Oosterveld-Vlug Mariska G, Pasman H Roeline W, van Gennip Isis E, de Vet Henrica C W, Onwuteaka-Philipsen Bregje D
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
Health Qual Life Outcomes. 2014 Feb 11;12:17. doi: 10.1186/1477-7525-12-17.
Patients who are cared for in long-term care facilities are vulnerable to lose personal dignity. An instrument measuring factors that influence dignity can be used to better target dignity-conserving care to an individual patient, but no such instrument is yet available for the long-term care setting. The aim of this study was to create the Measurement Instrument for Dignity AMsterdam-for Long-Term Care facilities (MIDAM-LTC) and to assess its validity and intra-observer agreement.
Thirteen items specific for the LTC setting were added to the earlier developed, more general MIDAM. The MIDAM-LTC consisted of 39 symptoms or experiences for which presence as well as influence on dignity were asked, and a single item score for overall personal dignity. Questionnaires containing the MIDAM-LTC were administered face-to-face at two moments (with a 1-week interval) to 95 nursing home residents residing on general medical wards of six nursing homes in the Netherlands. Constructs related to dignity (WHO Well-Being Five Index, quality of life and physical health status) were also measured. Ten residents answered the questions while thinking aloud. Content validity, construct validity and intra-observer agreement were examined.
Nine of the 39 items barely exerted influence on dignity. Eight of them could be omitted from the MIDAM-LTC, because the thinking aloud method revealed sensible explanations for their small influence on dignity. Residents reported that they missed no important items. Hypotheses to support construct validity, about the strength of correlations between on the one hand personal dignity and on the other hand well-being, quality of life or physical health status, were confirmed. On average, 83% of the scores given for each item's influence on dignity were practically consistent over 1 week, and more than 80% of the residents gave consistent scores for the single item score for overall dignity.
The MIDAM-LTC has good content validity, construct validity and intra-observer agreement. By omitting 8 items from the instrument, a good balance between comprehensiveness and feasibility is realised. The MIDAM-LTC allows researchers to examine the concept of dignity more closely in the LTC setting, and can assist caregivers in providing dignity-conserving care.
在长期护理机构接受护理的患者容易丧失个人尊严。一种能够测量影响尊严因素的工具可用于更有针对性地为个体患者提供维护尊严的护理，但目前尚无适用于长期护理环境的此类工具。本研究的目的是创建阿姆斯特丹长期护理机构尊严测量工具（MIDAM-LTC），并评估其有效性和观察者内一致性。
在早期开发的、更通用的MIDAM基础上增加了13个针对长期护理环境的项目。MIDAM-LTC包括39个症状或经历，询问其存在情况以及对尊严的影响，还有一个关于整体个人尊严的单项评分。包含MIDAM-LTC的问卷在两个时间点（间隔1周）面对面发放给荷兰六家养老院普通病房的95名居民。还测量了与尊严相关的结构（世界卫生组织幸福五指数、生活质量和身体健康状况）。10名居民在边思考边回答问题。检验了内容效度、结构效度和观察者内一致性。
39个项目中有9个对尊严几乎没有影响。其中8个可以从MIDAM-LTC中删除，因为边思考边回答问题的方法揭示了它们对尊严影响小的合理原因。居民表示他们没有遗漏重要项目。关于个人尊严与幸福、生活质量或身体健康状况之间相关性强度的支持结构效度的假设得到了证实。平均而言，每个项目对尊严影响的评分在1周内有83%实际一致，超过80%的居民对整体尊严的单项评分一致。
MIDAM-LTC具有良好 的内容效度、结构效度和观察者内一致性。通过从该工具中删除8个项目，实现了全面性和可行性之间的良好平衡。MIDAM-LTC使研究人员能够在长期护理环境中更深入地研究尊严概念，并可协助护理人员提供维护尊严的护理。
