Harris R, Wilson-Barnett J, Griffiths P, Evans A
Northwick Park & St. Mark's NHS Trust, Harrow, U.K.
Int J Nurs Stud. 1998 Dec;35(6):303-13. doi: 10.1016/s0020-7489(98)00042-x.
The aim of this study is to evaluate the reliability and validity of the Byron Physical Assessment Framework (BPAF). The BPAF is a systems based checklist of physiological measurements, signs, and symptoms designed to structure and document the assessment of a patients physical condition by nursing staff. Initially the BPAF was refined using extensive literature review and expert opinion to improve the comprehensiveness and clarity for its intended purpose. As a result the content validity of the BPAF was supported. Inter-rater reliability between both expert-expert and novice-expert pairings was assessed. A total of 68 assessments were conducted by pairs of qualified nurses with patients on general medical and surgical wards and a nursing-led unit in one London Hospital. Reliability of the dichotomous data items of the BPAF was found to be generally good (kappa > 0.6) with only one item showing a poor reliability (kappa < 0.20). Reliability for continuous items such as pulse and respiratory rate was surprisingly low with evidence of large variation between raters in addition to systematic bias. With relatively little teaching, novice assessors were able to use the BPAF and achieve good inter-rater reliability with expert assessors although this was lower than the reliability of the expert diads. The utilisation of the BPAF to fulfil intended purpose was assessed by examining completed assessments and the outcome in terms of nurses' actions in light of new abnormal findings. Both were found to be fair, showing that the BPAF does affect the actions of nurses although it could be utilised more.
本研究旨在评估拜伦身体评估框架（BPAF）的可靠性和有效性。BPAF是一个基于系统的生理测量、体征和症状清单，旨在构建并记录护理人员对患者身体状况的评估。最初，通过广泛的文献综述和专家意见对BPAF进行了完善，以提高其针对预期目的的全面性和清晰度。结果，BPAF的内容效度得到了支持。评估了专家与专家、新手与专家配对之间的评分者间信度。在伦敦一家医院的普通内科和外科病房以及一个由护理主导的科室中，合格护士对共进行了68次对患者的评估。结果发现，BPAF的二分数据项的信度总体良好（kappa>0.6），只有一项显示信度较差（kappa<0.20）。脉搏和呼吸频率等连续性项目的信度出奇地低，除了系统偏差外，评分者之间还存在很大差异。经过相对较少的培训，新手评估者能够使用BPAF，并与专家评估者取得良好的评分者间信度，尽管这低于专家配对的信度。通过检查已完成的评估以及根据新的异常发现护士采取的行动结果，评估了BPAF实现预期目的的情况。两者均被认为尚可，表明BPAF确实会影响护士的行动，尽管其利用率还可以更高。
