一般病棟の認知障害高齢者に対する入院時から身体拘束の回避・解除を念頭においた転倒予防ケア行動評価尺度の開発

Development of A Fall-prevention Care Behavior Evaluation Scale for Older Adults with Cognitive Impairment in A General Ward, with the Aim of Avoiding Physical Restraints during Hospitalization

要旨

　目的：一般病棟の認知障害高齢者に対する入院時から身体拘束の回避と解除を念頭においた転倒予防ケア行動評価尺度を開発し，妥当性と信頼性を検討した．

　方法：全国の一般病棟看護師1,128名を対象に，尺度原案54項目の質問紙調査を実施した．分析対象を303名とした．

　結果：探索的因子分析（主因子法，プロマックス回転）の結果，22項目5因子構造となり，【入院時から納得を目指す接近】【身体拘束を回避・解除する転倒予防連携】【その人らしさを尊重するケア者の態度】【拘束回避の転倒予防技術】【その人らしい活動支援】と命名した．モデル適合度はCFI = .949，RMSEA = .061，基準関連妥当性 .792，Cronbach α係数 .947，再テスト信頼性係数 .783であった．

　結論：本尺度は，妥当性・信頼性を確認され，看護師がチームで認知障害高齢者への身体拘束回避の転倒予防ケアを継続する上で活用可能と示唆された．

　Aim: The present study aimed to develop a fall-prevention care evaluation scale for older adults with cognitive impairment in a general ward from the time of admission to avoid physical restraint and to examine the scale's validity and reliability.

　Methods: We asked 1128 nurses in general wards across Japan to take a self-administered anonymous questionnaire survey comprising scale of the 54 items. We received 308 responses, a response rate of 27.3%. We analyzed 303 nurses.

　Results: Our exploratory factor analysis (principal factor method: promax rotation) revealed a structure comprised of 5 factors and 22 items; the former were defined as [an approach that aims to convince from the time of hospitalization], [collaborative fall prevention that avoids the use of physical restraint], [care attitude that respects that person], [fall prevention technology to avoid restraint], and [Supporting activities that respect that person]. Model goodness-of-fit indices were as follows: CFI = .949, RMSEA = .061, a criterion-related validity of .792, a Cronbach's alpha of .947, and a test-retest reliability coefficient of .783.

　Conclusions: The above results show the validity and reliability of this scale. It was suggested that this scale could be used by a team of nurses to conduct fall-prevention care for the older adults with cognitive impairment to avoid physical restraints.