看護師版対患者Over-Involvement尺度の開発と信頼性・妥当性の検討

Abstract

背景 看護におけるover-involvementは問題視されているが、看護において重要であるといわれるinvolvementとの区別があいまいで、状況によりその区別が判断されている。状況によりどの看護師にも起こり得るover-involvementの影響は、患者、看護師双方に問題となるにもかかわらず、信頼性および妥当性が検討された看護師の対患者over-involvement評価尺度は、開発されていない。 目的 本研究では、看護師と患者との二者関係におけるover-involvement尺度を開発し、その信頼性・妥当性を検討することを目的とする。 方法 関西圏にある400床以上の1公立病院に勤務する看護師265名を対象に、看護師版対患者Over-Involvement尺度原案21項目の自己記入式の調査用紙を配布し、222名の有効回答が得られた。統計的に不適切な項目を削除後、最尤法-プロマックス回転による因子分析を行った。 結果 看護師版対患者Over-Involvement尺度として、12項目3因子が得られ、第1因子より順に 『残心感』『被影響性』『気がかり』と命名された。Cronbachのα係数が、第1因子より順に0.73、0.81、0.77 (全体0.87) であり、信頼性が確認された。妥当性については、臨床看護師のストレッサー尺度との相関が、r=0.45 (p<0.01) であり収束的妥当性が確認された。 結論 看護師版対患者Over-Involvement尺度の信頼性・妥当性が確認された。本尺度は、実用化されることにより、今後、involvementを管理する能力を養成するプログラムの開発が期待されるが、看護師版対患者Over-Involvement尺度はそれらのプログラムの効果を評定する尺度などに活用されることが期待される。

Backgrounds While over-involvement often created problems during nursing practice, there have been no clear boundaries to distinguish it from involvement which is known to be important for nursing, and the judgment on differences between the two is usually made case by case. Although any nurses may risk over-involvement in certain situation and this in turn may cause problems detrimental to both nurses and patients, no reliable and validated scale for rating nurse over-involvement toward patients has been developed so far. Aim This study is intended to develop a scale for rating over-involvement in term of nurse-patient relationships and to evaluate reliability and validity of the scale. Method A self-completed questionnaire of 21-item Scale for Rating Nurse Over-Involvement toward Patients (preliminary design) was distributed to 265 nurses selected as the subjects of this study from a public hospital with more than 400 beds located at Kansai region, Japan and valid answers were collected from 222 subjects. After the items that had no statistically significant correlation were excluded, factor analysis was performed using maximum-likelihood method with promax rotation. Result As Scale for Rating Nurse Over-Involvement toward Patients, 3 factors consisting of 12 items were extracted, which were designated in the order from factors 1 to 3 as "Attachment, " "Affectedness" and "Concern. " The Cronbach's alpha values in the order from factors 1 to 3 were 0.73, 0.81 and 0.77 (overall 0.87), respectively, and thus the reliability was proved. As for validity, their correlation with clinical nurses' stressor scale (r=0.45, p< 0.01) confirmed convergent validity. Conclusion The reliability and validity of Scale for Rating Nurse Over-Involvement toward Patients were confirmed. With the application of this scale, the programs used for training the ability to manage involvement are anticipated to be developed in the future, and the Scale for Rating nurse Over-Involvement toward Patients are expected to be used as an Rating for evaluating the effects of such programs.