Educational video for elderly people about nursing care in therapeutic bloodlettingABSTRACT
Objective: To create and validate an educational video for elderly people about nursing care before, during and after therapeutic bloodletting.
Method: Methodological study developed in four stages: scoping review; video construction; content validation by judges and semantic validation by the elderly people. Thirteen judges and seven elderly people participated, from September to December 2023. The judges validated the content using Google Forms® and the elderly people validated at the Collection and Transfusion Unit in a city in the interior of Mato Grosso, Brazil, with data analysis performed using the Content Validity Index.
Results: Video lasting six minutes and 19 seconds, composed of 11 scenes. It included information about therapeutic bloodletting and nursing care before, during and after the procedure. In the validation by the judges, a Content Validity Index of 0.85 was obtained and among the elderly people a 1.00.
Conclusion: Both experts and elderly individuals considered the educational video as an appropriate audiovisual resource to convey the necessary care in this therapy, judging it as a tool that presented enlightening information throughout the bloodletting process.
Descriptors:
Elderly; Bloodletting; Nursing care; Educational technology
RESUMO
Objetivo: Construir e validar um vídeo educativo para pessoas idosas sobre os cuidados de enfermagem antes, durante e após a sangria terapêutica.
Método: Estudo metodológico desenvolvido em quatro etapas: revisão de escopo; construção do vídeo; validação de conteúdo pelos juízes e semântica pelos idosos. Participaram 13 juízes e sete idosos, no período de setembro a dezembro de 2023. A validação dos juízes ocorreu pelo Google Forms® e a dos idosos na Unidade de Coleta e Transfusão numa cidade do interior do Mato Grosso, Brasil, com análise dos dados realizada pelo Índice de Validade de Conteúdo.
Resultados: Vídeo com duração de seis minutos e 19 segundos, composto de 11 cenas. Contemplou informações sobre a sangria terapêutica e os cuidados de enfermagem antes, durante e após o procedimento. Na validação dos juízes, obteve-se Índice de Validade de Conteúdo de 0,85 e entre os idosos de 1,00.
Conclusão: Os especialistas e os idosos consideraram o vídeo educativo como um recurso audiovisual adequado para transmitir os cuidados necessários nessa terapêutica, julgando-o como uma ferramenta que apresentou informações esclarecedoras em todo o processo da sangria.
Descritores:
Idoso; Sangria; Cuidados de enfermagem; Tecnologia educacional
RESUMEN
Objetivo: Construir y validar un video educativo para personas mayores sobre los cuidados de enfermería antes, durante y después de la sangría terapéutica.
Método: Estudio metodológico desarrollado en cuatro etapas: revisión de alcance; construcción de vídeos; validación de contenido por parte de jueces y semántica por parte de personas mayores. Participaron 13 jueces y siete ancianos, de septiembre a diciembre de 2023. La validación de los jueces se realizó mediante Google Forms® y la de los ancianos de la Unidad de Recolección y Transfusión de una ciudad del interior de Mato Grosso, Brasil, con análisis de datos. realizado por el Índice de Validez de Contenido.
Resultados: Vídeo de seis minutos y 19 segundos de duración, compuesto por 11 escenas. Incluía información sobre sangría terapéutica y cuidados de enfermería antes, durante y después del procedimiento. En la validación de los jueces se obtuvo un Índice de Validez de Contenido de 0.85 y entre las personas mayores fue de 1.00.
Conclusión: Los expertos y ancianos consideraron el video educativo como un recurso audiovisual apropiado para transmitir los cuidados necesarios en esta terapia, juzgándolo como una herramienta que presentó información esclarecedora durante todo el proceso de sangría.
Descriptores:
Anciano; Sangría; Cuidados de enfermería; Tecnología educativa
INTRODUCTION
Population aging is a global phenomenon that has been progressively manifesting. In recent years, the world’s population life expectancy has increased to approximately 72 years between 2015-2020, an increase of approximately 25 years when compared to the period 1950-1955. This increase occurred heterogeneously across different countries1.
In Brazil, the number of individuals aged 60 or over was 2.6 million in 1950. In 2020, it increased to 29.9 million and is estimated to reach 72.4 million in 21002. Data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) indicate that the population of Mato Grosso has aged, showing an increase in the number of people aged 65 or over. On the other hand, the age group of 0-14 years has decreased. In 2010, the ratio was 20 elderly people per 100 children, and in 2022 it increased to 34 per 100, a significant 70% increase3.
Aging is a complex process and, although aging and becoming ill are not synonymous, it is a biopsychosocial process consisting of anatomical, psychological and physiological changes that make the elderly individual more vulnerable to the onset of various diseases4. Certain hematological disorders can arise in the elderly, involving conditions related to erythrocytosis, iron overload and accumulation of toxic metabolites, such as polycythemia vera or secondary polycythemia, hemochromatosis and porphyria cutanea tarda5.
Therapeutic bloodletting, also known as phlebotomy, is indicated to treat these hematological disorders, particularly when symptoms are evident and interfere with the elderly person’s quality of life5. This is a procedure analogous to blood donation, a simple, palliative and ancient technique that involves the removal of a specific amount of blood to overcome and prevent various conditions harmful to the body6.
In the case of polycythemia vera, there is an increase in the production of erythrocytes in the bone marrow, leading to an increase in their numbers and greater blood viscosity7, increasing the risk of thrombotic events, such as cerebrovascular disease, cardiovascular disease and arterial or venous thromboembolism8. For this condition, therapeutic phlebotomy is presented as a therapeutic intervention to reduce the risk of thrombotic events9.
A large-scale, prospective, multicenter, randomized clinical trial conducted by the Grupp Italiano Malattie Ematologiche nell'Adulto (GIMEMA), aimed to evaluate the efficacy of conventional therapeutic strategies (phlebotomy, hydroxyurea or a combination of both) in preventing adverse hematologic events in a cohort of 365 Italian patients. Among the participants, 68% (n = 248) were treated with phlebotomy, while 52.6% (n = 192) received hydroxyurea. The findings indicated that phlebotomy treatment was effective in maintaining hematocrit levels below 45%, significantly reducing the incidence of thrombotic complications without evidence of an increase in severe adverse effects related to therapy8.
Hemochromatosis alters iron metabolism, resulting in its excessive deposition in multiple organs and it is associated with significant complications. A longitudinal study involving patients with primary hemochromatosis demonstrated that phlebotomy improves life expectancy. Removal of accumulated iron was shown to be effective in reversing hepatic fibrosis, cardiac dysfunction and skin hyperpigmentation10, as well as reducing fatigue11, contributing above all to quality of life.
Regarding porphyria cutanea tarda, the Clinical Protocol and Therapeutic Guidelines for Porphyrias (Protocolo Clínico e Diretrizes Terapêuticas para Porfirias)12 recommends phlebotomy as a non-drug measure to deplete body iron stores, which helps restore the activity of the enzyme uroporphyrinogen decarboxylase, whose inhibition is a key feature of porphyria cutanea tarda13.
Although it is considered a safe and low-complexity method, nursing care plays a fundamental role throughout the entire process, providing qualified and safe care. Implementing adequate care, together with the patient and their family members, helps to minimize the adverse events and reduce feelings of insecurity, fear and anxiety, promoting comfort and offering strong guidance regarding treatment14.
The use of educational technologies aimed at health education about therapeutic bloodletting becomes a relevant teaching resource by providing knowledge, shared responsibility and participation in the necessary care before, during and after the procedure to bring clarity to the therapy, contributing to better patient adherence to treatment15.
Technologies used as health education tools should consider the specificity of each person or target group16. Educational videos are classified as gerontechnology, which allows capturing the attention of the target audience, providing clear and objective information about the procedure to be performed. The use of technologies with audiovisual resources stimulates the curiosity of patients, promoting effective content assimilation, contributing to a broad and accessible understanding17.
Studies on the therapeutic bloodletting procedure focus on addressing the sociodemographic and epidemiological characterization of patients undergoing this procedure6, the main indications for therapeutic bloodletting18 and the role of the healthcare team, with an emphasis on the nursing role during the therapeutic bloodletting procedure19,20. It is necessary to invest in research that explores the aspects of health education to inform the public, especially the elderly people, about the procedure, minimizing doubts, fears and risks of adverse reactions.
Therefore, the present study aimed to create and validate an educational video for elderly people about nursing care before, during and after therapeutic bloodletting.
METHOD
This is a methodological study, result of a Master’s dissertation entitled “Educational video for elderly people on nursing care in therapeutic bloodletting”, presented to the Graduate Program in Gerontology (Professional Modality) of the Universidade Federal da Paraíba, conducted in four stages, from January to December 2023: development of a scoping review; video construction; video content validation by expert judges and semantic validation by elderly people undergoing treatment with therapeutic bloodletting.
In the first stage, a mapping of nursing care before, during, and after therapeutic phlebotomy in elderly individuals was conducted between January and March 2023, based on the guiding question: “what are the nursing care practices before, during and after therapeutic bloodletting in elderly people?”, using to the mnemonic structure PCC (Population, Concept and Context), where P = elderly; C = Nursing care; C = Therapeutic bloodletting. The databases used were: BDENF, LILACS, IBECS, SCOPUS, EMBASE, COCHRANE, Web of Science; and, for gray literature, the CAPES portal and the first 100 results on Google Scholar, using the descriptors “elderly”, “nursing care” and “bloodletting”.
Articles and/or theses addressing the topic, in any language, with no time limit, were included, and studies that did not answer the research question, that addressed therapeutic bloodletting performed by non-nursing professionals, abstracts, letters to the editor and opinion articles were excluded, resulting in a final sample of seven studies, including: resolutions21,22, articles20,23, institutional protocols24 and dissertations25,26) .
The second stage involves the video construction, based on the findings of the scoping review, which occurred in three phases: pre-production, with the construction of the script and the development of the storyboard (visual script with sequential drawings); production, with the creation of the educational video; and post-production, with the editing and finalizing the educational video, which resulted in a video lasting six minutes and 19 seconds, using the software Adobe Illustrator, Adobe After Effects 2024, Photoshop and a soundtrack from Final Cut Pro X 1027.
The third stage consisted in the validation of the appearance of the scenes and content by the judges, regarding the objectives, structure, presentation and relevance of the video, as recommended in the literature27. After this stage, the semantic validation of the video was conducted with elderly individuals.
The number of judges who participated in the content validation considered the recommendations of Pasquali28, which suggests the participation of six to twenty judges, requiring at least three individuals who are experts in the subject, and an odd number of judges was recommended to prevent tie votes.
Recruiting experts proved to be challenging due to the specificity of the topic, which is directly related to healthcare in the field of hemotherapy. Thus, the search was conducted based on recommendations of nurses from regional blood centers, following the important criteria for selecting judges. Such criteria constitute professional experience and theoretical knowledge of the subjects addressed by the evaluated instruments28, defined for this study as being a nurse, having a minimum specialist degree, with experience in therapeutic bloodletting.
A total of 20 specialist nurses, recognized as references in the field of interest of the construct were contacted via email28, two did not respond and 18 agreed to participate in the validation of the script/storyboard of the research video. However, only 13 were effectively included, as they responded within the stipulated deadline, making up the final number for the content validation of this study.
In the data collection from the judges, an invitation letter was initially sent by email and WhatsApp, inviting the participants to the video validation process. After acceptance, the link to the adapted data collection form was sent, along with the Informed Consent Form (ICF).
The instrument used for content validation by the judges was adapted from a master’s dissertation29, which is in the public domain, and was organized into two parts. The first part contained information about the ICF and general information, such as age, gender, professional qualification, city of residence, work experience, degree, institution where the degree was obtained, professional activity and experiences of the experts. The second part consisted of video scenes with the script, comprising twenty-one evaluation items distributed in three blocks, as mentioned by other authors30: block 1 - Objectives (purposes, clarity and goals); block 2 - Structure and Presentation (organization, language, characters, structure, presentation strategy, coherence and formatting); block 3 - Relevance (significance, impact, motivation and interest). All questions required mandatory responses.
The instrument was organized on a Likert scale consisting of four items, assigning a level of relevance/representativeness to the responses, as follows: 1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree. At the end of each category, there was a space for the expert to justify their response or propose suggestions in the cases of responses 1 and 2, “strongly disagree” or “disagree”.
For the semantic validation of the video, seven elderly individuals were selected, referred to the Collection and Transfusion Unit (CTU), located in the city of Barra do Garças-MT, with a medical prescription for therapeutic bloodletting. This selection followed the convenience sampling model. The eligibility criteria included individuals with an indication for bloodletting and good cognitive status, assessed using the application of the Mini Mental State Examination (MMSE). The exclusion criterion was the failure to complete the evaluation instrument.
The instrument used for semantic validation by the elderly was organized into two parts. The first part contained general information, such as age, gender, marital status, housing, whether the elderly person had previously undergone therapeutic bloodletting, and the patient’s MMSE score. The second part consisted of twenty-one evaluation items distributed in three blocks like those of the experts. Additionally, there were questions about the assessment of the educational video regarding clarity, relevance, and level of relevance of the topics addressed in the video.
This instrument was also organized on a Likert scale, like the one of the experts. All questions required mandatory responses, but it was not necessary for the elderly people to justify their answers or make suggestions.
Data analysis was performed using the Content Validity Index (CVI) for both the expert judges and the elderly individuals. This index was calculated by dividing the sum of answers 3 and 4, which represent those who agreed, by the total number of answers obtained for the item. Items that achieved an agreement index equal to or higher than 80% (0.8) were considered valid)31.
Based on the values attributed by both expert judges and elderly individuals, item-by-item agreement was verified using the Item-level Content Validity Index (I-CVI). Where the I-CVI values for an item are the proportion of responses given as “strongly agree” or “agree” divided by the total number of evaluated items28.
The research complied with the guidelines established by Resolution No. 466 of December 12, 2012, of the National Health Council and the Ministry of Health, strictly adhering to all recommendations related to the regulation of research involving human beings. The study started after obtaining favorable approval from the Research Ethics Committee (REC) of the Health Sciences Center of UFPB, under opinion number 5,960,486, CAAE: 67422623,80000,5188.
RESULTS
By mapping the evidence on nursing care related to therapeutic bloodletting, identified in a scoping review, it was possible to define the video script, presenting specific guidelines for preparing and monitoring the patient. It is recommended that the patient be initially instructed on the importance of avoiding vigorous exercise, maintaining an adequate diet and consuming approximately 240 ml of fluids before the procedure.
In the pre-procedure stage, vital signs should be monitored, and comfort should be provided by elevating the lower limbs to promote venous return and cerebral oxygenation. During bloodletting, it is essential to observe possible adverse reactions, especially in the elderly individual, such as hypotension, pallor and dizziness. After the procedure, the patient should be instructed to avoid consuming alcohol and tobacco, refrain from flexing the punctured arm, and avoid lifting heavy objects. This set of measures enables the development of a clear and effective educational script for instructional videos aimed at the target audience.
During the development process, information was included about the definition of therapeutic bloodletting, main indications, procedure duration, criteria for determining the amount of blood to be withdrawn, authorized locations to perform therapeutic bloodletting, adverse events, and nursing care before, during, and after the procedure. With this information, the first version of the storyboard was created, containing ten scenes.
A total of thirteen judges participated in the content validation process, all nurses, four of whom were male (30.8%) and nine of whom were female (69.2%). Of these, 7.7% had doctoral degrees, 15.2% had master’s degrees, and 76.9% were specialists, with ages ranging from 38 to 59 years. Five lived in the state of Mato Grosso, two in Minas Gerais, and the others in São Paulo, Ceará, Goiás, Paraíba, Mato Grosso do Sul, and Maranhão. All had expertise in therapeutic bloodletting, with experience ranging from one to 28 years. Regarding the evaluations of educational technologies in healthcare, four (30.8%) stated that they had participated previously in assessments. Regarding the evaluators’ profiles, it was found that four judges (30.8%) worked in management and nine judges (69.2%) worked in direct healthcare.
After the evaluation and corrections of the video by the expert judges, four scenes were changed and one new scene was added, totaling 11 scenes. A second version of the storyboard was developed and sent for production of the video, which lasted six minutes and nineteen seconds.
Two versions of the video were developed, the first, evaluated by the expert judges and the second, which included the changes requested by the judges. The second version was submitted for evaluation by the target audience, but no further adjustments were needed, making it the final version, available at the following link: https://youtu.be/dHuyLmzm-90?si=9_9EhWPYJy5JDwt8.
Regarding the technical validation by expert judges of the script content and the appearance of the video storyboard, all scenes were analyzed and evaluated using the instrument designed for content validation, according to the rating that best represented each participant’s opinion. Additionally, suggestions were included in case of disagreement. Chart 1 shows the first version of the storyboard and the script topics, along with the CVI rating for each scene.
The evaluation of the first version of the script with storyboard showed a variation in the CVI from 0.69 to 1, with each scene being evaluated individually. In scene 01, the definition and main indications for bloodletting were presented, aiming to provide the patient with knowledge about the proposed treatment, in which one specialist (J1) assessed that there was “no indication for bloodletting for sickle cell disease”.
In scene 02, the experts (J6, J13) requested the correction of the bloodletting duration, considering that the bloodletting takes “on average 5 to 15 minutes”. Regarding scene 03, the experts emphasize that not all states in Brazil perform bloodletting in mobile units; it can also be performed in hospital units. In scene 04, an evaluator (J4) reported that patient instructions were provided by a physician.
Scene 05 refers to the care procedure before bloodletting; the judges considered it necessary to change only the figures representing the food, as it looked like greasy food (bacon and sausage), and the figure representing water. In scene 06, the vital signs are discussed, and the experts considered it necessary to include figures to measure not only blood pressure, but also heart rate and temperature. Scene 07 had 100% agreement, with no suggestions made by the judges. Scene 08 refers to the moment of blood collection, in which the judges had a 69% agreement, emphasizing the lack of some personal protective equipment (PPE) on the nursing professionals and suggested changing the image of the bench where the blood collection equipment is placed and emphasized that the puncture site should be in the cubital region.
Scene 09 describes the nursing care procedures after bloodletting, which received 92% approval. The judges suggested changing the image of the water, leaving only a glass representing hydration. They also recommended instructing patients to avoid driving for the next 30 minutes and, if there are any adverse effects, to elevate their lower limbs and seek medical care at a health unit. In scene 10, with the elderly person saying goodbye to the nurse, the experts considered it necessary to send this elderly person, along with a companion, to the dining area before leaving the unit, due to the increased risk of falling due to age and bloodletting, and to recommend a medical follow-up as advised.
In the first version of the storyboard, it was necessary to make several corrections to the script and the figures (Chart 2). Considering all the feedback, a second version was created, which was submitted to semantic validation with the elderly people, resulting in the construction of the educational video.
In the next stage, the script underwent content validation, done by CVI, and in addition to validating the appearance of the scenes, there was a block validation stage, which allowed us to know how each participant read, analyzed and expressed their opinion and suggestions, resulting in a valid instrument.
In the first block, “Objectives: purposes, goals or objectives”, of the six items, the only one in which there was divergence was number three (the care procedure in the video is necessary and was addressed). One judge (7.7%) considered it necessary to advise the patient to seek medical care at a health unit if experienced any discomfort, low blood pressure, dizziness, fainting, palpitations, and to continue taking their daily medications. This suggestion was added and inserted into the ninth scene of the script with the storyboard.
In the second block, “Structure and Presentation - Refers to the way of presenting the instructions, including general organization, language, characters, structure, presentation strategy, coherence, and formatting”, consisting of nine items, there were discrepancies in items eight, 12, and 14. In item eight (messages are presented clearly and objectively), one judge (7.7%) pointed out that there was too much information in the scenes and suggested paying attention to the dynamic resources. When constructing the storyboard, it was necessary to show all the figures that would compose the video, and they were presented in a playful and dynamic manner, making the video attractive and dynamic.
In item 12 (the images in the video are appropriate for the content), one judge (7.7%) pointed out the need to change some figures in the storyboard, and they were modified as requested by the judges and discussed in the scenes. Item 14 (The information is well structured regarding agreement and spelling) did not reach the minimum agreement index, it showed a CVI of 0.76, a score below the required level. The experts requested a revision of the text wording and grammatical agreement. This item was reviewed and modified according to the judges’ observations.
In the third block, “Relevance - Refers to the characteristics that assess the level of significance, impact, motivation and interest of the technology”, consisting of six items, there was unanimous agreement among the judges, with a total CVI of 1.00, considered valid.
The semantic validation of the video involved the participation of seven elderly individuals, of which five (71.42%) were male and two (28.57%) were female. Six (85.71%) had a partner and lived with family members. Regarding education level, four (57.14%) had completed higher education, two (28.57%) had completed high school, and one (14.28%) had incomplete elementary school. Regarding the procedure, only one (14.28%) had already undergone therapeutic bloodletting, while the other six (85.71%) were undergoing this therapy for the first time (Table 1).
The target audience consensus was reached with a CVI of 1.00, as shown in Chart 3, and was considered valid regarding its ability to achieve the intended purpose.
DISCUSSION
Given the advancement of technology and the current demographic context, in which the population is aging worldwide, the use of technology to care for elderly people becomes essential, enabling the creation of strategies that contribute to their quality of life, which can be called by gerontechnology.
Thus, educational videos represent a significant and feasible technology for healthcare services and professionals, as they promote health literacy among patients. They use simple and accessible language, facilitating knowledge construction and exchange of information.
Additionally, it has the potential to improve the quality of nursing care provided to elderly individuals, as well as encourage self-care among them. By providing detailed information and a broader understanding of nursing care related to therapeutic bloodletting, the video stimulates nursing professionals to perform their activities with greater knowledge and confidence32. This not only promotes professional autonomy, but also offers technical and scientific support, benefiting both the healthcare team and the patients they care for.
However, for gerontechnology to be considered effective, it must have a care-educational purpose for the elderly and their families, focused on their reality. Thus, such tools must be validated by judges to ensure that the educational objectives have been met33. The number of judges may vary, however, the likelihood of errors decreases when there is at least five judges participating in the evaluation, and when considering the heterogeneity of the expert group34.
Thus, there was diversity among the judges, with participants of both sexes, holding titles ranging from doctoral degrees to master’s and specialist certifications, who lived in eight different states, with a total of 13 experts, which allowed for efficient validation of the storyboard for the creation of the educational video35.
Some disagreements reported by the experts about the scenes presented divergences in relation to the literature, but did not lead to suggestions for changes, as had already been clarified by the researcher. An example of this occurred in the first scene, in which one of the judges stated that there was “no indication for bloodletting in sickle cell disease”. However, the conditions for which bloodletting is recommended include Polycythemia Vera, Hemochromatosis, Porphyria Cutanea Tarda, Secondary Polycythemia associated with conditions such as COPD and cyanotic heart disease, as well as Sickle Cell Disease5.
Despite the judges considering the average time to be five to fifteen minutes for the procedure, in scene two, this time is related only to the blood collection36. According to the technical opinion of COREN - DF21, the duration of the blood collection is approximately fifty minutes, from the patient’s arrival until their discharge, considering the entire process from the moment the patient enters the healthcare unit.
Blood collection can be performed safely in mobile units, in hemotherapy services or in healthcare units authorized for this activity, under the supervision of professionals in the hematology/hemotherapy area. In cases of extreme necessity and physical inability of the patient to travel, bloodletting can be performed at home, as long as it is supervised by a physician and a trained nursing team21,22.
During the validation process of the scenes, most of the judges contributed suggestions, which were accepted to restructure the narrative, adapting the script and storyboard to the health education purpose, and increasing the reliability of the educational material.
For this reason, to better detail the construction of the educational video, aiming at health literacy, in the storyboard construction phase, it was necessary to present all the figures that would compose the video in a playful and dynamic manner, making the video attractive. After all, the construction of the video aimed to address the topic in a dynamic and explanatory way, using illustrations as a learning tool, facilitating the educational process with engaging information for learning the topic addressed17.
In the semantic validation of the educational video, the elderly participants demonstrated high motivation. One elderly individual, who had already undergone bloodletting, highlighted that the video presented instructions that were unfamiliar to him, such as “avoiding physical activity after the procedure and, in case of adverse reactions, elevating the lower limbs”. These precautions are essential and should be communicated to patients at the end of the procedure, reinforcing the importance of clear instructions for patient safety and well-being.
The elderly participants who had never undergone bloodletting reported having no previous knowledge about the precautions presented in the video, emphasizing that the audiovisual resource offered clear and accessible information due to its illustrative and explanatory nature. They evaluated the video as a positive tool for learning about bloodletting therapy and did not express disagreement regarding the information presented.
Therefore, it has proven valuable to allow evaluators, experts or members of the target audience to freely express their opinions, without being limited to the numerical responses requested in the educational technology assessment instrument. This is because additional notes, in addition to what is formally requested in the instrument, can provide valuable feedback and clarify the scores assigned. These observations also help to better understand each evaluator’s perspective.
The evaluation of the video by the target audience analyzed aspects regarding clarity, relevance and degree of importance of the recommended care before, during and after the procedure. All elderly individuals considered the video clear and relevant. Regarding the level of relevance of the guidelines presented, all responded that they were highly significant.
For the educational video to be effective in modifying attitudes and behaviors, it is essential to maintain its clarity and fluidity. These qualities contribute to making the video a tool that positively influences behavior change in individuals37.
Thus, creating a multisensory experience, by involving multiple senses, enhances the capacity for retention and adherence to information, supporting the use of multimedia in health education. The use of illustrations in educational materials, as in this video, can facilitate the understanding of the information, increasing inclusion of illiterate elderly individuals, since the use of images favors visual association, learning, memorization and the development of specific skills38.
Finally, there is still a lack of studies in scientific literature that specifically address nursing care during the bloodletting process in elderly people, which is therefore a limiting factor, leaving a big gap regarding the specificities of care for this population. After all, population aging is an increasingly present reality in several countries, and understanding the particularities of nursing care for this population is essential for safe and high-quality healthcare.
CONCLUSION
The educational video for elderly people regarding the risks of falls was developed and considered valid in terms of content by nurse judges, and evaluated as understandable by elderly people, representatives of the target audience.
The educational material, consisting of eleven scenes, covers in detail from the explanation of the procedure to post-bloodletting guidelines. Evaluated by experts and the elderly target audience, the video achieved a Content Validity Index of above 80%, confirming its relevance as a teaching tool for care related to therapeutic bloodletting. The resource was considered effective in transmitting clear and accessible information, contributing to the health education of the elderly population and promoting their autonomy and safety in self-care, constituting an important innovation in geriatric nursing practice.
The validation of the material by experts and the target audience reinforces its effectiveness and suitability. This collaborative approach ensures the accuracy and accessibility of the content, aligning it with the specific needs of the elderly undergoing therapeutic bloodletting. The active participation of the elderly people in the semantic validation process also strengthens their empowerment, allowing greater involvement in care and access to relevant information.
Therefore, the importance of new studies on nursing care in therapeutic bloodletting is highlighted, especially in the context of changes resulting from aging, to continuously improve the care provided to the elderly population.
Acknowledgments
The study received funding from the CAPES/COFEN Agreement - Notice No. 08/2021.
REFERENCES
-
1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects 2019: Data Booklet (ST/ESA/SER.A/424) [Internet]. 2019 [cited 2024 Mar 12]. Available from: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Feb/un_2019_wpp_databooklet.pdf
» https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Feb/un_2019_wpp_databooklet.pdf -
2. Instituto Brasileiro de Geografia e Estatística (IBGE). Censo 2022: número de pessoas com 65 anos ou mais de idade cresceu 57,4% em 12 anos [Internet]. 2023 [cited 2024 Mar 12]. Available from: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/38186-censo-2022-numero-de-pessoas-com-65-anos-ou-mais-de-idade-cresceu-57-4-em-12-anos
» https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/38186-censo-2022-numero-de-pessoas-com-65-anos-ou-mais-de-idade-cresceu-57-4-em-12-anos -
3. Instituto Brasileiro de Geografia e Estatística (IBGE). Censo demográfico 2022 [Internet]. 2022 [cited 2024 Mar 12]. Available from: https://censo2022.ibge.gov.br/apps/pgi/#/home
» https://censo2022.ibge.gov.br/apps/pgi/#/home -
4. Lima ICC, Fernandes SLR, Miranda GRN, Guerra HS, Loreto RGO. Sexualidade na terceira idade e educação em saúde: um relato de experiência. Rev Saúde Pública Paraná. 2020;3:1 https://doi.org/10.32811/25954482-2020v3n1p137
» https://doi.org/10.32811/25954482-2020v3n1p137 -
5. Jesus SMCBP, Fujimoto DE, Lupinacci FL, Figueiredo MS. Perfil epidemiológico dos pacientes submetidos a sangria terapêutica em serviço público de referência no estado de São Paulo. Hematol, Transfus Cell Ther. 2021;43. https://doi.org/10.1016/j.htct.2021.10.687
» https://doi.org/10.1016/j.htct.2021.10.687 -
6. Amaral ALG, Silva LCM, Pires JCD, Tomazini V, Madeira MIA. Perfil epidemiológico dos pacientes de sangria terapêutica no banco de sangue de Ribeirão Preto do grupo GSH. Hematol, Transfus Cell Ther. 2022;44. https://doi.org/10.1016/j.htct.2022.09.731
» https://doi.org/10.1016/j.htct.2022.09.731 -
7. Bose N, Kanzariya H. Role of therapeutic apheresis and phlebotomy techniques in anaesthesia and critical care. Indian J Anaesth. 2014;58(5):672-8. https://doi.org/10.4103/0019-5049.144685
» https://doi.org/10.4103/0019-5049.144685 -
8. Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368(1):22-33. https://doi.org/10.1056/NEJMoa1208500
» https://doi.org/10.1056/NEJMoa1208500 -
9. Zubair A. Therapeutic phlebotomy. Clin Liver Dis. 2014;4(5):102-6. https://doi.org/10.1002/cld.408
» https://doi.org/10.1002/cld.408 -
10. Powel LW, Seckington RC, Deugnier Y. Haemochromatosis. Lancet [Internet]. 2016 [cited 2024 Mar 12];388(10045):706-16. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00287-8/abstract
» https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00287-8/abstract -
11. Ong SY, Gurrin LC, Dolling L, Dixon J, Nicoll AJ, Wolthuizen M, et al. Reduction of body iron in HFE-related haemochromatosis and moderate iron overload (Mi-Iron): a multicentre, participant-blinded, randomised controlled trial. Lancet Haematol. 2017;4(12):607-14. https://doi.org/10.1016/S2352-3026(17)30214-4
» https://doi.org/10.1016/S2352-3026(17)30214-4 -
12. Ministério da Saúde (BR). Relatório de recomendação: protocolo clínico e diretrizes terapêuticas de porfirias [Internet]. Brasília: MS; 2024 [cited 2024 Nov 12]. Available from: https://www.gov.br/conitec/pt-br/midias/consultas/relatorios/2024/relatorio-preliminar-protocolo-clinico-e-diretrizes-terapeuticas-de-porfirias#:~:text=A%20proposta%20de%20elabora%C3%A7%C3%A3o%20do%20Protocolo%20Cl%C3%ADnico%20e,com%20Porfirias%20no%20Sistema%20%C3%9Anico%20de%20Sa%C3%BAde%20%28
» https://www.gov.br/conitec/pt-br/midias/consultas/relatorios/2024/relatorio-preliminar-protocolo-clinico-e-diretrizes-terapeuticas-de-porfirias#:~:text=A%20proposta%20de%20elabora%C3%A7%C3%A3o%20do%20Protocolo%20Cl%C3%ADnico%20e,com%20Porfirias%20no%20Sistema%20%C3%9Anico%20de%20Sa%C3%BAde%20%28 -
13. Balogun O, Nejak-Bowen K. Understanding hepatic porphyrias: symptoms, treatments, and unmet needs. In: Seminars in Liver Disease. Thieme Medical Publishers; 2024;44(2):209-25. https://doi.org/10.1055/s-0044-1787076
» https://doi.org/10.1055/s-0044-1787076 -
14. Ministério da Saúde (BR), DATASUS: Departamento de Informática do SUS. Procedimentos hospitalares do SUS-por local de internação-Brasil [Internet]. Brasília, DF: MS; 2023 [cited 2024 Mar 12]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/qiuf.def
» http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/qiuf.def -
15. Maniva SJC, Carvalho ZM, Gomes RKG, Carvalho REFL, Ximenes LB, Freitas CHA. Educational technologies for health education on stroke: an integrative review. Rev Bras Enferm. 2018;71. https://doi.org/10.1590/0034-7167-2017-0041
» https://doi.org/10.1590/0034-7167-2017-0041 -
16. Rodrigues Junior JC, Rebouças CBA, Castro RCMB, Oliveira PMP, Almeida PC, Pagliuca LMF. Development of an educational video for the promotion of eye health in school children. Texto Contexto Enferm. 2017;26(2). https://doi.org/10.1590/0104-07072017006760015
» https://doi.org/10.1590/0104-07072017006760015 -
17. Zílio AC, Gross PQ, Lopes TB. Perfil dos pacientes submetidos à sangria terapêutica na região sul de Santa Catarina atendidos em um consultório privado de hematologia. Arq Catarin Med [Internet]. 2018 [cited 2024 Mar 12];47(3):100-15. Available from: https://revista.acm.org.br/index.php/arquivos/article/view/446
» https://revista.acm.org.br/index.php/arquivos/article/view/446 -
18. Santos JAD, Sessin APC, Giacomo JED, Rossetto DE, Bento RA, Rodrigues APC. Perfil epidemiológico dos pacientes submetidos a sangria terapêutica no ambulatório do banco de sangue São Paulo. Hematol Transfus Cell Ther. 2022;44(2):446. https://doi.org/10.1016/j.htct.2022.09.759
» https://doi.org/10.1016/j.htct.2022.09.759 -
19. Lopes ALM, Chaves JSI, Cezar JPL. Uso terapêutico de sangrias: uma revisão de literatura. Hematol, Transfus Cell Ther [Internet]. 2021 [cited 2024 Mar 12];43:407-8. Available from: http://www.htct.com.br/en-uso-terapeutico-de-sangrias-uma-articulo-resumen-S2531137921008452
» http://www.htct.com.br/en-uso-terapeutico-de-sangrias-uma-articulo-resumen-S2531137921008452 -
20. Rambo CAM, Rist JP, Zanom REB. Atuação do enfermeiro em Sangria Terapêutica. Atena Editora; 2019:1-6. https://doi.org/10.22533/at.ed.7791923121
» https://doi.org/10.22533/at.ed.7791923121 -
21. Conselho Regional de Enfermagem do Distrito Federal. Autarquia Federal - Lei nº 5.905/1973. Parecer Técnico COREN-DF nº 21/2021. Realização de sangria terapêutica no domicílio do paciente [Internet]. Brasília, DF: 2021 [cited 2024 Mar 12]. Available from: https://www.coren-df.gov.br/site/2021/08/10/parecer-tecnico-coren-df-no-21-2021/
» https://www.coren-df.gov.br/site/2021/08/10/parecer-tecnico-coren-df-no-21-2021/ -
22. Conselho Regional de Enfermagem da Bahia. Parecer COREN BA nº 09/2013. Realização de sangria terapêutica e hemodiluição pela enfermagem [Internet]. Salvador: 2013 [cited 2024 Mar 12]. Available from: https://www.coren-ba.gov.br/wp-content/uploads/2014/02/PT-009-SANGRIA-TERAP%C3%8AUTICA-E-HEMODILUI%C3%87%C3%83O.pdf
» https://www.coren-ba.gov.br/wp-content/uploads/2014/02/PT-009-SANGRIA-TERAP%C3%8AUTICA-E-HEMODILUI%C3%87%C3%83O.pdf -
23. Memorial Sloan Kettering Cancer Center. Instructions After Your Therapeutic Phlebotomy Procedure [Internet]. [New York]: 2024 [cited 2025 Jan 12]. Available from: https://www.mskcc.org/cancer-care/patient-education/instructions-after-your-therapeutic-phlebotomy-procedure
» https://www.mskcc.org/cancer-care/patient-education/instructions-after-your-therapeutic-phlebotomy-procedure -
24. Sousa GB, Aguiar KM, Alcântara TRM. Procedimento Operacional sangria/flebotomia terapêutica [Internet]. Barra do Garças: MT; 2021 [cited 2023 Apr 20]. Available from: https://www.studocu.com/pt-br/document/universidade-federal-de-mato-grosso/hematologia/08-po-sangria-terapeutica/31886419
» https://www.studocu.com/pt-br/document/universidade-federal-de-mato-grosso/hematologia/08-po-sangria-terapeutica/31886419 -
25. Barros BS. Guia de boas práticas para assistência de enfermagem aos doadores de sangue [Dissertação] [Internet]. Florianópolis. Universidade Federal de Santa Catarina; 2016[cited 2024 Mar 12]. Available from: https://repositorio.ufsc.br/handle/123456789/169197
» https://repositorio.ufsc.br/handle/123456789/169197 -
26. Silva KND. Análise dos eventos adversos à doação de sangue e condutas de enfermagem adotadas [Dissertação] [Internet]. Uberaba: Universidade Federal do Triângulo Mineiro; 2012 [cited 2025 Jan 12]. Available from: http://200.131.62.27/handle/tede/165
» http://200.131.62.27/handle/tede/165 -
27. Fleming SE, Reynolds J, Wallace B. Lights... camera... action! a guide for creating a DVD/video. Nurse Educ. 2009;34(3):118-21. https://doi.org/10.1097/NNE.0b013e3181a0270e
» https://doi.org/10.1097/NNE.0b013e3181a0270e - 28. Pasquali L. Instrumentação psicológica: fundamentos e práticas. Porto Alegre: Artmed; 2010.
- 29. Rosa BVC. Desenvolvimento e validação de vídeo educativo para famílias de pessoas com colostomia por câncer [Dissertação]. Santa Maria, RS: Universidade Federal de Santa Maria; 2015.
- 30. Teixeira E, Mota VMSS. Tecnologias Educacionais em Foco. São Caetano do Sul, SP: Difusão Editora; 2011.
-
31. Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc Saúde Coletiva. 2011;16(7):3061-8. https://doi.org/10.1590/S1413-81232011000800006
» https://doi.org/10.1590/S1413-81232011000800006 -
32. Ilha S, Santos SSC, Backes DS, Barros EJL, Pelzer MT, Costenaro RGS. Complex educational and care (geron)technology for elderly individuals/families experiencing Alzheimer's disease. Rev Bras Enferm, 2017;70(4):726-32. https://doi.org/10.1590/0034-7167-2016-0687
» https://doi.org/10.1590/0034-7167-2016-0687 -
33. Haynes SN, Richard DCS, Kubany ES. Content validity in psychological assessment: a functional approach to concepts and methods. Psychol Assess. 1995;7(3):238-47. https://doi.org/10.1037/1040-3590.7.3.238
» https://doi.org/10.1037/1040-3590.7.3.238 -
34. Everling M, Mont’Alvão CR. A Técnica Delphi e Análise de Conteúdo como Estratégias de Obtenção do Consenso em dinâmicas de design participativo. DeT [Internet]. 2019[cited 2025 Jan 12];9(19):18-28. Available from: https://www.ufrgs.br/det/index.php/det/article/view/539
» https://www.ufrgs.br/det/index.php/det/article/view/539 -
35. Ministério da Saúde (BR). Portaria nº 158, de 4 de fevereiro de 2016. Redefine o regulamento técnico de procedimentos hemoterápicos [Internet]. Diário Oficial da União; 2016 [cited 2025 Jan 12]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2016/prt0158_04_02_2016.html
» https://bvsms.saude.gov.br/bvs/saudelegis/gm/2016/prt0158_04_02_2016.html -
36. Galindo-Neto NM, Alexandre ACS, Barros LM, Sá GGM, Carvalho KM, Caetano, JA. Construção e validação de vídeo educativo para surdos acerca da ressuscitação cardiopulmonar. Rev Latino-Am Enfermagem. 2019;27:1-12. https://doi.org/10.1590/1518-8345.2765.3130
» https://doi.org/10.1590/1518-8345.2765.3130 -
37. Ximenes MA, Fontenele NA, Bastos IB, Macêdo TS, Galindo Neto NM, Caetano JA, et al. Construction and validation of educational booklet content for fall prevention in hospitals. Acta Paul Enferm. 2019;32(4). https://doi.org/10.1590/1982-0194201900059
» https://doi.org/10.1590/1982-0194201900059 -
38. Casarin F, Huppes B, Gautério-Abreu DP, Santos NO, Ilha S. Gerontotecnologias cuidativas à pessoa idosa/família: conceitos, apresentações e finalidades. Estud Interdiscip Envelhec. 2021;26(2)195-218. https://doi.org/10.22456/2316-2171.107917
» https://doi.org/10.22456/2316-2171.107917
Access to the dataset can be obtained upon request to the corresponding author.
