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Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form- Mini Nutritional Assessment by registered and enrolled nurses in clinical practice
Karlstads universitet, Fakulteten för samhälls- och livsvetenskaper, Avdelningen för omvårdnad.ORCID-id: 0000-0002-9608-336X
Karlstads universitet, Fakulteten för samhälls- och livsvetenskaper, Avdelningen för omvårdnad.ORCID-id: 0000-0003-3385-3731
Institutionen för medicin och hälsa, Linköpings universitet.
Landstinget i Värmland.
Vise andre og tillknytning
2008 (engelsk)Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, nr 5, s. 618-626Artikkel i tidsskrift (Annet vitenskapelig) Published
Abstract [en]

Aim.  Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form-Mini Nutritional Assessment.

Background.  In Sweden, registered nurses and enrolled nurses usually co-operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied.

Design cross-sectional.  Registered nurses and enrolled nurses made 228 assessments of patients’ skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke.

Results.  The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini-Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card.

Conclusion.  The Modified Norton Scale and Short Form Mini-Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients’ skin with the Pressure Ulcer Card.

Relevance to clinical practice.  The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop.

sted, utgiver, år, opplag, sider
2008. Vol. 17, nr 5, s. 618-626
Emneord [en]
interrater reliability, malnutrition, nurses, nursing assessment, pressure ulcer, screening tools
HSV kategori
Forskningsprogram
Omvårdnad
Identifikatorer
URN: urn:nbn:se:kau:diva-2695DOI: 10.1111/j.1365-2702.2007.02131.xOAI: oai:DiVA.org:kau-2694DiVA, id: diva2:25539
Tilgjengelig fra: 2008-09-30 Laget: 2008-09-23 Sist oppdatert: 2017-12-13bibliografisk kontrollert
Inngår i avhandling
1. Vara steget före: Bedömning av patienters smärta, näringstillstånd och hudkostym
Åpne denne publikasjonen i ny fane eller vindu >>Vara steget före: Bedömning av patienters smärta, näringstillstånd och hudkostym
2008 (svensk)Doktoravhandling, med artikler (Annet vitenskapelig)
Alternativ tittel[en]
Being one step ahead : Assessment of patients’ pain, nutrition and skin
Abstract [sv]

Det övergripande syftet var att beskriva och jämföra sjuksköterskors och underskö­terskors bedömningar av patienters smärta, näringstillstånd och hudkostym samt de­ras uppfattningar om att använda bedömningsinstrument. Vidare att beskriva sjuk­sköterskors och undersköterskors uppfattningar om hur de bedömer patienters smärta, näringstillstånd och hudkostym. Metod: Etthundrasjuttio pati­entjournaler granskades. Intervjuer med sjuksköterskor (n=9) och undersköterskor (n=9) genomfördes. Resultatet av sjuksköterskors (n=34) och undersköterskors (n=43) bedömningar jämfördes. Interbedömarreliabilitet undersöktes när sjuk­sköterskor (n=50) och undersköterskor (n=61) använde bedömningsinstrument.  Resultat: Sextio pro­cent av patientjournalerna vid inskrivningen och 78 % vid utskrivningen innehöll do­kumentation om patientens hudstatus. Det fanns dokumentation om trycksår i 15 % respektive 20 % av patientjournalerna. Patienter som var i risk för trycksårutveckling enligt Modifierad Nortonskala (MNS) erhöll i medeltal 4,6 omvårdnadsåtgärder och patienter som ej var i risk erhöll i medeltal 3,8. Det var inte några tydliga grän­ser för hur sjuksköterskor och undersköterskor genomförde bedömningar, vem som gjorde vad och på vilket sätt det gjordes. Det var inga skillnader mellan sjukskö­terskors och undersköterskors bedömningar av risk för undernäring och trycksår när det gäller poäng för initial bedömning och totalpoäng. Det var dock skillnader i deras bedömningar av enskilda delskalor och smärta. Sjuksköterskors och undersköterskors uppfattning om hur det var att använda bedömningsinstrument varierade. Inter­bedömarreliabiliteten avseende MNS, Short- Form Mini Nutritional Assessment och trycksårkortet varierade mellan och inom sjuksköterskegruppen och undersköterskegruppen. Konklusioner: Sjuksköterskor dokumenterar inte alltid bedömning av patienters hudkostym och risk för trycksårutveckling. Det är såväl likheter som skillnader mellan sjuksköterskor och undersköterskor när det gäller hur de genomför bedömningar och resultatet av deras bedömningar. Interbedömarreliabilite­ten mellan och inom sjuksköterske- och undersköterskegruppen varierar vid deras bedömning med olika bedömningsinstrument och trycksårkort. Ett viktigt led i arbetet med att säkerställa patientsäkerhet och hög vårdkvalitet är att vara steget före och fortlö­pande bedöma patienters smärta, näringstillstånd och hudkostym.

Abstract [en]

The overall aim was to describe and compare registered nurses’ (RNs’) and enrolled nurses’ (ENs’) assessments of pain, nutrition and skin and their perceptions of using assessment tools. Further to describe RNs’ and ENs’ perceptions of how they assess patients’ pain, nutrition and skin. Methods: One hundred and seventy patient records were reviewed for patients with hip fracture. Interviews were conducted with RNs (n=9) and ENs (n=9). Results of the RNs’ (n=34) and ENs’ (n=43) assessments of patients with hip fracture were compared. Interrater reliability was examined between and among RNs (n=50) and ENs (n=61) using assessment tools for assessments (n=228) of patients with hip fracture and stroke. Results: Sixty percent of patient records on admission and 78% at discharge had documentation of the patient’s skin status. Pressure ulcers were documented in 15% and 20% of patient records respectively. Patients at risk for developing pressure ulcers according to the Modified Norton Scale (MNS) received a mean of 4.6 nursing interventions, while those not at risk received a mean of 3.8. There were no established boundaries between RNs’ and ENs’ assessment who performed it and in what way it was done. There were no differences between RNs’ and ENs’ as­sessments of risk for malnutrition and pressure ulcer regarding screening or total scores. However, there were differences regarding their assessments on the subscales and patients’ pain.  RNs’ and ENs’ perceptions of using assessment tools varied. Interrater reliability regarding MNS total score was very good among RNs, good among ENs and between RNs and ENs. For Short- Form Mini Nutritional Assessment screening score, interrater reliability was good between RNs and ENs and among RNs, while it was moderate among ENs. Interrater reliability between and among RNs and ENs varied for Pressure Ulcer Card. Conclusions: RNs do not always document assessment of patients’ skin and risk for pressure ulcer. Patients at risk for pressure ulcers receive more nursing interventions than patients not at risk. There are both similarities and differences between RNs and ENs regarding how they perform their assessments and what the results of their assessments are. Interrater reliability between and among RNs and ENs varies regarding the different assessment tools. An important part of the work in establishing patient safety and high quality of care is to be one step ahead and continuously assess the patients’ pain, nutrition and skin.

sted, utgiver, år, opplag, sider
Karlstad: Karlstads universitet, 2008. s. 92
Serie
Karlstad University Studies, ISSN 1403-8099 ; 2008:39
Emneord
assessment, assessment tool, skin, nutrition, pain, registered nurse, enrolled nurse, bedömning, bedömningsinstrument, hudkostym, näringstillstånd, sjuksköterska, smärta, undersköterska
HSV kategori
Forskningsprogram
Omvårdnad
Identifikatorer
urn:nbn:se:kau:diva-2754 (URN)978-91-7063-199-3 (ISBN)
Disputas
2008-11-21, 21A 244, Karlstads universitet, Karlstad, 09:00 (svensk)
Opponent
Tilgjengelig fra: 2008-10-24 Laget: 2008-09-30 Sist oppdatert: 2015-12-17bibliografisk kontrollert

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