Inter-rater reliability in the assessment of consciousness in patients receiving palliative care in intensive care: A prospective cross sectional observational study.
Dilek Yildirim, Arzu Kavala, Seda Değirmenci Öz and 3 others
PMID 38508739WHAT IT FOUND
The nurses' total GCS scores only partly matched researchers' scores in 42 palliative ICU patients.
A single bedside consciousness rating may not be interchangeable.
Key findings
01Total GCS scores showed moderate agreement between nurses and each researcher-observer, and substantial agreement between the two researchers.
02Verbal response scores showed substantial agreement between nurses and researchers, while eye and motor response scores showed moderate agreement.
03Nurses reported uncertainty specifically about motor response assessment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one palliative and intensive care unit with convenience sampling, so it may not reflect other units. Only 42 patients and 18 nurses were included, although 258 assessments were completed. The paper gives different nurse counts: it describes six day-shift nurses during evaluations, says all registered nurses were included, and reports 18 nurses completing 258 assessments. The nurses knew they were taking part, and the paper says they may have reviewed GCS guidelines during data collection, which could have led to better agreement. The study could not link agreement to nurses' knowledge or length of professional experience. Patients receiving sedatives or paralytic drugs were excluded, so the finding does not cover those patients.
Declared interests
The authors received no financial support for the research, authorship or publication, and declared no conflict of interest.
The easy way to misread this
Do not read the agreement between the two researchers as proof that GCS scores are consistent in routine nursing care. The nurses' total scores only partly matched the researchers' scores.