ACCURACY OR BIAS IN NURSES RATINGS OF PATIENT COMPLIANCE - A COMPARISON OF TREATMENT MODALITY

Objective: The study examined the accuracy of nurses' assessments of p atient compliance and identified factors influencing these assessments , including possible biases. Design: Nurses' assessments of compliance , lab serum levels of dietary compliance, and interdialytic weight gai n (IWG) were collected and compared to each other. End-stage renal dis ease (ESRD) patients on peritoneal dialysis (PD) and hemodialysis (HD) were compared on these measures and their compliance. Setting: The st udy was conducted at the tertiary care university hospital at Stony Br ook. Patients: Data were collected for 62 ESRD patients (38 male, 24 f emale; mean age 54 years). The sample consisted of 26 HD and 36 PD pat ients. Interventions: Nurses rated patients' compliance with fluid res trictions (HD patients only) and overall dietary compliance, as well a s individual indicators of compliance including protein, potassium, an d phosphorus compliance on a 7-point rating scale. Interdialytic weigh t gain, dietary (serum BUN and K levels), and medication compliance we re recorded from charts for a 3-month period for each patient. Main Ou tcome Measures: The main outcome measures were the correlations betwee n nurses' ratings of compliance and medical compliance data and the re gression coefficients, which indicate the relative importance of each of the factors that nurses use to make their compliance ratings. Resul ts: Nurses' ratings for patients in both treatment modalities were hig h ly correlated with the medical data for measures of fluid (r = 0.66, p < 0.001), potassium (r = 0.36, p < 0.01), and phosphorus (r = 0.36 p < 0.01). A regression analysis indicates that potassium (B = 0.48, p < 0.001), phosphorus (B = 0.19, p < 0.05), and protein (B = 0.31, p < 0.01) all significantly contributed to nurses' assessments of patient s' overall compliance. However, nurses' ratings of education levels fo r patients in both treatment modalities were not associated with phosp horus (r = 0.07, p < 0.61), protein (r = 0.18, p < 0.23), or potassium (r = 0.03, p < 0.85) measures. Finally, regressions revealed that nur ses used personal knowledge of the patients when rating noncompliant p atients (B = 0.49, p < 0.05) but not when rating compliant patients (B = 0.05, p < 0.75), Conclusions: Nurses rely heavily on medical record s to rate patients' compliance and to make accurate assessments, Nurse s also use several individual indicators (lab values and IWG) to rate overall dietary compliance, suggesting a thorough assessment. While as sessments are not biased by personal factors such as nurses' perceptio ns of patients' education levels, nurses do rely on personal knowledge when rating noncompliant patients.