Yekefallah Leili, Ashktorab Tahereh, Manoochehri Houman, Majd Hamid Alavi
Department of Critical Care Nursing, Nursing and Midwifery School, Qazvin University of Medical Sciences, Qazvin, Iran.
Department of Nursing, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Iran J Nurs Midwifery Res. 2019 Jan-Feb;24(1):56-60. doi: 10.4103/ijnmr.IJNMR_146_17.
In Iran, futile care has become a challenge for intensive care nurses. The aim of the study was to develop a tool for assessing the reasons of futile care at intensive care units (ICUs).
A sequential mixed method in three stages was applied. In the first stage, a phenomenological study was performed with van Manen's method by interviewing 25 nurses at ICUs of 11 hospitals in Qazvin. To extract the items of the tool in the second stage, the concept of futile care in ICUs and its reasons were defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach's alpha), and test-retest reliability.
The initial tool had 119 questions. After validation, 39 items remained in the final questionnaire. Five extracted factors were as follows: professional competence (14 items), organizational policy (9 items), socio-cultural factors (7 items), personal beliefs and values (4 items), and legal issues (5 items). Cronbach's alpha for the whole questionnaire was 0.91 (range: 0.71-0.96). The test-retest reliability was 0.87 ( < 0.001).
Nursing managers and clinical nurses can use this tool to identify the causes of futile care and reduce it in their clinical settings. Policy makers can use this tool for improving the management of ICUs.
在伊朗，无效护理已成为重症监护护士面临的一项挑战。本研究的目的是开发一种用于评估重症监护病房（ICU）无效护理原因的工具。
采用分三个阶段的序贯混合方法。第一阶段，运用范曼恩方法进行现象学研究，对加兹温11家医院ICU的25名护士进行访谈。在第二阶段，为提取该工具的条目，对ICU无效护理及其原因的概念进行了界定。最终，通过表面效度、内容效度（定量和定性）、结构效度（探索性因素分析）、内部一致性（克朗巴哈系数）和重测信度对问卷的心理测量特性进行了评估。
初始工具包含119个问题。经过验证后，最终问卷保留了39个条目。提取的五个因素如下：专业能力（14个条目）、组织政策（9个条目）、社会文化因素（7个条目）、个人信念和价值观（4个条目）以及法律问题（5个条目）。整个问卷的克朗巴哈系数为0.91（范围：0.71 - 0.96）。重测信度为0.87（<0.001）。
护理管理者和临床护士可使用该工具来识别无效护理的原因，并在临床环境中减少无效护理。政策制定者可利用该工具改善ICU的管理。
