口腔癌術後病人口腔評估表之建立

Development of the Oral Assessment Scale for Patients with Oral Cancer After Surgery

李怡珍(Yi-Chen Lee)

指導教授 ： 許雅娟

長榮大學/健康科學學院/護理學系(所)/碩士(2014年)

https://doi.org/10.6833/CJCU.2014.00119

摘要

口腔健康促進是口腔癌病人手術後最主要的生理照護重點，一份可靠具有信效度、適切性的口腔評估工具，能指引護理人員正確發現口腔癌術後病人口腔狀況，並依評值結果制定個別化口腔照護措施。國內護理人員絕多數依臨床經驗進行口腔癌術後口腔評估，口腔評估工具的使用未普及，可能原因為目前的口腔評估表不全然適用於評估口腔癌術後口腔狀況，因此本研究目的旨在發展口腔癌術後病人口腔評估表及建構其信效度。
本研究透過五場專家諮詢會議討論、二次專家內容效度之檢定，編製完成「口腔癌術後病人口腔評估表」，此評估表共有十題項評估項目及相對應之1-3分評估內容指標，評估表總分介於10-30分，分數愈低，代表病人的口腔狀況愈佳；反之，則口腔狀況愈差。研究地點於南部某一醫學中心口腔顎面外科加護病房及普通病房，分別進行30位及100位預試及正式測試。收案條件包括(1)入院接受口腔惡性腫瘤切除；(2)手術前未接受過化學治療或放射線治療之口腔癌術後病人。研究者於術後第一天早上執行第一次口腔護理前，進行「口腔癌術後病人口腔評估表」測試，以檢定評估者間信度、內在一致性信度及效標關聯效度，以SPSS 19.0統計軟體進行資料統計與分析。
此「口腔癌術後病人口腔評估表」信效度建構結果呈現，專家效度指標値(CVI)為1.0。評估者間信度除第一題項「唇」及第二題項「舌」ICC值為0.97外，其餘八題項ICC值皆為1。正式測試整體Cronbach，s α係數為0.72。口腔狀況及口腔舒適程度呈顯著性負相關(r = -0.93，p＜0.001)，顯示此評估表具有良好之效標關聯效度。由此可見，「口腔癌術後病人口腔評估表」可視為具有非常良好信度、效度之評估表，可用以評估口腔癌術後病人口腔狀況之評估工具。

關鍵字

口腔癌術後 ； 口腔評估表之建立

並列摘要

Promoting oral health is a key point of physical care for postoperative patients of oral cancer. Therefore, using a credible and appropriate oral assessment scale can not only guide nursing staff discover the oral status of postoperative patients, but also take advantages of measuring outcomes to design individualized intervention related to oral care. In Taiwan, most nurses assess oral status after surgery based on personal clinical experiences. The usage of oral assessment scale in clinics is not common due to the incompletely developed current index. Thus the purpose of this study was to develop a useful, clinical-intense oral assessment scale and establish its psychometric properties.
The Oral Assessment Scale (OAS) was developed through five professional council meetings as well as two verifications of content validity by experts. The scale consists of 10 items and each has 1-3 score(s) evaluation. The possible score ranges from 10-30. The lower score indicates the better oral status.
Data were collected at Intensive Care Unit of Oral and Maxillofacial Surgery and general wards in a medical center of South Taiwan. Participants were oral cancer patients undergoing excision of oral tumor and had not been treated by chemotherapy or radiotherapy. The Oral Assessment Scale was administered in the first day morning after receiving surgery and before applying daily mouth care offered by nurses. SPSS 19.0 software package was used for assessing the inter-rater reliability by Intraclass Correlation Coefficient (ICC), internal consistency reliability by Cronbach’s α, and criterion-related validity by Pearson’s product-moment correlation coefficient.
Results showed that Content Validity Index of Oral Assessment Scale was 1.0. The ICCs of ten items was between 0.97 and 1. The level of Cronbach’s α was 0.72. There was a statistically significant negative relationship between oral status and the comfortable level of oral (r = -0.93, p < 0.001), which referred to well criterion-related validity. In conclusion, the Oral Assessment Scale is a valid and reliable assessment tool to assess the oral status for oral cancer patients after surgery.

並列關鍵字

Oral Cancer After Surgery ； Development of Oral Assessment Scale

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