classification, nursing care, ostomy, skin disease, skin manifestations, validation study



  1. Torres, Yesly Johana Rincon MSc, RN
  2. Gamboa, Sandra Guerrero PhD, MSc, RN
  3. Moreno-Ramos, Mily Constanza PhD, MSc, RN


OBJECTIVE: To realize the cultural adaptation and content validation and evaluate the reliability of the SACS 2.0 instrument in Colombian Spanish.


METHODS: The researchers conducted a methodological study with a quantitative approach. The adaptation process was carried out in five stages: translation, synthesis, reverse translation, evaluation by a committee of experts, and testing of the adapted version. In addition, the interobserver reliability was evaluated by four nurses who examined 210 stomas.


RESULTS: All of the proposed stages were carried out successfully, and an adapted version of the instrument in Colombian Spanish was obtained. During the content validation stage, the instrument obtained a content validity index of 1. The adapted version of the test showed substantial agreement for the aspect of clarity, adequacy, and understandability. In the interobserver reliability, there was agreement in 95.7% of the evaluations for the classification of the lesions according to the quadrants ([kappa] = 0.97-0.99).


CONCLUSIONS: Authors achieved a culturally adapted, valid, and reliable instrument for the evaluation and classification of peristomal skin alterations in Colombian Spanish.