Nunes Maristela Lopes Gonçalves, Martins Lina, Conceição de Gouveia Santos Vera Lucia
Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil.
Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada.
J Wound Ostomy Continence Nurs. 2023;50(2):124-130. doi: 10.1097/WON.0000000000000949.
To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version.
Psychometric (methodologic) evaluation of the instrument.
Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order.
The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors.
The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study.
This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.
使造口皮肤工具（变色、糜烂和组织过度生长）适用于巴西文化，并分析改编版本的心理测量特性。
该工具的心理测量（方法学）评估。
三名造口术/肠造口治疗护士对109名18岁及以上有造口周围皮肤并发症的成年人样本的造口周围皮肤状况的程度和严重程度进行了评估。这些参与者在巴西圣保罗和库里蒂巴的门诊医疗服务的门诊护理中心接受护理。此外，使用一组129名护士参与者测量了观察者间信度，这些参与者参加了2017年11月12日至15日在巴西米纳斯吉拉斯州贝洛奥里藏特市举行的巴西造口治疗大会。护士参与者使用原始DET评分中使用的相同照片，故意打乱原始顺序，评估葡萄牙语版本的造口周围皮肤并发症描述。
该研究分两个阶段进行。该工具由两名双语翻译人员翻译成巴西葡萄牙语，并回译成英语。回译版本被发送给该工具的一名开发者进行进一步评估。在第二阶段，由7名在造口术和造口周围皮肤护理方面有专业知识的护士评估内容效度。通过将造口周围皮肤并发症的严重程度与疼痛强度相关联来评估收敛效度。基于造口创建的类型和时间、回缩的存在以及术前造口部位标记来评估区分效度。最后，使用与该工具的原始英语版本相同顺序复制的标准化照片评估以及由一名研究者和护士数据收集者对有造口成年人的评估的配对分数来评估评分者间信度。
造口皮肤工具的内容效度指数为0.83。在使用标准化照片评估造口周围皮肤并发症时，护士的观察结果获得了轻度一致性水平（κ = 0.314）。相比之下，在临床环境中比较分数时，获得了中度至几乎完美的一致性（根据领域不同，κ = 0.48 - 0.93）。该工具与疼痛强度之间的正相关（r = 0.44；P = .001）表明造口皮肤工具改编版本的收敛效度。相比之下，区分效度分析结果不一，基于本研究无法就这种形式的结构效度得出明确结论。
本研究支持造口皮肤工具改编版本的收敛效度和评分者间信度。
