Conocimiento acerca del cuidado de la persona com heridas: evidencias de validez del instrumento

Macedo, Eurides Araújo Bezerra de; Freitas, Camylla Cavalcante Soares de; Dionisio, Alessandra Justino; Torres, Gilson de Vasconcelos

doi:10.1590/0034-7167-2018-0643

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (6) • Nov-Dec 2019 • https://doi.org/10.1590/0034-7167-2018-0643 linkcopiar

Conocimiento acerca del cuidado de la persona com heridas: evidencias de validez del instrumento

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: identificar las evidencias de validez según los índices de dificultad y discriminación de los ítems de un instrumento con el fin de evaluar el conocimiento de académicos de enfermería en el cuidado de la persona lesionada.

Método: se trata de un estudio metodológico desarrollado en una institución de enseñanza superior de enfermería realizado entre 117 estudiantes de graduación y 38 profesionales con experiencia en el área de heridas pertenecientes a un grupo de investigación. Se recogieron los datos mediante un cuestionario de 10 preguntas de opción múltiple, aplicado antes y después de las clases sobre heridas.

Resultados: la mayoría de las cuestiones presentó un nivel bajo de dificultad y poder discriminativo ineficiente, haciéndose necesaria la revisión del instrumento. Tras dos etapas de revisión, el cuestionario demostró una mejoría de los índices de dificultad y discriminación.

Conclusión: se logró un instrumento con mejor evidencia de validez, aunque tuvo que ser perfeccionado para su posterior revalidación en la misma población.

Descriptores:
Evaluación en Enfermería; Cuidados de Enfermería; Estudios de Validez; Heridas y Lesiones; Conocimiento

Knowledge questionnaire Domains/Questions	Before knowledge Classes 1 and 2		After knowledge Classes 1 and 2		Sign test			p value
Knowledge questionnaire Domains/Questions	DIFI	DI	DIFI	DI	N	E	P	p value
Wound assessment
Q1	0.69 (M)	0.57 (S)	0.94 (B)	0.10 (I)	02	54	21	< 0.001
Q2	0.81 (B)	0.38 (A)	1.00 (B)	0.00 (I)	00	62	15	< 0.001
Q3	0.79(B)	0.43 (S)	0.92 (B)	0.19 (I)	03	61	15	< 0.001
Choice of dressing
Q4	0.75 (M)	0.62 (S)	0.88 (B)	0.24 (R)	04	59	14	0.031
Q7	0.90 (B)	0.29 (R)	0.95 (B)	0.14 (I)	03	67	07	0.344
Q8	0.17 (AT)	0.10 (I)	0.64 (M)	0.67 (S)	03	35	39	< 0.001
Dressing technique
Q5	0.57 (M)	0.62 (S)	0.83 (B)	0.29 (R)	07	43	27	< 0.001
Q6	0.81 (B)	0.48 (S)	0.87 (B)	0.38 (A)	03	66	08	0.227
Recording and orientation
Q9	0.90 (B)	0.33 (A)	0.94 (B)	0.24 (R)	03	68	06	0.508
Q10	0.87 (B)	0.38 (A)	0.94 (B)	0.14 (I)	03	66	08	0.227
Total	0.72 (M)	0.42 (S)	0.89 (B)	0.24 (R)	06	17	54	< 0.001
Cronbach's Alpha	0.515		0.040		-

2^nd application - After theoretical and practical classes Domains/Questions Index (DIFI ;DI)	Changes made to the questionnaire⁽¹⁸⁾
Wound assessment	The answer "all alternatives are correct" was replaced⁽²¹⁾.
Q1 (0.95L; 0.009I)	The answer "all alternatives are correct" was replaced⁽²¹⁾.
Q2 (1.00L;0.00I)	The answer "all alternatives are correct" was replaced ⁽²¹⁾.
Q3 (0.95L;0.18I)	Distractors were improved to be similar to the correct alternative⁽²¹⁾.
Choice of dressing	The answer "all alternatives are correct" was replaced⁽²¹⁾.
Q4 (0.88L;0.18I)	The answer "all alternatives are correct" was replaced⁽²¹⁾.
Q7 (0.95L;0.09I)	It was renamed as Q5 so that questions about the same domain are in sequence in the instrument⁽²²⁾. The answer "all alternatives are correct" was replaced⁽²¹⁾, the terms "any" and "only" were removed from the alternatives⁽²¹⁾and the distractors were improved to be similar to the correct alternative⁽²¹⁾.
Q8 (0.55M;0.91S)	It was renamed as Q6 so that questions about the same domain are in sequence in the instrument⁽²²⁾. The correct alternative and one of the distractors were altered so that all alternatives are similar⁽²¹⁾.
Dressing technique	It was renamed as Q7 so that questions about the same domain are in sequence in the instrument⁽²²⁾. Distractors were improved to be similar to the correct alternative⁽²¹⁾.
Q5 (0.90L; 0.18I)
Q6 (0.79L; 0.64S)	It was renamed as Q6 so that questions about the same domain are in sequence in the instrument⁽²²⁾. Distractors were improved to be similar to the correct alternative⁽²¹⁾.
Recording and orientation	The option that considered all the alternatives as correct was replaced⁽²¹⁾.
Q9 (0.98L; 0.00I)
Q10 (0.98L; 0.00I)	Distractors were improved⁽²¹⁾.
Total (0.89L; 0.23R)	The content of the instrument was not modified, but all the questions were reviewed.

Knowledge questionnaire Questions/Domains	3^rd application Class 2
Knowledge questionnaire Questions/Domains	DIFI	DI
Wound assessment
Q1	0.40(M)	0.73(S)
Q2	0.95(B)	0.18(I)
Q3	0.88(B)	0.18(I)
Choice of dressing
Q4	0.76(B)	0.45(S)
Q7	0.26(M)	0.64(S)
Q8	0.67(M)	0.55(S)
Dressing technique
Q5	0.62(M)	0.73(S)
Q6	0.79(B)	0.18(I)
Recording and orientation
Q9	0.83(B)	0.18(I)
Q10	0.86(B)	0.00(I)
Total	0.70(M)	0.38(A)

Knowledge questionnaire Questions/Domains	Research Group
Knowledge questionnaire Questions/Domains	DIFI	DI
Wound assessment
Q1	0.39 (M)	0.20(R)
Q2	1.00(B)	0.00 (I)
Q3	0.84(B)	0.30(A)
Choice of dressing
Q4	0.68(M)	0.50(S)
Q7	0.29(M)	0.60(S)
Q8	0.92(B)	0.00(I)
Dressing technique
Q5	0.47(M)	0.90(S)
Q6	0.92(B)	0.10 (I)
Recording and orientation
Q9	0.74(M)	0.20 (R)
Q10	0.68(M)	0.70 (S)
Total	0.69(M)	0.35 (A)

Question	Suggestion from professionals (n)	Procedure adopted/Justification
Q1	Remove "No" from question (3).	Removed/Requesting a wrong answer results in lack of clarity⁽²¹⁾.
Q1	Clearer alternatives with a single correct alternative (8).	Terms were added to the alternatives, providing greater clarity and a single correct answer⁽²¹⁾.
Q2	Remove "No" from question(7).	Removed/ Requesting a wrong answer results in lack of clarity⁽²¹⁾.
Q2	Improve clarity and specificity in the question and in the alternatives(3).	The term "skin wound" was replaced by "skin wound bed", making the question more clear and specific.
Q3	Standardize the number of signs/symptoms in the alternatives (1).	Done, making the alternatives more similar⁽²¹⁾.
Q3	Specify the type of exudate in all alternatives (2).	Done/The type of necrosis was also specified, making the alternatives more clear, complete and similar ⁽²¹⁾.
Q4	Remove the term "except" (3).	Removed/Requesting a wrong answer results in lack of clarity ⁽²¹⁾.
Q4	Clearer alternatives with a single correct alternative (3).	Terms were added to the alternatives, providing greater clarity and a single correct answer ⁽²¹⁾.
Q5	Remove the initial verbs from the alternatives (3).	Removed. It allows grammatical agreement and agreement of meaning between the question and the alternatives, avoiding the excess of verbs⁽²¹⁾.
Q5	Review the alternatives so that there is only one correct alternative(2).	Two alternatives that were correct were altered, providing a single true alternative ⁽²¹⁾.
Q6	Specify the type of debridement(2).	Not done, as this was not the purpose of the question.
Q6	Put all the debriders into a single alternative (3).	One more debrider was added in each alternative so that all are similar⁽²¹⁾. All of them were not put into a single alternative to increase the difficulty of the question.
Q7	Replace the term curative with dressing when referring to the product used in the wound bed (1).	Replaced. The term curative is broad, referring not only the product/dressing, but to the set of care given to a wound⁽²³⁾.
	Use technical terms such as "perilesional tissue" and "lesional", instead of terms such as "toward the inside of the wound" (5).	Used. The use of the different terms in nursing records makes it difficult to retrieve information, impairing the measurement of results in nursing practice, as well as the possibility of constructing evidence ⁽²⁴⁾.
	Use the term "preferably" when indicating the use of saline to clean the lesion (1).	Used. Several studies recommend different cleaning solutions; however, saline solution (0.9%) is the preferred solution for wound cleaning and it can be used safely⁽²⁵⁾.
Q8	Remove the term "independent"(2).	Removed, because it can induce the right answer⁽²¹⁾.
Q8	Use term "exudate" instead of "secretion" (3).	Used. The use of the different terms in nursing records makes it difficult to retrieve information, impairing the measurement of results in nursing practice, as well as the possibility of constructing evidence ⁽²⁴⁾.
Q9	Review the alternatives so that there is only one correct alternative(4).	All alternatives were altered, providing greater clarity and a single correct answer⁽²¹⁾.
Q10	Review the alternatives so that there is only one correct alternative (4).	Terms were added to the alternatives so that only one can be considered correct⁽²¹⁾.

Knowledge questionnaire Domains/Questions	Before knowledge Class 3		After knowledge Class 3		Sign test			p value
Knowledge questionnaire Domains/Questions	DIFI	DI	DIFI	DI	N	E	P	p value
Wound assessment
Q1	0.58 (M)	0.64 (S)	0.93 (B)	0.09 (I)	00	26	14	< 0.001
Q2	0.15 (AT)	0.45 (S)	0.63 (M)	0.36 (A)	01	19	20	< 0.001
Q3	0.50 (M)	0.55 (S)	0.70 (M)	0.64 (S)	03	26	11	0.057
Choice of dressing
Q4	0.78 (B)	0.45 (S)	0.93 (B)	0.18 (I)	02	30	08	0.109
Q7	0.73 (M)	0.18 (I)	0.95 (B)	0.09 (I)	01	29	10	0.012
Q8	0.28 (M)	0.73 (S)	0.65 (M)	0.64 (S)	05	15	20	0.004
Dressing technique
Q5	0.33 (M)	0.27 (R)	0.48 (M)	1.00 (S)	04	26	10	0.180
Q6	0.10 (AT)	0.18 (I)	0.50 (M)	0.82 (S)	01	22	17	< 0.001
Recording and orientation
Q9	0.80 (B)	0.27 (R)	0.93 (B)	0.18 (I)	01	33	06	0.125
Q10	0.95 (B)	0.18 (I)	1.00 (B)	0.00 (I)	00	38	02	0.500
Total	0.52 (M)	0.39 (A)	0.77 (B)	0.40 (S)	01	04	35	< 0.001
Cronbach's alpha	0.405		0.517		-

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[TFN1] Note: DIFI (Difficulty Index) DI (Discrimination Index), N (Negative), E (Equal), P (Positive). Difficulty Index: > 0.75 L (Low), from 0.25 to 0,75 M (Medium) and< 0.25 H (High) and Discrimination Index:< 0.20 I (Inefficient, discard or totally review), from 0.20 a 0.9 R (Review), from 0.30 to 0.39 A (Acceptable, does not require revision) ≥ 0.40 S (Satisfactory, keep item).