Abstract
Purpose
The purpose of this study was to develop and validate the Communication Behavior Scale for nurses caring for people with Dementia (CBS-D).
Methods
Based on communication accommodation theory, the initial items were generated through a literature review and interviews with 20 experts. Content and face validity of the initial items were assessed. Data from 486 nurses caring for people with dementia were analyzed using item analysis, exploratory and confirmatory factor analysis, criterion-related validity, and internal consistency.
Results
The final scale consisted of 18 items and four factors (discourse response management, interpersonal control, emotional expression, and interpretability) that explained 57.6% of the variance. Confirmatory factor analysis indicated that the theoretical model with 18 items satisfied all goodness-of-fit parameters. Criterion-related validity was shown by the Global Interpersonal Communication Competence Scale (r=.506, p<.001). Cronbach's alpha for the total scale was .88.
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Table 1.
Characteristics | Categories | Data A | Data B | χ2 | p |
---|---|---|---|---|---|
n | (%) | ||||
Gender | Male | 9 (3.7) | 17 (7.0) | 2.60 | .107 |
Female | 234 (96.3) | 226 (93.0) | |||
Age (yr) | <30 | 37 (15.2) | 36 (14.8) | 0.71 | .949 |
30~39 | 57 (23.5) | 59 (24.2) | |||
40~49 | 68 (28.0) | 66 (27.2) | |||
50~59 | 69 (28.4) | 66 (27.2) | |||
≥60 | 12 (4.9) | 16 (6.6) | |||
Marriage | Married | 176 (72.4) | 175 (72.0) | 0.01 | >.999 |
Single | 59 (24.3) | 60 (24.7) | |||
Others | 8 (3.3) | 8 (3.3) | |||
Religion | Protestant | 83 (34.2) | 78 (32.2) | 2.53 | .771 |
Catholic | 39 (16.0) | 36 (14.8) | |||
Buddhist | 41 (16.9) | 44 (18.0) | |||
Others | 2 (0.8) | 6 (2.5) | |||
None | 78 (32.1) | 79 (32.5) | |||
Education | Diploma | 135 (55.5) | 133 (54.8) | 7.20 | .206 |
Bachelor | 97 (40.0) | 93 (38.2) | |||
Master | 10 (4.1) | 17 (7.0) | |||
Doctor’s degree | 1 (0.4) | 0 (0.0) | |||
Working organization | Elderly nursing ho | me 3 (1.2) | 3 (1.2) | 1.53 | .673 |
Elderly care hospit | al 224 (92.2) | 217 (89.3) | |||
Others† | 16 (6.6) | 23 (9.5) | |||
Working pattern | Day work | 122 (50.2) | 133 (54.7) | 7.19 | .126 |
3 shifts | 105 (43.2) | 101 (41.6) | |||
2 shifts | 5 (2.1) | 5 (2.1) | |||
Others†† | 11 (4.5) | 4 (1.6) | |||
Position | Head nurse | 62 (25.6) | 73 (30.0) | 4.08 | .395 |
Charge nurse | 28 (11.5) | 16 (6.6) | |||
Staff nurse | 134 (55.1) | 135 (55.6) | |||
Others§ | 19 (7.8) | 19 (7.8) | |||
Experience in nursing (yr) | ≤1 | 18 (7.4) | 11 (4.5) | 3.35 | .340 |
2≤~≤3 | 20 (8.2) | 20 (8.2) | |||
4≤~≤6 | 25 (10.3) | 18 (7.4) | |||
≥7 | 180 (74.1) | 194 (79.9) | |||
Experience in nursing for PWD (yr) | ≤1 | 50 (20.6) | 36 (14.8) | 3.60 | .308 |
2≤~≤3 | 52 (21.4) | 54 (22.1) | |||
4≤~≤6 | 55 (22.6) | 52 (21.3) | |||
≥7 | 86 (35.4) | 101 (41.8) | |||
Hard experience in caring for PWD | Yes | 167 (68.7) | 168 (69.1) | 1.00 | .605 |
No | 76 (31.3) | 75 (30.9) | |||
Education experience about | Yes | 136 (56.0) | 126 (52.0) | 0.67 | .413 |
communication with PWD | No | 107 (44.0) | 117 (48.0) | ||
Table 2.
No | Measure (Item) | M±SD | Communality | Factor1 | Factor2 | Factor3 | Factor4 |
---|---|---|---|---|---|---|---|
8 | I ask a question of the demented subject to answer easily such as ‘yes /no’. | 3.69±0.68 | .55 | .76 | .07 | -.06 | .18 |
7 | I adjust the volume of the voice and the speed of the speech according to the response of the demented subject. | 3.97±0.62 | .63 | .74 | .05 | .06 | -.14 |
9 | I talk about topics that the demented subject is interested in or is familiar with. | 3.72±0.61 | .63 | .72 | -.11 | -.14 | -.04 |
6 | I repeat the sentence if the demented subject does not respond. | 3.97±0.62 | .59 | .71 | -.01 | .01 | -.14 |
10 | I encourage the demented subject to express using nonverbal communication methods (eg: blinking, gestures, etc.) when it is difficult for the demented subject to communicate through verbal communication. | 3.76±0.68 | .48 | .44 | .07 | -.08 | -.31 |
13 | I tend to treat the demented subject as a child.† | 3.63±0.91 | .67 | -.01 | .83 | .07 | -.03 |
14 | I tend to say ‘banmal’ to the demented subject.† | 3.60±0.91 | .69 | -.05 | .80 | -.12 | .00 |
18 | I tend to ignore the behavior or desire of the demented subject.† | 3.53±0.94 | .63 | .11 | .74 | .00 | -.09 |
21 | I express positive attention with smiling at the demented subject. | 3.89±0.64 | .62 | .13 | .05 | -.74 | .07 |
15 | I give words of praise or encouragement to the demented subject. | 3.84±0.57 | .49 | -.12 | -.14 | -.69 | -.16 |
19 | I have a natural contact (eg: holding hand, etc.) while talking with the demented subject. | 3.80±0.68 | .49 | .13 | -.08 | -.68 | .06 |
16 | I pay attention to the nonverbal message of the demented subject (eg: changes in facial expressions, etc.). | 3.83±0.63 | .58 | .04 | -.03 | -.62 | -.23 |
22 | I maintain a stable emotional state regardless of the emotional changes of the demented subject. | 3.72±0.61 | .47 | .02 | .27 | -.59 | .07 |
17 | I encourage the demented subject to express emotions through realistic questions (‘when, who, what, where, how’) when they are anxious or aggressive. | 3.51±0.68 | .41 | .00 | .23 | -.50 | -.08 |
1 | I tell the demented subject by showing the object (eg: things, photos) directly. | 3.51±0.74 | .62 | .08 | .06 | -.04 | -.79 |
2 | I tell the demented subject clearly while showing my mouth shape. | 3.73±0.73 | .66 | .01 | .13 | -.03 | -.76 |
3 | I see if the demented subject focuses on the conversation while I make eye contact with the demented subject. | 3.88±0.64 | .61 | .18 | -.08 | -.15 | -.62 |
4 | I tell the demented subject one topic at a time. | 3.66±0.72 | .56 | .29 | -.00 | -.01 | -.58 |
Eigen value | 6.22 | 1.81 | 1.25 | 1.10 | |||
Variance (%) | 34.5 | 10.1 | 7.0 | 6.1 | |||
Cumulative Variance (%) | 34.5 | 44.6 | 51.6 | 57.6 |
Table 3.
Factor | No (Item) | SRW | AVE | CR |
---|---|---|---|---|
Discourse response management | 6 | .72 | .72 | .93 |
7 | .77 | |||
8 | .65 | |||
9 | .84 | |||
10 | .64 | |||
Interpersonal control | 13† | .66 | .52 | .77 |
14† | .80 | |||
18† | .58 | |||
Emotional expression | 15 | .70 | .63 | .91 |
16 | .72 | |||
17 | .49 | |||
19 | .66 | |||
21 | .71 | |||
22 | .55 | |||
Interpretability | 1 | .53 | .57 | .84 |
2 | .67 | |||
3 | .78 | |||
4 | .52 | |||
Model fitness χ2=214.30 (p<.001), CMIN/DF=1.66, SRMR=.05, | ||||
RMSEA=.06, GFI=.91, NFI=.86, CFI=.94 |
Table 4.
Classification | Discourse response management Ф2 | Interpersonal control Ф2 | Emotional expression Ф2 | Interpretability Ф2 | AVE | |
---|---|---|---|---|---|---|
Discourse response management | 1 | .72 | ||||
Interpersonal control | .08 1 | .53 | ||||
Emotional expression | .71† .06 | 1 | .63 | |||
Interpretability | .61 .05 | .59† | 1 | .57 | ||
Criteria | AVE>Ф2 | |||||
Factor A | Factor B | Ф (p) | SE | Ф-2×SE | Ф+2×SE | |
Discourse response management | <–> | Interpersonal control | .28 | .02 | 0.24 | 0.32 |
Discourse response management | <–> | Interpretability | .78 | .03 | 0.72 | 0.84 |
Discourse response management | <–> | Emotional expression | .84 | .02 | 0.8 | 0.88 |
Interpersonal control | <–> | Interpretability | .22 | .02 | 0.18 | 0.26 |
Interpersonal control | <–> | Emotional expression | .25 | .02 | 0.21 | 0.29 |
Interpretability | <–> | Emotional expression | .77 | .02 | 0.73 | 0.81 |