Burger Debora, Jordan Sue, Kyriacos Una
Division of Nursing and Midwifery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
School of Human and Health Sciences, Swansea University, Wales, UK.
J Clin Nurs. 2017 Sep;26(17-18):2794-2806. doi: 10.1111/jocn.13852. Epub 2017 Jun 20.
To develop and validate a modified Situation-Background-Assessment-Recommendation communication tool incorporating components of the Cape Town modified early warning score vital signs chart for reporting early signs of clinical deterioration.
Reporting early signs of physiological and clinical deterioration could prevent "failure to rescue" or unexpected intensive care admission, cardiac arrest or death. A structured communication tool incorporating physiological and clinical parameters allows nurses to provide pertinent information about a deteriorating patient in a logical order.
Mixed methods instrument development and validation.
We used a sequential three-phase method: cognitive interviews, content validation and inter-rater reliability testing to validate a self-designed communication tool. Participants were purposively selected expert nurses and doctors in government sector hospitals in Cape Town.
Cognitive interviews with five experts prompted most changes to the communication tool: 15/42 (35.71%) items were modified. Content validation of a revised tool was high by a predetermined ≥70% of 18 experts: 4/49 (8.2%) items were modified. Inter-rater reliability testing by two nurses indicated substantial to full agreement (Cohen's kappa .61-1) on 37/45 (82%) items. The one item achieving slight agreement (Cohen's kappa .20) indicated a difference in clinical judgement. The high overall percentage agreement (82%) suggests that the modified items are sound. Overall, 45 items remained on the validated tool.
The first modified early warning score-linked Situation-Background-Assessment-Recommendation communication tool developed in South Africa was found to be valid and reliable in a local context.
Nurses in South Africa can use the validated tool to provide doctors with pertinent information about a deteriorating patient in a logical order to prevent a serious adverse event. Our findings provide a reference for other African countries to develop and validate communication tools for reporting early signs of clinical deterioration.
开发并验证一种改良的情况 - 背景 - 评估 - 建议沟通工具，该工具纳入了开普敦改良早期预警评分生命体征图表的组成部分，用于报告临床恶化的早期迹象。
报告生理和临床恶化的早期迹象可预防“救援失败”或意外的重症监护入院、心脏骤停或死亡。一种包含生理和临床参数的结构化沟通工具使护士能够按逻辑顺序提供有关病情恶化患者的相关信息。
混合方法的工具开发与验证。
我们采用了连续的三个阶段的方法：认知访谈、内容验证和评分者间信度测试，以验证自行设计的沟通工具。参与者是从开普敦政府部门医院中特意挑选的专家护士和医生。
对五位专家进行的认知访谈促使沟通工具发生了大部分变化：42项中的15项（35.71%）被修改。18位专家对修订工具的内容验证率达到预定的≥70%：49项中的4项（8.2%）被修改。两名护士进行的评分者间信度测试表明，在45项中的37项（82%）上达成了实质性到完全一致（科恩kappa系数为0.61 - 1）。有一项达成了轻微一致（科恩kappa系数为0.20），表明临床判断存在差异。总体较高的一致百分比（82%）表明修改后的项目是合理的。总体而言，经过验证的工具上保留了45项。
在南非开发的首个与改良早期预警评分相关的情况 - 背景 - 评估 - 建议沟通工具在当地背景下被发现是有效且可靠的。
南非的护士可以使用经过验证的工具，按逻辑顺序向医生提供有关病情恶化患者的相关信息，以预防严重不良事件。我们的研究结果为其他非洲国家开发和验证用于报告临床恶化早期迹象的沟通工具提供了参考。
