经口气管插管患者口腔护理评估量表的研制

Oral Care Assessment Scale for Orally Intubated Critically Ill Patients:making and testing of reliability and validity

目的研制能够科学、有效地反映ICU护士对经口气管插管患者口腔护理评估执行情况的测评工具。方法课题组引入国外BRUSHED口腔评估模型,结合文献学习法、头脑风暴法、专家咨询法等确定经口气管插管患者口腔护理评估量表条目池,经过多次修改及专家咨询,形成测试版量表,邀请7名护理专家进行内容效度评定,并对260名ICU护士进行测试。结果最终版的经口气管插管患者口腔护理评估量表包含6个单选题,1个多选题（BRUSHED模型修订为BRUSHED-T模型,有8个选项）。总量表的Cronbach′sα系数为0.827,折半信度为0.806;因子分析提取的1个公因子的累积方差贡献率达54.185%,且各条目在该公因子的载荷均〉0.6;量表水平的内容效度指数（S-CVI/Ave）为0.952,条目水平的I-CVI值为0.8以上。其中多选题（BRUSHED-T模型）I-CVI值为1.000,8个选项选择率为66.9%~95.0%。结论经口气管插管患者口腔护理评估量表具有良好的信效度,可用于测评ICU护士对经口气管插管患者口腔护理的评估状况,其中BRUSHED-T评估模型简单易记,可帮助护理人员快速完成对此类患者口腔状况的评估。

Objective To develop a scientific and effective instrument which could reflect oral care assessment practices performed by critical care nurses for orally intubated critically ill patients.Methods Members of the research team introduced the foreign oral care assessment model of BRUSHED,and developed a primary version of the Oral Care Assessment Scale for Orally Intubated Critically Ill Patients based on literature reviews,brainstorming and expert consultation.The primary version went through several revisions and expert consultation to form a test version,which was later evaluated by 7experts for its content validity,and used to survey260 nurses.Results The final version of the Oral Care Assessment Scale for Orally Intubated Critically Ill Patients included 6single choice questions and a multiple choice question（the BRUSHED model was modified into BRUSHED-T model,and had 8choices）.The Cronbach′sαcoefficient was 0.827,and the Guttman Split-half coefficient was 0.806;one factor was extracted by factor analysis,accounting for 54.185% of the total variance;all items had loadings greater than 0.6on the factor;the scale-level content validity index（CVI）of the scale was 0.952,and item-level CVI was〉0.8.Among the items,the CVIof the multiple choice question（the BRUSHED-T model）reached 1.000,with 8choices being selected by 66.9%to 95.0% of the nurses participated in the survey.Conclusion The Oral Care Assessment Scale for Orally Intubated Critically Ill Patients has good reliability and validity,and can be used to measure the status of oral care assessment level for orally intubated patients in Chinese medical culture.The BRUSHEDT model,simple and easy to remember,can help nurses perform oral assessment for these patients.