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Purpose: To assess criterion validity and inter-rater reliability of the Incontinence Associated Skin Damage Severity assessment instrument (IASD.D.2) among hospital and nursing home nursing staff using photograph cases.
Method: Nursing staff (“evaluators”) at an urban, non-profit hospital and skilled nursing home/rehabilitation center (NH)) evaluated/scored five photo cases (of light, medium, or dark-toned skin) using the IASD.D.2. For criterion validity, the Berry-Mielke Universal Agreement coefficient R was used to measure agreement of the IASD.D.2 total scores of evaluators with those of experts (considered the “gold standard”). For inter-rater reliability, Berry-Mielke R measured agreement among total scores of evaluators, and ANOVA assessed differences in IASD.D.2 total scores of evaluators grouped by their self-reported skin tone. Significance at p<.05
Results: The hospital sample had 67 registered nurses (RNs) (61% female, 95% White, mean(sd) age=37.0(11.0) years, nursing experience=12.8(11.4) years). The NH sample had 34 nursing staff (35% RNs, 23.5% licensed practical nurses, and 41.5% certified nursing assistants). NH staff was 27% female, 44% White, 53% African American/African, mean(sd) age=45.0(13.8) years, nursing experience=12.6(13.5) years.
For all cases, agreement of hospital evaluators’ IASD.D.2 scores with experts’ scores was R=0.82 (p<0.001), and agreement of NH evaluators with experts was R=0.85 (p<0.001). Agreement among hospital evaluators’ scores was R=0.74 (p<0.001), and among NH staff types, R=0.79 (p<0.001). There was no significant difference in case scores by skin tone of evaluators in the hospital or NH.
Conclusion: The IASD.D.2 has good validity and reliability when used by hospital and NH nursing staff. It has potential to assist WOC nurses in consulting to and teaching staff in these settings about IASD to achieve good skin outcomes of incontinent patients.