Development of educational material for the prevention and treatment of friction injuries

Objective: to develop and validate an educational booklet to help health professionals to prevent and treat friction injuries. Method: methodological study. An integrative review of the literature of journals published between 2009 and 2019 was carried out in the main databases of Health Sciences. The evaluation of the educational booklet was conducted with 32 nurses, using the Delphi technique. The statistical analysis used was the Content Validity Index. Results: the judges considered the content of the educational booklet between the concepts “inadequate” and “adequate”, in the first assessment; after the corrections requested by the judges, the booklet was forwarded to the evaluators and the content of the educational booklet was rated between “adequate” and “totally adequate”. The overall Content Validity Index was 0.8118 in the first assessment and 1.0 in the second assessment. Conclusion: after the integrative literature review, the material was constructed and validated by professionals with experience in evaluating and treating individuals with wounds, obtaining consensus among the evaluators in the second evaluation.


INTRODUCTION
The integument is the largest organ in the body, necessary for the survival of the human being and for the perfect physiological balance of the organism, being able to suffer aggressions by intrinsic and extrinsic pathological factors. These aggressions can cause changes in their constitution, such as burns, traumatic ulcers, dermatitis, friction injury (FI) and others, which can lead to the individual's functional disability and cause changes in their quality of life [1][2][3] .
The professional who provides assistance to individuals who have risk factors or who have contracted FI has an important role in holistic care as well as performing extremely important work in the prevention and treatment of FI 4,5 .
FI comes from bruising, either by friction, trauma or shearing of the skin. The tension present in the retraction, friction or shock between the person's skin and the surface of the bed or surrounding materials can cause injuries of partial or full thickness [6][7][8][9] .
The body topography most affected by the FI is the back of the hands, the arms, the elbows and the legs of elderly or very young people as neonates. The production of serous exudate, especially in the first 24 hours, makes the FI mostly moist [1][2][3][4] .
Several studies report that 42% of FI are located on the elbows, 22% on the legs and 13% on the hands1-8.
For this reason, the nurse must assess the patient's skin at the time of admission and, from then on, daily; it should also guide health professionals and caregivers who assist these individuals in order to keep the skin dry and clean through maintenance, avoiding the occurrence of shear and, consequently, the FI 9,10 .
These guidelines can be given orally or in writing. It is also important to develop educational materials such as algorithms, booklets, protocols, applications, online courses, among others about preventive measures and therapeutic approaches 11 .
The construction of protocols, manuals, booklets, algorithms, guides and guidelines that include the best scientific evidence can favor the provision of assistance based on good clinical practices, promoting health improvement/recovery before the individual has been affected [11][12][13] .
The validation of a booklet is an important process, as it determines whether the instrument is adequate to provide analytical measures and appropriate information

DESCRIPTORES:
The type II FI (partial flap loss) shows partial loss of skin or flap; the skin cannot be repositioned, that is, to cover the lesion.
On the type III FI (total loss of the flap), the skin flap is completely absent, that is, the lesion is exposed, without protection.
On the third stage, preventive care was standardized, for example: use of hypoallergenic emollients or humectants to lubricate the skin, transfer technique, mobilization, decubitus change and transfer of the patient from one bed/stretcher to another in order to avoid or minimize the forces of rubbing, shearing, bruising and twisting, adhesive placement and removal technique and use of emollient soaps, with neutral pH and/or with Aloe vera, with the recommendation never to use alkaline, antibacterial or perfume soaps.
The fourth stage indicates the therapeutic approaches to treat FI. In this phase, local skin and lesion care and the ideal dressing are described, which aims to promote wound healing and reduce pain, and which is easily removed, acting as a protective barrier against bacterial invasion.

Third stage: formulation/ assembly of the booklet
The preliminary illustrations and content were developed and submitted to the editing and diagramming process, obeying the criteria related to content, structure/ organization, language, layout and design, cultural sensitivity and suitability for the elderly. This process was performed by an expert professional in the area.
The images were selected from the internet and then

Integrative literature review
Initially, 2,977 articles were identified. Of these, 503 were excluded because they were duplicated in the databases. Thus, 1,008 articles were selected for reading the title and 43 for reading the abstract, which resulted in a sample of 23 articles for reading the full text. Of these, 5 were excluded because they did not answer the guiding question, which led to a total of 18 articles selected to build the educational booklet, as shown in Fig. 1. Table 1 shows the articles selected during the integrative literature review to develop the educational booklet, which were classified according to the level of evidence.   Each page has up to five illustrations, totaling 22 illustrations, which can be seen in Fig. 2

Final version of the educational booklet
In Table 2, we observed that the judges used the Delphi technique during the evaluation of the booklet content.
In the first round, the judges evaluated the contents of the booklet with concepts such as: "partially adequate" to "totally adequate". Table 3 shows that in the first evaluation of the educational     This procedure contributes to a better understanding, effectiveness and implantation of the material in the institution, allowing the target audience to understand the content of the material and to be encouraged to use it 11,12,14,24,27 . W hen an educational booklet is validated by professionals with experience in the area and the Content Validity Index is above 1.0, it means that the evaluators considered the information contained in the booklet to be relevant, which is extremely important for this technology to be used as a tool in clinical practice and health education.
Scientific validation by the target audience gives credibility to the material 11,12 .
In the first version of the booklet developed in this study, several changes requested by the judges were implemented.
After the adjustments, the booklet was reassessed, with consensus among the evaluators. This critical analysis was fundamental for the improvement of the new version of the educational booklet The booklet developed is intended to guide health professionals in clinical practice, to provide timely assistance to individuals, in an effective, systematized, individualized, personalized manner, with the minimum possible risk, without damage and adverse events, providing assistance with safety.

CONCLUSION
The content of the educational booklet was constructed and validated. In the first evaluation, it presented 0.81 of Content Validity Index, meaning that the booklet has good content, and several suggestions were made. After making the corrections indicated by the evaluators, the booklet was reassessed and the Content Validity Index was 1.0, characterizing that the booklet has excellent content.
The booklet built in this study provides conditions for the professional to perform clinical evaluation, detect risk factors and prescribe preventive measures and therapeutic approaches.
It also facilitates the recording of the characteristics of the FI, ensuring the monitoring of the evolution of the lesion, minimizing the risks, damages and adverse events.