Adaptación transcultural del instrumento CALCULATE al portugués brasileño: lesión por presión en cuidados intensivos

Un estudio metodológico llevado a cabo de enero a diciembre de 2021, dividido en seis etapas: traducción, síntesis, retrotraducción, comité de expertos con aplicación del índice de validez de contenido, preprueba en 40 pacientes adultos y envío a las autoras. El estudio se realizó en las unidades de cuidados intensivos de un hospital público de enseñanza terciaria en el interior del estado de São Paulo, Brasil. El CALCULATE original tiene ocho ítems de evaluación (factores de riesgo) y se estratifica con un puntaje de 0-3 (alto riesgo) y 4-8 (riesgo muy alto).

Resultados:

Después de la evaluación de los expertos, la validez de contenido final fue de 0,9. Sugirieron palabras y frases que debían cambiar en cuanto a equivalencias textuales, así como definiciones de siglas y terminologías. En la preprueba, los ítems se evaluaron como adecuados para la comprensión; solo un ítem requirió una explicación adicional para su adecuación.

Conclusión:

Se realizó con éxito la adaptación transcultural de CALCULATE al portugués brasileño, revelando un buen índice de validez de contenido, confirmando la relevancia y adecuación de sus ítems. CALCULATE es adecuado para su uso en unidades de cuidados intensivos y centros de investigación y enseñanza.

Descriptores:
Úlcera por presión; Unidades de cuidados intensivos; Medición de riesgo; Traducción; Comparación transcultural; Investigación metodológica en enfermería

Items CALCULATE	Assessment by the five experts					CVI/item
Items CALCULATE	1^st	2^nd	3^rd	4^th	5^th	CVI/item
Item 1	3	3	4	3	2	0.80
Item 2	3	2	4	3	4	0.80
Item 3	4	3	4	3	3	1.00
Item 4	3	3	4	3	4	1.00
Item 5	3	3	4	3	3	1.00
Item 6	2	3	4	3	3	0.80
Item 7	3	2	4	3	3	0.80
Item 8	2	3	3	4	4	0.80
Total CVI	0.75	0.75	1.00	1.00	1.00	0.90

Item	Nurse assessment of each patient				Final agreement of the item %
	Number of responses considered appropriate
	1^st assessment	2^nd assessment	3^rd assessment	4^th assessment
1- Very unstable to reposition on the bed	10	10	10	10	100%
2-Impaired circulation	10	10	10	10	100%
3-Hemodialysis	9	10	10	10	97.5%
4-Mechanical ventilation	10	10	10	10	100%
5-Immobility	10	10	10	10	100%
6-Long surgery or cardiac arrestin the last 24 hours	10	10	10	10	100%
7-Low protein level	2	6	6	5	47.5%
8-Fecal incontinence	10	10	10	10	100%

Items	Translation of item (PV1)	Translation of specifications (PV1)	Main suggestions from the expert committee	Post-committee adequacy (PV2)	Pre-test suggestions	Adequaçy (FV)
Item 1	Too unstable to move	· Automatically includes in the very high-risk group. · Active hydration, active bleeding, development of life-threatening arrhythmias, abnormal hemodynamic parameters that are not brought to normal ranges within 10 minutes after changes in position.	Reposition on bed Exchange active hydration for volume resuscitation	· Automatically includes in the very high-risk group· · Volume resuscitation,active bleeding, development of life-threatening arrhythmias, abnormal hemodynamic parameters that arenot brought to normal ranges of values within 10 minutes after repositioning.	Adequate item	Maintained as PV2
Item 2	Weakened circulation	Includes: history of vascular disease, intravenous inotropes, diabetes.	Impaired circulation	· Includes: history of vascular disease,use of intravenous inotropes and diabetes *mellitus.*	Adequate item	Maintained as PV2
Item 3	Dialysis	· Intermittent hemodialysis (HDI) or continuous replacement renal therapy (CRRT) such as CVVH.	Hemodialysis Acronyms spelled out	· Intermittent hemodialysis (IHD), continuous renal replacement therapy(CRRT), such as continuous veno-venous hemofiltration(CVVH).	Adequate item	Maintained as PV2
Item 4	Mechanical ventilation	· Any type of mechanical ventilation including CPAP.	CPAP spelled out	· · Any type of ventilation including CPAP (continuous positive airway pressure).	Adequate item	Maintained as PV2
Item 5	Immobility	· Secondary to: a) neuromuscular disease (definition: severe spinal cord injury MG/GBS/CIPN) or b) sedation/paralysis (definition - RASS Scale⁽²¹⁾ - from 3 to 5 or paralyzed) or c) weakness of the limb preventing movement or turning around in bed or in a chair.	RASS without the negative symbol(-) Acronyms spelled out	· Secondary to: (a) neuromuscular disease (definition: myasthenia gravis / Guillain-Barré syndrome /chemotherapy-induced peripheral neuropathy and spinal cord injury or b) sedation/paralysis (definition: RASS from -3 a -5^* or paralyzed) or c) weakness of limbs preventing self-movement/ turning over in bed or chair.	Adequate item	Maintained as PV2
Item 6	Long surgery/ Cardiac arrest	· Duration of surgery: more than 4 hours in the last 24 hours or cardiac arrest while admitted to this hospital.	Cardiac arrest in this hospitalization	· Duration of surgery > 4 hours in the last 24 hours or a cardiac arrest in this hospitalization.	Adequate item	Maintained as PV2
Item 7	Low Protein level	· Low protein or serum albumin levels (albumin below 35gr/l) or poor nutritional status).	Albumin in Brazil: 3.5 mg/dl and not 35 g/l. Impaired/poor nutritional status	· Low protein and serum albumin (albumin below 3.5 g/dL) and/or poor nutritional status.	Difficulty in understanding the definition of poor nutritional status	Added description of definition in caption
Item 8	Fecal incontinence	Diarrhea: type 5, 6 or 7.	Add caption with definition	· Diarrhea: type 5 or 6 or 7^ A caption of the Bristol scale was added.**	Adequate item	Maintained as PV2

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[1] Corresponding author:
Bruna Cristina Velozo E-mail: bruna.velozo@unesp.br