Lesões mamilo-areolares decorrentes da prática da amamentação: construção e validação de uma classificação sob o enfoque dermatológico

• Ano de defesa: 2019
• Autor(a) principal: Cervellini, Marina Possato [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Breastfeeding; Wounds And Injuries; Validation Studies; Reproducibility Of Results; Obstetric Nursing.; Aleitamento Materno; Ferimentos E Lesões; Estudos De Validação; Reprodutibilidade Dos Testes; Enfermagem Obstétrica
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7746967; https://repositorio.unifesp.br/handle/11600/59983

Objectives: to construct a new classification of nipple-areolar lesions resulting from the practice of breastfeeding with a dermatological focus and validate it, according to content and appearance. Methodology: the construction of the classification was based on the findings of two literature reviews, the knowledge acquired, and the clinical experience accumulated in breastfeeding assistance and injuries, and the qualitative analysis between the researchers and a specialist dermatology judge. The content and appearance validation process were developed using the Delphi technique and using a Likert scale with a score of one to four. The data collection took place electronically and the re-elaboration of the classification versions was performed after each round of responses. To verify the validity of the instrument was used the Content Validity Index with a minimum value of 80% and Kappa coefficient analysis with a significance level of 5%. Results: The proposed classification was sent to 10 judges and after the analysis of data from the first cycle of answers, 90 to 100% agreement was obtained for the items, definition, erythema, ecchymosis, edema, vesicle, fissure and erosion. Only the crust, did not obtain minimum value in the three variables judged: clarity, pertinence and comprehensiveness. With the second round of responses, a minimum agreement of 87.5% and maximum of 100% was reached. After statistical analysis, a Kappa Coefficient = 1 (perfect agreement) was obtained for the items definition, erythema, ecchymosis, edema, vesicle and erosion, Kappa = 0.46 (moderate agreement) for the fissure and Kappa = 0.58 (concordance moderate) to the crust. A new version of the classification was elaborated and sent to 16 specialists participating in the process of appearance validation. After the analysis of the data of the first cycle of answers, a minimum agreement of 94% and maximum of 100% was obtained. Subsequently, the final version of the classification was drawn up. This is the first classification of nipple-areolar lesions resulting from the practice of breastfeeding with morphological characterization and standardized dermatological language. The high percentage of agreement found, coupled with the great experience of the judges' committee in the content validation process, was able to confer even more quality for this classification, making it possible to use it in all health areas that work in breastfeeding care. Although appearance validation has demonstrated excellent agreement among breastfeeding experts, prior training may be required for its use. Conclusions: the study allowed the construction and validation of the proposed classification and presents several future perspectives for the teaching, research and assistance areas, which may help in the recognition of each type of nipple-areolar lesion, prescription of specific treatments and care.