以人為中心的氣候量表中文版信效度之初探

A Preliminary Reliability and Validity of the Chinese Version of the Person-centered Climate Questionnaire-Patient (PCQ-P) for Long-term Care Residents

宋炫瑛(HSUAN-YING SUNG)

指導教授 ： 何清治

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2017年)

摘要

背景：傳統上，長照機構的組織、設計和經營比較像是一家醫院，而不像住民的家(Pot, 2013)。時至今日，長照機構對住民的照護品質觀念已從著重工作、規章、流程轉變到符合住民需要及偏好。在台灣長期照護機構評鑑已行之有年，頗有成效，其中與病房氣候有關評鑑基準包括專業服務與生活照顧、環境設施與安全維護、權益保障三大方面及對於機構在照顧住民的軟硬體上有基本照護品質要求，在制定機構相關法規及設置標準等規範，朝向以人為本的指標設計，但甚少研究是有系統地從住民的觀點來探討以人為中心照護病房氣候所期待的情形。
目的：編訂以人為中心照護氣候(Patient-Centred Care Climate Questionnaire - Patient, PCQ-P)中文版量表，並檢測其信效度。
方法：本研究採用橫斷面問卷調查設計，選定台灣中部10所長期照護機構、250位住民為研究對象。本研究採Bergland等人(2014)、Yoon等人(2015)及Edvardsson等人(2008a, 2009a)所編製PCQ-P英文版、生活滿意度(Satisfaction With Life Scale, SWLS)和日常生活功能評估(activity of Daily Life, ADL)量表。為了克服跨文化差異並保持原有的有效性，採用反覆性翻譯。本研究採用SPSS 18.0分析描述性統計、探索性及驗證性因素分析、同時效度、內部一致性。
結論：本研究顯示以人為中心照護氣候(PCQ-P)中文版量表分別與SWLS、ADL呈顯著中度正相關(r = 0.54)、低度正相關(r = 0.14)，具有顯著的收斂效度。內容效度指數(Content Validity Indictor, CVI)、極端群體比較、項目分析、探索性及驗證性因素分析的結果證明了PCQ-P中文版量表構建效度是令人滿意的。PCQ-P中文版量表的17個題項Cronbach’s α 為0.96，顯示出高信度，兩個子量表分別為安全0.95，友善0.92，均具有可靠之內部一致性。
結論：PCQ-P中文版量表是一個信效度良好的工具，且是一份簡單又直接的項目，可以用來衡量在台灣長照機構住民的認知。PCQ-P中文版量表提供了比較研究的重要基礎及深入探索以人為本照護的範本。

關鍵字

以人中心照護氣候中文版量表-病人版 ； 長期照護機構 ； 量表 ； 信效度 ； 病房氣候

並列摘要

Background: Traditionally, the organization, device and operation of long-term care institutions is more like a hospital, not a home to residents. To date, the concept of caring quality for residents from long-term care institutions is changing. Institutions focus on residents’ need and preference, rather than on work, regulation, and procedure. In Taiwan, accreditation of long-term care institutions has been implementing for many years, and results are becoming well. Of all, ward climate related with accreditation indicator including three dimensions: professional services and life care, environmental facilities and safety maintenance, and right protection to care for residents has basic requirement of quality care. Also, accreditation standards and rules are person-oriented. However, there is little literature that explore person-centered care ward climate.
Aim: The aim of this study is to formulate a preliminary reliability and validity of the Chinese version of the Patient-centered Care Climate Questionnaire-Patient (PCQ-P) for long-term care residents.
Methods: This study utilizes cross-sectional and survey design and there are a total of 250 samples selected from 10 long-term care institutions in Central Taiwan. This study adapts the English version of the Person-centred Climate Questionnaire-Patient version (PCQ-P) of Bergland et al. (2014), Yoon et al. (2015) and Edvardsson et al. (2008a, 2009a), Satisfaction with Life Scale (SWLS), and Activity of Daily Life (ADL). For overcoming cross-culture difference and maintain validity of inventory, this study uses repetitious translation. This study applies SPSS 18.0 to analyze descriptive statistics, exploratory factor and confirmatory factor analysis to analyze construct validity, concurrent validity, and internal consistency.
Results: This study demonstrated a substantial convergent validity of the PCQ-P in Chinese as higher scores correlated significantly with higher resident life satisfaction (r = 0.54), and with lower ADL functions (r = 0.14). The satisfactory construct validity as evidenced by a significantly higher mean PCQ-P score from residents in higher quality long-term care institutions. Factor analysis demonstrated that the PCQ-P had two factors (safety and hospitality) in Taiwanese long-term care institutions’ residents. Construct validity was estimated as satisfactory by Content Validity Index (CVI), comparisons of extreme groups, item analysis, exploratory factor analysis, and confirmatory factory analysis.
The 17-item questionnaire showed high reliability as Cronbach’s alpha was satisfactory for the total scale (0.96), and for the two subscales: safety 0.95, hospitality 0.92.
Conclusions: The Chinese version of the PCQ-P is a valid and reliable tool to directly measure the perceptions of the person-centered climate in the Taiwan nursing homes. The simple and straightforward PCQ-P items are easy to administer to long-term care institution’s residents. The Chinese version of the PCQ-P provides important fundaments for comparative studies and explore person-centeredness care further.

並列關鍵字

Patient-centered Care Climate Questionnaire – Patient (PCQ-P) ； Ward Climate ； Long-term Care Institution ； Inventory ； Reliability and Validity

參考文獻

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