Development and validation of the specific instrument for assistance complexity of puerperal and newborns: Fantinelli Scale

Fantinelli, Alessandra Andrade; Borges, Rosalia Figueiró; Stein, Renato Tetelbon; Molin, Rossano Sartori Dal; Roncada, Cristian

doi:10.1590/1806-93042020000200006

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 20 (2) • Apr-Jun 2020 • https://doi.org/10.1590/1806-93042020000200006 copy

Development and validation of the specific instrument for assistance complexity of puerperal and newborns: Fantinelli Scale

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to develop and validate a care complexity assessment system adapted for mothers and newborns, based on two pre-existing scales.

Methods:

this is a cross-sectional study of psychometric validation of instruments, applied in a roomming-in, in 2016. The instrument has 13 indicators, submitted to the evaluation of a panel of judges for validation. For the psychometric analysis of the instrument, five criteria were adopted: a) internal consistency through Cronbach's alpha (αC); (b) intraclass correlation coefficient (ICC); c) correlation between categorical items, mediating Kendall correlation; d) ceiling and floor effect; e) Kaiser-Meyer-Olkin test.

Results:

after evaluating the judges on the categories, the agreement was satisfactory, being equal to or greater than 80%. The mean total score of the 13 items was 22.5 ± 4.2, with an intermediate level score of 52.9%. For psychometric validation purposes, the instrument presented αC scores of 0.73 points, between minimum items of 0.70 and maximum of 0.74 points. In the correlation of αC by items and the total score, the instrument showed high relationships (r2: 0.84). In the ICC assessment of 0.73 points (CI95%= 0.71-0.75; p<0.001).

Conclusion:

the questionnaire presented psychometric indicators of acceptable content validity, with statistical evidence of reliability, obtained by satisfactory inter-rateragreement.

Key words:
Validation; Neonatal nursing; Rooming-in care

	X̅ ± SD	N	%
Age of puerperal women (years)	31.1 ± 5.7
Ethnicity/Race
White		869	62.2
Black		326	23.4
Brown		201	14.4
Gestational age (months)	37.9 ± 2.3
Number of pregnancies	1.7 ± 1.0
First pregnancy		708	50.7
From 2 to 3 pregnancies		647	46.3
From 4 to 5 pregnancies		37	2.7
More than 5 pregnancies		4	0.3
Newborn (Neonatal)		229	16.4
Type of hospitalization/pregnancy
Private		105	7.5
Health insurance		1,207	86.5
Others		84	6.0
Month of hospitalization/pregnancy
July		288	20.6
August		304	21.8
September		279	20.0
October		294	21.1
November		231	16.5
Care complexity questionnaire
Punctuation of total score	22.5 ± 4.2
Classification of total score
Minimal care		406	29.1
Intermediate care		739	52.9
Semi-intensive care		245	17.6
Intensive care		6	0.4

	Question	Factor 1	Factor 2	Factor 3
Motility, mobility, activity and wander	Q3	0.765
Eliminations	Q8	0.730
Overall observation of mothers and breasts	Q10	0.628
Baby position	Q11	0.716
Latch-on	Q12	0.619
Suction	Q13	0.646
Feeding	Q4		0.565
Skin integrity	Q6		0.524
Behavior, feelings and thoughts	Q7		0.566
Therapeutics	Q9		0.567
Mental state and sensory perception	Q1			0.527
Vital signs	Q2			0.756
Body care, friction and shearing	Q5			0.669

Frequency of answers per item		I agree		I partially agree		I partially disagree		Disagree		X̅ ± SD	r²	αC
Frequency of answers per item		n	%	n	%	n	%	n	%	X̅ ± SD	r²	αC
Q1	Mental state and sensory perception	1379	98.8^† † ceiling/floor effect for items with a prevalence above 20% of answers.	17	1.2	0	-	0	-	1.0±0.1	0.30^* * p-value of r2<0.05.	0.74
Q2	Vital signs	625	44.8^† † ceiling/floor effect for items with a prevalence above 20% of answers.	768	55.0	2	0.1	1	0.1	1.6±0.5	0.29^* * p-value of r2<0.05.	0.76
Q3	Motility, mobility, activity and wander	756	54.2^† † ceiling/floor effect for items with a prevalence above 20% of answers.	182	13.0	173	12.4	285	20.4^† † ceiling/floor effect for items with a prevalence above 20% of answers.	2.0±1.2	0.61^* * p-value of r2<0.05.	0.70
Q4	Feeding	1,015	72.7^† † ceiling/floor effect for items with a prevalence above 20% of answers.	360	25.8	19	1.4	2	0.1	1.3±0.5	0.28^* * p-value of r2<0.05.	0.72
Q5	Body care, friction and shearing	49	3.5	278	19.9	1,021	73.1	48	3.4	2.8±0.6	0.29^* * p-value of r2<0.05.	0.72
Q6	Skin integrity	57	4.1	104	7.4	1,216	87.1	19	1.4	2.9±0.5	0.11^* * p-value of r2<0.05.	0.74
Q7	Behavior, feelings and thoughts	1,172	84.0^† † ceiling/floor effect for items with a prevalence above 20% of answers.	178	12.8	17	1.2	29	2.1	1.2±0.6	0.23^* * p-value of r2<0.05.	0.73
Q8	Eliminations	781	55.9^† † ceiling/floor effect for items with a prevalence above 20% of answers.	201	14.4	34	2.4	380	27.2^† † ceiling/floor effect for items with a prevalence above 20% of answers.	2.0±1.3	0.57^* * p-value of r2<0.05.	0.70
Q9	Therapeutics	254	18.2	1,048	75.1	89	6.4	5	0.4	1.9±0.5	0.29^* * p-value of r2<0.05.	0.72
Q10	Overall observation of mother and breasts	1,117	80.0^† † ceiling/floor effect for items with a prevalence above 20% of answers.	216	15.5	53	3.8	10	0.7	1.3±0.6	0.27^* * p-value of r2<0.05.	0.72
Q11	Baby position	870	62.3^† † ceiling/floor effect for items with a prevalence above 20% of answers.	290	20.8	217	15.5	19	1.4	1.6±0.8	0.52^* * p-value of r2<0.05.	0.70
Q12	Latch-on	750	53.7^† † ceiling/floor effect for items with a prevalence above 20% of answers.	278	19.9	342	24.5	26	1.9	1.7±0.9	0.48^* * p-value of r2<0.05.	0.71
Q13	Suction	988	70.8^† † ceiling/floor effect for items with a prevalence above 20% of answers.	283	20.3	101	7.2	24	1.7	1.4±0.7	0.41^* * p-value of r2<0.05.	0.71

Frequency of answers per care		Minimum		Intermediate		Semi-intensive		Intensive
TS	Total Score	406	29.1	739	52.9	245	17.6	6	0.4	22.6±4.2	0.83^* * p-value of r2<0.05.	0.73

	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12	Q13	TS
Q1	1.00	0.05	-0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.00	0.04	-0.01	-0.03	-0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	-0.03	-0.01	-0.03	-0.04	-0.03	0.00
Q2		1.00	-0.29^ p of r<0.01;	-0.14^ p of r<0.01;	0.17^ p of r<0.01;	0.03	0.00	-0.18^ p of r<0.01;	-0.01	-0.03	-0.10^ p of r<0.01;	0.10^ p of r<0.01;	-0.10^ p of r<0.01;	-0.01
Q3			1.00	0.38^ p of r<0.01;	0.32^ p of r<0.01;	0.07^ p of r<0.01;	0.03	0.58^ p of r<0.01;	0.24^ p of r<0.01;	0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.16^ p of r<0.01;	0.11^ p of r<0.01;	0.13^ p of r<0.01;	0.54^ p of r<0.01;
Q4				1.00	0.15^ p of r<0.01;	-0.02	0.17^ p of r<0.01;	0.36^ p of r<0.01;	0.02	0.16^ p of r<0.01;	0.05^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.03	0.09^ p of r<0.01;	0.36^ p of r<0.01;
Q5					1.00	0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.05	0.32^ p of r<0.01;	0.24^ p of r<0.01;	0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.10^ p of r<0.01;	0.16^ p of r<0.01;	0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.43^ p of r<0.01;
Q6						1.00	-0.04	0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.24^ p of r<0.01;	0.03	0.06^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.09^ p of r<0.01;	0.04	0.18^ p of r<0.01;
Q7							1.00	0.04	-0.12^ p of r<0.01;	0.40^ p of r<0.01;	0.27^ p of r<0.01;	0.17^ p of r<0.01;	0.26^ p of r<0.01;	0.25^ p of r<0.01;
Q8								1.00	0.29^ p of r<0.01;	.064^* * p from r<0.05 to 0.01; Kendall's correlation test.	0.10^ p of r<0.01;	0.13^ p of r<0.01;	0.09^ p of r<0.01;	0.55^ p of r<0.01;
Q9									1.00	0.00	0.17^ p of r<0.01;	0.23^ p of r<0.01;	0.13^ p of r<0.01;	0.39^ p of r<0.01;
Q10										1.00	0.33^ p of r<0.01;	0.17^ p of r<0.01;	0.27^ p of r<0.01;	0.32^ p of r<0.01;
Q11											1.00	0.49^ p of r<0.01;	0.56^ p of r<0.01;	0.50^ p of r<0.01;
Q12												1.00	0.44^ p of r<0.01;	0.52^ p of r<0.01;
Q13													1.00	0.43^ p of r<0.01;
TS														1.00

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[1] Authors’ contribution

Fantinelli AA contributed to the elaboration of the project, data collection and writing of the manuscript. Borges RF participated in the elaboration of the project and review of the manuscript. Stein RT and Dal Molin RS wrote and revised the manuscript. Roncada C carried out project guidance, statistics, writing and revision of the manuscript. All authors approved the final version of the article.