訪問看護師のがん患者ターミナル看護支援尺度の開発と信頼性・妥当性の検討

Development of a Scale to Assess End-of-life Nursing Care Provided by Home-visit Nurses for Cancer Patients and Its Reliability/Validity

要旨

　目的：訪問看護師のがん患者ターミナル看護支援尺度の開発と，信頼性と妥当性の検証を目的とする．

　方法：フィールド調査により質的帰納的に抽出したデータと文献検討を基に，訪問看護師のがん患者ターミナル看護支援尺度原案を作成した．全国の訪問看護師に23項目5段階のリカート法にて自記式質問紙調査を行い，669名を解析対象とした．

　結果：最尤法プロマックス回転による因子分析の結果，2因子15項目が採択され，【がん患者および家族の安心・安寧の日常生活支援】【在宅療養の安定と急変対応に向けたチーム連携による支援】と命名された．また，信頼性，妥当性を確認した結果，尺度全体のCronbach's α係数 .948，基準関連妥当性 .745，モデルの適合度は，GFI = .882，AGFI = .841，CFI = .925，RMSEA = .097であった．

　結論：本尺度の信頼性，妥当性は，統計量的に許容範囲であることが確認され，在宅療養がん患者，家族を支援する訪問看護師や訪問看護ステーション管理者が支援内容の性質や程度を知る指標として活用できる．

　Objective: The present study aimed to develop a scale to assess end-of-life nursing care provided by home-visit nurses for cancer patients and examine its reliability and validity.

　Methods: A draft of the Scale to Assess End-of-life Nursing Care Provided by Home-visit Nurses for Cancer Patients was created based on data extracted qualitatively and inductively from the results of a field survey and literature review. A self-completed questionnaire survey involving home-visit nurses across Japan was conducted, using a 5-grade Likert method with 23 items, and 669 nurses were selected as analysis subjects.

　Results: A factor analysis based on the maximum likelihood promax rotation was conducted. Two factors (15 items) were extracted: [Support provided for cancer patients and their families to live a secure and peaceful life] and [Support provided through interprofessional collaboration to provide reliable home care and respond to sudden changes in conditions]. The reliability and validity of the scale were examined, Cronbach's alpha coefficient of the entire scale was .948, and the criterion-related validity was .745. The goodness of fit of the model was as follows: GFI = .882, AGFI = .841, CFI = .925, and RMSEA = .097.

　Conclusion: The results of the study suggest that the reliability and validity of the scale were within the permissible ranges, and that it can be used by home-visit nurses and managers of homevisit nursing stations who support cancer patients living at home and their families, as indices of the characteristics and levels of their nursing care support.