| Summary: | 碩士 === 國防醫學院 === 護理研究所 === 106 === Background. Dyspnea is a common clinical symptom and a subjective feeling that can cause physiological, mental, and behavioral changes in patients. Subjective description and self-rate by patients are generally used to assess dyspnea. However, for patients who are unable to communicate and/or express how they feel, their dyspnea may not be properly treated. As our knowledge, reliable and valid dyspnea assessment scales for patients in Taiwan who are unable to express themselves are scarce.
Purpuse. To develop a Chinese version of the Respiratory Distress Observation Scale (C-RDOS) and to test its reliability and validity.
Methods. This study was conducted in two phases. The first phase entailed creating the C-RDOS in compliance with internationally approved guidelines for cross-cultural adaptation of scales. The second phase involved adopting a cross-sectional study design, in which 80 patients diagnosed with lung cancer, chronic obstructive pulmonary disease, heart failure, or pneumonia were enrolled to test the internal consistency reliability and criterion validity of the C-RDOS. In addition, total of 80 patients who experienced pain within 24 hours after an orthopedic surgery and 80 healthy individuals from health management centers were selected to test the discriminant validity of the C-RDOS. Concurrently, the C-RDOS and a 4-point verbal descriptor scale (VDS) were used to assess the severity of dyspnea, and the 11-point numerical rating scale was used to assess the severity of pain in the participants. For descriptive and inferential statistical analyses were generated using SPSS for window, version 22.0. The p < .05 was set as the threshold for statistical significance.
Results: C-RDOS was rigorously developed by following the guidelines of cross-cultural adaptation of scales, and it performed a good content validity with item-content validity index (CVI) of 1.0 and scale-CVI of 1.0. The inter-rater reliability among five evaluators was excellent (Kendall’s W = 0.98, p < .001). The results revealed that the C-RDOS displayed an internal consistency reliability with Cronbach’s α of 0.81. In testing the criterion validity, patients undergoing weaning from mechanical ventilation, their C-RDOS scores and SpO2 were moderately and negatively correlated (r = ˗0.43, p < .001), whereas their C-RDOS and VDS scores were significantly and positively correlated (r = 0.90, p < .001). The discriminant validity was presented by, after controlling for heartbeats, pain scores of the patients who experienced pain within 24 hours after an orthopedic surgery non-correlated with the C-RDOS scores (r = 0.28, p = .21).
Conclusion: The C-RDOS established with good reliability and validity in compliance with internationally approved guidelines for cross-cultural adaptation of scales. This scale is anticipated to assist clinicians accurately assess the severity of dyspnea in intubated patients with difficult self-report and communication in Taiwan, and to provide appropriate care and further enhance the quality of the patient care.
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