Reliability and Validity of the Chinese Version of DESIGN-R, an Assessment Instrument for Pressure Ulcers
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Index: Ostomy Wound Manage. 2013;59(2):36–43.
Lack of a valid and reliable assessment instrument may have contributed to a lack of wound healing research in China. The DESIGN-R tool scores the severity of pressure ulcers (PUs) and monitors healing using the observable state assessment; it was developed by the Scientific Education Committee of the Japanese Society of Pressure Ulcers (JSPU) and tested for reliability and validity. A Chinese version of DESIGN-R was developed based on Brislin’s model of translation and tested for validity and reliability. Using a purposive sampling method, 44 practicing registered nurses (RNs) and 11 physicians (MDs) were recruited from 52 departments of Nanfang Hospital, Guangdong, China. Based on their experience, they were classified as general medical staff (gMS) or experienced medical staff (eMS). All used the Chinese version of DESIGN-R to assess eight photographs of PUs and descriptors. In addition, eight eMS also used the Bates-Jensen Wound Assessment Tool (BWAT) to assess the same wounds. Inter-rater reliability was high (total ICC score = 0.960). ICC inflammation/infection scores were 0.530 and 0.759 for gMS and eMS, respectively; granulation ICC scores were 0.532 and 0.794 in gMS and eMS, respectively. The correlation coefficients between the BWAT and DESIGN-R tool were >0.80 for all eight raters. The results suggest the Chinese version of DESIGN-R is valid and reliable and may be a useful scoring tool for RNs and MDs to monitor PU status in daily clinical practice. Additional research is warranted, and clinical instruments for inflammation/infection and granulation assessment must be developed for gMS.
Keywords: pressure ulcer, wound assessment, nursing, reliability, validity
Potential Conflicts of Interest: Part of this work was presented at the 17th Annual Scientific Meeting of Japan Academy of Gerontological Nursing, Kanazawa, Japan, July 14, 2012.
Pressure ulcers (PUs) are a serious health problem; they are unpleasant, upsetting, challenging to treat, and increase mortality and patient length of stay.1,2 Therefore, healthcare professionals use a range of techniques to prevent PUs.3 Despite preventive efforts, PU prevalence has been estimated to be 0.4% to 28% in the United States,1 9% to 18.1% in Europe,2,3 and 4.18% and 0.44% to 45.5% in Japan4 and Korea,5 respectively, depending on the facility and type of patient. Although no nationwide statistics on the incidence of PUs in China are available, given the size of China’s population, the number of patients with PUs can be predicted to be very large.
For effective and efficient PU management, it is essential to measure and describe wound healing progress precisely. The basic foundation of an assessment instrument is to document various aspects of PU appearance and change in wound status over time. A PU assessment instrument should provide objective information to facilitate appropriate wound assessment and management by the wound care clinician and the interdisciplinary team.