Elaboration, validation and reliability of the safety protocol for pediatric thirst management

Pierotti, Isadora; Nascimento, Leonel Alves do; Rossetto, Edilaine Giovanini; Furuya, Rejane Kiyomi; Fonseca, Lígia Fahl

doi:10.1590/1518-8345.3333.3321

Brasil

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Original Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.3333.3321 linkcopy

Elaboration, validation and reliability of the safety protocol for pediatric thirst management^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period.

Method: methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child’s anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol’s reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit.

Results: in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98)

Conclusion: the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.

Descriptors: Thirst; Operating Room Nursing; Recovery Room; Pediatrics; Clinical Protocols; Validation Studies

Review Criterion	CVI
Level of Consciousness	1
Oriented	0.91
Alert	1
Sleepy	1
Agitated	1
Movement	0.96
Spontaneous and intentional movement	0.93
Head firm and aligned to the torso	0.84
They do not move the limbs	0.84
Unintentional movement	0.95
Head hanging and/or lateralized	0.97
Airway Protection	1
Effective cough	0.97
Ineffective cough	1
No cough	0.97
Deglutition with elevation of the larynx	1
No abnormal spillage of saliva through the mouth	1
Ineffective swallowing	1
Abnormal saliva leakage through the mouth	0.97
Respiratory Pattern	1
Respiratory rate appropriate to your age group	0.97
Respiratory rate inappropriate for their age group	1
No respiratory effort	0.93
Respiratory effort	0.93
Nausea and Vomiting	1
There is no complaint or presence of nausea	0.93
There is complaint or presence of nausea	0.93
There is no complaint or presence of vomiting	0.93
There is complaint or presence of vomiting	0.95
Total CVI of the criteria^* * CVI = Content Validity Index total criteria - obtained through the mean (sum of the CVI of each criterion divided by the total number of criteria);	0.99
Total CVI of the items^† † Content Validity Index (CVI) total of items - obtained through the average (sum of the CVI values of each item divided by the total number of items)	0.95

Evaluation Criterion	CVI	CVI
Evaluation Criterion	Operating Procedures	Operative Manual
Level of Consciousness	0.95	0.94
Level of Consciousness	(1) Observe if the child is alert, with eyes open. (2) Ask the child: What is your name? What is your age? (3) Ask if he is thirsty and how intense it is, using the face scale. (4) Wait 60 seconds without stimulating the child and observe whether he goes back to sleep. (5) Ask the primary guardian: Do you think he/she is wide awake?	0.94
Movement	0.97	0.88
Movement	(1) Ask the child to move the upper and lower limbs. (2) Observe if he is able to keep his head steady and in line with his torso.	0.88
Airway Protection	0.91	0.94
Airway Protection	(1) Place your hands on the child’s abdomen and chest. (2) Ask the child to cough hard. (3) Ask the child to swallow. (4) Place the index and middle finger on the hyoid and thyroid cartilage to check the laryngeal elevation during swallowing. (5) Check for abnormal saliva leakage through the mouth.	0.94
Respiratory Pattern	1	1
Respiratory Pattern	(1) Observe and note the child’s respiratory rate. (2) Check for respiratory effort.	1
Nausea and Vomiting	0.93 (1) Ask and check if the child is nauseous, wants to vomit. (2) Observe if there is vomiting.	0.94
Total CVI of operating procedures^* * Content Validity Index (CVI) total of operational procedures - obtained by means of the average (sum of the CVI of each set of operational procedures of the evaluation criteria divided by the total number of criteria);	0.95
CVI of the operating manual^† † Content Validity Index (CVI) total of the operating manual - obtained through the average (sum of the CVI of the operating manual of each evaluation criterion divided by the total number of criteria)	0.94

Evaluation Criterion	Agreement Percentage	Kappa coefficient^* * Kappa coefficient: less than zero, poor agreement; from zero to 0.20, negligible agreement; 0.21 to 0.40, smooth agreement; 0.41 to 0.60, moderate agreement; 0.61 to 0.80, substantial agreement, 0.81 to 1, almost perfect agreement(20)
Level of Consciousness
Is oriented	99.1	0.96
Is alert	96.6	0.89
Is sleepy	96.6	0.89
Is agitated	100	1
Movement
Spontaneous movement	100	1
Head firm and aligned to the torso	100	1
Do not move the limbs	100	1
Unintentional movement	100	1
Head hanging and/or lateralized	100	1
Airway Protection
Effective and spontaneous cough	100	1
Ineffective cough	100	1
Has no cough	100	1
Ineffective swallowing	100	1
There is no abnormal spillage of saliva	100	1
Ineffective swallowing	100	1
There is no abnormal spillage of saliva	100	1
Respiratory Pattern
Adequate respiratory rate	100	1
Inadequate respiratory rate	100	1
No respiratory effort	100	1
Respiratory effort	100	1
Nausea and Vomiting
There is no complaint or presence of nausea	100	1
There is complaint or presence of nausea	100	1
There is no complaint or presence of vomiting	100	1
There is complaint or presence of vomiting	100	1

Kappa total^† † Kappa total realized through the average of individual items values		0.98

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
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[TFN1] ^*
CVI = Content Validity Index total criteria - obtained through the mean (sum of the CVI of each criterion divided by the total number of criteria);

[TFN2] ^†
Content Validity Index (CVI) total of items - obtained through the average (sum of the CVI values of each item divided by the total number of items)

Elaboration, validation and reliability of the safety protocol for pediatric thirst management*

Elaboration, validation and reliability of the safety protocol for pediatric thirst management^*