title: Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form-Mini Nutritional Assessment by registered and enrolled nurses in clinical practice.
abstract: OBJECTIVE
  Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form-Mini Nutritional Assessment.
  
  
  BACKGROUND
  In Sweden, registered nurses and enrolled nurses usually co-operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied. DESIGN CROSS-SECTIONAL: Registered nurses and enrolled nurses made 228 assessments of patients' skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke.
  
  
  RESULTS
  The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini-Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card.
  
  
  CONCLUSIONS
  The Modified Norton Scale and Short Form Mini-Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients' skin with the Pressure Ulcer Card.
  
  
  CONCLUSIONS
  The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop.
authors.affiliation: Department of Nursing, Karlstad University, Karlstad, Sweden. carina.baath@kau.se
authors.forename: Carina
authors.initials: C
authors.lastname: Bååth
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Hall-Lord
authors.forename: Ewa
authors.initials: E
authors.lastname: Idvall
authors.forename: Katarina
authors.initials: K
authors.lastname: Wiberg-Hedman
authors.forename: Bodil
authors.initials: B
authors.lastname: Wilde Larsson
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009729:Nursing; D015596:Nutrition Assessment; D003668:Pressure Ulcer / Q000451:nursing / Q000503:physiopathology*; D015203:Reproducibility of Results