health care practices.
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