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1.
J Nurs Educ ; 63(9): 626-629, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39237087

RESUMO

BACKGROUND: The purpose of this qualitative study was to evaluate the effects of curricular changes made to foster graduate students' understanding of how they can be catalysts of change. For more than a decade, the concept of the citizen nurse has been woven into coursework in nursing education, thus indicating an evaluation process was needed. METHOD: Ten oral history interviews were completed with current students or alumni. Data were analyzed for codes, allowing the final themes to emerge. RESULTS: Two main themes emerged. Students reported (1) having a new understanding of what it means to be a nurse and (2) feeling more prepared to take action. CONCLUSION: Students felt more prepared to lead change as the result of curricular changes that supported their ongoing education. [J Nurs Educ. 2024;63(9):626-629.].


Assuntos
Currículo , Pesquisa Qualitativa , Estudantes de Enfermagem , Humanos , Estudantes de Enfermagem/psicologia , Pesquisa em Educação em Enfermagem , Educação de Pós-Graduação em Enfermagem/organização & administração , Feminino
2.
J Prof Nurs ; 54: 113-117, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266079

RESUMO

For one School of Nursing in a mid-sized, urban, private, liberal arts university in the upper Midwest, internal and external factors coalesced, requiring the reassessment/alignment of the baccalaureate, masters, and doctoral programs with professional standards/competencies and institutional mission/values. The development process of a new curricular framework to conceptually support the curriculum within the School of Nursing was reflective of participatory inquiry. The process closely followed the principles of the nursing complexity leadership model, complexity science, and improvement science. The new curricular framework grounds the School of Nursing's programming in a shared mental model through three functional definitions and six guiding constructs. The curricular framework development from this collaborative effort provides consistency for future curricular development and design across and within each program in the School of Nursing, shaping who we are, who we are educating, and the vision we see for our future.


Assuntos
Currículo , Escolas de Enfermagem , Humanos , Bacharelado em Enfermagem , Liderança , Modelos Educacionais , Educação de Pós-Graduação em Enfermagem , Educação em Enfermagem
3.
J Prof Nurs ; 54: 17-23, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266086

RESUMO

Public health nursing (PHN) competencies are fundamental for addressing population health inequities. Few pathways exist for employing these competencies in the United States (US). Social entrepreneurship in nursing education might provide opportunities for innovating engagement in population health. Partnerships between business and nursing schools have the potential to fulfill this opportunity. PURPOSE: Explore opportunities for re-invigorating public health nursing through social entrepreneurship education in nursing-business partnerships in U.S. universities. METHODS: Reviewed programs in nursing/business school partnerships from Carnegie-classified R1 Universities. Identified appropriate coursework. RESULTS: Of 96 identified nursing schools, eight had business school partnerships, providing 12 programs. Most programs (n = 11) targeted graduate students and addressed core competencies for entrepreneurship. Five business schools had entrepreneurship expertise. Five nursing schools had PHN expertise. Three programs included population health competencies. DISCUSSION: Despite missed opportunities for advancing social entrepreneurship education among undergraduate and graduate nursing students, existing curricular offerings in the partnerships provide promise. Business/nursing partnerships and PHN knowledge can stimulate the preparation and agency of nurses in addressing population health inequities.


Assuntos
Currículo , Empreendedorismo , Saúde da População , Enfermagem em Saúde Pública , Humanos , Estados Unidos , Enfermagem em Saúde Pública/educação , Comércio , Escolas de Enfermagem/organização & administração , Bacharelado em Enfermagem , Estudantes de Enfermagem , Educação de Pós-Graduação em Enfermagem
4.
J Prof Nurs ; 54: 194-197, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266090

RESUMO

BACKGROUND: Nurses who earn a Doctor of Nursing Practice (DNP) degree are expected to make essential contributions to the scholarship of practice and the improvement of health care outcomes. The DNP program at Duke University School of Nursing requires that students demonstrate scholarship competence by writing a manuscript based on their DNP project and submitting it for publication. PURPOSE: The purpose of this article is to share an evaluation of the effectiveness of this approach. METHODS: The authors used a bibliometric study design. RESULTS: This study demonstrates that manuscripts authored by students based on the DNP projects they conduct while earning their DNP degree can be published and are cited by other scholars. Additionally, the majority of these authors continue to publish scholarly work in the nursing and broader health-focused literature after they graduate. CONCLUSION: Nurses who developed and submit manuscripts for publication based on their DNP project contribute to the literature and evidence base for practice.


Assuntos
Educação de Pós-Graduação em Enfermagem , Editoração , Redação , Humanos , Editoração/estatística & dados numéricos , Estudantes de Enfermagem/estatística & dados numéricos , Bibliometria , Pesquisa em Enfermagem
5.
J Prof Nurs ; 54: 245-248, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266098

RESUMO

The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork.


Assuntos
Prática Avançada de Enfermagem , Comportamento Cooperativo , Profissionais de Enfermagem , Humanos , Prática Avançada de Enfermagem/educação , Profissionais de Enfermagem/educação , Relações Interprofissionais , Docentes de Enfermagem , Educação de Pós-Graduação em Enfermagem , Enfermeiros Anestesistas/educação , Educação Interprofissional
6.
J Prof Nurs ; 54: 260-263, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266101

RESUMO

Currently, there are no standardized requirements for pedagogical preparation for nurse educators at the state and national level. Various stakeholders have identified an issue in the preparation of nurse educators in academia. Current recommendations are that faculty have a master's or doctoral degree in nursing (American Association of Colleges of Nursing, 2017); however, requirements do not include educational preparation prior to or concurrent with starting a faculty position. This policy paper highlights a recommendation to require one of the following: the Certified Nurse Educator credential or certificate in teaching for educators without prior formal education in pedagogy. Outcomes of such a requirement would include nurse educators have a better understanding of the science of nursing education and preparation related to teaching. A second outcome is students receive an education that uses evidence-based teaching methods.


Assuntos
Docentes de Enfermagem , Humanos , Educação de Pós-Graduação em Enfermagem , Certificação , Estados Unidos , Ensino
7.
J Prof Nurs ; 54: 50-53, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266107

RESUMO

Simulation-based education is an evidence-based strategy to address learning and evaluation of outcomes in the updated American Association of Colleges of Nursing Essentials. Currently, there is a dearth of rigorous research on nurse practitioner education simulation. Studies on the topic often neglect a sound theoretical or conceptual framework beyond the National League of Nursing Jeffries Simulation Theory. This article aims to explore and distinguish the implementation of various theories and frameworks to determine how these elements can be stand-alone or used in combination to explore simulation-based experience competency outcomes. Specific recommendations for simulation research are (a) to include learning theories, (b) level learning and track competency progression using a framework, and (c) use a framework for measuring outcomes. Simulation science for nurse practitioner education can be advanced through united and consistent use of established theories and frameworks. These efforts will inform emerging best practices of simulation-based learning to address competition-based learning initiatives, validity of high-stakes simulation evaluation, and how to credit learners for simulation activities.


Assuntos
Competência Clínica , Profissionais de Enfermagem , Treinamento por Simulação , Profissionais de Enfermagem/educação , Humanos , Competência Clínica/normas , Educação de Pós-Graduação em Enfermagem , Aprendizagem , Pesquisa em Educação em Enfermagem
8.
J Prof Nurs ; 54: 63-67, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39266109

RESUMO

The COVID-19 pandemic disrupted lives worldwide, including students pursuing secondary education. This disruption caused increased worry, anxiety, and overall stress in students. Graduate-level nursing students also not only experienced stress related to educational disruptions but also due to work and home life upheaval as well. Faculty were challenged to support students in reducing educational stress and anxiety. While the Institute for Healthcare Improvement introduced the concept of 'Psychological Personal Protective Equipment' (PPE) to support the mental well-being of healthcare workers, this article explores how faculty implemented psychological PPE in graduate-level education using Swanson's Theory of Caring as the theoretical framework during the pandemic and how these constructs can continue to support student wellbeing in today's challenging environment.


Assuntos
COVID-19 , Educação de Pós-Graduação em Enfermagem , Equipamento de Proteção Individual , Estudantes de Enfermagem , Humanos , COVID-19/prevenção & controle , Estudantes de Enfermagem/psicologia , Estresse Psicológico , Pandemias , Empatia , Ansiedade/prevenção & controle
9.
J Am Assoc Nurse Pract ; 36(9): 477-485, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39231024

RESUMO

ABSTRACT: Simulation has been shown to improve communication and psychometric skills in advanced practice nursing students. Little is known about the impact of a simulation educational intervention with a faculty-facilitated debriefing on the preparation of novice nurse practitioner students for their first clinical practicum. This article describes the development of an educational intervention to accomplish this. The simulation education intervention was implemented with preclinical nurse practitioner students designed to improve their preparation for their first precepted clinical experience. Students were surveyed preintervention and postintervention to explore their self-perception of confidence and preparation for clinicals looking at six domains: health history, physical examination, diagnostics, differentials, final diagnosis, and plan of care. Quantitative results were statistically significant for each domain. Qualitative findings gave deeper insight into the students' perceptions of how the intervention prepared them for clinicals. Advanced practice educators can use educational interventions such as this to prepare students for their first clinical practicums.


Assuntos
Enfermeiros de Saúde da Família , Estudantes de Enfermagem , Humanos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Enfermeiros de Saúde da Família/educação , Inquéritos e Questionários , Treinamento por Simulação/métodos , Treinamento por Simulação/normas , Treinamento por Simulação/estatística & dados numéricos , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Feminino , Masculino , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/psicologia , Pesquisa Qualitativa , Educação de Pós-Graduação em Enfermagem/métodos , Adulto
11.
J Am Assoc Nurse Pract ; 36(9): 471-474, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39231022

RESUMO

ABSTRACT: Since the Doctor of Nursing Practice (DNP) was implemented, there has been ongoing discussion about whether or not DNP-prepared faculty are eligible for promotion and tenure. This column updates that discussion through input from two DNP-prepared faculty key informants.


Assuntos
Educação de Pós-Graduação em Enfermagem , Docentes de Enfermagem , Humanos , Educação de Pós-Graduação em Enfermagem/tendências , Educação de Pós-Graduação em Enfermagem/métodos , Docentes de Enfermagem/tendências , Mobilidade Ocupacional
12.
Nurs Open ; 11(9): e70031, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39240184

RESUMO

AIM: To explore the experiences and needs of postgraduate nursing students within the Nigerian context. DESIGN: This qualitative study was conducted using a descriptive phenomenological approach. METHOD: Data were collected between February and April 2022 using a purposive sampling method and telephone semi-structured interviews. Colaizzi's method of Qualitative data Analysis was utilized. Twenty-two Nigerian postgraduate nursing students were interviewed. RESULTS: Three themes emerged: challenges of Nigerian postgraduate students before the pandemic, the impact of the pandemic on postgraduate education, and innovations to improve postgraduate education in Nigeria. The challenges include the burden of physical lectures, lack of infrastructure, and poor mentorship of postgraduate nursing students. The impact of the pandemic on postgraduate education includes abrupt disruption of the academic program, a prolonged academic calendar, and a communication gap between students and their research supervisors. Innovations to improve postgraduate nursing education in Nigeria also include adoption and sustainability of e-learning, upgrading post-basic to postgraduate nursing programmes, proper structuring of postgraduate nursing education, commencement of postgraduate nursing programmes in more universities and provision of financial aid for students. Our primary finding is that funding, mentorship and infrastructure were issues peculiar to all the respondents. CONCLUSION: This study concludes that efforts should be made to maintain a seamless educational program by ensuring an uninterrupted flow of learning through virtual means, thereby enhancing effective teaching and learning. IMPLICATIONS: Graduate nursing studies is one of the suggested solutions in the WHO strategic direction for nursing and midwifery globally to achieve Universal Health Coverage . The reason is that nurses can practice with more and better skills in any work setting, thus improving the quality of health care services. Our study provides insights into the experiences of postgraduate students and how these could discourage other nurses who might have thought about furthering their studies. Efforts should be made to provide all the support that these students need, using evidence from this study and similar studies to ensure they have a good learning experience and others can be motivated to learn at the graduate level as well. This will increase the proportion of nurses and midwives honed with better skills to provide more standard quality services that will improve patient care outcomes.


Assuntos
COVID-19 , Educação de Pós-Graduação em Enfermagem , Pesquisa Qualitativa , Estudantes de Enfermagem , Humanos , Nigéria , COVID-19/psicologia , Estudantes de Enfermagem/psicologia , Feminino , Masculino , Adulto , Pandemias , SARS-CoV-2 , Avaliação das Necessidades , Mentores/psicologia , Entrevistas como Assunto
13.
J Am Assoc Nurse Pract ; 36(9): 512-522, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39137055

RESUMO

BACKGROUND: Nurse practitioners (NPs) are critical in delivering primary health care, especially in underserved and rural areas. Transitioning from academic training to practical application poses challenges, highlighting the need for structured post-licensure training (PLT). PURPOSE: To address the knowledge gap regarding the impact of PLT programs on the clinical development, confidence, and care delivery of NPs using an innovative evaluative approach. METHODOLOGY: Using a mixed-methods approach, this study engaged 19 NP fellows in quantitative and qualitative evaluations. Assessments of clinical skills and feedback were collected using the REDCap platform, focusing on mentorship and the practical application of skills. RESULTS: Quantitative analysis showed improvements in several domains: patient-centered care (median score increase from 8 to 10, p = .005), knowledge of evidence-based practice (median score from 8 to 9, p = .028), and health systems (median score from 8 to 9, p = .014). Qualitative feedback underscored the benefits of the program's structured support and practical learning experiences while revealing the need for improvements in mentor preparedness. CONCLUSIONS: The PLT program effectively advanced NP proficiency across various domains, particularly in patient-centered care and evidence-based practice. However, it also highlighted a crucial need for focused mentorship in developing leadership skills. The study's limited scope, dependence on self-reported measures, and specific statistical methods constrain the broader applicability of its findings. Future research should aim to validate these results across diverse settings and explore long-term outcomes. IMPLICATIONS: This study provides new perspectives on NP workforce development, emphasizing the importance of structured mentorship and training, especially in medically underserved communities.


Assuntos
Competência Clínica , Área Carente de Assistência Médica , Profissionais de Enfermagem , Humanos , Profissionais de Enfermagem/educação , Feminino , Masculino , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Pesquisa Qualitativa , Educação de Pós-Graduação em Enfermagem/métodos , População Rural/estatística & dados numéricos
14.
J Dr Nurs Pract ; 17(2): 68-76, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103194

RESUMO

Background: The Doctor of Nursing Practice (DNP) degree prepares nurses for engagement in practice scholarship to improve health outcomes at multiple system levels. Organizational leaders' and employers' perceptions and expectations of DNP-prepared nurses require further study. Objective: To explore the perception of organizational leaders regarding expectations and engagement of DNP-prepared nurses in practice scholarship activities. Methods: Guided by the Actualized DNP Model, a cross-sectional design was used to survey organizational leaders (N = 87) regarding DNP-prepared nurses' engagement in practice scholarship. Results: Findings indicate that 92% (n = 80) of participants believed practice scholarship should be an expectation of DNP-prepared nurses serving in a variety of roles. Of the 77 respondents to the scholarship engagement questions, 97.4% (n = 75) reported that DNP-prepared nurses engaged in one or more practice scholarship activities over the past year. Conclusions: Aligning DNP practice scholarship competencies, as outlined in the American Association of Colleges of Nursing 2021 Essentials, with organizational needs, expectations, and provision of sufficient time to support these scholarship activities is needed. Implications for Nursing: Opportunities exist for DNP-prepared nurses to articulate and demonstrate their value by conducting practice scholarship through innovative advanced nursing roles to realize organizational goals. Organizational support is necessary for practice scholarship activities to transform DNP education.


Assuntos
Educação de Pós-Graduação em Enfermagem , Bolsas de Estudo , Liderança , Humanos , Educação de Pós-Graduação em Enfermagem/organização & administração , Estudos Transversais , Masculino , Feminino , Bolsas de Estudo/organização & administração , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Papel do Profissional de Enfermagem/psicologia
15.
Nurs Educ Perspect ; 45(5): 310-312, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39101821

RESUMO

ABSTRACT: Graduate students are faced with many stressors, including school, work, and home roles. They may not have the self-care skills and support to manage the increased stress from school. Self-care goal setting check-ins were implemented in a graduate course to support students' stress management. Student resilience levels, wellness, and burnout were moderate. Students indicated the check-ins were helpful, yet still found challenges in completing self-care. They also stated less assignments and integrating more wellness into the curriculum would be helpful in supporting their self-care goals. Nursing educators can impact student wellness by providing skills and support in the curriculum.


Assuntos
Esgotamento Profissional , Currículo , Educação de Pós-Graduação em Enfermagem , Resiliência Psicológica , Autocuidado , Estudantes de Enfermagem , Humanos , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Estudantes de Enfermagem/psicologia , Feminino , Masculino , Adulto , Objetivos
16.
Nurs Educ Perspect ; 45(5): 292-297, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39101837

RESUMO

BACKGROUND: The change from a clinical nurse specialist to nurse practitioner model has significantly affected graduate education and practice because of emphasis on the dominant biomedical prescriber role, marginalizing the nurse-psychotherapy and consultation-liaison roles fundamental to quality psychiatric advanced practice nursing practice. AIM/METHOD: We report on a four-year Workforce Development Project supported by an academic-practice partnership to restore formation and skill building of the marginalized roles. Part One focuses on program design, the curriculum for nine specialty courses, and the teaching and learning community approach that promotes engagement, faculty commitment, and preceptor recruitment and retention; the creative faculty staffing model is described. RESULTS: The educational frame described includes highlights of teaching/learning strategies drawn from the history of professional formation curriculum rooted in salutogenesis and belonging science, existentialism, solution-focused therapy, modeling and role modeling theory, and Peplau's Interpersonal Relations . CONCLUSION: There is significant interest and commitment to learning the nurse-psychotherapist and consultation-liaison roles.


Assuntos
Prática Avançada de Enfermagem , Currículo , Enfermagem Psiquiátrica , Humanos , Prática Avançada de Enfermagem/educação , Enfermagem Psiquiátrica/educação , Papel do Profissional de Enfermagem/psicologia , Educação de Pós-Graduação em Enfermagem/organização & administração , Profissionais de Enfermagem/educação , Desenvolvimento de Pessoal
17.
Nurs Educ Perspect ; 45(5): E29-E34, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39120557

RESUMO

BACKGROUND: The change from clinical nurse specialist to nurse practitioner model with emphasis on the biomedical prescriber role significantly affected graduate education/practice. AIM/METHOD: This article reports solutions, lessons learned, and insights from faculty in a four-year Workforce Development Project supported by an academic-practice partnership. Lessons learned that are shared as administrative and clinical practice insights include use of experiential learning platform and interaction process recordings, confirmation of the state of nurse psychotherapy blocks to clinical placements, movement toward a salutogenic psychosocial nursing process, changing student evaluation language of preceptors, and implementation of an Advanced Practice Nursing model for clinical supervision. RESULTS: The educational hypothesis that in-person experiential learning in a workshop format with live simulations is critical to the professional development of psychiatric mental health advanced practice nursing is supported. Resistance to the cultural change operationalized through the curriculum is described. Five student reflections exemplify progress made as a result of this program. CONCLUSION: This program with its enduring educational frame was an opportunity to regain a historical momentum as nurse leaders in mental health care. There is significant interest and commitment to learning the nurse-psychotherapist and consultation-liaison roles.


Assuntos
Prática Avançada de Enfermagem , Enfermagem Psiquiátrica , Humanos , Enfermagem Psiquiátrica/educação , Prática Avançada de Enfermagem/educação , Currículo , Educação de Pós-Graduação em Enfermagem/organização & administração , Papel do Profissional de Enfermagem/psicologia , Profissionais de Enfermagem/educação , Aprendizagem Baseada em Problemas
18.
Nurs Educ Perspect ; 45(5): 316-318, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39159252

RESUMO

ABSTRACT: As the field of nursing moves toward competency-based education, faculty need to adapt teaching and learning strategies to meet standards for assessing core behaviors of graduate psychiatric mental health nurse practitioner students. This article reviews a psychotherapy skills-based learning assignment at Frontier Nursing University that was adapted to meet developing competency-based learning standards. The assignment utilizes prerecorded video scenarios to provide students with opportunities to reinforce psychotherapy skills during didactic coursework. Assessment is conducted via an analytic rubric and specific feedback is given to each student in writing.


Assuntos
Competência Clínica , Educação Baseada em Competências , Profissionais de Enfermagem , Enfermagem Psiquiátrica , Psicoterapia , Humanos , Profissionais de Enfermagem/educação , Enfermagem Psiquiátrica/educação , Competência Clínica/normas , Psicoterapia/educação , Educação de Pós-Graduação em Enfermagem , Currículo , Estudantes de Enfermagem/psicologia
19.
J Nurs Educ ; 63(8): 546-551, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39120504

RESUMO

BACKGROUND: Evidence supports the use of multi-modal approaches to develop nurse practitioner (NP) students' telehealth competency. METHOD: A virtual flipped classroom approach that included eLearning, interactive webinars, and virtual standardized patient (SP) simulations was implemented and evaluated to teach NP students to use telehealth and other connected health technologies to improve care for underserved populations. RESULTS: Analysis of data from multiple-choice quizzes, surveys, and SP evaluations indicated students achieved high levels of knowledge, met the learning objectives, demonstrated above-average competency during telehealth simulations that improved over time, and were highly satisfied with the learning experiences. CONCLUSION: The educational benefits of a flipped classroom can be realized within a fully online learning experience. Future research should examine the effects of repeated simulation opportunities on telehealth competency development. [J Nurs Educ. 2024;63(8):546-551.].


Assuntos
Competência Clínica , Profissionais de Enfermagem , Telemedicina , Humanos , Profissionais de Enfermagem/educação , Pesquisa em Educação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Educação de Pós-Graduação em Enfermagem/organização & administração , Educação a Distância/organização & administração , Aprendizagem Baseada em Problemas
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