循证实践准备度评估量表的验证性因素分析
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摘要
目的对循证实践准备度评估量表(clinic readiness evidence-based nursing assessment,CREBNA)进行验证性因素分析,验证其结构效度。方法以2017年参加复旦大学护理学院证据转化与临床应用工作坊培训后开展证据应用项目的351名护理人员为研究对象,发放并填写CREBNA,调查护理人员循证实践准备度水平,构建量表的假设结构模型,并检测是否与样本数据相契合。结果根据模型检验的修正指数(modification index,MI)对模型进行了修正,修正后结果显示:误差变异量均为正数;因素负荷量为0.621～0.889;且标准误为0.010～0.036;基本适配指标均达到检验标准。修正后的卡方自由度比值(χ~2/df)为1.558;残差均方和平方根(root mean square residual,RMR)为0.025;渐进残差均方和平方根(root mean square error of approximation,RMSEA)为0.040;适配度指数(goodness of fitindex,GFI)为0.900,调整拟合优度指数(adjusted goodness fit index,AGFI)为0.874,达到临界值;标准拟合指数(normed fit index,NFI)为0.931,相对拟合指数(renal function index,RFI)为0.919,增量拟合指数(incremental index of fit,IFI)为0.974,Tucker-Lewis指数(简称TLI)为0.970,相对拟合指数(comparative fit index,CFI)为0.974,故模型外在质量良好。所估计参数t值为11.544～19.868,均达显著水平;潜在变量的平均抽取变异量为0.546～0.642,潜在变量的组合信度为0.923～0.943;标准化残差的绝对值最大值为2.508;存在2个修正指标值>5.000,故模型内在质量良好。结论 CREBNA具有良好的结构效度,能够用于评估循证实践活动的准备度,指导相关证据应用项目的开展。
Objective To evaluate the structural validity of the Clinic Readiness Evidence-Based Nursing Assessment(CREBNA)scale by confirmatory factor analysis.Methods Totally 351 nursing staffs who carried out the evidence utilization projects after attending the Evidence Conversion and Clinical Application Workshop of Fudan University School of Nursing in 2017 were involved in this survey, and the CREBNA scale was issued and filled out by participants to investigate the readiness of the evidence-based practice. The general information of nurses, the preparation of evidence-based practice were investigated, and the hypothetical structure model of the scale was contructed and checked whether it fited the sample data.Results The model was modified according to the Modification Indices(MI)of the model validation,the revised verification results showed that all of the error variances were positive, the factor loading was between 0.621 and 0.889, and the standard error of estimate was between 0.010 and 0.036, which reached the preliminary fit criteria. Thus, the preliminary fit of the estimation result was good, and there was no violation of the model identification rule.After modification,the results were χ~2/df=1.558,RMR=0.025,RMSEA=0.040,GFI=0.900,AGFI=0.874,NFI=0.931,RFI=0.919,IFI=0.974,TLI=0.970 and CFI=0.974.Overall,the model was acceptable,which indicated that the external quality of the model was very well. About the fit of internal structural model,the modified result showed that the t values of variables were from 11.544 and 19.868, all of them reached a significant level;the average variance extracted from potential variables was 0.546 to 0.642;and the composite reliability of potential variables was 0.923 to 0.943;the maximum absolute value of the standardized residuals was 2.508;there were two correction indices greater then 5.000.Overall, the internal quality of the model was acceptable.Conclusions The CREBNA scale has good structural validity and can be used to assess the readiness of evidence-based practices and could be used within evidence-based nursing practice to guide the evidence utilization.
Objective To evaluate the structural validity of the Clinic Readiness Evidence-Based Nursing Assessment(CREBNA)scale by confirmatory factor analysis.Methods Totally 351 nursing staffs who carried out the evidence utilization projects after attending the Evidence Conversion and Clinical Application Workshop of Fudan University School of Nursing in 2017 were involved in this survey, and the CREBNA scale was issued and filled out by participants to investigate the readiness of the evidence-based practice. The general information of nurses, the preparation of evidence-based practice were investigated, and the hypothetical structure model of the scale was contructed and checked whether it fited the sample data.Results The model was modified according to the Modification Indices(MI)of the model validation,the revised verification results showed that all of the error variances were positive, the factor loading was between 0.621 and 0.889, and the standard error of estimate was between 0.010 and 0.036, which reached the preliminary fit criteria. Thus, the preliminary fit of the estimation result was good, and there was no violation of the model identification rule.After modification,the results were χ~2/df=1.558,RMR=0.025,RMSEA=0.040,GFI=0.900,AGFI=0.874,NFI=0.931,RFI=0.919,IFI=0.974,TLI=0.970 and CFI=0.974.Overall,the model was acceptable,which indicated that the external quality of the model was very well. About the fit of internal structural model,the modified result showed that the t values of variables were from 11.544 and 19.868, all of them reached a significant level;the average variance extracted from potential variables was 0.546 to 0.642;and the composite reliability of potential variables was 0.923 to 0.943;the maximum absolute value of the standardized residuals was 2.508;there were two correction indices greater then 5.000.Overall, the internal quality of the model was acceptable.Conclusions The CREBNA scale has good structural validity and can be used to assess the readiness of evidence-based practices and could be used within evidence-based nursing practice to guide the evidence utilization.
引文
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[2] BONHAM C A,SOMMERFELD D,WILLGING C,et al.Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies[J/OL].[2014-03-03].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989 772/.
[3] HANNES K,VANDERSMISSEN J,DE BLAESER L,et al.Barriers to evidence-based nursing:a focus group study[J].J Adv Nurs,2007,60(2):162-171.
[4] 米元元,沈月,郝彬,等.ICU患者肠内营养支持并发腹泻的循证护理实践[J].中华护理杂志,2017,52(11):1291-1298.
[5] 胡力云.导尿管相关尿路感染预防指南的循证实践研究[D].北京:北京中医药大学,2016.
[6] 顾莺,胡雁,张玉侠,等.儿科外周静脉留置针维护的最佳证据应用[J].护理学杂志:综合版,2014,29(8):52-55.
[7] 王文超,胡静,张玉侠,等.儿童中心静脉导管维护的最佳证据应用[J].护理学杂志,2017,32(7):33-37.
[8] 朱红芳,汤磊雯,贺晓莉,等.抗凝剂皮下注射护理规范的循证实践[J].中华护理杂志,2015,50(1):33-37.
[9] 曹艳佩,杨晓莉,唐慧婷,等.气管插管危重患者口腔护理的循证实践[J].护理学杂志,2016,31(11):45-48.
[10]张俊平,周英凤,周敏俊,等.提高与母乳喂养相关的乳头疼痛或损伤管理的循证实践[J].中华护理杂志,2014,49(9):1062-1066.
[11]成磊,陆春梅,张玉侠,等.提升早产儿出院家庭准备度最佳循证实践方案的制订和应用[J].中华护理杂志,2016,51(7):787-791.
[12]吕天婵,张玉侠.早产儿胃潴留管理相关研究进展[J].中国护理管理,2015,15(12):1525-1528.
[13]成磊,胡雁.证据应用在循证护理实践的研究现状[J].护理学杂志,2016,31(3):101-105.
[14]黄苗,顾莺.健康服务领域研究成果应用的行动促进框架应用性研究的文献范畴分析[J].解放军护理杂志,2017,34(14):1-8.
[15]黄苗,顾莺,张玉侠,等.循证护理实践准备度评估量表的研制及信效度评价[J].中国循证儿科杂志,2017,12(2):121-125.
[16]吴明隆.结构方程模型:AMOS的操作与应用[M].2版.重庆:重庆大学出版社,2010:5-45.
[17]BAGOZZI R P,YI Y.On the evaluation of structural equation models[J].J Academy Marketing Sci,1988,16(1):74-94.
[18]CARMINES E G,MCIVER J P.An introduction to the analysis of models with unobserved variables[J].Political Methodol, 1983, 9(1):51-102.
[19]BROWNE M W,CUDECK R.Alternative ways of assessing model fit[J].Sociological Methods Res,1992,21(2):230-258.
[20]HILL M C,TIEDEMAN C R.Evaluating model fit[M].New York:John Wiley and Sons,,2005:10-20.
[21]HU L,BENTLER P M.Cutoff criteria for fit indexes in covariance structure analysis:conventional criteria versus new alternatives[J].Structural Equation Modeling,1999,6(1):1-55.
[22]WHITTAKER T A.A beginner’s guide to structural equation modeling (3rd ed.)[M].Structural Equation Modeling A Multidisciplinary,2011:694-701.
[23]RIGDON E E.A necessary and sufficient identification rule for structural models estimated in practice[J].Multivariate Behav Res,1995,30(3):359-383.
[24]VAN PROOIJEN J,VAN D K W A.Confirmatory analysis of exploratively obtained factor structures[J].Edu Psychol Measure,2001,61(5):777-791.
[25]SCHREIBER J B,NORA A,STAGE F K,et al.Reporting structural equation modeling and confirmatory factor analysis results: a review[J].J Edu Res,2006,99(6):323-338.
[26]ANDERSON J C,GERBING D W.Structural equation modeling in practice:a review and recommended two-step approach[J].Psychological Bulletin,1988,103(3):411-423.