title: Psychometric evaluation of the ostomy complication severity index.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the psychometric properties of a new instrument to measure incidence and severity of ostomy complications early in the postoperative period.
  
  
  METHODS
  71 participants were enrolled, most were men (52%), white (96%), and married or partnered (55%). The mean age of participants was 57 ± 15.09 years (mean ± SD). Fifty-two participants (84%) experienced at least 1 ostomy complication in the 60-day postoperative period. The research setting was 3 acute care settings within a large healthcare system in the Midwestern United States.
  
  
  METHODS
  We developed an evidence-based conceptual model to guide development and evaluation of a new instrument, the Pittman Ostomy Complication Severity Index (OCSI). The OCSI format includes Likert-like scale with 9 individual items scored 0 to 3 and a total score computed by summing the individual items. Higher scores indicate more severe ostomy complications.
  
  
  METHODS
  This study consisted of 2 phases: (1) an expert review, conducted to establish content validity; and (2) a prospective, longitudinal study design, to examine psychometric properties of the instrument. A convenience sample of 71 adult patients who underwent surgery to create a new fecal ostomy was recruited from 3 hospitals. Descriptive analyses, content validity indices, interrater reliability testing, and construct validity testing were employed.
  
  
  RESULTS
  Common complications included leakage (60%), peristomal moisture-associated dermatitis (50%), stomal pain (42%), retraction (39%), and bleeding (32%). The OCSI demonstrated acceptable evidence of content validity index (CVI = 0.9) and interrater reliability for individual items (k = 0.71-1.0), as well as almost perfect agreement for total scores among raters (ICC = 0.991, P ≤ .001). Construct validity of the OCSI was supported by significant correlations among variables in the conceptual model (complications, risk factors, stoma care self-efficacy, and ostomy adjustment).
  
  
  CONCLUSIONS
  OCSI demonstrated acceptable validity and reliability and can be used to assess incidence and severity of ostomy complications in the early postoperative period. We found the OCSI to be brief, easy-to-use, and clinically practical. It can be used to (a) identify priority areas for nursing intervention related to the ostomy, (b) determine appropriate interventions to prevent or treat complications, and (c) evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.
authors.affiliation: Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, Indiana University School of Nursing, Indiana University Health, Indianapolis. Tamilyn Bakas, PhD, RN, FAHA, FAAN, Indiana University School of Nursing, Indiana University Health, Indianapolis. Marsha Ellett, PhD, RN, Indiana University School of Nursing, Indiana University Health, Indianapolis. Rebecca Sloan, PhD, RN, ANP-BC, Indiana University School of Nursing, Indiana University Health, Indianapolis. Susan M. Rawl, PhD, RN, FAAN, Indiana University School of Nursing, Indiana University Health, Indianapolis.
authors.forename: Joyce
authors.initials: J
authors.lastname: Pittman
authors.forename: Tamilyn
authors.initials: T
authors.lastname: Bakas
authors.forename: Marsha
authors.initials: M
authors.lastname: Ellett
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sloan
authors.forename: Susan M
authors.initials: SM
authors.lastname: Rawl
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010030:Ostomy; D011183:Postoperative Complications; D011184:Postoperative Period; D011594:Psychometrics; D015203:Reproducibility of Results; D012720:Severity of Illness Index