Construcción y validación de un instrumento para la clasificación de las lesiones areolares del pezón derivadas de la lactancia

Cervellini, Marina Possato; Coca, Kelly Pereira; Gamba, Mônica Antar; Marcacine, Karla Oliveira; Abrão, Ana Cristina Freitas de Vilhena

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (1) • 2022 • https://doi.org/10.1590/0034-7167-2021-0051 copiar

Construcción y validación de un instrumento para la clasificación de las lesiones areolares del pezón derivadas de la lactancia

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

construir y validar una clasificación de las lesiones pezón-areolares resultantes de la lactancia materna según su contenido y apariencia.

Métodos:

estudio metodológico, desarrollado en cuatro etapas: definición operativa, construcción del instrumento, validación de contenido y apariencia. Para validar contenido y apariencia se utilizó la técnica Delphi y la escala tipo Likert, mediante la participación de diez y dieciséis jueces, respectivamente. Para el análisis se aplicó el Índice de Validez de Contenido y el Coeficiente Kappa.

Resultados:

el Índice de Validez de Contenido obtuvo un valor global de 0,93 y, por apariencia, 0,94. Los valores de Kappa oscilaron entre 0,46 y 1. Las altas tasas de acuerdo entre los jueces demostraron la calidad de la validez del contenido propuesto.

Conclusiones:

el Instrumento de Clasificación de Lesiones Pezón-Areolares desarrollado obtuvo valores aceptables para sus índices, demostrando ser válido en términos de contenido y apariencia.

Descriptores:
Lactancia Materna; Heridas y Traumatismos; Pezones; Estudio de Validación; Enfermería Obstétrica

Databases	Keywords or words
MEDLINE	1."nipples" [words] AND "sore" [words] 2."nipples" [words] AND "trauma" [words] 3."nipples" [words] AND "pain" [words]
PubMed Central	1."nipples/injuries" [mesh term] "nipples" [mesh term] AND "pain" [mesh term] 2."nipples" [mesh term] AND "sore" [words] 3."nipples/injuries" [mesh term] AND (evaluation OR classification OR signs AND symptoms [mesh term] OR treatment outcome [mesh term])
LILACS	1."mamilos" [words] AND "dor" [words] 2."mamilos" [words] AND "lesões" [words] 3."mamilos" [words] AND "trauma" [words]

Databases	Keywords or words
MEDLINE	1."estudos de validação" [type of publication] AND "lesões" [subject descriptor] AND "mamilos" [words] 2."reprodutibilidade dos testes" [subject descriptor] AND "feridas" [words] AND "mamilos" [words] "estudos de validação" [type of publication] AND "amamentação" [words] 3."estudos de validação como assunto" [subject descriptor] AND "lesões" [subject descriptor] AND "mamilos" [words]
PubMed Central	1."validation studies" [publication type] OR "validation studies as topic" [mesh term] AND "questionnaires" [words] AND "lesions" [words] AND "nipples" [words] 2."validation studies" [publication type] AND "lesions" [words] AND "nipples" [words]
LILACS	1."feridas" [words] AND "confiabilidade" [words] AND "mamilos" [words] 2."reprodutibilidade dos testes" [subject descriptor] AND "feridas" [words] AND "mamilos" [words]

First version	Content Validity Index			Kappa	Third version (after 2^nd round of answers)
First version	Clarity	Scope	Relevance	Kappa	Third version (after 2^nd round of answers)
D1. Nipple and areola complex injuries resulting from the practice of breastfeeding
1. Definition: changes in the nipple and areola complex skin, identified by (...)	0.90	0.90	0.90	1.00	1. Definition: changes in the nipple and areola complex characteristics skin during (...)
D2. Nipple and areola complex lesions without skin barrier disruption
2. Erythema: lesion with change in the natural skin color for (...)	1.00	1.00	1.00	1.00	2. Erythema: lesion characterized by the change from the natural skin color to red (...)
3. Ecchymosis or Blemish: lesion with change in the natural skin color to purplish or (...)	1.00	1.00	1.00	1.00	3. Ecchymosis: lesion characterized by the change from the natural skin color to purple (...)
4. Edema: lesion with modification of the skin's natural thickness due to fluid accumulation (...)	1.00	1.00	1.00	1.00	4. Edema: modification of the skin's natural thickness due to accumulation of fluid (plasma) in the dermis or (....)
5. Vesicle: lesion with modification of the skin's natural liquid content through the presence of a raised shape (...)	0.90	0.90	0.90	1.00	5. Vesicle: lesion with modification of the skin's natural liquid content, identified by the presence of a bulge (...)
D3. Nipple and areola complex lesions with skin barrier disruption
6. Fissure: lesion with loss of skin integrity, shape (...)	0.90	1.00	0.90	0.46	6. Fissure: linear and narrow shape continuity solution (...)
7. Erosion or Exulceration: circumscribed lesion with loss of skin integrity (...)	0.90	0.90	0.90	1.00	7. Erosion: solution of continuity of circumscribed or irregular shape, with loss of epidermis (...)
8. Crust: lesion formed in an area of tissue loss resulting from (...)	0.87	0.87	0.87	0.58	8. Crust: result of the drying of the serous, purulent exudate or (...)
Overall Content Validity Index	0.93	0.94	0.93
Global Content Validity Index	0.93

Nipple and Areola Complex Lesions Classification Instrument
Definition of nipple and areola complex lesions	Changes in the characteristics of the nipple and areola complex skin during breastfeeding, identified through changes in color, thickness, fluid content, or tissue loss.
Nipple and areola complex lesions without skin barrier disruption	Erythema	A lesion characterized by a change in the skin's natural color to red or pink in a particular nipple-areola area.
	Ecchymosis	A lesion characterized by a change in the skin's natural color to purple or brown in a particular nipple-areola area.
	Edema	Modification of the skin's natural thickness due to accumulation of fluid (plasma) in the dermis or hypodermis, with the presence of distension, shine and/or skin stiffness.
	Vesicle	A lesion with modification of the skin's natural liquid content, identified by the presence of a bulge filled with clear (serous) or white (milky) liquid, measuring up to 0.5 centimeters in diameter, located on the nipple surface.
Nipple and areola complex lesions with disruption of the skin barrier	Fissure	Linear and narrow continuity solution, which may present with bleeding or serous fluid of variable depth.
	Erosion	Continuity solution of circumscribed or irregular shape, with loss of epidermis or dermis, which may present with bleeding or serous fluid. When it occurs more superficially, it is called excoriation.
	Crust	Result of the drying of serous, purulent, or hematic exudate from a previously injured area. It can be light yellow, brown or dark red.

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[1] Corresponding author: Marina Possato Cervellini. E-mail: marina.cervellini@gmail.com