Adaptation of the inventory of ethical problems to the child health context

Methodological study, based on the universalist model. The following phases of equivalence were undertaken: conceptual, item, semantic and operational. Ten experts and 30 nurses from Family Health Services participated.

Results:

In the item and semantic equivalence developed by the judges, the first dimension of the IPE-APS presented the largest number of items with agreement <70 %, totaling five out of 18. In the pretest, the target population assessed the instrument as easy to understand, but suggestion a slight adjustment in the instruction and layout. The mean completion time was 15 minutes.

Conclusion:

The adaptation of the IPE-APS to the child health context was developed successfully. The tool is feasible and the subsequent validation phases will permit its inclusion in professional nursing practice.

Keywords
Validation studies; Problem solving; Child health; Family nurse practitioners; Bioethics

	Item equivalence
Item	1st Round n(%)	2nd Round n(%)
1	3(30.0)	6(60.0)
5	6(60.0)	10(100.0)
8	5(50.0)	9(90.0)
13	6(60.0)	10(100.0)
17	4(40.0)	7(70.0)

	Semantic equivalence
Item	1st Round n(%)	2nd Round n(%)
1	6(60.0)	9(90.0)
2	6(60.0)	10(100.0)
3	5(50.0)	9(90.0)
5	5(50.0)	8(80.0)
7	6(60.0)	10(100.0)
8	5(50.0)	8(80.0)
9	5(50.0)	10(100.0)
11	6(60.0)	10(100.0)
12	6(60.0)	8(80.0)
13	6(60.0)	8(80.0)
14	4(40.0)	9(90.0)
15	6(60.0)	10(100.0)
17	6(60.0)	9(90.0)
18	5(50.0)	9(90.0)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Deisy Vital dos Santos Carlos Amaral Avenue,1015, 44570-000, Santo Antônio de Jesus, BA, Brazil. deisy@ufrb.edu.br

Original version (IPE-APS)	Adapted version (IPE-APS-SC)
1st Domain: ethical problems in the relationships with the child/family
1. The proximity and bonding between the professionals and the users make it difficult to stay impartial in the relationship	1. The proximity and bonding between the professionals and the child and parents (or responsible caregivers) make it difficult to stay impartial in the clinical relationship within the professional limits
2. If the FHS team prejudges the users and relatives based on prejudices and stigmas	2. The FHS team prejudges the child and the parents (or responsible caregivers) based on prejudices and stigmas
3. The professional treats the user with a lack of respect	3. The professional treats the child and the parents (or responsible caregivers) with a lack of respect
4. The professionals give inappropriate or wrong prescriptions	4. The FHS professionals give inappropriate or wrong prescriptions to the child
5. The professionals prescribe drugs the user will not have money to buy when no other drug can be prescribed	5. Despite knowing that the parents (or responsible caregivers) will not have money to buy a certain drug, the professionals prescribe it if there is no other treatment option
6. The professionals prescribe a more expensive drug even if its efficacy is equal to that of the cheaper one	6. The professionals prescribe a more expensive drug even if its efficacy is equal to that of the cheaper one
7. During the medical or nursing consultation, the users request tests, drugs or other inappropriate or unnecessary procedures	7. During the medical or nursing consultation, the parents (or responsible caregivers) request tests, drugs or other inappropriate or unnecessary procedures for the child
8. The professionals feel powerless to convince the user to proceed with the treatment	8. The professionals face difficulties to convince the parents (or responsible caregivers) to continue with the child's monitoring (e.g. consultations, vaccination, healthy eating).
9. The professionals request diagnostic tests without informing the user on what is being asked and why.	9. The professionals request diagnostic tests without informing the parents (or responsible caregivers) on what is being asked and why.
10. The ACS comments on unnecessary information on the family and the couple's intimacy with the health team	10. The ACS comments on unnecessary information on the family and the child's intimacy with the health team
11. It is difficult to maintain the user's privacy in home care due to the interference of other family members or neighbors	11. It is difficult to maintain the child's privacy in home care due to the interference of other family members or neighbors
12. The ACS tells information obtained during his work about users and families to the neighbors	12. The ACS tells information obtained during his work about the children and their families to the neighbors
13. The professional tells information about the health of one of the family members when that person is unable to manage self-care and is exposed to risks	13. The professional tells information about the health of the child to other family members when he identifies care neglect, exposure of the child to risks or situations of violence by the parents (or responsible caregivers)
14. The professional is unable to identify to what extent he can interfere in the families and users' habits and customs with a view to them having a healthy lifestyle	14. The professional is unable to identify to what extent he can interfere in the parents' (or responsible caregivers) habits and customs regarding child care with a view to them having a healthy lifestyle
15. The users refuse treatment because they believe in a divine cure	15. The parents (or responsible caregivers) refuse treatment prescribed to the child because they believe in a divine cure.
16. People under age visit the UBS and ask the team for tests, drugs or other procedures not established in the Child and Adolescent Statute without the parents' consent and/or authorization	16. People under age visit the UBS and ask the team for tests, drugs or other procedures, not established in the Child and Adolescent Statute without the parents' consent and/or authorization
17. Users refuse to follow medical indications or to undergo tests	17. Parents (or responsible caregivers) refuse to follow medical indicators or to undergo tests the doctors and nurses indicated to the children
18. The team holds an interdisciplinary discussion about the user's health conditions in front of him, without his participation	18. The health team discusses the child's health conditions in front of the parents (or responsible caregivers) without including them in the conversation
2nd Domain - ethical problems in the team's relationships
19. The FHS team professionals act with a lack of commitment and involvement	19. The FHS professionals work with a lack of commitment and involvement in child health care
20. The FHS teams do not cooperate with one another	20. The FHS teams do not cooperate with one another in child health care
21. There is a lack of respect among the FHS team members	21. There is a lack of respect among the FHS team members
22. The team professionals do not display a profile to work in the FHS	22. The team professionals do not display a profile to work in child health care
23. In practice, it is difficult to comply with the role and responsibilities of each family health team professional	23. In practice, it is difficult to comply with the role and responsibilities of each family health team professional in care for the child
24. Professionals shirk in case of an inappropriate or wrong prescription	24. Professionals shirk in case of an inappropriate or wrong prescription for the child
25. Users ask one of the family health team members not to give the other members access to some information related to their health, even in situations in which the family's participation in care is necessary	25. Parents (or responsible caregivers) ask one of the FHS members not to give the other members access to some information related to the child's health, even in situations in which the entire family needs to participate in care
26. UBS servants raise doubts on the conduct of the FHS team doctor	26. UBS servants raise doubts on the conduct of the FHS professionals
3rd Dimension: ethical problems in the relations with the organization and the health system
27. The UBS faces problems in the facilities and routines that make it difficult to preserve the user's privacy	27. The UBS faces problems in the facilities and routines that make it difficult to preserve the child's privacy
28. The FHS team professionals feel a lack of support from intersectoral actions, which depend on the organization and management of the system, to discuss and solve ethical problems they face in their practice	28. Lack of support from intersectoral actions to discuss and solve ethical problems they face in their practice in child health
29. The UBS board does not act transparently in solving problems with the professionals	29. The UBS manager does not act transparently in solving problems with the professionals
30. Too many families are assigned to each FHS team	30. Too many families are assigned to each FHS team
31. The FHS physician refuses to attend to users without an appointment on that day, which ends up restricting the users' access to the UBS, although welcoming always takes place	31. The FHS physician refuses to attend to children without an appointment on that day, which ends up restricting their access to the UBS
32. The professionals from private health services ignore the diagnostic or therapeutic conduct by the physicians from the family health team	32. The professionals from private health services ignore the diagnostic or therapeutic conduct by the physicians from the family health team
33. The professionals from other public health network levels ignore the diagnostic or therapeutic conduct by the physicians from the family health team	33. The professionals from other public health network levels ignore the diagnostic or therapeutic conduct by the physicians from the family health team
34. Difficulties exist in the referral and counter-referral system to undergo complementary tests	34. Difficulties exist in the referral and counter-referral system to consult with specialists and for the children to undergo complementary tests
35. Difficulties exist in the return and reliability of the laboratory test results	35. Difficulties in the return and reliability of the laboratory test results
36. The UBS does not offer conditions to the family health teams to support the practice of home visits	36. The UBS does not offer conditions to the family health teams to support the practice of visits to the children's homes
37. The UBS has no conditions to deliver emergency care	37. The UBS has no conditions to deliver emergency care to children
38. There is no rearguard support from a removal service at the UBS	38. There is no rearguard support from a removal service at the UBS