scholarly journals Profissionais de enfermagem: compreensão sobre cuidados paliativos pediátricos

2019 ◽  
Vol 13 (1) ◽  
pp. 126
Author(s):  
Edna Regina Verri ◽  
Natalia Aparecida Santana Bitencourt ◽  
Jéssica Aires da Silva Oliveira ◽  
Randolfo Dos Santos Junior ◽  
Hélida Silva Marques ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pediatric Patients ◽  
Death And Dying ◽  
Structured Interview ◽  
Academic Training ◽  
Analysis Technique ◽  
Infant School ◽  
The Subject ◽  
Health Institutions ◽  
Nursing Professionals

ABSTRACT Objective: to investigate the understanding and practice ofpediatric palliative care. Method: it is a qualitative, exploratory and descriptive study, in a Maternal-Infant School Hospital with 30 Nursing professionals. A sociodemographic questionnaire and semi-structured interview were used to collect data. The data was submitted to the Content Analysis technique. Results: professionals presented difficulties related to the understanding of the philosophy and objectives of palliative care and difficulties in working with pediatric patients under this care, highlighting the feelings of failure and sadness in dealing with the situation. As a coping strategy, the affective detachment of the patient and his family, the spirituality and the offer to the patient of a differentiated and humanized care are used as coping strategies. Conclusion: it is necessary to include palliative care in the academic training of professionals, favoring the knowledge of the subject and preparing the professional to deal with death and dying, as well as the need for a space in the health institutions that provide shelter for the difficulties of professionals working in this context. Descritores: Palliative Care; Pediatrics; Pediatric Nursing; Death; Adaptation, Psychological; Humanization of Assistance. RESUMOObjetivo: investigar a compreensão e a prática dos profissionais de enfermagem sobre os cuidados paliativos pediátricos. Método: trata-se de estudo qualitativo, exploratório e descritivo, em um Hospital Escola Materno-Infantil com 30 profissionais de Enfermagem. Utilizaram-se, para a coleta de dados, questionário sociodemográfico e entrevista semiestruturada. Submeteram-se os dados à técnica de Análise de Conteúdo. Resultados: apresentaram-se, pelos profissionais, dificuldades relacionadas à compreensão da filosofia e aos objetivos dos cuidados paliativos e dificuldade em atuar com pacientes pediátricos que estão sob esse cuidado, destacando-se os sentimentos de fracasso e de tristeza ao lidarem com a situação. Empregam-se, com isso, como estratégias de enfrentamento, o distanciamento afetivo do paciente e de sua família, a espiritualidade e o oferecimento, ao paciente, de um atendimento diferenciado e humanizado. Conclusão: salienta-se a necessidade da inclusão de cuidados paliativos na formação acadêmica dos profissionais, favorecendo o conhecimento do tema e preparando o profissional para lidar com a morte e o morrer, assim como a necessidade de um espaço nas instituições de saúde que proporcione acolhimento frente às dificuldades dos profissionais que atuam nesse contexto. Descritores: Cuidados Paliativos; Pediatria; Enfermagem Pediátrica; Morte; Adaptação Psicológica; Humanização da Assistência. RESUMEN Objetivo: investigar la comprensión y la práctica de los profesionales de enfermería sobre los cuidados paliativos pediátricos. Método: se trata de un estudio cualitativo, exploratorio y descriptivo, en un Hospital Escuela Materno-Infantil con 30 profesionales de Enfermería. Se utilizaron, para la recolección de datos, cuestionario sociodemográfico y entrevista semiestructurada. Se sometieron los datos a la técnica de Análisis de Contenido. Resultados: se presentaron, por los profesionales, dificultades relacionadas a la comprensión de la filosofía y a los objetivos de los cuidados paliativos y dificultad en actuar con pacientes pediátricos que están bajo ese cuidado, destacándose los sentimientos de fracaso y de tristeza al lidiar con la situación. Se emplean, con ello, como estrategias de enfrentamiento, el distanciamiento afectivo del paciente y de su familia, la espiritualidad y el ofrecimiento, al paciente, de una atención diferenciada y humanizada. Conclusión: se destaca la necesidad de la inclusión de cuidados paliativos en la formación académica de los profesionales, favoreciendo el conocimiento del tema y preparando al profesional para lidiar con la muerte y el morir, así como la necesidad de un espacio en las instituciones de salud que proporcione acogida frente a las dificultades de los profesionales que actúan en ese contexto. Descritores: Cuidados paliativos; Pediatría; Enfermería Pediátrica; Muerte; Adaptación Psicológica; Humanización de la Atención. 

CUIDADO DE PACIENTES EM FINAL DE VIDA: o que profissionais de enfermagem expressam sobre

2021 ◽  
Vol 7 (1) ◽  
pp. 343-361
Author(s):  
Flávia Silvestrin ◽  
Tayna Nayara Nunes ◽  
Luiz Renato de Moraes Braga
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Health Professionals ◽  
Care Center ◽  
Death And Dying ◽  
Structured Interview ◽  
Discussion Groups ◽  
Analysis Technique ◽  
Nursing Team ◽  
Nursing Professionals

The perception that we have about death and dying in our society and the way it is experienced by health professionals can bring important psychic repercussions, especially for those who are closest to patients: the nursing team. Literature often suggests the creation of spaces for speech and/or discussion groups, as a care strategy for these professionals. The present study refers to a qualitative, exploratory and empirical research, whose proposal was to verify, through semi-structured interview, if nursing professionals in a Semi-Intensive Care Center have demands to work on themes related to care of end-of-life patients through an operative group and, according to the results, propose its realization. 21 professionals participated. The interviews were analyzed using the Content Analysis technique, which allowed to list five categories: Frequency; Difficulties; Coping strategies; Established links; Demands for updates and speech spaces. The results showed that the participants considered it necessary a space to talk about their experiences in the context of care for patients at the end of life, however, when it was proposed, it did not have adherence. A number of reasons can be considered about the impediments and difficulties in the implementation of a group with nursing professionals working in intensive care, as the main contingents are issues related to the profession itself, resistance, work overload, the context itself institutional and pandemic, making clear the need for further studies.

scholarly journals The Illness Experience: Palliative Care Given the impossibility of Healing

2016 ◽  
Vol 50 (spe) ◽  
pp. 47-53 ◽  
Author(s):  
Margarida Maria Florêncio Dantas ◽  
Maria Cristina Lopes de Almeida Amazonas
Keyword(s):  
Palliative Care ◽  
Participant Observation ◽  
Descriptive Analysis ◽  
Terminally Ill ◽  
Medical Model ◽  
Structured Interview ◽  
Subject Position ◽  
The Subject ◽  
Experience Of Illness ◽  
Therapeutic Possibilities

This paper presents a reflection about being terminally ill and the various ways that the subject has at its disposal to deal with this event. The objective is to understand the experience of palliation for patients undergoing no therapeutic possibilities of cure. The methodology of this study has the instruments to semi-structured interview, the participant observation and the field diary, and the Descriptive Analysis of Foucault’s inspiration how the narratives of the subjects were perceived. The Results of paper there was the possibility of looking at the experience of illness through the eyes of a subject position assumed by the very sick. As conclusion we have than when choosing palliative care, the terminally ill opts for a way to feel more comfortable and resists the impositions of the medical model of prolonging life.

scholarly journals Nursing care in palliative care in pediatric oncology

2021 ◽  
Vol 5 (3) ◽  
pp. 91-94
Author(s):  
Joana Muniz Mendonça ◽  
Luana Luzia de Assis Arruda Corbari ◽  
Matheus Mychael Mazzaro Conchy ◽  
Renan da Silva Bentes
Keyword(s):  
Palliative Care ◽  
Nursing Care ◽  
Pediatric Oncology ◽  
Pediatric Cancer ◽  
Pediatric Patients ◽  
Terminal State ◽  
The Family ◽  
The Face ◽  
Nursing Professionals ◽  
Informative Text

This research has as general theme "Nursing care in palliative care in pediatric oncology", an approach that needs to be further discussed due to the need to prepare nursing professionals working in the pediatric sector with cancer patients who are terminally. Thus, an informative text was produced with information based on authors who have already conducted research on this theme, with a qualitative approach, because this is a Bibliographic research. To guide this research, the general objective was to identify the knowledge and reactions of nursing professionals in pediatric cancer care and as specific objectives to identify the perceptions and feelings that permeate pediatric nursing practice in relation to cancer, treatment, and its implications and to know the care/care activities aimed at children hospitalized in the pediatric oncology sector. It is concluded that the courses directed to nursing need to offer disciplines that prepare these professionals to deal with pediatric patients who are in terminal state, preparing them to comfort the family in the face of the failure of the treatments that the patient underwent.

scholarly journals A condição da espiritualidade na assistência de enfermagem oncológica

2018 ◽  
Vol 12 (11) ◽  
pp. 3024
Author(s):  
Fellipe Cássio Silva ◽  
Ana Maria Sá Barreto Maciel ◽  
Ana Carla Silva Alexandre ◽  
Danielma Maria Barros Ferreira
Keyword(s):  
Palliative Care ◽  
Qualitative Data ◽  
Medical Oncology ◽  
Descriptive Study ◽  
System Method ◽  
Analysis Technique ◽  
Nursing Team ◽  
Qualitative Descriptive ◽  
Nursing Professionals ◽  
Oncology Center

RESUMO Objetivo: analisar aspectos referentes à espiritualidade em profissionais de Enfermagem que prestam assistência a pacientes em regime de cuidados paliativos. Método: trata-se de um estudo qualiquantitativo, do tipo descritivo, com seis profissionais da equipe de Enfermagem de um centro de oncologia. Utilizou-se um formulário semiestruturado para a coleta dos dados. Analisaram-se os dados qualitativos pela técnica de Análise de Conteúdo e os dados quantitativos com o auxílio do programa Epi Info,TM versão 2011. Resultados: revela-se que 83% afirmam desenvolver a espiritualidade durante a assistência prestada e 67% acreditam na interferência da espiritualidade na assistência por eles prestada, além de considerarem importante o diálogo sobre esta com os pacientes. Conclusão: constatou-se a crença em conseguir desenvolver a espiritualidade durante a assistência prestada e a existência de interferência da espiritualidade durante essa assistência prestada pela equipe de Enfermagem. Buscam-se, por meio de estudos dessa natureza, reflexões a respeito do processo de trabalho da Enfermagem no cuidado ao paciente oncológico a fim de subsidiar mecanismos que possam favorecer as habilidades no contexto da espiritualidade. Descritores: Espiritualidade; Religião; Cuidados Paliativos; Oncologia; Morte; Cuidados de Enfermagem.  ABSTRACT Objective: to analyze aspects related to spirituality in nursing professionals who provide care to patients in the palliative care system. Method: this is a qualitative, descriptive study with six professionals from the Nursing team of an oncology center. A semi-structured form was used to collect the data. Qualitative data was analyzed using the Content Analysis technique and the quantitative data with the help of the Epi Info, TM version 2011 program. Results: 83% reported developing spirituality during the care provided and 67% believed in interference of the spirituality in the assistance they provide, and also consider it important to dialogue with the patients. Conclusion: the belief in being able to develop spirituality during the care provided and the existence of spirituality interference during this care provided by the Nursing team was verified. Through studies of this nature, it is sought to reflect on the Nursing work process in the care of cancer patients, in order to subsidize mechanisms that may favor skills in the context of spirituality. Descriptors: Spirituality; Religion; Palliative Care; Medical Oncology; Death; Nursing Care.RESUMEN Objetivo: analizar aspectos referentes a la espiritualidad en profesionales de Enfermería que prestan asistencia a pacientes en régimen de cuidados paliativos. Método: se trata de un estudio cuali-cuantitativo, del tipo descriptivo, con seis profesionales del equipo de Enfermería de un centro de oncología. Se utilizó un formulario semiestructurado para la recolección de los datos. Se analizaron los datos cualitativos por la técnica de Análisis de Contenido y los datos cuantitativos con la ayuda del programa Epi Info, TM versión 2011. Resultados: se revela que el 83% afirma desarrollar la espiritualidad durante la asistencia prestada y el 67% cree en la interferencia de la espiritualidad en la asistencia por ellos prestada, además de considerar importante el diálogo sobre ésta con los pacientes. Conclusión: se constató la creencia en lograr desarrollar la espiritualidad durante la asistencia prestada y la existencia de interferencia de la espiritualidad durante esa asistencia prestada por el equipo de Enfermería. Se buscan, por medio de estudios de esa naturaleza, reflexiones acerca del proceso de trabajo de la Enfermería en el cuidado al paciente oncológico a fin de subsidiar mecanismos que puedan favorecer las habilidades en el contexto de la espiritualidad. Descriptores: Espiritualidad; Religión; uidados Paliativos; Oncología Médica; Muerte; Atención de Enfermería.

scholarly journals Morte/morrer de pessoas com hiv: o olhar da enfermagem

2018 ◽  
Vol 12 (12) ◽  
pp. 3337
Author(s):  
Amanda Regina da Silva Góis ◽  
Brígida Maria Gonçalves de Melo Brandão ◽  
Regina Celia de Oliveira ◽  
Solange Fátima Geraldo da Costa ◽  
Denize Cristina de Oliveira ◽  
...  
Keyword(s):  
Social Representations ◽  
Death And Dying ◽  
Structured Interview ◽  
People Living With Hiv ◽  
Categorical Analysis ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Living With Hiv ◽  
Nursing Professionals ◽  
Hiv Aids

RESUMOObjetivo: descrever os conteúdos representacionais de profissionais da Enfermagem sobre a morte e o morrer de pessoas vivendo com HIV. Método: trata-se de estudo qualitativo, de campo, descritivo e exploratório, fundamentado na Teoria das Representações Sociais, realizado em sete Serviços de Assistência Especializada (SAE) em HIV/AIDS e um Centro de Testagem e Aconselhamento (CTA, com 20 profissionais de enfermagem, por meio de entrevista semiestruturada. Analisaram-se as falas pela técnica de Análise de Conteúdo na modalidade Análise Categorial. Resultados: elegeram-se quatro categorias temáticas a partir da análise das falas: “O diagnóstico”; “Os significados da morte e do morrer”; “O enfrentamento dos profissionais da Enfermagem perante a morte e morrer de PVHIV” e “A morte dando lugar à possibilidade de vida”. Conclusão: incidem-se os conteúdos representacionais nas práticas em saúde e enfermagem desde a construção simbólica do adoecimento perante a possibilidade de morte relacionada ao HIV e às novas perspectivas de tratamento e promoção da saúde, sendo possível destacar o avanço do conhecimento científico dos profissionais de enfermagem, o que contribui para a sua assistência em saúde às PVHIV. Descritores: Enfermagem; Morte; HIV; Síndrome de Imunodeficiência Adquirida; Percepção Social; Promoção da Saúde.ABSTRACT Objective: to describe the representational contents of Nursing professionals about the death and dying of people living with HIV. Method: this is a qualitative, field-based, descriptive and exploratory study, based on the Theory of Social Representations, carried out in seven Specialized Assistance Services (SAS) in HIV / AIDS and a Testing and Counseling Center (TCC) with 20 nursing professionals, through a semi-structured interview. The speeches were analyzed by the technique of Content Analysis in the Categorical Analysis modality. Results: four thematic categories were chosen from the analysis of the lines: "The diagnosis"; "The meanings of death and dying"; "The confrontation of nursing professionals before death and die of PLHIV" and "Death giving way to the possibility of life". Conclusion: the focus was on the representational contents on health and nursing practices from the symbolic construction of illness to the possibility of death related to HIV and the new perspectives of treatment and health promotion, being possible to highlight the advance of the scientific knowledge of nursing professionals, which contributes to their health care to PLHIV. Descriptors: Nursing; Death; HIV; Acquired Immunodeficiency Syndrome; Social Perception; Health Promotion.RESUMEN Objetivo: describir los contenidos representacionales de profesionales de Enfermería sobre la muerte y el morir de personas viviendo con VIH. Método: se trata de un estudio cualitativo, de campo, descriptivo y exploratorio, fundamentado en la Teoría de las Representaciones Sociales, realizado en siete Servicios de Asistencia Especializada (SAE) en VIH / SIDA y un Centro de Pruebas y Asesoramiento (CTA, con 20 profesionales de enfermería, por medio de una entrevista semiestructurada. Se analizaron las hablas por la técnica de Análisis de Contenido en la modalidad Análisis Categorial. Resultados:  se elegieron cuatro categorias temáticas a partir del análisis de las hablas: “El diagnóstico”; “El significado de la muerte y del morir”; “El enfrentamiento de los profesionales de la enfermería ante la muerte y morir de PVHIV" y "La muerte dando lugar a la posibilidad de vida". Conclusión: se inciden los contenidos representacionales en las prácticas en salud y enfermería desde la construcción simbólica de la enfermedad ante la posibilidad de muerte relacionada al VIH y las nuevas perspectivas de tratamiento y promoción de la salud, siendo posible destacar el avance del conocimiento científico de los profesionales de enfermería, lo que contribuye a su asistencia en salud a las PVVIH. Descriptores: Enfermería; Muerte; VIH; Síndrome de Inmunodeficiencia Adquirida; Percepción Social; Promoción de la Salud.

scholarly journals Soul care in the hospital nursing context: an analysis based on Transpersonal Caring

2020 ◽  
Vol 54 ◽  
Author(s):  
Emanuelle Caires Dias Araújo Nunes ◽  
Hévellin da Silva Santos ◽  
Gleica Afonso Dutra ◽  
Juliana Xavier Pinheiro da Cunha ◽  
Regina Szylit
Keyword(s):  
Spiritual Care ◽  
Structured Interview ◽  
Care Process ◽  
Search For Meaning ◽  
Soul Care ◽  
Hospital Nursing ◽  
Analysis Technique ◽  
Nursing Team ◽  
Disease Experience ◽  
Nursing Professionals

Abstract Objective: To unveil spirituality in the care process of nursing professionals in the hospital context under the lens of Transpersonal Caring. Method: A descriptive-exploratory study implementing a qualitative approach conducted with professionals from the nursing team in a general hospital in Bahia, using a semi-structured interview submitted to the content analysis technique and analyzed from the perspective of the Theory of Transpersonal Caring theoretical framework. Results: There were 16 professionals who participated. It was found that the nursing team perceives the patient and family’s demand for spiritual care, and sometimes even has experiences and suggestions for interventions, especially those which cultivate faith and spirituality, but this does not happen with most of these professionals who demonstrate difficulties, unpreparedness and fear of taking on such care responsibility. Conclusion: There is a need to develop better interaction/spiritual care skills by nursing professionals in the challenging context of the search for meaning, faith and hope mobilized by the disease experience. The Systematization of Spiritual Nursing Care and Transpersonal Caring stand out as appropriate devices, which provide consistent subsidies for undertaking spiritual care.

scholarly journals Ta’awun based muhammadiyah solidarity buying To support the economy resilient of street vendors during covid-19 period in north lampung

2021 ◽  
Vol 8 (1) ◽  
pp. 80-88
Author(s):  
Agung Prihatmojo ◽  
Badawi Badawi ◽  
Purna Bayu Nugroho
Keyword(s):  
Structured Interview ◽  
Economic Resilience ◽  
Street Vendors ◽  
Analysis Technique ◽  
The Subject ◽  
Descriptive Approach ◽  
Food Needs ◽  
Using Data ◽  
The Impact

The purpose of this study was to determine the impact of solidarity buying on the economic resilience of street vendors' families during the Covid-19 pandemic. This study uses a qualitative research method with a descriptive approach. Determination of the subject using purposive to be determined according to the purpose of the study. The subjects in this study amounted to 5 street vendors in Kotabumi, North Lampung. The technique of collecting data is semi-structured interview. Data analysis technique with steps of data reduction, data presentation, and verification. Testing the validity of the data using data triangulation. The results of the ta'awun-based Solidarity buying research were able to increase the income of street vendors during the pandemic. The income of street vendors can increase not only from the profit of buying and selling but from the ta'awun of buyers who often overspend or give alms. Ta'awun really helps street vendors in setting aside money to pay debts. Ta'awun Muhammadiyah activities in North Lampung during the pandemic also helped fulfill the food needs of street vendors, namely the distribution of free basic-necessities to street vendors.

scholarly journals Death and dying of newborns and children: relationships between nursing and family according to Travelbee

2022 ◽  
Vol 75 (2) ◽  
Author(s):  
Jocellem Alves de Medeiros ◽  
José Jailson de Almeida Júnior ◽  
Luciane Paula Batista Araújo de Oliveira ◽  
Flávia Rayonara Santana da Silva ◽  
Clara Caroline dos Santos Silva ◽  
...  
Keyword(s):  
Interpersonal Relations ◽  
Death And Dying ◽  
Pediatric Intensive Care ◽  
Rio Grande ◽  
Structured Interview ◽  
Maternity Hospital ◽  
Bad News ◽  
Family Assistance ◽  
Theoretical Support ◽  
Nursing Professionals

ABSTRACT Objective: Identify the nursing staff's perception of their relationship with families of newborns and children who are in the process of death and dying. Methods: Qualitative research, carried out in the Neonatal and Pediatric Intensive Care Unit of a public maternity hospital in Rio Grande do Norte, with 17 nursing professionals, through a semi-structured interview. After being transcribed, the data were subjected to Bardin's content analysis and interpreted in the light of the theory of Interpersonal Relations proposed by Travelbee. Results: Four categories emerged from the analysis: "Caring and welcoming people, feelings and stories"; "Reactions in the midst of pain: moving between acceptance and suffering"; "Communication of bad news: challenges and strategies"; "The weight of caring and suffering". Final considerations: Family assistance can be established using Travelbee's principles, as they offer timely theoretical support for nursing actions in the context of the process of death and dying.

The Theme of Violence and the Teaching Strategies Used by Teachers of Nursing Undergraduate Courses

2017 ◽  
Vol 41 (S1) ◽  
pp. S674-S674
Author(s):  
Z. Scherer ◽  
E. Scherer ◽  
D. Baragatti
Keyword(s):  
Teaching Strategies ◽  
Public Health Problem ◽  
Structured Interview ◽  
Academic Training ◽  
Public Higher Education ◽  
Formal Curriculum ◽  
Pedagogical Strategies ◽  
The Everyday ◽  
The Subject ◽  
Competing Interest

IntroductionUnderstanding violence as a public health problem brings as required its inclusion in the curricula of undergraduate courses in health.ObjectiveTo describe the approach to the topic of violence and the teaching strategies used by teachers of undergraduate courses in nursing of two public higher education institutions of the State of São Paulo, Brazil.AimsKnowing the approach to the topic of violence in two nursing under graduation courses.MethodDescriptive, exploratory qualitative study. For data collection, semi-structured interview was used; were subject of the study, 15 teachers of the institutions studied that ministered courses whose programs contained the word “violence” or related. The data were subjected to analysis of the “collective subject discourse”.ResultsThe results referred to speeches about the importance of addressing violence in theory and practical course, the experience of violence in the everyday practice and pedagogical strategies in the theoretical and practical learning. Teachers recognize the importance of violence be crafted at graduation, describing that, although not always appear in the formal curriculum, the subject appears in an informal way in academic training. Recognize, however, that there is a fragmentation in the approach of the theme, because teachers are divided between theoretical and practical classes and not all of them study the subject.ConclusionIt is essential that there should be more discussions on violence among teachers as well as be designed strategies to better approach the theme at graduation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Communication of bad news in the context of neonatal palliative care: experience of intensivist nurses

2022 ◽  
Vol 43 ◽  
Author(s):  
Beatriz Helena Naddaf Camilo ◽  
Taynnara Caroline Serafim ◽  
Natália Rejane Salim ◽  
Álida Maria de Oliveira Andreato ◽  
Júlia Rudzinski Roveri ◽  
...  
Keyword(s):  
Palliative Care ◽  
Neonatal Intensive Care ◽  
Structured Interview ◽  
Qualitative Approach ◽  
Bad News ◽  
Neonatal Intensive Care Units ◽  
Care Experience ◽  
The Family ◽  
The Face ◽  
The Subject

ABSTRACT Objectives: To know the experiences of nurses in neonatal intensive care units in the face of the process of communicating bad news to the family of newborns in palliative care. Methods: Study with a descriptive qualitative approach, in which 17 professionals participated. Data were collected through a semi-structured interview script, from December/2018 to February/2019, and submitted to content analysis. Results: Four theoretical categories emerged, with 11 subcategories inserted: meanings attributed to bad news; nursing as a support for the family; difficulties in dealing with the process of communicating bad news; nursing and involvement with the family’s suffering. Final considerations: The challenges to deal with the situation are related to lack of preparation, impotence, and subjectivities. The results broaden knowledge on the subject and enable the improvement of nursing care in this context.

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