專科護理師健康照護服務品質量表之發展及心理計量檢測

Development and Psychometric Testing of the Nurse Practitioner Healthcare Service Quality Scale

背景：專科護理師（專師）照護模式逐漸成為台灣許多醫院替代住院醫師人力的經營政策。然而，目前國內仍未有從病人角度評估專師健康照護服務品質之量表，而無法提供專師照護服務品質成效的監測與未來改善之方向。目的：發展與測試專師健康照護服務品質量表（Nurse Practitioner Healthcare Service Quality Scale, NPHSQS）之信效度。方法：採橫斷式研究設計，應用Parasuraman、Zeithaml與Berry所提出的服務品質模式建立NPHSQS，進行內容效度審定後，以方便取樣選取北部某醫學中心之專師照護模式病房的病人進行調查，回收有效問卷200份，進行項目分析、建構效度、分組區辨效度及內在一致性檢測。結果：本量表共25題，專家效度CVI（content validity index）值.91，具合適的題項鑑別度CR（criticalratio）。探索性因素分析顯示，期望程度上萃取出可靠之回應性、保證性、關懷性及有形性四種因素，累積解釋變異量達62.47％；另感受評價上萃取出可靠之回應性、信賴感及有形性三種因素，累積解釋變異量達67.71％。整體量表內在一致性良好，在健康照護服務品質高低分二組上具有顯著不同的病人滿意度（p<.001）。結論：NPHSQS擁有良好的信、效度，可有效評估病人對專師的健康照護服務品質。

Background: Many hospitals in Taiwan currently use the nurse practitioner (NP) care model to ameliorate the chronic shortage of resident physicians. However, no healthcare service quality scale is presently available that allows the evaluation of the healthcare quality provided by NPs from the perspective of patients. A scale of this type is necessary in order to effectively monitor and improve care outcomes. Purpose: This project was designed to develop the Nurse Practitioner Healthcare Service Quality Scale (NPHSQS) and then to test its validity and reliability. Methods: A cross-sectional design combined with Parasuraman, Zeithaml, and Berry's Service Quality Model was adopted to construct the NPHSQS. After expert evaluation and confirmation of the model's content validity, 200 valid questionnaires were collected from a convenience sample of patients from medical center wards in northern Taiwan that regularly used the NP care model. The data were analyzed by group using item analysis, construct validity, internal consistency, and discriminant validity. Results: The 25-item NPHSQS developed in this study earned a CVI (content validity index) of .91 and a good CR (critical ratio). Exploratory factor analysis revealed that four factors extracted in the expectation level, including reliable responsiveness, assurance, empathy, and tangibility, explained 62.47% of the total variance. Furthermore, three factors extracted in the perception level, including reliable responsiveness, trust, and tangibility, explained 67.71% of the total variance. The NPHSQS has a good overall internal consistency coefficient and may also significantly distinguish differences in patient satisfaction between good and bad healthcare service quality groups (p < .001). Conclusion: The developed NPHSQS has good reliability and validity and is a reliable instrument for assessing the quality of NP-provided healthcare services from the perspective of healthcare recipients.