Hansen Michael Ulrich, Zdravkovic Slobodan, Jakobsson Ulf, Vejzovic Vedrana, Axelsson Malin
Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.
Center for Primary Health Research, Department of Clinical Sciences, Lund University, Lund, Sweden.
BMC Nurs. 2024 Dec 20;23(1):934. doi: 10.1186/s12912-024-02615-3.
Effective prehospital care for acute chest pain critically relies on ambulance nurses' adherence to clinical guidelines. However, current adherence is inadequate, with no instruments available to improve the situation. Therefore, this study aimed to develop and psychometrically evaluate an instrument measuring ambulance nurses' adherence to and attitudes towards acute chest pain guidelines, and to adapt and test the Attitudes Regarding Practice Guidelines instrument for measuring general attitudes towards guidelines.
An instrument development design was used. A 49-item Adherence Instrument was initially developed for measuring adherence to and attitudes towards acute chest pain guidelines and the 18-item Attitudes Regarding Practice Guidelines instrument was translated into Swedish. Both instruments were validated through cognitive interviews and expert reviews. To ascertain its reliability, a test‒retest was conducted. The construct validity of the Adherence Instrument was assessed via principal component analysis on the basis of a polychoric correlation matrix.
The developed Adherence Instrument was refined to 18 items and showed strong validity and reliability. Similarly, the Attitudes Regarding Practice Guidelines instrument, refined to 12 items, demonstrated strong validity and reliability. Principal component analysis of the Adherence Instrument identified five components: professional evidence-based practice, assessment of symptoms, confidence in skills, clinical autonomy, and guideline clarity and education. These components accounted for 64.5% of the total variance and demonstrated strong reliability, with an ordinal alpha of 0.84 for the entire scale.
The psychometric properties of the Adherence Instrument were satisfactory and will be useful in prehospital emergency care to measure attitudes and adherence towards acute chest pain guidelines.
急性胸痛的有效院前护理严重依赖于急救护士对临床指南的遵循。然而，目前的遵循情况并不理想，且没有可用的工具来改善这一状况。因此，本研究旨在开发并对一种测量急救护士对急性胸痛指南的遵循情况和态度的工具进行心理测量学评估，并对用于测量对指南的总体态度的《实践指南态度量表》进行改编和测试。
采用工具开发设计。最初开发了一个包含49个条目的《遵循量表》来测量对急性胸痛指南的遵循情况和态度，并将包含18个条目的《实践指南态度量表》翻译成瑞典语。这两个量表均通过认知访谈和专家评审进行验证。为确定其可靠性，进行了重测。基于多态相关矩阵，通过主成分分析评估《遵循量表》的结构效度。
所开发的《遵循量表》精简为18个条目，显示出很强的效度和信度。同样，《实践指南态度量表》精简为12个条目后，也显示出很强的效度和信度。《遵循量表》的主成分分析确定了五个成分：基于专业证据的实践、症状评估、技能信心、临床自主性以及指南清晰度和教育。这些成分占总方差的64.5%，并显示出很强的信度，整个量表的有序阿尔法系数为0.84。
《遵循量表》的心理测量学特性令人满意，将有助于院前急救护理中测量对急性胸痛指南的态度和遵循情况。
