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Objetivo. Comprender las vivencias de un grupo de profesionales de enfermería tuvo sobre la calidad de la atención en salud en la unidad de cuidados intensivos de adultos (UCI) durante la pandemia por la COVID-19, entre los años 2020 y 2021. Metodología. Estudio cualitativo desarrollado en la UCI de una institución prestadora de salud (IPS) de alta complejidad en la ciudad Medellín (Colombia). Se realizaron entrevistas en profundidad a 9 profesionales de enfermería. El análisis se realizó en paralelo con la recolección de la información a lo largo de toda la investigación usando herramientas analíticas de teoría fundamenta con el apoyo del software de investigación de datos cualitativos Atlas.ti. Resultados. Las vivencias de los profesionales de enfermería de este estudio se enmarcaron en las condiciones laborales difíciles, encuentro con la muerte, sobrecarga laboral, disminución de la calidad del cuidado, aumento de los eventos adversos, y tensiones entre emociones positivas y negativas. Conclusión. La pandemia fue un suceso emocional complejo, con tensiones entre valores y emociones, esto suscitado por condiciones laborales precarias, la creciente morbimortalidad, la sensación de que en ocasiones el esfuerzo no era reconocido, la angustia moral al sentir que no se podía actuar conforme a los propios principios y a la imperiosa decisión de tener que elegir qué pacientes salvar y cuidar, lo cual impactó negativamente en la calidad del cuidado. ABSTRACT Objective. To understand the experiences of a group of nursing professionals regarding the quality of health care in the intensive care unit (ICU) during the COVID-19 pandemic, between 2020 and 2021. Methodology. Qualitative study developed in the adult ICU of a high complexity health care institution (IPS) in the city of Medellin (Colombia). In-depth interviews were conducted with 9 nursing professionals. The analysis was carried out in parallel with the collection of information throughout the research using grounded theory analytical tools with the support of Atlas.ti qualitative data research software. Results. The experiences and meanings of the nursing professionals in this study were framed by difficult working conditions, encounter with death, work overload, decrease in the quality of care, increase in adverse events, and tensions between positive and negative emotions. Conclusion. The pandemic was a complex emotional event, with tensions between values and emotions, caused by precarious working conditions, increasing morbimortality, the feeling that sometimes the effort was not recognized, the moral anguish of feeling that one could not act according to one's own principles and the imperious decision of having to choose which patients to save and care for, which had a negative impact on the quality of care.

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Objetivo: Identificar la evidencia científica sobre los Sistemas alternativos y aumentativos de la comunicación en las Unidades críticas. Método: Revisión bibliográfica de artículos originales realizada en los meses de abril-setiembre del 2023 en las bases de datos de Medline (Pubmed), Cochrane Library, Scopus, Embase, Biblioteca en Salud (BVS), Web of Science, Science Direct, Scielo y Redalyc utilizando los descriptores de ciencias de la salud (Decs): Enfermero; Enfermería; Enfermería de cuidados críticos; Sistemas de comunicación alternativos y aumentativos; Comunicación; se utilizaron los operadores booleanos AND y OR y se realizaron diferentes combinaciones. Resultados principales: Se identificaron 500 artículos y tras emplear los criterios de inclusión y exclusión, fueron seleccionados 20 estudios originales. Conclusión general: La comunicación con los pacientes está limitada por la condición clínica y dispositivos biomédicos. Los sistemas empleados son Sin ayuda (comunicación verbal, no verbal y escrita) y Con ayuda, de baja tecnología (lápiz y papel, tableros y pictogramas) y alta tecnología (válvulas del habla y Tablet con aplicativos móviles).

Objective: to identify competencies that allow assessing adult Intensive Care Unit nurses with a focus on patient safety. Method: a scoping review in which articles were included without time or language limitations on the topic of nursing competency in intensive care and patient safety. Two reviewers independently read the studies in full. Results: thirty-four studies were included, and the following groups of competencies were identified: general competencies, clinical observation and judgment, critical thinking, resource management, patient safety, care management, teamwork competencies, and theoretical knowledge. Conclusion: careful assessment of patients, use of scientific evidence, decision-making, patient-centered care, technical and non-technical competencies, communication, leadership, and care planning were cited as core competencies for ICU nurses with a focus on patient safety. [ABSTRACT FROM AUTHOR]

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Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivo: medir el volumen urinario por medio de la ecografía vesical, realizado por una enfermera en pacientes críticos, después de la retirada de la sonda urinaria permanente y verificar los factores relacionados en la retención urinaria. Método: estudio cuantitativo, observacional y transversal, realizado con 37 pacientes críticos de ambos sexos, mayores de 18 años, con retiro de catéter vesical permanente en las últimas 48 horas. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Los datos fueron presentados a través de distribución de frecuencias, medidas de centralidad y variabilidad, asociación mediante la prueba exacta de Fisher y, para el análisis, regresión logística binomial múltiple. Resultados: de los 37 pacientes, en su mayoría fue de sexo masculino, con una edad média de 54,9 años. La medición del volumen urinario por ecografía osciló entre 332,3 y 950 ml, y el 40,54% de los pacientes presentó retención urinaria. La retención urinaria se asoció significativamente a la aparición de infección urinaria, estreñimiento intestinal y diuresis por rebosamiento espontáneo. Los pacientes con infección del tracto urinario tenían 7,4 veces más probabilidades de tener retención urinaria. Conclusión: la ecografía vesical fue eficaz para medir el volumen urinario después de retirar el catéter urinario permanente y puede contribuir a la detección de retención urinaria.

Background: The evolution of emergency departments added further complexity to the framework of nursing interventions. Understanding this evolution is vital to efficiently manage resources and ensure patients the provision of safe care. Objective: The objective of this study is to describe nursing interventions provided to patients in emergency departments. Methodology: A qualitative approach using a descriptive and exploratory methodology was employed by this study, involving two consecutive stages - (1) identification of nursing interventions using non-participant observation, semi-structured interviews, and a questionnaire, and (2) content analysis of the identified interventions. Results: A total of 1,429 interventions were identified and categorized into 24 dimensions. The most commonly observed interventions were Administration of medication, Clinical assessment, Collection of biological specimens, Management of clinical information, and Maintaining the department's functioning. Conclusion: The identified interventions show nurses' broad range of practices that surpass direct patient care, encompassing the management of workflows and clinical information. The study findings emphasize the significance of further understanding nursing interventions for the optimal management of emergency departments. [ABSTRACT FROM AUTHOR]

Background: Family-centered care is an approach that addresses the needs and values of each family. Objective: To know the perceptions of nurses in the cardiac intensive care unit of a hospital center in northern Portugal about relational practices with families in an intensive care unit. Methodology: Quantitative, descriptive, correlational, and cross-sectional study with a sample of 26 nurses, 65.4% (n = 17) female. The PREFUCI-Importance and PREFUCI-Frequency scales were used. Results: The practice of "being available to clarify doubts to family members" was the practice most frequently rated by participants as Totally important and implemented Always. The mean PREFUCI total score, calculated by summing the scores of the 15 items in each scale, was 59.5 on the importance scale and 52.69 on the frequency scale. Conclusion: Participants showed positive attitudes toward the importance of PREFUCI. However, the frequency of implementation is moderate, with a positive correlation between these two variables, reflecting the need to operationalize these practices. [ABSTRACT FROM AUTHOR]

Aims: Identify factors that interfere in the provision of oral hygiene care, developed by nurses, to orotracheally intubated patients in intensive care units, on primary scientific evidence. Methods: A systematic literature review study, developed according to the Joanna Briggs Institute protocol. To obtain the articles, a search on B-On? and PubMed? was made. The terms used in the search took into account the vocabulary indexed to the Medical Subject Headings (MeSH) database, having been structured according to Boolean operators, with the following combination in English: "Oral Hygiene" AND "Pneumonia, Ventilator-Associated" OR "Pneumonia, Ventilator Associated" AND "Critical Care Nursing". Articles published between December 2017 and December 2020, in English, Portuguese and Spanish, available in full, published in peer-reviewed scientific journals (peer review) and which fit the PICO question developed for the study, were defined as limiting. Results: After applying the inclusion and exclusion criteria, eight articles of a primary and qualitative nature were included in the review that address the factors that influence the provision of oral hygiene care by nurses to patients undergoing orotracheal intubation. Conclusions: The oral hygiene care practices provided to users under orotracheal intubation, by nurses, are influenced by their knowledge, attitudes, available resources, training and institutional policies, as well as by factors related to the user that are mainly related to difficulties in access to the oral cavity. [ABSTRACT FROM AUTHOR]

Objective: to quantify and investigate microorganisms associated with hospital healthcare-associated infections during the first year of the COVID-19 pandemic and analyze their outcomes. Methods: cross-sectional study carried out in a teaching hospital in the Campos Gerais region -- Paraná. Positive culture tests collected after 48 hours of patient admission were analyzed, along with the sensitivity profile of these microorganisms. The data correspond to the period from January 2020 to January 2021 and were analyzed descriptively according to microorganism, sensitivity and deaths. Results: there was an increase in the detection of microorganisms in the interval from August 2020 and January 2021, corresponding to the COVID-19 pandemic period. The most frequent microorganisms were Klebsiella pneumoniae, Staphylococcus aureus, and Escherichia coli. There was also a higher frequency of deaths due to healthcare-associated infections in intensive care units in the same period. Conclusion: there was an increase in the incidence of microorganisms associated with healthcare-associated infections in parallel with the growth of the pandemic in the studied region and a higher frequency of deaths from healthcare-associated infections in the exclusive care ward for COVID-19. [ABSTRACT FROM AUTHOR]

The incidence of medication errors has become a global public health problem, and the World Health Organization proposed in 2017 to reduce these errors by half in five years. The High surveillance drugs are more prone to adverse events, due to their composition and potential to cause damage and even death. The aim of this research was to analyze the safety of critically ill patients in the care intensive therapy using high surveillance medication in the hospital that makes up the Rede Sentinela. The methodology used in the research was an exploratory approach guided by the technique of observation, with a quantitative, exploratory and descriptive approach. As a result of safe practice strategies, they obtained the use of the technological tool in favor of safety in the prescription system, prescription printing, selection and dispensing of medicines. So how unsafe were the structural and procedural issues of the medication system and the absence of training and monitoring. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Introducción: El delirio es una disfunción cerebral aguda, asociada con un aumento de la mortalidad y la morbilidad, que afecta con frecuencia a pacientes adultos/ancianos críticamente enfermos. Las enfermeras tienen un papel crucial en la prevención/control del delirio, a través de la implementación de intervenciones no farmacológicas. Objetivo: Conocer las intervenciones de enfermería en la identificación, prevención y control del delirio en pacientes adultos/ancianos críticos. Materiales y métodos: Se realizó una Revisión Integrativa de la Literatura de artículos publicados entre 2014 y 2018, que identificaron intervenciones de enfermería dirigidas a la prevención y control del delirio en pacientes adultos/ancianos críticos. Se realizaron cuatro búsquedas, en las bases de datos electrónicas de EBSCOhost y B-on. Resultados: Se identificaron 13 estudios que presentan intervenciones de enfermería, en su mayoría no farmacológicas, para la prevención y control del delirio en pacientes adultos/ancianos críticos. De estas, se evidencian intervenciones relacionadas con el medio ambiente, la promoción del sueño, la intervención terapéutica temprana, la evaluación cognitiva y la orientación del paciente, intervenciones sistematizadas en protocolos, así como intervenciones dirigidas a la participación de los familiares, la formación de enfermeras y la enseñanza de los pacientes. También se identificaron factores de riesgo para el desarrollo de delirio y herramientas de evaluación. Discusión: La prevención del delirio es importante e imperativa, ya que su ocurrencia en pacientes críticos se asocia con aumento de la mortalidad, morbilidad, estancia hospitalaria y alto costo hospitalario. La identificación de factores de riesgo para la aparición de delirio debe incluirse en los protocolos de manejo del delirio. Conclusión: La evidencia ha demostrado que los enfermeros son esenciales en la identificación temprana, prevención y control del delirio, previniendo la progresión de la enfermedad, contribuyendo para la reducción de la morbimortalidad. La intervención de enfermería debe incluir la identificación de factores predisponentes y/o precipitantes para contribuir a la reducción de la ocurrencia y/o resolución del delirio. Como citar este artigo: Oliveira Cláudia; Garnacho Martins Nobre Cátia Filipa; Dourado Marques Rita Margarida; Madureira Lebre Mendes Maria Manuela; Cruz Pontífice Sousa Patrícia. O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico. Revista Cuidarte. 2022;13(1):e1983. http://dx.doi.org/10.15649/ cuidarte.1983

La administración de medicamentos es uno de los pilares fundamentales en la gestión del cuidado de la enfermería, de ahí la importancia y responsabilidad de su manejo con personas que estén recibiendo fármacos especializados por su condición aguda o crítica. Objetivo: Construir un instrumento de valoración con los principios homeodinámicos y el concepto de pandimensionalidad de la teoría de seres humanos unitarios, para la administración de medicamentos especializados, como inotrópicos y vasopresores en servicios de UCI y urgencias. Materiales y métodos: es una investigación cualitativa con enfoque descriptivo, para conocer la realidad del sujeto de cuidado desde la premisa sobre la relación de la administración de medicamentos y los principios de la teoría de Seres Humanos Unitarios. Resultados: se construyó un instrumento de valoración desde la perspectiva de la teoría de Rogers. La misma permite al profesional de enfermería evaluar y generar propuestas de cuidado guiadas al equilibrio armónico de los campos de energía, según propone esta teórica en relación con la administración de medicamentos. También le facilita al estudiante el identificar las alteraciones de los principios de la teoría en relación a los efectos de los medicamentos. Conclusiones: el instrumento permite contemplar los principios homeodinámicos y la pandimensionalidad; además, facilita los procesos de cuidado en la administración de medicamentos, que en ocasiones por diferentes causas no se evalúa la respuesta del sujeto de cuidado ante un medicamento, retrasando su evolución ante la enfermedad.

Copyright of Revista Cuidarte is the property of Universidad de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction/purpose: Dysphagia is a disorder that presents with specific signs and symptoms in critically ill patients. Intensive care unit (ICU) nurses are responsible for monitoring and detecting abnormalities in critically ill patients, so they must be trained to assess swallowing and the complications that may arise. The aim of this research is to analyse the dynamics of the detection and assessment of dysphagia by ICU nurses., Method: Cross-sectional descriptive study using an electronic questionnaire to nurses from different Spanish ICUs. The survey was adapted from previous research and consisted of 6 sections with 30 items of qualitative questions. The collection period was between December 2022 and March 2023. Statistical analysis was performed using frequencies and percentages, and the Chi-Square test was used for bivariate analysis., Outcomes: 43 nurses were recruited. Dysphagia is considered an important problem (90,7%) but in 50,3% of the units there is no standard or care protocol for this disorder. The most common technique is the swallowing test (32,6%). There is a consensus in our sample that aspiration pneumonia is the main problem; however, nurses in the busiest care units consider sepsis to be a frequent complication (p = ,029). The most common treatment is modification of food consistency (86,0%)., Conclusion: The findings of this research show a low systematisation of dysphagia screening in the units included. There is a need for greater implementation of interventions and clinical protocols for monitoring complications as well as for compensatory and rehabilitative management., (Copyright © 2024 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier España S.L.U. All rights reserved.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The current demand on health services requires that nurses play a key role, by adapting their competencies to different fields and complexity levels. The approach of situations presented by critically ill patients underpins the need for development of specialised competencies in specific areas such as patient safety, prevention and control of healthcare-associated infections, performance of specific techniques and interventions, autonomous medication management or the use of technology, among others. Spain relies on a specialist training programme that is unique worldwide. Training admission is managed through a contract as a "Resident Nurse Intern" (EIR, Enfermera Interna Residente), provided by regional healthcare services. Only 6 specialities have been established and developed, in an uneven manner and with a short provision of places, annually. Given that the specialization in critical care nursing does not exist, nurses usually self-fund their postgraduate training to enhance their opportunities career development. The development of a speciality for critical care nursing is a priority. The models proposed advocate for creating nursing roles that could cover the systemic gaps through the expansion of their competencies and the introduction of procedures that fit nursing into advanced practice, which could be achieved through Advanced Accreditation Diplomas. Simultaneously, it would be convenient to analyse how and why such a dynamic discipline in some countries became stuck in anachronistic models of the Spanish healthcare system. This analysis might contribute to move forward on the development of areas of improvement in terms of service access and quality of care., (Copyright © 2024 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier España S.L.U. All rights reserved.)

Objective: to analyze the nurse's conception of professional satisfaction in the Intensive Care Unit environment. Method: descriptive study of qualitative approach, carried out in a university hospital in the state of Sergipe. Data collection was performed in October 2020, through semi-structured interviews with nurses from the general Intensive Care Unit sector, and the data were analyzed through Content Analysis. Results: the following categories emerged from the statements: the work process of nurses in Intensive Care Units; factors that interfere in the professional satisfaction of nurses in the Intensive Care Unit environment; and the relationship of nurses with professional satisfaction in the intensive care environment during the Covid-19 pandemic. Final considerations: in the conception of Intensive Care Unit nurses, professional satisfaction is an important aspect in their work environment and can influence the provision of care offered to patients. [ABSTRACT FROM AUTHOR]

Nurses' attention was paid to spirituality in patient care in the ICU of a general hospital in São Paulo, institutional CEP approval (CAAE: 10991712.5.0000.007 0). 42 nurses participated, mostly women with an average age of 35.64 years, with specialization, 50%, Catholic. Of the total participants, 71.43% were practitioners, with 47.62% attending the church or religious temple. Regarding spirituality in the ICU, 57.14% consider it "very important". Regarding the approach to patient care, 47.62% think it is "very important". Regarding spiritual assistance in the ICU, 83.33% of the participants observed clinical evolution in these patients. Conclusion: nurses consider it important to approach the subject, above all, in direct care for critical patients and "respect for others" was considered one of the main behaviors related to religiosity/spirituality in care. It is emphasized that nursing care is reviewed and that it can be related to the religious/spiritual needs of the patients on a daily basis, considering the integrality of care. [ABSTRACT FROM AUTHOR]

Objective: to describe the strategies used by nurses to minimize the occurrence of delirium in patients admitted to the intensive care unit (ICU). Method: exploratory-descriptive study, with a qualitative approach, developed in a large public teaching hospital in the city of Salvador. It was carried out in September and October 2018, 16 nurses participated in the study. Data were collected through semi-structured interviews and analyzed using the "Thematic Content Analysis Technique". Results: from the data analysis, two thematic categories emerged, named: "Lack of knowledge about monitoring delirium in the ICU" and "Strategies of nurses to minimize the occurrence of delirium in the ICU". Conclusion: although the nurses' lack of knowledge about delirium, there is a coherence in the methods of interventions to prevent it. The implementation of protocols and educational activities are essential to empower nurses regarding the interventions performed. [ABSTRACT FROM AUTHOR]

Objective: to know the experience of pleasure and suffering in the nursing team of the intensive care unit. Method: qualitative research with participant and systematic observation and interviews with nursing technicians from the ICU of a hospital in São Luís, Maranhão, Brazil. 26 nursing technicians with a history of medical certificates were interviewed between July 2016 and July 2017. Content analysis for and dialectic hermeneutics was used to treat the results. Results: the experience of pleasure was verified by working with serious patients, relating the profession with acts of heroism. However, the experience of physical suffering was identified by using the body as a work tool, and the psychic suffering translated into routines loaded with excessive charges, and fear of losing the job leading to the practice of presenteism. Conclusion: it is concluded that the nursing technicians of the intensive care center experience pleasure from feelings of heroism in the profession, and work-related suffering due to excessive collections, permanent vigilance, problems with nursing management, absenteeism and feelings of exclusion. [ABSTRACT FROM AUTHOR]

Abstract OBJECTIVE Toidentify the occurrence of errors in the use of equipment by nurses working in intensive careandanalyzing them in the framework of James Reason's theory of human error. METHOD Qualitative field study in the intensive care unit of a federal hospital in the city of Rio de Janeiro. Observation and interviews were conductedwith eight nurses, from March to December 2014. Content analysis was used for the interviews, as well as the description of the scenes observed. RESULTS Lapses of memory and attention were identified in the handling of infusion pumps, as well as planning failures during the programming of monitors. CONCLUSION Errors cause adverse events that compromise patient safety. The authors propose creation of an instrument for daily checking of equipment, with checks throughout the work process in the programming of infusion pumps and monitors, in order to reduce failures and memory lapses.

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Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of RIIS: Revista de Investigação & Inovação em Saúde is the property of RIIS: Revista de Investigacao & Inovacao em Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of RIIS: Revista de Investigação & Inovação em Saúde is the property of RIIS: Revista de Investigacao & Inovacao em Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of RIIS: Revista de Investigação & Inovação em Saúde is the property of RIIS: Revista de Investigacao & Inovacao em Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of RIIS: Revista de Investigação & Inovação em Saúde is the property of RIIS: Revista de Investigacao & Inovacao em Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of RIIS: Revista de Investigação & Inovação em Saúde is the property of RIIS: Revista de Investigacao & Inovacao em Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)