| Summary: | 博士 === 國立臺北護理健康大學 === 護理研究所 === 104 === This study focused on the idea of care with humanity and empowerment of psychiatric nursing homes and the quality of care. This study investigated the condition of quality of care of humanity and empowerment perceived by residents, and investigated the prediction model from an ecological perspective, in order to improve the quality of care of psychiatric nursing homes.
This study used both qualitative and quantitative research methods, and the purpose was to investigate the quality of care with humanity and empowerment of psychiatric nursing homes. This study was divided into 3 stages totally. The research purpose of stage 1 was to perform in-depth interviews with residents about their life experiences and to perform the content analysis. The research purpose of stage 2 was to develop the “scale on quality of care with humanity and empowerment of psychiatric nursing homes.” The research purpose of stage 3 was to comprehensively collect the data of residents in psychiatric nursing homes in Taiwan to analyze the model of influence of different factors of ecosystem on quality of care with humanity and empowerment for residents.
According to the research results of interviews with 39 residents who had lived in nursing homes for at least six months about their experiences of quality of care in stage 1, the preliminary analysis obtained six core concepts of quality of care to which residents paid attention, including “family life,” “family safety,” “family interactions,” “family honor,” “sense of family happiness,” and “family decision-making,” as well as a total of 39 detailed items.
Stage 2 obtained the expert content validity (CVI= 0.94) of the detailed items mentioned above, and then developed a questionnaire to collect the data from 424 residents in psychiatric nursing homes. This study used factor analysis to develop the “scale on quality of care with humanity and empowerment of psychiatric homes.” In addition, this study used SPSS version 22.0 to perform tests on reliability and validity and perform exploratory factor analysis to extract two factors (dimensions) called: “quality of care with humanity” (21 items) and “quality of care with empowerment” (18 items). The total variance of these two factors was 56.55% and 50.83%, respectively, and the construct validity was good.
Stage 3 used Amos 22.0 to analyze and investigate 424 residents’ perception of model of quality of care with humanity and that of quality of care with empowerment of psychiatric nursing homes from an ecological perspective, as well as the factors affecting the models. The results showed that, if this study used psychiatric homes’ external transport convenience, residents’ age, number of years of education, and gender, type of hospital, level of family support, level of professional nursing care, level of caregivers' support, and level of patients’ hope as independent variables and used the quality of care with humanity as the dependent variable to perform multiple regression analysis, the R2 coefficient was .385. If this study used nursing homes’ external transport convenience, residents’ age, number of years of education, and gender, type of hospital, level of family support, level of professional nursing care, level of caregivers' support, level of patients’ hope, and quality of care with humanity as independent variables and used the quality of care with empowerment as the dependent variable to perform multiple regression analysis, the R2 coefficient was .661. There were a total of 50 parameters tested in the path analysis of preset model in this study. X2= 62.602, degree of freedom=55, p value=.225 >.05, and chi-square value did not reach significance, suggesting that the assumed path model diagram matched the actual data. The results of the structural equation modeling (SEM) combining path analysis and multivariate analysis of factor analysis showed that, among the indices of overall goodness of fit, 14 evaluation indices met the standard of acceptance. The results of SEM analysis showed that the goodness of fit of SEM and data of quality of care with humanity and quality of care with empowerment were good, and the models matched the actual condition.
The models developed in this study can be provided as reference for the improvement of indices of quality of care of psychiatric nursing homes and the future development of interventions of quality of care with humanity and quality of care with empowerment. It is hoped that they can be provided as important reference for future development of long-term care policies of psychiatric nursing homes.
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