Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

Stuedahl, Marit; Vold, Sidsel; Klepstad, Pål; Stafseth, Siv Karlsson

doi:10.1590/S0080-623420150000700017

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Sumário

Original Article • Rev. esc. enferm. USP 49 (spe) • Dec 2015 • https://doi.org/10.1590/S0080-623420150000700017 copy

Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

Confiabilidade inter observadores do Nursing Activities Score entre profissionais de saúde da Unidade de Terapia Intensiva

Confiabilidad inter-observador del Nursing Activities Score entre profesionales de la salud en una Unidad de Cuidado Intensivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU.

Method

This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics.

Results

The mean NAS were 88.4 (SD=16.2) and 88.7 (SD=24.5) respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1) was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%), than between critical care nurses and nurse managers (78.7). In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups.

Conclusion

The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers.

Workload; Nursing, Team; Nursing Care; Intensive Care Units; Reproducibility of Results

NAS total score (%)
Health Professionals	Registrations (N)	Mean (SD)		Median	Min-Max
ICU-CCN	101	88.4 (16.2)		85.6	58.3-148.7
ICU-NM	101	88.7 (24.5)		80.5	54.3-145.0
ICU-PHY	101	83.7 (21.1)*		89.4	28.8-140.6
NAS Nursing activities (%)
Health Professionals	Registrations (N)	Mean (SD)	Median		Min-Max
ICU-CCN	101	56.7 (15.9)	48.9		33.4-110.5
ICU-NM	101	65.9 (24.7)*	59.3		32.8-118.6
ICU-PHY	101	54.3 (18.0)	57.3		12.8-103.7
NAS Medical interventions (%)
Health Professionals	Registrations (N)	Mean (SD)	Median		Min-Max
ICU-CCN	101	28.2 (4.4)	28.0		19.0-39.3
ICU-NM	101	22.4 (4.9) *	23.0		11.50-38.0
ICU-PHY	101	26.4 (5.3)	27.0		14.0-37.9

Inter-rater reliability - NAS nursing activities items		CCN/PHY agreement (%)	Kappa	CCN/NM agreement (%)	Kappa	NM/PHY agreement %	Kappa
1	Monitoring and titration	100	**	100	**	100	**
4	Hygiene procedures	54.5	0.06*	32.7	-0.49*	39.6	0.05*
6	Mobilization and positioning	33.7	0.03*	49.5	0.16	39.6	0.02*
7	Support and care of patient and relatives	48.6	0.19	40.6	0.07*	41.6	0.12*
8	Administrative tasks	47.6	-0.36*	52.5	0.01*	49.5	0.02
Mean % agreement-nursing activities		56.9	-	55.1	-	54.1	-

Inter-rater reliability NAS - medical interventions items		CCN/ PHY agreement (%)	Kappa	CCN/ NM agreement (%)	Kappa	NM/ PHY agreement (%)	Kappa
2	Laboratory	68.3	0.24	25.8	-0.03*	31.7	0.17
3	Medications	97.0	-0.01*	69.3	0.04*	68.3	0.02*
5	Care of drains	74.3	0.34	74.3	0.32	70.3	0.24
9	Oxygen	100.0	**	99.0	**	100.0	**
10	Care of artificial airways	65.3	0.29	65.4	0.23	76.3	0.38
11	Treatment for improving lung function	86.1	0.48	78.3	0.19	80.2	0.32
12	Vasoactive medications IV	65.3	0.345	61.4	0.30	66.3	0.28
13	IV replacement of large fluid losses	94.1	-0.17*	93.1	-0.29*	99.0	0.66
14	Left atrium monitoring	99.0	**	100.0	**	99.0	**
15	CPR in the past 24h	100.0	**	100.0	**	100.0	**
16	Hemofiltration	98.0	0.90	96.0	0.80	94.0	0.69
17	Urine output measurement	95.0	**	96.0	**	93.1	0.19*
18	ICP-measurement	96.0	0.77	85.1	0.41	83.1	0.33
19	Treatment of acidosis/alkalosis	86.2	0.23	86.1	0.08*	92.1	0.17*
20	Intravenous hyper alimentation	75.3	0.50	65.4	0.30	58.4	0.18*
21	Enteral feeding	82.1	0.54	60.4	0.24	64.3	0.30
22	Specific interventions in ICU	72.3	0.21	71.3	0.15	77.2	**
23	Specific interventions outside ICU	87.1	0.47	90.1	0.49	85.2	0.32
Mean % agreement 18 items		85.63		78.72		79.91

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
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[1] Correspondence Addressed to: Siv K. Stafseth. Oslo University Hospital, Box 4950 Nydalen. 0424 - Oslo, Norway. sistaf@ous-hf.no