靈性關懷能力量表的編製與信效度研究

Development and Psychometric Properties of the Spiritual Care Competency Scale

研究目的：國內外過去對於安寧病人靈性照顧的相關研究很少，本研究旨在發展適用於國內照顧末期病人的靈性關懷能力量表，並且對該量表進行信效度研究。研究方法：本研究的起迄時間於2015年8月至2016年11月。量表根據基督宗教取向靈性照顧的基本知識、靈性照顧的態度、靈性照顧的專業知能三個向度編擬題項，初始題項設計為五點量表共85題，以財團法人基督教史懷哲宣道會過去兩年內上過靈性關懷教育課程的學員為研究樣本。研究結果：預試階段樣本為134人，男性23人，女性111人，經過項目分析及探索性因素分析，得到18個題項，分別命名為「靈性關懷知能（3題）」、「靈性關懷自我覺察（7題）」以及「靈性關懷照顧（8題）」三個因素，三個因素的總解釋變異量占58.34%。正式施測階段樣本為350人，男性61人，女性289人，資料分析結果各分量表的內部一致性信度係數介於.81到.88之間，全量表為.92，顯示有好的內部一致性信度係數。接著以其中175名樣本對本研究所提出的三因素假設模式進行第一次驗證性因素分析作為修正模式之用，發現假設模式的整體適配情形不甚理想，因此刪除因素負荷量低的兩個題項後提出修改模式，再以另175名研究樣本進行第二次驗證性因素分析作為驗證模式之用，發現修正模式比假設模式的適配度較理想，整體而言，修正模式之整體適配度與內在測量模式適配度大致仍符合合理適配標準的建議。研究結論：研究結果支持在修正模式的條件下本量表具有不錯的信度與效度。本量表所測量的安寧療護靈性照顧能力面向，建議未來相關教育訓練課程設計可涵蓋之；另建議未來研究需要加大樣本數並可擴及其他宗教信仰的樣本。

Purpose: Spiritual care is an essential part of providing palliative care services to patients. However, no studies have identified the abilities required for a palliative spiritual care provider in Taiwan. To understand what makes a good caregiver for terminally ill patients, we developed the Spiritual Care Competency Scale (SCCS) and examined its psychometric properties. Methods: We developed the initial 85 5-point Likert items of the SCCS based on our previous qualitative study of Christian-based competencies for hospice spiritual palliative care. That study identified 3dimensions of spiritual care: basic knowledge, attitude, and professional knowledge about spiritual care. We developed the SCCS in two stages. All participants had completed a spiritual care education course at the Schweitzer Christian Mission Foundation in Taiwan. Results: A total of 134 participants (23 male, 111 female) completed the initial measure. Following the item analysis and exploratory factor analysis, we selected 18 items comprising 3 factors for the final measure: Spiritual Care Knowledge (3 items), Spiritual Care Self Awareness (7 items), and Spiritual Care Practice (8 items). These 3 factors accounted for 58.34% of the total variance. In stage 2, 350 participants (61 males, 289 females) completed the 18-item measure. Analysis showed acceptable internal consistency coefficients for the three subscales (.81 to .88) and for the total scale (.92). The first 175 of the 350 participants were used to test the hypothesized 3-factor model using the confirmatory factor analysis (CFA). The results indicated that the overall goodness of fit of the proposed model was unsatisfactory. Subsequently, two items with a low factor loading were deleted from the SCCS, and the revised model was tested. The data from the remaining 175 participants of the original 350 were used for the second CFA to validate the revised model. The overall goodness of fit of the model and the internal structure of the measurement model fit were favorable. The revised model was more optimal than the originally hypothesized model. Conclusions: The results of the analysis of the revised model lend reasonable support to the validity and reliability of the SCCS. This scale highlights the important aspect of competency in spiritual palliative care, thus future education and training programs should consider including this aspect.