Development and validation of a paternalism and autonomist care assessment

• Published in: Journal of advanced nursing Vol. 75; no. 11; pp. 3166 - 3178
• Main Authors: Fernández‐Ballesteros, Rocío, Sánchez‐Izquierdo, Macarena, Olmos, Ricardo, Huici, Carmen, Caprara, María Giovanna, Santacreu, Marta, Ribera Casado, José Manuel, Cruz‐Jentoft, Alfonso
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2019
• Subjects: Adults; Appraisal; assessment; Autonomy; Behavior; care assessment; Caregivers; Caregiving; Day care centers; development; Discriminant validity; Evaluation; instrument; Nurses; Nursing; nursing care; Older people; Paternalism; Patient-centered care; Quantitative psychology; styles of care; type of care; Validity; assessment; autonomy; development; type of care; instrument; nursing; paternalism; care assessment; nursing care; styles of care
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14154

Aim There is a need for a validated instrument to measure the type of care (paternalism or person‐centred) provided for older adults. Since paternalism and person‐centred care are the most important caregiving styles in the field of care and as they are usually opposed, the study aims to develop and establish psychometrics data of an instrument to identify paternalistic and autonomist behaviours in older adults care contexts, which can help to enhance care practice. Design Instrument development. Methods After observing and standardizing behaviours in formal care contexts in 2016, an instrument was developed and proceeding to a first validation using standard validation techniques among caregivers in two care settings during 2016–2017: senior citizen centres and older adult day care centres. Results The Paternalist/Autonomist Care Assessment (PACA) is a 30‐item, behaviour‐based instrument which measures both the appraisal of caregivers on elements of care (Care Appraisal Scale‐ PACA‐Appraisal) and the occurrence of behaviours (Occurrence of Care in Context‐ PACA‐Occurrence). The Paternalist/Autonomist Care Assessment (PACA) was validated in 160 professional caregivers and was able to discriminate two factors: paternalistic or overprotective behaviours and autonomist behaviours. However, these factors were not fully dichotomous and were shown to coexist to some degree. Conclusion The instrument displayed good psychometric properties to measure paternalism and autonomy in older adult care. Moreover, it showed that the two types of care are not antagonistic and can coexist, with overprotective behaviours being more frequent in contexts of care for more dependent persons. Impact There are no validated instruments to measure paternalism and person‐centred behaviour in care contexts. The two measures yielded by the PACA show good construct and concurrent empirical validity, internal consistency, and convergent and discriminant validity. Family caregiver, professional caregivers, nurses, older adults. 目的 我们需要一个衡量为老年人提供的护理类型(家长式或以人为本)的有效工具。家长制和以人为中心的护理是护理领域最重要的护理方式,而且这两种护理方式通常是对立的,因此本研究旨在开发和建立确定老年人护理环境中的家长制和自主行为范畴的心理测量数据,有助于加强护理实践。 设计 量表开发。 方法 以2016年对正规护理环境下的行为进行的观察和标准化为基础,建立量表。并在2016‐2017年期间使用标准验证技术对两个护理环境:老年人中心和老年人日托中心中的护理人员进行了首次验证 。 结果 家长式/自主式护理评估表(PACA)是一个30项、基于行为的量表,它衡量护理人员对护理要素的评估(护理评估量表‐PACA‐评估)和行为的发生(不同背景中护理的发生‐PACA‐护理)。家长式/自主式护理评估(PACA)在160名专业护理人员中进行验证,两个因素:家长式或过度保护行为和自主式行为能够被区分。然而,这些因素并不是完全相互区别的,在某种程度上显示出共存性。 结论 该量表在衡量老年人护理中的家长式护理和自主性护理中显示出良好的心理计量特性。此外,研究表明,这两种类型的护理不是对立的,可以共存,在患者显示出更多依赖性时,过度保护行为出现更为频繁。 影响 护理中没有有效工具来判定家长式护理和以人为本的护理的区别。PACA得出的两个测度具有良好的结构效度和并发经验效度、内部一致性、收敛和判别效度。适用于家庭护理人员,专业护理人员,护士,老年人。