心不全患者のアドバンス・ケア・プランニングにおける看護師の取り組み測定尺度の開発と関連要因の検討

Development of a Scale of Nurses' Efforts in Advance Care Planning (ACP) for Patients with Heart Failure, and Factors Related to Nurses' ACP Efforts

要旨

　目的：心不全患者のアドバンス・ケア・プランニング（ACP）における看護師の取り組み測定尺度の開発とその関連要因を検討する．

　方法：循環器科勤務の看護師に質問紙調査を実施し，尺度の信頼性と妥当性を検討した．重回帰分析により関連要因を分析した．

　結果：572名を分析対象とした（有効回答率：29.9％）．因子分析の結果【対話を継続するための取り組み】【心不全と共に生きていくことを支える取り組み】【病の軌跡を共有する取り組み】【患者の意思をつむいでいく取り組み】【患者の価値を知ろうとする取り組み】の5因子が抽出された．確認的因子分析の結果，仮説モデルの適合度が確認された．信頼性はCronbach's α＝.77〜.90で，基準関連妥当性は看護師の自律性尺度との関連で確認された．重回帰分析の結果，認知能力，ACPに対する自信・知識，心不全の緩和ケアに関する知識が主な関連要因として示された．

　結論：本尺度の信頼性と妥当性が検証された．関連要因に基づく教育プログラムの開発が今後の課題である．

　Objective: To develop a scale of nurses' efforts in advance care planning (ACP) for heart failure patients and to examine the factors related to nurses' ACP efforts.

　Methods: A questionnaire survey was conducted with nurses working in cardiology wards, and the scale's reliability and validity were examined. Multiple regression analysis was performed to explore the factors associated with the nurses' ACP efforts for heart failure patients.

　Results: Data obtained from 572 participants were analyzed (valid response rate: 29.9%). Five factors and 32 items were extracted from an exploratory factor analysis. The five factors were “Efforts to continue dialogue,” “Efforts to support life with heart failure,” “Efforts to share the patient's illness trajectory,” “Efforts to share the patient's hopes,” and “Efforts to explore patient values.” A confirmatory factor analysis was conducted and the hypothesized statistical model was found to fit the actual data. Reliability was confirmed by Cronbach's alpha coefficient for the subscales; its value ranged from .77 to .90. Validity was confirmed by the correlation coefficient between the scale of nurses' ACP efforts and the scale for professional autonomy in nursing. Multiple regression analysis was performed with nurses' ACP efforts as the dependent variable. The main factors related to the nurses' ACP efforts were determined to be cognition (a subscale of the scale for professional autonomy in nursing), confidence in ACP, knowledge of ACP, and knowledge of palliative care of heart failure patients.

　Conclusion: The reliability and validity of this scale were verified. Future challenges include developing an educational program for nurses that is based on these results.