目的 编制NICU终末期患儿安宁疗护质量评价量表（Neonatal Intensive Care Unit-Palliative Care Quality Assessment Scale, NICU-PCQAS）,并检验其信效度,为测评NICU患儿安宁疗护质量提供适用工具。方法 在新生儿“优逝”理论框架指导下,借鉴成人死亡质量量表,通过文献回顾和半结构式访谈构建量表条目池;通过德尔菲专家函询、预调查形成量表初稿。采用方便抽样法,对2021年7月—2023年7月江苏省、浙江省、四川省等3所综合医院、9所妇幼保健院、6所儿童医院的344例NICU患儿的安宁疗护质量进行调查,并进行项目分析和信效度检验。结果 量表包括5个维度,20个条目。探索性因子分析共提取5个公因子,可解释总变异的76.35%;验证性因子分析结果显示,量表结构模型的拟合指标良好（χ2/df=1.25、残差均方根=0.03、增值拟合指数=0.99、拟合优度指数=0.99、近似误差均方根=0.03）。量表条目水平的内容效度指数为0.78~1.00,量表水平的内容效度指数为0.97。总量表的Cronbach‘s α系数为0.92,折半系数为0.75,各维度的Cronbach‘s α系数为0.86~0.93,折半系数为0.87~0.92。结论 NICU-PCQAS信效度良好,可用于测评NICU患儿的安宁疗护质量,为NICU新生儿安宁疗护的开展提供依据。
Objective To develop the Neonatal Intensive Care Unit-Palliative Care Quality Assessment Scale（NICU-PCQAS） and evaluate its reliability and validity,with the aim of providing an appropriate tool for assessing the quality of palliative care in NICU infants. Methods Guided by the conceptual model of a good death in the NICU,and referring to the Adult Quality of Dying and Death Questionnaire,the initial item pool was constructed through literature review and semi-structured interviews. The draft of the NICU-PCQAS was developed using a Delphi methodology and pre-investigation. Convenient sampling was used to investigate and evaluate the quality of palliative care of 344 neonates in 3 general hospitals,9 maternal and child health hospitals,and 6 children‘s hospitals in Jiangsu Province,Zhejiang Province,and Sichuan Province from July 2021 to July 2023. The data were then analyzed for item analysis,testing of reliability and validity. Results A 5-domain,20-item NICU-PCQAS was developed. Exploratory factor analysis identified five factors accounting for 76.35% of the variance. Confirmatory factor analysis showed a good fit（χ2/df=1.25,RMR=0.03,IFI=0.99,CFI=0.99,RMSEA=0.03）. The I-CVI ranged from 0.78 to 1.00,and the S-CVI was 0.97. The Cronbach‘s α was 0.92,and the Spearman-Brown coefficient was 0.75. Domain-specific Cronbach‘s α ranged from 0.86 to 0.93,and Spearman-Brown coefficients ranged from 0.87 to 0.92. Conclusion The NICU-PCQAS is reliable and valid,suitable for assessing the quality of palliative care in NICU infants,and supports the development of palliative care in NICUs.
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