Abstract
to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance. this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied. Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity. the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.
Highlights
Identifying Nipple and areola complex lesions (NAL) occurs during the clinical examination of postpartum women and, despite the clarity, by healthcare professionals, regarding the absence or presence of skin integrity in the nipple and areola complex region, there is no consensus on their classification, and the use of terminology “fissures” for any type of injury identified[6]
The study complied with Resolution 466 of December 2012, being sent to the Institutional Review Board of Universidade Federal de São Paulo and approved on November 14, 2017
300 publications were identified from October 2012 to February 2019 and 21 comprised the final sample
Summary
Nipple and areola complex lesions (NAL) resulting from breastfeeding have been presenting frequencies between 55% and 100%(1-3) among postpartum women and are generally related to the main causes of early weaning[3,4], mainly due to association with pain and difficulties with proper infant latch[1,4].A systematic review study with 1,409 women identified a greater intensity of pain (6.2/10) in postpartum women with NAL, when compared to those without injury (2.7/10) in the first week after delivery, highlighting the importance of prevention and early diagnosis of injuries in the care of these women[5].Identifying NALs occurs during the clinical examination of postpartum women and, despite the clarity, by healthcare professionals, regarding the absence or presence of skin integrity in the nipple and areola complex region, there is no consensus on their classification, and the use of terminology “fissures” for any type of injury identified[6].When rethinking clinical practice, it is clear how much a detailed physical examination can contribute to identifying the type of injury and, the choice of appropriate treatment[6]. Nipple and areola complex lesions (NAL) resulting from breastfeeding have been presenting frequencies between 55% and 100%(1-3) among postpartum women and are generally related to the main causes of early weaning[3,4], mainly due to association with pain and difficulties with proper infant latch[1,4]. Identifying NALs occurs during the clinical examination of postpartum women and, despite the clarity, by healthcare professionals, regarding the absence or presence of skin integrity in the nipple and areola complex region, there is no consensus on their classification, and the use of terminology “fissures” for any type of injury identified[6]. In addition to the lack of coverage of the lesions, only one validation study was developed to assess the agreement of the elaborated classification[9]
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