本調査の目的は、平成17年度までに作成した認知症グループホームにおける入所者の生活の質の確保を目的とした評価票試用後の課題を検討し、更に有用性の高い評価票開発の方向性を見出すことである。対象は、1県内の認知症グループホーム全170施設のうち、協力の得られた144施設で実際に利用者の介護を行っている介護従事者1,360人。方法は、自記式無記名調査用紙を用いた郵送調査。30項目からなる評価票の各項目の4段階評定による達成度、更に評価項目の表現、項目数、現場への活用の可能性等について自由回答にて意見を求めた。540人から回答を得た(回収率39.7%)。回答者の年齢42.1±13.1歳。介護歴4.9±3.9年。一評価項目の平均値3.35-2.46、標準偏差0.90-0.65で、いずれの項目も天井効果・フロア効果は認められなかった。全項目の平均値は3.02、標準偏差は0.72であった。Shapiro-Wilkの正規性の検定:表統計量0.874-0.766、p<.001。各項目間の相関係数:0.773-0.191、I-T相関0.693-0.469。各因子のChronbachのα係数:0.958-0.956。項目の合計得点の上位群、下位群の上位・下位分析:全項目p<.001。構成概念妥当性は、因子分析の結果、先行研究の概念枠組みとほぼ一致していた。しかし、主要因子以外にも因子得点の高い項目があったことから、項目の統合・削除等の検討が必要である。また、既存のスケールやグループホーム以外の集団との比較が必要である。基準関連妥当性については、対象毎の評価項目の合計得点と介護歴とのSpearmanの順位相関係数が0.133(p<.001)で、ほとんど相関なしであった。このことには、対象者の教育的背景の影響があるのではないかと考える。内容的妥当性では、「適切である」との意見が多かったが、一部「意味がわかりにくい」「項目数が多い」等の意見が出されており、評価項目を再検討する余地がある。作成した評価票の信頼性と妥当性をもとに、その有用性と課題の検討を行った。その結果、今後の課題としてより高い信頼性が得られる評定方法の検討、適切な変数を用いた評価票の基準関連妥当性の検証、関連する他の評価票との一致性等による構成概念妥当性の検証を行う必要性が導き出された。認知症グループホームのケアが実際に行われている現場で、介護従事者が使いやすく、自己のケアを振り返ることができる有用性の高い評価票の実現を目指して、更に改良を進めていきたいと考える。

The objectives of this survey are to discuss the problems, after the trial use of evaluation sheet s produced in 2005 or earlier, for securing the quality of life of residents of group homes for people with dementia, and to determine the direction for the development of more useful evaluation sheets. The subjects were 1,360 nurses who care for residents of 144 group homes that agreed to participate in this study among a total of 170 group homes for people with dementia in a prefecture in Japan. The method was the mail survey using self-administered anonymous questionnaire sheets. Respondents were expected to evaluate 30 items with four scales and freely comment on the expression of each evaluation item, the number of evaluation items, and applicability to actual care situations, etc. Replies were received from 540 respondents (collection rate : 39.7%). The average age of the respondents was 42.1 + 13.1 years. The average nursing career was 4.9 + 3.9 years. The average score of each evaluation item ranged from 3.35 to 2.46, with standard deviations of 0.90-0.65 ; and there were neither ceiling effects nor floor effects in each case. The average of all items was 3.02, with a standard deviation 0.72. Among other results, the Shapiro-Wilk normality test was statistic: 0.874-0.766, p<.001; correlation coefficient between items: 0.773-0.191, I-T correlation : 0.693-0.469 ; Chronbach's α coefficient of each factor : 0.958-0.956; and analysis of the upper and lower score groups of total scores in evaluation items: p<0.01 for all items. It was found from the factor analysis that construct validity is nearly consistent with the conceptual framework of the previous study. However, since there were some items having high factor scores, in addition to the major factors, it is necessary to consider the combination or removal of items. In addition, it is essential to compare the results with the existing scales and groups other than group homes. With regard to criterion-related validity, the Spearman's rank-correlation coefficient between the total score of evaluation items and nursing career for each subject was 0.133 (p<.001), which means little correlation. This is considered to be due to the educational background of the subjects. With regard to content validity, many answered "Appropriate", but some answered "Meaning unclear" and "Number of items is too large", etc. Thus, there is room to redesign evaluation items. Based on the reliability and appropriateness of the evaluation sheet, the author found some problems through the trial use of the evaluation sheet. In the future, it will be necessary to develop an evaluation method that is highly reliable, study the criterion-related validity of the evaluation sheet using appropriate variables, and discuss construct validity based on the commonalities with other related evaluation sheets, etc. The evaluation sheet is to be improved in order to actualize a highly useful evaluation sheet that is easy for nursing staff to use and reflect on their care performance at places where nursing care is actually provided in group homes for dementia patients.

原著論文