研究背景：
失智症者於病程發展過程中會逐漸喪失決策的能力，而無法進行醫療決策。基於病人自主權考量，在病人具自主決策能力時可透過預立醫囑以表達個人未來的醫療照護期望與意願。由於目前長期照顧機構護理人員對於失智症的照護及預立醫囑仍處於知識不清楚階段，在相關的在職教育介入前，期能先發展合宜工具可以評估長期照顧機構護理人員協助失智症者預立醫囑的知識、態度與技巧等狀況。
研究目的：
本研究為發展長照機構護理人員協助失智症住民預立醫囑之能力量表並測試其信效度。
研究方法：
本研究為一工具發展研究，研究對象為南部長照機構之護理人員。工具發展步驟如下，以文獻查證、資料統整後初擬問卷30題，並經由五位失智症照護與預立醫囑相關之學者及實務專家進行內容效度評估；以30位具臨床經驗的護理人員進行前驅測試。爾後，採立意取樣方式進行照顧失智症住民長照機構護理人員之資料收集，以Cronbach’s alpha及探索性因素分析檢測信效度。
研究結果：
本量表初擬30題，第一次明確性CVI值介於0.70-0.90，適切性CVI值介於0.68-0.82，專家建議做大幅修正，並進行第2次及第3次專家效度評估，統整後最終問卷所呈現的CVI值介於0.96-1.00；適切性CVI值介於0.96-1.00，經探索性因素分析縮減至26題，歸為共三個層面與七個因素。知識層面：文件相關記載、文件簽署、協助對象；態度層面：參與病人、主動協助；技巧層面：主動學習、病人權益，各層面總解釋變異量為57.42%、56.94%、61.44%，各層面Cronbach Alpha值為0.72、0.80、0.86，26題之整體Cronbach Alpha值為0.8。知識得分與工作總年資、接受安寧緩和醫療與預立醫囑的相關在職教育狀況呈正向相關；而態度得分與接受安寧緩和醫療的相關教育及失智症在職教育狀況呈正向相關；技巧得分則與人口學變項無顯著相關。
結論：
本研究所發展之問卷，經檢驗具良好的信效度，能有效了解長照機構護理人員在協助失智症住民預立醫囑的現況，可做為日後護理人員於長照機構預立醫囑教育推廣的依據，進而提升失智症住民的認知與簽署預立醫囑的意願。本研究的調查結果亦指出長照機構護理人員應思考失智症住民長期照護中所面對的倫理議題與困境。除了應積極充實自己的專業知識外，也須持續接受教育和訓練，更需增加倫理的知識與思辯的能力，以因應長期照護所面對的失智末期照護挑戰。

The purpose of this study was to develop a scale which can be used to understand the knowledge, attitude and practice of nurses’ advance directive planning for residents with dementia in long-term care facilities. This is an instrumental development study, subjects were nurses recruited from long-term care facilities in southern Taiwan. The scale was developed through the following steps: The initial 30 items were developed based on the literature review, palliative act and clinical experience. The content validity was assessed by five experts. A pilot testing was conducted using thirty experienced nurses. Afterwards, purposive sampling was used to recruit subjects from long-term care facilities. Expert content validity, internal consistency and factor analysis were performed to analyze data.
After evaluating by experts, the final clarity CVI is between 0.96-1.00. The scale was shortened to 26 items through exploratory factor analysis. Three levels and 7 factors were generated. The: active learning and patient rights. The total explained variation of knowledge, attitude, and practice levels are 57.42%, 56.94%, and 61.44%; Cronbach Alpha are 0.72, 0.80, and 0.86 for each level respectively.
The questionnaire has been tested and has good reliability and validity. It can effectively provide a scale for assessing the advance directive for caregivers in long-term institutions. Based on this, to enhance the awareness of dementia residents and the willingness to sign advance directives.
Key words: dementia, advance directive, long-term care facilities, scale

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