介護保険施設で働く看護職の道徳的感受性尺度の開発

Development of a moral sensitivity scale for nurses who work at nursing homes

　本研究は、介護保険施設で働く看護職の道徳的感受性尺度（MSS-NH）を作成し、その信頼性・妥当性を検討した。まず介護保険施設の看護職20名に対するインタビューよりMSS-NHの原案48項目を作成した。次に介護保険施設の看護職861名のデータを基に探索的因子分析を行い、17項目4因子構造【高齢者の尊厳を守る体制づくり】、【その人らしい生活を支える】、【高齢者の能力を活かす】、【栄養摂取法の意思決定】を採択した。信頼性は、Cronbachのα係数がMSS-NH全項目で0.85、下位尺度で0.72～0.83と一定の内的一貫性が確認された。妥当性は、確認的因子分析により上記の4因子を潜在変数とした仮説モデルがGFI、AGFI、CFIのいずれも0.9以上でかつRMSEAが0.05以下と容認できるモデル適合度であり、尺度の信頼性・妥当性が確認された。

　The purposes of this study were to develop a scale （MSS-NH） on moral sensitivity for nurses who work at nursing homes and to confirm its validity and reliability. First, we developed a draft of the MSS-NH. This version consisted of 48 items selected from data generated by interviewing 20 nurses who were working at nursing homes. Next, we tested the scale's validity and reliability. Data were obtained from 861 nurses who were working at nursing homes. Construct validity was tested with exploratory factor analysis, which resulted in a 4-factor solution with 17 items. The 4 factors were: organizing teams to protect elderly people's dignity; supporting the life that is unique to each person; practical use of elderly people's capabilities; and making decisions about artificial hydration and nutrition. Cronbach's alpha coefficient for all 17 items was 0.85; for the 4-factor groups, it varied between 0.72 and 0.83. Confirmatory factor analysis indicated that a 4-factor model was valid and that this model provided the best fit for the sample （GFI＝0.95, AGFI＝0.94, CFI＝0.95, RMSEA＝0.05）. These results verify that the MSS-NH is internally consistent and has construct validity.