CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE BRADEN QD SCALE FOR USE WITH NEONATES IN BRAZIL

Santos, Simone Vidal; Silveira, Jéssica Rodrigues; Costa, Roberta; Batalha, Luís Manuel da Cunha; Velho, Manuela Beatriz

doi:10.1590/1980-265X-TCE-2022-0044en

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Original Article • Texto contexto - enferm. 31 • 2022 • https://doi.org/10.1590/1980-265X-TCE-2022-0044en copy

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE BRADEN QD SCALE FOR USE WITH NEONATES IN BRAZIL

ADAPTACIÓN TRANSCULTURAL Y VALIDACIÓN DEL INSTRUMENTO BRADEN QD SCALE PARA SU USO CON NEONATOS EN BRASIL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to cross-culturally adapt and validate the Braden QD Scale for use with neonates in Brazil.

Method:

a methodological study of cross-cultural adaptation and observational cross-sectional validation study, carried out between December 2017 and August 2021. The participants were 10 specialists, 38 nurses and 105 newborns. The cross-cultural adaptation process involved the initial translation, synthesis, back-translation, expert committee, pre-test and approval of the adapted version of the original instrument by the author. Validation verified the validity, reliability and internal consistency psychometric properties, from simultaneous and independent application of the adapted instrument by two evaluators, and based on time evaluation from the video of five neonates at two different moments. The statistical tests performed were Content Validity Index, Cronbach's alpha and Kappa coefficient.

Results:

the Braden QD scale translation process resulted in the Portuguese version adapted for the Brazilian culture. The expert committee's Content Validity Index was ≥0.90 and that of the pre-test was ≥0.80. In interobserver reliability, all items obtained Kappa coefficients > 0.90. Cronbach's alpha was 0.773 and 0.769 for Evaluators 1 and 2, respectively, with Cronbach's alpha > 0.6 considered as reliable. In intraobserver agreement, the mean scores were not different in the practice.

Conclusion:

the instrument was cross-culturally adapted for use with neonates and children in Brazil. The Brazilian version presented statistical validity and reliability levels, proving to be valid for use in neonates in Brazil.

DESCRIPTORS:
Methods; Validation studies; Neonatal nursing; Pediatric nursing; Pressure injury; Risk measurement

Item evaluated	Description/Translation Consensus	Suggestion	Final result	Comment
Sensory perception 0. No deficit	Responsivo e não possui déficit sensorial que limita a capacidade de sentir ou comunicar desconforto.	Write the word “E” in capital letters and in bold.	Responsivo E não possui déficit sensorial que limita a capacidade de sentir ou comunicar.	Request accepted.
Friction and shear	Fricção: ocorre quando a pele se move contra as superfícies de apoio. Cisalhamento: ocorre quando a pele e a superfície óssea adjacente deslizam uma sobre a outra.	Change the word “superfícies” to “estrutura.”	Fricção: ocorre quando a pele se move contra as superfícies de apoio. Cisalhamento: ocorre quando a pele e a superfície óssea adjacente deslizam uma sobre a outra.	Not changed due to the definition of friction using the term “surface” in its description.
0. No problem	Possui força suficiente para se erguer completamente durante um movimento. Mantém boa posição corporal na cama/cadeira o tempo todo. É possível erguer o paciente completamente durante o reposicionamento.	Change “boa posição” to “posição adequada.”	Possui força suficiente para se erguer completamente durante um movimento. Mantém posição adequada do corpo na cama/cadeira o tempo todo. É possível levantar o paciente completamente durante o reposicionamento.	Suggestion accepted.
Nutrition	Dieta normal para a idade - avaliar o padrão dos últimos três dias consecutivos.	Change “normal” to “usual.”	Dieta usual para a idade - avaliar o padrão dos últimos três dias consecutivos.	Suggestion accepted.
0. Adequate	Dieta normal para a idade, fornecendo uma quantidade adequada de calorias e proteínas para promover o metabolismo e o crescimento.	Remove comma. Write the word “E” in capital letters and in bold.	Dieta para a idade fornecendo quantidade adequada de calorias E proteínas para promover o metabolismo e o crescimento.	Suggestion accepted.
Tissue perfusion and oxygenation 0. Adequate	Normotenso para a idade, e saturação de oxigênio ≥95%, e nível de hemoglobina normal, e enchimento capilar ≤2 segundos.	Write the word “E” in capital letters and in bold. Change “nível de hemoglobina normal” to “nível normal de hemoglobina” Swap terms from feminine to masculine.	Normotenso para a idade, E saturação de oxigênio ≥95%, E nível normal de hemoglobina, E tempo de enchimento capilar ≤2 segundos.	Suggestion accepted

Variables		n (%)
Gender
	Male	53 (50.5)
	Female	52 (49.5)
Delivery type
	C-section	77 (73.3)
	Vaginal delivery	28 (26.7)
Indication for C-section
	Fetal distress	27 (25.7)
	Pelvic presentation	11 (10.5)
	Hypertensive syndrome	10 (9.5)
	Placental abruption	6 (5.7)
	Twins	6 (5.7)
	Gestational Diabetes Mellitus/Macrosomia	3 (2.9)
	Malformation	2 (1.9)
	Elective	2 (1.9)
	Premature labor	2 (1.9)
	COVID	2 (1.9)
	Iterativity	1 (1)
	Infectious disease	1 (1)
Diagnoses
	Prematurity	55 (52.4)
	Pulmonary	27 (25.7)
	Others	10 (9.5)
	Neurological	5 (4.8)
	Cardiovascular	4 (3.8)
	Prematurity and pulmonary	3 (2.9)
	Musculoskeletal	1 (1.0)
	Mean (SD^†)	P50^‡ [P25; P75]	Min - Max
Weight	2,238.8 (993.3)	2,100 [1,580; 2,720]	480 - 4,600
GA^* by ultrasound, in weeks	34.1 (4.0)	34 [32; 37]	23 - 41
GA by Capurro, in weeks	33.6 (5.9)	34 [32; 37]	2 - 41

	Agreement n (%)	Disagreement n (%)	Kappa
Mobility	152 (100)	0 (0)	1.000
Perception	147 (96.7)	5 (3.3)	0.839
Friction	150 (98.7)	2 (1.3)	0,964
Nutrition	144 (94.7)	8 (5.3)	0.907
Perfusion	146 (96.1)	6 (3.9)	0.921
Number	151 (99.3)	1 (0.6)	0.992
Reposition	152 (100)	0 (0)	1.000
Risk	145 (96.7)	5 (3.3)	0.882
^*Agreement Analysis - Kappa Index

	Evaluator 1 (test-retest)			Evaluator 2 (test-retest)
	Agreement	Disagreement	Kappa	Agreement	Disagreement	Kappa
	n (%)	n (%)		n (%)	n (%)
Mobility	5 (100)	0 (0)	-	5 (100)	0 (0)	-
Perception	5 (100)	0 (0)	-	5 (100)	0 (0)	-
Friction	5 (100)	0 (0)	-	5 (100)	0 (0)	-
Nutrition	5 (100)	0 (0)	-	5 (100)	0 (0)	-
Perfusion	5 (100)	0 (0)	-	5 (100)	0 (0)	-
Number	3 (60)	2 (40)	0.444	4 (80)	1 (20)	0.688
Reposition	5 (100)	0 (0)	-	5 (100)	0 (0)	-
Risk	4 (80)	1 (20)	-	4 (80)	1 (20)	-
^*Agreement Analysis - Kappa Index

Evaluator 1	Evaluator 2	Dif^* (SD^†)	r^‡ (p)	p-value^§
Mean (SD)	Mean (SD)	Dif^* (SD^†)	r^‡ (p)	p-value^§
9.66 (3.05)	9.69 (3.04)	0.033 (0.389)	0.992 (<0.001)	0.299
^*Dif = Difference between the evaluators; †SD = Standard Deviation; ‡r = Pearson's correlation; §Paired t test.

	Test	Retest	Dif^† (SD^‡)	r^§ (p)	p^\|\|
	Mean (SD)	Mean (SD)	Dif^† (SD^‡)	r^§ (p)	p^\|\|
Evaluator 1	10.4 (1.82)	10.8 (1.92)	0.4 (0.548)	0.959 (<0.001)	0.178
Evaluator 2	10.4 (1.82)	10.6 (2.07)	0.2 (0.447)	0.982 (0.003)	0.374
^*Same Evaluator - Different times; †Dif = Difference between the evaluators; ‡SD = Standard Deviation; §r = Pearson's correlation; \|\| p = p-value as per the paired t test.

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR Simone Vidal Santos simonevidal75@gmail.com