Yoshimatsu Keiko, Nakatani Hisae
Department of Nursing, Faculty of Nursing and Nutrition, The University of Shimane, 151 Nisihayasigi-cho, Izumo-shi, Shimane-ken, 693-8550, Japan.
Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan.
BMC Nurs. 2023 May 6;22(1):154. doi: 10.1186/s12912-023-01288-8.
Home-visiting nurses are required to recognize risks in their work, ensure patient safety according to the characteristics of home-visiting nursing, and therefore, effectively support stability in patients' lives. In this study, we created a scale measuring home-visiting nurses' attitudes toward patient safety and examined its reliability and validity.
A total of 2,208 home-visiting nurses from Japan were randomly selected as participants. From the 490 responses collected (response rate: 22.2%), 421 responses with no missing values, other than those related to participants' basic information (valid response rate: 19.0%), were analyzed. Participants were randomly divided into two groups: 210 for exploratory factor analysis (EFA) and 211 for confirmatory factor analysis (CFA). To examine the reliability of the home-visiting nurses attitude scale developed in this study, ceiling and floor effects, inter-item correlations, and item-total correlations were checked. Subsequently, EFA was performed to confirm the factor structure. CFA, composite reliability, average variance extracted, and Cronbach's alpha for each factor were extracted to confirm the factor structure of the scale and the validity of the model.
The home-visiting nurses' attitudes toward patient safety were measured using 19 questionnaire items related to four factors: "Self-improvement for patient safety," "Incident awareness," "Counter measures based on incident experience," and "Nursing care to protect the lives of patients." Cronbach's α coefficients were 0.867, 0.836, 0.773, and 0.792 for Factors 1-4, respectively. Model indicators were χ = 305.155, df = 146, p < 0.001, TLI = 0.886, CFI = 0.902, RMSEA = 0.072 (90% confidence interval 0.061-0.083).
From the results of the CFA, criterion-related validity, and Cronbach's α coefficient, this scale is considered reliable and valid and thus, highly appropriate. Therefore, it may be effective at measuring home-visiting nurses' attitudes toward patients' medical safety from both behavioral and awareness aspects.
家访护士在工作中需要识别风险，根据家访护理的特点确保患者安全，从而有效支持患者生活的稳定。在本研究中，我们编制了一个衡量家访护士对患者安全态度的量表，并检验了其信效度。
从日本随机选取2208名家访护士作为研究对象。在收集到的490份回复（回复率：22.2%）中，分析了421份除与参与者基本信息相关外无缺失值的回复（有效回复率：19.0%）。参与者被随机分为两组：210名用于探索性因素分析（EFA），211名用于验证性因素分析（CFA）。为检验本研究编制的家访护士态度量表的信度，检查了天花板效应、地板效应、项目间相关性和项目-总分相关性。随后，进行探索性因素分析以确认因素结构。提取验证性因素分析、组合信度、平均方差抽取量以及各因素的克朗巴哈系数，以确认量表的因素结构和模型的效度。
通过19个与四个因素相关的问卷项目来衡量家访护士对患者安全的态度，这四个因素分别为：“为患者安全自我提升”“事件意识”“基于事件经验的应对措施”以及“保护患者生命的护理”。因素1至4的克朗巴哈α系数分别为0.867、0.836、0.773和0.792。模型指标为χ = 305.155，df = 146，p < 0.001，TLI = 0.886，CFI = 0.902，RMSEA = 0.072（90%置信区间0.061 - 0.083）。
从验证性因素分析结果、效标关联效度和克朗巴哈α系数来看，该量表被认为是可靠且有效的，因此非常合适。所以，它可能在从行为和意识两个方面衡量家访护士对患者医疗安全的态度方面有效。
