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研究生:沈文君
研究生(外文):Shen, Wen-Chun
論文名稱:德國法定照護保險新照護需求評估工具中文版信效度檢定
論文名稱(外文):Psychometric Testing of the Chinese Version of the New Assessment Instrument for Determining the Need for Long-term Care
指導教授:陳彰惠陳彰惠引用關係
指導教授(外文):Chen, Chung-Hey
口試委員:張宏哲王靜枝翁慧卿王瑞霞陳彰惠
口試委員(外文):Chang, Hong-JerWang, Jing-JyWeng, Hui-ChingWang, Ruey-HsiaChen, Chung-Hey
口試日期:2023-07-26
學位類別:博士
校院名稱:國立成功大學
系所名稱:健康照護科學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:英文
論文頁數:99
中文關鍵詞:照護需求評估工具長期照顧(護)德國照護保險信效度探索性因素分析
外文關鍵詞:care needs assessment toollong-term careGerman long-term care insurancereliability and validityexploratory factor analysis
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背景:隨著台灣社會高齡化趨勢加劇,長期照顧需求日益成為一項重要議題。我國政府於近二十年為了有效評估長期照顧需求,德國全民法定長照需保險量表已被廣泛應用於照護評估,然而該量表的中文版尚未建立並驗證。因此,本研究的目的在於翻譯德國法定照護保險所採用的「照護需求評估工具」為中文版,並評估其在台灣長期照顧需求評估上的信度和效度,同時探討台灣長期照顧需求的基本特質,以提供未來長照評估工具之參考。

研究方法:本研究為橫斷式研究設計,採方便取樣方法,研究地點為南部某醫學中心,本研究通過人體研究倫理審查委員會之審查後始進行收案。研究對象為該醫學中心具有長期照顧需求的20歲以上成年病患,共有346名研究參與者,其中53.5%為女性,46.5%為男性,平均年齡為75.2歲,呈現高齡化趨勢。研究工具為NBA量表中文版,該量表包含六個構面,用於評估長期照顧需求的不同層面。資料分析包括專家效度、內部一致性信度、折半信度、再測信度以及探索性因素分析。分析工具使用統計套裝軟體SPSS 25.0版進行統計。

研究結果:346名研究對象在NBA中文版的照護等級(共分五級)分布情形為第1級45人(13.0%)、第二級95人(27.5%)、第三級83人(24.0%)、第四級62人(17.9%)以及第5級57人(16.5%),另有4人評定為0級。NBA中文版內部一致性信度為0.973,六大構面的Cronbach's α介於0.758~0.995。折半信度方面,量表第一部分內部一致性Cronbach's α為0.951,第二部份為0.953,Guttman折半係數為0.915。再測信度檢定30位個案的前後測一致性,其全量表之組內相關係數(ICC)為0.969。探索性因素分析萃取出六個因素,解釋總變異量達79.151%,分別為「認知與溝通能力」、「日常生活功能」、「精神心理問題」、「醫療照護」、「攻擊行為」以及「居家護理」。
結論:本研究經嚴謹翻譯程序,完成NBA量表中文版,並驗證該量表具有良好的內部一致性信度、再測信度以及建構效度。研究結果顯示具有長照需球的研究個案其人口學屬性,呈現高齡化趨勢,教育程度偏低,主要照顧者多為親屬,這些結果有助於未來長期照顧政策和服務的制定。然而,因研究收案地點的限制,樣本可能存在收樣偏差的問題,建議未來進一步擴大研究取樣的範圍。此外,應進行NBA量表中文版與其他相關評估工具的比較研究,確保其適用性和有效性。未來研究可以進行長期追蹤研究,探討NBA量表中文版在評估患者功能改善和介入效果方面的應用價值。
Background: With the intensification of Taiwan's aging society, the demand for long-term care has become an increasingly important issue. Over the past two decades, the German long-term care insurance assessment tool, which is used to effectively evaluate long-term care needs, has been widely adopted. However, its Chinese version has not been established and validated. Therefore, the purpose of this study is to translate the German "Pflegebedürftigkeitsassessmentsystem" (NBA) assessment tool used in statutory long-term care insurance into Chinese and evaluate its reliability and validity in assessing long-term care needs in Taiwan. This study also aims to explore the basic characteristics of long-term care needs in Taiwan, providing reference for future long-term care assessment tools.

Methods: This study employed a cross-sectional design and convenient sampling method. The research was conducted at a medical center in southern Taiwan, and ethical approval was obtained from the Institutional Review Board before recruitment. The participants were adults aged 20 and above who required long-term care at the medical center. A total of 346 participants were included, with 53.5% being female and 46.5% being male. The average age was 75.2 years, reflecting an aging population trend. The research instrument used was the Chinese version of the NBA (C-NBA), which consists of six dimensions to assess different aspects of long-term care needs. Data analysis included expert validity, internal consistency reliability, split-half reliability, test-retest reliability, and exploratory factor analysis. Statistical analysis was performed using SPSS version 25.0.

Results: The distribution of care levels (five levels in total) among the 346 participants in the C-NBA was as follows: Level 1 (45 individuals, 13.0%), Level 2 (95 individuals, 27.5%), Level 3 (83 individuals, 24.0%), Level 4 (62 individuals, 17.9%), and Level 5 (57 individuals, 16.5%). Additionally, 4 individuals were assessed as Level 0. The internal consistency reliability of the C-NBA was 0.973, and the Cronbach's α values for the six dimensions ranged from 0.758 to 0.995. For split-half reliability, the Cronbach's α for the first part of the scale was 0.951, for the second part it was 0.953, and the Guttman's split-half coefficient was 0.915. Test-retest reliability, assessed with a subset of 30 cases, showed an intra-class correlation coefficient (ICC) of 0.969 for the entire scale. Exploratory factor analysis extracted six factors, explaining a total variance of 79.151%. These factors were "Cognition and Communication Skills", "Activities of Daily Living," " Psychological and Emotional Issues", "Medical Care," "Aggressive Behavior", and "Home Nursing Care".

Conclusion: Through a rigorous translation process, this study successfully established the C-NBA assessment tool and verified its good internal consistency reliability, test-retest reliability, and construct validity. The results showed that individuals with long-term care needs in Taiwan exhibited demographic characteristics of an aging population, lower educational levels, and predominantly family caregivers. These findings contribute to the formulation of future long-term care policies and services. However, due to limitations in the study's recruitment site, there may be sampling bias, suggesting the need to expand the study's sampling range in future research. Moreover, comparative studies between the C-NBA and other relevant assessment tools should be conducted to ensure its applicability and effectiveness. Future research can focus on long-term follow-up studies to explore the C-NBA's application value in assessing patient functional improvement and intervention effects.
摘 要 I
ABSTRACT III
誌 謝 VII
CONTENTS IX
1. INTRODUCTION 1
1.1 Background 1
1.2 Motivation of Research 3
1.3 Research Purpose 6
2. LITERATURE REVIEW 7
2.1 Developments of Long-term Care Insurance in Germany 7
2.2 Former Definition of LTC Need of SGB XI (Until End of 2016) 9
2.3 New Definition of LTC Need of SGB XI (From January 1st, 2017) 10
2.4 New Assessment Instrument of the LTCI System in Germany 13
2.5 Conceptual and Operational Definitions of the NBA 17
2.5.1. Module 1: Mobility 17
2.5.2. Module 2: Cognitive and Communication Skills 18
2.5.3. Module 3: Behavior and Psychological Issues 20
2.5.4. Module 4: Self-care 23
2.5.5. Module 5: Coping And Dealing Independently With Illness And Treatment-Related Demands And Stresses 26
2.5.6. Module 6: Planning Day-to-Day Living and Maintaining Social Contact 31
3. RESEARCH METHODS 33
3.1 Research Design and Study Subjects 33
3.2 Research Instruments 34
3.2.1. he scoring rules of C-NBA 35
3.3 Research Process 49
3.3.1. Phase 1: 50
3.3.2. Phase 2: 50
3.4 Research Ethics 51
3.5 Data Analysis 52
3.5.1. Descriptive statistics of demographic variables: 52
3.5.2. Reliability and validity testing of the C-NBA 53
4. RESEARCH RESULTS 55
4.1 Demographic Data of Study Participants 55
4.2 Reliability Testing of the C-NBA 58
4.2.1. Internal Consistency Reliability 58
4.2.2. Test-Retest Reliability 59
4.3 Validation of the C-NBA 61
4.3.1. Expert Content Validity 61
4.3.2. Construct Validity 65
4.4 Extracted Factors 72
4.4.1. Factor One: referred to as “Cognitive and Communication Skills” 72
4.4.2. Factor Two: referred to as “Activities of Daily Living” 72
4.4.3. Factor Three: referred to as “Psychological and Emotional Issues” 72
4.4.4. Factor Four: referred to as “Medical Care” 73
4.4.5. Factor Five: referred to as “Aggressive Behavior” 73
4.4.6. Factor Six: referred to as “Home Nursing Care” 74
5. DISCUSSION 75
5.1 Demographic Characteristics of the Study Participants 75
5.2 Reliability of the C-NBA 75
5.3 Validity of the C-NBA 77
5.3.1. Content Validity 77
5.3.2. Construct Validity 78
6. CONCLUSION 79
REFERENCES 81
APPENDIX 85
Appendix 1: Permission letter for utilizing the Assessment Instrument for Long-term Care Needs 85
Appendix 2: The C-NBA 86
Appendix 3: Barthel Index (巴氏量表) 99
中文(Chinese)
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行政院(2018)。重要政策-長照2.0,照顧的長路上更安心。https://www.ey.gov.tw/Page/5A8A0CB5B41DA11E/dd4675bb-b78d-4bd8-8be5-e3d6a6558d8d
李世代(2009)。長期照護需求與推估。載於陳惠姿(總校訂),長期照護實務(三版),(頁5-1-5-19)。臺北市:永大。
林谷燕(2016)。照顧需要性之評估-從長期照顧服務法與長照實務談起。月旦裁判時報,(54),64-72。
高琇珠(2010)。長期照護需求評估工具引進―日本介護評估量表台灣版之適用性(未出版之碩士論文)。國立台北護理學院,臺北市。
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英文(English)
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德文(German)
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Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS) & GKV-Spitzenverband Körperschaft des öffentlichen Rechts (2021). Richtlinien des GKV-Spitzenverbandeszur Feststellung der Pflegebedürftigkeit nach dem XI. Buch des Sozialgesetzbuches. Essen: MDS.
Rothgang, H., Hasseler, M., Fünfstück, M., Neubert, L., & Czwikla, J. (2015). Das NBA funktioniert. Altenheim, (8), 20-25. https://www.socium.uni-bremen.de/lib/download.php?file=5328232531.pdf&filename=AH_08_2015_Rothgang%20u.a._TT2_NBA.pdf
Windeler, J., Görres, S., Thomas, S., Kimmel, A., Langner, I., Reif, K., & Wagner, A. (2008). Maßnahmen zur Schaffung eines neuen Pflegebedürftigkeitsbegriffs und eines neuen bundesweit einheitlichen und reliablen Begutachtungsinstruments zur Feststellung der Pflegebedürftigkeit nach dem SGB XI. Institut für Public Health und Pflegeforschung Universität Bremen (IPP). Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS).
Wingenfeld, K., Büscher, A., & Gansweid, B. (2011). Das neue Begutachtungsinstrument zur Feststellung von Pflegebedürftigkeit. GKV-Spitzenverband.
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