title: Refinement of an instrument for assessing incontinent-associated dermatitis and its severity for use with darker-toned skin.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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 instrument's use in clinical and research settings.
authors.affiliation: Donna Zimmaro Bliss, PhD, RN, FAAN, FGSA, Professor and School of Nursing Foundation Professor of Nursing Research, the School of Nursing University of Minnesota, Minneapolis. Jennifer Hurlow, GNP-BC, CWOCN, Wound Practitioner LLC, Germantown, Tennessee. Jean Cefalu, MSN, A/GNP-c, CWOCN, CFCN, CNE, Instructor of Nursing, Louisiana State University Health Sciences Center, New Orleans. Leigh Mahlum, BA, College of Liberal Arts, University of Minnesota, Minneapolis. Kathleen Borchert, RN, MS, CWOCN, Advanced Practice Nurse, HealthEast Bethesda Hospital, St. Paul, Minnesota. Kay Savik, MS, Senior Research Associate and Biostatistician, School of Nursing, University of Minnesota, Minneapolis.
authors.forename: Donna Zimmaro
authors.initials: DZ
authors.lastname: Bliss
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hurlow
authors.forename: Jean
authors.initials: J
authors.lastname: Cefalu
authors.forename: Leigh
authors.initials: L
authors.lastname: Mahlum
authors.forename: Kathleen
authors.initials: K
authors.lastname: Borchert
authors.forename: Kay
authors.initials: K
authors.lastname: Savik
mesh_terms: D003872:Dermatitis / Q000175:diagnosis* / Q000209:etiology; D005242:Fecal Incontinence / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012880:Skin Pigmentation; D014549:Urinary Incontinence / Q000150:complications*