Thorsell Kajsa B E, Nordström Berit M, Nyberg Per, Sivberg Bengt V
Department of Health Sciences, Section of Nursing, Faculty of Medicine, Lund University, Box 157, Baravägen 3, SE 221 00 Lund, Sweden.
BMC Geriatr. 2006 Sep 19;6:14. doi: 10.1186/1471-2318-6-14.
Almost every country in the Western world has great difficulties allocating enough financial resources to meet the needs in the care of the increasing elderly population. The main problem is common to all countries and concerns the efforts to meet elderly persons' needs on an individual level while still maintaining society's responsibility for distributing justice. The aim of this study is to elaborate an instrument for measuring the quality of individual care and staff's working time in order to allocate public resources fairly. The present study gives an account of a new classification system named TiC (Time in Care), indicating how it can be used most effectively and also investigating the validity and reliability of the system.
All recipients in 13 sheltered homes for elderly care (n = 505) in a Swedish municipality were surveyed regarding the care they needed, in dimensions of General Care, Medical Care, Cognitive Dysfunction and Rehabilitation, and the time required. Construct validity was assessed by means of factor analysis. The inter-rater agreement of two raters concerning 79 recipients was measured using weighted Kappa. The stability of the instrument and its sensitivity to change were investigated through test-retest reliability measurements, conducted once a month during a six-month period. The content validity of the instrument was also assessed.
Factor analysis resulted in a reduction of the number of items from 25 to 16 in three dimensions: General Care, Medical Care and Cognitive Dysfunction. The Kappa analysis showed satisfactory to excellent inter-rater agreement. The care need scores were basically stable but showed sensitivity to change in health status.
The instrument was found to be useful and reliable for assessing individual needs in community health care.
西方世界几乎每个国家在分配足够的财政资源以满足日益增长的老年人口的护理需求方面都面临巨大困难。主要问题在所有国家都是普遍存在的，涉及在满足老年人个人需求的同时，仍要维护社会在分配正义方面的责任。本研究的目的是精心设计一种工具，用于衡量个人护理质量和工作人员的工作时间，以便公平分配公共资源。本研究介绍了一种名为TiC（护理时间）的新分类系统，说明了如何最有效地使用它，并研究了该系统的有效性和可靠性。
对瑞典一个市镇13所老年护理庇护所的所有接受者（n = 505）进行了调查，询问他们在一般护理、医疗护理、认知功能障碍和康复等方面所需的护理以及所需时间。通过因子分析评估结构效度。使用加权Kappa测量两名评估者对79名接受者的评分者间一致性。通过在六个月期间每月进行一次的重测信度测量，研究该工具的稳定性及其对变化的敏感性。还评估了该工具的内容效度。
因子分析使一般护理、医疗护理和认知功能障碍三个维度的项目数量从25个减少到16个。Kappa分析显示评分者间一致性令人满意至优秀。护理需求得分基本稳定，但对健康状况的变化表现出敏感性。
该工具被发现对于评估社区医疗保健中的个人需求是有用且可靠的。
