Validation of the withdrawal assessment tool-1 (WAT-1) in pediatric cardiovascular patients on an inpatient unit

IF 1.2 4区 医学 Q3 NURSING
Sarah McAlister MS, RN, CPNP, Jean A. Connor PhD, RN, CPNP, FAAN, Shannon Engstrand MPH, Mary C. McLellan MPH, BSN, RN
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引用次数: 1

Abstract

Purpose

Sedation and analgesia are administered to critically ill patients, which may result in physical dependence and subsequent iatrogenic withdrawal. The Withdrawal Assessment Tool-1 (WAT-1) was developed and validated as an objective measurement of pediatric iatrogenic withdrawal in intensive care units (ICUs), with a WAT-1 score ≥ 3 indicative of withdrawal. This study's objectives were to test interrater reliability and validity of the WAT-1 in pediatric cardiovascular patients in a non-ICU setting.

Design and methods

This prospective observational cohort study was conducted on a pediatric cardiac inpatient unit. WAT-1 assessments were performed by the patient's nurse and a blinded expert nurse rater. Intra-class correlation coefficients were calculated, and Kappa statistics were estimated. A two-sample, one-sided test of proportions of weaning (n = 30) and nonweaning (n = 30) patients with a WAT-1 ≥3 were compared.

Results

Interrater reliability was low (K = 0.132). The WAT-1 area under the receiver operating curve was 0.764 (95% confidence interval; ± 0.123). There was a significantly higher proportion (50%, p = 0.009) of weaning patients with WAT-1 scores ≥3 compared to the nonweaning patients (10%). The WAT-1 elements of moderate/severe uncoordinated/repetitive movement and loose, watery stools were significantly higher in the weaning population.

Practice Implications

Methods to improve interrater reliability warrant further examination. The WAT-1 had good discrimination at identifying withdrawal in cardiovascular patients on an acute cardiac care unit. Frequent nurse re-education may increase accurate tool use. The WAT-1 tool may be used in the management of iatrogenic withdrawal in pediatric cardiovascular patients in a non-ICU setting.

住院儿科心血管患者戒断评估工具-1 (wat1)的验证
目的对危重患者进行镇静镇痛治疗,可能导致身体依赖和随后的医源性戒断。戒断评估工具-1 (WAT-1)被开发并验证为重症监护病房(icu)儿科医源性戒断的客观测量,WAT-1评分≥3表示戒断。本研究的目的是测试在非icu环境下儿科心血管患者中wat1的相互信度和效度。设计和方法本前瞻性观察队列研究在儿科心脏病住院病房进行。WAT-1评估由患者的护士和一名盲法护理专家评分员进行。计算类内相关系数,估计Kappa统计量。比较WAT-1≥3的断奶(n = 30)和非断奶(n = 30)患者比例的双样本单侧检验。结果测者信度较低(K = 0.132)。受试者工作曲线下的watt -1面积为0.764(95%可信区间;±0.123)。断奶患者WAT-1评分≥3分的比例(50%,p = 0.009)明显高于未断奶患者(10%)。在断奶人群中,中度/重度不协调/重复运动和疏松、水样便的wat1因子明显较高。实践意义提高互传器可靠性的方法有待进一步研究。wat1在识别急性心脏科心血管病人的戒断反应方面有很好的辨别能力。频繁的护士再教育可提高工具使用的准确性。wat1工具可用于非icu环境下儿科心血管患者的医源性停药管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.50
自引率
7.70%
发文量
27
审稿时长
>12 weeks
期刊介绍: Linking science and practice by publishing evidence-based information on pediatric nursing and answering the question, ''How might this information affect nursing practice?'' The Journal for Specialists in Pediatric Nursing (JSPN) is the international evidence-based practice journal for nurses who specialize in the care of children and families. JSPN bridges the gap between research and practice by publishing peer-reviewed reliable, clinically relevant, and readily applicable evidence. The journal integrates the best evidence with pediatric nurses'' passion for achieving the best outcomes. The journal values interdisciplinary perspectives and publishes a wide variety of peer-reviewed papers on clinically relevant topics.
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