Reliability of nursing assistants' observations of functioning and clinical symptoms and signs

Simple methods for the early detection of function loss and disease in the elderly were evaluated. Such methods might be used by non-professional personnel as case-finding tools for early intervention. The aim of this study was to assess the reliability of functional and clinical data collected by non-professional nursing assistants. The study group consisted of sixty elderly short-stay patients in a stable clinical situation, admitted for rehabilitation and aid in a nursing home. Barthel ADL index items and clinical symptoms and signs were scored by nursing assistants and nurses (the reference method). Agreement between scores was assessed by Cohen's kappa statistics and test of marginal homogeneity. All the Barthel items and the clinical symptoms and signs had fair or better agreement (weighted kappa > 0.40). For dressing, chair-to-bed transfer, ambulation, bathing, paresis and edema, the agreement was strong (weighted kappa > 0.75). The reliability of the Barthel sumscores was also acceptable. We concluded that observation of functioning and clinical symptoms and signs by non-professional nursing assistants is reliable.