Evaluation Case Study Methodology Nursing

What is it?

Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research.1 However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’.1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables.2

Researchers describe how case studies examine complex phenomena in the natural setting to increase understanding of them.3 4 Indeed, Sandelowski5 suggests using case studies in research means that the holistic nature of nursing care can be addressed. Furthermore, when describing the steps undertaken while using a case study approach, this method of research allows the researcher to take a complex and broad topic, or phenomenon, and narrow it down into a manageable research question(s). By collecting qualitative or quantitative datasets about the phenomenon, the researcher gains a more in-depth insight into the phenomenon than would be obtained using only one type of data. This is illustrated in the examples provided at the end of this paper.

Often there are several similar cases to consider such as educational or social service programmes that are delivered from a number of locations. Although similar, they are complex and have unique features. In these circumstances, the evaluation of several, similar cases will provide a better answer to a research question than if only one case is examined, hence the multiple-case study. Stake asserts that the cases are grouped and viewed as one entity, called the quintain.6 ‘We study what is similar and different about the cases to understand the quintain better’.6


The steps when using case study methodology are the same as for other types of research.6 The first step is defining the single case or identifying a group of similar cases that can then be incorporated into a multiple-case study. A search to determine what is known about the case(s) is typically conducted. This may include a review of the literature, grey literature, media, reports and more, which serves to establish a basic understanding of the cases and informs the development of research questions. Data in case studies are often, but not exclusively, qualitative in nature. In multiple-case studies, analysis within cases and across cases is conducted. Themes arise from the analyses and assertions about the cases as a whole, or the quintain, emerge.6

Benefits and limitations of case studies

If a researcher wants to study a specific phenomenon arising from a particular entity, then a single-case study is warranted and will allow for a in-depth understanding of the single phenomenon and, as discussed above, would involve collecting several different types of data. This is illustrated in example 1 below.

Using a multiple-case research study allows for a more in-depth understanding of the cases as a unit, through comparison of similarities and differences of the individual cases embedded within the quintain. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case research. Multiple-case studies allow for more comprehensive exploration of research questions and theory development.6

Despite the advantages of case studies, there are limitations. The sheer volume of data is difficult to organise and data analysis and integration strategies need to be carefully thought through. There is also sometimes a temptation to veer away from the research focus.2 Reporting of findings from multiple-case research studies is also challenging at times,1 particularly in relation to the word limits for some journal papers.

Examples of case studies

Example 1: nurses’ paediatric pain management practices

One of the authors of this paper (AT) has used a case study approach to explore nurses’ paediatric pain management practices. This involved collecting several datasets:

  1. Observational data to gain a picture about actual pain management practices.

  2. Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.

  3. Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analysed separately and then compared7–9 and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices.7 Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice.8 There was also a difference in self-reported and observed practices9; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.

Example 2: quality of care for complex patients at Nurse Practitioner-Led Clinics (NPLCs)

The other author of this paper (RH) has conducted a multiple-case study to determine the quality of care for patients with complex clinical presentations in NPLCs in Ontario, Canada.10 Five NPLCs served as individual cases that, together, represented the quatrain. Three types of data were collected including:

  1. Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).

  2. Interviews with nurse practitioners (NPs) practising at the five NPLCs to determine their perceptions of the impact of the NPLC model on the quality of care provided to patients with multimorbidity.

  3. Chart audits conducted at the five NPLCs to determine the extent to which evidence-based guidelines were followed for patients with diabetes and at least one other chronic condition.

The three sources of data collected from the five NPLCs were analysed and themes arose related to the quality of care for complex patients at NPLCs. The multiple-case study confirmed that nurse practitioners are the primary care providers at the NPLCs, and this positively impacts the quality of care for patients with multimorbidity. Healthcare policy, such as lack of an increase in salary for NPs for 10 years, has resulted in issues in recruitment and retention of NPs at NPLCs. This, along with insufficient resources in the communities where NPLCs are located and high patient vulnerability at NPLCs, have a negative impact on the quality of care.10


These examples illustrate how collecting data about a single case or multiple cases helps us to better understand the phenomenon in question. Case study methodology serves to provide a framework for evaluation and analysis of complex issues. It shines a light on the holistic nature of nursing practice and offers a perspective that informs improved patient care.


  1. 1.↵
  2. 2.↵
  3. 3.↵
  4. 4.↵
  5. 5.↵
  6. 6.↵
  7. 7.↵
  8. 8.↵
  9. 9.↵
  10. 10.↵


1 Yin RK. Estudo de caso: planejamento e métodos. 4ª ed. Porto Alegre (RS): Bookman; 2010. [ Links ]

2 Stake RE. Investigación com estúdio de casos. 4ª ed. Madrid (ES): Ediciones Morata; 2007. [ Links ]

3 Coimbra MNCT, Martins AMO. Estudo de caso como abordagem metodológica no ensino superior. Nuances [Internet]. 2013 Dec [cited 2016 Jun 10]; 24(3):31-46. Available from: http://revista.fct.unesp.br/index.php/Nuances/article/view/2696 [ Links ]

4 Alves-Mazzotti AJ. Usos e abusos dos estudos de caso. Cad Pesqui [Internet]. 2006 Dec [cited 2016 Jun 10]; 36(129):637-51. Available from: http://www.scielo.br/pdf/cp/v36n129/a0736129.pdf [ Links ]

5 Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm [Internet]. 2008 Dec [cited 2015 Nov 20]; 17(4):758-64. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072008000400018 [ Links ]

6 Tanaka Luiza Hiromi; Leite Maria Madalena Janurio. Processo de trabalho do enfermeiro: visão de professores de uma universidade pública. Acta Paul Enferm [Internet]. 2008 Dec [cited 2015 Aug 01]; 21(3):481-6. Available from: http://www.scielo.br/pdf/ape/v21n3/pt_16.pdf [ Links ]

7 Breen LJ, FernanDec M, O'Connor M, Pember AJ. The preparation of graduate health professionals for working with bereaved clients: an Australian perspective. Omega (Westport) [Internet]. 2012 [cited 2015 Nov 25]; 66(4):313-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23785983 [ Links ]

8 Pront L, Kelton M, Munt R, Hutton A. Living and learning in a rural environment: a nursing student perspective. Nurse Educ Today [Internet]. 2013 Mar [cited 2015 Nov 10]; 33(3):281-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22732124 [ Links ]

9 Silva APSS, Pedro ENR. Autonomia no processo de construção do conhecimento de alunos de enfermagem: o chat educacional como ferramenta de ensino. Rev Latino-Am Enfermagem [Internet]. 2010 Apr [cited 2015 Feb 10]; 18(2): [08 telas]. Available from: http://www.scielo.br/pdf/rlae/v18n2/pt_11.pdf [ Links ]

10 Silva APSS, Pedro ENR, Cogo ALP. Chat educacional em enfermagem: possibilidades de interação no meio virtual. Rev Esc Enferm USP [Internet]. 2011 Dec [cited 2015 Feb 10]; 45(5):1213-20. Available from: http://dx.doi.org/10.1590/S0080-62342011000500026 [ Links ]

11 Villela JC, Maftum MA, Paes MR. The teaching of mental health in a nursing undergraduate course: a case study. Texto Contexto Enferm [Internet]. 2013 Jun [cited 2015 Nov 15]; 22(2):397-406. Available from: http://www.scielo.br/pdf/tce/v22n2/v22n2a16 [ Links ]

12 Shattell MM, Nemitz EA, Crosson N, Zackeru AR, Starr S, Hu J, Gonzales C, et al. Culturally competent practice in a pre-licensure baccalaureate nursing program in the United States: a mixed-methods study. Nurs Educ Perspect [Internet]. 2013 Nov [cited 2015 Nov 10]; 34(6):383-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24475599 [ Links ]

13 Fortugno M, Chandra S, Espin S, Gucciardi E. Fostering successful interprofessional teamwork through an undergraduate student placement in a secondary school. J Interprof Care [Internet]. 2013 Jul [cited 2015 Nov 15]; 27(4):326-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23363312 [ Links ]

14 Johansson P, Petersson G, Nilsson G. Experience of using a personal digital assistant in nursing practice: a single case study. J Nurs Manag [Internet]. 2011 Oct [cited 2015 Nov 20]; 19(7):855-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21988433 [ Links ]

15 Cogo ALP, Pedro ENR, Silva APSS, Valli GP, Specht AM. Tecnologias digitais no ensino de graduação em enfermagem: as possibilidades metodológicas por docentes. Rev Eletr Enf [Internet]. 2011 Dec [cited 2015 Nov 10]; 13(4):657-64. Available from: http://www.fen.ufg.br/revista/v13/n4/v13n4a09.htm. [ Links ]

16 Ramos FRS, Borges LM, Brehmer LCF, Silveira LR. Formação ética do enfermeiro: indicativos de mudança na percepção de professores. Acta Paul Enferm [Internet]. 2011 Feb [cited 2015 Nov 10]; 24(4):485-92. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002011000400007 [ Links ]

17 Ramos FRS, Schoeller SD, Brehmer LCF, Amaral RFC, Melo TAP. Motivações e experiências do ensino da ética/bioética em enfermagem. Av Enferm [Internet]. 2010 Dec [cited 2015 Nov 20]; 28(2):40-7. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-45002010000200004 [ Links ]

18 Webster BJ, Goodhand K, Haith M, Unwin R. The development of service users in the provision of verbal feedback to student nurses in a clinical simulation environment. Nurse Educ Today [Internet]. 2012 Feb [cited 2016 Jan 05]; 32(2):133-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22044767 [ Links ]

19 Sousa LD, Filho WDL, Vaz MRC, Figueiredo PP. A clínica como prática arborífica e rizomórfica do trabalho em enfermagem cirúrgica. Rev Esc Enferm USP [Internet]. 2013 Aug [cited 2015 Nov 10]; 47(6):1389-96. Available from: http://www.scielo.br/scielo.php?pid=S0080-2342013000601389&script=sci_abstract&tlng=pt [ Links ]

20 Barros EJL, Santos SSC, Gomes GC, Erdmann AL, Pelzer MT, Gautério DP. Ações ecossistêmicas e gerontotecnológicas no cuidado de enfermagem complexo ao idoso estomizado. Rev Bras Enferm [Internet]. 2014 Fev [cited 2015 Nov 15]; 67(1):91-6. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672014000100091 [ Links ]

21 Duarte SCM, Stipp MAC, Mesquita MGR, Silva MM. O cuidado de enfermagem no pós-operatório de cirurgia cardíaca: um estudo de caso. Esc Anna Nery [Internet]. 2012 Dec [cited 2015 Nov 20]; 16(4):657-65. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452012000400003 [ Links ]

22 Reed CC, Gerhardt SD, Shaver K, Koebcke M, Mullins D. Case study: family presence in the OR for donation after cardiac death. AORN J [Internet]. 2012 Jul [cited 2015 Nov 10]; 96(1):34-44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22742750 [ Links ]

23 Addicott R. Supporting care home residents at the end of life. Int J Palliat Nurs [Internet] 2011 Apr [cited 2015 Nov 10]; 17(4):183-7. Available form: http://www.kingsfund.org.uk/publications/articles/supporting-care-home-residents-end-life [ Links ]

24 Bergdahl E, Benzein E, Ternestedt BM, Elmbergerf E, Andershed B. Co-creating possibilities for patients in palliative care to reach vital goals: a multiple case study of home-care nursing encounters. Nurs Inquiry [Internet]. 2013 Jan [cited 2016 Jan 10]; 20(4):341-51. Available from: http://onlinelibrary.wiley.com/doi/10.1111/nin.12022/abstract [ Links ]

25 Moore J, Prentice D, Taplay K Collaboration: what does it really mean to nurses? J Clin Nurs [Internet]. 2015 Jul [cited 2015 Nov 20]; 24(13-14):2052-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25959803 [ Links ]

26 Bells A. Opinion piece: Australian residential aged care and the quality of nursing care provision. Contemp Nurse [Internet]. 2010 Apr [cited 2015 Nov 10]; 35(1):100-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20636183 [ Links ]

27 Almond P, Lathlean J. Inequity in provision of and access to health visiting postnatal depression services. J Adv Nurs [Internet]. 2011 Nov [cited 2015 Nov 20]; 67(11):2350-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21564204 [ Links ]

28 Linder LA, Christian BJ. Nighttime sleep characteristics of hospitalized school-age children with cancer. J Spec Pediatr Nurs [Internet]. 2013 Jan [cited 2015 Nov 15]; 18(1):13-24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23289451 [ Links ]

29 Silva VG, Motta MCS, Zeitoune RCG. A prática do enfermeiro na Estratégia Saúde da Família: o caso do município de Vitória/ES. Rev Eletr Enf [Internet]. 2010 [cited 2015 Nov 10]; 12(3):441-8. Available from: https://www.researchgate.net/publication/47369017_A_pratica_do_enfermeiro_na_Estrategia_Saude_da_Familia_o_caso_do_municipio_de_VitoriaES [ Links ]

30 Favero L, Mazza VA, Lacerda MR. Vivência de enfermeira no cuidado transpessoal às famílias de neonatos egressos da unidade de terapia intensiva. Acta Paul Enferm. [Internet] 2012 [cited 2015 Nov 25]; 25(4):490-6. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002012000400002 [ Links ]

31 Kennedy C, Harbison J, Mahoney C, Jarvis A, Veitch L. Investigating the contribution of community nurses to anticipatory care: a qualitative exploratory study. J Adv Nurs. [Internet]. 2011 Jul [cited 2015 Nov 20]; 67(7):1558-67. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21332574 [ Links ]

32 Kirk PH, Boblin S, Ireland S, Robertson K. The nurse as bricoleur in falls prevention: learning from a case study of the implementation of fall prevention best practices. Worldviews Evid Based Nurs [Internet]. 2014 Apr [cited 2015 Jan 20]; 11(2):118-25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24612610 [ Links ]

33 Musau J, Baumann A, Kolotylo C, O'shea T, Bialachowski A. Infectious disease outbreaks and increased complexity of care. Int Nurs Rev [Internet]. 2015 Sep [cited 2017 Mar 01]; 62(3):404-11. Available from: http://onlinelibrary.wiley.com/doi/10.1111/inr.12188/abstract;jsessionid=C6BD0AAC3B04645DC164CCF78E62DAE5.f02t02 [ Links ]

34 Shiu AT, Lee DT, Chau JP. Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study. J Adv Nurs [Internet]. 2012 Aug [cited 2015 Dec 05]; 68(8):1780-92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22118936 [ Links ]

35 Suter E, Deutschlander S, Makwarimba E, Wilhelm A, Jackson K, Lyons SW. Workforce utilization in three continuing care facilities. Health Sociology Review [Internet]. 2014 Oct [cited 2015 Nov 10]; 23(1):65-76. Available from: http://www.tandfonline.com/doi/abs/10.5172/hesr.2014.23.1.65 [ Links ]

36 Baillie L, Gallagher A. Raising awareness of patient dignity. Nurs Stand [Internet]. 2012 Oct [cited 2015 Nov 20]; 27(5):44-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23256301 [ Links ]

37 Wegner W, Pedro ENR. A segurança do paciente nas circunstâncias de cuidado: prevenção de eventos adversos na hospitalização infantil. Rev Latino-Am Enfermagem [Internet]. 2012 Jun [cited 2015 Dec 01]; 20(3):427-34. Available from: http://www.scielo.br/scielo.php?pid=S0104-1692012000300002&script=sci_abstract&tlng=pt [ Links ]

38 Hesselink AE, Harting J. Process evaluation of a multiple risk factor perinatal programme for a hard-to-reach minority group. J Adv Nurs [Internet]. 2011 Sep [cited 2015 Oct 18]; 67(9):2026-37. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21496067 [ Links ]

39 Stringer B, Meijel BV, Karman P, Koekkoek B, Kerkhof AJFM, Beekman ATF. Collaborative care for patients with severe personality disorders: analyzing the execution process in a pilot study (Part II). Perspect Psychiatr Care [Internet]. 2015 Oct [cited 2016 Feb 10]; 51(3): 220-7. Available from: http://onlinelibrary.wiley.com/doi/10.1111/ppc.12087/abstract [ Links ]

40 Minton C. Long-term ICU patients face many challenges. Nurs N Z [Internet]. 2015 Aug [cited 2015 Nov 18]; 21(7):18-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26398995 [ Links ]

41 Ishibashi A, Ueda R, Kawano Y, Nakayama H, Matsuzaki A, Matsumura T. How to improve resilience in adolescents with cancer in Japan. J Pediatr Oncol Nurs [Internet]. 2010 Apr [cited 2015 Nov 20]; 27(2):73-93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20176917 [ Links ]

42 Gerrish K, McDonnell A, Kennedy F. The development of a framework for evaluating the impact of nurse consultant roles in the UK. J Adv Nurs [Internet]. 2013 Oct [cited 2015 Feb 10]; 69(10):2295-308. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23461489 [ Links ]

43 Elbourne HF, May A. Crafting intermediate care: one team's journey towards integration and innovation. J Res Nurs [Internet]. 2015 Feb [cited 2015 Nov 10]; 20(1): 56-71. Available from: http://jrn.sagepub.com/content/20/1/56.abstract [ Links ]

44 Leach LS, Kagawa F, Mayo A, Pugh C. Improving patient safety to reduce preventable deaths: the case of a California safety net hospital. J Healthc Qual [Internet]. 2012 Apr [cited 2015 Dec 10]; 34(2):64-76. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23552203 [ Links ]

45 Birks M, Mills J, Francis K, Coyle M, Davis J, Jones J. Models of health service delivery in remote or isolated areas of Queensland: a multiple case study. AJAN [Internet]. 2010 [cited 2015 Apr 20]; 28(1):25-34. Available from: http://researchonline.jcu.edu.au/11945/ [ Links ]

46 Kaasalainen S, Ploeg J, Donald F, Coker E, Brazil K, Misener MR, et al. Positioning clinical nurse specialists and nurse practitioners as change champions to implement a pain protocol in long-term care. Pain Manag Nurs [Internet]. 2015 Apr [cited 2015 Dec 05]; 16(2):78-88. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25439111 [ Links ]

47 Havenga Y, Poggenpoel M, Myburgh C. Developing a model: an illustration. Nurs Sci Q [Internet]. 2014 Apr [cited 2015 Dec 05]; 27(2):149-56. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24740950 [ Links ]

48 Santos JLG, Lima MADS. Gerenciamento do cuidado: ações dos enfermeiros em um serviço hospitalar de emergência. Rev Gaúcha Enferm [Internet]. 2011 Dec [cited 2015 Nov 08]; 32(4):695-702. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472011000400009 [ Links ]

49 Richards J. The risky business of supervision, 2: gaining skills and knowledge. Br J Midwifery [Internet]. 2011 Jul [cited 2015 Dec 10]; 19(7):449-52. Available from: http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=be9fc613-72f8-41bd-b7a9-c0aaf0628aff%40sessionmgr4008&vid=0&hid=4106 [ Links ]

50 Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study. BMC Health Serv Res [Internet]. 2015 Dec 3 [cited 2017 Mar 01]; 15:535. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1192-6 [ Links ]

51 Locke R, Leach C, Kitsell, Griffith J.The impact on the workload of the ward manager with the introduction of administrative assistants. J Nurs Manag [Internet]. 2011 Mar [cited 2015 Nov 20]; 19(2):177-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21375620 [ Links ]

52 Berta W, Laporte A, Kachan N. Unpacking the relationship between operational efficiency and quality of care in Ontario long-term care homes. Can J Aging [Internet]. 2010 Dec [cited 2015 Nov 10]; 29(4):543-56. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21134304 [ Links ]

53 Harrington C, Ross L, Kong T. Hidden owners, hidden profits, and poor nursing home care: a case study. Int J Health Serv [Internet]. 2015 Jul [cited 2017 Mar 01]; 45(4):779-800. Available from: http://journals.sagepub.com/doi/abs/10.1177/0020731415594772?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed [ Links ]

54 Jeong SY, Higgins I, McMillan M. Experiences with advance care planning: older people and family members' perspective. Int J Older People Nurs [Internet]. 2011 Sep [cited 2016 Feb 01]; 6(3):176-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21998863 [ Links ]

55 Senna MH, Andrade SR. Indicators and information in local health planning: the perspective of the family health strategy nurses. Texto Contexto Enferm [Internet]. 2015 Oct-Dec [cited 2017 Mar 01]; 24(4):950-8. Available from: http://www.scielo.br/pdf/tce/v24n4/pt_0104-0707-tce-24-04-00950 [ Links ]

56 Caillag JM, Martins R, Primo MAM. Estudos de caso como opção de pesquisa empírica em operações. RAE [Internet]. 2012 Aug [cited 2016 Apr 01]; 52(4):380-5. Available from: http://rae.fgv.br/rae/vol52-num4-2012/estudos-caso-como-opcao-pesquisa-empirica-em-operacoes [ Links ]

57 Neves MF, Conejero MA. Uma contribuição empírica para geração de métodos de planejamento e gestão. Rev Adm [Internet]. 2012 [cited 2016 Oct 25]; 47(4):699-714. Available from: http://www.scielo.br/pdf/rausp/v47n4/a14v47n4.pdf [ Links ]


Leave a Reply

Your email address will not be published. Required fields are marked *