Clinic validation protocol for venous ulcers in high complexity

Methodological quantitative study conducted by four specialist nurses who evaluated 32 patients with venous ulcers, at the Onofre Lopes University Hospital, in Natal/Rio Grande do Norte. Data was collected between July and December/2013 and analysis was carried out using Kappa test (K), considering K ≥ 0.61.

Results

Items with unsatisfactory Kappa coefficients were excluded and the experts suggested changes in the categories anamnesis; examinations; verification of pain and pulse signs; surgical treatment of chronic venous disease; prevention of recurrence; reference and counter-reference.

Conclusions

The protocol was validated in the clinical setting and, after adjustments, it contained 15 categories and 76 items. Validation optimized the instrument regarding applicability and relevance.

Varicose ulcer; Tertiary healthcare; Clinical protocols; Validation studies

Categories of the protocol	Relevance
	Judge 1	Judge 2	Inter-raters
	Kappa	Kappa	Kappa
Sociodemographic data	0.99	0.98	0.92
Anamnesis	0.84	0.89	0.64
Tests (Request/completion/results)	0.84	0.82	0.79
Different checks: pain, pulses, edema, signs of infection, body mass index (BMI), vital signs (SSVV) and site of the wound.	0.92	0.89	0.78
Characteristics of the ulcer	1.00	1.00	1.00
Care with the wound and perilesional area	0.97	0.96	0.89
Drugs for treating the wound taken by the patient	1.00	1.00	1.00
Pain treatment	0.97	0.97	0.83
Surgical treatment of CVD	0.76	0.67	0.62
Compression treatment	0.84	0.83	0.64
Prevention of recurrence (clinical strategies)	0.44	0.61	0.41
Prevention of recurrence (educational strategies)	1.00	1.00	1.00
Reference	0.37	0.59	0.31
Counter-reference	0.73	0.57	0.53
Quality of life	0.99	0.95	0.91
General score	0.84	0.85	0.79

Category	Item	Judge 1	Judge 2	Inter-raters
Category	Item	Kappa	Kappa	Kappa
Anamnesis	Chronic diseases	0.53	0.66	0.45
	Drugs used by the patient	0.37	0.53	0.31
	Daily activities	0.37	0.66	0.33
	Risk factors	0.47	0.66	0.42
Tests (Request/ completion/results)	Serum albumin	0.44	0.50	0.33
Different checks	Pain	0.57	0.27	0.29
Surgical treatment of CVD	Valve malfunction	0.74	0.40	0.38
	Venous obstruction	0.66	0.45	0.41
	Method of incompetent perforating veins ligation	0.66	0.51	0.43
Compression therapy	Rest with elevated legs recommended (2 to 4 h/day) and elevating the feet of the bed 10 to 15 cm	0.59	0.91	0.58
Prevention of recurrence (clinical strategies)	Venous and surgical procedures in the investigation	0.37	0.59	0.34
	Lifetime compression treatment	0.53	0.66	0.45
	Regular monitoring of the skin surrounding the ulcer	0.42	0.59	0.40

Category of the protocol	Applicability
	Judge 1	Judge 2	Inter-raters
	Kappa	Kappa	Kappa
Sociodemographic data	0.99	0.98	0.97
Anamnesis	1.00	1.00	1.00
Tests (Request/ completion/results)	0.81	0.81	0.80
Different checks: pain, pulses, edema, signs of infection, body mass index (BMI), vital signs (SSVV) and site of the wound.	0.94	0.94	0.92
Characteristic of the ulcer	0.95	0.92	0.91
Care with the wound and perilesional area	1.00	1.00	1.00
Drugs related to the treatment of the wound taken by the patient	1.00	1.00	1.00
Pain treatment	1.00	1.00	1.00
Surgical treatment of CVD	0.90	0.93	0.89
Compression treatment	0,89	0,95	0,82
Prevention of recurrence (clinical strategies)	0.88	0.88	0.86
Prevention of recurrence (educational strategies)	0.86	0.88	0.85
Reference	1.00	0.87	0.88
Counter-reference	1.00	0.87	0.88
Quality of life	0.89	0.99	0.95
General score	0.94	0.93	0.92

Category	Item	Judge 1	Judge 2	Inter-raters
Category	Item	Kappa	Kappa	Kappa
Tests (request/ completion/results)	Serum albumin	0.54	0.76	0.51
Different checks	Tibial pulse	0.46	0.37	0.30

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author: Daniele Vieira Dantas E-mail: daniele00@hotmail.com