Establishment Of The Family Caregivers’ Care Ability Assessment Scale For Children With Enterostomy

ObjectivesIn view of the shortcomings of the current assessment tools for the family caregivers whoes children with enterostomy,the scale preparation process is strictly followed,aiming at the preparation of the primary caregiver care capacity assessment scale for children with enterostomy in line with our cultural and medical background.Reliability and validity tests were performed on the scale.Methods1.Item pool development:Based on Orem’s self-care theory and literature review and evidence-based guidelines.,a semi-structured in-depth interview was conducted among 13 family caregivers of children with enterostomy hospitalized in a comprehensive tertiary A children’s hospital in Shandong Province.By means of generic analysis and Colaizzi’s seven-step phenomenological data analysis.the nursing process and real feelings of the main caregivers of children with enterostomy were collected,and the corresponding thematic concepts were condensed.To provide reference for exploring the dimension and item pool of the nursing ability scale for the main caregivers of children with enterostomy,forty-two alternative item pools were formed.2.Formation of pre-test scale:The pool of alternative items was compiled into a letter inquiry paper.Experts from 11 tertiary hospitals in 5 provinces were invited to evaluate the initial dimensions of the scale and the contents of the pool of alternative items through two rounds of expert inquiries.After the expert inquiny,10 primary caregivers of in-patients with enterostomy at different ages,educational levels and nursing experiences with independent reading and understanding ability were selected as subjects for two rounds of cognitive interviews with caregivers.To further optimize the items and options of the scale.adjust the scale to a pre-test scale that is more acceptable to the subjects.3.Finalization and evaluation of the scale:From August 2018 to January 2019,142 primary caregivers of children with enterostomy who were hospitalized or reexamined in three general tertiary grade A children’s hospitals were selected for clinical testing.Collect and process the relevant data obtained from the survey,and use item distribution method,critical ratio method,correlation coefficient method to further judge whether items are deleted,and evaluate the appropriateness of the dimension of exploratory factor analysis.Cronbach’s alpha coefficient,split-half coefficient and retest reliability were used to evaluate the reliability of the scale.Meanwhile,content validity and structure validity were used to evaluate the validity of the scale.Results1.This study focused on the experience and feelings of the main family caregivers in the process of independent care of children with enterostomy.Three themes were taken out,which were the sense of helplessness,difficulties in implementing care measures and the continuous strengthening of self-efficacy.Among them,first theme includes two sub-themes:lack of effective disease awareness,a,nd questioning the ability to care for children independently.Second theme includes three sub-themes:uncertainty of stoma care,confusion of daily care knowledge and identification and poor coping with common complications of enterostomy.2.After two rounds of expert inquiries and cognitive interviews with caregivers,a pre-test scale consisting of six dimensions and fifty items was formed.After completing the clinical testing of 142 subjects,further screening of the entries and division dimensions,and finally established 34 items and 5 dimensions,namely ostomy cognition(4 items),basic skills of ostomy care(12 items)A formal scale of knowledge about daily life care(6 items),identification and response of enterostomy and peripheral complications(9 items),and caregiver execution(3 items).3.The Cronbach’s a coefficient of the total scale is 0.921,and the Cronbach’s a coefficients of the five dimensions are 0.895,0.891,0.810,0.861,and 0.685,respectively.The split-half coefficient of the total scale is 0.876,and the split-half coefficients of the five dimensions are 0.842,0.920,0.758,0.856,and 0.732,respectively.The retest reliability coefficient of the total scale is 0.813.and the retest reliability coefficients of the five dimensions are 0.705.0.825.0.737.0.804.and 0.792,respectively,and the differences are statistically significant.4.Content validity is assessed by calculating the content validity index(I-CVI)at the item level and the content validity index(S-CVI)at the scale level.Among them,the value range of I-CVI is 0.83 tol.00.both are greater than 0.78,indicating that the content validity of 34 items is higher.The S-CVI value is 0.95,which indicates that all the participating experts have a high degree of consensus and the content validity of the scale is good.In addition,the correlation coefficient between this scale item and the attribution factor is 0.574 to 0.903.The correlation coefficient between the item and other factors is 0.013 to 0.551.The correlation coefficient between each dimension and the total score of the scale is 0.500 to 0.782.The correlation coefficient between each dimension ranges from 0.192 to 0.592,and the difference is statistically significant.According to the requirements of exploratory factor analysis and the principle of item selection,four exploratory factor analyses were carried out and 13 items were deleted.Finally,five factors were extracted and 34 items were included in the scale.The cumulative explanatory variance was 62.251%.The structure validity of the scale was good.Conclusions1.This study completed the preparation of the primary caregiver’s care ability assessment scale for children with enterostomy,and finally contained 34 items and 5 dimensions,including ostomy cognition,basic skills of ostomy care.daily life care related knowledge and intestines.The five dimensions of stoma and surrounding complications identification and coping,caregiver execution,comprehensive coverage of the care traits of the main caregivers of children with enterostomy;2.The prepared scales have good reliability and validity,and each index has reached the acceptable range of psychometrics.At the same time,the items are moderate,the content covers more comprehensive,targeted and easy for parents to accept.The scale can be used as an assessment tool to assess the care ability of the main caregivers of children with enterostomy in China.