EVALUATION AND CLASSIFICATION OF VAGINAL STENOSIS IN BRACHYTHERAPY: INSTRUMENT CONTENT VALIDATION FOR NURSES

Silva, Rafaela Dutra Nunes da; Rosa, Luciana Martins da; Radünz, Vera; Cesconetto, Daiana

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Original Article • Texto contexto - enferm. 27 (2) • 2018 • https://doi.org/10.1590/0104-070720180005700016 copy

EVALUATION AND CLASSIFICATION OF VAGINAL STENOSIS IN BRACHYTHERAPY: INSTRUMENT CONTENT VALIDATION FOR NURSES

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to validate the content of an instrument prepared for evaluation and classification of vaginal stenosis after brachytherapy for its application by nurses.

Method:

a methodological study that included ten nurses who are experts in brachytherapy. The data collection was performed between December 2015 and April 2016 and it was carried out through the application form made available to experts via the Google Drive/Microsoft® tool in three validation rounds, conducted by the Delphi Technique; 12 contents were evaluated. The data analysis was performed by calculating the Content Validity Index - CVI.

Results:

in the first round, the use of intimate tampons was excluded (CVI=0.4), other contents have been adjusted, as well as the appearance of the instrument, according to the experts’ recommendations. The content in the third round of evaluation reached the CVI=1.

Conclusion:

the instrument content validation standardizes the technique; consequently, it increases and qualifies the clinical practice and research development.

DESCRIPTORS:
Nursing; Oncology; Brachytherapy; Validation study; Pathological constriction; Cervical cancer

	Content	1st Round		2nd Round		3rd Round
	Content	n Total agreement	CVI^* * CVI=Content Validity Index (ten evaluating judges in the 1st round of validation and nine in the 2nd and 3rd rounds of validation).	n Total agreement	CVI^* * CVI=Content Validity Index (ten evaluating judges in the 1st round of validation and nine in the 2nd and 3rd rounds of validation).	n Total agreement	CVI^* * CVI=Content Validity Index (ten evaluating judges in the 1st round of validation and nine in the 2nd and 3rd rounds of validation).
1	Discomforts and questions	8	0.80	8	0.89	9	1
2	Sexual relations	7	0.70	7	0.78	9	1
3	Vaginal dilation exercises	8	0.80	8	0.89	9	1
4	Pain perception	4	0.40	7	0.78	9	1
5	Vaginal bleeding	7	0.70	7	0.78	9	1
6	Use of intimate tampons	4	0.40	Content excluded in the 1st round
7	Previous gynecological examination	7	0.70	7	0.78	9	1
8	Vaginal lubrication	7	0.70	7	0.78	9	1
9	Gynecological examination	7	0.70	7	0.78	9	1
10	Classification of vaginal stenosis after the interview and gynecological examination	5	0.50	7	0.78	9	1
11	Nursing prescriptions oriented or implemented	7	0.70	7	0.78	9	1
12	Referrals to other indicated professionals	8	0.80	8.00	0.89	9	1

Before validation	After validation
Discomforts and Questions - Is there any discomfort or complaint you may want to report that have come up after the end of brachytherapy? - Are there any questions you want to ask?	Initial content maintained.
Sexual relations - Do you have sexual relations? ( ) Yes ( ) No - If so, how many times a week? - If not, why not?	Sexual relations - Do you have sexual relations with vaginal penetration? ( ) Yes ( ) No - How many times a week? - If not, Why don't you have sexual relations with vaginal penetration?
Vaginal dilation exercise - Do you do vaginal dilation exercise? ( ) Yes ( ) No - If so, how many times a week? - If not, why not? - Please, describe the directions given by the nurse for the performance of vaginal physiotherapy: ( ) reported in full ( ) reported partially ( ) did not report - If REPORTED PARTIALLY, record the identified health education needs:	Vaginal dilation exercise - Do you do vaginal dilation exercise? ( ) Yes ( ) No - How many times a week? If not, why don't you perform the exercises? - Please, describe the directions given by the nurse and/or other professional of the health team to perform the vaginal dilation exercise: ( ) reported in full the institutionally recommended care ( ) reported partially ( ) did not report - If REPORT PARTIALLY or DID NOT REPORT, record the health education needs:
Pain perception - Do you feel pain during the sexual act or at another moment? ( ) Yes ( ) No - If so, what is the pain intensity (from 1 to 10)? - If so, what is the location of the pain? - If so, how long does the pain last? - If so, what are the characteristics of pain? - If so, what do you do to control the pain?	Pain perception - During the sexual act, or at another moment, do you feel pain in the region where the radiotherapy was performed (pelvic, vaginal, perianal region)? ( ) Yes ( ) No - What is the intensity (from 1 to 10), duration, characteristics and location of the pain? - What are the strategies used for controlling the pain?
Vaginal bleeding - Do you have any bleeding or other vaginal secretion? ( ) Yes ( ) No - If so, what are the characteristics of the bleeding or secretion? - If so, when (approximate start date) did this bleeding or secretion start? - Are you under treatment to control the bleeding and/or vaginal secretion? ( ) Yes ( ) No - If so, what is the treatment? - If not, why don't you or why didn't you seek care to start the treatment?	Bleeding and vaginal secretion - Do you have any vaginal bleeding? ( ) Yes ( ) No, or do you have any other type of secretion? ( ) Yes ( ) No - What is the start date and the characteristics of the bleeding and/or secretion? - Are you under treatment to control the bleeding and/ or vaginal secretion? ( ) Yes ( ) No. What is the treatment performed? - If the patient does not perform treatment, ask and record the reason for this attitude.
Use of intimate tampons - Do you use intimate tampons? ( ) Yes ( ) No - If not, why not?	Content excluded.
Previous gynecological examination - Have you had a gynecological examination after the end of the brachytherapy? ( ) Yes ( ) No - If so, when were you examined? ___/___/___ - Was there any difficulty in performing the previous gynecological examination? ( ) Yes ( ) No - If so, what were the difficulties encountered? - If not, why weren't you examined?	Previous gynecological examination - Have you had a gynecological examination after the end of the brachytherapy? ( ) Yes ( ) No - When were you examined after the end of the brachytherapy? - Was there any difficulty in performing the previous gynecological examination? ( ) Yes ( ) No - What were the difficulties and/or discomforts felt? - If you did NOT undergo gynecological examination after the end of the brachytherapy, why not?
Vaginal lubrication - Do you use or feel the need to use vaginal lubricant? ( ) Yes ( ) No - If so, why do you feel the need? - If so, which lubricant do you use? - If so, how often do you use the lubricant?	Vaginal dryness and use of lubricant - Do you experience vaginal dryness? ( ) Yes ( ) No - Do you use or feel the need to use vaginal lubricant? ( ) Yes ( ) No - Why do you feel the need to use lubricant? - What is the lubricant and how often do you use it?
Gynecological examination: - Examination performed ( ) Yes ( ) No. - Size of the speculum used: ( ) small ( ) medium ( ) large - Characteristics of the vaginal canal and uterus that show physiological abnormalities: - If there were any obstacles to the gynecological exam, mention the reason(s): - Was the collection of material for oncotic colpocitology performed? ( ) Yes ( ) No - If the oncotic colpocitology was not performed, mention the reason(s):	Initial content maintained.
Classification of vaginal stenosis^* * The items that are part of the classification of vaginal stenosis were built based on some scientific publications,17-19 on the clinical experience in Oncology and on the changes proposed by the evaluating judges. : ( ) Degree 0; ( ) Degree 1; ( ) Degree 2; ( ) Degree 3; ( ) Degree 4; ( ) Degree 5. To define the degree of vaginal stenosis consider the following characteristics: Degree 0: asymptomatic woman; Degree 1: woman who reports some vaginal discomfort, but what does not prevent the use of tampons, sexual activity and gynecological examination; Degree 2: woman who presents vaginal narrowing and/or shortening that partially interferes with the use of intimate tampons, sexual activity and gynecological examination; Degree 3: woman who presents complete constriction of the vagina, identified in the visual inspection during the gynecological examination and that makes it impossible to perform the gynecological examination and sexual activity; Degree 4: woman who presents ulcer and necrosis in the vaginal canal (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations); Degree 5: woman who presents vesical and/or intestinal fistulas (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations).	Classification of vaginal stenosis^* * The items that are part of the classification of vaginal stenosis were built based on some scientific publications,17-19 on the clinical experience in Oncology and on the changes proposed by the evaluating judges. : ( ) Degree 0; ( ) Degree 1; ( ) Degree 2; ( ) Degree 3; ( ) Degree 4; ( ) Degree 5. To define the degree of vaginal stenosis consider the following characteristics: Degree 0: asymptomatic woman; Degree 1: woman who reports some vaginal discomfort, but what does not prevent sexual activity, the performance of gynecological examination or the recommended vaginal dilation exercise after brachytherapy; Degree 2: woman who presents vaginal narrowing and/or shortening that partially interferes with the use of intimate tampons, sexual activity, gynecological examination, and in the exercise of recommended vaginal dilation after brachytherapy; Degree 3: woman who presents complete constriction of the vagina, identified in the visual inspection during the gynecological examination and that makes it impossible to perform the gynecological examination and sexual activity; Degree 4: woman who presents ulcer and necrosis in the vaginal canal (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations); Degree 5: woman who presents vesical and/or intestinal fistulas (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations).
Nursing prescriptions oriented or implemented	Record of nursing interventions oriented or implemented
Referrals to other indicated professionals	Initial content maintained.

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Luciana Martins da Rosa, Avenida Mauro Ramos, 1250, 88020-301 - Florianópolis, SC, Brazil. E-mail: luciana.m.rosa@hotmail.com