護理紀錄稽核量表之建構及其信效度研究

Validity and Reliability of a Nursing Process Scale

10.6224/JN.202206_69(3).06

戴瑞芬(Jui-Fen TAI)；王棋(Chi WANG)；林麗英(Li-Ying LIN)；唐佩玲(Pei-Ling TANG)

護理過程 ； 護理紀錄 ； 量表發展 ； 結構方程模型 ； nursing process ； nursing recording ； scale development ； structural equation modeling

護理雜誌

69卷3期（2022 / 06 / 01）

31 - 40

繁體中文

背景：具有信效度的護理紀錄稽核工具，可以確保護理紀錄完整，提升病人的照護品質。目的：建立具有信效度的護理紀錄稽核工具。方法：本研究利用結構方程模型分析，來自某醫學中心「護理紀錄稽核量表」資料，共660份。依項目生成和內容有效性測試、項目分析與有效性測試、可靠性測試等三階段進行分析。結果：研究依稽核表之信效度結果與臨床實務整合後，刪除因素負荷量低的項目，並以轉軸後成份矩陣，重新編排各因子內的項目，完成修訂「護理紀錄稽核量表」。在探索性因素分析其Cronbach's α為.653，Kaiser-Meyer-Olkin檢驗值為.614，巴特利球形檢定（Bartlett's test of sphericity）結果亦呈現顯著，萃取出五個因子，22題；再經驗證性因素分析模式修正後，縮減為三個因子，10題，所有指標亦達理想標準。因考量臨床的廣度，故最終重要項目由32題改為22題，其中包含驗證性因素分析建議的10題。結論／實務應用：發展精簡且高信效度之稽核工具，不僅可以節省稽核者時間，亦能有效的評值護理紀錄的品質，提高紀錄的完整性，更重要的是此稽核表通過護理主管會議審查，已於42個臨床病房全面使用。

Background: A valid and reliable nursing record audit tool can simplify nursing records and provide a basis for quality auditing. Purpose: To ensure the validity and reliability of the Nursing Process Scale to promote accurate monitoring of nursing record quality. Methods: This study employed structural equation modeling to examine the content validity and reliability of the current Nursing Process Scale. A total of 660 results from a medical center were used to revise the content and then the validity and reliability of the revised scale were analyzed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used in three stages, namely item generation and content validity testing, item analysis and validity testing, and reliability testing. Results: Validity, reliability, and organization based on clinical practice were used to identify and remove scale items with low factor loadings. The remaining items were organized under several factors in the revised Nursing Process Scale, which had good internal consistency with a Cronbach's α of .653 in the EFA, a Kaiser-Meyer-Olkin value of .614, and a significant Bartlett's test of sphericity value. Five factors and 22 questions were extracted from the original 32 questions. The CFA conducted after the model correction reduced the number of questions to 10 and the number of factors to 3, with each index reaching the ideal level. To improve ease-of-use in clinical settings, the important items were reduced from 32 to 22 questions, including the 10 questions suggested by the CFA. Conclusion: The validity, reliability, and organization based on clinical practice were considered in the removal of items with low factor loadings. Axial conversion was used to generate a component matrix, which allowed item rearrangement across factors and the revision of the Nursing Process Scale. The development of simple valid and reliable audit tools will save auditor time and allow the effective evaluation of nursing record quality and improvement in record integrity. This revised scale was reviewed and approved for implementation in 42 clinical wards.

1. Mooi, E.,Sarstedt, M.(2019).Factor analysis.A concise guide to market research: The process, data, and methods using IBM SPSS statistics
   連結：
2. The 5 steps of the nursing process. (n.d.). In Nursingprocess.org. Retrieved August 23, 2021, from https://www.nursingprocess.org/Nursing-Process-Steps.html
3. Akhu-Zaheya, L.,Al-Maaitah, R.,Bany Hani, S.(2018).Quality of nursing documentation: Paper-based health records versus electronic-based health records.Journal of Clinical Nursing,27(3-4),e578-e589.
4. American Nurses Association. (n.d.). The nursing process. Retrieved July 12, 2021, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
5. Bentler, P. M.,Bonett, D. G.(1980).Significance tests and goodnessof fit in the analysis of covariance structures.Psychological Bulletin,88(3),588-606.
6. Chin, W. W.(1998).The partial least squares approach to structural equation modeling.Modern methods for business research
7. Dall’Ora, C.,Ball, J.,Recio-Saucedo, A.,Griffiths, P.(2016).Characteristics of shift work and their impact on employee performance and wellbeing: A literature review.International Journal of Nursing Studies,57,12-27.
8. De Groot, K.,Triemstra, M.,Paans, W.,Francke, A. L.(2019).Quality criteria, instruments, and requirements for nursing documentation: A systematic review of systematic reviews.Journal of Advanced Nursing,75(7),1379-1393.
9. De Marinis, M. G.,Piredda, M.,Pascarella, M. C.,Vincenzi, B.,Spiga, F.,Tartaglini, D.,Alvaro, R.,Matarese, M.(2010).‘If it is not recorded, it has not been done!’? Consistency between nursing records and observed nursing care in an Italian hospital.Journal of Clinical Nursing,19(11-12),1544-1552.
10. Diamantopoulos, A.,Siguaw, J. A.(2000).Introducing LISREL: A guide for the uninitiated.SAGE.
11. Geyer, N.(2015).How important are nursing records? : Legal and ethical column.Professional Nursing Today,19(1),14-16.
12. Haas, O.,Hutzler, M.,Egginger, T. H.,Maier, A.,Rothgang, E.(2021).Automating time-consuming and error-prone manual nursing management documentation processes.CIN: Computers, Informatics, Nursing,39(10),584-591.
13. Hair, J. F., Jr.,Black, W. C.,Babin, B. J.,Anderson, R. C.(2018).Multivariate data analysis.Cengage Learning EMEA.
14. Henseler, J.,Ringle, C. M.,Sinkovics, R. R.(2009).The use of partial least squares path modeling in international marketing.New challenges to international marketing
15. Hu, L.-T.,Bentler, P. M.(1999).Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.Structural Equation Modeling: A Multidisciplinary Journal,6(1),1-55.
16. Joint Commission International. (2017). Joint Commission International accreditation standards for hospitals (6th ed.). https://bit.ly/3GY1vXQ
17. Jöreskog, K. G.,Sörbom, D.,du Toit, S.,du Toit, M.(2000).LISREL 8: New statistical features.Scientific Software International.
18. Kaiser, H. F.(1974).An index of factorial simplicity.Psychometrika,39(1),31-36.
19. Müller-Staub, M.,de Graaf-Waar, H.,Paans, W.(2016).An internationally consented standard for nursing process-Clinical decision support systems in electronic health records.CIN: Computers, Informatics, Nursing,34(11),493-502.
20. MykkäNen, M.,Miettinen, M.,Saranto, K.(2016).Standardized nursing documentation supports evidence-based nursing management.Studies in Health Technology and Informatics,225,466-470.
21. Nomura, A. T. G.,Pruinelli, L.,da Silva, M. B.,Lucena, A. D. F.,Almeida, M. D. A.(2018).Quality of electronic nursing records: The impact of educational interventions during a hospital accreditation process.CIN: Computers, Informatics, Nursing,36(3),127-132.
22. Nunnally, J. C.(1967).Psychometric theory.McGraw-Hill.
23. Pokorski, S.,Moraes, M. A.,Chiarelli, R.,Costanzi, A. P.,Rabelo, E. R.(2009).Nursing process: From literature to practice. What are we actually doing?.Revista Latino-Americana de Enfermagem,17(3),302-307.
24. Polit, D. F.,Beck, C. T.(2006).Essentials of nursing research: Methods, appraisal, and utilization.Lippincott Williams & Wilkins.
25. Polit, D. F.,Beck, C. T.(2008).Nursing research: Generating and assessing evidence for nursing practice.Wolters Kluwer Health.
26. Samadbeik, M.,Shahrokhi, N.,Saremian, M.,Garavand, A.,Birjandi, M.(2017).Information processing in nursing information systems: An evaluation study from a developing country.Iranian Journal of Nursing and Midwifery Research,22(5),377-382.
27. Vera, M. (2019). Nursing diagnosis (NDx): Complete guide and list for 2019. UpToDate. Retrieved July 26, 2021, from https://www.coursehero.com/file/38929245/Nursing-Diagnosis-NDx-Complete-Guide-and-List-for-2019-Nurseslabspdf/
28. 財團法人醫院評鑑暨醫療品質策進會（2019）．2019醫院評鑑基準及評量項目（含委員共識）。https://www.jct.org.tw/lp-1156-1-xCat-03.html [Joint Commission of Taiwan. (2019). 2019 hospital accreditation standards and indicator (including committee consensus). https://www.jct.org.tw/lp-1156-1-xCat-03.html]