Sykepleie til intensivpasienten målt med Nursing Activities Score: analyse av interrater reliabilitet mellom tre faggrupper på Hovedintensiv ved St Olavs Hospital Trondheim

Abstract

Background: The Nursing Activities Score is a validated tool for measuring workload in intensive care units. The tool consists of 5 items and subgroups related to nursing interventions and 18 items are related to medical interventions. Interrater reliability and agreement between raters have not been tested or evaluated in Norway. Purpose: In this descriptive study the aim was to determine if different raters scored workload a like with the new tool Nursing Activities Score. Materials and Methods: In a 6-week period health professionals scored Nursing Activities Score on a chart for daily registration. At St. Olav University hospital, 101 patients were included from one intensive care unit. Patients mean age 56,63 year, gender 83,2 % male, SAPS II was mean 42,17 and diagnosis related to CNS and ventilationproblem was common. The Nursing Activities Score from each patient was performed as a triple score from three raters; the intensive care nurse (bedside), the doctor and the nurse in charge of the unit. Interrater reliability was analyzed by agreement between groups and means, subscores were analyzed using kappa statistics and proportion of agreement. Results and Conclusions: The overall score for Nursing activities score were 88,38 %. The mean for doctors score were significant lower. (ICU nurse-88,4%, doctor- 83,70%, nurse in charge- 88,3%). Results from the 18 medical interventions showed better agreement between bedside nurses and doctors, than for bedside nurses and nurse in charge. The opposite association was present for the subgroups in nursing interventions; mobilization and administrative tasks. The care of families and relatives was underestimated by doctors and nurses in charge. The study indicates that the results of Nursing Activities Score differs by the rater’s scoring practice.