1181 Rev. Latino-Am. Enfermagem Original Article 2015 Nov.-Dec.;23(6):1181-6 DOI: 10.1590/0104-1169.0711.2664 www.eerp.usp.br/rlae Lights, camera and action in the implementation of central venous catheter dressing1 Maria Verônica Ferrareze Ferreira2 Simone de Godoy3 Fernanda dos Santos Nogueira de Góes3 Fernanda de Paula Rossini4 Denise de Andrade5 Objective: to develop and validate an educational digital video on changing the dressing of short- term, non-cuffed, non-tunneled central venous catheters in hospitalized adult patients. Method: this is a descriptive, methodological study based on Paulo Freire’s assumptions. The development of the script and video storyboard were based on scientific evidence, on the researchers’ experience, and that of nurse experts, as well as on a virtual learning environment. Results: the items related to the script were approved by 97.2% of the nurses and the video was approved by 96.1%. Conclusion: the educational instrument was considered to be appropriate and we believe it will contribute to professional training in the nursing field, the updating of human resources, focusing on the educational process, including distance education. We believe it will consequently improve the quality of care provided to patients with central venous catheters. Descriptors: Central Venous Catheters; Cross Infection; Health Education; Health Evaluation; Educational Technology; Nursing Care. 1 Paper extracted from doctoral dissertation “Dressing of central venous catheters: supports for nursing teaching and care”, presented to Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. 2 PhD, Laboratory Specialist, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. 3 PhD, Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. 4 PhD, RN, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. 5 PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Corresponding Author: Maria Verônica Ferrareze Ferreira Copyright © 2015 Revista Latino-Americana de Enfermagem This is an Open Access article distributed under the terms of the Creative Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto Commons Attribution Non-Commercial License (CC BY-NC). Av. Bandeirantes, 3900 This license lets others distribute, remix, tweak, and build upon your work Bairro: Monte Alegre non-commercially, and although their new works must also acknowledge CEP: 14040-902, Ribeirão Preto, SP, Brasil you and be non-commercial, they don’t have to license their derivative E-mail: [email protected] works on the same terms. 1182 Rev. Latino-Am. Enfermagem 2015 Nov.-Dec.;23(6):1181-6. Introduction learning. Note that technologically advanced European universities have largely used videos since 1990(10-11). Catheter-related infection, especially catheter- Given the previous discussion, we opted to related bloodstream infection (CRBI), is a concern given developed a learning objective to lead users to its severity and lethal nature. It presents a complex reflect and act on, and consequently, transform the and multi-factor etiology. Studies show that the main context of healthcare. Hence, this study’s aim was to determinants include: the patient’s clinical condition, develop and validate an educational digital video that type and composition of the catheter, insertion technique, approaches the dressing of short-term, non-cuffed, site, type of dressing, frequency with which the system non-tunneled central venous catheters in hospitalized is manipulated, and duration of catheter placement(1-3). adult patients. It is worth noting that there is considerable interest among researchers, professionals and health facilities Method in reducing the incidence of catheter-related infections to improve the quality and safety of care provided The objective of this descriptive methodological to patients. Such efforts should be multidisciplinary study was to develop a reliable, precise, and useable and focus on patient behavior and adherence to instrument to be employed in other studies(12). recommendations during the insertion and handling of Its methodological process was based on Paulo catheters, epidemiological surveillance of infections, and Freire’s theory. A script was validated before the video assessment of results(2,4). was developed, as previously done by other researchers. Even though there is no consensus regarding An instrument, a storyboard with detailed description of the best approach to reduce this type of infection, the content to be included, was also developed in which researchers suggest that training programs and the the scenes and audio were established. The instruments qualification of health providers effectively contribute to to validate the script and video were previously reducing infection rates(1-4). submitted to apparent and content validation(6,9,13-14). In this sense, the teaching process should ground Preexisting and well-established theoretical the development and support of healthcare training, principles were used in the development of the aggregating values, knowledge and experiences. aforementioned material(2,15). In addition to organizing Educational actions refer to teaching-learning practices content related to the topic in a logical manner, we also designed to challenge and promote knowledge to support studied the scenario, the material and other resources clinical decision-making based on critical reflection on to specify the details of narration, photos, figures and the profession’s ethical and legal aspects. scenes involved in the filming. The use of Freire’s theory is justified due to the Experts selected according to pre-established principles of dialogue, as a living exercise of dialogue: criteria validated the script(16). The selection of experts transitive consciousness, from naïve to critical; critical- to validate the video took into account the professionals’ reflective pedagogy; and transformation-action(5). theoretical knowledge, competencies, and practical skills Due to a variety of teaching strategies, informatics in performing dressings for CVCs. Hence, the following increasingly gains relevance as an essential teaching inclusion criteria were used: being a nurse working on a tool. Hence, technological resources applied to nursing Hospital Infection Control Committee or providing care to informatics are an essential basis for rapid access to patients with CVC, as well as teaching in undergraduate information and both the construction and updating of nursing programs, and having a Master’s degree. knowledge. Specifically considering the field of nursing, The experts were instructed in regard to the many professionals have invested in the production of completing the validation instrument and invited educational tools to facilitate teaching. These educational to classify each item assessed as “strongly agree, tools are generally known as hypermedia and consist of agree, disagree, strongly disagree, or I do not know”, a combination of various media resources (e.g., texts, not choosing more than one answer. Comments pictures, animation, and videos, among others), with were welcomed. the single purpose of education(6-9). The video was filmed in the Nursing Practice Currently, educational videos are largely used to Simulation Center, University of São Paulo at Ribeirão encourage and support the understanding of students in Preto, College of Nursing (EERP-USP), between June and various contexts: classrooms, laboratories, and distance November, 2012. www.eerp.usp.br/rlae Ferreira MVF, Godoy S, Góes FSN, Rossini FP, Andrade D. 1183 To facilitate the validation of the script and In regard to the relevance of images and scenes educational video, and because there was a support present in the video script, the suggestions included the platform and management of the program in the possibility of performing the dressing on a real patient in teaching institution where the video was developed, the a hospital setting. material and an informed consent form was included in For the environment, one nurse suggested adding a virtual learning environment on the Internet, Stoa. some items in the movie set to make it better resemble Twelve experts validated the script and 13 experts a hospital ward. validated the video. All the participants signed free and In regard to verbal language, some experts informed consent forms. recommended avoiding long sentences to facilitate the narration and also to establish well-defined pauses. Results The question that addressed the inclusion of topics obtained one “disagree” response and one expert Script validation suggested using PVPI alcohol to perform the antisepsis of the CVC insertion site only when the patient is allergic The instrument used to validate the script of to the 0.5% chlorhexidine solution, advising against the the educational video was composed of six questions use of alcohol at 70% due to its low residual effect. addressing the video’s objective, content, relevance, environment, verbal language and inclusion of topics. Educational video recording The answers