Disseny i validació d'un qüestionari per mesurar les actituds necessàries per tenir cura de la salut de les persones

Résumé

Nowadays, there is a clear trend among professionals towards the evidence that training to take care of people does not only have to be technical but also ethical (Bellver Capella, 2014), (Domingo Moratalla, 2013) (Arroyo Gordo M. d., Cortina Orts, Torralba Madrid, & Zugasti Cabrillo, 1997), (Noddings, 2003). This action matters (Watson, 2011), since care is the fundamental phenomenon of existing (Heidegger, 1999) and encompasses not only the physical field but also the moral: build, believe and mature (Foucault, 1990). The training of nurses, responsible for taking care of people's health, should combine both the accumulation of knowledge and the development of attitudes. Nurses need to have principles that support their professional performance, without these principles, care will be meaningless (Nightingale, 1990) (Bellver Capella, 2014). The training of these professionals can no longer be focused on knowing what to do, but also on how to do it (Watson, 2011). Cortina (Arroyo Gordo M. d., Cortina Orts, Torralba Madrid, & Zugasti Cabrillo, 1997) points out that a mature nurse will be the one who has managed to develop a series of attitudes: compassion, vocational attitude, responsibility, communication skills, ability to promote, technical competence and self-esteem. Two questions arise: Are we ensuring that the students who are trained in our Faculties can do so adequately, not only acquiring knowledge but also developing the necessary attitudes? Is the teaching and learning process we are following the right one? To answer these questions, we need an instrument to measure among students of the Degree in Nursing, these attitudes so necessaries to take care of people. This research is focused on the design and validation of a questionnaire to measure the attitudes proposed by Cortina. The theoretical support that bases the work rests on two theoretical constructions: caring and attitude. The theoretical construction of caring and nursing care is developed taking as a reference among others, the nursing models (Marriner Tomey & Raile, 1999) and the works of authors such as (Collière, 1982), (Watson, 2008), (Noddings, 2003) and (Gilligan, 2003). The theoretical construction of attitude and attitudes necessaries to take care of people's health is developed from the Theory of Reasoned Action of Fishbein & Ajzen, (1980) and the contribution of authors among others as (Moya Morales, et al., 1997), (Munné Matamala, 1986), Cortina. It is a methodological investigation (Polit & Hungler, 2000), with a quantitative design for validation of tests (Bandalos, 2018) and (Jornet Meliá, Suárez Rodríguez, & Pérez Carbonell, 2000). Taking into account the Standards for Educational and Psychological tests (2018). The application of the questionnaire for its validation has been carried out on a representative sample of students in the third and fourth year of the Degree in Nursing. The instrument designed has been a Likert-type questionnaire due to the simplicity of the elaboration method and the good general results, without neglecting the quality (Morales Vallejo, Urosa Sanz, & Blanco Blanco, 2003). The VANCS questionnaire has been configured in seven (7) dimensions: compassion; vocational attitude; responsibility; attitude towards communication; attitude towards empowerment in health; attitude towards technical competence and attitude towards professional self-esteem. In each of these dimensions, the items, according to the theoretical referents used by Fishbein and Ajzen (1980), have been grouped into three subdimensions: cognitive, affective-evaluative and behavioral. The sociodemographic variables studied were: age, sex, grade, first enrollment option, previous studies. The design and validation of the content of the questionnaire has been possible thanks to the Experts Judgment (Pedrosa, Suárez Álvarez, & García-Cueto, 2014), (Galicia Alarcón, Balderrama Trápaga, & Edel Navarro, 2017), (Escobar Pérez & Cuervo Martínez, 2008), (Bernal García, Salamanca Jiménez, & Pérez Gutiérrez, 2020). The favorable report of the project, by the Comitè Ètic d'Investigació en Humans of the Universitat de València, triggered the start of data collection, which took place between October 2020 and May 2021. The sample obtained was of 309 participants in the test and 90 in the retest. The statistical techniques used to determine the reliability, construct validation and temporal stability have been the following: Cronbach's alpha coefficient and the (CI) Confidence Interval; Multidimensional Scaling (MDS) with calculation of statistical Stress Kruskal, and RSQ (correlation coefficient square) and the t-student for paired samples with the intraclass correlation coefficient ICC. A descriptive analysis of a representative sample of third and fourth grade students has also been carried out, with the calculation of statistics (median, standard deviation, range) to obtain results on the level of attitudes among students, calculating the t- student for unpaired samples, to identify significant differences between the responses of third and fourth grade students. The results obtained show that the questionnaire presents adequate psychometric properties: α = .789 with a confidence interval (95% CI.753, .822); Stress values between 0.01 and 0.05, and RSQ values above (.99), very close to the value 1. Regarding the retest test, only 13 of the 117 items that make up the questionnaire have resulted with a p <0.05 and the Intraclass Correlation Coefficient has been 0.837. The assessment of the level of attitudes among third and fourth year students has shown that the lowest medians appear in the attitudes of responsibility and attitude towards professional self-esteem. Concerning third and fourth year students attitude levels, the differences are significant in attitudes: compassion, vocational attitude, responsibility, communication skills, ability to promote, technical competence and self-esteem. These results leave open lines of research such as: application of the VANCS questionnaire in a larger sample that includes a representation of all nursing training centers in the Comunitat Valenciana; measure the change and evolution of the level of attitude of nursing students throughout their training; determine how much teaching and learning methodologies affect the level of student attitudes; adapt and validate the VANCS questionnaire for application among the professional community, to determine the evolution of attitudes according to professional experience. These results will allow the explicit inclusion of teaching, modification and evaluation of attitudes in the training programs for nurses.