一般病院におけるせん妄ケア評価指標の開発

Development of the Instrument to Evaluate Nursing Care for Patients at Risk of Delirium in General Hospitals

抄録

　本研究の目的は，せん妄リスクのある患者に対する看護ケアの評価指標案について，その信頼性と妥当性を評価することである．先行研究からせん妄リスクのある患者へ実践するケアの評価指標案を作成し，パイロットスタディを経て46項目に精選した．一般病棟においてせん妄患者への看護経験がある臨床経験1年以上の看護師を対象にWeb調査を実施した．項目分析，探索的因子分析の結果，「多職種連携」「苦痛・不快を取り除くケア」「生活パターンの維持と覚醒を促すケア」「体のリズムを整えるケア」「せん妄患者の言動に配慮した関わり」「せん妄リスクのアセスメント」「状況理解を促すコミュニケーション」「家族ケア」の8因子32項目が抽出された．指標全体のChronbach's α係数.94，再テストの級内相関係数.74，基準関連妥当性の相関係数.82であった．以上より，せん妄ケア評価指標の信頼性と妥当性が確保されていることが確認できた．

　The purpose of this study was to develop the instrument to evaluate nursing care for patients with the risk of delirium，and to examine its reliability and validity. Draft indicators were developed besed on the results of our ethnographic study of nursing care provided to patients at risk of delirium. Next，we conducted a pilot study and selected 46 items. A web-based questionnaire survey was conducted with nurses working in general wards with at least one year of nursing experience. Results of item analysis and exploratory factor analysis revealed 32 items and 8 factors including，“Interprofessional collaboration” “Care to relieve pain and discomfort” “Care to maintain daily routine and awaking” “Care to respect physical rhythms” “Interaction with patients with delirium by considering the meanings of their behaviors” “Assessment of delirium risks” “Communication to realize the situation” and “Family care”. The Cronbach's α coefficient for the entire items was .94，the intraclass correlation coefficient in test-retest was .74，the correlation coefficient indicating concurrent validity was .82. The findings of this survey showed that the instrument to evaluate nursing care developed here are adequately reliable and valid，and that the indicators are useful to evaluate the conditions of nursing care practices for patients at risk of delirium.