Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding

Abstract

Objectives: to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance. Methods: 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. Results: 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. Conclusions: 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.

Traumas mamilares em nutrizes: revisão de escopo

“…Only one study considered that pain, by itself, should already be called nipple trauma (20) . It seems that recent study cited (35) also did not consider when defining as "changes in the characteristics of the nipple-areolar skin during breastfeeding, identified through changes in color, thickness, liquid content, or by tissue loss". Therefore, the present study proposed that pain should be included in the definition of nipple trauma.…”

“…A total of 16 types of nipple trauma related to breastfeeding were mentioned in the articles included in this review (Table 1), but without a description that adequately differentiates them from each other: even when examining the most cited type of trauma, cracking or fissures (Figure 5). However, an article was recently published upon an Instrument for the Classification of Nipple-Ariolar Injuries (35) that defined seven of them: erythema, ecchymosis, edema, vesicle, fissure, erosion and crust. In this tool, the fissure was defined as a linear and narrow less of continuity, which may have bleeding or serous fluid, of variable depth.…”

“…The types of nipple trauma should also be better characterized in the studies, contemplating their degree of tissue involvement, considering the cases in which there is or there is not the presence of pain and continuity solution. Tools such as the one proposed in the cited study (35) should also be developed, used and tested in clinical practice, both for its improvement and for professionals' learning. Considering that professionals may have difficulty of locating didactic and standardized definitions, it is recommended that nurses use standardized language as the proposed by NANDA International Classification of Nursing Diagnoses (36) , based on the diagnosis "Injury in the nipple-areola complex" (00320).…”

Effectiveness of individualized counseling on the duration of exclusive breastfeeding: study protocol for a multicenter, randomized, parallel, and open clinical trial

“…A nipple-areolar evaluation will be performed, regarding skin color and type of nipple [ 27 ]. In case of nipple-areolar lesions detected by visual inspection, the Nipple-Areolar Lesions Classification Instrument [ 28 ] and the Nipple Trauma Score [ 29 ] will be applied.…”

Lesões mamilares precoces decorrentes da amamentação: análise de imagens fotográficas e associações clínicas

“…Esforços para a padronização da avaliação de LMs considerando suas peculiaridades vêm sendo explorados. Recentemente publicado, o Instrumento de Classificação das Lesões Mamilo-Areolares (ILMA) (36) traz em sua proposta a unificação da nomenclatura de LMs sob enfoque dermatológico, diferenciando lesões sem…”