Validity and reliability of an intuitive conscious sedation scoring tool: The nursing instrument for the communication of sedation
Validity and reliability of an intuitive conscious sedation scoring tool: The nursing instrument for the communication of sedation
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DOI：
10.1097/ccm.0b013e3181e7c73e
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发表时间：
2010-08-01
影响因子：
8.8
通讯作者：
Griswold, Michael
中科院分区：
文献类型：
--
作者：
Mirski, Marek A.;LeDroux, Shannon N.;Griswold, Michael
目标：开发一个对称的7级量表（+3，“危险激动”到-3，“深度镇静”），这是直观和易于使用的，护理仪器的沟通镇静（NICS）。设计：前瞻性队列研究。设置：大学医学中心。患者：混合外科，医疗重症监护室（ICU）的人口。干预措施：患者评估。测量和主要结果：NICS的标准、结构、表面效度和评分者间信度随时间的变化，以及NICS与四种常见重症监护室镇静量表之间易用性和护理偏好的比较。由59名重症监护室提供者对104例患者（20例插管[INT]，84例未插管）进行了共计395次观察。将NICS与唤醒量表的8分水平进行比较，检验标准有效性，证明了极好的相关性（r（s）= 0.96，总体上，0.95未插管，0.85插管，所有p <0.001）。通过比较NICS与里士满躁动-镇静量表，证实了结构效度，证明了良好的相关性（r（s）= 0.98，p <0.001）。在对53名重症监护室护士进行的盲法调查中确定了表面有效性，以评估NICS和其他四种镇静量表。NICS被高度评价为易于评分、直观，并且是镇静和躁动的临床相关指标，总体上是首选（74% NICS，17%里士满躁动-镇静量表，11%其他，p <0.001 NICS vs.里士满躁动-镇静量表）。在三个时间间隔内使用五个量表评估评估者间可靠性，在此期间37%的患者接受镇静药物治疗。随着时间的推移，平均NICS评分始终与其他量表相关，r（s）> 0.9。使用组内相关系数作为一个衡量评分者间的可靠性，NICS得分高，或高于里士满躁动镇静量表，里克镇静躁动量表，运动活动评估量表，或Ramsay在三个时间periods.Conclusion：NICS是一个有效的和可靠的镇静量表，用于混合人群的重症监护病房患者。NICS在护理偏好和沟通便利性方面排名最高，因此可能允许更有效和交互式的镇静管理。(Crit Care Med 2010; 38：1674-1684）
Objective: To develop a symmetrical 7-level scale (+3, "dangerously agitated" to -3, "deeply sedated") that is both intuitive and easy to use, the Nursing Instrument for the Communication of Sedation (NICS).Design: Prospective cohort study.Setting: University medical center.Patients: Mixed surgical, medical intensive care unit (ICU) population.Interventions: Patient assessment.Measurements and Main Results: Criterion, construct, face validity, and interrater reliability of NICS over time and comparison of ease of use and nursing preference between NICS and four common intensive care unit sedation scales. A total of 395 observations were performed in 104 patients (20 intubated [INT], 84 non intubated) by 59 intensive care unit providers. Criterion validity was tested comparing NICS WITH the 8-point level of arousal scale, demonstrating excellent correlation (r(s) = .96 overall,.95 non intubated, 0.85 intubated, all p < .001). Construct validity was confirmed by comparing NICS with the Richmond Agitation-Sedation Scale, demonstrating excellent correlation (r(s) = .98, p < .001). Face validity was determined in a blinded survey of 53 intensive care unit nurses evaluating NICS and four other sedation scales. NICS was highly rated as easy to score, intuitive, and a clinically relevant measure of sedation, and agitation and was preferred overall (74% NICS, 17% Richmond Agitation-Sedation Scale, 11% Other, p < .001 NICS vs. Richmond Agitation-Sedation Scale). Interrater reliability was assessed, using the five scales at three timed intervals, during which 37% of patients received sedative medication. The mean NICS score consistently correlated with each of the other scales over time with an r(s) of >.9. Using the intraclass correlation coefficient as a measure of Interrater reliability, NICS scored as high, or higher than Richmond Agitation-Sedation Scale, Riker Sedation-Agitation Scale, Motor Activity Assessment Scale, or Ramsay over the three time periods.Conclusion: NICS is a valid and reliable sedation scale for use in a mixed population of intensive care unit patients. NICS ranked highest in nursing preference and ease of communication and may thus permit more effective and interactive management of sedation. (Crit Care Med 2010; 38: 1674-1684)