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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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ORIGINAL ARTICLE07-08-2020
Nurses’ practice in quilombola communities: an interface between cultural and political competence
Revista Brasileira de Enfermagem. 2020;73(5):e20190433
Abstract
ORIGINAL ARTICLENurses’ practice in quilombola communities: an interface between cultural and political competence
Revista Brasileira de Enfermagem. 2020;73(5):e20190433
DOI 10.1590/0034-7167-2019-0433
Views1See moreABSTRACT
Objectives:
to understand Family Health Strategy nurses’ practices in the context of quilombola communities with an interface for cultural and political competences.
Methods:
a single integrated, qualitative case study carried out on seven Family Health Strategies located in the Metropolitan Region of Belo Horizonte, state of Minas Gerais. Seven nurses and 59 quilombolas participated. Data were collected through individual interviews with nurses, collective interviews with quilombolas and observation. For analysis, the thematic content analysis was adopted.
Results:
the results revealed structural and territorial problems, which are configured as barriers for professional-user encounter as well as for professional practice performance.
Final Considerations:
it is necessary that Family Health Strategy nurses, based on political and cultural competences, create strategies that minimize the difficulties found in the implementation of health actions directed to quilombolas. Such strategies anchored in inclusive public policies.
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ORIGINAL ARTICLE07-08-2020
No to distance education! Production of meaning of discourses of nursing representative entities
Revista Brasileira de Enfermagem. 2020;73(5):e20190465
Abstract
ORIGINAL ARTICLENo to distance education! Production of meaning of discourses of nursing representative entities
Revista Brasileira de Enfermagem. 2020;73(5):e20190465
DOI 10.1590/0034-7167-2019-0465
Views0See moreABSTRACT
Objectives:
to analyze the processes of production of meanings, based on the positions of Brazilian nursing representative entities, on distance education, considering the implications for nursing as a discipline, profession and work.
Methods:
this documentary research was carried out in sources from the Federal Nursing Council and Associação Brasileira de Enfermagem, from 2015 to 2018. Data were examined from discourse analysis, using paraphrase and polysemy as analytical devices.
Results:
they were organized based on the effects of meanings produced and affiliated to two analytical categories: “Forms of mobilization and operating entities” and “Basis and justifications for the positions”.
Final Considerations:
the discourses signal concern about the future training of new professionals. Resistance, participation, visibility, broad and emphatic debate on the topic are shown as strategies for coping and defending a training process less captured by neoliberal logic, and more relational and committed to the quality of health care.
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ORIGINAL ARTICLE07-13-2020
Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73(5):e20190576
Abstract
ORIGINAL ARTICLECulture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study
Revista Brasileira de Enfermagem. 2020;73(5):e20190576
DOI 10.1590/0034-7167-2019-0576
Views0See moreABSTRACT
Objectives:
to assess the patient safety culture of the health team working in three maternity hospitals.
Methods:
observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used.
Results:
of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%.
Conclusions:
no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.
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REVIEW07-13-2020
The quality of life of family health professionals: a systematic review and meta-synthesis
Revista Brasileira de Enfermagem. 2020;73(5):e20190645
Abstract
REVIEWThe quality of life of family health professionals: a systematic review and meta-synthesis
Revista Brasileira de Enfermagem. 2020;73(5):e20190645
DOI 10.1590/0034-7167-2019-0645
Views1See moreABSTRACT
Objectives:
to perform a systematic review and meta-synthesis of qualitative studies about the work-related quality of life of Family Health Strategy professionals.
Methods:
this systematic review was developed to answer the following PVO question: “Which factors (variables) are associated with the work-related quality of life (outcome) of Family Health Strategy professionals (population)?” The PubMed, Scopus, Embase, SciELO, Web of Science, LILACS, Science Direct, OpenThesis, OpenGrey, and OATD databases were selected. The meta-synthesis analyzed the main codes and secondary codes of all included studies.
Results:
the database search resulted in 1,744 reports; six were considered eligible for the meta-synthesis. Four factors were considered for the quality of work life: working conditions; work processes; interpersonal relationships; and personal aspects.
Conclusions:
although this study confirms the adequacy of aspects commonly related to the quality of work life, other factors are important in the case of FHS professionals, especially work context.
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LETTER TO THE EDITOR07-01-2020
Letter to the Editor: doubts and considerations about Coronary Syndrome
Revista Brasileira de Enfermagem. 2020;73(5):e2020730502c
Abstract
LETTER TO THE EDITORLetter to the Editor: doubts and considerations about Coronary Syndrome
Revista Brasileira de Enfermagem. 2020;73(5):e2020730502c
DOI 10.1590/0034-7167.2020730502c
Views0Dear Editor,We wrote this letter referring to the article “Impact of anxiety and depression on morbidity and mortality of patients with coronary syndrome”() to make some comments, in order to clarify doubts that we were missing from answering. We have already made it clear that our intention is not to question the work of the […]See more -
ORIGINAL ARTICLE08-10-2020
Workers’ Health in Brazil: Accidents recorded by Social Security from 2008 to 2014
Revista Brasileira de Enfermagem. 2020;73(6):e20180892
Abstract
ORIGINAL ARTICLEWorkers’ Health in Brazil: Accidents recorded by Social Security from 2008 to 2014
Revista Brasileira de Enfermagem. 2020;73(6):e20180892
DOI 10.1590/0034-7167-2018-0892
Views0See moreABSTRACT
Objectives:
to analyze the incidence of occupational accidents in Brazil, recorded by Social Security according to the geographic regions, age group, gender and their prevalence according to the causes and branch of economic activity.
Methods:
ecological descriptive study with time series analysis from 2008 to 2014. Data on the beginning and end of the historical series were compared in each ecological unit studied.
Results:
the South and Southeast regions, male, between 20 and 49 years of age presented the highest falls in incidence. 70.87% of the causes occurred in group XIX of ICD-10. The economic activity with the highest prevalence of accidents was the manufacturing industry.
Conclusions:
accidents at work have decreased in Brazil, however, the incidence is still high. Advances need to be made in the recording of accidents and in the prevention and surveillance of workers’ health.
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ORIGINAL ARTICLE08-10-2020
Neonatal near miss in the intensive care unit
Revista Brasileira de Enfermagem. 2020;73(6):e20180931
Abstract
ORIGINAL ARTICLENeonatal near miss in the intensive care unit
Revista Brasileira de Enfermagem. 2020;73(6):e20180931
DOI 10.1590/0034-7167-2018-0931
Views0See moreABSTRACT
Objective:
To analyze near miss cases among newborns hospitalized in the Intensive Care Unit.
Methods:
An observational, cross-sectional, retrospective study using the STROBE guideline. Data were collected from 1,101 records of live births (newborns). Statistical analysis used the Epi-Info program 3.3.2 and Chi-square and Fisher’s exact tests.
Results:
A total of 162 newborns were hospitalized, of which 63 had at least one criterion of near miss. The variables that remained associated with neonatal near miss were weight <1.750 g, gestational age <33 weeks and Apgar at 5 minutes <7, pragmatic criteria to identify cases of neonatal near miss morbidity.
Conclusion:
Prematurity and low birth weight were the factors that contributed most to the near miss outcome among newborns hospitalized in intensive care, a rate two and a half times higher than the number of deaths, according to scientific evidence.
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08-10-2020
Care for the critical patient undergoing point-of-care testing: integrative review
Revista Brasileira de Enfermagem. 2020;73(6):e20180948
Abstract
Care for the critical patient undergoing point-of-care testing: integrative review
Revista Brasileira de Enfermagem. 2020;73(6):e20180948
DOI 10.1590/0034-7167-2018-0948
Views0See moreABSTRACT
Objective:
to identify, based on the evidence, point-of-care testing in bedbound in critically ill patients.
Method:
integrative review, carried out through search in Pubmed, Virtual Health Library, Joanna Briggs Institute, The British Institute of Radiology, Brazilian Radiology, and Google Scholar databases. We used the PICO research strategy and selected articles published from 2013 onwards, which presented information about point-of-care testing.
Results:
the different interventions found in the analysis of the 23 selected articles allowed the thematic grouping of care related to safety in communication, patient identification, care with devices, and the prevention and control of infection, which can be used in point-of-care testing.
Final considerations:
The care described in the evidence provided support for validating a safe care protocol for critically ill patients undergoing imaging studies in bed.
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ORIGINAL ARTICLE06-16-2021
Patient participation in care safety: Primary Health Care professionals’ perception
Revista Brasileira de Enfermagem. 2021;74(2):e20200773
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
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.
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REVIEW03-30-2020
Internet influence on the biopsychosocial health of adolescents: an integratitive review
Revista Brasileira de Enfermagem. 2020;73(2):e20180766
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
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.
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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
Revista Brasileira de Enfermagem. 2020;73(4):e20190031
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
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.
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ORIGINAL ARTICLE05-15-2020
Configuration of power relations in physicians and nurses’ professional practices
Revista Brasileira de Enfermagem. 2020;73:e20180629
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
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.
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ORIGINAL ARTICLE02-10-2020
Theater of the Oppressed and bullying: nursing performance in school adolescent health
Revista Brasileira de Enfermagem. 2020;73(1):e20170910
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
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.
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ORIGINAL ARTICLE02-10-2020
Common Mental Disorders and Contemporary Factors: 1982 Birth Cohort
Revista Brasileira de Enfermagem. 2020;73(1):e20180162
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
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.
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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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