Reliability and criterion-related validity testing (construct) of the Endotracheal Suction Assessment Tool (ESAT©)

Document Type

Journal Article

Publication Title

Journal of Clinical Nursing


Blackwell Publishing Ltd


School of Nursing and Midwifery




Davies, K., Bulsara, M., Ramelet, A. S., & Monteroso, L. (2018). Reliability and criterion‐related validity testing (construct) of the Endotracheal Suction Assessment Tool (esat©). Journal of Clinical Nursing, 27(9-10). 1891-1900. doi:10.1111/jocn.14269

Available here.


Aims and objectives

To establish criterion‐related construct validity and test–retest reliability for the Endotracheal Suction Assessment Tool© (ESAT©).


Endotracheal tube suction performed in children can significantly affect clinical stability. Previously identified clinical indicators for endotracheal tube suction were used as criteria when designing the ESAT©. Content validity was reported previously. The final stages of psychometric testing are presented.


Observational testing was used to measure construct validity and determine whether the ESAT© could guide “inexperienced” paediatric intensive care nurses’ decision‐making regarding endotracheal tube suction. Test–retest reliability of the ESAT© was performed at two time points.


The researchers and paediatric intensive care nurse “experts” developed 10 hypothetical clinical scenarios with predetermined endotracheal tube suction outcomes. “Experienced” (n = 12) and “inexperienced” (n = 14) paediatric intensive care nurses were presented with the scenarios and the ESAT© guiding decision‐making about whether to perform endotracheal tube suction for each scenario. Outcomes were compared with those predetermined by the “experts” (n = 9). Test–retest reliability of the ESAT© was measured at two consecutive time points (4 weeks apart) with “experienced” and “inexperienced” paediatric intensive care nurses using the same scenarios and tool to guide decision‐making.


No differences were observed between endotracheal tube suction decisions made by “experts” (n = 9), “inexperienced” (n = 14) and “experienced” (n = 12) nurses confirming the tool's construct validity. No differences were observed between groups for endotracheal tube suction decisions at T1 and T2.


Criterion‐related construct validity and test–retest reliability of the ESAT© were demonstrated. Further testing is recommended to confirm reliability in the clinical setting with the “inexperienced” nurse to guide decision‐making related to endotracheal tube suction.

Relevance to clinical practice

The ESAT© is the first validated tool to systematically guide endotracheal nursing practice for the “inexperienced” nurse.



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