The Study On The Elderly Health Service Competence Of Nurses In Primary Health Care Institutions Under The Background Of Active Aging

Objectives:The objectives of this research are to construct an index system of the elderly health service(EHS)competence of nurses in primary health care institutions(PHCIs);compile the corresponding scale and test its reliability and validity;use the results to understand the current situation of the EHS competence of nurses in PHCIs;analyze the relationship between the influencing factors and active aging of elderly individuals;and provide a scientific basis for actively building the EHS competence of primary nurses to promote the realization of active aging.Methods:This study mainly adopted a combination of quantitative and qualitative methods.(1)Literature research and semistructured interviews:An index system for the EHS competence of nurses in PHCIs was constructed.(2)Delphi method:Two rounds of expert correspondence were performed.Then,the preliminarily formed indicator system was confirmed and modified,a scientific and standardized indicator system of the EHS competence of nurses in PHCIs was established,and a pretest scale was formed.(3)Empirical study:A multistage stratified random cluster sampling survey was conducted on 482 primary nurses to test the reliability and validity of the pretest scale.SPSS 26.0 and AMOS 26.0 were applied for data analysis,and Cronbach’sα,half reliability,and retest reliability were used for the reliability test.The validity was cross-validated through exploratory factor analysis and confirmatory factor analysis and the formal version of the EHS competence scale for nurses in PHCIs was formed.A cluster sampling survey was conducted on 720 primary nurses in the Eighth Division of the Xinjiang Production and Construction Corps.Correlation analysis and regression analysis were both performed to verify the current situation and determine the influencing factors of the aforementioned EHS competence by SPSS 26.0.Finally,the relationship between the EHS competence of primary nurses and the active aging of elderly individuals was explored.Results:(1)On the basis of literature research and semistructured interviews,the elements of the EHS competence of nurses in PHCIs were refined via expert panel discussions.Then,an indicator system of the aforementioned EHS competence was initially constructed.This system included 3 first-level indicators,11second-level indicators,33 third-level indicators,and 45 three-level indicator descriptions.The system was used to explain professional knowledge,practical skills,and personal characteristics.(2)The final constructed system included 3 first-level indicators(theoretical knowledge,practical skills,and personal characteristics),10 second-level indicators(professional knowledge of elderly care,humanistic knowledge related to elderly care,elderly care skills,elderly health management and health education skills,emergency management skills of public health emergencies,communication and cooperation skills,scientific research skills,service values,service attitude,and personality psychology),35 third-level indicators,and 41 three-level indicator descriptions.These indicators were used to explain the EHS competence index system of nurses in PHCIs.(3)A total of 41 three-level indicator descriptions in the EHS competence indicator system of nurses in PHCIs were converted into scale items,and the five-point Likert scoring method was adopted to form the EHS competence scale of nurses in PHCIs.After item analysis and reliability and validity tests,six items of the scale were deleted.The results of the item analysis showed that the decision value of 41 items ranged from 6.981 to 17.235,all of which were greater than 3,and the difference was statistically significant(P<0.05).The correlation coefficient between each item and the total score of the scale ranged from 0.360 to 0.659(P<0.05),all of which were greater than 0.3.Meanwhile,eight common factors with eigenvalues of>1 were extracted by exploratory factor analysis,and the cumulative variance contribution rate was 67.085%.The model fitting indices(X~2/df=1.020,RMSEA=0.007,RMR=0.025,GFI=0.932,CFI=0.998,NFI=0.923,PNFI=0.826)were obtained by confirmatory factor analysis.All values were within the acceptable range,and the fit of the model fits is good.The average variance extraction(AVE)of each dimension was 0.513?0.645,the combined reliability was 0.763?0.890,and the convergent validity of the scale was relatively ideal.The eight dimensions presented a significant correlation(P<0.05)and were smaller than the square root of the corresponding AVE.Furthermore,the differential validity of the scale data was ideal.The reliability analysis obtained a Cronbach’sαcoefficient of 0.919,a Spearman?Brown coefficient of 0.812,and a retest reliability score of0.893.The formal scale of EHS competence of grassroots nurses entailed 8 dimensions and 35 items and included professional knowledge of elderly care,humanistic knowledge of elderly care,elderly care skills,elderly health management and health education skills,emergency management skills of public health emergencies,communication and research skills,service values and attitudes,and personality and psychology.(4)The total score of the EHS competence of the primary nurses ranged from 57 to 160,with a total score of 110.05±16.81,which was at the lower middle level.The average score of the standardized health education and management skills dimension was the highest(3.26±0.70),whereas the average score of the emergency management skills for public health emergencies dimension was the lowest(3.02±0.77).Age,professional title,type of primary medical institution,and working years at the grassroots level and the items on whether working experience exists in a tertiary or secondary hospital and whether formal health training for elderly individuals and nursing practice environment were determined as the influencing factors of the EHS competence of primary nurses(P<0.05).These findings can explain 47.2%of the total variance(F=70.488,P<0.05).(5)The level of active aging of elderly individuals was between medium and low,with a total score of 91.85±16.32.Furthermore,the EHS competence of primary nurses was positively correlated with the level of active aging of elderly individuals(r=0.347,P<0.05).The nursing practice environment presented a positive regulating effect on the relationship between the EHS competence of primary nurses and the active aging(β=0.290,F=8.254,P<0.05)(ΔR~2=0.020).Conclusions:(1)The index system of the EHS competence of nurses in PHCIs constructed via multiple evaluation methods in this study is scientific and feasible.On the basis of the indicator system and empirical research,the scale of the EHS competence of nurses in PHCIs has good reliability and validity and can be used as a measuring tool for the EHS competence of primary nurses.(2)The primary nurses have a lower moderate level of EHS competence.This finding is correlated with age,professional title,type of primary medical institution,and working years at the primary level,and the items on working experience exist in tertiary or secondary hospitals,and whether formal health training for elderly individuals and nursing practice environment are the influencing factors of the EHS competence of primary nurses.(3)The EHS competence of primary health care nurses is positively correlated with the level of active aging of elderly individuals,and the nursing practice environment has a positive regulatory effect on the relationship between the EHS competence of primary health care nurses and active aging.