Galik Elizabeth, Resnick Barbara, Vigne Erin, Holmes Sarah Dee, Nalls Victoria
University of Maryland School of Nursing, Baltimore, MD.
University of Maryland School of Nursing, Baltimore, MD.
J Am Med Dir Assoc. 2017 Jan;18(1):59-64. doi: 10.1016/j.jamda.2016.08.008. Epub 2016 Oct 21.
Resistiveness to care is behavior that prevents or interferes with caregivers' performing or assisting with activities of daily living and puts residents at risk for inappropriate use of antipsychotic drugs, other restraining interventions, social isolation, and physical abuse. The purpose of this study was to establish the psychometric properties of a previously developed Resistiveness to Care measure.
This was a descriptive study using baseline data from an ongoing randomized controlled trial testing a Function and Behavior Focused Care (FBFC) intervention. Residents were eligible to participate if they were 55 years of age or older, had a Mini-Mental State Exam (MMSE) score of 15 or less, and were not enrolled in hospice or admitted for subacute care. Descriptive information included age, race, gender, cognitive status, and marital status. In addition to the Resistance to Care Scale, the Barthel Index, the Physical Activity Survey in Long Term Care (PAS-LTC), and the Cohen-Mansfield Agitation Inventory (CMAI) were completed. Psychometric testing was done using Rasch analysis and the Winsteps statistical program.
The participants were moderate to severely cognitively impaired (MMSE of 7.23), functionally dependent (Barthel Index 47.31, SD 27.59), and engaged in only 134.17 (SD = 207.32) minutes of physical activity daily. Reliability was supported based on a Cronbach alpha of 0.84 and the DIF analysis, as there was no difference in function of the items between male and female participants. Validity was supported as all items fit the measurement model based on INFIT and OUTFIT statistics.
The findings support the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit from the addition of items that are easier to endorse with regard to resistiveness to care (shutting eyes or spitting out food may be useful additions).
抗拒护理行为是指妨碍或干扰护理人员协助进行日常生活活动的行为，会使居民面临不适当使用抗精神病药物、其他约束性干预措施、社会隔离和身体虐待的风险。本研究的目的是确定先前开发的抗拒护理量表的心理测量特性。
这是一项描述性研究，使用了一项正在进行的随机对照试验的基线数据，该试验测试了以功能和行为为重点的护理（FBFC）干预措施。年龄在55岁及以上、简易精神状态检查表（MMSE）得分在15分及以下、未入住临终关怀机构或未因亚急性护理入院的居民有资格参与。描述性信息包括年龄、种族、性别、认知状态和婚姻状况。除了抗拒护理量表外，还完成了巴氏指数、长期护理身体活动调查（PAS-LTC）和科恩-曼斯菲尔德激越量表（CMAI）。使用拉施分析和Winsteps统计程序进行心理测量测试。
参与者存在中度至重度认知障碍（MMSE为7.23），功能依赖（巴氏指数47.31，标准差27.59），每天仅进行134.17（标准差 = 207.32）分钟的身体活动。基于0.84的克朗巴哈系数和差异项目功能（DIF）分析，支持了量表的信度，因为男性和女性参与者之间项目功能没有差异。基于拟合优度（INFIT）和标准化拟合优度（OUTFIT）统计，所有项目均符合测量模型，支持了量表的效度。
研究结果支持抗拒护理量表在疗养院环境中用于患有痴呆症的老年人时的信度和效度。该量表未来的改进工作可能受益于增加一些更易于认可的抗拒护理项目（闭眼或吐出食物可能是有用的补充项目）。
