| Summary: | 碩士 === 國立成功大學 === 護理學系碩博士班 === 101 === Background: Nursing is a profession associated with high levels of stress and fatigue. When nurses are exposed to long-term work-related fatigue status, this can have adverse effects on both their own health and patient-care. It is thus worth examining how to assess work-related fatigue in this context.
Purpose: To explore the validity and reliability of the Chinese version of the Checklist Individual Strength Questionnaire, developed by Vercoulen et al., when applied to assess the work-related fatigue of hospital nurses.
Method: A cross-sectional design was applied in this study, and online structured questionnaires were used to collect the data. The participants were 538 nurses working in a medical center and its affiliated community hospitals (i.e., regional and district hospitals) in southern Taiwan for least 3 months. The measurement tools consisted of a basic demographic information questionnaire, the Chinese version of the Checklist Individual Strength Questionnaire (CIS-C) (Wang et al., 2000), and the Taiwanese Depression Questionnaire (TDQ) (Lee et al., 2000). With regard to the data analysis, means, standard deviations and percentages were used to describe distributions of the variables. With regard to the construct validity, the validity of the instrument, as well as the fitness of the model and the scales used, was first examined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) by first-order structured equation modeling (SEM) were then adopted to further examine the validity of the CIS-C. The Chi-square statistical method was used to test the association between the CIS-C and TDQ to ass the validity of the criteria. The internal consistency was also examined to test the reliability of the CIS-C.
Result: The results of the item analysis show that the data was reliable and appropriate for use in the subsequent factor analysis. The first-order SEM method was used to evaluate whether the subscales in the CIS-C could be represented by a four-factor model or not, and the results showed that the four-factor model was not appropriate for the assessment of fatigue among clinical nurses working in Taiwan. The exploratory factor analysis extracted the following three factors: the level of perceived fatigue, the level of energy, and the physical response to fatigue. These three factors could explain 61.286% of the total variance in work-related fatigue. With regard to the results of the CFA obtained using a first-order structural equation model test, the overall model fitness was not very high (χ2=1055.313, df=167, χ2 /df=6.319, GFI=.810, AGFI=.761, RMR=.144, RMSEA=.147), however, the parameters were accepted based on the testing criteria, and each had good convergent and discriminate validity. The test of criteria validity showed that there was a significant association between work fatigue and depressive tendency, which indicates that the CIS-C can appropriately reflect the work-related fatigue of nurses in Taiwan. With regard to the reliability, the results for the internal consistency of each subscale are as followings: the Cronbach’s α of the level of perceived fatigue, the level of energy, and the physical response to fatigue were .911, .869 and .436, respectively. Only one factor had low reliability, but the overall Cronbach’s α coefficient of the CIS-C was .909, which is within the ideal range.
Conclusions and recommendations: Based on the examination of the CIS-C carried out in this work, a new model was developed with a three-factor structure, and this model had acceptable reliability and validity. It recommends that future research re-test the sensitivity and specificity of the CIS-C to generate a new cut-off point for the CIS-C that can be used with hospital nurses working in Taiwan.
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