Table 2.
Comparison of nurses’ and physicians’ responses
| Cohen’s Kappaa coefficient (IC95%) | Agreement rate % | p value for balance of discordant responsesb | Detailed discrepancy | |
|---|---|---|---|---|
| Is nutrition support considered a priority? | 0.29 [− 0.06; 0.64] | 80.6 | 0.53 | |
| Is there a nutrition support team in the unit? | 0.47 [0.18; 0.76]* | 75,0 | 0.32 | |
| Is a dietician involved in nutrition care? | 0.28 [− 0.03; 0.60] | 66.7 | 0.25 | |
| Are there written local nutrition guidelines? | 0.26 [− 0.04; 0.57] | 63.9 | 0.17 | |
| How often are children weighed? | 0.12 [− 0.20; 0.44] | 77.4 | 0.03 | Nurses answer “all the time” more frequently |
| How often is length/height measured? | 0.38 [0.13; 0.64]* | 65.7 | 0.20 | |
| How is nutritional status assessed? | 0.30 [0.05; 0.55]* | 64.5 | 0.09 | |
| Are nutritional indices (such as BMI) calculated? | 0.17 [− 0.05; 0.39] | 55.6 | 0.05 | Physicians answer « no » more often |
| How are nutritional goals set? | 0.03 [− 0.04; 0.10] | 25.7 | < 0.01 | Nurses answer “I don’t know” more often Physicians answer “recommended dietary allowance” more often |
| Knowledge about enteral solutions | 0.06 [− 0.17; 0.30] | 45.7 | 0.07 | Nursing teams consider their knowledge insufficient more often |
| Use of fibers in enteral nutrition | 0.22 [− 0.04; 0.48] | 60.0 | 0.34 | |
| Delay to start enteral nutrition | 0.06 [− 0.13; 0.25] | 40.0 | 0.39 | |
| Route and modalities of enteral nutrition | 0.36 [0.10; 0.61]* | 57.1 | 0.33 | |
| Patients’ positioning while on enteral nutrition | 0.14 [− 0.13; 0.41] | 54.3 | 0.01 | Nurses answer “all the time” more often |
| Gastric residual volume measurements | 0.54 [0.31; 0.77]* | 66.7 | 0.37 | |
| Post-pyloric feeding | 0.49 [0.20; 0.78]* | 74.3 | 0.74 | |
| Enteral nutrition withholding prior to extubation | 0.00 [− 0.0004; 0.0004] | 97.2 | 0.32 | |
| Duration of enteral nutrition withholding prior to extubation | 0.66 [0.39; 0.93]* | 85.7 | 0.65 | |
| Enteral nutrition withholding prior to transport | − 0.01 [− 0.31; 0.29] | 55.6 | 0.13 | |
| Enteral nutrition withholding while neuro-blocking agent use | 0.38 [0.11; 0.65]* | 65.7 | 0.04 | Nurses answer « yes » more often |
| Enteral nutrition withholding while prone positioning | 0.34 [0.03; 0.65]* | 79.4 | 0.28 | |
| Enteral nutrition withholding while hemodynamic instability | 0.26 [0.05; 0.46]* | 51.4 | 0.04 | Physicians answer “withholding if hemodynamic instability” more often |
| Use of industrial 3-chamber parenteral nutrition bags | 0.12 [− 0.26; 0.50] | 79.4 | 0.26 | |
| Use of standardized parenteral nutrition bags | 0.60 [0.33; 0.87]* | 83.3 | 0.01 | Nurses answer « yes » more often |
| Use of Y-infusion of different parenteral nutrient solutions | 0.48 [0.22; 0.75]* | 73.5 | 0.02 | Nurses answer « yes » more often |
| Micronutrient supplementation | 0.35 [− 0.05; 0.75] | 68.7 | 0.81 | |
| Use of individualized compounded parenteral nutrition bags | 0.12 [− 0.10; 0.34] | 50.0 | 0.03 | Nurses answer « yes » more often |
| Pre-op fasting practices | − 0.08 [− 0.33; 0.18] | 36.1 | 0.19 | |
| Post-op fasting practices | 0.19 [− 0.12; 0.50] | 58.8 | 0.11 |
Agreement is poor (< 0.0), slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80) or almost perfect (0.80–1.00)
Landis and Koch [11]
Data in italics correspond to discordant responses between physicians and nurses (p < 0.05)
*Cohen’s kappa is significantly different from 0 when the confidence interval (IC95%) do not contain 0. Agreement between raters is significantly greater than chance agreement
aCohen’s kappa measures the agreement between two raters beyond chance agreement
bp value for MacNemar test < 0.05: discordant answers between nurses and physicians are not balanced