TY - JOUR
T1 - Validity and reliability of an intuitive conscious sedation scoring tool
T2 - The nursing instrument for the communication of sedation
AU - Mirski, Marek A.
AU - Ledroux, Shannon N.
AU - Lewin, John J.
AU - Thompson, Carol B.
AU - Mirski, Kara T.
AU - Griswold, Michael
N1 - Funding Information:
NICS was an investigator-initiated research study funded, in part, by a grant from Hospira. There was no input as to hypothesis, trial design, data acquisition, or analysis from the study sponsor. Partial support also was a courtesy of The Gannaway and Rund Funds.
PY - 2010/8
Y1 - 2010/8
N2 - Objective: To develop a symmetrical 7-level scale (+3, "dangerously agitated" to-3, "deeply sedated") that is both intuitive and easy to use, the Nursing Instrument for the Communication of Sedation (NICS). Design: Prospective cohort study. Setting: University medical center. Patients: Mixed surgical, medical intensive care unit (ICU) population. Interventions: Patient assessment. Measurements and Main Results: Criterion, construct, face validity, and interrater reliability of NICS over time and comparison of ease of use and nursing preference between NICS and four common intensive care unit sedation scales. A total of 395 observations were performed in 104 patients (20 intubated [INT], 84 non intubated) by 59 intensive care unit providers. Criterion validity was tested comparing NICS WITH the 8-point level of arousal scale, demonstrating excellent correlation (rs =.96 overall,.95 non intubated, 0.85 intubated, all p <.001). Construct validity was confirmed by comparing NICS with the Richmond Agitation-Sedation Scale, demonstrating excellent correlation (rs =.98, p <.001). Face validity was determined in a blinded survey of 53 intensive care unit nurses evaluating NICS and four other sedation scales. NICS was highly rated as easy to score, intuitive, and a clinically relevant measure of sedation, and agitation and was preferred overall (74% NICS, 17% Richmond Agitation-Sedation Scale, 11% Other, p <.001 NICS vs. Richmond Agitation-Sedation Scale). Interrater reliability was assessed, using the five scales at three timed intervals, during which 37% of patients received sedative medication. The mean NICS score consistently correlated with each of the other scales over time with an rs of >.9. Using the intraclass correlation coefficient as a measure of Interrater reliability, NICS scored as high, or higher than Richmond Agitation-Sedation Scale, Riker Sedation-Agitation Scale, Motor Activity Assessment Scale, or Ramsay over the three time periods. Conclusion: NICS is a valid and reliable sedation scale for use in a mixed population of intensive care unit patients. NICS ranked highest in nursing preference and ease of communication and may thus permit more effective and interactive management of sedation.
AB - Objective: To develop a symmetrical 7-level scale (+3, "dangerously agitated" to-3, "deeply sedated") that is both intuitive and easy to use, the Nursing Instrument for the Communication of Sedation (NICS). Design: Prospective cohort study. Setting: University medical center. Patients: Mixed surgical, medical intensive care unit (ICU) population. Interventions: Patient assessment. Measurements and Main Results: Criterion, construct, face validity, and interrater reliability of NICS over time and comparison of ease of use and nursing preference between NICS and four common intensive care unit sedation scales. A total of 395 observations were performed in 104 patients (20 intubated [INT], 84 non intubated) by 59 intensive care unit providers. Criterion validity was tested comparing NICS WITH the 8-point level of arousal scale, demonstrating excellent correlation (rs =.96 overall,.95 non intubated, 0.85 intubated, all p <.001). Construct validity was confirmed by comparing NICS with the Richmond Agitation-Sedation Scale, demonstrating excellent correlation (rs =.98, p <.001). Face validity was determined in a blinded survey of 53 intensive care unit nurses evaluating NICS and four other sedation scales. NICS was highly rated as easy to score, intuitive, and a clinically relevant measure of sedation, and agitation and was preferred overall (74% NICS, 17% Richmond Agitation-Sedation Scale, 11% Other, p <.001 NICS vs. Richmond Agitation-Sedation Scale). Interrater reliability was assessed, using the five scales at three timed intervals, during which 37% of patients received sedative medication. The mean NICS score consistently correlated with each of the other scales over time with an rs of >.9. Using the intraclass correlation coefficient as a measure of Interrater reliability, NICS scored as high, or higher than Richmond Agitation-Sedation Scale, Riker Sedation-Agitation Scale, Motor Activity Assessment Scale, or Ramsay over the three time periods. Conclusion: NICS is a valid and reliable sedation scale for use in a mixed population of intensive care unit patients. NICS ranked highest in nursing preference and ease of communication and may thus permit more effective and interactive management of sedation.
KW - agitation
KW - level of arousal
KW - pharmacology
KW - scales
KW - sedation
KW - titration
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U2 - 10.1097/CCM.0b013e3181e7c73e
DO - 10.1097/CCM.0b013e3181e7c73e
M3 - Article
C2 - 20581667
AN - SCOPUS:77954955943
SN - 0090-3493
VL - 38
SP - 1674
EP - 1684
JO - Critical care medicine
JF - Critical care medicine
IS - 8
ER -