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腦神經科常見護理診斷之效度建構

Validation of the High Frequency Nursing Diagnosis in Neurologic Wards

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摘要


本研究目的在測定腦神經科常見護理診斷之相關因素及定義性特徵的臨床效度。採探索性研究設計,經文獻查證後研擬「護理診斷相關因素及定義性特徵之臨床效度鑑定表」,以Fehring Model爲依規,針對北部某醫學中心腦神經科病房常見的「身體活動功能障礙」及「呼吸道清除功能失效」二個護理診斷,遴聘11位專家進行診斷內容效度(Diagnostic content validation, DCV)測試,以及2位臨床護理專家針對腦中風及頭部外傷病患共計40名,進行臨床診斷效度(Clinical diagnostic validity, CDV) 測試。研究資料以SPSS軟體建檔,採描述性分析,結果顯示(1)「身體活動功能障礙」護理診斷的主要相關因素爲:神經肌肉障礙及感覺或認知障礙2項,次要相關因素則爲疼痛和不舒服。(2)「身體活動功能障礙」護理診斷的主要定義性特徵爲:在物理環境中,沒有能力作有目的的移動、關節活動度受限制、肌肉協調能力障礙及肌肉的力量控制力減少等4項。(3)「呼吸道清除功能失效」護理診斷的主要相關因素爲:氣管內插管或氣管瘦管留置、固定不動、疾病、分泌物增加、軟弱無力/疲憊等5項,次要相關因素則爲呼吸道阻塞及咳嗽嘔吐反射能力減低等2項。(4)「呼吸道清除功能失效」護理診斷的主要定義性特徵爲:呼吸過速、呼吸困難、有痰咳不出、不正常呼吸音等4項,次要定義特徵爲發燒。本研究結果可供臨床護理人員正確迅速評估病患之依據。

並列摘要


The purposes of this study were to validate the related factors and defining characteristics of the two high frequency nursing diagnoses. An exploratory research design was used in this study. Diagnostic Content Validation (CCV) model and Clinical Diagnostic Validity (CDV) model proposed by Fehring (1986) were used to validate the nursing diagnoses of impaired physical mobility and ineffective airway clearance. Eleven experts validated the diagnoses according to Diagnostic Content Validation model. Two exports observed the forty patients with cerebral vessel accident or head injury in clinical setting to validate the diagnoses according to Clinical Diagnostic Validity model. In the Statistical Program for the Social Science Personal Computer (SPSS-PC), the descriptive analysis was used for data analysis. The results showed as followings: (1) The major related factors of impaired physical mobility were neuromuscular impairment, perceptual/cognitive impairment. (2) The major defining characteristics of impaired physical mobility were inability to purposefully move within the physical environment, limited range of motion, impaired coordination, and decreased muscle strength and control. (3) The major related factors of ineffective airway clearance were intubation, immobility, disease, increased sputum, and fatigue. (4) The major defining characteristics of ineffective airway clearance were tachypnea, dyspnea, exspresses difficulty with sputum, and abnormal breath sound. The result of this study provided us to improve the accuracy of nursing diagnosis.

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