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  • Journal of Wound, Ostomy and Continence Nursing  (3)
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  • 1
    In: Journal of Wound, Ostomy and Continence Nursing, 2014, Vol.41(4), pp.365-370
    Description: PURPOSE:: The purpose of this study was to refine an instrument for assessing incontinence-associated dermatitis (IAD) and its severity for use on lighter- and darker-toned skin, the Incontinence-Associated Dermatitis and its Severity Instrument-D (IADS-D), and to test its validity and reliability among WOC nurses. METHODS:: Revisions to the existing instrument included examples of colors of normal and IAD-damaged skin that would be observed on light-, medium-, and dark-toned skin using pixels from patient photographs, additional photographs of IAD manifestations on different skin tones, and training materials. Four certified WOC nurse consultants and 2 WOC nurse clinical experts assessed the face and content validity of the IADS-D instrument. The IADS-D instrument was tested for criterion validity and interrater reliability using photo cases by attendees at the Wound, Ostomy, and Continence Nurses Society 2012 conference. RESULTS:: The IADS-D instrument had good face and content validity. The overall average intraclass correlation coefficient (ICC) of IADS-D scores for all photo cases of testers (n = 266, 95% female, age 53.0 ± 7.9 years, mean ± SD) and those of investigators, experts, and consultants serving as the criterion was 0.90. The overall ICC for interrater reliability between all nurse testers was 0.99 and the ICC for tester skin tone was 0.99. CONCLUSION:: The IADS-D instrument has excellent validity and interrater reliability among WOC nurses. Its refinement for use with lighter- and darker-toned skin addresses the lack of a much-needed instrument in nursing practice and research. Results support continued development and evaluation of the instrumentʼs use in clinical and research settings.
    Keywords: Incontinence ; Skin and Skin Disorders ; Screening ; Research Methods ; Ethnic Groups ; Professional Development ; Dermatology Nursing ; Quantitative Research ; Nurse Specialists ; Minority & Ethnic Groups ; Urinary Incontinence ; Research Methodology ; Medical Screening ; Skin ; Skin Diseases ; Dermatology ; United States–Us;
    ISSN: 1071-5754
    E-ISSN: 15283976
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  • 2
    In: Journal of Wound, Ostomy and Continence Nursing, 2018, Vol.45(5), pp.449-455
    Description: 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 Societyʼs 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 evaluatorsʼ 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 evaluatorsʼ scores with expertsʼ 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 evaluatorsʼ 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.
    Keywords: Dermatitis -- Care And Treatment ; Medical Personnel -- Practice;
    ISSN: 1071-5754
    E-ISSN: 15283976
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  • 3
    In: Journal of Wound, Ostomy and Continence Nursing, 2000, Vol.27(2), pp.90-91,93–97
    Description: PURPOSE: In our clinical and research experience, persons with fecal incontinence anecdotally report altered diet intake to avoid incontinence. The purpose of this study was to compare the dietary intake of 39 persons with fecal incontinence living in the community with that of age- and gender-matched control subjects who had normal bowel function. The diets of both groups were compared with recommended dietary allowances (RDAs) for their constituent nutrients. METHODS: Subjects prospectively recorded the type, amount, and method of preparing all foods and beverages ingested for 8 consecutive days. Diet records were analyzed using the Nutritionist IV software program. MAIN OUTCOME MEASURES: The main outcome measures were the amounts and percentage of the RDAs of macronutrients and micronutrients in the subjectsʼ diets. RESULTS: There were no significant differences in the intake of total kilocalories, protein, fat, dietary fiber, caffeine, or lactose by the fecal incontinence and control groups. The fecal incontinence group had a greater intake of carbohydrates, manganese, and vitamin B1 compared with the control group. Diets of both groups exceeded 100% of the RDA for protein, phosphorus, iron, sodium, potassium, Vitamins B1, B2, B3, B12, and C and folate. Diets of both groups had less than 50% of the RDA for biotin, chromium, copper, and manganese but did not differ significantly. The percentages of the RDA for calcium and vitamin D were 84% ± 6% and 56% ± 8% for the fecal incontinence group and 90 ± 8 (P = .6) and 69 ± 11 for the control group (P = .4). CONCLUSIONS: The diets of persons with fecal incontinence were similar to those of control subjects with normal bowel function. Both the fecal incontinence and control groups may improve their nutritional patterns by lowering sodium and protein intake and increasing dietary fiber and monounsaturated fat intake. Calcium and vitamin D supplementation may improve dietary deficiencies and lower disease risks. Including a nutritional assessment and consultation in the care of persons with fecal incontinence to improve their general health and prevent disease is recommended, but consideration must be given to altered diet patterns perceived by the patient to prevent fecal incontinence.
    Keywords: Diet ; Feeding Behavior ; Fecal Incontinence -- Prevention & Control ; Self Care -- Statistics & Numerical Data;
    ISSN: 1071-5754
    E-ISSN: 15283976
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