The Initial Development of a Checklist for Assessing Thirst in Patients With Advanced Dementia

評估嚴重失智症患者口渴之檢核表初步發展

10.1097/jnr.0000000000000123

楊雅萍(Ya-Ping Yang)；王琪珍(Chi-Jane Wang)；王靜枝(Jing-Jy Wang)

口渴 ； 精神行為症狀 ； 失智症 ； 工具發展 ； thirst ； behavior and psychological symptoms ； dementia ； instrument development

The Journal of Nursing Research

24卷3期（2016 / 09 / 01）

224 - 231

英文

背景 嚴重失智症患者由於認知障礙導致口語表達困難會用精神行為症狀表達自己的需要。因此，了解患者因特定需要所產生的行為特徵對照顧者及醫護人員的失智症患者照護是相當重要的。目的 發展一可用來了解嚴重失智症患者之口渴需求的評核表。方法 採質性訪談與調查等混合式研究設計，初始題項的發展包括邀請10位具照顧過失智症患者經驗的長期照護機構護理人員，再邀請4位專家進行內容效度檢定。然後，邀請照護者於8家長期照護機構進行嚴重失智症患者的觀察，以完成此初構評核表的填寫並進行問卷信效度的檢定。使用專家內容鑑定分析、測試者一致分析、內在一致性信度分析與探索性因素分析等方法進行資料分析。結果 初擬18題內容效度為.96，觀察者間信度為-.33-1.00，內在一致性為.52。經探索性因素分析縮減至以下7題，依序為重複動作、坐立不安、心神不寧或焦慮、持續性或無理的要求、踱步或漫無目的遊走或來回走動、無目的重複句子或問題和反應變遲緩等7個題項，其總解釋變異量49.3%，題數縮減後的內部一致性信度為.66。結論／實務應用 期此初步發展的評核工具能協助照顧者辨識嚴重或無法清楚表達之失智症患者口渴或液體需求。

Background: Patients with advanced dementia (PwAD) often have difficulty expressing their needs verbally because of cognitive impairments. PwAD thus often communicate these needs through behaviors and psychological symptoms. Understanding the behavioral characteristics of certain needs is critical for caregivers and clinicians when caring for PwAD. Purpose: The purpose of this study was to develop a checklist that may be used to assess the thirst status of PwAD. Methods: A mixed method design was used. The checklist was developed using qualitative interview sand surveys. The initial items were developed through interviews with 10 professional nurses who were caring for PwAD. Four experts in dementia assessed the content validity of these items. PwAD caregivers from eight facilities were then invited to complete the checklist based on their current PwAD patient care experience. Data obtained in this study were analyzed with regard to content validity, interrater reliability, internal consistency, and exploratory factor analysis. Results: The content validity of the initial 18 items was .96, interrater reliability was -.33 to 1, and internal consistency reliability was .52. Exploratory factor analysis identified seven checklist items, including repetitive movements, squirming, restlessness or anxiety, persistent or unreasonable demands, pacing back and forth, repeating a sentence or question without purpose, and slow reaction. The factor loadings of these seven items accounted for 49.3% of the total variance. The reassessed internal consistency reliability was .66. Conclusions/Implications for Practice: Caregivers may use this checklist as an aid to identify the thirst or fluid needs of PwAD who are unable to communicate their needs effectively.

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