Paradigms that guide the models of attention to the health in Brazil: an analytic essay

SILVA, Flávio César Bezerra da ; COSTA, Francisca Marta de Lima; ANDRADE, Hamilton Leandro Pinto de; FREIRE, Lúcia de Fátima; MACIEL, Patrícia Suerda de Oliveira; ENDERS, Bertha Cruz ; MENEZES, Rejane Maria Paiva de. Paradigms that guide the models of attention to the health in Brazil: an analytic essay. Revista de Enfermagem UFPE On Line., Recife, v.3,n.4, p.460-65. out/dez. 2009. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista/search/results >.

Satisfação no Trabalho: o caso do Município de Condeixa-a-Nova

No âmbito da gestão de Recursos Humanos a análise da satisfação no trabalho considera-se de grande relevância, uma vez que esta variável influencia o desempenho dos trabalhadores, a sua produtividade e, consequentemente o sucesso organizacional. Neste contexto, esta dissertação teve como objectivos analisar o nível de satisfação no trabalho dos funcionários das diferentes categorias profissionais da Câmara Municipal de Condeixa-a-Nova (CMC); verificar se as varáveis socioprofissionais, nomeadamente, a idade, o sexo, o tempo de serviço, a categoria profissional, as habilitações académicas e o tipo de vínculo que têm com a autarquia estão relacionadas com a satisfação no trabalho e analisar até que ponto as diferentes dimensões da satisfação influenciam o trabalho dos funcionários da CMC. A abordagem de investigação foi quantitativa, de âmbito estatístico descritivo e análise inferencial, desenvolvida a partir da aplicação de um questionário sobre a satisfação no trabalho. A amostra é composta por 91 funcionários da CMC, o que representa 41,94% da população total. Da análise dos dados conclui-se que existem diferenças ao nível da satisfação total no trabalho entre as diferentes categorias profissionais, sendo a categoria de encarregado operacional a que apresenta uma média de satisfação total no trabalho mais elevada e as categorias de assistente operacional, técnico superior e assistente técnico as que apresentam valores médios de satisfação no trabalho mais baixos. Por outro lado, e de uma forma geral, os funcionários manifestam uma grande satisfação ao nível da dimensão liderança e uma maior insatisfação ao nível da dimensão dos factores pessoais. / Inside of the human resources management, the study of job satisfaction is considered of great importance since this variable influences the performance of employees, their productivity and consequently the organizational success. In this context, this dissertation aimed to analyze the job satisfaction level from the various professional categories of the city council of Condeixa-a-Nova (CMC), verify the relationship between socio-professional variables (age, sex, length of service, professional category, academic qualifications) and job satisfaction and analyze to what extent the different dimensions of job satisfaction influence the work of employees from CMC. The research approach was quantitative, descriptive and statistical, with a inferential analysis, developed from the application of a questionnaire about job satisfaction. The sample consists of 91 workers of CMC, which represents 41,94 % of the total population. From the data analysis, we concluded that there are differences at the level of total job satisfaction between the different professional categories. The professional category of “encarregado operacional” has a highest average of job total satisfaction and the professional categories of “assistente operacional”, “técnico superior” and “assistente técnico” have the lowest average. On the other hand, and in general, employees express a great satisfaction at the level of leadership and a lower satisfaction of the personal factors dimension.

Satisfação Profissional do Trabalhador: um construto para o conhecimento de suas causas

Contexto: O estudo da Satisfação Profissional (SP) é um tema actual que tem despertado a atenção de vários investigadores. Sendo um tema bastante complexo, os investigadores têm procurado compreender as diversas determinantes da SP, considerando que só dessa forma os gestores das organizações estarão em condições de desenvolver estratégias que promovam o nível de satisfação dos seus colaboradores. Objetivos: Identificar quais os factores que contribuem para a SP da amostra. Método: O estudo teve por base uma bateria de três questionários, de administração direta, aplicados aos trabalhadores de duas fábricas da região centro. Para avaliar a SP recorreu-se ao “Job Discriptive Index” (JDI) adaptado à população portuguesa por Jesuíno, Sockza e Matoso (1983), e à Escala de Satisfação Organizacional, desenvolvida por Jorge Vala e colaboradores (1995). Para apurar as caraterísticas sociodemográficas da amostra fez-se uso ainda de um questionário construído pelos autores do estudo para o efeito. A amostra final é constituída por trabalhadores de duas empresas (N=52) - 24 da empresa “P” e 28 da empresa “B”, num total de 48 homens (92,3%) e 4 mulheres (7,7%), com prevalência de idades entre 31-40 anos (32,7%). O estudo teve a duração de dois semestres, e desenvolvido em quatro fases distintas: Fase conceptual, metodológica, Empírica e Reflexiva1. Resultados: Os resultados demonstram que a SP é mais influenciada por factores de ordem profissional e socioprofissionais, nomeadamente: relacionamento do trabalhador com a chefia, relacionamento do trabalhador com os colegas do mesmo nível, perspetivas de promoção, tempo de serviço e o tipo de vínculo contratual. Dos factores sociodemográficos, verificamos que a idade e o estado civil exercem influência moderada sobre a satisfação. Conclusão: Os resultados obtidos devem ser analisados como preliminares, passíveis de serem confirmados no futuro. Com este estudo foi possível concluir que a maioria dos trabalhadores das empresas em estudo (75%) se sente satisfeita, em oposição a 25% dos casos que afirma sentir-se insatisfeito em relação ao seu trabalho. / Context: The study of the Professional Satisfaction (PS) is an actual theme that has aroused the attention of different investigators. Being a complex theme, the investigators have trying to understand the diversity of PS determinants, considering that approach, the only way to the managers being able to develop strategies to elevate the satisfaction level of the collaborators. Goals: Identify what factors contributes to the PS of the sample Method: As support, the study had a group of three direct implementation questionnaires applied to the workers of two factories from the area. To evaluate the PS we resort to the “Job Descriptive Index” (JDI) adapted to the Portuguese Population by Jesuíno, Sockza and Matoso (1983) and to the Organizational Satisfaction Scale, developed by Jorge Vala and his collaborators (1995). To settle the socio demographic characteristics of the sample it was used another questionnaire elaborated by the authors of the study to achieve those characteristics. The final sample is constituted by workers of two factories (N=52), 24 of them from the factory “P” and the other ones (28) of the factory “B”, resulting in a total of 48 males (92,3%) and 4 females (7,7%) mostly with an age average between 31 and 40 years (32,7%) The study had the duration of two semesters and it was developed in four distinct phases, the first one, the conceptual phase, the second one, the methodological, the third one, the empirical and the last one, the reflexive phase. Results: The results show us that factors like professional order and socio professionals as the relations between employers and managers, between employers at the same level, promotional expectations, service time and the different types of contract have influences over the PS. Above the social demographic factors the study verifies that factors like age and marital status have a moderate influence above PS. Conclusion: The achieved results must be analyzed as preliminaries since they have to be confirmed in the future. With this study it was possible to conclude that the majority of the studied workers in the factories (75%) feel satisfied and the remaining 25% of the cases says unsatisfied in his relation to work.

Error Recovery Performance: The Impact of Leader Behavioral Integrity and Job Satisfaction

This article introduces the concept of error recovery performance, followed by the development and validation of an instrument to measure it. The first objective of this article is to broaden the current concept of service recovery to be relevant to the back-of-house operations. The second objective is to examine the influence of leader behavioral integrity (BI) on error recovery performance. Moreover, the study examines the mediating effect of job satisfaction between BI and error recovery performance. Finally, the study links error management performance with work-unit effectiveness. Data for Study 1 were collected from 369 hotel employees in Turkey. The same relationships were tested again in Study 2 to validate the findings of Study 1 with a different sample. Data for Study 2 were collected from 33 departmental managers from the same hotels. Linear regression analysis was used to test the direct effects. The mediating effects were tested using the mediation test suggested by Preacher and Hayes. In addition, in Study 2, general managers of the hotels were asked to rate the effectiveness of each manager and their respective department. Results from Study 1 indicate that BI drives error recovery performance, and this impact is mediated by employee job satisfaction. Results of Study 2 confirm this model and finds further that managers’ self-rated error recovery performance was associated with their general managers’ assessment of their deliverables and of their department’s overall performance.

Shining a Light on the Dark Side: How the Global Financial Crisis Exposed the Dark Side of Leadership

The global financial crisis has had innumerate outcomes around the globe. Whilst most of these are generally perceived to be negative, there are outcomes which could be considered positive for society. One such outcome is the spotlight that the financial crisis has shone on corruption within organisations and in particular, the role that destructive leaders play in the promotion of negative behaviours within organisations. This interest in identifying so-called ‘dark-side’ traits in leaders is a positive step both academically and practically. Academically, there is a limited research examining individuals with ‘dark-traits’ within organisations (Mahmut, Homewood & Stevenson, 2008). Practically, most leader derailment can be attributed to ‘dark-side’ traits and leaders with such traits are implicated in a host of issues for organisations including poor staff morale and satisfaction, bullying, poor levels of productivity, high staff turnover, unethical behaviour and even white collar crime (e.g. Boddy,2010; 2011; Lesha & Lesha, 2012; O’Boyle, Forsyth, Banks & McDaniel, 2012; Sanecka, 2013). This paper focuses on one of the ‘dark-side’ traits; psychopathy. Psychopathy is a personality disorder characterised by guiltlessness, incapacity to experience love, impulsivity, shallow emotions, superficial charm and an inability to learn from experience (Cleckley, 1941, 1982). Research has found that individuals with high levels of psychopathy can be found working within organisations and experiencing some degree of career success (e.g. Babiak, Neumann & Hare, 2010; Board & Fritzon, 2005; Boddy, 2010; Lilienfeld, Latzman, Watts, Smith & Dutton, 2014). These individuals are theoretically thought to be attracted to careers which offer power, status and monetary rewards. In particular, the finance industry has been suggested as an ideal work place for the organisational psychopath. Some authors go as far as attribute organisational psychopaths a key role in the financial crisis (Boddy, 2011). However, little research has been conducted to explore whether levels of psychopathy in employees differ across industries and what careers might be most attractive to individuals with high levels of psychopathy. This paper presents the results of a large scale survey of 265 alumni of universities in the Central England region of the UK. The survey was conducted to assess the link between levels of three factors of psychopathy (Egotism, Callousness and Antisocialism) with occupation as defined by Holland’s RIASEC model. Participants completed Brinkley, Diamond, Magaletta & Heigel’s (2008) revision of Levenson’s Self-Report Psychopathy Scale and responded to questions regarding their current occupation. Logistic regression analyses were conducted to assess whether levels of Egotism, Callousness and Antisocialism were predictive of occupation. The results showed that when compared to individuals who occupy job roles within the Social sector of Holland’s model, individuals with higher levels of psychopathy were more likely to be employed within Realistic, Investigative, Enterprising and Conventional roles. When comparing Social and Realistic roles, more Egotistical individuals were likely to be employed within Realistic roles. When comparing those employed in Social roles to Investigative, Enterprising and Conventional roles, individuals with higher levels of Antisocialism were more likely to be employed within the latter three occupations than within Social roles. This suggests that individuals with psychopathy do gravitate towards certain career paths. Social roles where job incumbents are required to be caring and interact with others to a large extent appear to be unattractive to individuals with high levels of psychopathy. Social roles are also associated with lower monetary rewards and are generally less prestigious (Henley, 2001). These individuals instead seek out occupations where there are higher levels of risk, power and reward. Roles in the Realistic category include those which include high levels of risk e.g. fighter pilot, fireman etc., (Cohen, Meir, Segal & Amar, 2003). Investigative careers hold the highest level of prestige and ranking. Enterprising roles include management positions where power is wielded over subordinates and sales roles, where customers can be manipulated (ACT, 2009). Conventional roles include those within the finance industry, which include some of the most financially lucrative positive available (Babiak & Hare, 2006). The above suggests that individuals with higher levels of psychopathy may be seeking to satisfy their self-centred natures by selecting careers which provide them with high levels of reward in one way or another. Alternatively, these individuals may select roles where their traits can be accepted. The importance of Antisocialism in predicting occupation may be testament to the importance of finding a career which ‘fits’ such traits. Antisocialism is generally associated with negative outcomes in the workplace (Ettner, MacLean & French, 2010). Therefore, finding environments tolerant of antisocial tendencies may be a priority for individuals with high levels of these traits. The results suggest that Enterprising, Investigative and Conventional work environments may be tolerant of Antisocialism in employees and Realistic environments tolerant of Egotism. Academically, the results show that there is value in studying ‘dark-side’ characteristics in organisations. Individuals with higher levels of psychopathic traits, do not appear to randomly enter employment. Instead, they appear to gravitate to careers which meet their needs and/or tolerate their traits. It is important to further explore what industries and positions are particularly attractive to individuals with higher levels of psychopathy and what makes them attractive to these individuals. Such knowledge is important for practitioners to be able to advise organisations as to the likely level of risk they face of employing organisational psychopaths and to enable organisations which are particularly attractive to highly psychopathic employees to design selection systems which detect undesirable traits in candidates. Furthermore, organisations can examine their culture to assess whether traits such as antisocialism are tolerated (or even rewarded) and what the implications of this are.

A satisfação profissional e a cultura organizacional : uma análise a partir do modelo ASH no Centro Federal de Educação Tecnológica do Rio Grande do Norte

With the need of the companies in becoming more competitive within the market, it arises an incessant search for selective human potential, with a high level of capacity and low rotativity, which motivation results in production raise, quality optimization and waste reduction. This scenario requires a strategy development which advantages the Human Resources Quality Management. This way, the model of the Human System Audit (HSA), developed by the Spanish researchers Ouijano and Navarro, presents itself as an important tool to diagnosis and evaluation, contemplating the environment where the organization is inserted, its strategies, its organizational design, its processes and its organizational effectiveness. In this sense, the present study has identified the existent relation between the professional satisfaction and the Organizational Culture, based in the model HSA. The research has been a quantitative-descriptive one and has had as population the technical-administrative workers from the Federal Center of Technical Education of Rio Grande do Norte (CEFET RN). The data collection has occurred during May, 2008, by means of the application of a questionnaire in the HSA model. The sample was composed by 167 subjects, distributed among the Five units of the institution. It was used the factorial analysis, with the extraction method of main components and orthogonal rotation varimax, in order to extract the dimensions of the satisfaction and of the organizational culture and the calculation of Cronbach s Alpha coefficient, to evaluate the reliability of these dimensions. The factorial analysis of the satisfaction indicators has identified four factors,, all of them showing significance: gratefulness and relationship , self-realization , stability and security and physical conditions and social benefits . The result of the factorial analysis with the indicators of the organizational culture has extracted four factors and among them, three of them have obtained significance: Personal Satisfaction Style , Competitive-Denial-Power Style and the Conventional-Dependent Style . After identifying the dimensions of the satisfaction and culture found at CEFET-RN, it has been notice the existence or not of relation among them, through the application of Pearson s coefficient. It has been verified that all of the dimensions of the Professional satisfaction are correlated with some dimension of the organizational culture, having in outstand position, with higher intensity, the relation between the culture style of Personal Satisfaction and the satisfaction factor referring to the self-realization

Towards Empowerment: Narrative Study of Counselling Psychology Trainees and How They Make Sense of Their Personal and Professional Development in the Context of Their Past Experiences

The discipline of counselling psychology continues to grow and change in response to social, economic and political pressures. It has been argued that its quest for a coherent and distinct identity, which emphasises the possibility of the coexistence of multiple approaches, creates an inherently uncertain and dilemmatic training environment that may hinder the development of trainees’ professional identities. In order to gain a deeper understanding of the issue at hand, the aim was to explore how final year trainees and newly qualified counselling psychologists constructed and made sense of their emerging professional identities and what experiences, past and present, they drew upon in the context of their training to shape those identities. Applying narrative inquiry to analyse eight open-ended interviews, eight preliminary themes were originally identified in participants’ narratives, which with further refinements lead to stories of struggle and marginalisation, growth and discovery, and power and resilience. Participants’ stories of struggle and marginalisation emerged in reference to early family dynamics and stressful life experiences, which seemed to also foster a strong identification with the counselling psychology profession, while stories of growth and discovery focused on the importance of having supportive figures, who helped to instill a sense of security and create an atmosphere of openness. It was in this learning environment that participants felt it was possible to develop a more resilient, empowered professional self, which allowed them to shed an earlier sense of struggle and vulnerability. However, where more of an emphasis was placed on power and resilience, there seemed to be less room for participants to express other feelings that came into conflict with their preferred sense of professional self. While there seems to be a need for a ‘safer’ climate, in which trainees could voice and acknowledge anxieties, vulnerabilities and limitations, addressing concerns around power and vulnerability that may be contributing to the silencing of particular voices and identities may be equally important if trainees are to develop coherent and distinct counselling psychologist identities.

Mothers’ perception of recovery and satisfaction with patent medicine dealers’ treatment of childhood febrile conditions in rural communities

Background Infant mortality in rural areas of Nigeria can be minimized if childhood febrile conditions are treated by trained health personnel, deployed to primary healthcare centres (PHCs) rather than the observed preference of mothers for patent medicine dealers (PMDs). However, health service utilization/patronage is driven by consumer satisfaction and perception of services/product value. The objective of this study was to determine ‘mothers’ perception of recovery’ and ‘mothers’ satisfaction’ after PMD treatment of childhood febrile conditions, as likely drivers of mothers’ health-seeking behaviour, which must be targeted to reverse the trend. Methods Ugwuogo-Nike, in Enugu, Nigeria, has many PMDs/PHCs, and was selected based on high prevalence of childhood febrile conditions. In total, 385 consenting mothers (aged 15–45 years) were consecutively recruited at PMD shops, after purchasing drugs for childhood febrile conditions, in a cross-sectional observational study using a pre-tested instrument; 33 of them (aged 21–47 years) participated in focus group discussions (FGDs). Qualitative data were thematically analysed while a quantitative study was analysed with Z score and Chi square statistics, at p < 0.05. Results Most participants in FGDs perceived that their child had delayed recovery, but were satisfied with PMDs’ treatment of childhood febrile conditions, for reasons that included politeness, caring attitude, drug availability, easy accessibility, flexibility in pricing, shorter waiting time, their God-fearing nature, and disposition as good listeners. Mothers’ satisfaction with PMDs’ treatment is significantly (p < 0.05) associated with mothers’ perception of recovery of their child (χ2 = 192.94, df = 4; p < 0.0001; Cramer’s V = 0.7079). However, predicting mothers’ satisfaction with PMDs’ treatment from a knowledge of mothers’ perception of recovery shows a high accord (lambda[A from B] = 0.8727), unlike when predicting mothers’ perception of recovery based on knowledge of mothers’ satisfaction with PMDs’ treatment (lambda[A from B] = 0.4727). Conclusions Mothers’ satisfaction could be the key ‘driver’ of mothers’ health-seeking behaviour and is less likely to be influenced by mothers’ perception of recovery of their child. Therefore, mothers’ negative perception of their child’s recovery may not induce proportionate decline in mothers’ health-seeking behaviour (patronage of PMDs), which might be influenced mainly by mothers’ satisfaction with the positive attributes of PMDs’ personality/practice and sets an important agenda for PHC reforms.

Credible or not : A study on the factors influencing consumers' credibility assessment of product placements on Instagram

Background: To align with the new trend of using social media in the marketing mix, product placement has been adapted to social media platforms as one strategy to create attention. Especially on Instagram, product placements have gained popularity among companies. While scholars have focused on measuring the effectiveness of the strategy, suggesting that credibility is one component necessary for success, a gap in the research is illuminated when focusing on what makes a product placement on Instagram credible. Previous studies regarding credibility and its relation to traditional media have concluded that there are some factors essential in consumers’ credibility evaluation process. Since social media differs from traditional media, there was a need to investigate the applicability of credibility to the social media platform Instagram. Purpose: The purpose of this thesis was to examine key factors of product placement on Instagram that influence credibility. Method: To meet the purpose of this thesis a study with a mixed method research design was conducted. The qualitative data was collected through semi-structured interviews with the intention to discover how consumers evaluate credibility. The scales and items developed from the findings of the qualitative study were tested using a questionnaire to identify which factors that have the most influence on consumers’ credibility assessment. Conclusions: The overall findings indicate that consumers evaluate credibility based upon source, message and receiver characteristics. The empirical evidence suggests that the Expertise of influencer, Professionalism of picture, Trustworthiness of influencer, Connection to influencer and Causes of irritation are the factors that have the most influence on consumers’ credibility assessment of product placement on Instagram. The findings further implies that it is not only the factor itself that influence, credibility can additionally be transferred from one factor to another.

Satisfação profissional versus metodologia de trabalho

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Enfermagem

Postoperative Bowel Function and Related Factors in Enhanced Recovery Protocol with Patients Undergoing Hepatectomy

Patients’ bowel dysfunction is a major factor that weakens the results of surgical care as it can cause pain and weaken patients’ rehabilitation. Bowel dysfunction is a common postoperative problem, yet most incidents remain undocumented. The nursing profession has a significant role in enhancing the bowel function postoperatively. However, studies of postoperative bowel function after hepatectomy are scarce and somewhat incongruous. Enhanced recovery protocols are innovative models of care aiming for better outcomes of surgical care. Enhanced recovery protocols can improve gastrointestinal function after surgery, yet patients are also known to be satisfied with their care. The aim was to investigate if postoperative bowel function day varies between patients in terms of age, gender, ASA score, type of surgery, histology, patients’ experienced pain and experienced satisfaction three days after discharge and three months after operation in patients undergoing hepatectomy. The goal was to produce information for basis of scientific research, to give nurses in clinical setting more tools to work with hepatectomy patients undergoing enhanced recovery protocol and to produce information to nurse managers to use in process management of patients undergoing enhanced recovery protocol. The design of this study is descriptive. Data was collected retrospectively from hepatectomy patients (n = 134) undergoing enhanced recovery protocol within the first year of enhanced recovery protocol implementation. The data was based on registers and analyzed statistically. Mean age of patients was 62 years and mean day of discharge was 4. Main (n = 72) histology of the patients was colorectal liver metastases. Mean bowel function day was 3. Most of the patients were very satisfied or satisfied with the care three days after discharge (99%) and three months (90%) after operation. Most of the patients (72%) experienced moderate pain three days after discharge, but three months after operation 47% of the patients did not experience pain and 48% experienced moderate pain. There were no statistically significant differences in bowel function between different age groups, genders, ASA score groups or histologies. Neither were there statistically significant differences in postoperative bowel function in terms of experienced satisfaction or pain. There were statistically significant differences in postoperative bowel function between different types of surgery (p < 0.01). Nurses should take into consideration hepatectomy patients’ type of surgery and pay special attention in supporting major open hepatectomy patients’ postoperative bowel function. Nurses should educate patients undergoing major open hepatectomy about prolonged postoperative bowel function.

Patients' satisfaction and quality of life in coronary artery disease

OBJECTIVES: To assess satisfaction of survivors of coronary artery diseases (CAD) with healthcare services and to determine whether specific components of standard health-related quality of life (HRQL) assessment tools might identify areas of satisfaction and dissatisfaction. METHOD: A specific tool developed to provide a comprehensive assessment of healthcare needs was administered concomitantly with generic and specific HRQL instruments, on 242 patients with CAD, admitted to an acute coronary unit during a single year. RESULTS: 92.5% of patients confirmed their trust in and satisfaction with the care given by their General Practitioner; even so, one third experienced difficulty getting an appointment and a quarter wanted more time for each consultation or prompt referral to a specialist when needed. Around a third expressed dissatisfaction with advice from the practice nurse or hospital consultant. Overall 54% were highly satisfied with services, 33% moderately satisfied and 13% dissatisfied.Cronbach's alpha was 0.87; the corrected total-item correlation ranged between 0.55-0.75, with trivial 'floor' score and low 'ceiling' effect. Several domains in all three HRQL tools correlated with items relating to satisfaction. The Seattle Angina Questionnaire Treatment Score correlated significantly with all satisfaction items and with the global satisfaction score. CONCLUSION: Cardiac patients' demanded better services and advice from, and more time with, health professionals and easier surgery access. The satisfaction tool showed acceptable psychometric properties. In this patient group, disease-specific HRQL tools seem more appropriate than generic tools for surveys of patient satisfaction

Paradigms that guide the models of attention to the health in Brazil: an analytic essay

SILVA, Flávio César Bezerra da ; COSTA, Francisca Marta de Lima; ANDRADE, Hamilton Leandro Pinto de; FREIRE, Lúcia de Fátima; MACIEL, Patrícia Suerda de Oliveira; ENDERS, Bertha Cruz ; MENEZES, Rejane Maria Paiva de. Paradigms that guide the models of attention to the health in Brazil: an analytic essay. Revista de Enfermagem UFPE On Line., Recife, v.3,n.4, p.460-65. out/dez. 2009. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista/search/results >.