Do Not Attempt Resuscitation の意思決定を行う家族に関わるICU看護師の困難感（IND-FDNAR）尺度の開発

The Development of A Scale to Assess “ICU Nurses' Difficulties toward Patient's Family Deciding on Do Not Attempt Resuscitation” (IND-FDNAR)

要旨

　目的：DNARの意思決定を行う家族に関わるICU看護師の困難感尺度を開発し，尺度の信頼性および妥当性を検証する．

　方法：DNARに関する文献検討や先行研究をもとに尺度原案を作成し，ICU看護師2,544人に質問紙調査を実施した．

　結果：768人（有効回答率30.1％）を分析対象とした．探索的因子分析の結果，【家族との関わりへの戸惑い】【看護師間の連携調整の難しさ】【グリーフケアの難しさ】【医師との連携調整の難しさ】【患者の状況判断の不確かさ】【決断過程の曖昧さ】の6因子34項目が抽出された．尺度全体のクロンバックαは .93で内的整合性が確認された．また確認的因子分析により構成概念妥当性を認め，ICU看護師の終末期ケア困難感尺度との相関により基準関連妥当性が確認された．

　結論：本尺度の信頼性および妥当性が確認された．

　Purpose: This study aimed to develop a scale to assess “ICU nurses' difficulties toward patient's family deciding on Do Not Attempt Resuscitation” (IND-FDNAR).

　Methods: A scale was created based on literature review and previous research on DNAR, and a questionnaire survey was conducted with 2,544 ICU nurses.

　Results: Seven hundred and sixty-eight responses (valid response rate: 30.1%) were analyzed. An exploratory factor analysis resulted in a 34 item list, and six factors were extracted: (1) Confusion dealing with families, (2) Difficulties coordinating among nurses, (3) Difficulties managing grief care, (4) Difficulties coordinating with physicians, (5) Uncertainty in determining the status of the patient, and (6) Ambiguity in the decision-making process. Cronbach's α internal consistency reliability coefficient was .93, indicating that the scale was reliable. Construct validity was assessed by confirmatory factor analysis. Criterion-related validity was confirmed by correlating the experimental scale with a scale for difficulties felt by ICU nurses providing end-of-life care.

　Conclusion: The results indicated that a valid and reliable scale was developed to assess critical care nurses' difficulties toward patient's family deciding on Do Not Attempt Resuscitation.