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Evaluation of Validity and Reliability of a Revised Incontinence-Associated Skin Damage Severity Instrument (IASD.D.2) by 3 Groups of Nursing Staff

Bliss, Donna Z.; Gurvich, Olga V.; Hurlow, Jennifer; Cefalu, Jean E.; Gannon, Alexandra; Wilhems, Anna; Wiltzen, Kjerstie R.; Gannon, Elise; Lee, Haeyeon; Borchert, Kathleen; Trammel, Sheila Howes

Journal of Wound Ostomy & Continence Nursing: September/October 2018 - Volume 45 - Issue 5 - p 449–455
doi: 10.1097/WON.0000000000000466
Continence Care

PURPOSE: The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas.

DESIGN: Observational, evaluative design.

SAMPLE AND SETTING: Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female.

METHODS: Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a “gold standard” in this study) was analyzed.

RESULTS: The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience.

CONCLUSION: The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.

Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, Minneapolis.

Olga V. Gurvich, MA, University of Minnesota School of Nursing, Minneapolis, Minnesota.

Jennifer Hurlow, MSN, GNP-BC, CWCN, University of Manchester, Manchester, United Kingdom.

Jean E. Cefalu, PhD, APRN, CWOCN, CNE, Louisiana State University–New Orleans School of Nursing.

Alexandra Gannon, BSN, RN, University of Minnesota School of Nursing, Minneapolis.

Anna Wilhems, BSN, RN, University of Minnesota School of Nursing, Minneapolis.

Kjerstie R. Wiltzen, BSN, BAN, RN, University of Minnesota School of Nursing, Minneapolis.

Elise Gannon, University of Minnesota School of Nursing, Minneapolis.

Haeyeon Lee, University of Minnesota School of Nursing, Minneapolis.

Kathleen Borchert, MS, RN, APRN, CNS, CWOCN, CFCN, University of Minnesota Fairview Medical Center, Minneapolis.

Sheila Howes Trammel, ARNP, FNP-BC, CWCN, CCCN, CFCN, Hennepin County Medical Center, Minneapolis, Minnesota.

Correspondence: Donna Z. Bliss, PhD, RN, FAAN, FGSA, University of Minnesota School of Nursing, 308 Harvard St S.E., 5-140 Weaver-Densford Hall, Minneapolis, MN 55455 (

Parts of this study were funded by internal funds from the University of Minnesota.

The authors declare no conflicts of interest.

© 2018 by the Wound, Ostomy and Continence Nurses Society.