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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Validity and reliability of the italian-Neonatal skin risk assessment scale (i-NSRAS)
Felice Curcio1, Manuel Vaquero Abellán2, Elisabetta Dioni3
1Faculty of Medicine and Nursing, Department of Nursing, University of Córdoba, Córdoba, Spain; Faculty of Medicine and Surgery, University of Sassari (UNISS), Sassari, Italy.
Insights
The Italian-Neonatal Skin Risk Assessment Scale is a valid and reliable tool for identifying infants at risk of pressure injuries. This newborn-specific scale aids in early intervention and resource management.
Area of Science:
- Neonatal care
- Dermatology
- Clinical assessment tools
Background:
- Infant skin possesses unique anatomical and physiological characteristics, increasing vulnerability.
- Infants face a higher risk of pressure injuries due to immature skin, immobility, and medical device use.
- Validated tools are essential for accurately assessing pressure injury risk in neonates.
Purpose of the Study:
- To evaluate the psychometric properties of the Italian version of the Neonatal Skin Risk Assessment Scale.
- Assessing construct validity, internal consistency, and reliability of the scale in the neonatal population.
Main Methods:
- A cross-sectional descriptive study involving 200 infants across two Italian hospitals.
- Utilized exploratory and confirmatory factor analysis for construct validity.
- Assessed internal consistency with McDonald's omega and Cronbach's alpha; reliability with Intraclass Correlation Coefficients (ICC).
Main Results:
- Confirmatory factor analysis supported a two-factor model: 'duration and intensity of pressure' and 'skin immaturity'.
- The Italian-Neonatal Skin Risk Assessment Scale demonstrated good internal consistency (omega = 0.86, alpha = 0.86).
- Excellent intra-observer (ICC=0.99) and inter-observer (ICC=0.98) reliability was observed.
Conclusions:
- The Italian-Neonatal Skin Risk Assessment Scale is a valid and reliable instrument for assessing pressure injury risk in neonates.
- This scale is the first newborn-specific tool to incorporate medical device assessment.
- Its implementation can optimize preventive strategies and risk stratification in neonatal intensive care units.
Background:
The skin of infants has important anatomical and physiological differences from that of children and adults. Because of skin immaturity, reduced mobility, neurological changes, and the need for medical devices, infants are at high risk for pressure injuries. Specific, validated tools are needed to assess the risk of pressure injuries in this population.
Objectives:
To assess the psychometric properties of the Italian version of Neonatal Skin Risk Assessment Scale (construct validity, internal consistency and reliability).
Method:
A cross-sectional descriptive study was conducted in the neonatal units of the two Italian hospitals. 200 infants were examined 3 times by 54 nurses to assess the risk of pressure injuries. Exploratory and confirmatory factor analysis were performed jointly to assess construct validity. Internal consistency was analyzed using McDonalds omega coefficient and Cronbach's alpha, while intra and interobserver agreement using Intraclass Correlation Coefficients (ICC).
Results:
Exploratory factor analysis confirmed a 2-factor model; the factor "duration and intensity of pressure" explained four subscales (mental state, mobility, activity and nutrition), while "skin immaturity" explained the subscales (general physical condition and skin moisture). Confirmatory factor analysis results indicated good model fits (X2/df = 0.84, p = 0.002, RMSEA = 0, NNFI = 1.01, NFI = 0.98 y CFI = 1 (M1 with MI). The italian-Neonatal Skin Risk Assessment Scale showed a good internal consistency, McDonalds omega coefficient and Cronbach's alpha both 0.86. An excellent intra and inter observer reliability was also observed, ICC 0.99 and 0.98 respectively.
Conclusion:
The psychometric characteristics indicate that the italian-Neonatal Skin Risk Assessment Scale is useful, valid and reliable for measuring risk of pressure injuries in the neonatal population.
Implications For Clinical Practice:
This is the first valid and reliable newborn-specific scale that assesses the presence of medical devices. Its use could enable efficient management of preventive resources, early classification of newborns at risk and assignment of preventive interventions, facilitate the development of risk assessment protocols.
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