Development and validation of a tool for competence assessment of the insert of the intrauterine device

Lopes, Raquel Rabelo de Sá; Galvão, Endi Lanza; Guedes, Helisamara Mota

doi:10.1590/1806-9304202200020006

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Saúde Materno Infantil

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 22 (2) • Apr-Jun 2022 • https://doi.org/10.1590/1806-9304202200020006 copy

Development and validation of a tool for competence assessment of the insert of the intrauterine device

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:.

to develop and validate an instrument to assess the professional competence of nurses in the insertion of the intrauterine device (IUD)

Methods:

methodological study, developed in three stages: 1) tool development (Theoretical procedures); 2) evaluation of the tool by experts and judgment of the initially proposed items (Appearance validation and content validation); 3) test of the version resulting from the assessment by experts and assessment of internal consistency (Analytical procedures). Ten judges participated in the face and content validation, among obstetric nurses and gynecologists/obstetricians from the Sofa Feldman Hospital in Belo Horizonte (MG), while 38 nursing residency students were evaluated using the test tool, in the last stage of the study. Calculations of the Content Validity Index (CVI) and Cronbach’s alpha coefficient were performed as psychometric measures.

Results:

the initial tool covered 39 items. No item obtained CVI<0.8; however, through suggestions from the judges, items were merged, totaling 34 items. The total Cronbach’s alpha coefficient for this version was 0.828.

Conclusion:

the tool developed is valid and reliable. It is believed that the implementation of this tool will contribute to the training of professionals and the improvement of knowledge, behaviors, and skills in nursing consultations with a focus on reproductive planning with an emphasis on the insertion of the IUD.

Key words:
Nursing; Intrauterine devices; Clinical competence; Competency-based education; Validation study

	Content Validity Index
	Representativeness	Simplicity	Clarity	Relevance	Precision
DOMAIN 1: KNOWLEDGE
The obstetric nurse has the knowledge and/or understanding of...
1. structure governing reproductive health for women of all ages, including laws, policies, protocols, and professional guidelines	1.0	1.0	1.0	1.0	1.0
2. culture, local beliefs, traditional and modern health practices (beneficial and harmful)	1.0	1.0	1.0	1.0	1.0
3. female anatomy and physiology related to conception and reproduction	1.0	1.0	1.0	1.0	1.0
4. components of health history, family history, and relevant genetic history	1.0	1.0	1.0	1.0	1.0
5. content and investigation of the physical examination and laboratory studies that assess the potential for a pregnancy	1.0	1.0	0.9	0.9	1.0
6. reproductive planning methods, their basic principles, deadlines for use, mode of action, indication and contraindication for use, benefits, and risks	1.0	1.0	1.0	1.0	1.0
7. signs and symptoms of urinary tract infection and STDs	1.0	1.0	1.0	1.0	1.0
8. main screening methods for cervical cancer, (such as visual inspection with acetic acid, Pap smear)	1.0	1.0	1.0	1.0	1.0
DOMAIN 2: BEHAVIORS
The obstetric nurse ...
9. is responsible for the clinical decisions and actions	0.9	0.9	0.9	0.9	0.9
10. acts consistently following the professional ethics, values, and human rights	1.0	0.9	0.9	1.0	0.9
11. uses universal/standard precautions, infection prevention, and control strategies	1.0	1.0	1.0	1.0	1.0
12. behaves in a courteous, non-judgmental, non-discriminatory, and culturally appropriate manner with all patients regardless of their status, origin, or religious belief	0.9	1.0	0.9	0.9	0.9
13. maintains the confidentiality of all information shared by women; communicates essential information among other health providers or family members only with women’s explicit permission and imperative need	1.0	1.0	1.0	1.0	0.9
14. allows women to make informed choices about their health	0.9	0.9	0.9	0.9	0.9
15. refers or transfers to care providers or facilities for continuing care when health care needs exceed their competence	0.9	1.0	0.9	1.0	1.0
16. works collaboratively (teamwork) with other health professionals to improve services for women and families	1.0	1.0	0.9	1.0	1.0

	Content Validity Index
	Representativeness	Simplicity	Clarity	Relevance	Precision
DOMAIN 3: SKILLS
The obstetric nurse has the skill and/or ability to ...
17. education discussions with and for women and their families using appropriate communication and listening skills	1.0	1.0	1.0	1.0	1.0
18. advising women on managing side effects and problems with using different reproductive planning methods	1.0	1.0	1.0	1.0	1.0
19. order, interpret and perform common laboratory tests (such as blood count, pap smear, STD screening, BHCG)	1.0	1.0	1.0	1.0	1.0
20. perform anamnesis addressing the health, obstetric, gynecological, and reproductive health history	1.0	1.0	1.0	1.0	1.0
21. complete and verify that all documentation for performing the IUD insertion is duly completed (appointment form, anamnesis, informed consent form)	1.0	1.0	1.0	1.0	1.0
22. perform physical examination	1.0	1.0	1.0	1.0	1.0
23. provide care, support, and referral or treatment for women with STIs	0.9	1.0	1.0	0.9	1.0
24. guide what the IUD is, its mechanism of action, time of use, its indications and contraindications, and how the procedure will occur	1.0	1.0	1.0	1.0	1.0
25. resolve the woman’s doubts regarding the method and the consent form	1.0	1.0	1.0	1.0	1.0
26. removing the IUD that has visible or not visible threads, including the use of alligator clips	1.0	1.0	1.0	1.0	0.9
27. perform a vaginal examination to assess the position of the uterus	1.0	1.0	1.0	1.0	1.0
28. perform vulva inspection and specular examination using lubricant	1.0	1.0	1.0	1.0	1.0
29. perform disinfection/cleaning of the cervix when necessary	1.0	1.0	1.0	1.0	1.0
30. perform hysterometry and IUD insertion, using Pozzi forceps to straighten the uterus	1.0	1.0	1.0	1.0	1.0
31. cut the threads and leave them outside the cervix by approximately 3 cm	1.0	1.0	1.0	1.0	1.0
32. recognize warning signs after insertion (example: vagal reflex, uterine perforation) and take appropriate action	1.0	1.0	1.0	1.0	1.0
33. guide possible side effects, warning signs, and when to seek help from the health service	1.0	1.0	1.0	1.0	1.0
34. guide the woman to perform the self-examination to assess the location of the IUD	1.0	1.0	1.0	1.0	1.0
35. prescribe symptomatic cramps	0.9	0.9	0.9	0.9	1.0
36. fill in the patient´s record properly explaining the size of the wire left	1.0	1.0	1.0	1.0	1.0
37. schedule review from 42 days	1.0	1.0	1.0	1.0	1.0
38. request US if necessary	0.9	1.0	1.0	0.9	1.0
39. check the size of the wires through speculum examination at the review appointment	1.0	1.0	1.0	1.0	1.0

Domain	Item	Scale means if the item is excluded	Scale variance if the item is excluded	Cronbach's alpha	Cronbach's Alpha if the item is excluded	Corrected item-total correlation
Knowledge
	2	34.08	4.615		0.960	0.903
	3	34.11	4.421		0.956	0.958
	4	34.11	4.637		0.966	0.789
	5	34.11	4.637		0.966	0.789
	6	34.13	4.388		0.960	0.900
	7	34.08	4.669		0.962	0.857
	8	34.08	4.669		0.962	0.857
Behavior	9	19.61	1.218		0.763	0.879
	10	19.61	1.218		0.763	0.879
	11	19.63	1.212	0.841	0.784	0.852
	12	19.68	1.033		0.949	0.443
	13	19.53	1.385		0.809	0.726
Skills	14	76.18	17.019		0.606	0.493
	15	76.24	16.942		0.607	0.406
	16	76.26	17.605		0.635	0.066
	17	76.21	16.982		0.607	0.440
	18	76.16	17.434		0.616	0.381
	19	76.34	16.610		0.602	0.401
	20	-	-		-	-
	21	76.18	17.289		0.614	0.370
	22	78.03	17.972		0.634	0.034
	23	79.89	16.259		0.634	0.154
	24	76.21	17.576	0.630	0.622	0.204
	25	76.53	16.202		0.680	0.045
	26	76.26	16.253		0.600	0.375
	27	76.21	16.549		0.595	0.616
	28	76.21	17.144		0.611	0.374
	29	77.13	11.090		0.617	0.399
	30	76.37	15.590		0.595	0.366
	31	76.24	16.564		0.597	0.546
	32	76.13	17.577		0.618	0.442
	33	-	-		-	-
	34	-	-		-	-

Items initially proposed by the researchers	Version after evaluation of the tool by the judges	Tested final version
DOMAIN 1: BASIC KNOWLEDGE The obstetric nurse has the knowledge and/or understanding of...	DOMAIN 1: BASIC KNOWLEDGE The obstetric nurse has the knowledge and/or understanding of...	DOMAIN 1: BASIC KNOWLEDGE The obstetric nurse has the knowledge and/or understanding of...
1. structure governing reproductive health for women of all ages, including laws, policies, protocols, and professional guidelines	1. structure governing reproductive health for women, including laws, policies, protocols, and guidelines	1. structure governing reproductive health for women, including laws, policies, protocols, and guidelines
2. culture, local beliefs, traditional and modern health practices (beneficial and harmful)	2. culture, local beliefs, traditional and modern health practices (beneficial and harmful) related to contraception	2. culture, local beliefs, traditional and modern health practices (beneficial and harmful) related to contraception
3. female anatomy and physiology related to conception and reproduction	3. anatomy and physiology of the female body, related to the processes of conception and reproduction	3. anatomy and physiology of the female body, related to the processes of conception and reproduction
4. components of health history, family history, and relevant genetic history	4. components of women’s health history and family history, relevant for IUD insertion	4. components of the woman’s health history and family history, relevant for IUD insertion
5. content and investigation of the physical examination and laboratory studies that assess the potential for a pregnancy	5. content and investigation of women’s physical examination and laboratory studies that assess the potential for a pregnancy	5. content and investigation of the woman’s physical examination and laboratory studies that assess the potential for a pregnancy
6. reproductive planning methods, their basic principles, deadlines for use, mode of action, indication and contraindication for use, benefits, and risks	6. contraceptive methods, their mechanisms of action, deadlines for their use, indication, contraindication, benefits, and risks	6. contraceptive methods, their mechanisms of action, deadlines for their use, indication, contraindication, benefits, and risks
7. signs and symptoms of urinary tract infection and STDs	7. signs and symptoms of urinary tract infection and sexually transmitted infections	7. signs and symptoms of urinary tract infection and sexually transmitted infections
8. main screening methods for cervical cancer, (such as visual inspection with acetic acid, Pap smear)	8. screening methods for cervical cancer, (such as visual inspection with acetic acid, Pap smear)	8. screening methods for cervical cancer, (such as visual inspection with acetic acid, Pap smear)
DOMAIN 2: BASIC BEHAVIOR The obstetric nurse...	DOMAIN 2: BASIC BEHAVIOR The obstetric nurse...	DOMAIN 2: BASIC BEHAVIOR The obstetric nurse...
9. is responsible for the clinical decisions and actions it performs	9. acts following human rights, ethics, and professional support	9. acts following human rights, ethics, and professional support
10. acts consistently following professional ethics, values, and human rights	-	10. uses universal/standard precautions, infection prevention, and control strategies
11. uses universal/standard precautions, infection prevention, and control strategies	10. uses universal/standard precautions, infection prevention, and control strategies	11. allows women to make informed choices about their health
12. behaves in a courteous, non-judgmental, non-discriminatory, and culturally appropriate manner with all clients regardless of their status, origin, or religious belief	-	12. refers to the doctor and/or transfers to the hospital for continuity of care when these exceed their competence
13. maintains the confidentiality of all information shared by the women; communicates essential information among other health providers or family members only with women’s explicit permission and imperative need	-	13. works collaboratively (teamwork) with other healthcare professionals
14. allows women to make informed choices about their health	11. allows women to make informed choices about their health	DOMAIN 3: BASIC SKILLS The obstetric nurse has the skill and/or ability to...
15. refers or transfers to care providers or facilities for continuing care when health care needs exceed their competence	12. refers to the doctor and/or transfer to the hospital for continuity of care when these exceed their competence	14. promote health education with/and for women and their families using appropriate communication and listening skills
16. works collaboratively (teamwork) with other health professionals to improve services for women and families	13. works collaboratively (teamwork) with other healthcare professionals	15. advise women on the management of side effects and problems arising from the use of different contraceptive methods
DOMAIN 3: BASIC SKILLS The obstetric nurse has the skill and/or ability to...	DOMAIN 3: BASIC SKILLS The obstetric nurse has the skill and/or ability to...	16. order, interpret, and perform common laboratory tests (e.g., blood count, Pap smear, STI screening, BHCG)
17. education discussions with and for women and their families using appropriate communication and listening skills	14. promote health education with/and for women and their families using appropriate communication and listening skills	17. perform anamnesis addressing the health, obstetric, gynecological, and reproductive health history of women
18. advising women on managing side effects and problems with using different reproductive planning methods	15. advise women on the management of side effects and problems arising from the use of different contraceptive methods	18. complete and verify that all documentation for the insertion of the IUD is duly completed and signed (appointment form, anamnesis, informed consent form)
19. order, interpret, and perform common laboratory tests (e.g., blood count, pap smear, STD screening, BHCG)	16. order, interpret, and perform common laboratory tests (e.g., blood count, Pap smear, STI screening, BHCG)	19. perform a physical examination of the woman
20. perform anamnesis addressing the health, obstetric, gynecological, and reproductive health history	17. perform anamnesis addressing the health, obstetric, and gynecological history, and women’s reproductive health	20. provide care, support, and referral for women with a sexually transmitted infection
21. complete and verify that all documentation for performing the IUD insertion is duly completed (appointment form, anamnesis, informed consent form)	18. complete and verify that all documentation for the insertion of the IUD is duly completed and signed (appointment form, anamnesis, informed consent form)	21. guide the woman on what the IUD is, mechanism of action, duration of use, how the procedure will be performed, possible side effects, warning signs of complications when to seek the health service, and clarify women’s doubts regarding the method
22. perform physical examination	19. perform a physical examination of the woman	22. remove the IUD that has visible threads or not, using alligator clips for those that do not have visible threads, at any time, when the woman wishes or the term of use has expired
23. provide care, support, and referral or treatment for women with STIs	20. provide care, support, and referral for women with a sexually transmitted infection	23. perform a bimanual pelvic exam
24. guide what the IUD is, its mechanism of action, time of use, its indications and contraindications, and how the procedure will occur	21. guide women on what the IUD is, mechanism of action, duration of use, how the procedure will be performed, possible side effects, warning signs of complications when to seek the health service, and clarify the woman’s doubts regarding the method	24. perform vulva inspection and speculum examination
25. resolve women’s doubts regarding the method and the consent form	-	25. perform cervical antisepsis
26. remove the IUD that has visible wires or not, including the use of alligator clips	22. remove the IUD that has visible threads or not, using alligator forceps for those that do not have visible threads, at any time, when the woman wishes or when the use period ends	26. perform clamping of the anterior lip of the cervix with Pozzi forceps to straighten the uterus and perform hysterometry
27. perform a vaginal examination to assess the position of the uterus	23. perform a bimanual pelvic exam	27. Insert the IUD rods into the insertion guide conductor, insert the IUD into the bottom of the uterine cavity using the deposition technique, cut the wires and leave them outside the external orifice of the cervix by approximately 2 to 3 cm
28. perform vulva inspection and specular examination using lubricant	24. perform vulva inspection and speculum examination	28. recognize warning signs after IUD insertion (example: vagal reflex, uterine perforation) and take appropriate action
29. perform disinfection/cleaning of the cervix when necessary	25. perform cervical antisepsis	-
30. perform hysterometry and IUD insertion, using Pozzi forceps to straighten the uterus	26. perform clamping of the anterior lip of the cervix with Pozzi forceps to straighten the uterus and perform hysterometry	29. guide the woman to perform the self-examination (vaginal examination) to assess the positioning of the IUD
31. cut the threads and leave them outside the cervix by approximately 3 cm	27. insert the IUD rods into the insertion guide conductor, insert the IUD into the bottom of the uterine cavity using the deposition technique, cut the wires and leave them outside the external orifice of the cervix in approximately 2 to 3 cm	30. prescribe symptomatic cramps according to professional practice law
32. recognize warning signs after insertion (example: vagal reflex, uterine perforation) and take appropriate action	28. recognize warning signs after IUD insertion (example: vagal reflex, uterine perforation) and take appropriate action	31. fill in the patient´s record properly, explaining the size of the wires left
33. guide possible side effects, warning signs, and when to seek help from the health service	-	32. schedule an IUD review between 30 and 40 days after insertion
34. guide the woman to perform the self-examination to assess the location of the IUD	29. guide women to perform the self-examination (vaginal examination) to assess the positioning of the IUD	33. check wire size by speculum examination at the IUD review appointment
35. prescribe symptomatic cramps	30. prescribe symptomatic cramps according to professional practice law	34. request an ultrasound if threads of a different size than the one left on the day of the IUD insertion
36. fill in the patient´s recordproperly explaining the size of the wire left	31. fill in the patient´s recordproperly, explaining the size of the wires left
37. schedule review from 42 days	32. schedule an IUD review between 30 and 40 days after insertion
38. request US if necessary	33. check wire size by speculum examination at the IUD review appointment
39. check the size of the wires through speculum examination at the review appointment	34. request an ultrasound if threads of a different size than the one left on the day of the IUD insertion

Variable	Strongly Disagree (1)		Partially Disagree (2)		I don’t Know/Not Applicable (3)		Partially agree (4)		I totally agree (5)
Variable	f	(%)	f	(%)	f	(%)	f	(%)	f	(%)
DOMAIN 1: KNOWLEDGE
Does the nurse have the knowledge and/or understanding of...
1. structure governing reproductive health for women, including laws, policies, protocols, and guidelines	0	0	0	0	0	0	6	15.8	32	84.2
2. culture, local beliefs, traditional and modern health practices (beneficial and harmful) related to contraception	0	0	0	0	0	0	4	10.5	34	89.5
3. anatomy and physiology of the female body, related to the processes of conception and reproduction	0	0	0	0	0	0	5	13.2	33	86.8
4. components of women’s health history and family history, relevant for IUD insertion	0	0	0	0	0	0	5	13.2	33	86.8
5. content and investigation of the woman’s physical examination and laboratory studies that assess the potential for a pregnancy	0	0	0	0	0	0	5	13.2	33	86.8
6. contraceptive methods, their mechanisms of action, deadlines for their use, indication, contraindication, benefits, and risks	0	0	0	0	0	0	6	15.8	32	84.2
7. signs and symptoms of urinary tract infection and sexually transmitted infections	0	0	0	0	0	0	4	10.5	34	89.5
8. screening methods for cervical cancer, (such as visual inspection with acetic acid, Pap smear)	0	0	0	0	0	0	4	10.5	34	89.5
DOMAIN 2: BEHAVIOR
The nurse...
9. acts following human rights, ethics, and professional support	0	0	0	0	0	0	3	7.9	35	92.1
10. uses universal/standard precautions, infection prevention and control strategies	0	0	0	0	0	0	3	7.9	35	92.1
11. allows women to make informed choices about their health	0	0	0	0	0	0	4	10.5	34	89.5
12. refers to the doctor and/or transfers to the hospital for continuity of care when these exceed their competence	0	0	1	2.6	0	0	3	7.9	34	89.5
13. works collaboratively (teamwork) with other healthcare professionals	0	0	0	0	0	0	2	5.3	36	94.7
DOMAIN 3: SKILLS
The nurse has the ability and/or ability to...
14. promote health education with/and for women and their families using appropriate communication and listening skills	0	0	0	0	0	0	3	7.9	35	92.1
15. advise women on the management of side effects and problems arising from the use of different contraceptive methods	0	0	0	0	0	0	5	13.2	33	86.8
16. order, interpret, and perform common laboratory tests (e.g., blood count, Pap smear, STI screening, BHCG)	0	0	1	2.6	0	0	3	7.9	34	89.5
17. perform anamnesis addressing the health, obstetric, gynecological, and reproductive health history of the women	0	0	0	0	0	0	4	10.5	34	89.5
18. complete and verify that all documentation for the insertion of the IUD is duly completed and signed (appointment form, anamnesis, informed consent form)	0	0	0	0	0	0	2	5.3	36	94.7
19. perform a physical examination of the women	0	0	0	0	0	0	9	23.7	29	76.3
20. provide care, support and referral for women with a sexually transmitted infection	0	0	0	0	38	100.0	0	0	0	0
21. guide the woman on what the IUD is, mechanism of action, duration of use, how the procedure will be performed, possible side effects, warning signs of complications when to seek the health service, and clarify the women’s doubts regarding the method	0	0	0	0	0	0	3	7.9	35	92.1
22. remove the IUD that has visible threads or not, using alligator forceps for those that do not have visible threads, at any time, when the women wishe or when the use period ends	0	0	0	0	36	94.7	1	2.6	1	2.6
23. perform bimanual pelvic exam	36	94.7	0	0	0	0	0	0	2	5.3
24. perform vulva inspection and speculum examination	0	0	0	0	0	0	4	10.5	34	89.5
25. perform cervical antisepsis	4	10.5	0	0	0	0	0	0	34	89.5
26. perform clamping of the anterior lip of the cervix with Pozzi forceps to straighten the uterus and perform hysterometry	0	0	1	2.6	0	0	3	7.9	34	89.5
27. Insert the IUD rods into the insertion guide conductor, insert the IUD into the bottom of the uterine cavity using the deposition technique, cut the wires and leave them outside the external orifice of the cervix in approximately 2 to 3 cm	0	0	0	0	0	0	4	10.5	34	89.5
28. recognize warning signs after IUD insertion (example: vagal reflex, uterine perforation) and take appropriate action	0	0	0	0	0	0	4	10.5	34	89.5
29. guide the woman to perform the self-examination (vaginal examination) to assess the positioning of the IUD	8	21.1	1	2.6	0	0	4	10.5	25	65.8
30. prescribe symptomatic for cramps according to professional practice law	1	2.6	0	0	0	0	6	15.8	31	81.6
31. fill in the patient´s record properly, explaining the size of the wires left	0	0	0	0	0	0	5	13.2	33	86.8
32. schedule an IUD review between 30 and 40 days after insertion	0	0	0	0	0	0	1	2.6	37	97.4
33. check wire size by speculum examination at the IUD review appointment	0	0	0	0	38	100	0	0	0	0
34. request an ultrasound if threads of a different size than the one left on the day of the IUD insertion	0	0	0	0	38	100	0	0	0	0

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Authors’ contribution

All authors contributed to the design, structuring, analysis, and interpretation of data, and developed or performed a critical review of the article.

The authors declare no conflict of interest.