門診護理人員溝通行為量表之發展與驗證

Development and Validation of the Outpatient Nurses Communication Behavior Inventory

背景：門診是民眾最常的選擇就醫之處，然在醫學中心，由於看診人數多，護理人員需在短時間提供病人相關的診療資訊。所以良好的溝通是門診護理人員首重能力。然，現有溝通能力評估量表很少符合門診情境。
目的：發展門診護理人員溝通行為量表，並測試信度與效度。
方法：第一階段為文獻查證與統整，編擬溝通評量表。第二階段進行兩回合專家內容效度之檢定。第三階段於2018年12月至2019年1月，北台灣某醫學中心，採方便取樣方式，收案220名有執照門診護理人員填寫量表，進行量表建構效度及檢視量表內在一致性。
結果：第一階段經由文獻查證統整出六個構面溝通模式，包括接觸、介紹、溝通、詢問、回答、離開，共25題。第二階段乃經兩回合專家效度後，維持六構面，但修改為21題，其題項內容效度指標（item-content validity index）與量表內容效度指標（scale-level content validity index）值均為1.0。第三階段則採用驗證性因素分析檢視建構效度，結果維持六大因素，總共16題。模式三顯示溝通量表呈現良好模型（goodness of fit;χ2 = 155.75, p < .001, RMSEA = .06, GFI = .92, AGFI = .87, NNFI = .97, NFI = .95, Model AIC = 253.75）。內部一致性Cronbach’sα為.89。
結論／實務應用：量表具有良好的信、效度，可用於評估門診護理人員溝通行為，亦可作為教學及評量依據。CICARE（connect, introduce, communicate, ask, respond and exit）六大構面可提醒門診護理人員隨時展現有效溝通，提升護病溝通行為，全面提升照護品質。

Background: Outpatient clinics in medical centers are the most common location where people seek medical treatment. Because they must provide patients with treatment information in a timely manner, good communication skills are a key competency for outpatient nurses. However, the tools available for communication behavior assessment are general and rarely tailored for outpatient settings.
Purpose: The purpose was to develop a communication behavior inventory for outpatient nurses and to examine its reliability and validity.
Methods: During phase one, the authors conducted a literature search and synthesis, using the findings to develop the Outpatient Nurses Communication Behavior Inventory. During phase two, two expert validation rounds were conducted to confirm content validity. During phase three, 220 licensed outpatient nurses were recruited from a medical center in northern Taiwan to complete the instrument (December 2018–January 2019.) The construct validity and internal consistency of the inventory were evaluated.
Results: The literature search and synthesis identified six domains of communication, including connect, introduce, communicate, ask, respond, and exit. A total of 25 items were generated. Following the two expert panel validation rounds, the six domains remained but the inventory items were reduced to 21. Both item-content validity index and scale-level content validity index were 1.0. In phase three, the results of the confirmatory factor analysis retained six factors with a total of 16 items. Model three showed that the inventory demonstrated goodness of fit (χ2 = 155.75, p < .001, RMSEA = .06, GFI = .92, AGFI = .87, N NFI = .97, NFI = .95, Model AIC = 253.75). Internal consistency was demonstrated with a Cronbach’sαof .89.
Conclusion/ Implications for Practice: The Outpatient Nurses Communication Behavior Inventory exhibits good reliability and validity and may be used to assess outpatient nurses’communication behaviors and as a basis for education. The six CICARE (connect, introduce, communicate, ask, respond and exit) domains may be utilized to remind outpatient nurses to demonstrate effective communication consistently, promote outpatient nurses’communication with patients, and improve quality of care.