認知症高齢がん患者の疼痛マネジメントにおける看護実践自己評価尺度の開発

Development of a Self-Report Scale of Nursing Practice in Pain Management for Older Patients with Cancer and Dementia

要旨

　目的：認知症高齢がん患者の疼痛マネジメントにおける看護実践自己評価尺度を作成し，信頼性と妥当性を検討した．

　方法：質的研究と文献検討，エキスパートパネルを基に，中等度から重度の認知症がある高齢がん患者の疼痛マネジメントにおける看護実践を測定するための尺度原案を作成した．認知症高齢がん患者へのケア経験がある臨床看護経験3年以上の病棟看護師889人を対象にした質問紙調査を行った．

　結果：項目分析から，32項目の尺度とした．探索的因子分析により「認知症高齢者に関心を寄せ，本人の持つ力やペースを尊重し安楽を目指す」「痛みの可能性を踏まえ，認知症高齢者が示す複数のサインを照合し，推論しながら観察を続ける」などの6因子が抽出された．尺度全体のCronbach's α信頼性係数は .95，再テストの級内相関係数は .58，併存妥当性を示す相関係数は .64であった．

　結論：認知症高齢がん患者の疼痛マネジメントにおける看護実践自己評価尺度は，信頼性と妥当性を概ね確保していることを確認した．

　Aim: The aim of this study was to develop the Pain Management Scale for Older Patients with Cancer and Dementia (PMSOP-CAD), and to examine its reliability and validity.

　Methods: We drafted a scale for elderly cancer patients with moderate to severe dementia, based on concepts derived from our past qualitative research, a literature review, and an expert panel. The questionnaires were distributed to 889 ward nurses who had at least three years of experience in clinical nursing care for older patients with cancer and dementia.

　Results: The PMSOP-CAD consisted of 32 items. We conducted exploratory factor analysis and extracted 6 factors including, for example, “further understanding older patients with dementia, respecting their physical and emotionally expressive ability and their own pace to seek their comfort” and “inferring where the pain comes from while continuing to observe and collate signs and symptoms.” The Cronbach's α for the entire scale was .95, the intraclass correlation coefficient by retests was .58, the correlation coefficient indicating concurrent validity was .64.

　Conclusion: The results of this study suggest that the validity and reliability of PMSOP-CAD was confirmed to be within a statistically acceptable.