成人期の術前患者の認知的評価における尺度開発への試み

Try to Development of an Instrument to Measure the Cognitive Appraisal for Preoperative Surgical Patient in the Adulthood

要旨

　本研究は成人期の術前患者の認知的評価尺度開発への試みとして初期段階での尺度の信頼性と妥当性を検討することを目的とした．

　はじめに，尺度原案はLazarusら（1984/1991）の理論を概念枠組みとし，また面接を通じて得たデータを基に3下位尺度70項目で構成された．

　次に尺度の信頼性と妥当性を内容妥当性，表面妥当性，構成概念妥当性，内的整合性の視点から検討した．内容妥当性は外科系実践看護婦6名と成人看護学領域の研究者21名の計27名を被検者に，表面妥当性はがん疾患で術前1週間以内の患者17名を被検者に検討した．この時点で4下位尺度55項目となった．構成概念妥当性と内的整合性（信頼性）は同条件の患者70名を被検者に検討した．因子分析（主因子法・バリマックス回転）の結果7因子を抽出し，最終的には手術との出会いにおける①抑うつ的見積もり，②消極的対処選択への見積もり，③好機的見積もり，④防衛的見積もり，⑤挑戦的見積もり，⑥回避的見積もり，⑦楽観的対処選択への見積もり，の7下位尺度47項目で構成された．また内的整合性は全体でCronbach'sα係数0.83，下位尺度ごとでCronbach'sα係数0.62～0.86の値を示し，尺度開発への試みの段階としてはある程度の信頼性と妥当性を得ることができた．

Abstract

　The purpose of this study was try for develop the instrument that measures cognitive appraisal for the preoperative Surgical patients in the adulthood.

　First, a draft of the cognitive appraisal scale was used of a conceptual framework of the Stress, Appraisal, and Coping theory by Lazarus and Folkman (1984/1991) and was based on the qualitative data of preoperative patients in adulthood by interview. The draft of the scale was composed of 70 items classified 3 subscales.

　Second, this draft of the scale was examined about content validity, face validity, construct validity, and reliability. Content validity was examined by 6 surgical expert nurses and 21 nursing researchers who are adult health care nursing. Face validity was examined by 17 preoperative cancer patient. As a result, this scale was consisted of 55 items classified 4 subscales. Construct validity and reliability were examined by 70 cancer patients who are taking operation within 1 week. Seven factors were extracted from the factor analysis.

　Finally, the scale was composed of 47 items classified 7 subscales: depression appraisal, the appraisal of choosing negative coping, good chance appraisal, defense appraisal, challenge appraisal, avoidance appraisal, and the appraisal of choosing optimistic coping in the encounter with the operation. And, the Cronbach's α coefficient showed 0.83 in the whole reliability of the scale. The α coefficient showed 0.86 from 0.62 in every subscale. Therefore, the construct validity and reliability of the scale was established in some degree.