長期療養高齢者の苦痛を緩和する看護実践尺度の信頼性と妥当性の検討

Examining the Reliability and Validity of a Nursing Practice Scale for Relieving Discomfort in Older Adults Receiving Long-term Medical Care

抄録

　本研究の目的は，長期療養高齢者の苦痛を緩和する看護実践尺度の信頼性および妥当性を検討することである．文献より項目を作成し，内容的妥当性の検討を経た48項目の尺度原案について，医療療養病床に勤務する看護師を対象に調査を行い，信頼性と妥当性を検討した．探索的因子分析の結果，尺度は，【苦痛のサインをとらえる実践】【苦痛を特定する実践】【意向・ニーズをとらえる実践】【多職種連携により苦痛を予防または緩和する実践】【日常の関わりのなかでの高齢者の尊厳を守る実践】の5因子41項目の構成とした．Cronbachのα係数は，全体で0.948，各因子では，0.824〜0.902の範囲であり，内的一貫性を確保していることを確認した．また，外的基準との相関係数は0.706であり，併存的妥当性を確認した．さらに，長期療養高齢者の苦痛を緩和するケア実践を1次因子，抽出した5因子を2次因子としたモデルのデータへの適合度は，CFI＝0.919，RMSEA＝0.070であり，構成概念妥当性を確認した．本尺度は，看護師が高齢者の苦痛を緩和するための看護実践を振り返り，自身の看護実践を高めることに活用できる．これにより，高齢者の苦痛を予防・緩和し，高齢者に安寧をもたらすことに寄与することが期待できる．

　The purpose of this study is to examine the reliability and validity of a nursing practice scale for relieving discomfort in older adults receiving long-term medical care. We prepared items based on the literature, developed a draft scale with 48 items that were reviewed for content validity, and conducted a survey on nurses working in facilities with long-term care beds to examine the reliability and validity. As a result of exploratory factor analysis, the following five factors with 41 items were included in the scale: [Practices to capture signs of discomfort], [Practices to identify discomfort], [Practices to identify wishes and needs], [Practices to prevent or relieve discomfort through interprofessional collaboration], and [Practices to protect the dignity of the older adults in day-to-day involvement]. Cronbach's αcoefficients were 0.948 for all and between 0.824 and 0.902 for each factor, demonstrating internal consistency. The correlation coefficient with external criteria was 0.706, demonstrating concurrent validity. Furthermore, the goodness-of-fit to the model with the practice of care to relieve the discomfort of older adults receiving long-term medical care as the first-order factor and the extracted five factors as the second-order factor were CFI=0.919 and RMSEA=0.070, respectively, demonstrating construct validity. This scale can be used by nurses to reflect on their nursing practice to relieve discomfort in older adults and to improve their own nursing practice. It is expected that this will contribute to preventing and relieving discomfort and bringing comfort in older adults.