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01-01-2016
Epistemology of nursing care: a reflection on its foundations
Revista Brasileira de Enfermagem. 2016;69(6):1240-1245
Abstract
Epistemology of nursing care: a reflection on its foundations
Revista Brasileira de Enfermagem. 2016;69(6):1240-1245
DOI 10.1590/0034-7167-2016-0331
Views0See moreABSTRACT
Objective:
to reflect on nursing care and its epistemology from its historical, theoretical, philosophical, spiritual dimensions and as a social practice.
Method:
discussions originated in the discipline “Epistemology of caring”, from the graduate nursing program of the School of Nursing, Federal University of Minas Gerais, and in critical analysis of nursing literature together with the professional practice of the authors.
Results:
we identified the necessity of developing a critical conscience on health care provision, research, and teaching, as well as on challenges in maintaining high standards of working interpersonal relationships, which has a profound impact on population health.
Conclusion:
we suggest the rescue of integrality, humanization, unity, and spirituality in researches and practices of individual, familiar, and community care, as an advance in incorporating epistemology of caring in nursing.
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01-01-2016
Health needs and nursing care
Revista Brasileira de Enfermagem. 2016;69(6):1236-1239
Abstract
Health needs and nursing care
Revista Brasileira de Enfermagem. 2016;69(6):1236-1239
DOI 10.1590/0034-7167-2016-0128
Views0See moreABSTRACT
Objective:
to present the concept of needs according to different approaches to discuss the possibility of health care that incorporates a broader view of human vulnerabilities in health services.
Methods:
the arguments are founded on nursing theorists who worked on the construction of frameworks relevant to care, based on needs and on philosophers who show the possibility of identifying the vulnerabilities of human beings, defending art as a therapeutic instrument that can promote health care.
Conclusion:
although care can acquire a new dimension with the introduction of art, according to certain perspectives, philosophical studies on ethics and aesthetics should be resumed to identify human vulnerabilities that can in fact be compensated by sensible understanding of the outer world. To incorporate art in nursing care requires studies from theorists to be recovered, deepening concepts and working on empirical investigations for their adequate use.
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01-01-2016
Case studies and role play: learning strategies in nursing
Revista Brasileira de Enfermagem. 2016;69(6):1231-1235
Abstract
Case studies and role play: learning strategies in nursing
Revista Brasileira de Enfermagem. 2016;69(6):1231-1235
DOI 10.1590/0034-7167-2016-0277
Views0See moreABSTRACT
Objective:
to report professors’ experience in a public university of Southern region of Brazil using case studies and role play as learning strategies for nursing care of hospitalized adults.
Method:
learning experience report from the Nursing Care of Adults I class of nursing undergraduate course.
Results
the development of case studies and role play considered health care needs from epidemiological profile of chronic noncommunicable diseases morbidity and mortality, nursing as an assisting method, and social aspects of hospitalized individuals. Role play planning was made by creating a stage in laboratory of practices and dialogues comprising students and professors interaction.
Conclusion
case studies and role play encouraged students to active search for learning and brought theory closer to real health care situations.
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01-01-2016
Politicy of care in the criticism towards gender stereotypes
Revista Brasileira de Enfermagem. 2016;69(6):1223-1230
Abstract
Politicy of care in the criticism towards gender stereotypes
Revista Brasileira de Enfermagem. 2016;69(6):1223-1230
DOI 10.1590/0034-7167-2016-0441
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Objectives:
analyze gender inequalities among Brazilian women in Portugal and in contemporary nursing based on care politicity in the light of gender; disclose oppression of the female produced by the stereotypes that look upon women as natural caregivers; point out politicity to deconstruct gender stereotypes.
Method:
theoretical reflection with narrative review of literature to analyze classic references in the feminist epistemology combined with the care politicity thesis.
Results:
the similarities between the stereotypes of the Brazilian Eves and the Portuguese Maries as either the sexualized or sanctified nurse are inserted in the Jewish-Christian moral genealogy that reaffirms the subservience of the female to the male.
Conclusion:
by attaching priority to care that needs non-care to expand the possibilities of care giving, the theoretical assumption of politicy of care can contribute to subvert the stereotypical images of Brazilian women in Portuguese lands and in contemporary nursing.
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01-01-2016
Strategies for thirst relief: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(6):1215-1222
Abstract
Strategies for thirst relief: integrative literature review
Revista Brasileira de Enfermagem. 2016;69(6):1215-1222
DOI 10.1590/0034-7167-2016-0317
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Objective:
to analyze the strategies used to relieve the thirst of hospitalized patients.
Method:
an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva.
Results:
the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion.
Conclusion:
the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.
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01-01-2016
Care of the self and power relations: female nurses taking care of other women
Revista Brasileira de Enfermagem. 2016;69(6):1204-1214
Abstract
Care of the self and power relations: female nurses taking care of other women
Revista Brasileira de Enfermagem. 2016;69(6):1204-1214
DOI 10.1590/0034-7167-2016-0021
Views0See moreABSTRACT
Objective:
to analyze the care of self of female nurses and the power relations established by them in the care of other women.
Method:
integrative review of literature published between 2005 and 2015. There were 25 publications in the sample.
Results:
qualitative state of the art with reference domain of a liberating perspective, based on humanization, autonomy and empowerment as a risk reduction strategy in the practice of care to women. The findings suggest solidified power relations among female nurses and women, focused on professional domain concentrated on nurse education under the patriarchal and society’s normalization discourse. Some studies consider the importance of understanding power in a capillary way, operating on the bodies of individuals.
Conclusion:
there is little discussion about the care of self of nurses and the effects on their professional practice, indicating gaps in knowledge in this field.
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01-01-2016
Nursing competencies in promoting the health of individuals with chronic diseases
Revista Brasileira de Enfermagem. 2016;69(6):1195-1203
Abstract
Nursing competencies in promoting the health of individuals with chronic diseases
Revista Brasileira de Enfermagem. 2016;69(6):1195-1203
DOI 10.1590/0034-7167-2016-0312
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Objective:
to identify nurse’s competencies related to health promotion of individuals with chronic cardiac disease, in the light of the Galway consensus.
Method:
integrative literature review was conducted to search for studies published between 2010 and 2014 in the databases LILACS, BDENF, IBECS; and PubMed in February 2015. The 21 included studies were analyzed according to the eight domains of competence: Catalyzing change, Leadership, Evaluation, Planning, Implementation, Assessment, Advocacy and Partnerships.
Results:
all domains of competence were included in the nursing interventions in health promotion of chronic cardiac patients, and the Planning and Evaluation were the most evident competences.
Conclusion:
the results of this research highlighted the nurse as an agent capable of operating care management, in order to improve coordination of the latter with work and education and, thus, the health care of the population.
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01-01-2016
Assisted therapy with dogs in pediatric oncology: relatives’ and nurses’ perceptions
Revista Brasileira de Enfermagem. 2016;69(6):1188-1194
Abstract
Assisted therapy with dogs in pediatric oncology: relatives’ and nurses’ perceptions
Revista Brasileira de Enfermagem. 2016;69(6):1188-1194
DOI 10.1590/0034-7167-2016-0243
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Objective:
to understand the perception of nursing staff professionals and legal guardians of children and adolescents with cancer regarding Assisted Therapy with dogs.
Method:
qualitative study based on participant observation conducted with 16 participants in a reference hospital of child cancer. We applied an in-depth interview and interpreted the data according to a content analysis technique.
Results:
the practice is admittedly beneficial to participants despite the fact they do not understand its true objectives and therapeutic applications. Participants only associate it with something distracting and entertaining without realizing the occurrence of a more complex process behind it, which comprises changes besides the emotional ones (more easily perceived).
Conclusion:
the perceptions of participants reinforce recommendations that can be applied in the hospital environment, also showing that the therapy in question can become an effective technology to promote the health of children and adolescents with cancer.
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ORIGINAL ARTICLE12-04-2023
Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
Abstract
ORIGINAL ARTICLEBurnout, ethical climate and work organization in covid-19 intensive care units: mixed method study
Revista Brasileira de Enfermagem. 2023;76:e20220684
DOI 10.1590/0034-7167-2022-0684
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Objectives:
to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units.
Methods:
mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used.
Results:
the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit.
Conclusions:
there was an association between burnout and ethical climate and elements of the work organization.
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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 -
ERRATUM06-14-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(2):e2024n2e06
DOI 10.1590/0034-7167.20247702e06
Views2In the article “Is there scientific relevance to the plot of films and documentaries about eating disorders?”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(1):e20220547, page 7:Where it read:[…]See more -
ORIGINAL ARTICLE07-29-2024
Educational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
Abstract
ORIGINAL ARTICLEEducational technology for multidisciplinary training for managing waiting lists for elective patients
Revista Brasileira de Enfermagem. 2024;77(3):e20230299
DOI 10.1590/0034-7167-2023-0299
Views1See moreABSTRACT
Objectives:
to construct and assess an educational technology for managing patient waiting lists for multidisciplinary training.
Methods:
study supported by Instructional Design – ADDIE model, whose stages of construction of educational technology were developed in the form of a multi-professional training course. Its respective content assessment was carried out by a committee of experts from 2021 to 2022. The analysis occurred based on the proportion of content adequacy with 95% Confidence Interval.
Results:
seventeen products were created as educational technology learning objects: five storyboards; four videos; three comic books; two pedagogical action plans; a mind map; and a YouTube® playlist. Nine experts assessed content adequacy, which reached 0.89.
Conclusions:
this educational technology contributes to the performance of professionals who manage waiting lists by reducing inequalities, alleviating differences, in addition to promoting equity in care and good health for patients in the Brazilian Health System.
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REVIEW11-22-2024
Spirituality and religiosity in children, adolescents and their families in a vulnerable context: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230425
Abstract
REVIEWSpirituality and religiosity in children, adolescents and their families in a vulnerable context: a scoping review
Revista Brasileira de Enfermagem. 2024;77(5):e20230425
DOI 10.1590/0034-7167-2023-0425
Views1See moreABSTRACT
Objective:
to map evidence in the literature on the spirituality and religiosity of children, adolescents and their families in social vulnerability.
Methods:
this is a scoping review based on the JBI methodology, with the search without delimiting the time period, in English, Portuguese and Spanish, in the Virtual Health Library, PubMed, Embase, Cochrane Library, Scopus and Web of Science databases.
Results:
twenty-two studies were identified. The most studied population were adolescents, followed by children and their families. Regarding the setting, the context of vulnerability related to the low socioeconomic level experienced by these populations was highlighted. Furthermore, spirituality and religiosity were considered important for coping, social support, purpose and strength.
Conclusion:
there is an influence of spirituality and religiosity in the lives of children, adolescents and families, being a protective factor and a source of comfort, playing essential tools for living in context.
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ORIGINAL ARTICLE12-13-2024
Stress in nursing workers caring for people with COVID-19
Revista Brasileira de Enfermagem. 2024;77(5):e20230542
Abstract
ORIGINAL ARTICLEStress in nursing workers caring for people with COVID-19
Revista Brasileira de Enfermagem. 2024;77(5):e20230542
DOI 10.1590/0034-7167-2023-0542
Views1See moreABSTRACT
Objectives:
to analyze stress from the perspective of nursing workers caring for people with COVID-19 in a public hospital in the Recôncavo region of Bahia.
Methods:
this is an exploratory qualitative study, conducted through semi-structured interviews. The data were analyzed using word clouds, similarity trees, and content analysis.
Results:
nursing workers were exposed to stress while attending to patients with COVID-19. The reported stressors in the workplace included: work overload, lack of planning, speed in performing tasks, fatigue, lack of participation in decision-making, lack of support from management, technological changes, excessive responsibility without preparation, interpersonal conflicts, and professional undervaluation.
Conclusions:
exposure to these stressors leads to emotional exhaustion and demotivation, which were intensified during the COVID-19 pandemic.
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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
Views2See moreABSTRACT
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.
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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
Views1See 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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08-20-2021
Validation of an educational game about first aid for schoolchildren
Revista Brasileira de Enfermagem. 2021;74(6):e20201107
Abstract
Validation of an educational game about first aid for schoolchildren
Revista Brasileira de Enfermagem. 2021;74(6):e20201107
DOI 10.1590/0034-7167-2020-1107
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Objectives: to validate the content and appearance of an educational game about first aid for schoolchildren with experts in education and health.
Methods: this is a methodological, quantitative and descriptive research, carried out using the Delphi technique, using an online collection instrument, covering 55 items of the game. Content and appearance assessment was performed by 26 judges. The data were analyzed using Content Validity index.
Results: the final prototype is presented in a board format, composed of four buildable pawns and 117 cards between questions, alerts and challenges. Overall Content Validity index of 0.95 and greater than 0.8 was obtained for all items in two Delphi rounds.
Conclusions: the educational game validated by experts is a pedagogical tool for teaching first aid to schoolchildren as an option to traditional educational practices.
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REFLECTION12-21-2020
War against the COVID-19 pandemic: reflection in light of Florence Nightingale’s nursing theory
Revista Brasileira de Enfermagem. 2020;73:e20200371
Abstract
REFLECTIONWar against the COVID-19 pandemic: reflection in light of Florence Nightingale’s nursing theory
Revista Brasileira de Enfermagem. 2020;73:e20200371
DOI 10.1590/0034-7167-2020-0371
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Objective:
To reflect on the relationship and importance of the environmental theory regarding practices for promotion, prevention, and treatment of COVID-19.
Methods:
A theoretical-reflexive study about the COVID-19 pandemic in light of the environmental theory proposed by Florence Nightingale.
Results:
It is observed that the application of the theoretical foundations proposed by the environmental theory is related to the current practices used in the fight against the COVID-19 pandemic.
Final Considerations:
It is believed that the theoretical basis is fundamental for the critical-reflexive training of the nursing professional, for the consolidation of Nursing as a science; therefore, it could provide a foundation in nowadays battle against the pandemic.
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ORIGINAL ARTICLE06-04-2021
Information demands from families of children with Autism Spectrum Disorder
Revista Brasileira de Enfermagem. 2021;74(5):e20200642
Abstract
ORIGINAL ARTICLEInformation demands from families of children with Autism Spectrum Disorder
Revista Brasileira de Enfermagem. 2021;74(5):e20200642
DOI 10.1590/0034-7167-2020-0642
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Objective:
to identify the information demands of families of children with Autism Spectrum Disorder.
Method:
this is a qualitative study conducted through semi-structured and audio-recorded interviews with 55 family members, in the states of Paraná, Ceará, and Macapá, between September 2018 and September 2019. Thematic category analysis and Qualitative Data Analysis Software resources were used for data organization.
Results:
it was identified that families need information regarding the characteristics of Autism Spectrum Disorder (definition, cause, possibility of cure, prognosis and the probability of having another child with Autism Spectrum Disorder); child’s routine and behavior; future rights and expectations.
Final considerations:
information demands are relevant to support professionals, health managers and other services in health care organization to support families of children with autism.
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12-04-2023
Nursing and the Sustainable Development Goals (SDGs): An Essential Commitment
Revista Brasileira de Enfermagem. 2023;76(6):e760601
Abstract
Nursing and the Sustainable Development Goals (SDGs): An Essential Commitment
Revista Brasileira de Enfermagem. 2023;76(6):e760601
DOI 10.1590/0034-7167.2023760601
Views0The Sustainable Development Goals (SDGs) are a global initiative launched by the United Nations (UN) in September 2015 as part of the 2030 Agenda for Sustainable Development, whose objectives summarize a universal call to action to end poverty, protect the environment and ensure that all people have access to opportunities and well-being, all in an […]See more -
ORIGINAL ARTICLE11-16-2020
From despair to hope: copying of relatives of hospitalized children before bad news report
Revista Brasileira de Enfermagem. 2020;73:e20200340
Abstract
ORIGINAL ARTICLEFrom despair to hope: copying of relatives of hospitalized children before bad news report
Revista Brasileira de Enfermagem. 2020;73:e20200340
DOI 10.1590/0034-7167-2020-0340
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Objective:
to understand the experiences of relatives of critically ill children before bad news report.
Method:
a phenomenological study based on Heidegger’s philosophical framework. Data collection was carried out from October 2018 to March 2019, through phenomenological interviews with 15 relatives of children hospitalized in a Pediatric Intensive Care Unit.
Results:
relatives, in their existentiality, experience the facticity thrown into unpredictable situations, regardless of their choices and are faced with feelings of shock, despair and fear before bad news. After emotional impact, especially regarding the possibility of death, relatives reveal hope as a mechanism for coping with the situation.
Final considerations:
solidarity and sensitivity by health professionals, especially nurses, are essential in understanding the existential dimension of relatives who experience such an experience, understanding the several facets of their existence and offering them opportunities to project themselves.
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ORIGINAL ARTICLE12-21-2020
Social identity of transgender persons: concept analysis and proposition of nursing diagnoses
Revista Brasileira de Enfermagem. 2020;73:e20200070
Abstract
ORIGINAL ARTICLESocial identity of transgender persons: concept analysis and proposition of nursing diagnoses
Revista Brasileira de Enfermagem. 2020;73:e20200070
DOI 10.1590/0034-7167-2020-0070
Views0See moreABSTRACT
Objective:
To analyze the concept of social identity of transgender persons and develop nursing diagnoses related to it.
Methods:
A concept analysis according to the Walker and Avant model. A scope review was carried out with a search of eight databases, a portal and two information systems, during June and July 2019. Articles, theses, and dissertations were analyzed in Portuguese, English, and Spanish, with no time frame definition.
Results:
Of the 6.847 productions, 10 were included, and the concept of social identity was described in 4 of them. Critical, prior, and consequential attributes for the social identity of transgender persons were identified, and the analysis of the concept substantiated the proposal of the diagnosis: Willingness to improve the social identity of the transgender person.
Conclusion:
Social identity establishes a relationship with health, and the proposed nursing diagnosis strengthens the sense of belonging of transgender people, enhancing their rights as citizens.
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ORIGINAL ARTICLE06-27-2019
Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy
Revista Brasileira de Enfermagem. 2019;72(3):584-591
Abstract
ORIGINAL ARTICLENursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy
Revista Brasileira de Enfermagem. 2019;72(3):584-591
DOI 10.1590/0034-7167-2018-0323
Views0See moreABSTRACT
Objective:
to identify Nursing diagnoses in patients in home care by cross-mapping terms obtained in the anamnesis and clinical examination, with NANDA-I Taxonomy.
Method:
descriptive exploratory study, transversal type, performed with 131 patients from a home health care program in northern Minas Gerais State. With the aid of an instrument based on the theoretical model of Basic Human Needs, the terms indicators of conditions that required nursing interventions were extracted. The cross-mapping of these terms was also performed with NANDA-I Taxonomy diagnoses.
Results:
378 terms and expressions referring to 49 different diagnoses were identified in 11 of the 13 domains of NANDA-I Taxonomy.
Conclusion:
the profile of identified nursing diagnoses can contribute to care management and organizational processes of nurses who provide care to patients in home care.
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ORIGINAL ARTICLE08-20-2021
Resilience of family caregivers of children and adolescents in treatment of neoplasms and associated factors
Revista Brasileira de Enfermagem. 2021;74(6):e20190388
Abstract
ORIGINAL ARTICLEResilience of family caregivers of children and adolescents in treatment of neoplasms and associated factors
Revista Brasileira de Enfermagem. 2021;74(6):e20190388
DOI 10.1590/0034-7167-2019-0388
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Objectives:
analyze the level of resilience of family caregivers of children and adolescents hospitalized for cancer treatment and associated factors.
Methods:
cross-sectional study, carried out in 2018, with 62 family caregivers in a university hospital in the state of Rio Grande do Sul, Brazil. The instruments CDRisc-10-Br, SRQ20, PSS-14 and WHOQOL-Bref were used to measure resilience, minor psychological disorders, stress, and quality of life, respectively. Inferential statistics were used.
Results:
female caregivers, married, with one child and who practice some predominated religion. They were classified as having a moderate level of resilience (48.4%); with suspicion for minor psychological disorders (45%) and high level of stress (41%). In terms of quality of life, they were satisfied in the Physical, Psychological and Social Relations domains; and dissatisfied in the Environment domain.
Conclusions:
there were direct weak to moderate correlations between the level of resilience and quality of life and inversely with stress and minor psychological disorders.
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