坂井 志麻

CONTEXT: In recent times, advance care planning for patients' end-of-life care preferences has attracted much attention worldwide. OBJECTIVES: To develop the Readiness for Advance Care Planning (RACP) Scale. METHODS: Participants included 624 Japanese citizens who were registered with a web-based survey company as of February 2019. Items regarding the process of advance care planning (ACP) were developed based on a literature review and expert panel discussions. The expert panel included nine experts and practitioners in the field of end-of-life care. Construct validity, concurrent validity, internal consistency, and test-retest reliability were evaluated. RESULTS: Initially, 37 items were collected. Examination of the floor effect, item-total, good-poor analysis, and exploratory factor analysis yielded a five-factor model with 28 items. The goodness of fit of the model was GFI = 0.80, CFI = 0.91, and RMSEA = 0.08. The concurrent validity was statistically significant (rs = 0.26-0.45, ps < 0.001). Cronbach's alpha for the overall scale was 0.95. The corresponding values for the subscales ranged from 0.90 to 0.97. The intraclass correlation coefficients indicating test-retest reliability was 0.66 (P < 0.001) for the total scale and ranged from 0.52-0.65 for the five subscales. CONCLUSIONS: The validity and reliability of the scale were generally acceptable. The RACP is an appropriate instrument to evaluate the level of readiness for ACP behaviors among people of various generations at every health stage. More studies are needed to examine the clinical utility of the RACP, both nationally and internationally.

目的:外来看護師の在宅療養移行支援実践評価尺度を開発し,その妥当性と信頼性を検討する.方法:文献検討とインタビューより抽出したデータを基に,外来看護師の在宅療養移行支援実践評価尺度原案を作成した.全国805施設の外来看護師を対象に質問紙調査を行い,妥当性・信頼性の検証を行った.結果:分析対象は360名で(有効回答率22.3%),探索的因子分析の結果,25項目4下位尺度を作成した.モデルの適合度は,GFI=.845,AGFI=.812,CFI=.904,RMSEA=.073であった.収束的妥当性はr=.741(p<.001)で,弁別的妥当性はr=-.471(p<.001)であった.尺度全体のクロンバックαが.945で,下位尺度は.771〜.915であった.結論:本尺度の妥当性,信頼性は,統計量的に許容範囲であることが確認された.地域包括ケアシステムにおいて,外来看護師が実践する在宅療養移行支援の標準的指標となり,教育研修の効果測定に活用できる.(著者抄録)

AIMS: To develop the Discharge Planning of Ward Nurses (DPWN), a Japanese self-evaluation instrument for ward nurses' discharge planning practices. DESIGN: Cross-sectional survey. METHODS: Participants were 624 ward nurses from six hospitals in Japan with a discharge planning department. Items about discharge planning practices were collected from literature and interviews with nurses and researchers. Construct validity, concurrent validity, internal consistency and test-retest reliability were tested. RESULTS: Initially, 55 items were collected. Examination of the floor effect, item-total, good-poor analyses and exploratory factor analysis yielded a four-factor model with 24 items ('teaching home-care skills with community/hospital professionals,' 'identifying clients' potential needs early in the discharge process,' 'introducing social resources' and 'identifying client/family wishes and building consensus for discharge'). The four-factor structure was supported by confirmatory factor analysis. The DPWN correlated with scales ascertaining similar concepts, supporting concurrent validity. Internal consistency and test-retest reliability were generally satisfactory.