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ORIGINAL ARTICLE
A relação entre gênero, formação educacional e ambiente de aprendizagem com a ansiedade do estudante de enfermagem
Revista Brasileira de Enfermagem. 2024;77(6):e20220615
12-16-2024
Abstract
ORIGINAL ARTICLEA relação entre gênero, formação educacional e ambiente de aprendizagem com a ansiedade do estudante de enfermagem
Revista Brasileira de Enfermagem. 2024;77(6):e20220615
12-16-2024DOI 10.1590/0034-7167-2022-0615
Views0See moreRESUMEN
Objetivos:
identificar las variables asociadas a la práctica clínica relacionadas con la ansiedad de los estudiantes de enfermería.
Métodos:
se utilizó un diseño descriptivo, cuantitativo, correlacional con las recomendaciones STROBE, EQUATOR. La población fue de 233 estudiantes de enfermería con una muestra de 135 personas. Los datos se recopilaron de marzo a abril de 2022 utilizando instrumentos validados.
Resultados:
la prueba de chi-cuadrado y razón de verosimilitud significativa para género, formación académica y entorno de aprendizaje son superiores a 0.05, por lo que no existe una relación significativa entre las variables y la ansiedad de los estudiantes.
Conclusiones:
los estudiantes necesitan prepararse nuevamente antes de ingresar al campo de la práctica. Investigaciones cualitativas también son necesarias.
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ORIGINAL ARTICLE
Software for the care of people with cardiovascular risk: construction and evidence of validity
Revista Brasileira de Enfermagem. 2024;77(6):e20240276
12-16-2024
Abstract
ORIGINAL ARTICLESoftware for the care of people with cardiovascular risk: construction and evidence of validity
Revista Brasileira de Enfermagem. 2024;77(6):e20240276
12-16-2024DOI 10.1590/0034-7167-2024-0276
Views0See moreABSTRACT
Objectives:
to build and validate software for the care of people with cardiovascular risk.
Methods:
a methodological study, applied to software development, anchored in a nursing theory and classification system, in three stages: 1) requirements engineering; 2) software architecture and coding; and 3) testing and content validity by 12 experts in computer science, with a Content Validity Ratio score.
Results:
called e-TEORISC, in software format, for nursing care for people with cardiovascular risk, online and offline, containing a database linked to the Nursing Process stages. Experts considered that the attributes of functional suitability, performance efficiency, reliability, maintainability, usability, safety and portability obtained desirable scores.
Conclusions:
e-TEORISC has evidence of validity to instrumentalize care for people at cardiovascular risk, with potential for technology transfer to the Brazilian Health System.
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ORIGINAL ARTICLE
Sleep quality of patients with heart failure and associated factors
Revista Brasileira de Enfermagem. 2024;77(6):e20240244
12-16-2024
Abstract
ORIGINAL ARTICLESleep quality of patients with heart failure and associated factors
Revista Brasileira de Enfermagem. 2024;77(6):e20240244
12-16-2024DOI 10.1590/0034-7167-2024-0244
Views0See moreABSTRACT
Objectives:
to assess sleep quality of patients with heart failure and associated sociodemographic and clinical characteristics.
Methods:
a cross-sectional study, developed with 88 patients. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. The data were analyzed using descriptive and inferential statistics.
Results:
the mean sleep quality score was 8.59 ± 3.60 points. 83% of participants were classified as poor sleepers. The number of hours of sleep was 5.99 ± 1.48. Family income of up to one minimum wage and functional class were significantly associated with poor sleepers. There was a positive correlation between functional class and poor sleep quality.
Conclusions:
a high frequency of poor sleepers was identified. Worse scores were associated with family income and symptomatic functional class. Health interventions are necessary to control sleep quality, especially in relation to health functionality.
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ORIGINAL ARTICLE
Religion and professional experience: Are they predictors of nurses’ spiritual intelligence? Cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(6):e20240217
12-16-2024
Abstract
ORIGINAL ARTICLEReligion and professional experience: Are they predictors of nurses’ spiritual intelligence? Cross-sectional study
Revista Brasileira de Enfermagem. 2024;77(6):e20240217
12-16-2024DOI 10.1590/0034-7167-2024-0217
Views0See moreABSTRACT
Objectives:
to analyze the relationship between religion and professional experience with spiritual intelligence in nurses
Methods:
cross-sectional and analytical study carried out in 2021, with the participation of 544 nursing professionals working in health facilities in Peru during the COVID-19 pandemic. Multiple regression analysis and Pearson’s correlation were used to analyze the data.
Results:
in nurses, a healthy level of spiritual intelligence predominated (42.8%). Those who did not profess a religion were more likely to have a lower spiritual intelligence score (global scale and dimensions); however, experienced nurses were more likely to have higher spiritual intelligence (global scale and dimensions) than novice nurses (p<0.05).
Conclusions:
spiritual intelligence in nurses was predicted by religion and professional experience. This finding suggests that spiritual intelligence in nursing is consolidated through religious practices and during professional practice.
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ORIGINAL ARTICLE
Effectiveness of the modified Seldinger technique for peripheral central catheter in newborns: a randomized clinical trial
Revista Brasileira de Enfermagem. 2024;77(6):e20240189
12-16-2024
Abstract
ORIGINAL ARTICLEEffectiveness of the modified Seldinger technique for peripheral central catheter in newborns: a randomized clinical trial
Revista Brasileira de Enfermagem. 2024;77(6):e20240189
12-16-2024DOI 10.1590/0034-7167-2024-0189
Views0ABSTRACT
Objectives:
to evaluate the effectiveness of peripheral central catheterization by comparing the modified Seldinger technique and the conventional technique in critically ill newborns.
Methods:
randomized unmasked clinical trial conducted in a public children’s hospital. Participation of 111 newborns with randomized allocation, 56 in the control group (conventional technique) and 55 in the experimental group (modified Seldinger). Success and absence of complications were evaluated as primary outcomes. The pain scale, difficulty in hemostasis, procedure time and number of punctures were considered secondary outcomes.
Results:
there was no statistical significance between groups, either for success (p=0.705) or absence of complications (p=0.347). A lower pain score, improved hemostasis, increased assertiveness with fewer punctures and reduced procedure time were not observed in the experimental group.
Conclusions:
the modified Seldinger technique did not prove to be a more effective insertion technology compared to the conventional method. Brazilian Clinical Trial Registry: RBR-69vks36.
Keywords:Comparative Effectiveness ResearchNewbornPeripheral CatheterizationRandomized Controlled TrialTechnologySee more -
ORIGINAL ARTICLE
Psychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
Revista Brasileira de Enfermagem. 2024;77(6):e20240085
12-16-2024
Abstract
ORIGINAL ARTICLEPsychometric analysis of ProQOL-BR in nursing: building hospital safety and protection
Revista Brasileira de Enfermagem. 2024;77(6):e20240085
12-16-2024DOI 10.1590/0034-7167-2024-0085
Views0ABSTRACT
Objectives:
to analyze the psychometric properties of the ProQOL-BR instrument in hospital nursing professionals.
Methods:
a methodological study to validate the ProQOL-BR. Confirmatory factor analysis, assessment of local and global adjustment quality, Pearson hypothesis testing and Cronbach’s alpha internal consistency analysis were used.
Results:
a total of 490 professionals participated. The model presents adequate quality due to factor weights (λ≥ 0.40), acceptable overall fit quality and adequate chi-square ratio and degrees of freedom (χ2/g.1=2.51) for the parameters of CFI (0.923), GFI (0.902), TLI (0.914) and RMSEA (0.042). In terms of validity, it was shown to be adequate with CC=0.89. The internal consistency obtained by standardized Cronbach’s alpha was 0.761. Criterion validity was shown to be favorable with significant correlations (0.001).
Conclusions:
the instrument was validated regarding content, criteria and reliability. Three questions were removed from the original instrument, ProQOL-BR, leaving the final instrument with 25 questions.
Keywords:BurnoutHealth Status IndicatorsNursing StaffQuality of Professional LifeValidation Studies as TopicSee more -
ORIGINAL ARTICLE
Health literacy development of Primary Health Care patients: qualitative research
Revista Brasileira de Enfermagem. 2024;77(6):e20240154
12-16-2024
Abstract
ORIGINAL ARTICLEHealth literacy development of Primary Health Care patients: qualitative research
Revista Brasileira de Enfermagem. 2024;77(6):e20240154
12-16-2024DOI 10.1590/0034-7167-2024-0154
Views0ABSTRACT
Objectives:
to identify the process of health literacy development among primary care patients, relating it to their self-care practices.
Methods:
qualitative, prospective research with 22 patients from two Family Health Strategy units. Data were obtained through individual semi-structured interviews, examined through descriptive statistics and thematic content analysis.
Results:
the results discuss how participants learn about health and how this resonates in their behaviors, culminating in two thematic categories: “Health knowledge construction”; and “Dialogue between health knowledge construction and patient care actions”.
Final Considerations:
health knowledge is developed mainly through interpersonal relationships, mediated by health professionals through bonding and communication. Community educational actions and training of health professionals in communication can promote health literacy and self-care among patients.
Keywords:Chronic DiseaseHealth LiteracyPrimary Health CareQualitative ResearchWorld Health OrganizationSee more -
ORIGINAL ARTICLE
Religión y experiencia profesional: ¿Serán predictores de la inteligencia espiritual de los enfermeros? Estudio transversal
Revista Brasileira de Enfermagem. 2024;77(6):e20240217
12-16-2024
Abstract
ORIGINAL ARTICLEReligión y experiencia profesional: ¿Serán predictores de la inteligencia espiritual de los enfermeros? Estudio transversal
Revista Brasileira de Enfermagem. 2024;77(6):e20240217
12-16-2024DOI 10.1590/0034-7167-2024-0217es
Views0See moreRESUMEN
Objetivos:
analizar la relación entre religión y experiencia profesional con la inteligencia espiritual en enfermeros.
Métodos:
estudio transversal y analítico realizado en 2021, participaron 544 profesionales de enfermería que laboraban en establecimiento de salud de Perú durante la pandemia por COVID-19. Para el análisis de los datos se emplearon el análisis de regresión múltiple y correlación de Pearson.
Resultados:
en los enfermeros predominó un nivel de inteligencia espiritual saludable (42,8%). Quienes no profesaban una religión tenían mayor probabilidad de tener menor puntaje de inteligencia espiritual (escala global y dimensiones); sin embargo, los enfermeros expertos tuvieron mayor probabilidad de tener mayor inteligencia espiritual (escala global y dimensiones) que los enfermeros novatos (p<0,05).
Conclusiones:
la inteligencia espiritual en los enfermeros fue predicha por la religión y la experiencia profesional. Este hallazgo sugiere que la inteligencia espiritual en enfermería se consolida mediante prácticas religiosas y durante el ejercicio profesional.
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ORIGINAL ARTICLE
Fatores associados ao bem-estar materno em situação de parto de puérperas em Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
12-16-2024
Abstract
ORIGINAL ARTICLEFatores associados ao bem-estar materno em situação de parto de puérperas em Minas Gerais
Revista Brasileira de Enfermagem. 2024;77(6):e20230304
12-16-2024DOI 10.1590/0034-7167-2023-0304pt
Views1RESUMO
Objetivos:
analisar os fatores associados ao bem-estar materno em situação de parto de puérperas em Minas Gerais.
Métodos:
estudo transversal, aninhado a uma coorte, realizado com puérperas em um município mineiro. Foi adotada a escala Bem-Estar Materno em Situação de Parto 2. Estimaram-se as prevalências do bem-estar materno em situação de parto. A magnitude da associação entre mal-estar materno e práticas assistenciais foi estimada pela Razão de Prevalência (RP), utilizando-se a regressão de Poisson.
Resultados:
participaram 183 puérperas com idade entre 15 e 46 anos, sendo que 26,2%, 27,9% e 45,9% relataram, respectivamente, ótimo, adequado e mal-estar na assistência ao parto. O mal-estar materno foi mais prevalente entre puérperas que passaram por parto cesárea (RP = 1,60) e que não receberam informações sobre amamentação (RP = 1,59).
Conclusões:
observou-se elevada prevalência de mal-estar no parto, associada à realização de cesáreas e à falta de informações sobre amamentação.
Keywords:Assistência ao PartoBem-Estar MaternoHumanização da AssistênciaParto ObstétricoPeríodo Pós-PartoSee more -
ORIGINAL ARTICLE
The nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
12-16-2024
Abstract
ORIGINAL ARTICLEThe nursing practice environment and hospital sociotechnical complexity: a mixed-methods study
Revista Brasileira de Enfermagem. 2024;77(6):e20230315
12-16-2024DOI 10.1590/0034-7167-2023-0315
Views1See moreABSTRACT
Objectives:
to analyze the relationship between the nursing practice environment and hospital sociotechnical complexity as perceived by nurses.
Methods:
a sequential explanatory mixed-methods study was conducted in a hospital in southern Brazil. The Brazilian version of the Practice Environment Scale-Nursing Work Index and the Complexity Characterization Questionnaire were administered to 132 nurses. Subsequently, semi-structured interviews were conducted with 18 participants, and the data were subjected to thematic analysis. Data integration was achieved through a connection approach.
Results:
the nursing practice environment was found to be favorable, except in the subscale concerning Staffing and Resource Adequacy, where complexity was present in the activities. The three emerging categories explained human and technical aspects related to complexity in the practice environment, quality of care, and patient safety. Unexpected variability was inversely correlated with the practice environment.
Conclusions:
the study results indicate a relationship between these constructs, with implications for the quality and the safety of care.
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REVIEW
Recommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
12-16-2024
Abstract
REVIEWRecommendations for guidelines for promoting mental health in the workplace: an umbrella review
Revista Brasileira de Enfermagem. 2024;77(6):e20240086
12-16-2024DOI 10.1590/0034-7167-2024-0086
Views1See moreABSTRACT
Objectives:
to summarize the recommendations of guidelines for promoting mental health in the workplace.
Methods:
an umbrella review, according to Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses methodological assumptions. Data collection was carried out in January 2021 and updated in July 2023 in the American Psychological Association, Cochrane Library, EMBASE, National Library of Medicine, and Scopus databases. Systematic reviews that assessed guidelines with recommendations for mental health care for workers were included. PROSPERO registration CRD42023461845.
Results:
four systematic reviews published between 2015 and 2018 were identified. The abstracts highlighted actions that facilitate and inhibit the recommendations as well as three categories of intervention: primary prevention – worker protection; secondary prevention – promoting workers’ mental health; and tertiary prevention – supporting, monitoring and rehabilitating workers upon returning to work.
Conclusions:
the interventions are based on prevention, promotion and early recognition, support and rehabilitation of mental health problems.
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ORIGINAL ARTICLE
Music in the relief of stress and distress in cancer patients
Revista Brasileira de Enfermagem. 2021;74(2):e20190838
05-21-2021
Abstract
ORIGINAL ARTICLEMusic in the relief of stress and distress in cancer patients
Revista Brasileira de Enfermagem. 2021;74(2):e20190838
05-21-2021DOI 10.1590/0034-7167-2019-0838
Views0See moreABSTRACT
Objectives:
to evaluate the effects of music on the physiological stress and distress of cancer patients being treated in a hospital.
Methods:
quasi-experimental study carried out with cancer patients hospitalized in the nursing wards of a public hospital. There was a single 15-minute intervention using music. It was individual, and headphones were used for patients to listen to three songs chosen by each one. The levels of stress and distress were measured before and after the intervention, using music to analyze the cortisol in the saliva and the answers to the distress thermometer. The significance level of the statistical analysis was 5%, using the non-parametric Wilcoxon test.
Results:
the mean age of the 26 patients was 56 years old. Most were female, white, and had breast cancer. After intervention, there were statistically significant diminutions in both stress and distress — p < 0.001.
Conclusions:
the use of music diminishes the stress and the distress of cancer patients.
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ORIGINAL ARTICLE
Costs of healthcare-associated infections in an Intensive Care Unit
Revista Brasileira de Enfermagem. 2021;74(1):e20200275
03-24-2021
Abstract
ORIGINAL ARTICLECosts of healthcare-associated infections in an Intensive Care Unit
Revista Brasileira de Enfermagem. 2021;74(1):e20200275
03-24-2021DOI 10.1590/0034-7167-2020-0275
Views0See moreABSTRACT
Objectives:
to evaluate hospitalization costs of patients with and without Healthcare-Associated Infections an Intensive Care Unit.
Methods:
a retrospective case-control study. Data collection was retrieved from the medical records of Intensive Care Unit of a medium-sized public hospital in Goiás-Brazil. For each case, two controls were selected. Data on socioeconomic, clinical, and hospital costs were collected. To verify associations between variables, Odds Ratio and linear regression were calculated.
Results:
a total of 21 patients diagnosed with Healthcare-Associated Infections and 42 controls were evaluated. The hospitalization cost for patients with infection was four times higher than for non-infection patients (p-value<0.001). There was an association between infection and higher mortality (p-value <0.001), longer hospital-stay (p-value =0.021), and higher hospital costs (p-value =0.007).
Conclusions:
hospitalization costs of diagnosed Healthcare-Associated Infections patients are high compared to those who do not have this diagnosis.
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ORIGINAL ARTICLE
Factors associated with depressive symptoms in older adults in context of social vulnerability
Revista Brasileira de Enfermagem. 2020;73:e20190107
06-01-2020
Abstract
ORIGINAL ARTICLEFactors associated with depressive symptoms in older adults in context of social vulnerability
Revista Brasileira de Enfermagem. 2020;73:e20190107
06-01-2020DOI 10.1590/0034-7167-2019-0107
Views0See moreABSTRACT
Objective:
To identify factors associated with depressive symptoms in the elderly inserted in a context of high social vulnerability.
Methods:
A cross-sectional study was carried out with 302 elderly people enrolled in Primary Care. We used a sociodemographic questionnaire, Geriatric Depression Scale, Mini Nutritional Assessment, Shor-form-6D Quality of Life Questionnaire and Medical Outcome Study Scale. For data analysis, a logistic regression was performed considering two groups, with and without depressive symptoms.
Results:
A good perception of the quality of life (OR: 0.21) and receiving emotional support (OR: 0.98) were presented as protective factors for depression, have risks of malnutrition (OR: 4.87), belong to the female sex OR: 1.88) and living alone (OR: 2.34), indicated a predictor factor for depression.
Conclusion:
Quality of life and social support were identified as protective factors for depressive symptoms while being at risk of malnutrition, living alone, reporting pain and being female are predictors.
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Sociodemographic and health profile of TB/HIV co-infection in Brazil: a systematic review
Revista Brasileira de Enfermagem. 2019;72(5):1389-1396
09-16-2019
Abstract
Sociodemographic and health profile of TB/HIV co-infection in Brazil: a systematic review
Revista Brasileira de Enfermagem. 2019;72(5):1389-1396
09-16-2019DOI 10.1590/0034-7167-2018-0285
Views0ABSTRACT
Objective:
to ascertain the epidemiological profile of TB/HIV co-infection in Brazilian scenarios.
Method:
this is a systematic review conducted via electronic search in databases PubMed, EMBASE, LILACS and SciELO, having as inclusion criterion articles based on the Brazilian scenario of TB/HIV co-infection.
Results:
of the total 174 studies, 15 were selected, revealing the epidemiological profile of the co-infection in different scenarios: male, economically active age, low education level, brown/black ethnicity, low income, heterosexual, pulmonary clinical form, alcoholism and Directly Observed Therapy.
Conclusion:
the sociodemographic and epidemiological profile of people with TB/HIV co-infection has an expected occurrence pattern, which corroborates articles found in the literature, either at national level or by grouping the studies according to region or state.
Keywords:Acquired Immunodeficiency SyndromeCo-infectionCommunity Health NursingPublic HealthTuberculosisSee more -
ORIGINAL ARTICLE
Gerontotechnology for fall prevention of the elderly with Parkinson
Revista Brasileira de Enfermagem. 2019;72:243-250
12-05-2019
Abstract
ORIGINAL ARTICLEGerontotechnology for fall prevention of the elderly with Parkinson
Revista Brasileira de Enfermagem. 2019;72:243-250
12-05-2019DOI 10.1590/0034-7167-2018-0704
Views0See moreABSTRACT
Objective:
to develop the gerontological nursing care process among the elderly with Parkinson’s disease, aiming at the promotion of health through the creation of gerontotechnologies for fall prevention.
Method:
Convergent Care Research was used as a methodological route. Data were collected from February to October 2017, with the participation of nine elderly people with Parkinson’s disease. An educational booklet, a memory game called “não cai istepô”, a memory game called “caiu de maduro” were developed through clinical evaluation through scales, recorded semi-structured interview and workshops.
Results:
the application of gerontotechnology resulted from the elderly in self-care, empowerment and knowledge through play, revealing interest in behavior change, independence and learning, as well as serving as a facilitator of care.
Conclusion:
the gerontotechnologies presented as a playful and innovative instrument for the nursing gerontological care process.
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ORIGINAL ARTICLE
Self-confidence in the care of critically ill patients: before and after a simulated intervention
Revista Brasileira de Enfermagem. 2019;72(6):1618-1623
10-21-2019
Abstract
ORIGINAL ARTICLESelf-confidence in the care of critically ill patients: before and after a simulated intervention
Revista Brasileira de Enfermagem. 2019;72(6):1618-1623
10-21-2019DOI 10.1590/0034-7167-2018-0758
Views0See moreABSTRACT
Objective:
To evaluate the self-confidence of nurses in the care of critically ill patients, before and after a simulated intervention.
Method:
A quasi-experimental study was carried out with 103 nurses who participated in a workshop on the care of critically ill patients in the first semester of 2016. A clinical simulation pedagogical instrument was used throughout the event, and self-confidence was assessed by the Portuguese version of the Self-confidence Scale (SCSvp).
Results:
Most participants reported not being prepared to provide first care to critically ill patients, which was carried out during care practice. The participants presented a significant increase in self-confidence after the simulated intervention (p<0.001) in the cardiac, neurological, and respiratory dimensions.
Conclusion:
Simulation has proved to be an effective strategy for the development of individuals’ self-confidence, which contributes to the improvement of skills required for professional practice.
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ORIGINAL ARTICLE
Effect of first aid training on teams from special education schools
Revista Brasileira de Enfermagem. 2020;73(2):e20180288
02-17-2020
Abstract
ORIGINAL ARTICLEEffect of first aid training on teams from special education schools
Revista Brasileira de Enfermagem. 2020;73(2):e20180288
02-17-2020DOI 10.1590/0034-7167-2018-0288
Views0See moreABSTRACT
Objectives:
Analyze the effect of first aid training on the knowledge of multidisciplinary teams from special education schools, in school accidents.
Methods:
A quasi-experimental, before-and-after study with a single comparison group. Descriptive statistics and McNemar’s test were used to evaluate the effect of the intervention.
Results:
This study had the participation of 162 higher education professionals, predominantly teachers (82.1%), female (97.5%), aged over 40 (69.2%). An increase in correct answers was observed, with statistical significance (≤0.05), especially in proper handling in case of fall with traumatic brain injury, electric shock, and burn due to hot liquid (98.1%, 98.1% and 96.9% of proper response, respectively).
Conclusions:
First aid training for child accidents, through content exhibition, in a dialogical and practical way, proved to be efficient for multidisciplinary teams from special education schools for people with disabilities.
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ORIGINAL ARTICLE
Permanent education and matrix support in primary health care: family health routine
Revista Brasileira de Enfermagem. 2020;73(6):e20190076
08-07-2020
Abstract
ORIGINAL ARTICLEPermanent education and matrix support in primary health care: family health routine
Revista Brasileira de Enfermagem. 2020;73(6):e20190076
08-07-2020DOI 10.1590/0034-7167-2019-0076
Views0See moreABSTRACT
Objective:
To analyze the understanding of the professionals working on the Family Health Support by about permanent education and matrix support in the daily routine of primary health care.
Methods:
Descriptive research with a qualitative approach. Data were collected through semi-structured interviews with the participation of 19 professionals from different backgrounds. The results were organized based on Thematic Content Analysis.
Results:
Thematic categories emerged from the analysis: Permanent Health Education: knowledge and daily activities; Matrix support as a premise of Permanent Health Education; The principle of integrality as the foundation of the supporting teams; Conditions of praxis in the promotion of Permanent Health Education.
Final Considerations:
The study evidenced that professionals experience their routines within the service and that the sharing of knowledge to transform the reality of users and the territory is based on matrix support and integrality. However, they face structural difficulties in carrying out actions.
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