がん終末期看護に携わる看護師のやりがい感尺度の信頼性と妥当性の検討

Examination of Reliability and Validity of The Sense of Meaningful Experiences in End-of-Life Nursing for Cancer Patient Scale (SMEEN)

要旨

　目的：本研究の目的はがん終末期ケアに携わる看護師が経験するやりがい感の実態調査の過程で作成された尺度の信頼性と妥当性を検討することである．

　方法：先行研究および第1調査の実態調査データから5因子37項目の「がん終末期看護のやりがい感尺度（SMEEN）」を作成し，170施設のがん診療連携拠点病院の看護師1,304名の自記式質問紙調査のデータを用いて検討した．

　結果：因子分析により【ともに居るケアの意味と役割の実感】【さまざまな人生観に触れる学びと感動】【患者家族と医療チームの一体感】【苦痛軽減へ貢献した実感】【その人をより理解するケアの追求】の5因子構造が同定された．尺度全体のCronbach's αは0.95であり，各下位領域も0.80〜0.92と十分な内的一貫性が示された．Multitrait Scaling分析の結果，構成概念妥当性が認められ，また終末期看護に携わる看護師の満足度尺度およびPOMS短縮版の活気との正相関が認められた．さらに既知集団では，緩和ケア病棟経験者および緩和ケアチームの経験者の得点が有意に高かった．

　考察：SMEEN37項目版が十分な信頼性と妥当性を有することが確認された．本尺度の活用により，終末期看護経験における肯定的側面に着目した実態把握や教育支援の評価が可能と考えられた．

　Purpose: The purpose of this study is to examine the reliability and validity of a scale that was created in the process of studying the sense of meaningful experiences by nurses in end-of-life care for cancer patients.

　Methods: In the first study, the 37-item SMEEN, which had five factors, was developed based on a previous qualitative study. Then, in the second study, a self-administered questionnaire was sent to 1,304 nurses at 170 hospitals randomly selected from among the designated prefectural cancer treatment centers throughout Japan.

　Result: The factor analysis confirmed, as did the first study, the 5-factor structure: realization of the meaning and role of care focusing on being together; learning and impressions of knowing various views of life; feeling of cohesiveness between the patient's family and the medical team; realization that they contributed to reduce total pain; and pursuit of care that better understands the client. The overall Cronbach's α was 0.95, and each sub-scale was 0.80 to 0.92, showing sufficient internal consistency. As a result of multi-trait scaling analysis, the validity of the construct was confirmed. A positive correlation with the satisfaction scale of nurses involved in end-of-life care and vigor in terms of the shortened version of POMS were observed. In addition, as a known population validity, nurses with experience in palliative care units and on palliative care teams scored significantly higher than the inexperienced.

　Discussion: Adequate reliability and validity of the 37-item SMEEN was confirmed. By using this scale, it will be possible to grasp the actual situation and evaluate educational support that focuses on the positive aspects of the end-of-life nursing experience.