急性期病院における認知症高齢者への看護に対する困難感尺度の開発

Development of a Measurement Scale to Assess the Feeling of Difficulty in Nursing Care for Older Patients with Dementia in Acute-care Hospitals

抄録

　目的：急性期病院における認知症高齢者への看護に対する困難感の因子構造を明らかにし，困難感を測定する尺度の作成および尺度の信頼性と妥当性を検証する．

　方法：文献検討に基づく質問項目32項目を自己作成し，急性期病院の看護師1,731人を対象に質問紙調査を行い，尺度の項目の選定と信頼性および妥当性の検証を行った．

　結果：回収した質問紙のうち620部（有効回答率35.8％）を分析対象に，項目分析と探索的因子分析を行った結果，7因子22項目が採用された．次いで，確証的因子分析を行った結果，GFI＝0.904，AGFI＝0.880，CFI＝0.900，RMSEA＝0.061であり，観測変数へのパス係数はいずれも統計学的に有意であることが示された（P＜0.01）．また，各因子のCronbach's α係数は0.642〜0.834，全体0.864であった．

　結論：本尺度は，急性期病院の特性を反映した7因子からなる困難感の構造であり，急性期病院における認知症高齢者への看護に対する困難感を測定する一定の信頼性と妥当性が確認された．

　Objectives: The study aimed to develop a measurement scale to assess the feeling of difficulty in nursing care for older patients with dementia in acute-care hospitals and to examine its reliability and validity by clarifying the factor structure of the feeling of difficulty.

　Methods: We administered a questionnaire survey to 1,731 nurses of acute-care hospitals, using 32 original questions, based on literature available, to select scale items and evaluate the reliability and validity of the scale.

　Results: Among the questionnaires collected, 620 (response rate: 35.8%) were analyzed. Based on the results of item analysis and exploratory factor analysis, 7 factors and 22 items were selected. A confirmatory factor analysis subsequently showed GFI=0.904, AGFI=0.880, CFI=0.900 and RMSEA=0.061, suggesting that any path coefficient for the observed variable was statistically significant (P<0.01). In addition, Cronbach's alpha of the individual factors was 0.642 - 0.834, and the overall value was 0.864.

　Conclusion: The scale has the structure to assess the feeling of difficulty composed of 7 factors that demonstrate the characteristics of acute-care hospitals. A certain level of reliability and validity of the scale for measurements of the feeling of difficulty in nursing care for older patients with dementia in acute-care hospitals was confirmed.