title: Testing inter-rater reliability of the Urostomy Education Scale.
abstract: OBJECTIVE
  Previous research has validated the Urostomy Education Scale as a standardised evidence based tool to document patients' level of stoma self-care skills. The aim of this study was to test the scale's inter-rater reliability among urology nurses in a continuous validation of the Urostomy Education Scale.
  
  
  METHODS
  During the study period from June 2011 to September 2012, 38 ward nurses performing standard stoma care attended 150 validation sessions evaluating 70 patients' level of stoma self-care skills using the Urostomy Education Scale. In pairs, the nurses randomly observed the patients during a training episode involving change of a stoma appliance. Data were categorised into three groups to investigate the impact of nurses' experience on reliability: comparing two inexperienced nurses, two experienced or one of each. Data were compared for agreement by testing variation between groups and analysing Bland Altman Plots with Limits of Agreement.
  
  
  RESULTS
  The variation in scores was not influenced by the nurses' level of experience (p > 0.05). Reliability was found to be high with Bland Altman Plot and Limits of Agreement documenting that 84% of scores (95% CI (Confidence interval): 74; 89) were within a range of 2 points.
  
  
  CONCLUSIONS
  The Urostomy Education Scale demonstrates high reliability irrespective of nurses' different levels of experience. The results are clinically relevant and contribute to a precise documentation of stoma self-care skills. The tool ensures evidence based patient education and can provide a high standard of communication in transitions between sectors.
authors.affiliation: Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. Electronic address: suskrs@rm.dk.
authors.forename: Susanne A
authors.initials: SA
authors.lastname: Kristensen
authors.affiliation: Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Centre of Research in Rehabilitation, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. Electronic address: benjense@rm.dk.
authors.forename: Bente Thoft
authors.initials: BT
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000451:nursing*; D003718:Denmark; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D015203:Reproducibility of Results; D012648:Self Care / Q000592:standards*; D014519:Ureterostomy / Q000451:nursing*
keywords: Evidence based; Ostomy; Patient education; Radical cystectomy; Rehabilitation; Reliability; Specialised nursing; Stoma self-care; Supportive care; Validation