急性期病院の認知障害高齢者に対するパーソン・センタード・ケアをめざした看護実践自己評価尺度の開発

Development of the Self-assessment Scale of Nursing Practice for Elderly Patients with Cognitive Impairment with the Aim of Person-centred Care in Acute Hospitals

抄録

　本研究の目的は，急性期病院における認知障害高齢者に対するパーソン・センタード・ケアを目指した看護実践の内容を明らかにし，看護師による自己評価尺度を開発することである．2014年9月に2か所の急性期病院の病棟に勤務の看護師を対象とした．看護師には自記式調査票を配布し，記入を依頼した．283人を対象に探索的因子分析を用いた結果，因子負荷量の低い項目を削除し，19項目4因子から構成されていたことが明らかになった．Cronbachのα係数は4因子とも0.797以上，再テスト法で相関係数が0.7以上であった．構成概念妥当性として共分散構造解析の結果，適合度指数はGFI＝0.912，AGFI＝0.863，RMSEA＝0.721であった．潜在変数と観測変数間のパス係数は0.53〜0.87と有意に高かった．併存妥当性は認知症の人に対する態度尺度の合計得点との相関係数を算出したが，本尺度との有意な相関関係がみられた．以上の結果から，本尺度は尺度として信頼性・妥当性が高いことが明らかになった．

　This study clarified the nursing practice of person-centred care for elderly patients with cognitive impairment and developed a nursing practice self-assessment scale at acute care hospitals. The participants were 283 nurses working on wards in two acute care hospitals in September 2014. Their responses were used for the exploratory factor analysis. Items with low factor loading were deleted. This scale comprised 19 items and four factors. Cronbach's α was more than 0.797 for all four factors and the total items. In test-retest analysis, the correlation coefficients were ≥0.7. Reviewing the covariance structure analysis for construct validity, the best fit indices were GFI = 0.912, AGFI = 0.863, and RMSEA = 0.721. The pass coefficients between potential and observational variables were significantly high from 0.53 to 0.87. The concurrent validity calculated the relationship between the total score of an attitude scale for persons with dementia and this scale; it was significantly correlated to three factors of this scale and the total score. Reliability and validity of this scale were therefore demonstrated.