Notice to CNE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: 1. Identify the advantages of the Richards-Campbell Sleep Questionnaire (RCSQ) compared with polysomnography. 2. Describe the 5 visual analogue scales comprising the RCSQ. 3. Discuss the patient-versus-nurse interrater reliability/agreement of perceived sleep quality rating in medical intensive care unit patients using the RCSQ. To read this article and take the CNE test online, visit www.ajcconline.org and click “CNE Articles in This Issue.” No CNE fee for AACN members. By Biren B. Kamdar, MD, MBA, MHS, Pooja A. Shah, Lauren M. King, RN, MSN, Michelle E. Kho, PhD, PT, Xiaowei Zhou, ScM, Elizabeth Colantuoni, PhD, Nancy A. Collop, MD, and Dale M. Needham, MD, PhD Backgroun d 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 agree- ment 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 ana- logue 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. (American Journal of Critical Care. 2012;21:261-269) PATIENT-NURSE INTERRATER RELIABILITY AND AGREEMENT OF THE RICHARDS-CAMPBELL SLEEP QUESTIONNAIRE www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, July 2012, Volume 21, No. 4 261 ©2012 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2012111 N C E 1.0 Hour Critical Care Evaluation