Construction and validity of an online course for nurses on the analysis and interpretation of prenatal laboratory testsABSTRACT
Objective: To develop and validate an online course for Primary Health Care nurses on the analysis and interpretation of prenatal tests for low-risk pregnancies.
Method: A technological development study employing the Analyze, Design, Develop, Implement, Evaluate model to create the course within a virtual learning environment. Content validity was conducted with eight specialists using an instrument that assessed aspects such as objectives, structure, presentation, and relevance, utilizing the Content Validity Index.
Results: A six-module course with a 30-hour workload was developed for a virtual environment. The content was validated, achieving a Content Validity Index of ≥ 0.80 across all domains and an overall score of 0.99.
Conclusion: This study highlights the importance of using educational technologies in nursing education. The development and validity of the course represent a significant step in integrating educational technologies, thereby strengthening professional training and practice.
DESCRIPTORS:
Nursing; Education, Nursing, Continuing; Educational Technology; Prenatal Care; Primary Health Care
HIGHLIGHTS
1. Course on the analysis and interpretation of prenatal tests for low-risk pregnancies.
2. Course structure organized into six stages within a virtual learning environment.
3. Course content validated with a Content Validity Index of 0.99.
4. Course development guided by the Analyze, Design, Develop, Implement, Evaluate model.
RESUMO
Objetivo: Construir e validar um curso online para enfermeiros da Atenção Primária à Saúde sobre análise e interpretação de exames pré-natais em gestação de risco habitual.
Método: Estudo de desenvolvimento tecnológico que utilizou o modelo Analyze, Design, Develop, Implement, Evaluate para a construção do curso em ambiente virtual de aprendizagem. A validação de conteúdo foi realizada com oito especialistas por instrumento, avaliando aspectos como objetivos, estrutura, apresentação e relevância, utilizando o Índice de Validade de Conteúdo.
Resultados: Elaborou-se um curso em seis etapas, com carga horária de 30 horas para ambiente virtual. O conteúdo foi validado apresentando Índice de Validade de Conteúdo ≥ 0,80 em todos os domínios e a avaliação global de 0,99.
Conclusão: Este estudo destaca a importância da utilização de tecnologias educacionais na formação de enfermeiros. A construção e a validação do curso representam um passo significativo na integração de tecnologias educacionais, fortalecendo a formação e a atuação profissional.
DESCRITORES:
Enfermagem; Educação Continuada em Enfermagem; Tecnologia Educacional; Cuidado Pré-Natal; Atenção Primária à Saúde
HIGHLIGHTS
1. Curso sobre análise/interpretação de exames pré-natais de risco habitual.
2. Estrutura do curso organizada em seis etapas em ambiente virtual de aprendizagem.
3. O conteúdo do curso foi validado com Índice de Validade de Conteúdo de 0,99.
4. Construção do curso orientada pelo modelo Analyze, Design, Develop, Implement, Evaluate.
RESUMEN
Objetivo: Construir y validar un curso en línea para enfermeras de atención primaria sobre el análisis e interpretación de exámenes prenatales en embarazos de bajo riesgo.
Método: Estudio de desarrollo tecnológico que utilizó el modelo Analyze, Design, Develop, Implement, Evaluate para construir el curso en un entorno virtual de aprendizaje. La validación del contenido se realizó con ocho expertos por instrumento, evaluando aspectos como objetivos, estructura, presentación y relevancia, mediante el Índice de Validez de Contenido.
Resultados: Se desarrolló un curso de seis etapas, con una carga de trabajo de 30 horas para un entorno virtual. El contenido fue validado, presentando un Índice de Validez de Contenido ≥ 0,80 en todos los dominios y una evaluación general de 0,99.
Conclusión: Este estudio resalta la importancia del uso de tecnologías educativas en la formación de enfermeras. La construcción y validación del curso representan un paso significativo en la integración de tecnologías educativas, fortaleciendo la formación y la práctica profesional.
DESCRIPTORES:
Enfermería; Educación Continua en Enfermería; Tecnología Educacional; Atención Prenatal; Atención Primaria de Salud
HIGHLIGHTS
1. Curso sobre el análisis e interpretación de exámenes prenatales de riesgo rutinarios.
2. Estructura del curso organizada en seis etapas en un entorno de aprendizaje virtual.
3. El contenido del curso fue validado con un Índice de Validez de Contenido de 0,99.
4. La construcción del curso se guió por el modelo Analyze, Design, Develop, Implement, Evaluate.
INTRODUCTION
Primary Health Care (PHC) is the main gateway to the Brazilian Unified Health System and is responsible for providing a comprehensive set of healthcare services. Within the context of prenatal care, PHC plays a strategic role in the early identification of pregnant women and in ensuring continuous prenatal follow-up, promoting access to comprehensive care, which is essential for reducing risks and improving maternal and child health outcomes1.
Despite advances, maternal mortality rates in Brazil remain high. In 2023, the materna mortality ratio was 57 deaths per 100,000 live births, far from the World Health Organization target of fewer than 30 deaths per 100,000 live births by 2030. Regarding infant mortality, the country recorded 12.6 deaths per 1,000 live births in 2023, representing a significant reduction compared with previous years2.
This scenario reflects the importance of implementing public policies such as high-quality prenatal care, which has proven effective in reducing these rates. Routine laboratory testing and appropriate follow-up throughout pregnancy are essential for the early detection of complications such as preeclampsia, gestational diabetes, and infections, all of which may pose risks to maternal and fetal health3.
The 2030 Agenda for Sustainable Development includes targets related to reducing maternal and child mortality. Sustainable Development Goal 3 aims to ensure healthy lives and promote well-being for all, with a particular focus on reducing maternal and child deaths. In this context, promoting comprehensive and continuous care for pregnant women is essential to achieving these goals, reducing regional disparities, and ensuring universal access to high-quality prenatal care4.
In this context, continuing education for nurses is essential for the early identification of prenatal complications, the analysis and interpretation of laboratory tests, the monitoring of maternal health, and guidance on preventive practices. Educational programs enable nurses to remain up to date on best practices, technologies, and guidelines for maternal care, ensuring evidence-based and effective healthcare delivery. The implementation of ongoing educational strategies is essential not only for diagnosing complications but also for providing counseling and psychological support to pregnant women, thereby helping reduce mortality rates5.
In light of these considerations, the Federal Nursing Council (COFEN - Conselho Federal de Enfermagem) emphasizes the use of innovative educational technologies, such as applications and digital platforms, to enhance nurses’ knowledge and skills. These technological tools provide dynamic and interactive learning environments that facilitate continuous professional development and promote the adoption of evidence-based practices. The implementation of these resources not only strengthens clinical competence but also contributes to the humanization of care, particularly in prenatal follow-up6.
The implementation of continuing education programs that integrate evidence-based practices and educational technologies has proven effective in improving the quality of care, resulting in better perinatal outcomes7. Continuous professional development for nurses has also been associated with reductions in obstetric and neonatal complications and has played an important role in reducing maternal and neonatal mortality, highlighting the need for innovative educational strategies that address current healthcare challenges8.
In this regard, educational courses are essential educational technologies for the teaching-learning process in healthcare, particularly within the context of continuing education. They encompass digital resources, virtual platforms, and interactive educational materials that foster the development of professional competencies and skills7.
Therefore, the development and validity of a course focused on the analysis and interpretation of prenatal laboratory tests in low-risk pregnancies represent a promising initiative, as it not only strengthens professional competencies but also contributes to building a more robust and effective healthcare system. This study aimed to develop and validate an online course for PHC nurses on the analysis and interpretation of prenatal laboratory tests in low-risk pregnancies.
METHOD
This is a technological development study of a course designed for nurses working in PHC on the analysis and interpretation of prenatal laboratory tests in low-risk pregnancies. The ADDIE model was adopted as the instructional design framework for course development, representing the phases of Analysis, Design, Development, Implementation, and Evaluation, which correspond to the different stages of instructional design applied to course development9.
During the Analysis (A) phase, the Modular Object-Oriented Dynamic Learning Environment (Moodle®) was selected as the virtual learning environment (VLE), and its infrastructure and the actions required to structure the course were defined.
The Design (D) phase involved detailed course planning, including the definition of learning objectives for each module, content selection, choice of media and presentation formats, teaching-learning methodologies, instructional techniques, and communication strategies with learners. The course development team consisted of a master’s student in nursing, a nurse specialized in obstetric nursing and faculty member of a graduate program, and a pharmacist who was also a faculty member of a graduate program. The course content was defined based on a review of the technical literature and current recommendations on the topic.
During the Development (D) phase, the content selected by the development team was uploaded to the Moodle® platform in the form of a study book, including links to video lectures and supplementary readings. All materials were organized systematically and rigorously.
The Analysis, Design, and Development phases took place between September and December 2024, with remote support from an information technology analyst. The Implementation (I) and Evaluation (E) phases are currently under development and are therefore not addressed in this study.
After its development, the course underwent content validity by experts in the analysis and interpretation of prenatal laboratory tests, the central topic o f the course. Experts were selected according to the following criteria: clinical experience in the subject area; publications in journals and/or conference proceedings on the topic and/or on the development and validity of educational technologies; specialization (lato sensu and/or stricto sensu) related to the topic; and membership in a scientific society in the field10. Participants were required to meet at least two of these criteria for inclusion.
The snowball sampling method was used to recruit the experts, thereby ensuring targeted and qualified participant recruitment11. The initial contacts were intentionally selected from the researchers’ professional network, and additional participants were nominated by the experts themselves. Individual email invitations were sent containing access to the electronic validity form, the course, the Informed Consent Form (ICF), and a request to nominate additional experts.
Each expert nominated up to three professionals to join the panel. Experts who did not respond within the initial ten-day period received up to three reminder emails. Invitations were sent to ten experts nominated by the first members of the panel. The experts who responded and composed the validity panel were all from southern Brazil. Although there is no consensus in the literature regarding the number of experts required for content validity, this study followed the recommendation of including six to 20 participants12.
Data collection for content validity was conducted between November and December 2024 with eight experts who completed the electronic form. All participants electronically signed the ICF and completed the questionnaire. Responses were initially stored in Google Forms® and subsequently exported to Microsoft Excel® for data storage and analysis.
Content validity was performed using a previously validated instrument13 consisting of participant characterization, instructions for completing the instrument, and 14 items assessing the objectives, structure, presentation of the content, and relevance of the course. The assessed items are presented in Table 1. The instrument items were rated by the experts using a four-point Likert scale13 (1 - Inadequate; 2 - Partially adequate; 3 - Adequate; and 4 - Completely adequate).
Data analysis was performed by calculating the Content Validity Index (CVI), which considers the highest Likert-scale ratings by summing responses scored as 3 and 4 for each questionnaire item and dividing the total by the number of participating experts13. Educational material with a CVI of 0.80 or higher was considered valid13.
The research project was approved by a Research Ethics Committee under Opinion 5,047,628 on October 19, 2021.
RESULTS
Course development
With a total workload of 30 hours, the course on the analysis and interpretation of prenatal laboratory tests in low-risk pregnancies was developed as a self-paced online course. Its objective is to prepare nurses to analyze, interpret, and use prenatal laboratory tests in clinical decision-making and comprehensive prenatal care, based on scientific evidence and current guidelines.
The Analysis (A) phase served as the foundation for course development by defining its content based on a review of the technical literature and current recommendations. Learning objectives were established for each lesson according to the corresponding content.
The Design (D) phase involved organizing the course within the VLE into the following stages: course introduction and orientation; list of abbreviations; three lessons covering the core course content; and a final assessment consisting of 14 mandatory questions required for course completion and certification. The stages are sequential and interdependent. Participants must complete each stage before accessing the next one. The course will be offered through closed cohorts by invitation and registration. Initial access is granted after learners receive an invitation from the course administrators and complete registration on the platform.
Figure 1 presents an overview of the Moodle® VLE where the course was hosted. Moodle® is an open-source learning management system widely used in universities to create, manage, and track VLE-based courses. It adopts a socio-constructivist pedagogical approach, prioritizing interaction, collaboration, and active learning. It features a modern, responsive, and accessible interface. The course stages were clearly outlined in tabs, allowing participants to understand the path to be followed through the proposed activities. This visual organization not only guides learners regarding the content to be covered but also reinforces the importance of each stage of the learning process.
After navigating through the course introduction and orientation page, learners can access the modules containing the core course content, as well as a dedicated module with a list of abbreviations that can be consulted at any time. The estimated time to complete this introductory stage is 30 minutes, which is sufficient for participants to become familiar with the course materials and expectations, thereby facilitating effective assimilation of the content.
During the Development (D) phase, the three content modules (three lessons) were developed to systematically address the theoretical and practical foundations of the analysis and interpretation of prenatal laboratory tests in low-risk pregnancies. The first content module (Lesson 1, Figure 2) establishes the theoretical foundation that will guide nurses throughout the course. Focusing on women’s health within the historical context of Brazil, this module explores the evolution of health policies and the social changes that have shaped women’s healthcare in Brazil to the present day. In addition, the module integrates topics related to continuing health education and educational technologies, addressing the importance of continuous professional development and the use of technological resources in the learning process.
Lesson 2 (Figure 3) presents an approach to the nursing consultation within the scope of PHC, with a specific focus on prenatal follow-up for low-risk pregnancies, emphasizing that this activity is one of the nurse’s exclusive professional responsibilities. Addressing this topic is fundamental to the follow-up of low-risk pregnancies because it encourages nurses to act proactively and effectively in disease prevention and in the promotion and restoration of maternal and child health, based on scientific evidence to ensure comprehensive, high-quality prenatal care. This lesson includes study materials and supplementary resources, such as articles, manuals, resolutions, and ordinances, with the aim of promoting learning.
The third course lesson (Figure 4) addresses specific content related to the laboratory tests recommended during prenatal follow-up for low-risk pregnancies. In this context, the main laboratory tests recommended by current health guidelines are presented, including their purpose, limitations, specimen collection procedures, and interpretation of results. Each laboratory test is described in detail to enable healthcare professionals to understand its importance in the early detection of potential abnormalities, thereby contributing to safe prenatal care. This approach is intended to prepare nurses to interpret test results more effectively and make evidence-based clinical decisions, promoting comprehensive, high-quality care for pregnant women.
The final stage of the course consists of an assessment comprising 14 questions related to the content covered throughout the lessons. This activity is mandatory and requires a minimum passing score of 7.0 for course completion and certification. If learners do not achieve the required score on their first attempt, they may retake the assessment as many times as necessary until they obtain the minimum passing score. This assessment strategy was designed to assess the assimilation of the knowledge acquired, reinforce the key topics addressed throughout the course, and consolidate learning.
Course content validity
For content validity, experts had a mean age of 35 years, ranging from 29 to 47 years. Most participants (seven; 87.5%) were women. Regarding academic qualifications, one participant (12.5%) was a postdoctoral researcher with a degree in pharmacy, two (25%) held PhDs in biochemistry, three (37.5%) held master’s degrees in pharmacy and biochemistry, and two (25%) were lato sensu specialists in biochemistry. Concerning their professional field, five participants (62.5%) worked in clinical laboratory analysis, whereas three (37.5%) worked in healthcare services (hospitals and clinical laboratories), with an equal distribution between public and private institutions. Their professional experience averaged more than five years.
Table 1 presents the results of the content validity of the six course stages. The validity process yielded positive results, achieving an overall CVI of 0.99, with no suggestions for modifications or revisions from the experts, further supporting the high overall CVI obtained.
DISCUSSION
The use of the ADDIE model for the development of the course instructional design provided a systematic, outcome-oriented approach, ensuring that the content was relevant and applicable to the reality of professionals working in PHC13. The ADDIE model guides the development of educational programs through well-defined phases. Accordingly, the course content was organized sequentially, following pedagogical guidelines and the established learning objectives. Each stage was developed based on meaningful learning principles, which emphasize the importance of connecting new knowledge with learners’ prior knowledge14.
A welcoming interface and a clearly structured VLE are fundamental to fostering a positive and engaging learning environment, encouraging learners to participate actively. The use of interactive resources can enhance the teaching-learning process, while the integration of different media creates a dynamic environment tailored to learners’ needs, particularly regarding initial guidance, autonomy, and engagement throughout the educational process. Providing an introductory section with objective information about course operation, the schedule, assessment procedures, and communication channels helps reduce learners’ initial uncertainty, contributing to more effective navigation while accommodating different levels of familiarity with digital technologies. A clear visual organization combined with interactivity not only reinforces learners’ active participation but also promotes a rich and meaningful learning experience15.
The platform used (Moodle®) enables interaction between instructors and learners through its built-in tools, facilitating activities, discussion forums, and the sharing of experiences for collaborative knowledge construction. Organizing the course into six sequential stages was intended to provide learners with an efficient way to structure their learning process, offering greater flexibility and a gradual progression that facilitates the understanding of complex topics.
The time allocated for course introduction and orientation is considered important, as a structured and concise introduction can increase participant engagement and reduce the anxiety associated with the VLE. This approach facilitates learners’ adaptation to the virtual environment by providing a clear understanding of course expectations and adequately preparing them to engage with the specific course content16.
The inclusion of a list of abbreviations demonstrates a commitment to knowledge accessibility. Clear terminology is essential to prevent misunderstandings and ensure that all participants understand the material presented. Access to resources such as glossaries or lists of abbreviations promotes an inclusive and effective learning environment, allowing learners to focus on the content without being hindered by language barriers17. Furthermore, the inclusion of technical content, particularly regarding prenatal laboratory tests, aims to prepare nurses to interpret test results appropriately, thereby facilitating the early detection of abnormalities and timely interventions, since the provision of adequate healthcare during pregnancy contributes to improved maternal and newborn health outcomes after birth18.
In this context, one study recognized that digital and educational technologies have been increasingly encouraged in Brazil because of their potential to improve nursing practice in PHC. That study described the development and validity of a flip chart on prenatal care, demonstrating that the educational technology effectively supported healthcare professionals in this setting19.
Validating courses designed to support nurses’ practice in prenatal care is an essential step to ensure that the content addresses professionals’ educational needs and complies with the guidelines established by regulatory agencies. The course underwent content validity and achieved a CVI of 0.99, demonstrating the adequacy and relevance of its content and reinforcing its importance in the education of healthcare professionals13.
Furthermore, the findings of the present study are consistent with those of other validity studies involving online courses. These include a study on the development and validity of a course for nurses providing home care to children with central venous catheters, which achieved an overall CVI ranging from 0.88 to 0.9620; a study validating a wound care course, which reported an overall CVI of 0.9821; and a study that developed and assessed an interprofessional training course on patient waiting list management, obtaining a CVI of 0.8922. Content validity not only ensures the technical quality of educational materials but also contributes to the education of better-prepared healthcare professionals.
This stage is essential in the development of educational programs because it ensures that the content meets standards of clarity and relevance23. In this regard, the participation of experts in the validity process ensured that the course adopted a didactic approach aligned with the continuing education needs of professionals working in PHC. Face validity and usability assessments were not conducted in this study but may be addressed in future research.
COFEN Resolution 564/201724, which approves the Code of Ethics for Nursing Professionals, emphasizes the importance of continuous professional development and nurses’ responsibility in promoting maternal and child health. In addition, COFEN Resolution 672/202125 updates the standards governing nurses’ practice in prenatal care, reinforcing the need for appropriate training and validity of specific competencies to ensure safe and high-quality care for pregnant women.
Nurses’ practice in prenatal follow-up is grounded in scientific evidence and represents an established strategy within PHC, recognized for its contribution to the early detection of risks and the promotion of safe pregnancies through welcoming care and the establishment of therapeutic relationships aimed at providing individualized care. Continuous professional development and regular updating of clinical practices are essential to improving maternal and child health outcomes in PHC26, 27. These findings reinforce the need to implement continuing health education strategies that provide specific and up-to-date content to strengthen nurses’ autonomy and clinical decision-making capacity in prenatal care. Such strategies are essential for preparing professionals to identify risks early and implement appropriate interventions, thereby promoting high-quality prenatal care.
The rapid digital transformation of healthcare education and professional development demonstrates the transformative impact of digital educational technologies on reshaping educational practices and approaches. The integration of digital tools complements traditional teaching methods and promotes more dynamic and interactive educational environments capable of enhancing both learning effectiveness and learner engagement. Addressing the challenges of digital integration requires a comprehensive approach that combines technical training, pedagogical innovation, and institutional support to promote the sustainable and meaningful use of digital tools in education28.
CONCLUSION
This study aimed to develop and validate an online course for PHC nurses on the analysis and interpretation of prenatal laboratory tests in low-risk pregnancies. The course was developed based on the ADDIE model and pedagogical frameworks, resulting in structured content aligned with the educational needs of this target audience.
The expert validity demonstrated the scientific and pedagogical adequacy of the course, as reflected by its high CVI. One l imitation of this study is that the panel of experts was drawn from a single region of the country, which may limit the diversity of perspectives and the generalizability of the findings.
The findings indicate that the course is a valid educational technology to support nurses’ education in the analysis and interpretation of prenatal laboratory tests within the context of PHC. Its implementation in clinical practice may contribute to improving the professional competencies required for prenatal care. Therefore, this study provides a validated educational technology with the potential to be incorporated into continuing health education strategies, particularly in the context of prenatal care for low-risk pregnancies.
HOW TO REFERENCE THIS ARTICLE:
*Article extracted from the master’s thesis:
FUNDING
Data availability:
The authors declare that the data can be made available upon request to the corresponding author.
References
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Source: the authors (2024).
Source: the authors (2024).
Source: the authors (2024).
Source: the authors (2024).