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01-01-2015
Nursing actions in primary care and the control of diseases preventable through vaccines
Revista Brasileira de Enfermagem. 2015;68(5):803-809
Abstract
Nursing actions in primary care and the control of diseases preventable through vaccines
Revista Brasileira de Enfermagem. 2015;68(5):803-809
DOI 10.1590/0034-7167.2015680506i
Views0See moreABSTRACT
Objective:
to discuss the actions performed by nurses in the control and eradication of diseases preventable with vaccines in healthcare setting, according to the National Primary Health Care Policy.
Method:
qualitative research supported by the social phenomenology of Schutz. It had as its setting a Family Health Clinic, located in the city of Rio de Janeiro (Brazil), with ten nurses. The data collection occurred through interviews.
Results:
nurses’ actions aimed at the control and eradication of preventable diseases mainly involve updating a vaccination card, administering the vaccine, and guiding the user of the Health Unit, with the purpose of preventing diseases. The National Primary Care Policy and all manuals from the Ministry of Health recognize the importance of focusing on the service user.
Conclusion:
the user’s lifestyle must be considered, and his access to services aiming at the expansion of the control of diseases preventable with vaccines should be promoted.
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01-01-2015
Children with neuropsychomotor development delay: music therapy promoting quality of life
Revista Brasileira de Enfermagem. 2015;68(5):797-802
Abstract
Children with neuropsychomotor development delay: music therapy promoting quality of life
Revista Brasileira de Enfermagem. 2015;68(5):797-802
DOI 10.1590/0034-7167.2015680505i
Views0See moreABSTRACT
Objective:
to identify the influence of music therapy on the behavior and quality of life of children with neuropsychomotor development delay (NPMDD).
Method:
experimental research, with applications of music therapy (in a group of children) held in the specialized association in Cruz das Almas – Bahia, composed of 17 children with NPMDD aged 5 to 12 years. The behavior of children involving emotional, physical, social and school aspects was observed.
Results:
there was an evolution in all aspects, being this improvement significant to Emotional Capacity and School Capacity domains, showing the beneficial effects of music therapy.
Conclusion:
music therapy becomes a treatment option for children with NPMDD, improving their quality of life.
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01-01-2015
Spirituality, religion and personal beliefs of adolescents with cancer
Revista Brasileira de Enfermagem. 2015;68(5):791-796
Abstract
Spirituality, religion and personal beliefs of adolescents with cancer
Revista Brasileira de Enfermagem. 2015;68(5):791-796
DOI 10.1590/0034-7167.2015680504i
Views0See moreABSTRACT
Objective:
to examine adolescents’ perception about spirituality, religion and personal beliefs in their lives due to cancer and a possible strategy for coping with the disease.
Method:
qualitative research, both descriptive and exploratory. The data were collected by means of a personal semi-structured interview, and the categories were analyzed by content analyzes.
Results:
nine adolescents who were undergoing cancer treatment at one of the two institutions located Uberaba, Brazil, participated in the study. Based on the analysis and interpretation of results, it was possible to systematize them according to four categories: spiritual history of the individual; faith and belief; importance of spirituality in their lives, and the community acting as a spiritual supporter. Most adolescents referred to spirituality as being an important tool for dealing with the disease, especially concerning religious rituals and community support.
Conclusion:
spirituality creates hope for adolescents, which helps them to cope with cancer-related diffi culties and contribute to the search for the meaning of life.
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01-01-2015
Coping strategies of nursing students for dealing with university stress
Revista Brasileira de Enfermagem. 2015;68(5):783-790
Abstract
Coping strategies of nursing students for dealing with university stress
Revista Brasileira de Enfermagem. 2015;68(5):783-790
DOI 10.1590/0034-7167.2015680503i
Views0See moreABSTRACT
Objective:
to identify the coping strategies used by nursing students in a university in southern Brazil, establishing the relationship between the sociodemographic and academic variables examined.
Method:
an exploratory, descriptive, quantitative study, carried out with 146 nursing students, through application of the Coping Strategies Inventory. For the data analysis, descriptive statistics, analysis of variance and regression analysis were used.
Results:
it was found that the coping strategy most used by nursing students is escape. A connection was also detected between the academic dissatisfaction variable and the use of negative coping strategies.
Conclusion:
it was noted that students satisfi ed with the course used positive coping strategies targeting the problem, whereas dissatisfi ed students used negative strategies focusing on the emotion.
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01-01-2015
Unemployment and psychological distress in nurses
Revista Brasileira de Enfermagem. 2015;68(5):775-782
Abstract
Unemployment and psychological distress in nurses
Revista Brasileira de Enfermagem. 2015;68(5):775-782
DOI 10.1590/0034-7167.2015680502i
Views0See moreABSTRACT
Objective:
to assess psychological distress in nurses searching for their first job, especially symptoms of depression, and identify the factors that caused mental suffering, and how these nurses cope with the situation.
Method:
this was a qualitative study carried out with unemployed nurses who had graduated less than two years before the time of the study, and were residents of the town of Assis in the Brazilian state of São Paulo. Data were gathered by means of semi-structured interviews, content analysis, and application of the Beck Depression Inventory psychometric scale.
Results:
of the 14 nurses that participated, three had scores on the psychometric scale indicative of depression. Participants reported psychological distress related to unemployment, poor university education, and surplus labor due to the large number of graduates and lack of jobs, as well as a culture of employment centered on professionals’ social networks. The unemployed nurses did not have effective ways of coping.
Conclusion:
unemployment promoted psychological distress among the new nurses, especially symptoms of depression, without effective means of coping.
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01-01-2015
Teste de triagem neonatal: expandir ou não expandir?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
Abstract
Teste de triagem neonatal: expandir ou não expandir?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
DOI 10.1590/0034-7167.2015680501i
Views0“A principal restrição sobre o que podemos detectar no teste de triagem neonatal está rapidamente se tornando o que escolhemos detectar em vez daquilo que nos é limitado por razão de viabilidade técnica ou custo”().Os avanços tecnológicos estão conferindo ao mundo médico uma oportunidade de aumentar o número de patologias para as quais os recém-nascidos […]See more -
01-01-2015
Newborn blood spot screening: to expand or not to expand?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
Abstract
Newborn blood spot screening: to expand or not to expand?
Revista Brasileira de Enfermagem. 2015;68(5):771-772
DOI 10.1590/0034-7167.2015680501i
Views0“The principal constraint on what we can detect in newborn screening is fast becoming what we choose to detect: rather than what is limited for us by technical feasibility or cost”().Technological advances are providing the medical world an opportunity to extend the number of conditions newborn babies are screened for. Tandem mass spectrometry (TMS, also […]See more -
01-01-2015
International Classification for Nursing Practice – ICNP®: application to the Brazilian reality
Revista Brasileira de Enfermagem. 2015;68(4):730-731
Abstract
International Classification for Nursing Practice – ICNP®: application to the Brazilian reality
Revista Brasileira de Enfermagem. 2015;68(4):730-731
DOI 10.1590/0034-7167.2015680422i
Views0The author and organizer, Telma Ribeiro Garcia, added her theoretical and practical knowledge to those of a dozen other authors for the creation of the book “International Classification for Nursing Practice – ICNP®: application to the Brazilian reality”. She is a retired professor of the Department of Public Health Nursing and Psychiatry at the Federal […]See more
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ORIGINAL ARTICLE08-08-2022
Social and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil
Revista Brasileira de Enfermagem. 2022;75(6):e20210482
Abstract
ORIGINAL ARTICLESocial and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil
Revista Brasileira de Enfermagem. 2022;75(6):e20210482
DOI 10.1590/0034-7167-2021-0482
Views0See moreABSTRACT
Objective:
To analyze the mortality rate of COVID-19 among children and adolescents aged 0 to 14 years.
Methods:
Ecological and exploratory study of children’s mortality rate by COVID-19 in Brazil, from February to October 2020. The study used the Severe Acute Respiratory Syndrome database to collect the data and made the analysis using descriptive spatial statistics by age and race/color classification.
Result:
The mortality rate due to COVID-19 represented 1.34 deaths per one hundred thousand in the total group evaluated. The age group with the highest frequency and mortality rate was 1 to 4 years of age. There is a higher frequency of deaths in the brown and Indigenous population.
Conclusion:
The distribution of deaths due to COVID-19 is unequal in the national territory, and there is a wide variation in the mortality rate by age and race/color groups.
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ORIGINAL ARTICLE12-08-2023
Construction and validity of educational technology about the human papillomavirus vaccine for adolescents
Revista Brasileira de Enfermagem. 2023;76:e20230048
Abstract
ORIGINAL ARTICLEConstruction and validity of educational technology about the human papillomavirus vaccine for adolescents
Revista Brasileira de Enfermagem. 2023;76:e20230048
DOI 10.1590/0034-7167-2023-0048
Views1See moreABSTRACT
Objectives:
to construct and validate an educational technology in comic book format about the human papillomavirus vaccine aimed at adolescents.
Methods:
a methodological study, with a quantitative approach, through the agreement method. It was carried out in two phases: educational technology construction and content validity. Participants are expert judges in the health field. Data collection took place in a virtual environment, through a questionnaire. Data analysis was performed by calculating the Content Validity Index. A Content Validity Index of at least 80% was accepted.
Results:
the comic book’s overall Content Validity Index was 82%, reaching the minimum limit established to be validated.
Conclusions:
comics are fundamental in the teaching-learning process, aiming to catch adolescents’ attention. Therefore, it is characterized as a valid tool to inform, in a playful manner, about the human papillomavirus vaccine.
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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 -
ORIGINAL ARTICLE01-10-2024
Nursing care management strategies to address the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230254
Abstract
ORIGINAL ARTICLENursing care management strategies to address the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230254
DOI 10.1590/0034-7167-20230254
Views1See moreABSTRACT
Objective:
To characterize nursing care management strategies for addressing the COVID-19 pandemic.
Method:
A descriptive, qualitative study conducted with 22 nurse professionals at a University Hospital in Southern Brazil. Data collection through interviews in June and August 2021, analyzed according to Bardin’s Content Analysis and the theoretical framework of complex thinking.
Results:
The identified strategies were organized into four categories: Reorganization of health services; People management and emergency admission; Multiprofessional articulation; and Bedside nursing care.
Final Considerations:
Professional performance revealed a complex interplay between leadership and care management practices, even in the face of working condition restrictions, and were understood as crucial in the pandemic scenario.
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REVIEW01-10-2024
Prevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
Abstract
REVIEWPrevalence and exposure variables of latent infection by mycobacterium tuberculosis in healthcare workers
Revista Brasileira de Enfermagem. 2024;77:e20240052
DOI 10.1590/0034-7167-2024-0052
Views1See moreABSTRACT
Objectives:
To identify in the scientific literature the prevalence, diagnostic methods, and exposure variables of latent infection by Mycobacterium tuberculosis in healthcare workers.
Methods:
An integrative review of the scientific literature based on the following review question: What are the available scientific evidence in the literature that address the prevalence of latent infection by Mycobacterium tuberculosis in healthcare workers and its association with possible risk factors among these workers?
Results:
Being a physician or nurse, being older, and being male were generally associated with higher prevalences. The study also showed that interferon-gamma release assays were more commonly used as a diagnostic method compared to skin tests.
Conclusions:
More studies are needed regarding the epidemiology of latent infection by Mycobacterium tuberculosis in the context of healthcare workers, aiming for higher impact actions that contribute to the reduction of tuberculosis worldwide.
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01-01-2016
Nursing care in Specialized HIV/Aids Outpatient Services
Revista Brasileira de Enfermagem. 2016;69(3):515-521
Abstract
Nursing care in Specialized HIV/Aids Outpatient Services
Revista Brasileira de Enfermagem. 2016;69(3):515-521
DOI 10.1590/0034-7167.2016690314i
Views1See moreABSTRACT
Objective:
to analyze the discourses about the care provided by nurses operating in Specialized HIV/Aids Outpatient Services in four public institutions of the city of Fortaleza, Ceará, Brazil.
Method:
descriptive and exploratory study with a qualitative approach, which used as a method the discourse analysis.
Results:
when titling the “care as negative”, such title came from the analogy proposed by Freud (1912) with the photographic negative, represented by what that care can configure from the unconscious movement, since nurses did not perceive themselves in the care actions developed by supporting the work of other occupational categories, contributing to maintain the ideology of biomedicine.
Conclusion:
it is necessary to justify and theorize a nursing clinical practice from epistemological issues of the profession, in such a way that nurses can understand their relevance within the care provided.
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ORIGINAL ARTICLE04-16-2021
Practices used by a home care team: implications for caregivers
Revista Brasileira de Enfermagem. 2021;74(2):e20190794
Abstract
ORIGINAL ARTICLEPractices used by a home care team: implications for caregivers
Revista Brasileira de Enfermagem. 2021;74(2):e20190794
DOI 10.1590/0034-7167-2019-0794
Views0See moreABSTRACT
Objectives:
to analyze the practices of a home care team and their implications for caregivers’ performance.
Methods:
qualitative study with data obtained from observation of 21 users, 30 caregivers and 6 professionals from the home health care service in a municipality in Minas Gerais, from February to June 2018. The material was analyzed from the perspective of discourse analysis according to Michel Foucault.
Results:
team interference upon caregivers is exercised by disciplinary practices and prescriptive, authoritative and surveilling behaviors. The team’s knowledge-power relationship determines caregivers’ acceptance through convincing or through difficulty of understanding assigned orientations. Educational practices would enable caregivers to be constituted as active, participative, empowered and reflective subjects.
Final Considerations:
team practices interfere with caregivers’ ways of acting and being and they have implications in objectification and subjectification processes.
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08-16-2021
Pregnant women’s contribution in the construction and evaluation of an educational technology: the “Comics for Pregnant Women”
Revista Brasileira de Enfermagem. 2021;74:e20201243
Abstract
Pregnant women’s contribution in the construction and evaluation of an educational technology: the “Comics for Pregnant Women”
Revista Brasileira de Enfermagem. 2021;74:e20201243
DOI 10.1590/0034-7167-2020-1243
Views1See moreABSTRACT
Objectives:
to describe the contribution of pregnant women to the construction and evaluation of educational technology.
Methods:
a participatory study developed in three stages, which occurred between March 2018 and June 2019 for identifying the content, construction, and evaluation of the comic. Non-directive interviews were conducted in educational groups with 34 pregnant women. After the comic was built by a team, including a designer, an instrument was applied to 41 pregnant women to evaluate the items Objectives, Organization, Writing style, Appearance, and Motivation.
Results:
the comic contains 40 pages of contents, illustrations, and quizzes (word search, cross-puzzle, seven mistakes, etc). The pregnant women evaluated it as easy to understand, self-explanatory, aesthetically attractive, and capable of motivating good care practices during pregnancy, obtaining a minimum agreement of 92.1%.
Final Considerations:
the innovation of the educational technology consisted of incorporating the voices of pregnant women in prenatal care, with the potential to stimulate reflections and the learning process of this target audience.
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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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