Bliss Donna Z, Gurvich Olga V, Hurlow Jennifer, Cefalu Jean E, Gannon Alexandra, Wilhems Anna, Wiltzen Kjerstie R, Gannon Elise, Lee Haeyeon, Borchert Kathleen, Trammel Sheila Howes
Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis. Olga V. Gurvich, MA, University of Minnesota School of Nursing, Minneapolis, Minnesota. Jennifer Hurlow, MSN, GNP-BC, CWCN, University of Manchester, Manchester, United Kingdom. Jean E. Cefalu, PhD, APRN, CWOCN, CNE, Louisiana State University-New Orleans School of Nursing. Alexandra Gannon, BSN, RN, University of Minnesota School of Nursing, Minneapolis. Anna Wilhems, BSN, RN, University of Minnesota School of Nursing, Minneapolis. Kjerstie R. Wiltzen, BSN, BAN, RN, University of Minnesota School of Nursing, Minneapolis. Elise Gannon, University of Minnesota School of Nursing, Minneapolis. Haeyeon Lee, University of Minnesota School of Nursing, Minneapolis. Kathleen Borchert, MS, RN, APRN, CNS, CWOCN, CFCN, University of Minnesota Fairview Medical Center, Minneapolis. Sheila Howes Trammel, ARNP, FNP-BC, CWCN, CCCN, CFCN, Hennepin County Medical Center, Minneapolis, Minnesota.
J Wound Ostomy Continence Nurs. 2018 Sep/Oct;45(5):449-455. doi: 10.1097/WON.0000000000000466.
The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas.
Observational, evaluative design.
Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female.
Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed.
The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience.
The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.
本研究旨在使用3组不同的护理人员评估失禁相关性皮肤损伤严重程度工具的修订版（IASD.D.2）。该工具的修订包括将失禁相关性皮炎（IAD）发生的1个身体区域重新编号为2个区域（右侧和左侧），这使得总分可能从52分提高到56分，并明确了身体区域的边界。
观察性、评估性设计。
5名伤口、造口和/或失禁（WOC）护理认证的临床专家评估内容效度。评估人员包括WOC护士（WOCN）协会2014年会议的参会者、医院护士以及一家养老院的护理人员。评估人员包括WOCN协会2014年全国会议的参会者、一家获得磁铁认证的社区医院的医院护士以及美国中西部一家专业养老院的护理人员。评估人员组包括198名会议参会者（均为护士；年龄53±8.2岁，均值±标准差）、67名医院护士（年龄37±11岁）以及34名养老院护理人员（年龄45±13.8岁）。每组中大多数评估人员（>75%）为女性。
临床专家评估修订后工具的内容效度。评估人员使用修订后的工具对5至9个照片病例进行评分。所有评估人员对其中4个病例进行了评分。分析所有评估人员病例评分的一致性以评估评分者间信度。还对按评估人员自我认定的肤色或护理经验（<10年与≥10年）分组的评估人员评分进行了差异测试。为提供效标效度的证据，分析了评估人员评分与专家评分（在本研究中视为“金标准”）的一致性。
每组内所有评估人员的IASD.D.2评分一致性范围为0.74至0.79，表明评分者间信度良好。每组评估人员与专家对所有病例评分的一致性范围为0.82至0.85，表明效标效度良好。评估人员的肤色或护理经验对评分无显著差异。
修订后的IASD.D.2具有良好的内容效度、效标效度和评分者间信度。该工具有可能使研究和临床实践中IAD严重程度的报告标准化，并有助于护理人员之间关于IAD的沟通。
