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Complement Ther Clin Pract ; 43: 101365, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33819832


BACKGROUND AND PURPOSE: Traumatic psychological events are thought to alter brain physiology, notably regions such as the thalamus and the limbic system, affecting personal choice, autonomy, and behavior. Innovative therapies are needed to address the diverse, mental and physical consequences of these changes. Trauma Center-Trauma Sensitive Yoga (TC-TSY) has shown promising results in clinical trials among individuals experiencing posttraumatic symptomatology. MATERIALS AND METHODS: Using a qualitative, descriptive design, we examined the impact of TC-TSY training on the professional practice of seven practitioners who were certified yoga instructors and/or registered psychologists. RESULTS: The findings suggest TC-TSY training enriched their practices, chiefly through its choice-based, widely applicable approach; invitation- and mindfulness-based language; and building of therapeutic trust and attunement. Some participants questioned the accessibility and suitability of the training, as well as the rigidity of TC-TSY terminology. CONCLUSION: More research is needed to examine potential outcomes of TC-TSY practice related to self-efficacy, coping, quality of life, and stress reduction among traumatized individuals.

Trastornos por Estrés Postraumático , Yoga , Humanos , Salud Mental , Práctica Profesional , Calidad de Vida , Trastornos por Estrés Postraumático/terapia , Centros Traumatológicos
Sr Care Pharm ; 36(5): 267, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33879288


Now may be a good time to get to know the folks who represent you and your professional practice. For the next two years, Congress and the Biden Administration will be controlled by members of the same party, and that generally signals an opportunity for legislation to be passed and signed into law. In this column, we explore the best ways to engage and have your voice heard.

Práctica Profesional
Arch. argent. pediatr ; 119(2): e113-e116, abril 2021.
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1151874


En la práctica médica diaria, nos vemos envueltos en situaciones que requieren una visión integral del paciente, no solo dotada de conocimiento científico. Es aquí donde cobra importancia incorporar nociones legales, antropológicas, filosóficas y sociológicas. Todo esto puede resumirse en que tener conocimiento y formación en bioética resulta fundamental para la práctica profesional actual. De esta forma, la atención será de calidad y, además, contribuiremos al cambio de paradigma en las ciencias de la salud. El objetivo de este artículo es recorrer conceptos como persona, dignidad e interés superior del niño, y realizar una reflexión sobre la importancia que les damos en nuestra práctica profesional.

In our daily medical practice, we are constantly facing situations that require a comprehensive view of the patient, based not only on scientific knowledge, but also encompassing relevant legal, anthropological, philosophical, and sociological concepts. This can be summarized by saying that bioethical knowledge and training are critical in current professional practice. This will allow us to provide quality care while contributing to a paradigm change in health sciences. The objective of this article is to review concepts such as person, dignity, and best interests of the child, and reflect on the importance we give to them in our professional practice

Humanos , Masculino , Femenino , Defensa del Niño , Respeto , Práctica Profesional , Atención al Paciente , Derechos Humanos
J Prosthet Dent ; 125(5): 816.e1-816.e7, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33745683


STATEMENT OF PROBLEM: Whether recommendations for the use of occlusal devices are made uniformly in terms of indications, designs, and wearing time is unclear. Different recommendations may lead to different clinical outcomes. PURPOSE: The purpose of this survey was to assess the professional practice of dental surgeons in France regarding the use of occlusal devices. MATERIAL AND METHODS: A 26-question cross-sectional survey was sent to a panel of French dentists via the County Councils of the Dental Order. The questionnaire concerned the amount of occlusion-related treatment, the use of an anterior deprogramming device, stabilization splint, and anterior repositioning appliance, and the patient follow-up as well as the drawbacks of using an occlusal device as a therapeutic solution. The statistical tests used in the study were the chi-square test and the Yate correction for continuity. RESULTS: A total of 771 responses were received. Invasive options were still reported as being used as a first-line treatment for temporomandibular disorder, although a statistical difference was found between experienced and recently graduated practitioners, with recent graduates preferring noninvasive options as first-line treatment. Also, the results showed that anterior deprogramming devices were not used or that their application, particularly the length of treatment, was unfamiliar to practitioners. The anterior repositioning appliance seems to be used, but only a few practitioners integrate it into their practice. In general, about one-third of dentists appear to have a good knowledge of occlusion-related treatments, in particular, the use of occlusal devices. CONCLUSIONS: The results indicated that only 20% to 30% of practitioners have good knowledge of contemporary occlusion-related practice. There is a need for the standardization of practice and improved education for practitioners in the use of occlusal devices.

Ferulas Oclusales , Trastornos de la Articulación Temporomandibular , Estudios Transversales , Francia , Humanos , Práctica Profesional
PLoS One ; 16(3): e0234855, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33725021


This study aimed to investigate the knowledge, practices, and attitudes of medical professionals toward Traditional Chinese Medicine (TCM) for the prevention and treatment of coronavirus disease 2019 (COVID-19). All 401 medical professionals were surveyed using an anonymous with an investigator using the Questionnaire star APP. The participants answered 14 questions; of the 401 participants, 55.2% agreed with the statement "TCM can be used for the prevention and treatment of COVID-19," 40.4% remained neutral, and 4.4% disagreed. Moreover, 75.3% agreed with the statement "There is no specific drug for COVID-19," 67% agreed with the statement "TCM can develop immunity to COVID-19" and 62.1% agreed with "TCM can alleviate the symptoms of patients with COVID-19." Meanwhile, 69.1% were aware that TCM has been recommended for COVID-19 by the National Health Commission of the People's Republic of China. Regarding the selection of sources of knowledge on whether "TCM can be used for the prevention and treatment of COVID-19," There were 277, 123, 82, 369, and 17 participants selected sources from "Hospital training," "Academic journals," "Academic Conferences," "Social media platforms (such as WeChat)" and "Others," respectively. Further, 358 participants will take TCM for the prevention of COVID-19. Multiple logistic regression analysis showed that age, major and received TCM treatment within the last five years were independent factors affecting the participants' attitudes. In the absence of specific drugs for COVID-19, more than half of the participants agreed that TCM could be used for the prevention and treatment of COVID-19 and most participants are willing to take TCM to prevent COVID-19, although unsure about its effectiveness. The main information sources on TCM for the treatment and prevention of COVID-19 were social platforms and hospital training.

Actitud , Conocimiento , Medicina China Tradicional , Práctica Profesional , Profesionalismo , Adulto , /patología , China , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Medios de Comunicación Sociales , Encuestas y Cuestionarios , Adulto Joven
BMC Complement Med Ther ; 21(1): 67, 2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-33602181


BACKGROUND: This descriptive study provides the first examination of global naturopathic education, regulation and practice frameworks that have potential to constrain or assist professional formation and integration in global health systems. Despite increasing public use, a significant workforce, and World Health Organization calls for national policy development to support integration of services, existent frameworks as potential barriers to integration have not been examined. METHODS: This cross-sectional survey utilized purposive sampling of 65 naturopathic organisations (educational institutions, professional associations, and regulatory bodies) from 29 countries. Organizational representatives completed an on-line survey, conducted between Nov 2016 - Aug 2019. Frequencies and cross-tabulation statistics were analyzed using SPSSv.25. Qualitative responses were hand-coded and thematically analysed where appropriate. RESULTS: Sixty-five of 228 naturopathic organizations completed the survey (29% response rate) from 29 of 46 countries (63% country response rate). Most education programs (68%) were delivered via a national framework. Higher education qualifications (60%) predominated. Organizations influential in education were professional associations (75.4%), particularly where naturopathy was unregulated, and accreditation bodies (41.5%) and regulatory boards (33.8%) where regulated. Full access to controlled acts, and to health insurance rebates were more commonly reported where regulated. Attitude of decision-makers, opinions of other health professions and existing legislation were perceived to most impact regulation, which was globally heterogeneous. CONCLUSION: Education and regulation of the naturopathic profession has significant heterogeneity, even in the face of global calls for consistent regulation that recognizes naturopathy as a medical system. Standards are highest and consistency more apparent in countries with regulatory frameworks.

Educación Profesional , Salud Global , Naturopatía , Práctica Profesional , Control Social Formal , Acreditación , Actitud , Estudios Transversales , Prestación de Atención de Salud , Humanos , Medicina Integral , Organizaciones , Encuestas y Cuestionarios
Viana do Castelo; s.n; 20210000. ilus, tab.
Tesis en Portugués | BDENF - Enfermería | ID: biblio-1222548


Na atualidade, verifica-se um aumento da cirurgia ambulatória devido às suas inúmeras vantagens, tais como: a redução da permanência da pessoa doente em internamento hospitalar, ficando desta forma, menos exposta a processos infeciosos; a recuperação no seu ambiente familiar e um regresso mais rápido à sua atividade de vida diária. Contudo, apesar destas vantagens, existe uma diminuição de contacto com os profissionais de saúde, nomeadamente com o enfermeiro, acarretando medos e ansiedade à pessoa submetida a cirurgia ambulatória. Também a família vivencia sentimentos de medo e insegurança pelo facto de possuírem poucos conhecimentos para lidar com a situação que envolve uma cirurgia. Deste modo, torna-se importante que nas unidades de saúde hospitalar, a consulta de enfermagem pós-cirurgia ambulatória com carácter presencial se torne numa realidade, dando assim, respostas mais efetivas às necessidades da pessoa submetida a cirurgia ambulatória e família na promoção da sua qualidade de vida. Assim, tendo em conta este pressuposto pareceu-nos ser primordial realizar o estudo numa instituição hospitalar com cirurgia ambulatória, com o objetivo geral de conhecer a importância atribuída pelos enfermeiros à consulta de enfermagem presencial pós-cirurgia ambulatória, com a finalidade de contribuir para a criação de uma consulta de enfermagem pós-cirúrgica com carácter presencial, prevenindo complicações e, consequentemente, a obtenção de ganhos em saúde. Metodologia: Estudo qualitativo, exploratório descritivo; recolha de dados: entrevista semiestruturada. Participantes: enfermeiros de uma unidade hospitalar do norte de Portugal. Efetuada análise de conteúdo segundo o referencial de Bardin (2011). O estudo respeitou o princípio ético-moral. Resultados: Os enfermeiros do estudo entendem que a consulta de enfermagem presencial pós-cirurgia ambulatória é essencial para a prestação de cuidados à pessoa submetida a cirurgia ambulatória, na medida em que, permite avaliar, informar, identificar, responder às expetativas e necessidades, podendo o doente e família usufruir de uma maior qualidade de vida e bem-estar. Salientam, que a consulta de enfermagem pós-cirurgia ambulatória presencial facilita uma prestação de cuidados mais ajustados às necessidades individuais, favorece um acesso mais direto a cuidados humanizados e garante um processo de acompanhamento familiar. Realçam, que a consulta de enfermagem pós cirurgia presencial é um momento crucial para o enfermeiro realizar educação para a saúde, para avaliar eventuais complicações, para promover a expressão de sentimentos e emoções, para dar segurança e para estabelecer uma comunicação empática. Contudo, apontam como aspetos dificultadores à sua existência em contexto hospitalar o custo económico que acarreta e uma maior sobrecarga familiar. Sugerem a necessidade de existir uma maior articulação e cooperação nas equipas de saúde. A existência de enfermeiros especialistas em Enfermagem Médico-Cirúrgica na consulta de enfermagem pós-cirurgia ambulatória presencial, é fundamental para que a pessoa submetida a cirurgia ambulatória e sua família possam usufruir de cuidados especializados com reflexos na melhoria da qualidade de vida da pessoa.

Currently, there is an increase in outpatient surgery due to its numerous advantages, such as: the reduction of the sick person's stay in hospital, thus being less exposed to infectious processes; recovery in their home environment and a quicker return to their daily life activity. However, despite these advantages, there is a decrease in contact with health professionals, namely with the nurse, causing fears and anxiety to the person undergoing outpatient surgery. Also, the family experiences feelings of fear and insecurity due to the fact that they have little knowledge to deal with the situation that involves a surgery. This way, it is important that in hospital health units, nursing consultation after outpatient surgery with face-to-face character becomes a reality, giving more effective responses to the needs of the person undergoing outpatient surgery and family in promoting their quality of life. Thus, considering this assumption, it seemed to us to be essential to carry out the study in a hospital institution with outpatient surgery, with the general objective of knowing the importance attributed by nurses to the face-to-face nursing consultation after outpatient surgery, in order to contribute to the creation of a post-surgical nursing consultation with face-to-face character, preventing complications and consequently obtaining health gains. Methodology: Qualitative, exploratory, descriptive study; Data collection: semi-structured interview. Participants: Nurses from a hospital unit in northern Portugal. Content analysis was carried out according to Bardin's reference (2011). The study respected the ethical-moral principle. Results: The nurses in the study understand that the face-to-face nursing consultation of post-outpatient surgery is essential for the provision of care to the person undergoing outpatient surgery, as it allows assessing, informing, identifying, responding to expectations and needs, and the patient and family can enjoy a better quality of life and well-being. They emphasize that the face-to-face nursing consultation after ambulatory surgery facilitates the provision of care that is more adjusted to individual needs, favors a more direct access to humanized care and guarantees a family monitoring process. They emphasize that the face-to-face nursing consultation after surgery is a crucial moment for nurses to carry out health education, to assess any complications, to promote the expression of feelings and emotions, to provide security and to establish empathic communication. However, they point the economic cost that it entails and a greater family burden as difficult factors to its existence in a hospital context. They suggest the need for greater articulation and cooperation in health teams. It is essencial the existence of specialist nurses in Medical-Surgical Nursing in the face-to-face nursing consultation after outpatient surgery, so that the person undergoing outpatient surgery and his family can enjoy specialized care with reflexes in improving the person's quality of life.

Práctica Profesional , Enfermería de Consulta , Procedimientos Quirúrgicos Ambulatorios
BMC Surg ; 21(1): 51, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478441


BACKGROUND: Most evidence regarding lateral lymph node dissection for rectal cancer is from expert settings. This study aimed to evaluate the safety and efficacy of this procedure in a practice-based cohort. METHODS: A total of 383 patients who were diagnosed with stage II-III mid-to-low rectal cancer between 2010 and 2019 and underwent primary resection with curative intent at a general surgery unit were retrospectively reviewed. After propensity matching, 144 patients were divided into the following groups for short- and long-term outcome evaluation: mesorectal excision with lateral lymph node dissection (n = 72) and mesorectal excision (n = 72). RESULTS: This practice-based cohort was characterized by a high pT4 (41.6%) and R1 resection (10.4%) rate. Although the operative time was longer in the lateral dissection group (349 min vs. 237 min, p < 0.001), postoperative complications (19.4% vs. 16.7%, p = 0.829), and hospital stay (18 days vs. 22 days, p = 0.059) did not significantly differ; 5-year relapse-free survival (62.5% vs. 66.4%, p = 0.378), and cumulative local recurrence (9.7% vs. 15.3%, p = 0.451) were also in the same range in both groups. In the seven locally recurrent cases in the lateral dissection group, four had undergone R1 resection. CONCLUSIONS: Lateral lymph node dissection was found to be safe in this practice-based cohort; however, the local control effect was not obvious. To maximize the potential merits of lateral lymph node dissection, strategies need to be urgently established to avoid R1 resection in clinical practice.

Escisión del Ganglio Linfático/métodos , Neoplasias del Recto , Adulto , Anciano , Anciano de 80 o más Años , Disección , Femenino , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Práctica Profesional , Puntaje de Propensión , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Neoplasias del Recto/terapia , Estudios Retrospectivos , Resultado del Tratamiento
Am Psychol ; 76(1): 165-166, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33475390


Callahan et al. (2020) asserted that the Examination for Professional Practice in Psychology (Part 2-Skills) has not undergone appropriate validation. Although they recognized that content validity is the foundation of licensure examinations, they suggested additional validational strategies that are not recommended for licensure examination development. This response clarifies the appropriate validation standards for the examination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Concesión de Licencias , Práctica Profesional , Humanos , Estándares de Referencia
Am Psychol ; 76(1): 167-168, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33475391


Turner et al. (2021) subtly relapse in conceptualizing the Examination for Professional Practice in Psychology (Part 2-Skills) exam as a competency evaluation despite Association of State and Provincial Psychology Boards' (ASPPB) prior concession that Part 2 measures only the knowledge of skills (not skill competency). They do not address the purpose of redundant evaluation or the other concerns raised in Callahan et al. (2020). Instead, Turner et al. remain narrowly focused on defense of content validity and a reliance on outdated standards that fail to meet contemporary expectations for assessment of health care professionals. The adopted processes and procedures, albeit time consuming and effortful, are known to be methodologically inadequate. ASPPB's methods demonstrably foster linguistic biases and systemic racism that constricts licensure of diverse individuals as psychologists. Specific suggestions are offered, and ASPPB is urged to take drastic corrective action. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Racismo , Sesgo , Humanos , Práctica Profesional
AJR Am J Roentgenol ; 216(3): 844-846, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33474988


OBJECTIVE. Many models have been used to understand radiology practice, including economics, engineering, and information technology. Each has advantages, but each also has drawbacks, failing to illuminate important aspects of radiologists' work. A model that offers additional insights is ecology. CONCLUSION. By looking at radiology practice through the ecologic concept of symbiosis, radiologists can gain new understanding and appreciation of aspects of their work that can render it more fruitful and sustainable.

Ecología , Objetivos Organizacionales , Radiología/organización & administración , Ecosistema , Ingeniería , Interacciones Huésped-Parásitos , Humanos , Modelos Económicos , Modelos Teóricos , Práctica Profesional , Radiología/economía , Sistemas de Información Radiológica , Simbiosis
Khirurgiia (Mosk) ; (1): 93-97, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33395519


It is very difficult to find certain surgical field in which surgeon's decision is absolutely evidence-based. The objective of evidence-based medicine (and surgery) is offering the best treatment for each patient that should encourage conducting the randomized trials (RT) as the highest level of evidence. The results of RTs often contradict the existing clinical experience, and experience per se does not always confirm the significance of the results obtained. One cannot make any conclusions based on RT data. Treatment strategy for a particular patient remains unclear. The authors have analyzed the results of large-scale RTs devoted to laparoscopic cholecystectomy, rectal surgery, lung cancer surgery, postoperative care, treatment of pulmonary emphysema. It was shown that RT data as the highest level of evidence are not always true for surgery. In most clinical situations, the decision is not based on RT results. The desire of surgeons to master a new technique is often more significant than patient care, while clinical experience and the laws of the market are more important than science. There is no doubt that knowledge of RT results are essential in training period, but this means quite a bit for a particular patient. The best decision can be made during discussion and conversation with colleagues, where an experience of each specialist will have the same value as the best evidence.

Medicina Basada en la Evidencia/normas , Medicina de Precisión/normas , Práctica Profesional/normas , Calidad de la Atención de Salud/normas , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Operativos , Colecistectomía Laparoscópica , Competencia Clínica/normas , Toma de Decisiones , Procedimientos Quirúrgicos del Sistema Digestivo , Medicina Basada en la Evidencia/métodos , Humanos , Relaciones Interprofesionales , Cuidados Posoperatorios/normas , Enfisema Pulmonar/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos/normas
Vet Clin North Am Exot Anim Pract ; 24(1): 103-117, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33189246


Problem behaviors are a leading cause of relinquishment in pet psittacines. Exotic animal practitioners with a good understanding of diagnosis and treatment of common psittacine behavior issues are in a position to enhance the welfare of these birds and their caregivers. Reduced-stress veterinary appointments also lead to less fear and better behavior diagnoses and treatment plans. Every treatment plan focuses on physical and social enrichment, along with behavior modification to treat the motivation behind the diagnosed problem. This article describes how to conduct an appointment that provides the best opportunity for an accurate behavior diagnosis and effective treatment plan.

Bienestar del Animal , Conducta Animal , Aves , Animales , Mascotas , Práctica Profesional , Medicina Veterinaria
J Nurs Adm ; 51(1): 9-11, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33278195


This article describes a survey exploring the use of professional introductions by nurses.For this project, a survey inquiring about introduction practices was administered to nurses attending a regional research conference.

Práctica Profesional/tendencias , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Encuestas y Cuestionarios , Factores de Tiempo
Rev. enferm. UFSM ; 11: e28, 2021. tab, ilus
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1177833


Objetivo: analisar a concordância dos enfermeiros sobre as contribuições das concepções de Dorothea Orem para a prática profissional no contexto hospitalar. Método: estudo quantitativo, transversal, realizado em 36 hospitais portugueses, com participação de 3451 enfermeiros. A coleta de dados decorreu entre julho de 2015 e março de 2016, por meio de questionário. Para análise, usou-se estatística descritiva e analítica. Resultados: confirmou-se que 75 a 85% dos participantes, consideraram que as concepções de Orem com relação aos quatro conceitos metaparadigmáticos, estão de acordo ou totalmente de acordo com a sua prática. A Região do país, o serviço e a condição em que se exerce a profissão foram as variáveis que influenciaram a concordância com as concepções. Conclusão: a conformidade observada nos resultados quanto à concordância dos enfermeiros com os conceitos metaparadigmáticos, reforça o contributo do referencial de Orem para a sustentação da prática e para a garantia da cientificidade da profissão.

Objective: to analyze the concordance of nurses about the contributions of Dorothea Orem's conceptions to professional practice in the hospital context. Method: a quantitative cross-sectional study conducted in 36 Portuguese hospitals, with the participation of 3451 nurses. Data was collected using a questionnaire between July 2015 and March 2016. For analysis, descriptive and analytical statistics were used. Results: it was confirmed that 75 to 85% of the participants considered that Orem's conceptions regarding the four meta-paradigmatic concepts are in concordance or totally in concordance with their practice. The Region of the country, the service, and the condition in which the profession is practiced were the variables that influenced the concordance with the conceptions. Conclusion: the conformity observed in the results regarding the concordance of the nurses with the meta-paradigmatic concepts reinforces the contribution of Orem's framework to support the practice and to guarantee the scientificity of the profession.

Objetivo: analizar el acuerdo de enfermeros sobre las contribuciones de las concepciones de Dorothea Orem para la práctica profesional en el contexto hospitalario. Método: estudio cuantitativo, transversal, realizado en 36 hospitales portugueses, con la participación de 3451 enfermeros. La recolección de datos se llevó a cabo entre julio de 2015 y marzo de 2016, mediante un cuestionario. Para el análisis se utilizó estadística descriptiva y analítica. Resultados: se constató que 75 a 85% de los participantes consideraron que las concepciones de Orem sobre los cuatro conceptos metaparadigmáticos, están de acuerdo o totalmente de acuerdo con su práctica. La región del país, el servicio y la condición en la que se ejerce la profesión fueron las variables que influyeron en el acuerdo con las concepciones. Conclusión: la conformidad observada en los resultados sobre la concordancia de los enfermeros con los conceptos metaparadigmáticos, refuerza el aporte del marco de Orem para sostener la práctica y garantizar la cientificidad de la profesión.

Humanos , Práctica Profesional , Teoría de Enfermería , Modelos de Enfermería , Enfermería , Hospitales