Educational technology for prevention of primary neonatal bloodstream infection

Vasconcelos FBCC¹, Pennafort VPS², Mendonça AEO³, Cavalcante ES⁴, Melo DH⁵.

1,3,4 - Federal University of Rio Grande do Norte/UFRN. Natal (RN), Brazil.

2 - Onofre Lopes University Hospital/HUOL/EBSERH. Natal (RN), Brazil.

5 - Federal University of Ceara/UFC. Fortaleza (CE), Brazil.

INTRODUCTION

Among the various types of Healthcare-Associated Infections (HAIs), Primary Bloodstream Infections (PBIs) stand out, defined by their potential to cause serious systemic outcomes in addition to bacteremia or sepsis, without being able to identify, a priori, the initial focus.¹ PBIs have an important impact on in-hospital morbidity and mortality rates, as well as on high hospital costs, especially in Neonatal Intensive Care Units (NICUs), given their greater immunological susceptibility when compared to other groups.²

HAIs in the NICU occur mainly through the cross-transmission of microorganisms present on the hands of healthcare professionals, on surfaces in the hospital environment, and on contaminated non-critical equipment and items, highlighting the need to build strategies to implement systematized infection control practices and reduce the occurrence of PBIs in the NICU.³  

The cost of this adverse event varies, depending on the country and the health unit where the patient is. North-American estimates point to an extra cost of 50.000 dollars per episode of PBI. With regard to newborns, the mortality rate associated with PBI is approximately 35%, 24% in the pre-surfactant era and 11% in the post-surfactant era.^4-5

The incidence rates of PBIs associated with the use of Central Venous Catheters (CVC) in the neonatal population are still worrying in developing countries.⁶ It should be noted that PBIs related to CVCs are associated with significant unfavorable health outcomes. Around 65% to 70% of cases could be prevented by adopting appropriate measures, such as adhering to the bundles of good insertion practices proposed by the Institute of Healthcare Improvement (IHI) and optimizing device maintenance practices.⁷

In this context, goal 8 of the Brazilian Health Regulatory Agency (ANVISA) stands out, i.e., “to reduce the incidence of priority HAIs nationally”, and goals 10 and 11, which aim to reduce the incidence of Klebsiella pneumoniae and Acinetobacter spp. resistant to carbapenems in isolates from LCBI - neonatal ICU central catheters by ≤ 8% and ≤ 24%, respectively.⁴

In these circumstances, the proposal of an Educational Technology (ET) represents an opportune tool for promoting good practices related to improving quality and patient safety.^8-9 The use of these technologies in health education activities is considered to benefit the educational process, enabling the construction of technical-scientific knowledge and providing professionals with the use of systematized actions to provide quality care.¹⁰

Educational materials have been widely used for health education and are vehicles for socializing knowledge that can contribute to improving the living conditions and health of the population.¹¹ In this way, ET can have a wide reach and impact among professionals, caregivers and patients by improving practices and empowering self-care. The use of educational videos as facilitators of the learning process and of changes in behavior and conduct stands out among the ETs.^12,13

Educational videos can represent an additional and motivating element for learning for all those involved - students, professionals and users of health services. The use of moving images combined with audio are dynamic resources that make it possible to capture humanized elements, personalizing the activity developed and making it more subjective and sensitive compared to written methodological aspects.^8,14,15

The development of an educational video may contribute to evidence-based practice by standardizing care and establishing effective strategies to prevent PBIs in newborns.

OBJECTIVE

To describe the process of developing and validating an educational technology for health professionals, in video format, about the prevention of primary neonatal bloodstream infection.  

METHOD

This is a methodological study to develop and validate an ET in video format on the subject of preventing primary neonatal bloodstream infection, carried out in the NICU of a hospital in the interior of Ceará, Brazil, between August/2021 and July/2022. The facility offers 10 inpatient beds and mainly treats cases of prematurity, perinatal asphyxia and malformations.

The study was developed based on the adapted stages:⁸

1- Choice of theme and selection of content used in the preparation of the ET: two meetings were held with health professionals in the sector in order to identify the main challenges faced in preventing neonatal PBIs. The possible causes of neonatal PBIs were difficulty in adhering to hand hygiene, prolonged use of the CVC, breach of aseptic technique when implanting, changing dressings, and/or handling the catheter and connections. The institutional protocols and checklist for implanting, handling and preserving CVC in newborns were included, based on ANVISA manuals, on the National Patient Safety Program of the Ministry of Health, and on other recommendations from the World Health Organization (WHO) and the Pan American Health Organization (PAHO) on the prevention of neonatal PBI.^1,16-18

2- Writing the script and recording the video: at this stage, the text to be spoken was organized, guided by national and international recommendations, as well as the institutional protocol and checklist for the prevention of neonatal PBI, since these are normative documents on good practices recommended by the WHO and ANVISA for the safety of newborns. These recommendations appeared in the text written on the screen (lettering) with the suggested scenes on the video, as shown in Figure 1.

Screenwriter:			Status:
Estimated time length:			Revised by:
Version:			Approved by:
Scene	Text	Speech indication		Lettering	Scene description
1	Description of the text to be narrated or spoken by an actor/professional or presenter.	Suggestion of how the speech will be inserted onto the video: live, spoken by a person (or professional) within the frame in the studio (hospital environment), or on set, or off with the voice-overs.		In this field, any form of visually presented text will be added: lettering, captions, charts, images, among others.	In this space, it is recommended to describe each component of the scene: framing, setting, clothing, camera movements, intonation,     etc.

Figure 1. Planning of the video script for the prevention of primary neonatal bloodstream infection. Sobral (CE), Brazil, 2022.

The decision was made to develop the video in a real-life setting in order to bring the viewer even closer to the reality of the service in terms of the care recommended for the prevention of neonatal PBI related to the implantation and handling of CVCs. A storyboard was drawn up with the help of a graphic designer, describing the sequence of scenes and illustrations. The video was then produced at the ideal speed for audiobooks, i.e., between 150 and 160 words per minute.^8,19 To develop and animate the video, Vegas® and Power Point® programs were used to create some effects, to produce and to edit the video.

3- Validation of the educational technology in video format by expert judges and target audience (professionals working in neonatology).

3.1- Selection of experts and target audience: the search for judges was carried out by consulting the CVs available on the Lattes Platform of the National Council for Scientific and Technological Development (CNPq), and using the non-probabilistic Snow Ball²⁰ sampling technique, in which the first five experts, selected for convenience, indicated other reference judges on the subject of the study according to the following inclusion criteria adapted from Fehring:²¹ experience in the areas of quality management, patient safety, child and newborn health, or social communication. 25 judges were selected, 18 of whom actually took part in the validation process, as seven did not respond to the invitation to take part in the study.

The judges had to score at least five points in the classification system adapted from Fehring's²¹ criteria in order to guarantee their expertise on the subject of ET, as described in the professional qualifications: PhD (4 points); Master's degree (3 points); clinical practice of at least 3 years in the area of neonatology (3 points); residency or specialization in the areas of neonatology, patient safety, health quality management, or social communication (2 points); teaching in higher education in the area of the study (2 points); article published in the area of the study (2 points); and participation in scientific events in the area of the study in the last two years (1 point).  

For internal validation of the ET, 42 nursing professionals (nursing technicians and nurses) and doctors who provided direct care to newborns in the NICU, or who worked in the areas of quality management and patient safety, were invited to participate. Employees who did not respond to the invitation to take part in the survey or were away from work during the study period were excluded. As a result, 28 professionals from the nursing team actually took part in this stage, 17 and 11 of whom were nursing technicians and nurses, respectively.

3.2- Validation of ET by experts and target audience: the judges and the target audience received the evaluation material by e-mail, as well as the link to access the form available on Google Forms. The form adapted from Campos et al (2021)⁸ to validate the ET covered the characterization of the participants and the following criteria: objectives and relevance of the content; structure and presentation of the information; appearance; media style; and motivation for the video. For each criterion, the evaluators responded to a four-point Likert scale: 1- Totally Adequate (TA), 2- Adequate (A), 3- Partially Adequate (PA), and 4- Inadequate (I). It should be noted that, in this evaluation tool, the judges and target audience could justify the “partially adequate” or “inadequate” answers, as well as recommending other changes to improve the video.

4- Quantitative analysis of data: to calculate the Concordance Index per Item, the total sum of the “Totally Adequate” (TA) and “Adequate” (A) answers was considered in relation to the maximum possible score if all the evaluators (judges and target audience) judged all the items positively. To do this, the number of items in the evaluation tool was multiplied by the number of evaluators in order to obtain the maximum possible score. The items considered validated were those that obtained concordance rates higher than or equal to 0,78 among the evaluators, i.e, equivalent to 78% agreement among the evaluators.^21,22 The Total Concordance Index for each item evaluated by the experts was calculated as the arithmetic mean in relation to three domains: objectives, structure/presentation, and relevance of the content, distributed over 21 items. The overall concordance index evaluated by the target audience, on the other hand, considered the following domains: objectives, structure and presentation, media style, appearance, and motivation, distributed over 25 items.

The final version of the educational video was edited after the evaluation carried out by the expert judges and the target audience, according to suggestions from the participants.

The research was approved by the Research Ethics Committee of the Onofre Lopes University Hospital by means of substantiated opinion no. 5.146.900. It is worth noting that the legal guardians of the newborns authorized the use of the images provided for the development of the video.

RESULTS

The final version of the video, with a total running time of 8 minutes and 6 seconds, is available in the QUALISAÚDE collection - Technical Products of the Professional Master's Degree in Quality Management in Health Services from the Federal University of Rio Grande do Norte via the following link: https://repositorio.ufrn.br/handle/123456789/60682.

Most of the experts were in the 31-40 year-old group (83,3%). In terms of academic training and qualifications, more than half had a master's degree, accounting for 61,1%; around 17% had a doctorate; and 22,2% were specialists. Most of them defined themselves as health professionals specializing in quality management (44,4%) or child health, and 38,9% had published scientific papers in the area of the study. The judges evaluated the ET in terms of its objectives, the pertinence and relevance of the content covered, as well as the presentation, format and structure of the video.

Table 1 shows the expert judges' evaluation of the domains of the Educational Technology developed.

Table 1. Expert judges' evaluation of the objective, structure and presentation, and relevance domains of the Educational Technology (ET). Sobral (CE), Brazil, 2022.

Scores n= 18
Items	TA*	A†	PA‡	I§	Concordance index per item
1. OBJECTIVES	No. of answers	No. of answers	No. of answers	No. of answers
1.1 Is the information/content consistent with the daily needs of the target audience of the ET?	16	2	0	0	100%
1.2 Is the information/content important for the quality of the work of the target audience of the ET?	18	0	0	0	100%
1.3 Does it encourage changes in behavior and attitude?	10	8	0	0	100%
1.4 Is it recommended for sharing in scientific circles in the field?	14	4	0	0	100%
1.5 Does it meet the objectives of institutions working with the target audience of the ET?	16	2	0	0	100%
Total for Domain 1	74	16	0	0	100%
2. STRUCTURE AND PRESENTATION	No. of answers	No. of answers	No. of answers	No. of answers
1.1 Is the educational media appropriate for the target audience of the ET?	15	3	0	0	100%
1.2 Are the messages presented clearly and objectively?	13	4	0	1	94,4%
1.3 Is the information presented scientifically correct?	16	2	0	0	100%
1.4 Is the material appropriate to the sociocultural level of the target audience of the ET?	15	3	0	0	100%
1.5 Is there a logical sequence to the proposed content?	18	0	0	0	100%
1.6 Does the writing/presentation style correspond to the level of knowledge of the target audience?	16	2	0	0	100%
1.7 Is the information on the contents page and/or presentation coherent?	16	2	0	0	100%
1.8 Are the titles and topics the appropriate length?	14	3	1	0	94,4%
1.9 Are the illustrations expressive and sufficient?	15	2	1	0	94,4%
1.10 Is the video appropriate?	14	4	0	0	100%
1.11 Is the length of the video appropriate?	13	5	0	0	100%
Total for Domain 2	165	30	2	1	98,5%
3. RELEVANCE	No. of answers	No. of answers	No. of answers	No. of answers
3.1 Do the themes depict key aspects that should be reinforced?	16	2	0	0	100%
3.2 Does the material allow learning to be transferred and generalized to different hospital settings?	Expert judges 14	4	0	0	100%
3.3 Does the ET promote building and improving knowledge?	17	1	0	0	100%
3.4 Does the material cover the subjects needed to train the target audience of the ET?	18	0	0	0	100%
3.5 Is it suitable for use by any professional who is the target audience of the ET (from other health services)?	16	2	0	0	100%
Total for Domain 3	81	9	0	0	100%
Total for all three domains	320	55	2	1	99,2%

With regard to the objectives of the educational video, the judges considered the information and content to be coherent for the target audience, with a Total Concordance Index of 100%, i.e, with the ‘totally adequate" or "adequate" answers. In addition, 55,6% rated the material as totally adequate for encouraging changes in the target audience's behavior and attitudes, while the others considered it adequate. 70% were observed to say that the material is suitable for sharing in scientific circles in the field, and 88,9% stated that it meets the objectives of institutions working with the target audience of the ET.

Regarding the structure and presentation of the educational video, the Total Concordance Index was 98,5%, showing that the video is appropriate for the target audience. Sixteen experts considered the ET to be totally adequate in terms of “scientifically correct information”. On the other hand, one evaluator pointed out that the messages were not presented clearly and objectively.

The expert judges considered that the material was adequate or totally adequate for the sociocultural level of the target audience, as well as presenting a logical sequence of the proposed content. Out of all the evaluators, the majority (88,9%) judged the writing/presentation style to be totally adequate for the target audience's level of knowledge, and the information to be coherent. The time length of the video was considered adequate.

The last part of the validation instrument was made up of questions related to the relevance of the ET, with a Total Concordance Index of 100%. In addition, 94,4% agreed that the ET developed promotes knowledge building and improvement, and 100% of the judges assessed the material as covering the subjects needed to train the target audience. It should be noted that the Adequacy Concordance Index for the three domains was 99,2%, which shows that the material is adequate, with the possibility of generalizing learning in the different contexts of the neonatology hospital setting.

Some of the judges' recommendations/suggestions were: revising the font and punctuation; changing the effect of the topics; including other illustrations, such as the use of PPE; citing morbidity and mortality related to PBI and the indices of recent years in Brazil; describing information on safety and quality to agree on the last slide; changing the sequence of narration about dressing - “say everything about dressing and then X-ray”.

Internal validation of the ET by the target audience

The target audience was mostly made up of professionals (nurses and nursing technicians), 60,7% of whom were aged between 31 and 40, working in neonatology and with an average of 6 to 10 years‘ experience, with some having more than 20 years’ experience. It was noteworthy that 17,9% of the target audience had never had access to educational material on the prevention of PIB.

Table 2 shows the target audience's evaluation of the domains of the developed Educational Technology.

Table 2. Evaluation of the target audience on the domains of objective, structure and presentation, media style, appearance, and motivation of the Educational Technology (ET). Sobral (CE), Brazil, 2022.

Scores n= 28
Items	TA*	A†	PA‡	I§	Concordance index per item
1. OBJECTIVES	No. of answers	No. of answers	No. of answers	No. of answers
1.1 Does it meet the objectives of the target audience of the ET?	25	3	0	0	100%
1.2 Does the ET help when working in the NICU?	24	4	0	0	100%
1.3 Is it suitable for use by any professional in the field of the target audience of the ET?	25	3	0	0	100%
Total for Domain 1	74	10	0	0	100%
2. STRUCTURE AND PRESENTATION	No. of answers	No. of answers	No. of answers	No. of answers
2.1 Is the media attractive and does it convey the content of the material?	24	3	1	0	96,4%
2.2 Is the size of the title and content in the topics appropriate?	22	4	2	0	85,7%
2.3 Do the topics have a logical sequence?	24	3	1	0	96,4%
2.4 Is the information in the contents page, presentation and acknowledgments consistent?	27	1	0	0	100%
2.5 Is the material (audiovisual media) appropriate?	25	1	2	0	96,4%
2.6 Is the length of the video appropriate?	22	5	1	0	100%
2.7 Do the themes depict important aspects?	26	1	1	0	96,4%
Total for Domain 2	170	18	8	0	95,9%
3. MEDIA STYLE	No. of answers	No. of answers	No. of answers	No. of answers
3.1 Is the audiovisual media in the appropriate style?	21	7	0	0	100%
3.2 Are the text and tone appropriate?	25	3	0	0	100%
3.3 Is the vocabulary accessible?	25	3	0	0	100%
3.4 Is the theme of each section associated with the corresponding text/speech?	24	4	0	0	100%
3.5 Is the text/spoken script clear?	24	4	0	0	100%
3.6 Does the writing style correspond to the level of knowledge of the target audience?	23	5	0	0	100%
Total for Domain 3	142	26	0	0	100%
4. APPEARANCE	No. of answers	No. of answers	No. of answers	No. of answers
4.1 Do the sections look organized?	24	4	0	0	100%
4.2 Are the illustrations simple?	24	4	0	0	100%
4.3 Do the illustrations complement the text?	20	6	2	0	92,8%
4.4 Are the illustrations expressive and sufficient?	20	7	1	0	96,4%
Total for Domain 4	88	21	3	0	97,3%
5. MOTIVATION
5.1 Is the material appropriate for the profile of the target audience of the ET?	25	3	0	0	100%
5.2 Are the contents of the ET presented logically?	24	4	0	0	100%
5.3 Does the ET address the issues that are necessary for the everyday life of the target audience of the ET?	24	4	0	0	100%
5.4 Does it invite/encourage changes in behavior and attitude?	22	6	0	0	100%
5.5 Does the ET offer new knowledge to the target audience?	24	4	0	0	100%
Total for Domain 5	119	21	0	0	100%
Total for all five domains	593	96	11	0	98,4%

For 80% of the target audience, the objectives of the ET were totally adequate. The professionals emphasised that this tool will be able to help them in their work. In addition, they considered the video to be totally adequate for use by any professional working in the field of neonatology, emphasising the didactic quality and clarity of information.  

When asked about the structure and presentation of the ET, a Total Concordance Index of positive responses of 95,9% was obtained among the participants who agreed that the media is attractive, indicates the content of the material and is totally appropriate; 78,6% said that the title was totally adequate and so was the time length. For 84,3%, the video presented a logical sequence of scenes and 96,2% of the professionals totally agreed with the relevance of the theme depicted. The only thing that stood out was the inclusion of other illustrations to make the scenes more attractive.

More than 75% of the target audience considered the style of the audiovisual media to be totally adequate. In addition, the Total Concordance Index for domain 3 was 100%, which demonstrates agreement on the following: interesting text and tone, accessible vocabulary, clearly narrated text, and writing style that was adequate for the level of knowledge.

As for the evaluation of the appearance of this tool, there was a Total Concordance Index of 97,3% among the professionals. In this domain, the sections were considered organized, with simple and expressive illustrations complementing the texts.

 Domain 5 (on the motivation of the ET) also obtained a Total Concordance Index of 100%. In this domain, the target audience considered the video to be appropriate for the care context, with the content presented in a logical way, and the subjects covered as necessary for their practice and capable of promoting new knowledge, as well as encouraging changes in behavior in the area. It should be noted that the Adequacy Concordance Index for the five domains evaluated by the professionals was 98,4%, which shows that the material has been validated and is suitable for use in the NICU context.

Following evaluations by the judges and the target audience, the educational video was adjusted, improved and edited according to the recommendations and suggestions of the participants. The characteristics of the ET and the changes made are shown in Figure 2.

TOPICS	CHARACTERISTICS
Title	Educational Technology in video format for the prevention of primary neonatal bloodstream infection.
Subjects covered	Definition of primary neonatal bloodstream infection (PBI); epidemiological context of PBI; prevention of neonatal PBI; main types of CVC used in neonatology; good practices during insertion, maintenance and handling of the catheter; comfort measures for the newborn during venipuncture procedures.
Time length	08 minutes e 06 seconds
Number of scenes cenas	49 scenes
Editions done	12 editions done
Main changes made based on the final evaluations	- Insertion of information related to the epidemiological data of PBI in Brazil and worldwide and its impact; - inclusion of other illustrative images to make the video more attractive; - grammar adjustments; - change in the layout and background to make it more attractive; - contextualization and inclusion of images related to newborn comfort measures carried out during central venous catheter implantation procedures.

Figure 2. Characteristics of the educational technology, in video format, validated after evaluations. Sobral (CE), Brazil, 2022.

Figure 3 illustrates some scenes from the video, the appearance and design used.

USE THE PPE AS INDICATED

CENTRAL VENOUS CATHETERIZATION THROUGH VENOUS DISSECTION

FIX THE CATHETER WITH  A SUITABLE COVER

PREVENTION OF PRIMARY NEONATAL BLOODSTREAM INFECTION

THE MAIN NEONATAL PBI ARE ASSOCIATED WITH THE USE OF CENTRAL VENOUS CATHETERIZATION

Figure 3. Representation of the final version of the Educational Technology. Sobral (CE), Brazil, 2022.

DISCUSSION

The work of the multidisciplinary team in the neonatal ICU is known to require skill and up-to-date knowledge in the prevention of HAIs. Some studies, however, have identified some events as often related to the resistance of professionals to performing hand hygiene properly, or to the inadequate use of personal protective equipment, factors that can lead to infections. Other factors that make it difficult to control and prevent HAIs are overcrowding and excessive workload.²³

Based on this need identified in the literature, the ET developed addressed, among other subjects, good practices during the insertion, maintenance and handling of the central venous catheter in the NICU, reinforcing behaviors that promote the prevention and control of HAIs, especially PBIs. 

It is believed that the efficient and qualified work of the multi-professional team is a strategy for the prevention and control of HAIs and contributes proactively to improving the quality of life of the newborn.²³ In this respect, the use of educational and audiovisual strategies has contributed positively to the qualification of care in neonatology by facilitating the process of acquiring technical-scientific knowledge to improve care in newborn safety.²⁴

Regarding the diversity of educational technologies in health, studies consider that videos have a significant educational impact capable of promoting changes in behavior and professional autonomy,^8,19 and are also pointed out as a well-structured tool with greater potential for sharing knowledge.^25-26

From this perspective, the expert judges and the target audience emphasized that the ET developed is interesting, motivating and applicable in various settings, such as in the academic and care environments, due to its characteristics that facilitate the learning process in the context of PBI prevention in newborns. It is interesting to note that some of the target audience said they had no knowledge of any educational material on the prevention of PBI in the NICU, and that the video will help them in their professional work.

In this way, the evaluation of the ET by expert judges and by the target audience allowed for greater precision in the validation process. Other authors agree that when the evaluations of the ET by both groups are added together, the capacity for adequate validation becomes greater and the potential for improving the tool is enhanced. This means that the ET can become more directed towards achieving pedagogical and professional practice objectives.^8,27

Pedagogical practices capable of stimulating curiosity, as well as combining scientific knowledge and technical procedures, can be extremely important for the teaching and learning process. From this perspective, it was evident that individuals who underwent training using audiovisual material had a higher level of learning on the subject than those who received printed materials, such as booklets and manuals.⁸ 

 In addition, videos are easily accessible strategies, capable of satisfying the main needs and doubts of individuals in the teaching and learning process, resulting, for example, in a significant improvement in knowledge and skills for managing problems in different healthcare scenarios.²⁵

Moreover, the versatility and ease of recording and documenting various subjects, as well as the possibility of making the message to be shared visible and concrete, make videos a very effective communication strategy. As it generates a multi-sensory experience, videos promote greater retention of information and are therefore considered a promising tool for interdisciplinary health education.^28,29-30

The NICU is a place that needs massive investment in good practices, considering not only the immediate needs and care of newborns, most of whom are premature, but also their unstable health condition and dependence on different types of existing technology.^25-27 In view of this reality, knowledge alone is understood as not guaranteeing a change in habits, and the lack of a qualified information approach can influence inappropriate practices and choices.³⁰

In this respect, the developed ET represents the appropriation of scientific recommendations for good practices in neonatology services in order to standardize conduct with the aim of establishing effective strategies for the prevention of PBI in newborns.

There were some limiting factors in the study, such as the difficulty in getting the medical team to participate as a target audience in the validation process. Although the tool has successfully passed the validation process and has shown the potential to be implemented in practice, the need for further statistical analysis is recognized in order to achieve criteria such as the sensitivity and reliability of the developed ET.

CONCLUSION

The video developed was validated in all the domains which were evaluated: objective, content, structure, appearance, media style, and motivation. The process of improving this educational tool took into account not only the overall results of the evaluations, but also the individual suggestions of the invited judges and target audience. Thus, a more complete and reliable ET was validated, bringing it closer to the experience and knowledge needs of neonatology professionals.

According to the results, it can be inferred that the educational video produced for the prevention of PBI in neonatology has the potential to facilitate theoretical and practical teaching for health professionals working in the neonatal ICU, as well as representing a dynamic pedagogical strategy for undergraduate health students. Teaching and learning strategies such as this need to be encouraged in the health field as they promote the safety of newborns based on recommended good practices.

The educational video developed is expected to be implemented in neonatal intensive care units and welcomed by the multi-professional team so that positive changes can be achieved in the engagement and motivation of professionals in the care recommended for newborns, thus reducing the risks of PBI in the neonatal period. Future research is therefore suggested to evaluate the effectiveness of the educational video and its possible benefits for professionals, students and patients.

CONTRIBUTIONS

Conception: VASCONCELOS FBCC, PENNAFORT VPS; Study planning: VASCONCELOS FBCC, PENNAFORT VPS, MENDONÇA AEO, CAVALCANTE ES, MELO DH. Data analysis and interpretation: VASCONCELOS FBCC, PENNAFORT VPS. Writing and critical review: VASCONCELOS FBCC, PENNAFORT VPS, MENDONÇA AEO, CAVALCANTE ES, MELO DH. All the authors have read and agreed to the current version of the manuscript.

CONFLICT OF INTERESTS

There are no conflicts of interests.

REFERENCES

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