【摘要】：目的:初步編制符合我國國情的ICU轉(zhuǎn)出患者家屬轉(zhuǎn)科應(yīng)激壓力評估量表,旨在為ICU醫(yī)護人員識別及評估家屬轉(zhuǎn)科應(yīng)激壓力提供客觀的評價工具。方法:(1)通過廣泛文獻回顧、對12名ICU轉(zhuǎn)出患者家屬進行半結(jié)構(gòu)式訪談及參考國外相關(guān)評估工具構(gòu)建量表理論框架,擬定量表條目池;(2)應(yīng)用Delphi法對7名護理專家進行專家函詢,計算問卷回收率、專家權(quán)威系數(shù)及各級指標的和諧系數(shù),根據(jù)各條目的均值、標準差、變異系數(shù)對條目進行篩選,形成預(yù)調(diào)查量表;(3)使用預(yù)調(diào)查量表對重慶市4家三級甲等醫(yī)院中心ICU 145名患者家屬進行調(diào)查,采用經(jīng)典測量理論下的離散趨勢法、因子分析法、相關(guān)系數(shù)法及Cronbach’α系數(shù)法對條目進行篩選,形成終量表;(4)使用終量表對重慶市4家三級甲等醫(yī)院中心ICU 186名患者家屬進行正式調(diào)查,采用Cronbach’α系數(shù)進行信度分析,采用探索性因子分析及驗證性因子分析法進行效度分析。結(jié)果:(1)初步構(gòu)建的量表包括分離焦慮、環(huán)境改變、病情嚴重程度、護理模式改變、安全性、照顧能力自我效能感6個一級指標,30個二級指標。(3)使用Delphi法對7名護理專家進行2輪咨詢,專家權(quán)威系數(shù)為0.83,兩輪專家積極系數(shù)均為100%,2輪專家意見協(xié)調(diào)系數(shù)分別為:一級指標0.36、0.36,二級指標0.35、0.37,P值均小于0.05。通過對指標的篩選,結(jié)合專家意見,形成預(yù)調(diào)查量表,包括6個一級指標,25個二級指標。(4)預(yù)調(diào)查結(jié)果經(jīng)過經(jīng)典測量理論下的統(tǒng)計學(xué)分析,刪除5個條目,形成終量表包含6個一級指標(轉(zhuǎn)科分離焦慮、環(huán)境改變、病情危重程度、護理模式改變、轉(zhuǎn)科過程安全性、照顧能力自我效能感),20個二級指標。(5)終量表的調(diào)查結(jié)果分析,量表總Cronbach’α系數(shù)0.882,探索性因子分析提取6個公因子,與量表6個維度一致,累積方差解釋率72.226%,驗證性因子分析模型的擬合情況:χ2/df=1.677,相對擬合指數(shù)=0.936,塔克-路易指數(shù)=0.921,近似誤差均方根=0.061,擬合度優(yōu)。終量表具有較好的信效度。結(jié)論:本研究構(gòu)建的ICU轉(zhuǎn)出患者家屬轉(zhuǎn)科應(yīng)激壓力評估量表經(jīng)Delphi法專家咨詢、預(yù)調(diào)查條目篩選后,能較全面的反應(yīng)了ICU轉(zhuǎn)出患者家屬的心理壓力特點,量表具有良好的信度和效度,適合于ICU轉(zhuǎn)出患者家屬轉(zhuǎn)科應(yīng)激壓力的評估。
[Abstract]:Objective: to develop a stress assessment scale for family members of patients with ICU transferred out of hospital in order to provide an objective evaluation tool for identifying and evaluating the stress of family members transferred from ICU to hospital. Methods: (1) based on extensive literature review, 12 families of patients with ICU were interviewed in a semi-structured way, and the theoretical framework of the scale was constructed with reference to relevant evaluation tools abroad, and the pool of items was drawn up. (2) 7 nursing experts were interviewed by Delphi method. To calculate the questionnaire recovery rate, expert authority coefficient and harmony coefficient of all levels of indicators, according to the average, standard deviation, variation coefficient of each item to screen the items, (3) using the pre-survey scale to investigate the family members of ICU patients in four Grade 3A hospitals in Chongqing, adopting the discrete trend method based on classical measurement theory and factor analysis, Correlation coefficient method and Cronbach' 偽 coefficient method were used to screen items to form the final scale. (4) the final scale was used to investigate the family members of ICU 186 patients in four Grade 3A hospitals in Chongqing, and the reliability was analyzed by Cronbach' 偽 coefficient. Exploratory factor analysis and confirmatory factor analysis were used for validity analysis. Results: (1) the scale consisted of separation anxiety, environmental change, severity of illness, nursing mode change, safety, and so on. The self-efficacy of care ability was 6 first-degree indicators and 30 second-level indicators. (3) 7 nursing experts were consulted by Delphi method for 2 rounds. The expert authority coefficient is 0.83, the two rounds expert positive coefficient is 100 and two rounds expert opinion coordination coefficient is: the first class index is 0.36 / 0.36, the second class index is 0.35 / 0.37 / P < 0.05 respectively. Through the screening of indicators, combining with expert opinions, the pre-survey scale was formed, including 6 first-grade indicators and 25 second-level indicators. (4) after statistical analysis under classical measurement theory, 5 items were deleted. The formative final scale included 6 first-grade indexes (separation anxiety, environmental change, severity, nursing model change, safety, self-efficacy), and 20 secondary indicators. (5) the analysis of the results of the final scale. The total Cronbach' 偽 coefficient of the scale was 0.882. The exploratory factor analysis extracted 6 common factors, which was consistent with the six dimensions of the scale. The cumulative variance interpretation rate was 72.226, and the fitting of the confirmatory factor analysis model was as follows: 蠂 2 / df1.677, relative fitting index 0.936, Taker-Louis index 0.921, approximate error RMS 0.061, and good fit. The final scale has good reliability and validity. Conclusion: the stress assessment scale constructed in this study can reflect the psychological stress characteristics of the family members of patients with ICU transferred out of ICU after the expert consultation of Delphi method and the screening of pre-investigation items. The scale has good reliability and validity, which is suitable for the assessment of stress in the family members of ICU patients.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473

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