INTRODUCTION
Respiratory secretions and saliva transmit COVID-19. Some precautions are indicated
to avoid contamination and transmission to other individuals, such as: covering your
mouth when coughing or sneezing, washing your hands regularly, and avoiding touching
your face, especially in the area of eyes, nose, and mouth1,2.
The performance of health professionals who provide home care goes beyond hospital
environments. Many work in the patients’ homes and, in this health context, home patients
are generally those with acute, chronic, re-aggravated conditions, in palliative care,
with respiratory syndromes, neurological disorders, hypertension, and diabetes more
susceptible to the COVID-19 virus.3,4
Professionals who provide home care must have technical-scientific knowledge that
goes beyond those learned during professional training, as entering the home and developing
care actions requires much more than knowing and acting. This is because the care
is performed in a space controlled by the patient and his family, and the health professional
is a mere guest3,4.
There is a need for health professionals to strictly observe the precautions standardized
by the Ministry of Health in order to minimize transmission. It is recommended that
the use of personal protective equipment (PPE) be adopted by all health professionals
involved in home care and that all patients, family members, and caregivers are advised
on the measures to be used to prevent infection COVID-195,6.
In this sense, it is important to build and validate applications that provide professionals
with appropriate information on the use of PPE and measures to prevent the spread
of COVID-19 infection for patients, family members, caregivers, and communities. Thus,
when using this technology, the professional will safely provide damage-free care
with minimal risk to the patient, avoiding contamination.
An application is a software with a specific function capable of assisting in a given
task. Smartphones are important tools, as most of the population has them, and they
are almost always available due to their portability7.
The use of computational tools in the health area is expanding, as this type of support
can provide professionals with greater precision and agility in their work. Concerning
assistance in the health area in Brazil, the adoption of technological resources has
been a growing factor since the 1960s, with the scientific foundation of the profession8,9,10.
This research is part of a project to develop a mobile application for health professionals,
providing information about the techniques for using PPE and the guidelines that must
be provided to patients, family members, and caregivers to prevent the spread of COVID-19
for family members, caregivers, and the community. Thus, when using this technology,
the professional who provides care at home will provide harm-free, safe, and risk-free
care for the patient, family members, caregivers, and the community.
OBJECTIVE
Develop an application to guide health professionals during home care in the fight
against the COVID-19 pandemic.
METHOD
The study applied the modality of technological production based on software engineering
of the methodological development research type. The study was developed at the University
of Vale do Sapucaí from February to March 2020.
The study was approved by the Research Ethics Committee of the Faculdade de Ciências
da Saúde Dr. José Antônio Garcia Coutinho (Opinion No. 4,472,241).
For the construction of the ORIENTA COVID-19 application, the methodology relevant
to Contextualized Instructional Design was used, which involves a constructivist proposal
and consists of the intentional action of planning, developing, and applying specific
didactic situations, incorporating mechanisms that favor contextualization11,12. The construction of the ORIENTA COVID-19 application followed the following steps:
First step: Analysis
An integrative literature review was performed. The following steps were delimited
for the development of the research: identification of the theme and selection of
the research question; the establishment of criteria for the inclusion and exclusion
of studies; defining the information to be extracted from the selected studies and
categorizing the studies; the evaluation of the studies included in the integrative
review; the interpretation of the results, presentation of the review; and the synthesis
of knowledge12.
The theme was “Application to guide health professionals in coping with the COVID-19
pandemic during home care”.
The objective was to answer the following guiding question: What are the personal
protective equipment and the correct techniques to use during home care of patients
with COVID-19?
What should preventive measures available in the literature be provided to patients,
family members, and caregivers to prevent the spread of COVID-19 to family members,
caregivers, and the community?
For the construction of an adequate question for the resolution of the researched
clinical question, the PICO13 strategy was used, with “P” corresponding to the population (a health professional
who attends at home); “I” to intervention (technique of PPE and undressing and preventive
measures that professionals should use during home care related to the transmission
of COVID-19); “C” for comparison (does not apply, as this is not a comparative study)
and “O” for an outcome (application protocol).
An integrative literature review was carried out with the Health Sciences databases:
(MEDLINE), Scientific Electronic Library Online (SciELO), and Latin American and Caribbean
Literature in Health Sciences (LILACS).
The descriptors controlled in Health Sciences were COVID-19, personal protective equipment,
family health strategy, and home care. Depending on the searched base, the search
strategy occurred from its different combinations, adopting the Boolean AND operator
in Portuguese, Spanish, and English.
The following inclusion criteria were adopted for the selection of publications: only
primary studies directly connected with the theme; be available in full, original
articles published between 2015 and 2020.
As exclusion criteria: theses, dissertations, monographs, technical reports, and articles
that, after reading the abstract, are not related to the proposed object of study,
and publications that are repeated in the databases.
The titles and abstracts were read independently by two authors of the study in question
to ensure that the texts contemplated the guiding question of the review and met the
established inclusion criteria. In case of doubt regarding the selection, it was decided
to initially include the publication and decide on its selection only after reading
its entire content.
To classify the level of evidence of the selected studies, the categories of the Agency
for Healthcare Research and Quality were used, which cover six levels: Level 1: evidence
resulting from the meta-analysis of multiple controlled and randomized clinical trials;
Level 2: evidence obtained from individual studies with an experimental design; Level
3: evidence from quasi-experimental studies; Level 4: evidence from descriptive studies
(non-experimental) or qualitative approach; Level 5: evidence from case reports or
experience; Level 6: evidence based on expert opinion.
Chart 1 presents the articles selected during the integrative literature review to
develop the ORIENTA COVID-19 application, which were classified according to the level
of evidence.
Second step: Design
This step involved planning and producing didactic content, defining topics and writing
subjects, selecting media, and designing the interface (layout). We opted for using
texts, drawings, photos, and videos structured in topics. The didactic contents addressed
in the application were distributed in the following phases:
Phase 1 - COVID-19 infection
Information was provided on the definition, type, signs, and symptoms of COVID-19
and preventive measures recommended by the World Health Organization.
Phase 2 - Use of Personal Protective Equipment by health professionals during the
COVID-19 pandemic
At this stage, the definition of PPE was provided; thus, the types of PPE recommended
by the World Health Organization should be used when providing care to patients with
COVID-19.
We will also seek well-defined instructions on the correct techniques for donning
and undressing PPE during home care, which must be carried out systematically to prevent
the professional from contracting the infection.
Phase 3
The second phase will consist of preventive measures that professionals should guide
patients, family members, caregivers, and the community during home care to avoid
contamination and transmission of the COVID-19 infection.
Third stage: Development
Understood the selection of the application’s tools, the definition of the navigation
structure, and the planning of the configuration of environments. A decision tree
was built to guide the professional system analyst regarding the construction of the
application.
Fourth step: Implementation
The configuration of tools and educational and technological resources was prepared,
as well as the construction of an environment for downloading an application on the
Internet and installing it on a mobile device, which will be available for free on
the Play Store.
RESULTS
During the integrative literature review, 9,982 articles were identified in the LILACS,
PUBMED, and SciELO databases. After exclusion, 19 articles were selected to develop
the ORIENTA COVID-19 application (Figure 1).
Figure 1 - Flowchart of the studies’ identification, selection, and inclusion process, prepared
based on the PRISMA recommendation. Pouso Alegre, MG, Brazil, 2021.
Figure 1 - Flowchart of the studies’ identification, selection, and inclusion process, prepared
based on the PRISMA recommendation. Pouso Alegre, MG, Brazil, 2021.
The application has 40 screens and 130 images describing clothing and undressing of
PPE, including the technique for using a homemade mask, care guidelines to prevent
the transmission of COVID-19, and social etiquette. Examples of application screens
are shown in Figure 2.
Figure 2 - Screen examples of the ORIENTA COVID-19 application. (A) Summary with hyperlinks to
the subjects addressed; (B) Recommendations for home care; (C) Screen related to the
choice of personal protective equipment and gowning and undressing techniques; and
(D) Mask care during use and after removing it. Pouso Alegre, MG, Brazil, 2021.
Figure 2 - Screen examples of the ORIENTA COVID-19 application. (A) Summary with hyperlinks to
the subjects addressed; (B) Recommendations for home care; (C) Screen related to the
choice of personal protective equipment and gowning and undressing techniques; and
(D) Mask care during use and after removing it. Pouso Alegre, MG, Brazil, 2021.
DISCUSSION
Many applications are available online, including everything from fitness systems
to monitoring and controlling the most diverse diseases. When well designed, they
are didactic and educational tools that can benefit patients and health professionals10,31,32.
The application developed in this study sought to meet the needs and clarify doubts
of health professionals who are at the forefront of home care, offering information
about the types and correct techniques for using PPE and measures to prevent and avoid
contamination and transmission of the infection caused by COVID-19 among professionals,
patients, families, caregivers, and communities.
The use of applications as a tool for therapeutic, preventive, and diagnostic procedures
is quite innovative and capable of generating interest and motivation for learning
since the mobile devices that host these applications are used by 45% to 85% of health
professionals or caregivers, being consulted more than books and magazines10,29,30,31,32.
An application developed by health professionals should be built to manage care, indicate
preventive measures and assist in formulating the diagnosis, and provide subsidies
for a clinical assessment of risk factors for developing a disease or complication10,31,32 .
The ORIENTA COVID-19 application was developed after an integrative literature review.
It can be considered a technological innovation in health as it is the first mobile
application produced in Brazil to support health professionals during home care, bringing
benefits to health professionals, caregivers, and patients assisted, and providing
guidance that should be provided during the COVID-19 home visit, thus avoiding the
transmission of the infection to the relatives of the patients assisted and to the
community.
Applications must be built scientifically, so the application favors the execution
of the correct technique and general care, systematic and individualized care recording,
enabling safe assistance30,31,32.
The ORIENTA COVID-19 application allows quick access to information on the main national
and international guidelines during home visits through smartphones and tablets. It
assists the professional in data collection, guidance related to signs and symptoms,
and preventive measures to avoid the transmission of COVID-19. It also offers which
PPE should be used by professionals during home visits and the technique of gowning
and undressing. It also contributes to the professional’s routine, increasing their
scientific knowledge, as it puts an up-to-date tool in the professional’s pocket that
helps clinical practice develop actions to prevent complications, damages, and risks.
CONCLUSION
After an integrative review of the literature obtained from the main databases, a
multimedia application was developed on a mobile platform called ORIENTA COVID-19
to support health professionals during home care related to signs and symptoms, preventive
measures to prevent the spread of COVID-19 among professionals, family members, caregivers,
the community and guide the use of personal protective equipment.
The application developed in this study can potentially reduce adverse events, assisting
with minimal risk, damage, and greater safety and quality, but its update will be
carried out according to new evidence.
1. Universidade do Vale do Sapucaí. Mestrado Profissional em Ciências aplicadas à
Saúde, Pouso Alegre, MG, Brazil
Corresponding author: Geraldo Magela Salomé Av. Prefeito Tuany Toledo, 470, Pouso Alegre, MG, Brazil. Zip code: 37550-000 E-mail:
salomereiki@univas.edu.br
