PICCTIP TOOL: VIDEO VALIDITY FOR MEASUREMENT OF PERIPHERALLY INSERTED CENTRAL CATHETER IN INFANTSABSTRACT
Objective: To validate the content and appearance of a video about PICCTIP Tool for measuring PICC in infants.
Method: A methodological study to validate a video about PICCTIP Tool. Validity occurred based on video assessment by 78 judges (nurses, educators and designers) from July to August 2023. The Content Validity index was used to analyze the data, and internal consistency was measured by Cronbach’s alpha, with a cut-off point of 0.80 or greater and 0.75, respectively.
Results: The video content was validated with an overall index of 0.98 in the nurses category, 0.99 in the pedagogues category and 0.90 in the designers category. Appearance was also validated with indexes of 0.97 in the nurses and pedagogues categories and 0.95 in the designers category. Regarding overall appearance, Cronbach’s alpha obtained in the nurses category was 0.98, in the pedagogues category it was 0.99 and in the designers category it was 0.96.
Conclusion: The video about PICCTIP Tool is valid in terms of content and appearance, and has good internal consistency. It can be used as a knowledge translation tool for qualified physicians and nurses who perform PICC insertion in infants.
DESCRIPTORS:
Instructional Film and Video; Infant Newborn; Vascular Access Devices; Central Venous Catheters; Biomedical Translational Science; Validity Study; Nursing
RESUMO
Objetivo: Validar o conteúdo e aparência de um vídeo sobre a Ferramenta PICCTIP para mensuração do PICC em neonatos.
Método: Estudo metodológico para validação de vídeo sobre a Ferramenta PICCTIP. A validação ocorreu a partir da avaliação do vídeo por 78 juízes (enfermeiros, pedagogos e designers), no período de julho a agosto de 2023. Para a análise dos dados foi utilizado o índice de Validação de Conteúdo e a consistência interna foi mensurada pelo Alpha de Cronbach, tendo como ponto de corte valor igual ou superior a 0,80 e 0,75, respectivamente.
Resultados: O vídeo teve seu conteúdo validado com índice global de 0,98 na categoria dos enfermeiros, 0,99 na categoria pedagogos e 0,90 na categoria designers. A aparência também foi validada com índices de 0,97 nas categorias dos enfermeiros e pedagogos e 0,95 na categoria designers. Quanto a aparência geral, o alfa de Cronbach obtido na categoria dos enfermeiros foi 0,98, na categoria pedagogos de 0,99 e designers de 0,96.
Conclusão: O vídeo sobre a Ferramenta PICCTIP é válido quanto ao conteúdo e aparência, além de possuir uma boa consistência interna. Pode ser utilizado como uma ferramenta para translação do conhecimento, para médicos e enfermeiros habilitados que realizam a inserção de PICC em neonatos.
DESCRITORES:
Filme e vídeo educativo; Recém-nascido; Dispositivos de acesso vascular; Cateteres venosos centrais; Ciência translacional biomédica; Estudo de validação; Enfermagem
RESUMEN
Objetivo: Validar el contenido y apariencia de un video sobre la Herramienta PICCTIP para la medición de PICC en lactantes.
Método: Estudio metodológico para validar un vídeo sobre la Herramienta PICCTIP. La validación ocurrió con base en la evaluación del video por 78 jueces (enfermeros, pedagogos y diseñadores) en el período de julio a agosto de 2023. Para el análisis de los datos, se utilizó el índice de Validación de Contenido, y la consistencia interna se midió por el alfa de Cronbach, con un valor de punto de corte igual o mayor a 0.80 y 0,75, respectivamente.
Resultados: El vídeo tuvo su contenido validado con un índice global de 0.98 en la categoría de enfermeras, 0.99 en la categoría de pedagogos y 0.90 en la categoría de diseñadores. La apariencia también fue validada con índices de 0.97 en las categorías de enfermeras y pedagogas y 0.95 en la categoría de diseñadores. Respecto a la apariencia general, el alfa de Cronbach obtenido en la categoría de enfermeras fue de 0.98, en la categoría de pedagogos fue de 0.99 y en la categoría de diseñadores fue de 0.96.
Conclusión: El vídeo sobre la Herramienta PICCTIP es válido en cuanto a contenido y apariencia, además de tener una buena consistencia interna. Se puede utilizar como una herramienta de traducción de conocimientos para médicos y enfermeras calificados que realizan la inserción de catéteres PICC en bebés.
DESCRIPTORES:
Película y Vídeo Educativos; Recién Nacido; Dispositivos de Acceso Vascular; Catéteres Venosos Centrales; Ciencia Traslacional Biomédica; Estudio de Validación; Enfermería
INTRODUCTION
Videos consist of technological tools that use audiovisual resources to convey a message1. When they are created for the purpose of promoting the teaching-learning process, they are known as educational videos2. They have been presented as a practical audiovisual resource, relatively broad in scope, cost-effective, easy to access and use, and can be watched several times3.
In this context, they stand out as powerful teaching-learning tools, with the potential to improve the development of skills, with emphasis on communication and patient care4. They are also characterized as a relevant strategy for knowledge translation (KT), characterized as knowledge construction, exchange and application, enabling the exchange of knowledge between research centers and healthcare services5. In a study carried out with nurses to assess a video on neonatal pain management, it was observed that it was considered a useful and viable tool in the KT process6.
However, in order to fulfill their educational role and be an ally in knowledge construction, videos need to follow a series of methodological steps in their structuring and elaboration process2. Thus, it is necessary to not only have the process of creating educational videos, but also to validate them, ensuring rigor in the content offered. The validity process contributes to the refinement of the material produced, through a critical eye of evaluators, which allows for necessary adjustments in audiovisual content and guarantees video improvement7.
In this perspective, a video called “PICCTIP: Ferramenta para mensuração do Cateter Central de Inserção Periférica (PICC) em neonatos” was developed with the aim of providing healthcare professionals who insert PICC in infants with the tools to use PICCTIP Tool. The tool consists of a mnemonic that addresses the seven steps for performing the Tomazoni technique, which is a method of measuring the PICC developed specifically for infants8,9. The video produced is five minutes and three seconds long, and addresses the differences between the traditional technique and the Tomazoni technique, explaining objectively and playfully each step for applying PICCTIP Tool.
The traditional technique uses the venous network anatomy as a reference to measure catheter length, measuring the path up to the third intercostal space10. The Tomazoni technique, on the other hand, measures the distance from the puncture site to the right sternoclavicular space8. A randomized clinical study compared these two methods for inserting PICC in newborns and demonstrated that the Tomazoni technique provided more precise catheter tip positioning compared to the traditional method8. Despite the proven efficacy of the Tomazoni technique and the availability of PICCTIP Tool, there is a lack of validated educational materials to guide healthcare professionals in the application of these methods. Therefore, in order to improve the video quality and scientific rigor, this study aimed to validate the content and appearance of a video about PICCTIP Tool for measuring PICC in infants.
METHOD
This is a methodological study that aims to investigate methods for collecting and organizing data11.
The material validated in this study is an educational video entitled “PICCTIP - Ferramenta para a mensuração do cateter central de inserção periférica em neonatos”, developed to facilitate learning and implementation of PICCTIP Tool by healthcare professionals using the Tomazoni technique, lasting five minutes and three seconds. The creation process followed a theoretical-methodological framework structured in three phases: pre-production; production; and post-production. The video begins by presenting the traditional technique and the Tomazoni technique. Then, each letter of the mnemonic “PICCTIP” is explained in detail. Finally, the video ends with the credits. Content was carefully prepared to ensure technical and scientific rigor, using animations, anatomical illustrations and real images to better understand the target audience.
The validity stage began with the selection of judges who would compose the Validity Committee. Since it was decided to perform a content and appearance validity, health judges (nurses and physicians) and technical judges (pedagogues and designers) were selected. Health judges who were healthcare professionals working in care or teaching, qualified in PICC insertion (only for nurses), with experience/specialization in intravenous therapy, pediatrics, neonatology, or PICC and who achieved six points or more in the selection criteria of adapted Fehring model12, which consists of scores according to professional experience, academic qualifications and production, were included. Technical judges who were professionals in pedagogy/design, had mastery in pedagogy/visual resources and achieved three points or more in the selection criteria of adapted Fehring model were included12. It is worth mentioning that for the group of designers, experience in video production was also considered. Professionals who submitted an incomplete form were excluded. It is also worth noting that health judges were composed only of nurses, given that physicians recommended to participate in the research did not achieve the minimum score to participate in validity.
Judge selection was carried out by convenience using the “snowball” technique. In this way, each participant in the research recommended other participants13. The process was initiated by seed researchers who recommended some professionals specialized in nursing, pedagogy and design who could participate in the study as judges. From there, the process of nominations continued, as the researchers participated in the study, aiming to reach the minimum recommendation of six participants14.
In total, 136 health judges and 37 technical judges were invited. Data collection interruption was defined based on the criterion of reaching the minimum number recommended by the literature for the study design in question14.
The validity instrument was adapted15-17 and divided into two axes: content validity; and appearance validity. In the first axis, eight topics were presented, namely: objective; content; environment; verbal language; functionality; usability; relevance and efficiency. In the second axis, seven topics were used: Instrumento de Validação de Aparência de Tecnologias Educativas (IVATE)18; idea concept; dramatic construction; rhythm; characters; visual style; and audio. However, it is worth noting that for the group of technical judges in pedagogy, the last three items such as objective, language and relevance were removed because they were not in their area of expertise. The group of technical judges in design, in content validity, only responded to the topic of efficiency and relevance, and the last item of the topic relevance was removed, since it was not applicable to this group.
The instrument was assessed using the Likert Scale: strongly agree (5); agree (4); neither agree nor disagree (3); disagree (2); strongly disagree (1)13. Data collection took place online from July to August 2023 using a research management application. An email was sent to judges with instructions on how to participate in the validity process and access assessment instrument, which included the Informed Consent Form (ICF) and the video link to be assessed. Upon acceptance, the instrument had a 15-day deadline to complete. However, due to low participation by participants, contact was also made via instant messaging applications and image and video sharing applications, and the time limit for completion was reduced to 14 days, optimizing judge recruitment.
Data analysis was performed using Microsoft Excel® and Statistical Package for the Social Sciences® (SPSS) version 22.0 for Windows®, and Content Validity Index (CVI) and Cronbach’s alpha were calculated. In this study, three types of CVI were calculated, namely: I) CVI of each Item (I-CVI): calculated from the sum of responses “5” and “4”, divided by the total number of responses; II) CVI of each Category (C-CVI): calculated from the sum of the CVI of each item and divided by the number of items per category; and III) Total CVI of each validity chunk (T-CV): calculated from the sum of CVI values of each category and divided by the number of categories in each validity chunk. It is worth mentioning that the CVI value greater than or equal to 0.80 was considered for the video to be considered valid19.
Cronbach’s alpha was used to assess the validity process internal consistency. The following score was considered for its interpretation: α≤0.30 - very low; 0.30<α≤0.60 - low; 0.60<α≤ 0.75 - moderate; 0.75<α≤ 0.90 - high; and α>0.90 - very high19. The study used the Delphi technique, in which several rounds of the form would be carried out until an agreement level greater than or equal to 0.80 and consistency above 0.75 were reached. However, these indices were already achieved in the first round, eliminating the need for the others.
This study followed the recommendations of Resolution 580 of March 22, 2018 of the Brazilian National Health Council of the Ministry of Health. The video was registered with the Brazilian Book Chamber (In Portuguese, Câmara Brasileira do Livro - CBL) under Hash number: 7c9a6d4496207dbcff231955256a4a3268635c9419ab2f4b6cdf01af6897e91f to ensure copyright.
RESULTS
A total of 58 nurses and 20 technical judges participated in the validity process, 12 of whom were from the field of education and 8 from the field of design. It should be noted that all forms were completed in full, and none had to be discarded due to lack of information.
Concerning nurse characteristics, the majority were female (86.8 %), with an average age of 37.78±9.76 years, residents of the Northeast region (44.83 %), with 14.22±9.54 years of experience in the health area, with professional experience (89.7 %) and specializations (69 %). As for pedagogy judges, the majority were female (91.7 %), with an average age of 39.5±11.25 years, from the Northeast region (100 %), with 13.75±9.55 years of experience in the field of education, with specialization (66.7 %) and professional experience (50 %). On the other hand, when it comes to professional design judges, the majority are male (62.5 %), with an average age of 33.38±4.77 years, from the South region (50 %), with 10.75±5.23 years of experience in the design area, having professional experience in design (87.5 %), video production (62.5 %) and participation in research groups (62.5 %).
In content validity, it is possible to observe that the I-CVI of each item has a level of agreement between 0.84 and 1 (Table 1). In general, it is observed that, in item 1.4 (Table 1), CVI values below 1 were obtained in both groups of judges, suggesting that the existence of a problem and its resolution were not clear in the video. Thus, the video’s objective was inserted in it to clarify this issue. In the content topic, in item 2.8 (Table 1), which deals with sufficient and adequate information, there is a divergence between CVI values among nursing and pedagogy professionals.
In appearance validity, I-CVI was around 0.83 to 1 (Table 2). The environment topic presented CVIs slightly above 0.9 (Table 1) in judges’ assessment. Two items that corroborate this idea are the 7.3 for efficiency (Table 1) and 1.6 for IVATE (Table 2), in which there was also divergence in judges’ assessment.
As for validity, considering the categories of each validity chunk, C-CVI values ranged from 0.88 to 1 (Table 3). Thus, in general, it can be seen that the video was validated in the first round, reaching recommended T-CVI values of 0.80. Furthermore, it presented very high internal consistency values above 0.90, except in two specific categories in which it reached α=0.80, with high consistency (Table 4).
Among the suggestions made by judges after validity, there were: inserting the objective in the video; replacing the term “space” with “articulation”; lowering the volume of the music; increasing the audio volume; removing noise; inserting subtitles; shortening the time of the video credits; explaining the weight and indication for performing the Tomazoni technique; correcting some spelling points; checking the correct locations and angles of the measurement; inserting a conclusion for the video; improving the measurement drawings correlating them with anatomical landmarks; correctly pronouncing the word catheter; removing the pillow from the first character; correcting the neck position. These modifications were made to the video and it is possible to see some changes in the before and after images present (Figure 1).
DISCUSSION
Educational technologies have stood out as teaching tools that contribute to the promotion of knowledge and the teaching of skills for professionals in nursing care2. In addition to this, such technologies have been increasingly used in the educational field to train nurses in their care practice2. Educational videos, in turn, provide information in a more accessible language, encouraging behavior change20. Thus, educational technologies that are developed and validated enable safer nursing care, valuing the work performed by healthcare professionals21.
Thus, this study proposed to address the validity process of an educational video about PICCTIP Tool with the purpose of improving and ensuring scientific and methodological rigor of the material produced. Thus, the selection of renowned judges in the area is essential to minimize biased results and inadequate conclusions2. In judge selection, it was decided to have two categories: health judges and technical judges. Thus, it was possible to have a broad assessment in which each professional category observed aspects of mastery of their area, adding more quality to the video validity. It is noteworthy that the use of different professionals in validity processes is a consolidated and recommended practice17,22, since the diversity of technical and clinical perspectives broadens the critical analysis, ensuring that the material meets both the scientific criteria and the target audience’s practical demands.
In relation to validity judges, it is worth noting that nursing professionals have stood out as frequent participants in health technology validity processes7,23. In this study, medical professionals did not participate because they did not achieve the minimum score for the selection criteria. This can be explained by the fact that many physicians, after graduation, focus on their insertion in the job market, seeking to complete postgraduate studies only to become specialists in a given area24, and not updating their CVs. This has an impact on the low selection of physicians in validity processes. It is also worth noting that there was a low participation of design professionals, since they generally perform the assessment service for a fee, resulting in a lower than expected number of these professionals participating in this study.
Even though it was validated, the judges made suggestions for the video and most of them were accepted, however, some were not. The first of these was the use of QR Codes to access the references used in the video. The insertion of this technology in the different fields of health and education25 is notable; however, it was decided not to adopt this format, due to the insecurity of some platforms in keeping this link active for a long time. Therefore, to avoid possible unavailability of these QR Codes®, they were not added to the video. Leaving only the complete references in the video to be consulted at the end.
Another point raised by judges was that the environment in which the video takes place did not resemble that of a Neonatal Intensive Care Unit (NICU); however, it is worth noting that PICC insertion can be done in infants admitted to other sectors of the hospital from intermediate to intensive care.26 Therefore, the video sought to provide a general approach to infant care environments, not just the NICU. In addition, the judges pointed out that infants’ drawings did not resemble a real infant. However, it is worth taking into account that when working with animated videos, it is expected that the illustrations created are a representation and not a copy, which is why the video attempted to bring the closest representation of an infant.
Furthermore, it was observed that some judges reported not using surgical pens for marking, due to the sensitivity of infant skin. Although there are no specific studies highlighting this relationship between surgical pens and infant skin, this type of instrument is widely used in surgical procedures and the descriptions of these products ensure the non-toxicity of the pen ink, as well as its sterility, presenting it as a safe material for use27.
Finally, the inclusion of real footage, examples of measurement with real images and the need to explain all the processes for inserting the PICC were highlighted. Although it is understood that the use of real footage would add to the video quality, the video’s central idea is that it should be developed using animation, with a more playful, simple and direct proposal. Moreover, the video already included examples of measurement with real images to facilitate understanding. It is worth noting that the focus is on explaining PICCTIP Tool, not explaining the catheter insertion technique, but rather the measurement. The videos developed need to be designed in such a way that their central objectives are met2, and the objective of this video is to address content in an animated, fast and targeted way. Furthermore, the objective was added to the video to reinforce to the audience its purpose.
Overall, the validated video represents a significant advance in KT between research and clinical practice, especially in neonatal care. By addressing PICCTIP Tool stages in a clear and playful way, the video becomes an easy-to-access and understand tool that can be used repeatedly by physicians and nurses in different contexts. The video is not tiring and has a pleasant presentation, with a consistent visual style, good narration rhythm and animations throughout. In addition, its validity by specialized judges ensures that content is scientifically rigorous and methodologically appropriate, meeting the target audience’s needs.
The use of educational technologies such as this video can contribute to the standardization of clinical practices, reducing variability and improving the quality of care provided to infants. It is therefore noted that the video on PICCTIP Tool can be used as an educational technology to perform KT for healthcare professionals who perform the PICC insertion procedure in infants. Contributing to an adequate measurement of PICC, specific to infants, which has the potential to prevent adverse events related to catheter mispositioning9.
The study was limited by the lack of physicians to validate the video and the small number of design professionals, which may have influenced the diversity of perspectives during the assessment process. Another limitation was the decision not to include real footage, which could have brought a more realistic representation to the video. However, it was decided to maintain an animated and playful approach, which was already in line with the initial purpose of the material. Despite this, the video had excellent levels of agreement and internal consistency, demonstrating its quality. Although the video was validated in terms of content and appearance, it is recommended that a clinical or experimental study be carried out to assess its effectiveness in practice.
CONCLUSION
The video was validated in terms of content and appearance in a satisfactory manner by health and technical judges. Moreover, it presented good internal consistency. It is worth mentioning that in order to improve the video, adjustments were made based on judges’ opinions. Finally, it is worth highlighting that since it is an educational technology, it is recommended that a clinical/experimental study be carried out to attest to its effectiveness as an educational tool for KT among the scientific community and in health spaces that care for infants.
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NOTES
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1
The image is only in Portuguese because it consists of screenshots from the video, which was produced exclusively in Portuguese and has not yet been translated into English.
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ORIGIN OF THE ARTICLE
Extracted from dissertation “Desenvolvimento do vídeo sobre a Ferramenta PICCTIP: Mensuração do Cateter Central de Inserção Periférica em Neonatos”, presented to the Graduate Program in Nursing, Universidade Federal de Santa Catarina, in 2023.
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FUNDING INFORMATION
Scholarship from the Coordination for the Improvement of Higher Education Personnel (In Portuguese, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) - Number 88887.666817/2022-00 - Academic Excellence Program - Academic Master’s Degree - Universidade Federal de Santa Catarina (UFSC). Research Productivity Grants - PQ, Process 309565/2022-7 - Linked research as a subproject of the Project Educational and Assistance Technologies for the Prevention of Adverse Events of Vascular Access Devices in Pediatric Patients, submitted to CNPq Call 09/2022.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Universidade Federal de Santa Catarina, Opinion 5.775.511/2022 and Certificate of Presentation for Ethical Consideration 64901422.8.0000.0121.
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TRANSLATED BY
Letícia Belasco.
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DATA AVAILABILITY
All data supporting the results of this study were published within the article itself.
Edited by
All data supporting the results of this study were published within the article itself.
