Investigating Nurses' Level of Self-Confidence when Using the Glasgow Coma Scale to Assess Level of Consciousness and the Inter-rater Reliability of the Test

Mohannad Eid AbuRuz


Background: Since its development more than 40 years ago, the Glasgow Coma Scale is the most
commonly used instrument for assessing level of consciousness. However, this instrument has
limitations, one being its potentially suboptimal inter-rater reliability among nurses.
Aims: The purpose of this study was to assess critical care nurses' self-confidence and the inter-rater
reliability when performing the Glasgow Coma Scale for patients with altered levels of consciousness.
Materials and Methods: A non-experimental, prospective, observational design was used in the
intensive care units, telemetry units, and emergency rooms of three hospitals (one governmental, one
teaching, and one private) in Amman, Jordan. The sample of critical care nurses (N = 270) provided
self-reported answers to a self-confidence questionnaire, and 135 pairs were formed to assess inter-rater
reliability of the Glasgow Coma Scale.
Results: Overall, self-confidence was high (mean ± SD, 20.29±2.90). However, inter-rater reliability
was intermediate (Kappa statistics (κ) =0.53, p<0.001). Nurses working in intensive care units had the
highest level of agreement and self-confidence, followed by those in telemetry, then by those in the
emergency room. Longer years of experience resulted in increased self-confidence (r=0.38, p<0.05) and
improved agreement levels.
Conclusion: Health care providers should not rely on a single score to make clinical decisions regarding
patient health.


Inter-rater Reliability, Self-confidence, Glasgow Coma Scale, Critical Care, Nurses, and Jordan.

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