Development and assessment of learning objects about intramuscular medication administration

OBJECTIVES: to develop and assess a learning object about intramuscular medication administration for nursing undergraduates and nurses. METHOD: a random, intentional and non-probabilistic sample was selected of nurses from a Brazilian social network of nursing and students from the Undergraduate Program at the University of São Paulo School of Nursing to serve as research subjects and assess the object. RESULTS: the participants, 8 nurses and 8 students, studied the object and answered an assessment instrument that included the following criteria: educational aspects (relevance of the theme, objectives and texts/hypertexts), interface of the environment (navigation, accessibility and screen design) and didactic resources (interactivity and presentation of resources). In total, 128 significant answers were obtained, 124 (97%) of which were positive, assessed as excellent and satisfactory, considered as a flexible, dynamic, objective resources that is appropriate to the nursing learning process. CONCLUSION: the educational technology shows a clear and easily understandable language and the teaching method could be applied in other themes, contributing to the education and training of nursing professionals, positively affecting nursing teaching, stimulating the knowledge, autonomous and independent learning, aligned with the new professional education requirements.


Introduction
In nursing, many people consider the theme intramuscular medication administration (IM) a relatively simple procedure. Nevertheless, both professional practice and the literature review present various reports of complications related to this procedure. In the literature, reports were found of severe errors the nursing team committed in performing this procedure, which resulted in the formation of an abscess, local pain or in the limb where the medication was applied, reduced limb sensitivity, local necrosis, skin and fatty tissue atrophy, shoulder movement contraction and limitation, hematoma, nodulation, erythema, among others (1) .
Hence, it is considered that changing this reality is related to nursing staff education and training, aiming to guarantee the accomplishment of safe practices for the patient (1) . When discussing the learning process and its new trends, some considerations about the method applied in teaching processes at Brazilian colleges are relevant, mainly regarding new teaching technologies focused on the autonomy and independence of college students.
Reflecting on the current Brazilian educational system is important in view of the urgent need for reformulation, mainly in the development of didactical materials to adapt to the new professional education requirements deriving from Information and Communication Technologies (ICTs), breaking with the idea of isolated science, strengthening its trends towards interdisciplinarity, increasingly driving people towards its use in different knowledge areas (2) .
The use of ICT in Nursing teaching can grant interactive, dynamic, attractive and multisensorial experiences, supporting the improvement of the teaching-learning process (3) . In that context, the learning objects (LO) can be highlighted, characterized by flexible learning environments, compatible with active learning methods that value the students' autonomy (4) .
The Los can easily be reused in different learning contexts, reducing the costs of purchasing programs and installation licenses, besides the capacity to be used in any teaching platform around the world, offering the advantage of practicality for the sake of fast and safe updates.
In that perspective, the development of this object about intramuscular medication administration can positively influence nursing teaching, stimulating the knowledge and autonomous and independent learning, aligned with the new professional education requirements.
Based on this context, the objectives in this study were to: develop the learning object about intramuscular medication administration and assess it from the perspective of nursing undergraduates and nurses, with a view to testing this complementary teaching method, verifying the possible aspects, whether positive or negative, and proving the hypothesis about its probable positive impact in nursing teaching.

Method
This exploratory and descriptive study is characterized as an applied technological production research, undertaken between 2012 and 2013. The study context was the Telenursing Center of the University of São Paulo School of Nursing (CETEnf -EEUSP), which is a virtual laboratory that offers support for the creation of pedagogical products, serving as an educative space for theoretical-practical teaching and research development in telenursing and nursing informatics (5) .
The creation of the LO followed the cyclical phases of analysis, design, development, implementation and assessment, proposed by Filatro (5) . In the Analysis  Only 156 people manifested their interest in participating in the study and only 16 (8 undergraduates from EEUSP and 8 nurses) answered the assessment instrument of the LO, due to the available time. Initially, a 20-day deadline was set to return the assessment form and, as a result of the small demand within that deadline, it was extended to another 30 days. According to the NBR ISO/IEC 14598-6 (6) , with a view to consistent results, software should be assessed by at least eight participants for each assessment category.
The assessment instrument was based on other studies (7)(8)

Development of the Learning Object
In the analysis phase, a bibliographic review on intramuscular medication administration was undertaken to identify learning needs and define the educational objectives of the LO. The articles analyzed showed that the nursing team commits severe errors in this procedure, such as the formation of abscess, local pain or in the limb where the medication was applied, reduced limb sensitivity, local necrosis, skin and fatty tissue atrophy, shoulder movement contraction and limitation, hematoma, nodulation, erythema, among others (1) .
Based on the bibliographic reference framework, the educational objectives were elaborated according to Bloom's taxonomy (9) in three domains: cognitive, affective and psychomotor, as shown in Figure 1. -Perceive the importance of studying the theme for professional practice. -Reflect on the need for humanization of the procedure. -Consciously apply the content studied in practice.
-Simulate the intramuscular application following the rules of antisepsis, muscle fold, needle angulation, application, aspiration and injection of the prescribed volume. -Decide on the type of needle that is to be used, relating it with the patient's profile, the drug, the volume for administration and the specific muscle.     The texts serve as theoretical support tools for the users of the learning object, observing simplicity, clarity and objectivity. In combination with the animations, these are valuable didactical tools to help the students with any concept abstraction difficulties, as they produce a playful environment to develop classes, stimulate cognitive processes like perception, memory, language, thought and permit the modeling of real events that evolve over time (11) .

Discussion
In nursing, the need for innovations in the teaching-learning process is observed, which stimulates the knowledge and autonomous and independent learning through the adoption of learning objects. It is evidenced that the use of computer technologies permits more creative teaching processes, furthering the students' more active learning (4) .

Studies show that young people increasingly
show interest in technology, increasing the mean number of weekly accesses for educational purposes.
These findings support the adoption of technology use in teaching to permit autonomous and interactive learning (12)(13)(14) .
The educational aspects of the LO assessed demonstrate that the theme is relevant for nursing and that the objectives and content are pertinent.
Medication administration, a technique that is frequently used in health institutions and is apparently simple, should be a well-established practice, as an error can entail severe consequences. This is not unreal in health, as reports of injuries, tissue necrosis, muscle group contractions, fibroses and even loss of joint movement range were found in the literature with regard to children and adults who used intramuscular medication (3) .
There are themes related to intramuscular medication administration that were not focused on in this study, but which are nevertheless essential.
The evaluators suggested the following, for example: use of IPE (Individual Protection Equipment) by professionals and the humanization process with the patient.
The LOA as computer technology is a resource that can be used to support the learning. Its main idea is to "break" the educational contents into small parts that can be reused in different learning environments.
Any electronic material that contains information that contributes to the knowledge construction can be considered a learning object, whether in the form of an image, a HyperText Markup Language (HTML) page, an animation or simulation (1) . Furthermore, it is highlighted that this process is not limited that the visible part of instructional products, nor does it simply refer to abstract teaching planning, but it reflects the articulation between form and function, in order to comply with the proposed educational objectives (5) .
When using the web, actions like updates,  (16) .
Based on the comments and suggestions, the contributions and limits of the LO could be highlighted, considering it as an innovative resource that can contribute to the teaching-learning process in nursing, indicating improvements and refinement needs of the media according to the needs of the target public it is to be applied to.

Conclusion
This study was elaborated to develop a learning object about intramuscular medication administration and assess it from the perspective of nursing undergraduates and nursing professionals.
The object was developed in accordance with a planning that permitted the construction of a flexible, dynamic, clear, objective and easily understandable resource, addressing a relevant theme for nursing.