Abstract: Refining the Incontinence Associated Dermatitis and its Severity Instrument to Include Dark-Toned Skin (IADS-D) and Validity Testing by WOC Nurses (45th Annual Conference (June 22-26, 2013 ))

Tuesday, June 25, 2013: 4:10 PM

Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Professor, Minneapolis, MN, Jenny Hurlow, MSN, GNP-BC, CWOCN, Plastic Surgery Group of Memphis, APN, Memphis, TN, Jean E. Cefalu, MSN, APRN, CWOCN, CFCN, LSUHSC School of Nursing, Instructor, Adult/Gerontological Nurse Practitioner, New Orleans, LA, Kathleen Borchert, MS, RN, CWOCN, ACNS-BC, Bethesda Hospital, HealthEast Care System, Clinical Nurse Specialist, St. Paul, MN, Kay Savik, MS, University of Minnesota School of Nursing, Biostatistician, Minneapolis, MN, Leigh Mahlum, University of Minnesota School of Nursing, Student, Minneapolis, MN and Kristin Arvidson, BS, University of Minnesota, Student, Minneapolis, MN

Background: Timely recognition of incontinence associated dermatitis (IAD) may facilitate management and prevent worsening. The Incontinence Associated Dermatitis and its Severity Instrument (IADS) was developed and validated using light-toned skin. There is no validated instrument for assessing IAD on darker-toned skin. Whether assessment of IAD on different skin tones is influenced by the assessor’s skin tone is unknown.

Purpose: To refine the IADS for assessment of darker-toned skin (IADS-D), validate the IADS-D by comparing its use by wound, ostomy, and continence (WOC) nurses with that of clinical experts, and assess differences in scores by rater skin tone.

Method: Four certified WOC nurses with different skin tones experienced in assessing IAD provided face validity of the IADS-D. Nine photographic cases with and without IAD were developed and organized into two sets of 6 cases, which had 3 cases in common. Two cases had medium (medium/olive/moderate brown) and 4 dark (dark brown/black) skin tone. 261 nurse attendees at 2012 WOCN Society National Conference (96% female, mean(sd) age=53(8) years, WOC experience=12(8) years) used the IADS-D to assess one set of 6 cases randomly distributed. Agreement of IADS-D scores among raters and between raters and experts+investigators was determined using intraclass correlations (ICCs). IADS-D scores were compared by self-reported skin tone of raters using ANOVA: 25% raters had light, 43% fair, 22% medium, 7% olive/moderate brown, and 2% dark brown skin.

Results: Average ICC among WOC nurse raters for each case=77-.99 (all p<.001). Overall ICC between raters and experts for all cases=.92 (p<.001). Average ICC for raters’ vs. experts’ scores for each case=79-.99 (all p<.001). Two cases (normal skin) had near perfect agreement. There was no significant difference in IADS-D scores by raters’ skin tone (p>.05).

Conclusion: The IADS-D had good criterion validity among WOC nurses and was not influenced by rater skin tone.

1310 Refining the Incontinence Associated Dermatitis and its Severity Instrument to Include Dark-Toned Skin (IADS-D) and Validity Testing by WOC Nurses