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REVIEW03-15-2024
Nursing care for parents who have experienced fetal demise: integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20220811
Abstract
REVIEWNursing care for parents who have experienced fetal demise: integrative review
Revista Brasileira de Enfermagem. 2024;77(1):e20220811
DOI 10.1590/0034-7167-2022-0811
Views0See moreABSTRACT
Objectives:
to identify scientific evidence regarding nursing care for parents who have experienced grief following fetal demise.
Methods:
an integrative review of original studies was conducted across six databases. The studies were classified according to the level of evidence.
Results:
the qualitative analysis of the nine studies comprising the sample involved thematic categories, exploring the impact of perinatal loss on families, inadequate communication by healthcare professionals, and the importance of a holistic approach in care. The role of the nurse is highlighted in making a positive contribution to the team, emphasizing participation in training and the provision of essential information.
Final Considerations:
grieving affects not only family dynamics but also the social environment, emphasizing the urgency of a more empathetic and comprehensive approach. Care should be holistic, going beyond technical nursing assistance, and addressing the biopsychosocial context of the parents.
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ORIGINAL ARTICLE03-15-2024
Is there scientific relevance to the plot of films and documentaries about eating disorders?
Revista Brasileira de Enfermagem. 2024;77(1):e20220547
Abstract
ORIGINAL ARTICLEIs there scientific relevance to the plot of films and documentaries about eating disorders?
Revista Brasileira de Enfermagem. 2024;77(1):e20220547
DOI 10.1590/0034-7167-2022-0547
Views1See moreABSTRACT
Objectives:
to analyze films and documentaries about eating disorders from the last twenty years, identifying the way they approach the topic as well as their relevance for didactic use in teaching the health field.
Methods:
a descriptive study, whose data collection was carried out on the main streaming and video platforms, resulting in the survey of 60 media. Of these, only 25 had audio/subtitles in Portuguese (inclusion criteria). scientific relevance was analyzed considering psychopathological and epidemiological aspects of these disorders. A questionnaire about the plot, characters and descriptive data analysis were used.
Results:
most media were dramas about female teenagers who tried to conform to beauty stereotypes, whose symptoms portrayed converged with current medical diagnostic manuals.
Conclusions:
in practical terms, a classificatory list of 11 media was prepared that could be used as a teaching resource for teaching this topic in the health field.
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ORIGINAL ARTICLE03-11-2024
Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
Abstract
ORIGINAL ARTICLEEthnically distinct populations and coping with violence against children in the COVID-19 pandemic
Revista Brasileira de Enfermagem. 2024;77:e20230350
DOI 10.1590/0034-7167-2023-0350
Views0See moreABSTRACT
Objective:
To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic.
Method:
A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software.
Results:
Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children.
Final considerations:
The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.
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ORIGINAL ARTICLE03-11-2024
Experiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
Abstract
ORIGINAL ARTICLEExperiences of women with physical disabilities in labor and delivery assistance
Revista Brasileira de Enfermagem. 2024;77:e20230290
DOI 10.1590/0034-7167-2023-0290
Views0ABSTRACT
Objective:
To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery.
Methods:
Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool.
Results:
Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery.
Final Considerations:
Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.
Keywords:Disabled PersonsHealth PersonnelLabor, ObstetricParturitionStress Disorders, Post-TraumaticSee more -
ORIGINAL ARTICLE03-11-2024
Use of an application on the measles vaccine for Warao indigenous refugees in Brazil
Revista Brasileira de Enfermagem. 2024;77:e20230253
Abstract
ORIGINAL ARTICLEUse of an application on the measles vaccine for Warao indigenous refugees in Brazil
Revista Brasileira de Enfermagem. 2024;77:e20230253
DOI 10.1590/0034-7167-2023-0253
Views0See moreABSTRACT
Objective:
To evaluate the need to develop an application with information about the measles vaccine for Warao indigenous people.
Methods:
This was a quantitative study conducted at the Espaço de Acolhimento Tapanã refugee shelter in the city of Belém, Pará, Brazil. The study sample was selected for convenience. Data were analyzed descriptively using Bioestat 5.0 software.
Results:
Twenty-one Warao indigenous individuals were interviewed. It was identified that 91% (n=20) had lost their vaccination card; 91% (n=20) stated they had lost their vaccination card more than three times, and 91% expressed interest in an application to store their vaccination information.
Conclusions:
The research provided important information for the development of a health application named WaraoMedI (Warao Measles Diversity Indigenous), as well as offered nursing professionals evidence about the challenges Warao indigenous refugees face in self-managing their vaccination information.
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REVIEW03-11-2024
Continuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
Abstract
REVIEWContinuing nursing education actions in the face of homophobia: an integrative review
Revista Brasileira de Enfermagem. 2024;77:e20230094
DOI 10.1590/0034-7167-2023-0094
Views0ABSTRACT
Objectives:
to analyze continuing nursing education actions in the scientific literature in the face of homophobia.
Methods:
an integrative literature review with structured search in June 2022 in eight databases, using the descriptors Nursing Education, Homophobia, Sexual and Gender Minorities. Final sample consisted of six primary studies.
Results:
continuing nursing education actions are supported by strategies such as use of teaching materials, lectures, case studies and focus groups, addressing content such as gender identity issues and affective-sexual orientation, health disparities and their relationship with homophobia in healthcare settings.
Final considerations:
carried out in various healthcare settings, continuing education actions proved to be successful in raising nurses’ awareness in facing homophobia in health services, however, their expansion is necessary to create health spaces that meet the specific needs of these people.
Keywords:Continuing EducationHomophobiaNursingSexual and Gender MinoritiesTraining of Human Resources in HealthSee more -
EDITORIAL03-11-2024
O uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
EDITORIALO uso da ultrassonografia point-of-care na prática clínica do enfermeiro como alicerce para a segurança do paciente
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201pt
Views0Recentemente, mais um caso de dano grave associado ao cuidado em saúde foi reportado pela mídia. Uma jovem grávida teve a mão e o punho amputados depois de dar à luz ao terceiro filho em um hospital do Rio de Janeiro(). Após o incidente ocasionado pelo acesso vascular, a mulher apresentou hemorragia e foi reinternada.Os […]See more -
EDITORIAL03-11-2024
The use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
Abstract
EDITORIALThe use of point-of-care ultrasound in nurses’ clinical practice as a foundation for patient safety
Revista Brasileira de Enfermagem. 2024;77:e77suppl0201
DOI 10.1590/0034-7167.202477suppl0201
Views0Recently, another case of serious harm associated with healthcare was reported by the media. A young pregnant woman had her hand and wrist amputated after giving birth to her third child in a hospital in Rio de Janeiro(). After the incident caused by vascular access, the woman suffered hemorrhage and was readmitted.The harm caused to […]See more
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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views0In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1:Where it read:[…]See more -
ERRATUM01-13-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
DOI 10.1590/0034-7167.20247706e06pt
Views0No artigo “Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2024;77(4):e20240126, página 5:Onde se lia:[…]See more -
ORIGINAL ARTICLE01-13-2024
Indicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
Abstract
ORIGINAL ARTICLEIndicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
DOI 10.1590/0034-7167-2024-0204
Views0See moreABSTRACT
Objectives:
to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission.
Methods:
a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher’s exact test, Pearson’s Chi-square, and logistic regression were used.
Results:
the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007).
Conclusions:
three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views0ABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
Keywords:Blood CultureBlood Specimen CollectionHealth Knowledge, Attitudes, PracticeNursing CareQuality of Health CareSee more -
ORIGINAL ARTICLE01-13-2024
Evaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
Abstract
ORIGINAL ARTICLEEvaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
DOI 10.1590/0034-7167-2023-0190
Views0ABSTRACT
Objectives:
to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care.
Methods:
methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory.
Results:
the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit.
Conclusions:
the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.
Keywords:Acquired Immunodeficiency SyndromeComprehensive Health CareHIVPrimary Health CareProgram EvaluationSee more -
ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views0See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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Mudança de pressão do balonete traqueal antes e depois da realização dos cuidados de enfermagem
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
Abstract
Mudança de pressão do balonete traqueal antes e depois da realização dos cuidados de enfermagem
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
DOI 10.1590/0034-7167-2016-0486
Views0See moreRESUMEN
Objetivo:
verificar los câmbios de presión del manguito traqueal antes y después de la higiene oral, elevación de la cabecera del lecho a 0º, 30º y 60º, cambio de decúbito, aspiración traqueal y baño en el lecho.
Método:
La población fue compuesta por 88 pacientes, totalizando 3696 verificaciones de julio a septiembre de 2014.
Resultados:
Los valores de presión fueron analisados em siete procedimentos de atención de enfermeira realizados em la parte de la mañana. Seis apresentaron alteraciones significativas antes y después de la realización de los procedimentos de enfermería. En el periodo de la tarde, cinco de los procedimentos de atención de enfermería realizados apresentaron alteraciones, y por la noche, sólo dos.
Conclusión:
Hubo diferencias antes y después de la realización de la atención de enfermería, demostrando alteración de la presión del manguito. El baño em el lecho y la elevación de la cabecera del lecho a 30º presentó valores de presíonmásalterados em los tres turnos de trabajo, preferentemente después del baño.
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RESEARCH01-01-2017
Tracheal cuff pressure change before and after the performance of nursing care
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
Abstract
RESEARCHTracheal cuff pressure change before and after the performance of nursing care
Revista Brasileira de Enfermagem. 2017;70(6):1145-1150
DOI 10.1590/0034-7167-2016-0486
Views0See moreABSTRACT
Objective:
Verify the changes of endotracheal cuff pressure before and after oral hygiene, head-of-bed elevation at 0º, 30º, and 60º, change in body position, aspiration of the endotracheal tube, and in-bed bathing.
Method:
The study sample was composed of 88 patients. We performed 3,696 checks from July to September 2014.
Results:
Pressure values were analyzed in seven nursing care in the morning. Six of them were significantly altered before and after nursing procedure. In the afternoon, five of the health care provided were altered, and in the evening, only two. Most of pressure values were below recommended.
Conclusion:
There were differences before and after health care provided, showing changes in cuff pressure. In-bed bathing and head-of-bed elevation at 30º were the ones that most altered pressure values in the three working shifts. Therefore, it is necessary to measure cuff pressure at least twice per working shift, preferably after bathing.
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RESEARCH01-01-2017
Technical nursing students interacting with family members of hospitalized children
Revista Brasileira de Enfermagem. 2017;70(6):1137-1144
Abstract
RESEARCHTechnical nursing students interacting with family members of hospitalized children
Revista Brasileira de Enfermagem. 2017;70(6):1137-1144
DOI 10.1590/0034-7167-2016-0374
Views0See moreABSTRACT
Objective:
To understand technical nursing students’ meaning of interacting with family members of hospitalized children.
Method:
Symbolic Interactionism was used as the theoretical framework and Qualitative Content Analysis was the methodological procedure. A total of eight graduates from an institution situated in the city of Osasco, Sao Paulo state, participated in this study. Data were collected through semi-structured interviews.
Results:
A total of five representative themes were revealed: Dealing with difficult situations with family members; Perceiving oneself to be unprepared to interact with family members; Family members being a helpful tool; Developing strategies to obtain a good interaction with family members; and Teachers being facilitators of the interaction with family members.
Final considerations:
To be acquainted with this experience has led to the understanding of the need to include the theme of family care in the curriculum of the Technical Nursing Course. Additionally, the present study contributed to reflections on the importance of such knowledge for this population and to the development of future studies, as this theme has been scarcely explored in the literature.
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RESEARCH01-01-2017
Family interview guide: strategy to develop skills in novice nurses
Revista Brasileira de Enfermagem. 2017;70(6):1129-1136
Abstract
RESEARCHFamily interview guide: strategy to develop skills in novice nurses
Revista Brasileira de Enfermagem. 2017;70(6):1129-1136
DOI 10.1590/0034-7167-2016-0072
Views0See moreABSTRACT
Objective:
describe the skills of nurses to conduct family interviews based on the Family Care Guide for Nursing Clinical Practice.
Method:
exploratory case study that analyzed the content of 16 guides applied to a child emergency service by a novice nurse from the family nursing area.
Results:
the records indicated the presence of perceptual, conceptual, and executive skills required to conduct family interviews, in particular skills for the development of genograms, therapeutic relationships, and actions to fulfill family needs.
Final considerations:
the Family Care Guide for Nursing Clinical Practice is a useful tool to guide the training processes, promote the development of family interview skills in novice nurses, and allow the cognitive consolidation of essential elements of patient- and family-centered care.
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RESEARCH01-01-2017
Actions of nurses in early detection of breast cancer
Revista Brasileira de Enfermagem. 2017;70(6):1119-1128
Abstract
RESEARCHActions of nurses in early detection of breast cancer
Revista Brasileira de Enfermagem. 2017;70(6):1119-1128
DOI 10.1590/0034-7167-2016-0155
Views0ABSTRACT
Objective:
Identify the actions for early detection of breast cancer performed by nurses from basic health units; compare the compliance of these actions with the recommendations from the Ministry of Health; analyze the availability of documents to check these recommendations and analyze the association of variables “training,” “lato sensu training,” and “years of activity” of these professionals with the actions performed.
Method:
A cross-sectional study conducted with 133 nurses from 38 basic health units in the Southeast region of the municipality of São Paulo, interviewed with a validated questionnaire.
Result:
Most nurses reported actions to detect this neoplasm. Guidance on the first mammogram age was significantly associated with training, years of activity and availability of Basic Attention Book nº 13.
Conclusion:
This study observed a positive influence of training and years of activity on the actions for early detection of breast cancer and the need for adjustments in national guidelines.
Keywords:Breast NeoplasmsNursing Professional RoleOncology NursingPrimary HealthcareScreening programsSee more -
EDITORIAL01-01-2017
In memoriam – Irmã Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
Abstract
EDITORIALIn memoriam – Irmã Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
DOI 10.1590/0034-7167.2017700601
Views0Maria Notarnicola, descendente de italianos, nasceu em São Paulo, onde realizou seus estudos primários e secundários. Ingressou na Companhia das Filhas da Caridade de São Vicente de Paulo em 1937, quando estava com quase 17 anos de idade, com o nome de Irmã Maria Tereza. Trabalhou por cinco anos na Creche Catarina Labouré, em São […]See more -
EDITORIAL01-01-2017
In memoriam – Sister Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
Abstract
EDITORIALIn memoriam – Sister Maria Tereza Notarnicola
Revista Brasileira de Enfermagem. 2017;70(6):1117-1118
DOI 10.1590/0034-7167.2017700601
Views0Maria Notarnicola, of Italian descent, was born in São Paulo, where she held her primary and secondary studies. She joined the Company of the Daughters of Charity of Saint Vincent de Paul in 1937, when she was almost 17 years old, with the name of Sister Maria Tereza. She worked for five years in Catarina […]See more -
REFLECTION01-01-2017
The essence of care in health vulnerability: a Heideggerian construction
Revista Brasileira de Enfermagem. 2017;70(5):1112-1116
Abstract
REFLECTIONThe essence of care in health vulnerability: a Heideggerian construction
Revista Brasileira de Enfermagem. 2017;70(5):1112-1116
DOI 10.1590/0034-7167-2016-0570
Views0See moreABSTRACT
Objective:
Reflect on the essence of care in health vulnerability from the phenomenological perspective of Martin Heidegger.
Method:
Theoretical-reflexive study, anchored in three essential parts: 1) Care in Heidegger; 2) The essence of care in health vulnerability; And 3) Nursing care actions on health vulnerability.
Results:
Vulnerability must be recognized as an indelible trait of the human condition and has its constituents in the human being, co-presence and care. Caring is an interactive process that reveals itself in the relationship with the other. Respecting the integrity of the Being in vulnerability must be a priority in nursing care, through behaviors that privilege the Being.
Conclusion:
Understanding ontological care and its relation to vulnerability under Heidegger’s phenomenological view allowed us to uncover the facets of care in health vulnerability by adding to the nursing knowledge body a comprehensive and reflective perspective.
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