在多地点急性护理环境中测量的INSPECT（交互式营养特定体格检查能力工具）的评分者间信度和评分者内信度。
Inter-Rater and Intra-Rater Reliability of the INSPECT (Interactive Nutrition Specific Physical Exam Competency Tool) Measured in Multi-Site Acute Care Settings.
作者信息
Zechariah Sunitha, Waller Jennifer L, Stallings Judith, Gess Ashley J, Lehman Leigh
机构信息
College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
出版信息
Healthcare (Basel). 2022 Jan 21;10(2):212. doi: 10.3390/healthcare10020212.
Even as new medical modalities, diagnostics, and technologies are rapidly changing healthcare, providing patients with safe, high-quality care remains the central focus. To provide safe patient care, healthcare providers are obligated to demonstrate and maintain the necessary competence. As more healthcare disciplines move toward a competency-based education model, it is essential to extend the competence verification from the academic educational level to the patient's bedside. The nutrition-focused physical exam (NFPE) is a competency recently adopted by registered dietitian nutritionists (RDNs) for assessing patients' nutritional status. Being a newly acquired skill, validated tools are required to measure NFPE competence during routine clinical practice. The Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) is a new tool developed specifically to observe and measure RDNs' NFPE competence in clinical settings. The INSPECT was designed and validated for content using expert RDNs' input in the first and second phases of the study. This current study aimed to assess the reliability of the INSPECT through multi-site observations by clinical supervisors evaluating RDNs' NFPE competency during patient assessment. The INSPECT exhibited good inter-rater reliability (ICC = 0.78 for the first assessment and ICC = 0.68 for the second assessment), moderate to strong intra-rater reliability for 37 of 41 items (Spearman rho = 0.54 to 1.0), and excellent internal consistency (Cronbach's α = 0.86 for the first assessment and α = 0.92 for the second assessment). In total, 10 out of the 11 INSPECT subsets showed good to excellent internal consistency (α ranging from 0.70 to 0.98). The results demonstrate that the INSPECT is a reliable tool, is stable over time, and has good agreement and excellent consistency between raters. The INSPECT can be a valuable tool to measure, promote and maintain RDNs' NFPE competence in authentic acute care settings.
尽管新的医疗模式、诊断方法和技术正在迅速改变医疗保健行业，但为患者提供安全、高质量的护理仍然是核心关注点。为了提供安全的患者护理，医疗保健提供者有义务展示并保持必要的能力。随着越来越多的医疗学科转向基于能力的教育模式，将能力验证从学术教育层面扩展到患者床边至关重要。以营养为重点的体格检查（NFPE）是注册营养师（RDN）最近采用的一项用于评估患者营养状况的能力。作为一项新获得的技能，在常规临床实践中需要经过验证的工具来衡量NFPE能力。交互式营养特定体格检查能力工具（INSPECT）是专门开发的一种新工具，用于在临床环境中观察和衡量RDN的NFPE能力。在研究的第一阶段和第二阶段，INSPECT通过专家RDN的意见进行了设计和内容验证。本研究旨在通过临床主管在患者评估期间对RDN的NFPE能力进行多地点观察，来评估INSPECT的可靠性。INSPECT表现出良好的评分者间信度（第一次评估的ICC = 0.78，第二次评估的ICC = 0.68），41项中的37项具有中度到高度的评分者内信度（斯皮尔曼rho系数 = 0.54至1.0），以及出色的内部一致性（第一次评估的Cronbach's α = 0.86，第二次评估的α = 0.92）。总共11个INSPECT子集中有10个显示出良好到出色的内部一致性（α范围从0.70到0.98）。结果表明，INSPECT是一个可靠的工具，随着时间推移稳定，评分者之间具有良好的一致性和出色的一致性。INSPECT可以成为在真实急性护理环境中衡量、促进和维持RDN的NFPE能力的宝贵工具。
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