Patient-nurse interrater reliability and agreement of the Richards-Campbell sleep questionnaire

Abstract

Background: The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple, validated survey instrument for measuring sleep quality in intensive care patients. Although both patients and nurses can complete the RCSQ, interrater reliability and agreement have not been fully evaluated.

Objectives: To evaluate patient-nurse interrater reliability and agreement of the RCSQ in a medical intensive care unit.

Methods: The instrument included 5 RCSQ items plus a rating of nighttime noise, each scored by using a 100-mm visual analogue scale. The mean of the 5 RCSQ items comprised a total score. For 24 days, the night-shift nurses in the medical intensive care unit completed the RCSQ regarding their patients' overnight sleep quality. Upon awakening, all conscious, nondelirious patients completed the RCSQ. Neither nurses nor patients knew the others' ratings. Patient-nurse agreement was evaluated by using mean differences and Bland-Altman plots. Reliability was evaluated by using intraclass correlation coefficients.

Results: Thirty-three patients had a total of 92 paired patient-nurse assessments. For all RCSQ items, nurses' scores were higher (indicating "better" sleep) than patients' scores, with significantly higher ratings for sleep depth (mean [SD], 67 [21] vs 48 [35], P = .001), awakenings (68 [21] vs 60 [33], P = .03), and total score (68 [19] vs 57 [28], P = .01). The Bland-Altman plots also showed that nurses' ratings were generally higher than patients' ratings. Intraclass correlation coefficients of patient-nurse pairs ranged from 0.13 to 0.49 across the survey questions.

Conclusions: Patient-nurse interrater reliability on the RCSQ was "slight" to "moderate," with nurses tending to overestimate patients' perceived sleep quality.

Figure

Bland-Altman plot of total scores of 92 Richards-Campbell Sleep Questionnaires shows the relationship between patient score (x axis) and the difference between the patient's score and the nurse's score (y axis). Each circle represents 1 patient-nurse paired questionnaire. The solid diagonal line is a fitted representation of the simple linear regression of patient-nurse score difference as a function of patients’ scores, with the gray shaded area representing the 95% confidence interval.