介護老人福祉施設における認知症ケア評価指標の作成と信頼性・妥当性の検討

Development and Validation of an Assessment Index for Dementia Care in Nursing Homes for the Elderly

抄録

　本研究は，介護老人福祉施設の看護職・介護職者が実践する認知症ケアを具体的に評価するための評価指標を作成し，評価指標の信頼性・妥当性を検討することを目的とする．評価指標項目の原案は，文献検討とインタビューから55項目を作成し，介護老人福祉施設の看護・介護職者817人を対象に質問紙調査を行った．回収された653部を分析対象とし，項目分析，探索的因子分析を行った結果，5因子33項目が採用された．次いで確認的因子分析を行い，適合度指標GFI＝0.844，AGFI＝0.819，CFI＝0.910，RMSEA＝0.065であった．既知グループ法では，研修会参加あり者（p＝0.003），他者とのケア振り返り実施者（p＜0.001）は，認知症ケア評価指標の合計得点が有意に高かった．内的整合性を示すCronbach’s α係数は0.849〜0.933であり，全項目で0.961であった．適合度指標が一部推奨値より低いものの許容範囲と解釈した．以上より，5因子33項目の認知症ケア評価指標は一定の信頼性と妥当性が確認できたと考える．

　The study aimed to create an evaluation index for dementia care practiced by nurses and long-term care workers in nursing homes for the elderly, and to examine its reliability and validity. The original evaluation index consisted of 55 items that were created from a literature review and interviews. A questionnaire survey was conducted for 817 nurses and care workers at nursing homes for the elderly. Among the questionnaires collected, 653 response forms were analyzed. Based on the results of item analysis and exploratory factor analysis, 5 factors and 33 items were selected. A confirmation factor analysis was subsequently conducted with the following findings: GFI=0.844, AGFI=0.819, CFI=0.910, and RMSEA = 0.065. The total score of the dementia care evaluation index was significantly higher for those who participated in the dementia workshop (p = 0.003) and for those who performed care reflection with others (p ＜0.001). Cronbach’s alpha for the coefficient factors was 0.849-0.933 and was 0.961 overall. Although the goodness-of-fit index did not meet the recommended values for some items, it was interpreted as an acceptable range. The index that included 5 factors and 33 items was confirmed to have significant reliability and validity.