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系統識別號 U0026-1408201301035500
論文名稱(中文) 個人疲勞強度量表中文版於台灣護理人員信效度之再驗證
論文名稱(英文) Evaluation of the Reliability and Validity of the Chinese Version of the Checklist Individual Strength Questionnaire: Data from Hospital Nurses of Workplace
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 101
學期 2
出版年 102
研究生(中文) 許瑞津
研究生(英文) Jui-Chin Hsu
學號 t26974088
學位類別 碩士
語文別 中文
論文頁數 91頁
口試委員 召集委員-蘇世斌
口試委員-王靜枝
指導教授-王琪珍
中文關鍵字 護理人員疲勞  個人疲勞強度量表 
英文關鍵字 Nurse fatigue  Checklist Individual Strength Questionnaire 
學科別分類
中文摘要 背景:護理是一門具有高度壓力與疲勞的專業工作,當護理人員處於長期工作疲勞狀態下,會危及自身健康和病人照護安全,如何有效測量其工作疲勞是值得探討的議題。
研究目的:探討Vercoulen等人發展的個人疲勞強度量表中文修訂版於測量醫院職場護理人員疲勞之信效度驗證。
研究方法:採用橫斷性研究設計,來自南部某醫療機構之醫學中心及其附屬區域醫院與地區醫院等符合工作至少三個月以上等條件之臨床護理人員有538份,以結構式問卷,透過上網填答收集資料。研究工具包括基本資料問卷、王等人(2000)之中文修訂版個人疲勞強度量表( Checklist Individual Strength Questionnaire, Chinese version; CIS-C )及Lee等人(2000)編制的台灣人憂鬱量表(Taiwanese Depression Questionnaire, TDQ)。資料分析,以平均值、標準差、百分比描述各變項之分佈,建構效度驗證;先進行項目分析,驗證量表原初始因素結構模式之適配度,再進行探索性因素分析及一階結構方程模式之驗證性因素分析。效標關聯效度驗證;則以卡方統計方法檢定憂鬱分數與疲勞強度分數的關聯。以項目間內在一致性檢定疲勞量表的信度。
研究結果:項目分析顯示資料可信且適合用來進行因素分析。原始量表因素結構模式,参數違犯估計,不適用於臨床職場護理人員的工作疲勞特徵。故進行初探性因素分析,結果萃取出三個構面,重新命名,分別為疲勞認知程度、活力感受程度及生理疲勞反應,解釋總變異量61.286 %,以一階結構方程模式驗證,整體模式適配度雖不佳(χ2=1055.313、df=167、χ2 /df=6.319、GFI=.810、AGFI=.761、RMR=.144、RMSEA=.147),然参數並未違犯估計,且分別具良好的收斂效度及區別效度。進一步檢定效標關聯效度,工作疲勞與憂鬱傾向的關聯統計具顯著意義,顯示此量表適用來測量護理人員的工作疲勞。信度部分,各分量表內在一致性如下;疲勞認知程度之Cronbach’s α係數.911,活力感受程度之Cronbach’s α係數.869,僅生理疲勞反應的Cronbach’s α係數.436偏低。但是整體信度的Cronbach’s α係數.909,仍在理想範圍。
結論及建議:中文修訂版個人疲勞強度量表(CIS-C)經本研究驗證發現,新模式結構呈現三個因素,其具可接受之效度與信度。我們建議若要應用個人疲勞強度量表來篩檢台灣臨床護理人員是否有工作疲勞時,需重新檢定此量表的敏感度與特異度的最佳臨界切點(cut-off point)。
英文摘要 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.
論文目次 目錄
中文摘要 I
Abstract III
致謝 VI
目錄 VII
表目錄 IX
圖目錄 X
附錄 X
第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 4
第三節 研究問題 4
第二章 文獻查證 5
第一節 工作疲勞論述 5
一、工作疲勞之意涵與理論基礎 5
二、工作疲勞定義及其調查問卷比較 8
第二節 個人疲勞強度量表( CIS )及其信效度 12
一、CIS量表之內容及發展過程 12
二、CIS量表在其他族群之應用與信效度探討 13
第三節 研究工具信效度檢定方法 18
一、項目分析(item analysis) 18
二、效度(validity)考驗 20
三、信度(Reliability)分析 26
第三章 研究材料與方法 27
第一節 研究設計 27
第二節 研究對象 27
一、研究對象來源 27
二、樣本數 28
三、抽樣方式 29
第三節 研究工具 30
一、基本資料問卷 30
二、中文修訂版個人疲勞強度量表(Checklist Individual Strength Questionnaire, Chinese version) 32
三、台灣人憂鬱量表(Taiwanese Depression Questionnaire; TDQ) 35
第四節 資料收集 36
一、網路問卷調查 36
二、收案流程 36
第五節 量表檢定流程 37
第六節 資料處理與統計分析 38
第七節 倫理考量 42
第四章 研究結果與分析 43
第一節 人口學變項統計 43
第二節 項目分析 46
第三節 建構效度 49
一、驗證原量表初始模式 49
二、探索性因素分析 52
三、新模式驗證性因素分析 58
第四節 效標關聯效度 65
第五節 信度 67
第五章 討論 68
第一節 項目分析 68
第二節 建構效度 69
一、驗證原量表初始模式 69
二、探索性因素分析 69
三、新模式驗證性因素分析 71
第三節 效標關聯效度 74
第四節 信度 75
第六章 結論與建議 76
第一節 結論 76
第二節 研究結果應用與建議 77
第三節 研究限制 78
參考資料 79

表目錄
表2-1工作疲勞調查問卷彙整 11
表2-2國內外探討CIS量表之信效度整理 16
表2-3整體模式適配指標之絕對適配指標 24
表3-1基本資料問卷各變項的選項及統計變項定義說明 31
表3-2個人疲勞強度問卷第16題修正 32
表3-3個人疲勞強度問卷各構面之題號及正反題向 34
表4-1個人基本資料統計分析表 (N=538 ) 44
表4-2工作特徵變項統計分析表 (N=538 ) 45
表4-3個人疲勞強度量表之項目分析摘要表(N=538) 48
表4-4個人疲勞強度量表原始模式參數估計值 50
表4-5新模式四因素之因素摘要 53
表4-6新模式三因素之因素摘要 56
表4-7直交轉軸與斜交轉軸因素分析量比較摘要表 57
表4-8個人疲勞強度量表新模式三因素參數估計值 59
表4-9個人疲勞強度量表新模式三因素適配度評鑑指標 60
表4-10個人疲勞強度量表新模式三因素之因素參數估計表及收斂效度 63
表4-11結構方程式中雙因素間之標準化係數(三因素) 64
表4-12個人疲勞強度量表之區別效度表(三因素) 64
表4-13 CIS之構面、總分及TDQ總分之相關(N=538) 65
表4-14有無疲勞及有無憂鬱之交叉表(N=538) 66
表4-15個人疲勞強度量表各構面信度分析 67
表5-1新模式三因素與CIS-J適配度指標比較 72

圖目錄
圖2-1疲勞適應模式( The Fatigue Adaptation Model) 7
圖3-1中文修訂版個人疲勞強度量表檢定流程圖 37
圖4-1個人疲勞強度量表初始模式圖 51
圖4-2陡坡圖 55
圖4-3個人疲勞強度量表新模式三因素模式一階圖(N=538) 61

附錄
附錄一個人疲勞強度量表中文版使用同意書 87
附錄二個人疲勞強度問卷 88
附錄三台灣人憂鬱症量表-李昱醫師 89
附錄四台灣人憂鬱症量表-董氏基金會 90
附錄五臨床試驗同意書 91
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