Vaartio Heli, Leino-Kilpi Helena, Suominen Tarja, Puukka Pauli
Department of Nursing Science, University of Turku, Finland.
Pain Manag Nurs. 2009 Dec;10(4):206-19. doi: 10.1016/j.pmn.2008.02.003. Epub 2008 Nov 7.
Nursing advocacy has been defined in several ways, but its structure has not been operationalized. Therefore, different theoretical aspects of advocacy have not been able to be verified empirically. Our aim was to validate the content and structure of the concept of nursing advocacy within procedural pain care from the point of view of both patients and nurses. The concept of nursing advocacy was outlined first by integrative literature review and then delineated with data of semi-structured interviews among adult internal medicine and surgical patients and nurses (phases I-II). Then, the instrument was developed with facet-design approach, and the content and construct validity of it established in two subsamples within otolaryngeal surgical care (phases III-V). These descriptive and explorative studies were conducted from 2003 to 2007 in a total of 12 Finnish hospitals. The findings supported the validity of both the concept and the instrument. Pearson correlations and Cronbach alphas supported the conceptual dimensions of advocacy operationalized in this instrument. Internal consistency validity of the instrument scales were supported by subscale CVI, which ranged from 0.97 to 0.99, and item CVI, which ranged from 0.93 to 1.00. The instrument structure was strengthened with exploratory factor analysis, which explained 65% (sample of patients) or 57% (sample of nurses) of the variance in antecedents, 75% or 74% of the variance in activities, and 60% or 56% of the variance in the consequences of advocacy. This four-part 56-item (58-item for nurses) instrument promises to measure the dimensions of nursing advocacy. However, the instrument needs further validation in different settings.
护理倡导的定义有多种，但尚未将其结构付诸实践。因此，倡导的不同理论方面无法通过实证进行验证。我们的目的是从患者和护士的角度验证程序性疼痛护理中护理倡导概念的内容和结构。首先通过综合文献综述概述护理倡导概念，然后用成人内科和外科患者及护士的半结构化访谈数据进行描述（第一至二阶段）。然后，采用层面设计方法开发该工具，并在耳鼻喉科手术护理的两个子样本中确定其内容效度和结构效度（第三至五阶段）。这些描述性和探索性研究于2003年至2007年在芬兰的12家医院进行。研究结果支持了该概念和工具的有效性。皮尔逊相关性和克朗巴赫α系数支持了该工具中实施的倡导概念维度。该工具量表的内部一致性效度得到了子量表CVI（范围为0.97至0.99）和项目CVI（范围为0.93至1.00）的支持。探索性因素分析强化了该工具的结构，该分析解释了倡导前因中65%（患者样本）或57%（护士样本）的方差、活动中75%或74%的方差以及后果中60%或56%的方差。这个由四部分组成的包含56个项目（护士用58个项目）的工具有望测量护理倡导的维度。然而，该工具需要在不同环境中进一步验证。
