Pfister D, Müller M, Müller S, Kern M, Rolke R, Radbruch L
ALPHA Rheinland, Von-Hompesch-Str. 1, 53123, Bonn, Deutschland.
Schmerz. 2011 Dec;25(6):643-53. doi: 10.1007/s00482-011-1111-7.
Palliative care in nursing homes has become an increasing focal point of healthcare in Germany and the evaluation of the specific quality of palliative care in this setting is under discussion. The assessment of quantitative data has the advantage of allowing pre-post comparisons of different interventions and implementation procedures and can therefore be used for evaluation of effectiveness. However, no assessment tool in German is available yet. Recent research on the assessment of healthcare professionals' knowledge indicated that knowing about technical and psychosocial aspects of palliative care is an easily measurable index for the quality of care. In consequence this index will be used as the core of the test instrument. The specific self-efficacy related to palliative care should be additionally included.
An analysis of the two most common tests of palliative care knowledge by three experts revealed that these instruments were only partly useful in Germany because of differences in the healthcare systems. The experts also criticised that the tests included only a few items concerning psychosocial care and that these items often showed ceiling effects. In addition, the instruments were not suitable for use in nursing homes. For specific self-efficacy only one test is available in Dutch. The items of these three instruments were face validated by 5 experts and new items were generated where needed. The content validity was verified again by five experts with the think-aloud method. Items were validated in 23 calliative care trainers whose expert knowledge served as an external criterion. Items that scored low in this group were eliminated. A second sample of 36 assistant nurses working in nursing homes who took part in a workshop for palliative care was used to assess change sensitivity before and after training.
A total of 23 items for the knowledge test and 15 items for specific self-efficacy were selected. The level of difficulty was suitable because an expert group could answer the questions while for assistant nurses the items were sufficiently difficult to show a difference between groups. Items were very sensitive to change after a training course.
The BPW is the first standardized test instrument for palliative care in the German language. In comparison to the other tests it includes items from the psychosocial domain without demonstrating a ceiling effect for these items. Content and criterion validity were good. Additional tests with larger samples and with other groups of nurses working in other settings would be needed to improve the data on reliability and to extend the validation to other settings.
在德国，养老院中的姑息治疗已日益成为医疗保健的焦点，对这种环境下姑息治疗的具体质量评估正在讨论中。定量数据评估的优势在于能够对不同干预措施和实施程序进行前后比较，因此可用于评估有效性。然而，目前尚无德语的评估工具。近期关于医疗保健专业人员知识评估的研究表明，了解姑息治疗的技术和心理社会方面是护理质量的一个易于衡量的指标。因此，该指标将用作测试工具的核心。此外，还应纳入与姑息治疗相关的特定自我效能感。
三位专家对两种最常用的姑息治疗知识测试进行分析后发现，由于医疗保健系统存在差异，这些工具在德国仅部分有用。专家们还批评这些测试仅包含少数关于心理社会护理的项目，且这些项目常常出现天花板效应。此外，这些工具不适用于养老院。对于特定自我效能感，仅有一份荷兰语测试可用。这三种工具的项目经5位专家进行表面效度验证，并在需要时生成新的项目。通过出声思考法，再次由5位专家验证内容效度。在23名姑息治疗培训师中对项目进行验证，他们的专业知识作为外部标准。在该组中得分较低的项目被剔除。选取了36名在养老院工作且参加过姑息治疗工作坊的助理护士作为第二个样本，以评估培训前后的变化敏感性。
共选取了23个知识测试项目和15个特定自我效能感项目。难度水平合适，因为专家组能够回答这些问题，而对于助理护士来说，这些项目又足够难，能够显示出组间差异。培训课程后，项目对变化非常敏感。
BPW是首个德语的标准化姑息治疗测试工具。与其他测试相比，它包含心理社会领域的项目，且这些项目未显示出天花板效应。内容效度和标准效度良好。需要用更大样本以及在其他环境中工作的其他护士群体进行额外测试，以改进可靠性数据，并将验证扩展到其他环境。
