护士吞咽困难知识与自我报告能力问卷的编制与验证

文献信息

中文摘要

背景： 吞咽困难是医疗保健环境中常见的病症，并与严重并发症相关。护士在早期识别和安全处理中发挥关键作用。然而，护士的知识和能力存在显著差距。现有吞咽困难问卷的范围有限，且大多针对特定人群设计。本研究旨在编制并验证一个全面的工具，以评估护士在吞咽困难护理中的知识和感知能力。
方法： 护士吞咽困难知识与自我报告能力问卷（DKSCQ-N）分两个阶段编制并验证。第一阶段包括通过文献综述生成条目、将条目映射到六个领域，以及使用规格表和内容效度指数进行专家评估。对护士进行认知访谈，以评估清晰度、相关性和可用性。在第二阶段，从巴基斯坦各地医院的537名护士中收集数据，以建立信度和结构效度。使用内部一致性和重测信度评估信度。使用验证性因子分析和收敛效度评估效度。
结果： 专家评审显示出较强的内容效度（S-CVI = 0.95）。在认知访谈后进行小幅修订以提高清晰度。验证性因子分析支持一个21个条目、双因子模型，拟合可接受（χ2/df = 4.062，CFI = 0.93，TLI = 0.921，RMSEA = 0.076，GFI = 0.88）。两个因子均表现出良好的收敛效度和区分效度。DKSCQ-N的体征和症状、并发症和管理领域与吞咽困难知识量表之间存在显著相关性，支持了收敛效度。内部一致性较高（Cronbach's α = 0.906），重测信度表明在两周期间具有极好的稳定性（ICC = 0.829）。
结论： DKSCQ-N是评估护士吞咽困难知识和自我报告能力的有效且可靠的工具。它提供了一个全面且具有情境相关性的测量工具，有助于识别学习需求并评估医院环境中的培训成果。

英文摘要

BACKGROUND: Dysphagia is a common condition across healthcare settings and is associated with serious complications. Nurses play a key role in early identification and safe management. However, substantial gaps exist in nurses' knowledge and competence. The scope of existing dysphagia questionnaires is limited, and most are designed for specialised populations. This study aimed to develop and validate a comprehensive tool to assess nurses' knowledge and perceived competence in dysphagia care.
METHODS: The Dysphagia Knowledge and Self-reported Competence Questionnaire for Nurses (DKSCQ-N) was developed and validated in two phases. Phase 1 included item generation through literature review, mapping items across six domains, and expert evaluation using a Table of Specification and the Content Validity Index. Cognitive interviews with nurses were conducted to assess clarity, relevance and usability. In Phase 2, data were collected from 537 nurses from hospitals across Pakistan to establish reliability and construct validity. Reliability was assessed using internal consistency and test-retest reliability. Validity was assessed using confirmatory factor analysis and convergent validity.
RESULTS: Expert review demonstrated strong content validity (S-CVI = 0.95). Minor revisions were made after cognitive interviews to improve clarity. Confirmatory factor analysis supported a 21-item, two-factor model with acceptable fit (χ2/df = 4.062, CFI = 0.93, TLI = 0.921, RMSEA = 0.076, GFI = 0.88). Both factors demonstrated good convergent and discriminant validity. Significant correlation between the signs and symptoms, complication and management domains of DKSCQ-N and Dysphagia knowledge Scale supported convergent validity. Internal consistency was high (Cronbach's α = 0.906) and test-retest reliability indicated excellent stability over two-weeks period (ICC = 0.829).
CONCLUSION: The DKSCQ-N is a valid and reliable instrument to assess dysphagia knowledge and self-reported competence of nurses. It provides a comprehensive and contextually relevant measure that can help identify learning needs and assess training outcomes in hospital settings.