The content validity of the Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS); does it capture the nurse’s worry?

Abstract

BACKGROUND Early recognition and treatment of clinical deterioration in hospitalized patients is essential and performed by nurses. Clinical deterioration can be detected using the (Modified) Early Warning Score ((M)(EWS)-criteria) or the nurse’s worry. The nurse’s worry is an intuitive feeling nurses develop over time and experience. Studies have shown that nurses find it difficult to describe their worries. The Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS), is developed for nurses to objectify their worry, and consists of nine individual indicators. However, content validity (CV) of the DENWIS has not been established. AIMS The primary aim was to determine the CV of the DENWIS. Secondary aims were to explore the correlations between the individual DENWIS-indicators and the years of work experience of the nurse, the type of ward, and the type of hospital. METHOD A prospective validation multicenter study was conducted using a digital quantitative survey. This survey was sent to (student) nurses working on internal medicine/surgical wards in one university hospital and one general hospital in the Netherlands. The relevance of each item was scored on a 4-point Likert scale. Additional questions were added to the survey. RESULTS All DENWIS-indicators except “Agitation” scored an Item-Content Validity Index of 0.79 or higher (range 0.77-0.99). The correlations between “Change in Mentation” and years of work experience (phi = .28, p=0.001), and “Unexpected Trajectory” and type of hospital (phi = -0.25, p=0.01) were statistically significant. There were no other significant correlations. CONCLUSION All the DENWIS-indicators except “Agitation” are content valid. Revision and adaption of items are needed by the developer. There were significant correlations established, but weak. Therefore, they do not seem clinically relevant. RECOMMENDATIONS After revision and/or adaption, nurses in current daily practice can use the DENWIS to give words to their worry, added to the (M)EWS, and therefore early recognize and treat the clinically deteriorating patient.