循证护理实践准备度评估量表的研制及信效度评价

Development and evaluation of reliability and validity of Clinic Readiness to Evidence-based Nursing Assessment scale

目的构建适合中国国情的循证护理实践准备度评估(CREBNA)量表,并检验其信度和效度。方法通过对"健康服务领域研究成果应用的行动促进框架"模式核心元素的文献分析和质性访谈形成CREBNA条目池,经2轮德尔菲专家函询对条目池进行筛选,选取6名专家对CREBNA量表和条目行相关性评分,并计算内容效度,形成CREBNA量表测试稿,在2016年复旦大学护理学院的培训班中以自愿原则选取三级医院的护士或护理管理者为CREBNA量表测试稿测试对象,行条目筛选、探索性因素分析和维度划分,并进行信度分析,形成CREBNA正式量表。结果根据文献分析和质性访谈结果共形成包括3个维度61个条目的 CREBNA量表条目池及其内涵。2轮德尔菲专家函询删改25个条目。6名专家相关性评分一致性系数为0.861,量表内容效度为0.976,所有条目的条目内容效度为0.833~1,对4个条目表述进行调整。CREBNA量表测试共发放问卷300份,有效问卷256份。各条目与对应维度总分的相关系数为0.569~0.829(P<0.01)、与CREBNA量表总分的相关系数为0.482~0.781(P<0.01),探索性因素分析共提取出3个因子,各条目的因子负荷量为0.455~0.853,累积解释总变异量为62.5%,3个因子分别命名为证据、组织环境和促进因素。CREBNA正式量表包括31个条目,总的Cronbach'sα系数为0.959,3个维度的Cronbach'sα系数分别为0.940、0.933和0.915,拆半信度为0.978,重测信度为0.917。结论构建的CREBNA量表具有良好的信度和效度,能够用于评估开展循证实践的准备度,指导我国证据应用的开展。

Objective To develop a Clinic Readiness to Evidence-based Nursing Assessment（CREBNA）scale and test its reliability and validity.Methods According to the qualitative interviews,scoping review of promoting action on research implemrntation in health severice（PARIHS）model results obtained primary item pool of CREBNA.After two rounds of experts evaluation,the CREBNA item pool of EBNP readiness was established,the questionnaire was formed based on item pool,the test version of CREBNA was identified by experts,judgment of the relevance between the item and dimensions in the expected structure,and the content validity of questionnaire.Convenience sampling was used in the research,clinical nurses who were participants in training course of Fudan University School of Nursing in 2016 were selected as investigators.The dimensions,reliability and validity of this scale were tested by exploratory factor analysis and reliability analysis.Results The CREBNA item pool included 3 dimensions,36 items.CREBNA questionnaire of 36 entries was formed based on item pool,the S-CVI of scale was 0.976.256 questionnaires were included in the final analysis,the correlations between items and the scale total score ranged from 0.482-0.781（P〈0.01）,3 factors were extracted by exploratory factor analysis and labeled as Evidence,Context,Facilitation,62.524%of total variance were explained.The formal scale contained 31 items,The Cronbach α coefficients were 0.959 for the total scale and 0.915-0.940 for the subscales.The test-retest reliability was 0.917 and split-half reliability coefficient was 0.978 for the total questionnaire.Conclusion It suggested that the CREBNA scale was reliable and valid enough to be applicable to evaluate the evidence-based practice process.