Nursing Care during the Perioperative within the Surgical Context
DOI:
https://doi.org/10.17533/udea.iee.v40n2e02Keywords:
perioperative period, nursing care, operating rooms, surgical procedures, operativeAbstract
The study describes basic nursing care during the perioperative. Introduces the origins of perioperative nursing, general care that must be practiced with patient in this context. During the preoperative, care related with risk assessment and preparation of patient from the emotional and physical point of view are important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin, maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and symptomatology being presented by patients until they are stable and suitable for transfer to another service or their home.
Downloads
References
1. Sigurdsson, Hrafn Oli. The meaning of being a perioperative nurse. In: AORN J. 2001; 74(2):202-17.
2. Nightingale F. Nursing Notes: what it is, and what it is not. New York: Appleton and Company; 1860.
3. Archundia García A. Historia de la cirugía. En: Cirugía 1. Educación quirúrgica, 5th Ed. México: McGraw Hill; [internet] 2014.
4. González AA, Zamora HM, Contreras CJI, Ibacache FM. Cirugía ambulatoria: ¿Qué hacer en el período posoperatorio? Desde el término de la cirugía hasta el control domiciliario. Rev. Chil. Cir. 2018; 70(5):474-9.
5. Becker AM, Lane-Fall M. Transitions of Care in the Perioperative Period. Curr. Anesthesiol. Rep. 2017; 7:421–6.
6. Brown Will SE. Perioperative Nursing Care in Obstetrics and Gynecology. AORN J. 2019; 110(2):130-3.
7. Joint Commission International. Estándares de acreditación para hospitales de Joint Commission International. 5ed Oakbrook Terrace, Illinois: Joint Commission; 2014.
8. Etherington C, Wu M, Cheng-Boivin O, Larrigan S, Boet S. Interprofessional communication in the operating room: a narrative review to advance research and practice. Can. J. Anesth. 2019; 66:1251–60. https://doi.org/10.1007/s12630-019-01413-9
9. Chard R, Makary MA. Transfer-of-Care Communication: Nursing Best Practices. AORN J. 2015; 102(4):330-9.
10. AORN. Guidelines for Perioperative Practice. Denver: AORN; 2015: 583-8.
11. Morte K, Marenco C, Lammers D, Bingham J, Sohn V, Eckert M. Utilization of mobile application improves perioperative education and patient satisfaction in general surgery patients. Am. J. Surg. 2021; 221(4):788-92.
12. Gutierres LS, Santos JLG, Peiter CC, Menegon FHA, Sebold LF, Erdmann AL. Good practices for patient safety in the operating room: nurses’ recommendations. Rev. Bras. Enferm. 2018; 71(Suppl 6):2775-82.
13. Escarramán Martínez D. Manual de valoración preoperatoria para residentes [internet]. México; 2021 [Cited 7 Mar 2022] Available from: https://siemprevirtual.com/pdffree/Manual%20de%20Valoracio%CC%81n%20preoperatoria_compressed.pdf
14. Rothrock JC. Alexander`s care of the patient in surgery. 13th ed. St Louis Missouri; 2007.
15. Bedaso A, Ayalew, M. Preoperative anxiety among adult patients undergoing elective surgery: a prospective survey at a general hospital in Ethiopia. Patient Saf. Surg. 2019; 13:18.
16. Aguilera Castro F. Anestesiología y medicina perioperatoria. Bogotá: Celsus; 2010.
17. Rincón Valenzuela D, Escobar B, Torres M, Buitrago G, Gaitán Duarte H, Gómez Buitrago LM, et al. Preparación de paciente para el acto quirúrgico y traslado al quirófano. Bogotá: SCARE; 2014.
18. López Segura M. Manejo preoperatorio del paciente con Enfermedad Renal Crónica [Internet]. Anestesiar. 2021 [cited 20 Jan 2022]. Available from: https://anestesiar.org/2021/manejo-preoperatorio-del-paciente-con-enfermedad-renal-cronica/
19. Egholm JWM, Pedersen B, Møller A, Adami J, Juhl CB, Tønnesen H. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst. Rev. 2018; 11(11):CD008343.
20. Ubaldini J. Consenso de enfermedad tromboembólica, consenso argentino SAC. Rev. Argent. Cardiol. 2009; 77(5):411-28.
21. Salgueiro C, Wikinski JA. Asociación de anestesia, analgesia y reanimación de Buenos Aires. Guía para la evaluación prequirúrgica. Cirugías programadas en pacientes adultos [Internet]; 2003 [cited 18 Nov 2022] Available from: http://www.anestesia.org.ar/search/articulos_completos/1/1/671/c.php
22. Colombia. Ministerio de la Protección Social. Garantizar la funcionalidad de los procedimientos de consentimiento informado [Internet]; 2009 [cited 10 Nov 2021]. Available from: https://www.minsalud.gov.co/sites/rid/1/Garantizar%20la%20funcionalidad%20de%20los%20procedimientos%20de%20consentimiento%20informado.pdf
23. Álvarez CA, Guevara CE, Valderrama SL, Sefair CF, Cortes JA, Jiménez M F, et al. Recomendaciones prácticas para la antisepsia de la piel del paciente antes de cirugía. Infectio 2017; 21(3):182-91
24. Medina Garzón M, Castaño Plata María C, Moreno Herrera Cristhian C. Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance. Rev. Cuid 2021; 12(2):e1054.
25. Centro para el control y prevención de enfermedades, CDC. Guía para la prevención de infecciones en entornos de atención médica ambulatoria: expectativas mínimas para la atención segura [Internet]. 2016 [cited 9 Feb 2022]. Available from: https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide-spanish-508.pdf
26. Vasconez Correa MS, Reyes Rueda EY, García Maldonado JA. Manejo de sitio quirúrgico como riesgo de infección de heridas en pacientes hospitalizados. Pol. Con. 2019; 4(10):162-96.
27. Capote Guerrero G, Labrada Tapia DA, Sosa García D, Gorgoso Vázquez A. Ayuno preoperatorio. Multimed. 2020; 24(5):1221-32.
28. Abad-Torrent A. Actualización 2017. Guías prácticas para el ayuno preoperatorio. ¿Alguna novedad? Anestesiar 2018; 10(5):3.
29. Arredondo Ortiz MA, Hernández Amador JF, Villanueva Sáenz E. Preparación del colon en la cirugía colorrectal electiva. Acta Méd. Grupo Ángeles 2019; 17(1):33-7.
30. Monteiro da Costa AK, Pereira Campos MC, Santos JDM, Machado Raylane da Silva, Nogueira LT, Andrade Santos EMR. Efecto de la intervención educativa en el postoperatorio de personas con ostomias intestinales de eliminación: revisión sistemática. Enferm.Glob. 2020; 19(57):648-90.
31. Quintero A, Yasnó D A, Riveros OL, Castillo J, Borráez BA. Ansiedad en el paciente prequirúrgico: un problema que nos afecta a todos. Rev. Colomb. Cir. 2019;32(2):115-20.
32. Salazar Maya AM. Conviviendo con la ambivalencia en las interacciones de cuidado [Dissertation]. Bogotá: Universidad Nacional de Colombia; 2008.
33. Hernández RC, Gómez-Urquiza LJ, Pradas-Hernández L, Roman VK, Suleiman-Martos N, Albendín-García L, et al. Effectiveness of nursing interventions for preoperative anxiety in adults: A systematic review with meta-analysis. J. Adv. Nurs. 2021; 77(8):3274–85.
34. Remes O, Brayne C, Linde DVR, Lafortune L. A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain Behav. 2016; 6(7):e00497.
35. Jaruzel CB, Gregoski MJ. Instruments to measure preoperative acute situational anxiety: An integrative review. AANA Journal 2017; 85(1):31–5.
36. Labrague JL, McEnroe-Petitte MD. Influence of music on preoperative anxiety and physiologic parameters in women undergoing gynecologic surgery. Clin. Nurs. Res. 2016; 25(2):157–73.
37. Hernández Mayhua IH, Velásquez Rondón S. Effects of Spiritual Care on Situational Anxiety of Surgical Patients. Rev. Cub. Enferm. 2021;37(1): e3914.
38. Urchaga JD, Morán Astorga C, Fínez-Silva MJ. La religiosidad como fortaleza humana. Int. J. Dev. Euc Psychol. 2019; 1(1):309-16.
39. Fonseca M. Importancia de los aspectos espirituales y religiosos en la atención de pacientes quirúrgicos. Rev. Cir. 2016; 68(3):258-64.
40. Willis DG, Leone-Sheehan DM. Spiritual Knowing: Another Pattern of Knowing in the Discipline. Adv. Nurs. Sci. 2019; 42(1):58-68.
41. Bermejo J C. Salir de la noche. Por una enfermería humanizada. Madrid: Sal Térrea; 1999.
42. Porras-Caballero FC, Rosales Sánchez KP, Medellín Navarro DV, Sánchez Jáuregui DF. Aplicación de técnicas de relajación en pacientes preoperatorios, hospitalizados y sus cuidadores. Dilemas Contemp. Educ. Política Valores. 2020; 8(spe5): 00015.
43. Gonçalves MA, Cerejo MN. Construção e validação de uma Escala de Avaliação de Informação Pré-Operatória. Referência 2020; 5(4):e20067.
44. Torralba Madrid MJ, López Martínez D. Cuestiones éticas y legales en la práctica de la enfermería de salud mental. Rev. Rol Enferm. 1999; 22(5):362-63.
45. Morales-Castillejos Lizbeth, Gracia-Verónica Yara, Landeros-Olvera Erick. Relación de la inteligencia emocional con el cuidado otorgado por enfermeras/os. Rev. Cuid. 2020; 11(3):e989.
46. Roy MC, Stevens M, de León-Rosales SP. International society for infection disease. Guía para el control de infecciones asociadas a la atención en salud en el quirófano [Internet]. 2018. [cited 19 Mar 2022]. Available from: https://isid.org/guia/prevencion/quirofano/
47. Göras C, Olin K, Unbeck M, Pukk-Härenstam K, Ehrenberg A, Tessma MK, Nilsson U, Ekstedt M. Tasks, multitasking and interruptions among the surgical team in an operating room: A prospective observational study. BMJ Open. 2019; 9(5): e026410.
48. Ingvarsdottir E, Halldorsdottir S. Enhancing patient safety in the operating theatre: From the perspective of experienced operating theatre nurses. Scand. J. Caring Sci. 2018; 32(2):951–60.
49. National Association for Surgical Care. Competence description - advanced level - Specialist nurse in surgical medicine [Internet]; 2021 [cited 20 Feb 2022]. Available from: http://www.rfop.se/media/32blh0zu/komp-operationsskoeterska-ny-2021-foer-korr.pdf [Swedish].
50. Ekman I, Norberg A. Person-centred care. In: Flexband S.Advanced Nursing Core competencies in nursing [Internet]. Poland: Dimograf (Poland); 2021 [cited 5 May 2022]. P.49–72. Available from: https://www.adlibris.com/se/bok/omvardnad-pa-avancerad-niva-karnkompetenser-inom-sjukskoterskans-specialistomrade-9789144136240 [Swedish]
51. Hudson BF, Ogden J, Whiteley MS. A thematic analysis of experiences of varicose veins and minimally invasive surgery under local anaesthesia. J. Clin. Nurs. 2015; 24(11-12):1502–12.
52. Kim B-H, Kang H-Y, Choi E-Y. Effects of handholding and providing information on anxiety in patients undergoing percutaneous vertebroplasty. J. Clin. Nurs. 2015; 24(23-24):3459–68.
53. Pulkkinen M, Junttila K, Lindwall L. The perioperative dialogue - A model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anesthesia. Scand. J. Caring Sci. 2016; 30(1):145–53.
54. Yilmaz E, Togaç KH, Çetinkaya A, Togaç S. A qualitative study of the operating room experience of patients who underwent surgery under spinal anesthesia: “It was like an adventure”. Nurs. Health Sci. 2020; 22(3):648–57.
55. Celik F, Edipoglu IS. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res 2018, 23(1):41.
56. Haynes AC, Lywood A, Crowe EM, Fielding JL, Rossiter JM, Kent C. A calming hug: Design and validation of a tactile aid to ease anxiety. PLoS ONE. 2022; 17(3):e0259838.
57. Sepúlveda-Plata MC, García-Corzo G, Gamboa-Delgado EM. Effectiveness of nursing intervention to control. Rev. Fac. Med. 2018; 66(2):195-200.
58. Wiwatwongwana D, Vichitvejpaisal P, Thaikruea L, Klaphajone J, Tantong A, Wiwatwongwana, A. The effect of music with and without binaural beat audio on operative anxiety in patients undergoing cataract surgery: A randomized controlled trial. Eye. 2016; 30(11):1407–14.
59. Wu P-Y, Huang M-L, Lee W-P, Wang C, Shih W-M. Effects of music listening on anxiety and physiological responses in patients undergoing awake craniotomy. Complement. Ther. Med. 2017; 32:56–60.
60. Cuming RG. Concepts basic to perioperative nursing. Rothrock JC, McEwen DR, editors. Alexander´s care of the patient in surgery. 16th Ed. Elsevier Science Health Science; 2018.p:1-14.
61. Campbell DB. Anesthesia. Rothrock IJ, McEwen DR, Editors. Alexander´s care of the patient in surgery. 16th Ed. Elsevier Science Health Science; 2018. P.390-496.
62. Escobar Orozco A, Castiblanco Montañez A, Ávila Ruiz LP, Beltrán Martínez EA, Escobar Bustos JA. Cuidados de enfermería en la inserción y manejo de catéter arterial. Rev. Paraninfo Dig. 2018; XII(28):e192.
63. Bodenham A. Acceso vascular. Rev. Med. Clíni. Las Condes. 2017;28(5): 713-26.
64. Chaparro J, Oñate M. Prevención de lesiones por presión en pacientes sometidos a cirugía traumatológica prolongada, un desafío para enfermería. Rev. Med. Clíni. Las Condes. 2021; 32(5):617-23. https://doi.org/10.1016/j.rmclc.2021.09.006
65. Burlingame BL. Guideline Implementation: Positioning the Patient AORN J. 2017; 106(3):227-37.
66. Spruce L. Back to Basics: Preventing Perioperative Pressure Injuries AORN J. 2017; 105(1):92-9.
67. Kimsey DB. A Change in Focus: Shifting from Treatment to Prevention of Perioperative Pressure Injuries. AORN J. 2019; 110(4):379-93.
68. Buso FD, Ferreira MB, Felix MM, Galvão CM, Barichello E, Barbosa MH. Pressure injury related to surgical positioning and associated factors. Acta Paul. Enferm. 2021; 34:eAPE00642.
69. Chen HL, Shen WQ, Liu P, Liu K. Length of surgery and pressure ulcers risk in cardiovascular surgical patients: a dose-response meta- analysis. Int. Wound J. 2017; 14(5):864–9.
70. Oliveira KF, Pires OS, De-Mattia AL, Barichello E, Galvão CM, Araújo CA, et al. Influence of support surfaces on the distribution of body interface pressure in surgical positioning. Rev. Latino-Am. Enfermagem. 2018; 26:e3083.
71. Carvalho RLR, Campos CC, Franco LMC, Rocha AM, Ercole FF. Incidence and risk factors for surgical site infection in general surgeries. Rev. Latino-Am. Enfermagem. 2017; 25:e2848.
72. Hernández Cantú E, Esparza Dávila SP, Reyes Silva AKS. Eficacia de un modelo de prevención de infección de sitio quirúrgico en un hospital de segundo nivel de atención. Index Enferm. 2020; 29(1-2):9-12.
73. Angeleri CL, Blugerman G, Biondi H, Carbone E, Chattas A, Colombini A, et.al. La Sociedad Argentina de Infectología SADI. Guía de profilaxis antibiótica quirúrgica [Internet]. Actualización 2017 [cited 29 Nov 2021] Available from: http://clinicainfectologica2hnc.webs.fcm.unc.edu.ar/files/2018/03/GU%C3%8DA-DE-PROFILAXIS-ANTIBI%C3%93TICA-QUIR%C3%9ARGICA-SADI-2017.pdf
74. La Sociedad Argentina de Infectología SADI. Guía de profilaxis antibiótica quirúrgica. Actualización 2017 [Internet]. 2017 [cited 29 Nov 2021]. Available from: http://clinicainfectologica2hnc.webs.fcm.unc.edu.ar/files/2018/03/GU%C3%8DA-DE-PROFILAXIS-ANTIBI%C3%93TICA-QUIR%C3%9ARGICA-SADI-2017.pdf
75. Organización Mundial de la Salud. Guía de la OMS sobre Higiene de Manos en la Atención de la Salud: Resumen [Internet]. 2009 [cited 5 Nov 2021]. Available from: http://cmas.siu.buap.mx/portal_pprd/work/sites/hup/resources/LocalContent/247/2/guia_lavado_de_manos.pdf
76. Phillips N, Hornacky A, Kohn's B. Operating Room Technique. 14th Ed. St Louis Missouri: Elsevier; 2022.
77. Yi J, Zhan L, Lei Y, Xu S, Si Y, Li S, et al. Establishment and validation of a prediction equation to estimate risk of intraoperative hypothermia in patients receiving general anesthesia. Scient. Rep. 2017; 7:13927.
78. Emmert A, Gries G, Wand S, Buentzel J, Br¨auer A, Quintel M, et al. Association between perioperative hypothermia and patient outcomes after thoracic surgery. Medicine. 2018; 97: e0528.
79. Giuliano KK, Hendricks J. Inadvertent Perioperative Hypothermia: Current Nursing Knowledge. AORN J. 2017; 105(5):453–63.
80. Ribeiro E, Navarro NT, Armede VCB, Rodrigues HS, Valle JP, Duran ECM. Unintentional hypothermia frequency in the perioperative period of elective surgeries. Rev. SOBECC. 2016; 21:68–74.
81. Sagiroglu G, Ozturk GA, Baysal A, Turan FN. Inadvertent Perioperative Hypothermia and Important Risk Factors during Major Abdominal Surgeries. J. Coll. Physicians Surg. Pak. 2020; 30(2):123–8.
82. Scholten R, Leijtens B, Kremers K, Snoeck M, Koëter S. The incidence of mild hypothermia after total knee or hip arthroplasty: A study of 2600 patients. J. Orthop. 2018; 15(2):408–11.
83. Vural F, Çelik B, Deveci Z, Yasak K. Investigation of inadvertent hypothermia incidence and risk factors. Turk. J. Surg. 2018; 34(4):300–5.
84. Chacón AR. Hipotermia perioperatoria. Rev. Chil. de Anest. 2021; 50(1):56-78.
85. Mason SE, Kinross JM, Hendricks J, Arulampalam TH. Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: A cohort study with cost effectiveness analysis. Surg. Endosc. 2017; 31:1923–9.
86. Choi JW, Kim DK, Kim JK, Lee EJ, Kim JY. A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery. PloS One. 2018; 13:e0190711.
87. Kander T, Sch€ott U. Effect of hypothermia on hemostasis and bleeding risk: A narrative review. J. Int. Med. Res. 2019; 47:3559–68.
88. Akers JL, Dupnick AC, Hillman EL, Bauer AG, Kinker LM, Hagedorn Wonder A. Inadvertent Perioperative Hypothermia Risks and Postoperative Complications: A Retrospective Study. AORN J. 2019; 109(6):741–7.
89. Madrid E, Urrútia G, Roqué i Figuls M, Pardo-Hernandez H, Campos JM, Paniagua P, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Syst. Rev. 2016; 21 4(4):CD009016.
90. Martins LP, Oliveira Junior NJ, Riege F, Arregino DS. The nursery against the complications of hypothermia in the immediate post-operative. Rev. Enferm. UFPI. 2019; 8(1):68–73.
91. Collins S, Budds M, Raines C, Hooper V. Risk Factors for Perioperative Hypothermia: A Literature Review. J. Perianesth. Nurs. 2019; 34(2):338–46.
92. Fuganti CCT, Martinez EZ, Galvão CM. Effect of preheating on the maintenance of body temperature in surgical patients: a randomized clinical trial. Rev. Latino-Am. Enferm. 2018; 26: e3057.
93. Bayter-Marín JE, Rubio J, Valedón A, Macías AA. Hypothermia in elective surgery: The hidden enemy. Rev. Colomb. Anestesiol. 2017; 45:48–53.
94. Peixoto CA, Guimarães Ferreira MB, Marques dos Santos Felix M, Bueno de Moraes Pereira C, Vitor C Cândido J, Ferreira Resende Rocha V. Factors contributing to intraoperative hypothermia in patients undergoing elective surgery. Perioper. Care Oper. Room Manag. 2021; 22:1-6.
95. Zaman SS, Rahmani F, Majedi MA, Roshani D, Valiee S. A Clinical Trial of the Effect of Warm Intravenous Fluids on Core Temperature and Shivering in Patients Undergoing Abdominal Surgery. J. Perianesth. Nurs. 2018; 33(5):616-25.
96. Davidson M, Litchfield K. Patient recovery and the post-anaesthesia care unit (PACU). Anaesth. Intensive. Care. 2019; 19(9):457-60.
97. Pezzim IM, Firmino APO, Carvalho R, Romero WG, Wandekoken KD, Fiorin BH, Lopes AB. Anxiety contributes to increasing the degree of dependence on nursing care in the immediate postoperative period of bariatric surgery. REME – Rev. Min. Enferm. 2020; 24:e-1321.
98. Cook T, Woodall N, Frerk C, 4th National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br. J. Anaesth. 2011; 106(5):617-31.
99. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br. J. Anaesth. 2017; 118:317e34.
100. Elsaid RM, Namrouti AS, Samara AM. Sadaqa W, Zyoud SH. Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine. BMC Surg. 2021; 21:177.
101. Pierotti I, Larios Fracarolli1 IF, Fahl Fonseca L, Aroni P. Evaluation of the intensity and discomfort of perioperative thirst. Esc. Anna Nery. 2018; 22(3):e20170375.
102. González Pabón N, Rivera Álvarez LN. Eficacia de la música en la reducción del dolor posoperatorio de cirugía cardiaca. Av. Enferm. 2020; 38(3):358-6.
103. Pereira Portella Guerreiro M, Duarte Siqueira F, Cristiane Matte Dezordi C Kirchner RM, de Lima Dalmolin G, Fernandes Stumm EM. Estresse percebido em familiares de pacientes em sala de espera de um centro cirúrgico. Enferm. Foco. 2019; 10(4):22-7.
104. Oltra Rodríguez E, Fernández García B, Cabiedes Mira-gaya L, Riestra Rodríguez R, González Aller C, Osorio Álvarez S. Calidad percibida por usuarios de cirugía menor según nivel asistencial y profesionales que la realizan. Rev. Esp. Salud Pública. 2018;92: e201804015.
Downloads
Published
Versions
- 2023-09-20 (2)
- 2022-06-27 (1)
How to Cite
Issue
Section
License
Copyright (c) 2022 Investigación y Educación en Enfermería
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Derechos de propiedad / Direitos de Propriedade
English: If the article is accepted for publication, all copyright will be of exclusive property of Investigación y Educación en Enfermería. The text and the graphics included in the publication are exclusive responsibility of the authors and not necessarily reflect the thought of the Editorial Committee.
Español: Si el artículo es aprobado para publicación, todos los derechos son de propiedad de Investigación y Educación en Enfermería. El texto y las gráficas incluidas en la publicación son de exclusiva responsabilidad de los autores y no necesariamente refleja el pensamiento del Comité Editorial.
Português: Se o artigo for aceito para publicação, todos os direitos autorais serão de propriedade exclusiva de Investigación y Educación en Enfermería. O texto e os gráficos incluídos na publicação são de responsabilidade exclusiva dos autores e não refletem necessariamente o pensamento do Comitê Editorial.