- 學位論文
護理之家督導考核量表信度效度測試/實證性研究
The Reliability and Validity of Nursing Home Accreditation Scale – An Empirical Study
摘要
人口快速老化導致長期照顧需求日與俱增，能肩荷照顧老人之責的家庭日漸減少，許多老人轉而尋求機構式的照顧。據統計，相關長期照顧機構之平均佔床率為七成以上。隸屬衛政體系的護理之家，衛生署採用督導考核及評鑑方式，以確保護理之家提供良好的專業服務。然而督導考核評分表尚未經實證資料測試，無法驗證其信度及效度。本研究採次級資料分析法，以接受2007年督導考核287所護理之家為研究對象，對「護理之家督導考核評分表」之行政管理、住民安全、服務內容及整體環境四個面向進行測試。信度以Cronbach''s α係數表示其內部一致性，效度則採驗證性因素分析，以作建構效度確認。結果顯示護理之家督導考核評分表的Cronbach''s α係數分別為.871；各面向Cronbach''s α係數為:行政管理.710、住民安全.705、服務內容.765、整體環境.557，顯示此量表同質性高，具有良好內在一致性。參考單題刪除後之Cronbach''s α值，刪題後Cronbach''s α值數值升高者分別為行政管理面向的題項5「照顧服務員需熟悉照顧之實務操作、題項10「明定住民入住契約」及題項11「依法配合資料通報」；住民安面向全中題項4「護理人員應接受急救訓練」；服務內容面向的題項16「提供住民隱私且具隔離空間」，顯示這些題項與量表一致性較低，可考慮將之刪除。效度採驗證性因素分析，以行政管理中的工作人員管理及住民權益、住民安全中的必備急救設備及感染控制、服務內容中的飲食照顧及照顧計畫六個次量表為測量模式，參考卡方值、自由度、RMSEA、GFI、AGFI與CFI指數，結果顯示模式適配度良好，六個一階因素分析與理論相符；接著進行的三個二階因素分析，亦證實護理之家督導考核評分表六個次量表及其相對應指標，可用來反應護理之家的品質檢測。本研究結果顯示護理之家督導考核評分表具有良好的信度及效度，測試結果可供政府單位及其他學者進行後續研究，以不斷提升護理之家照顧品質，及保障民眾的安全及權益。
並列摘要
Due to the rapid increase of the aging population and the decrease of care responsibility of the family, the demand for institutionalized care has seen rapidly grown. According to the statistics, the occupied led rate of institution was exceeding 70%. As for the Department of Health, nursing homes have to receive supervisory evaluations and accreditation to ascertain the quality of care. The tools of accreditations have not yet been evaluated with empirical data, it is unlikely to establish the reliability and validity of tool. This study has conducted secondary analysis from 287 nursing homes that received accreditation in 2007. There was four domains in the “Nursing Home Accreditation Scale”: administration management, resident’s safety, service content, and holistic environments. Cronbach''s α coefficient is used to reveal reliability and validity is seen in confirmatory factor analysis. The results showed that the Cronbach''s α coefficient for reliability of the Nursing Home Accreditation Scale is .871, and Cronbach''s α coefficient in administration management .710, resident’s safety .705, service content .765, and holistic environment .557 respectively. It meant that the scale is with a high homogeneity. Referencing the deletion of item to increase Cronbach''s α, there were domain of administration management item 5 ”nursing aides need to be familiarized with the clinical practice”, item 10 ” set contracts for residents”, and item 11” adhere to reporting system”. As for the domain of resident’s safety, item 4” nursing staff should receive emergency training”. In the domain of item 16” provide resident privacy and isolation space”. These items showed low consistency and can be deleted. Confirmatory factor analysis was used to test validity. There were six measurement models: management of working staff and resident rights of administration management, usage of necessary emergency equipment and infection control for resident’s safety, and diet care and care plan of service content. The indices of fitness were Chi-square value the degree of freedom, RMSEA, GFI, AGFI, and CFI. The results showed the Nursing Home Accreditation Scale is comprised of six first-order and three second-order factors. Their corresponding indices can be used to reflect and represent the care quality of nursing homes. Therefore, the Nursing Home Accreditation Scale is found with excellent reliability and validity. The results can provide reference for government and scholars to continue to enhance the care quality of nursing homes, and ensure the safety and rights of the general public.