關懷行為量表之驗證因素分析與護理實習生臨床照護行為之調查

Confirmatory Factor Analysis on Caring Behaviors Scale and an Investigation on Student Nurses’ Caring Behaviors

背景：關懷概念是護理展現「科學」、「技能」、「倫理」的核心，關懷的互動中，對病人與護理師都具有深遠且正向的影響，因此，本研究旨在驗證關懷行為量表應用於評估五專護生關懷照護的信、效度分析；並探討護生實習過程中對個案的關懷行為。方法：採橫斷式研究設計，以南台灣三所護專學生為取樣對象，採叢集抽樣並以自填式關懷行為量表進行資料收集，發出紙本問卷650份，回收有效問卷共計619份，以LISREL 8.52進行量表驗證性因素分析，並採用SPSS18.0版進行資料的統計分析。結果： 參與本研究護生年齡介於17-22歲間，整體平均年齡為18.59歲（± 1.57）。「關懷行為量表」之三個面向（分量表）均達模式適配指標（GFI值 > 0.90；SRMR值 < 0.05）。整體關懷行為量表，經一階相關模式的驗證分析顯示達到中度適配標準（RMSER = 0.080, 95% CI = 0.076-0.083）。護生的整體關懷行為標準化得分為58.60，為中等程度，而樣本對於「幫助病人渡過不平順的過程」的關懷表現高於「為病人權益的維護」與「了解病人」。結論：本研究量表經驗證分析顯示能達到適配度指標，但就其分量表而言尚有部分題目之歸屬需釐清，故進一步驗證分析有其必要。另外，依據研究結果，護生實習期間關懷行為表現為中等程度，顯示臨床實習經驗對提升護生的關懷行為表現仍有其限制，建議提出合宜的關懷教育課程方案，以強化護生的關懷行為。

Background: Caring reflects the core of nursing including science, skill, and ethics, the interpersonal relationship process with caring brings considerable and positive influence to patients as well as nurses. Therefore, this study focused on testing both the reliability and validity of the Caring Behavior Scale that applied to student nurses of three five-year junior colleges and exploring the caring behaviors of student nurses. Methods: A cross-sectional research design using a convenience sampling was conducted from three nursing colleges in Southern Taiwan. A total of 650 questionnaires were distributed, with 619 valid returns received. Participants? caring behavior was assessed using the Caring Behaviors Scale (CBS). Data were analyzed using SPSS (Version 18.0) for descriptive statistic analysis, and LISERL 8.52 program for confirmatory factor analysis (CFA). Results: Participants were at age between 17 to 22 years old and their average ages were 18.59 ± 1.57 years old. The results revealed that the caring behaviors scale and its three subscales exhibited adequate fit (GFI > 0.90；SRMR < 0.05). The overall CBS showed to have a moderate fit (RMSER = 0.080, 95% CI = 0.076-0.083) after using a first-order CFA. Participants showed a moderate caring behavior with an average CBS standardized score of 58.60. Comparing to “patients advocacy” and “understanding the patient”, student nurses scored higher in “helping the patient through the illness trajectory”. Conclusions: Although the CBS meets the fitting criteria through CFA, further analyses are required to clarify the belonging of ambiguous items Based on the CBS, this study found that the participants only have moderate caring behaviors during clinical placement. It implies that the effect of promoting caring behaviors of student nurses with regular clinical placement experience is not satisfactory. Thus, the study proposes to provide student nurses with adequate education program on caring behavior to enhance their caring behaviors.