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Research Corner: When and How to Evaluate Interrater Reliability of Patient Assessment Tools
Céline Gélinas RN, PhD
Christine Hedges RN, PhD, ACNS-BC; Department Editor

AACN Advanced Critical Care
December 2011 
Volume 22  Number 4
Pages 412 - 417
  PDF Version Available!

Critical care nurses select and use assessment tools* in their practice. Many of these tools are aimed at assessing symptoms, conditions, or risks on the basis of the evaluation made by the nurses or other clinicians on the health care team. For instance, the assessment of pain in nonverbal patients, depth of sedation, and screening for delirium are common in critical care settings. To achieve specific goals and provide patients with adequate care and treatment, how do critical care nurses know whether a tool is reliable and valid?Reliability refers to measurement error and provides evidence that a test is measuring something in a reproducible manner.1 Validity provides evidence that a test is measuring what it is intended to measure and refers to the degree to which evidence and theory support the interpretation of test scores when used as proposed.1-3 Reliability is an important concern and a necessary condition for validity. There are different strategies to check for reliability. Interrater reliability is one of them and is particularly relevant when clinicians, including critical care nurses, are end users of the assessment tool. Interrater reliability aims to estimate the degree to which 2 or more independent raters are consistent in their scores or classifications.4 In this column, various approaches to examining interrater reliability, and other aspects that the critical care nurse should look for when examining or interpreting interrater reliability findings are discussed.Since the publication of documents such as the clinical guidelines by the Society of Critical Care Medicine5 and a position statement by the American Society for Pain Management Nursing,6 use of valid tools for pain assessment in nonverbal patients, evaluation of the depth of sedation, and screening of delirium in ICU patients is strongly recommended. Critical care teams should select assessment tools appropriate to their clinical population and context of care to optimize care and treatment.

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