养老院管理员质量改进自我效能感量表。
Nursing Home Administrator Quality Improvement Self-Efficacy Scale.
机构信息
Elena O. Siegel, PhD, RN, is Assistant Professor, Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California. E-mail:
出版信息
Health Care Manage Rev. 2017 Oct/Dec;42(4):328-340. doi: 10.1097/HMR.0000000000000111.
BACKGROUND
Nursing home (NH) quality improvement (QI) is challenging. The critical role of NH leaders in successful QI is well established; however, current options for assessing the QI capabilities of leaders such as the licensed NH administrator are limited.
PURPOSE
This article presents the development and preliminary validation of an instrument to measure NH administrator self-efficacy in QI.
METHODOLOGY/APPROACH: We used a mixed-methods cross-sectional design to develop and test the measure. For item generation, 39 NH leaders participated in qualitative interviews. Item reduction and content validity were established with a sample of eight subject matter experts. A random sample of 211 administrators from NHs with the lowest and highest Centers for Medicare and Medicaid Services Five-Star Quality ratings completed the measure. We conducted exploratory and confirmatory factor analyses and tested the measure for internal reliability and convergent, discriminant, and known group validity.
FINDINGS
The final measure included five subscales and 32 items. Confirmatory factor analysis reaffirmed the factorial structure with good fit indices. The new measure's subscales correlated with valid measures of self-efficacy and locus of control, supporting the measure's convergent and discriminant validity. Significant differences in most of the subscales were found between the objective (Centers for Medicare and Medicaid Services Five-Star Quality rating) and subjective (Self-Rated Facility QI Index) quality outcomes, supporting the measure's known group validity.
PRACTICE IMPLICATIONS
The instrument has usefulness to both NH organizations and individual NH administrators as a diagnostic tool to identify administrators with higher/lower chances of successfully implementing QI. Organizations and individuals can use this diagnostic to identify the administrator's professional development needs for QI, in general, and specific to the instrument's five subscales, informing directions for in-house training, mentoring, and outside professional development. Attending to NH administrators' QI professional development needs prior to implementing QI holds promise to enhance the chances for successful implementation of QI, which is urgently needed in many NHs.
背景
养老院（NH）质量改进（QI）具有挑战性。NH 领导者在成功的 QI 中的关键作用已得到充分证实；然而，目前评估领导者（如持牌 NH 管理员）QI 能力的选择有限。
目的
本文介绍了一种衡量 NH 管理员在 QI 方面自我效能感的工具的开发和初步验证。
方法/方法：我们使用混合方法的横断面设计来开发和测试该工具。为了进行项目生成，39 名 NH 领导者参加了定性访谈。通过对八名主题专家的样本进行项目缩减和内容有效性评估，建立了内容有效性。来自 CMS 五星质量评级最低和最高的 NH 的 211 名管理员的随机样本完成了该工具。我们进行了探索性和验证性因素分析，并测试了该工具的内部信度以及收敛、区分和已知组有效性。
结果
最终的工具包括五个子量表和 32 个项目。验证性因素分析再次确认了具有良好拟合指数的因子结构。新工具的子量表与自我效能感和控制点的有效测量值相关，支持了该工具的收敛性和区分效度。在大多数子量表中，客观（CMS 五星质量评级）和主观（自我评估设施 QI 指数）质量结果之间存在显著差异，支持了该工具的已知组有效性。
实践意义
该工具对 NH 组织和单个 NH 管理员都具有实用性，可作为一种诊断工具，用于识别更有可能成功实施 QI 的管理员。组织和个人可以使用此诊断工具确定管理员在 QI 方面的一般专业发展需求，以及特定于该工具的五个子量表的需求，为内部培训、指导和外部专业发展指明方向。在实施 QI 之前满足 NH 管理员的 QI 专业发展需求有望提高成功实施 QI 的机会，这在许多 NH 中是迫切需要的。
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