Made available in DSpace on 2014-12-17T14:46:56Z (GMT). No. of bitstreams: 1 DanieleVD_TESE.pdf: 4938953 bytes, checksum: ba81cf3eb020178b1818aa9393647bed (MD5) Previous issue date: 2014-06-06 / Universidade Federal do Rio Grande do Norte / Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs <docs.google.com>. After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa &#8805; 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity / As ?lceras venosas s?o les?es resultantes da insufici?ncia venosa cr?nica, anomalias valvulares venosas e trombose venosa. Sua ocorr?ncia vem crescendo com o aumento da expectativa de vida da popula??o mundial. Consideram-se aspectos fundamentais na abordagem ? pessoa com ?lcera venosa a assist?ncia com atua??o interdisciplinar, ado??o de protocolo, conhecimento espec?fico, habilidade t?cnica, articula??o entre os n?veis de complexidade assistencial do Sistema ?nico de Sa?de e participa??o ativa dos pacientes e seus familiares, em uma perspectiva hol?stica. A constru??o de um protocolo assistencial para pessoas com ?lcera venosa pode auxiliar os profissionais dos servi?os de alta complexidade na avalia??o do paciente e no estabelecimento de uma assist?ncia de qualidade, de forma sistematizada e focada nos fatores que interferem na cicatriza??o da les?o. Assim, este estudo objetivou analisar as evid?ncias de valida??o de um protocolo assistencial para pessoas com ?lceras venosas atendidas em servi?os de alta complexidade. Trata-se de um estudo metodol?gico, com abordagem quantitativa, desenvolvido em tr?s etapas: revis?o da literatura, evid?ncia de valida??o de conte?do e evid?ncia de valida??o no contexto cl?nico. Aprovado pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte (Parecer: 147.452 e CAAE: 07556312.0.0000.5537). A revis?o da literatura foi realizada em agosto e setembro de 2012, tornando-se a base para a constru??o do protocolo. Em seguida, foi realizada a evid?ncia de valida??o de conte?do, que incluiu 53 ju?zes (especialistas) selecionados por meio da plataforma Lattes, para avaliar os itens do protocolo. Os ju?zes foram contatados por e-mail e avaliaram o protocolo via Google Docs <docs.google.com>. Ap?s a an?lise dos ?ndices obtidos nesta etapa, que apresentaram Kappa entre 0,75 e 0,96 e IVC entre 0,80 e 0,98, e as sugest?es dos ju?zes, o protocolo foi ajustado e submetido ? evid?ncia de valida??o no contexto cl?nico, no Hospital Universit?rio Onofre Lopes em Natal/RN. A evid?ncia de valida??o no contexto cl?nico envolveu quatro ju?zes, que atuaram em duplas (pareados), avaliando 32 pacientes com ?lceras venosas no contexto cl?nico de alta complexidade. Nas duas etapas, utilizaram-se o ?ndice Kappa e ?ndice de Validade de Conte?do para analisar as respostas dos ju?zes. Os par?metros estabelecidos como aceit?veis para esses ?ndices foram: Kappa &#8805; 0,61 e ?ndice de Validade de Conte?do > 0,80.Tanto na evid?ncia de valida??o de conte?do, como na evid?ncia de valida??o no contexto cl?nico, os itens do protocolo que n?o atingiram os ?ndices Kappa e ?ndice de Validade de Conte?do estabelecidos foram exclu?dos e alguns itens foram modificados ou inclu?dos ap?s sugest?es. Os processos de evid?ncia de valida??o de conte?do e evid?ncia de valida??o no contexto cl?nico permitiram o aprimoramento do protocolo para o cuidado ? pessoa com ?lcera venosa, proposto inicialmente. A vers?o inicial do protocolo, constru?do a partir da literatura, continha 15 categorias e 108 itens; ap?s a evid?ncia de valida??o de conte?do, mantiveram-se as 15 categorias com redu??o para 91 itens; a vers?o final, validada clinicamente, ? composta das mesmas 15 categorias, sendo 76 itens. O protocolo foi validado em seu conte?do e no aspecto cl?nico, sendo assim, aceitou-se a hip?tese alternativa no estudo. Esse protocolo poder? contribuir para a sistematiza??o da assist?ncia, permitindo adequar condutas e promover maior resolutividade no tratamento da pessoa com ?lcera venosa em servi?os de sa?de de alta complexidade