Evaluating Pressure Ulcer Risk With PURPOSE T in Acute Care-Inter-Rater Reliability Between Registered Nurses and Assistant Nurses.

This study evaluated the inter-rater reliability and usability of the Swedish version of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T) when used by both registered nurses and assistant nurses. Although previous validation studies involved only registered nurses, assistant nurses often perform these assessments in practice. The study was conducted in three acute care hospitals in Sweden between October 2022 and September 2023, involving 117 patients. In pairs, eight registered nurses and eight assistant nurses independently assessed patients using PURPOSE T in paper format. The percentage agreement between the registered nurses and assistant nurses was 86.6% (n = 97/112). The corresponding simple kappa statistic was 0.69 (95% CI 0.55-0.84); the PABAK kappa statistic was 0.73 (95% CI 0.61-0.86). Both registered nurses and assistant nurses found the tool generally easy to use, though some items in Step 2 were reported as challenging. While the study indicated good inter-rater reliability and PURPOSE T was perceived as user-friendly by both groups, education and training should be prioritised when implementing the instrument in routine care to optimise its use. A digital application may provide more effective facilitation and guidance during the assessment compared with a paper-based version.