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Article(id=1322929529760645703, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.15.009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764604800000, receivedDateStr=2025-12-02, revisedDate=1782662400000, revisedDateStr=2026-06-29, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340578737, onlineDateStr=2026-10-30, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340578737, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340578737, creator=13701087609, updateTime=1793340578737, updator=13701087609, issue=Issue{id=1322929431592972373, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='15', pageStart='2577', pageEnd='2768', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340555332, creator='13701087609', updateTime=1793343107287, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940135335145743, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940135335145744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2646, endPage=2651, ext={EN=ArticleExt(id=1322929529978749512, articleId=1322929529760645703, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Sinicization of the Moral Competence Scale for Home Care Nurses and its reliability and validity test, columnId=1220689492655129450, journalTitle=Chinese Nursing Research, columnName=Scale Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To translate the Moral Competence Scale for Home Care Nurses(MCSHCN) into Chinese and to test its reliability and validity among community home-visit nurses.

Methods

According to the Brislin translation model,the MCSHCN was translated,back-translated,culturally adapted,and pre-surveyed to develop the Chinese version.A convenience sampling method was used to recruit 498 community home-visit nurses from Hangzhou city,Zhejiang province.The construct validity,content validity,internal consistency,and split-half reliability of the Chinese version of the MCSHCN were tested.

Results

The Chinese version of the MCSHCN consisted of 5 dimensions and 45 items.Exploratory factor analysis extracted 5 common factors,with a cumulative variance contribution rate of 66.856%.Confirmatory analysis model fitting indicators,χ²/ν=1.725,RMSEA=0.052,GFI=0.801,NFI=0.800,TLI=0.899,and CFI=0.904.The scale-level content validity index(S-CVI) was 0.985.The item-level content validity index(I-CVI) ranged from 0.833 to 1.000.The Cronbach's α coefficient of the scale was 0.969.The split-half reliability was 0.868.

Conclusions

The Chinese version of the MCSHCN for home care nurses has good reliability and validity.It could be used as an effective tool to evaluate the moral competence of home-visit nurses in China.

, authors=Shinan HAN1, Yan MA2, Wen GAO1, Xuejiao ZHU1, authorsList=Shinan HAN, Yan MA, Wen GAO, Xuejiao ZHU, authorCompany=null, correspAuthors=Xuejiao ZHU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929530310099529, articleId=1322929529760645703, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=家庭访视护士伦理胜任力量表的汉化及信效度检验, columnId=1220689492902593405, journalTitle=护理研究, columnName=量表研究, runingTitle=null, highlight=null, articleAbstract=
目的

对家庭访视护士伦理胜任力量表（MCSHCN）进行汉化，并检验其在社区家庭访视护士中的信效度。

方法

根据Brislin翻译模型，对家庭访视护士伦理胜任力量表进行正译、回译、跨文化调适及预调查，形成中文版家庭访视护士伦理胜任力量表。采用便利抽样法，选取浙江省杭州市498名社区家庭访视护士进行调查，检验量表的结构效度、内容效度、内部一致性和折半信度等。

结果

中文版家庭访视护士伦理胜任力量表包括5个维度、45个条目。探索性因子分析共提取5个公因子，累计方差贡献率为66.856%。验证性分析模型拟合指标：卡方自由度比（χ2/ν）=1.725，近似误差均方根（RMSEA）=0.052，拟合优度指数（GFI）=0.801，规范拟合指数（NFI）=0.800，Tucker-Lewis指数（TLI）=0.899，比较拟合指数（CFI）=0.904。量表水平的内容效度指数（S-CVI）为0.985，条目水平的内容效度指数（I-CVI）为0.833~1.000。量表的Cronbach's α系数为0.969，折半信度为0.868。

结论

中文版家庭访视护士伦理胜任力量表具有良好的信效度，可作为评估我国家庭访视护士伦理胜任力的有效工具。

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韩诗楠，护士，硕士研究生在读

, correspAuthorsNote=
朱雪娇，E-mail:
ZHU Xuejiao, E-mail:
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pageStart=2, pageEnd=5, url=null, language=null, rfNumber=22, rfOrder=21, authorNames=关于印发公立医院高质量发展促进行动(, journalName=中华人民共和国国家卫生健康委员会公报, refType=null, unstructuredReference=关于印发公立医院高质量发展促进行动(2021—2025年)的通知(国卫医发〔2021〕27号)[J].中华人民共和国国家卫生健康委员会公报,2021(9):2-5., articleTitle=2025年)的通知(国卫医发〔2021〕27号), refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322929530536591946, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, xref=1, ext=[AuthorCompanyExt(id=1322929530544980555, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, companyId=1322929530536591946, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School of Public Health and Nursing, Hangzhou Normal University, Zhejiang 310000 China), AuthorCompanyExt(id=1322929530557563468, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, companyId=1322929530536591946, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1杭州师范大学公共卫生与护理学院，浙江 310000)]), AuthorCompany(id=1322929530649838157, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, xref=2, ext=[AuthorCompanyExt(id=1322929530658226766, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, companyId=1322929530649838157, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Zhejiang Hospital), AuthorCompanyExt(id=1322929530666615375, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, companyId=1322929530649838157, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2浙江医院)])], figs=[ArticleFig(id=1322929534533763696, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, language=EN, label=Table 1, caption=

General information of community home-visit nurses（n=498）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数百分比（%）
性别男10.2
女49799.8
临床护理工作经历有35471.1
无14428.9
第一学历中专16132.3
专科20140.4
本科及以上13627.3
现阶段学历中专10.2
专科6112.2
本科及以上43687.6
职称护士295.8
护师9919.9
主管护师29459.0
副主任护师6412.9
主任护师122.4
护理管理经历是8316.7
否41583.3
接受伦理相关培训次数无12925.9
1次或2次19839.8
>2次17134.3
), ArticleFig(id=1322929534600872561, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, language=CN, label=表1, caption=

社区家庭访视护士的一般资料（n=498）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数百分比（%）
性别男10.2
女49799.8
临床护理工作经历有35471.1
无14428.9
第一学历中专16132.3
专科20140.4
本科及以上13627.3
现阶段学历中专10.2
专科6112.2
本科及以上43687.6
职称护士295.8
护师9919.9
主管护师29459.0
副主任护师6412.9
主任护师122.4
护理管理经历是8316.7
否41583.3
接受伦理相关培训次数无12925.9
1次或2次19839.8
>2次17134.3
), ArticleFig(id=1322929534802199154, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, language=EN, label=Table 2, caption=

The factor loading of the Chinese version of the Moral Competence Scale for Home Care Nurses items

, figureFileSmall=null, figureFileBig=null, tableContent=
条目因子1因子2因子3因子4因子5
条目1：我关心服务对象/家庭并协调服务对象/家庭与相关人员/组织之间在意图（计划）上的分歧0.613
条目2：我坚持在相关人员/组织之间共享政策和相关信息0.711
条目3：我创设周围的系统和环境，以更好地让服务对象/家庭专注于解决问题0.623
条目4：我关心服务对象/家庭，与他们及相关人员/组织共同思考0.702
条目5：我关心服务对象/家庭，与他们及相关人员/组织共同交流分享目标（计划）0.600
条目6：我向服务对象/家庭提供适当的信息，并支持“那些令服务对象/家庭满意的选择（决策）”0.574
条目7：我寻找最佳时机和机会与服务对象/家庭一起解决问题0.724
条目8：我常与相关人员/组织讨论0.605
条目9：我向相关人员/组织陈述我所提供护理的理由，并传达自己判断和护理的合理性0.753
条目10：我创设机会和制度，以便相关人员/组织能够共享护理政策和信息（病例讨论、护理协调会议等）0.673
条目11：我考虑并尝试所有可能的解决方案0.714
条目12：我通过关键人物（如上级领导、医生、家属等）间接解决问题0.706
条目13：我与管理者或监督者讨论并报告情况，并根据组织的决策提供护理0.691
条目14；我提供的护理是在与本（工作）领域更有经验的护士和同事协商（确定）的0.703
条目15：我在长期照护中根据实际情况提供护理0.690
条目16：我常营造一种有利于坦诚讨论的平静氛围0.685
条目17：我有意志力，不会被直接面对的问题或反对意见所击败0.776
条目18：我有顽强的毅力直接面对问题或反对意见0.734
条目19：我有勇气直接面对问题或反对意见0.683
条目20：我可以坦率地表达我的观点，不会在任何人面前动摇0.723
条目21：我有能经受考验和磨难的情感力量0.815
条目22：我有不回避问题或反对意见的正义感0.768
条目23：我有强烈的责任感0.578
条目24：我相信我的价值观、思维和判断是恰当的0.587
条目25：我对护理实践有着坚定不移的信念0.669
条目26：我努力积极地面对观点冲突的困难局面0.619
条目27：我努力尝试新的行动并拓宽我的努力范围0.630
条目28：我决定我的护理是否适合该家庭0.639
条目29：我做决定时会考虑到家庭重视什么0.650
条目30：我做决定时会优先考虑家庭的想法和价值观0.658
条目31：我认为考虑谁遇到了麻烦很重要0.561
条目32：我会考虑到人们对专业人员（护士）的期望0.710
条目33：我认为不给服务对象/家庭造成不利影响很重要0.639
条目34：我根据可靠的证据做出决定0.768
条目35：我做决定时会考虑患者/家庭的未来0.629
条目36：我会经常思考作为1名专业护士我参与（居家护理）的程度0.742
条目37：做决定前我会考虑所有的可能性0.658
条目38：我努力履行作为专业（护士）的职责和角色0.726
条目39：我做决定时会考虑组织的情况和框架0.692
条目40：我做决定时会考虑组织的政策和规定0.689
条目41：我做决定时会参考独立方（如伦理委员会、社区医生、社区工作者等）的客观意见0.741
条目42：我做决定时会考虑相关人员/组织的意见0.729
条目43：我能感受到服务对象/家庭与我之间存在的意图（计划）差异0.723
条目44：我能感受到相关人员/组织与我之间存在的意图（计划）差异0.747
条目45：我能感受到服务对象/家庭之间存在的意图（计划）差异0.694
特征值21.5522.8712.4151.8291.419
累计方差贡献率（%）47.89354.27359.63863.70266.856
), ArticleFig(id=1322929534902862451, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, language=CN, label=表2, caption=

中文版家庭访视护士伦理胜任力量表各条目因子载荷

, figureFileSmall=null, figureFileBig=null, tableContent=
条目因子1因子2因子3因子4因子5
条目1：我关心服务对象/家庭并协调服务对象/家庭与相关人员/组织之间在意图（计划）上的分歧0.613
条目2：我坚持在相关人员/组织之间共享政策和相关信息0.711
条目3：我创设周围的系统和环境，以更好地让服务对象/家庭专注于解决问题0.623
条目4：我关心服务对象/家庭，与他们及相关人员/组织共同思考0.702
条目5：我关心服务对象/家庭，与他们及相关人员/组织共同交流分享目标（计划）0.600
条目6：我向服务对象/家庭提供适当的信息，并支持“那些令服务对象/家庭满意的选择（决策）”0.574
条目7：我寻找最佳时机和机会与服务对象/家庭一起解决问题0.724
条目8：我常与相关人员/组织讨论0.605
条目9：我向相关人员/组织陈述我所提供护理的理由，并传达自己判断和护理的合理性0.753
条目10：我创设机会和制度，以便相关人员/组织能够共享护理政策和信息（病例讨论、护理协调会议等）0.673
条目11：我考虑并尝试所有可能的解决方案0.714
条目12：我通过关键人物（如上级领导、医生、家属等）间接解决问题0.706
条目13：我与管理者或监督者讨论并报告情况，并根据组织的决策提供护理0.691
条目14；我提供的护理是在与本（工作）领域更有经验的护士和同事协商（确定）的0.703
条目15：我在长期照护中根据实际情况提供护理0.690
条目16：我常营造一种有利于坦诚讨论的平静氛围0.685
条目17：我有意志力，不会被直接面对的问题或反对意见所击败0.776
条目18：我有顽强的毅力直接面对问题或反对意见0.734
条目19：我有勇气直接面对问题或反对意见0.683
条目20：我可以坦率地表达我的观点，不会在任何人面前动摇0.723
条目21：我有能经受考验和磨难的情感力量0.815
条目22：我有不回避问题或反对意见的正义感0.768
条目23：我有强烈的责任感0.578
条目24：我相信我的价值观、思维和判断是恰当的0.587
条目25：我对护理实践有着坚定不移的信念0.669
条目26：我努力积极地面对观点冲突的困难局面0.619
条目27：我努力尝试新的行动并拓宽我的努力范围0.630
条目28：我决定我的护理是否适合该家庭0.639
条目29：我做决定时会考虑到家庭重视什么0.650
条目30：我做决定时会优先考虑家庭的想法和价值观0.658
条目31：我认为考虑谁遇到了麻烦很重要0.561
条目32：我会考虑到人们对专业人员（护士）的期望0.710
条目33：我认为不给服务对象/家庭造成不利影响很重要0.639
条目34：我根据可靠的证据做出决定0.768
条目35：我做决定时会考虑患者/家庭的未来0.629
条目36：我会经常思考作为1名专业护士我参与（居家护理）的程度0.742
条目37：做决定前我会考虑所有的可能性0.658
条目38：我努力履行作为专业（护士）的职责和角色0.726
条目39：我做决定时会考虑组织的情况和框架0.692
条目40：我做决定时会考虑组织的政策和规定0.689
条目41：我做决定时会参考独立方（如伦理委员会、社区医生、社区工作者等）的客观意见0.741
条目42：我做决定时会考虑相关人员/组织的意见0.729
条目43：我能感受到服务对象/家庭与我之间存在的意图（计划）差异0.723
条目44：我能感受到相关人员/组织与我之间存在的意图（计划）差异0.747
条目45：我能感受到服务对象/家庭之间存在的意图（计划）差异0.694
特征值21.5522.8712.4151.8291.419
累计方差贡献率（%）47.89354.27359.63863.70266.856
), ArticleFig(id=1322929534995137140, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, language=EN, label=Table 3, caption=

Fitting indicators before and after model correction

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项目χ2/νRMSEAGFINFITLICFI
优秀标准<3.000<0.050>0.900>0.900>0.900>0.900
良好标准3.000~5.000<0.080>0.800>0.800>0.800>0.800
实测结果1.7250.0520.8010.8000.8990.904
), ArticleFig(id=1322929535087411829, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929529760645703, language=CN, label=表3, caption=

模型修正前后的拟合指标

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项目χ2/νRMSEAGFINFITLICFI
优秀标准<3.000<0.050>0.900>0.900>0.900>0.900
良好标准3.000~5.000<0.080>0.800>0.800>0.800>0.800
实测结果1.7250.0520.8010.8000.8990.904
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家庭访视护士伦理胜任力量表的汉化及信效度检验
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韩诗楠 1 , 马燕 2 , 高雯 1 , 朱雪娇 1, *, *
护理研究 | 量表研究 2026,40(15): 2646-2651
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护理研究 |量表研究 2026 , 40 (15) : 2646 -2651
家庭访视护士伦理胜任力量表的汉化及信效度检验
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韩诗楠1, 马燕2, 高雯1, 朱雪娇1, *, *
作者信息
  • 1杭州师范大学公共卫生与护理学院，浙江 310000
  • 2浙江医院
通讯作者:
朱雪娇，E-mail:
ZHU Xuejiao, E-mail:
作者简介:

韩诗楠，护士，硕士研究生在读

Sinicization of the Moral Competence Scale for Home Care Nurses and its reliability and validity test
Shinan HAN1, Yan MA2, Wen GAO1, Xuejiao ZHU1
Affiliations
  • 1School of Public Health and Nursing, Hangzhou Normal University, Zhejiang 310000 China
  • 2Zhejiang Hospital
出版时间: 2026-08-10 doi: 10.12102/j.issn.1009-6493.2026.15.009
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摘要
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目的

对家庭访视护士伦理胜任力量表（MCSHCN）进行汉化，并检验其在社区家庭访视护士中的信效度。

方法

根据Brislin翻译模型，对家庭访视护士伦理胜任力量表进行正译、回译、跨文化调适及预调查，形成中文版家庭访视护士伦理胜任力量表。采用便利抽样法，选取浙江省杭州市498名社区家庭访视护士进行调查，检验量表的结构效度、内容效度、内部一致性和折半信度等。

结果

中文版家庭访视护士伦理胜任力量表包括5个维度、45个条目。探索性因子分析共提取5个公因子，累计方差贡献率为66.856%。验证性分析模型拟合指标：卡方自由度比（χ2/ν）=1.725，近似误差均方根（RMSEA）=0.052，拟合优度指数（GFI）=0.801，规范拟合指数（NFI）=0.800，Tucker-Lewis指数（TLI）=0.899，比较拟合指数（CFI）=0.904。量表水平的内容效度指数（S-CVI）为0.985，条目水平的内容效度指数（I-CVI）为0.833~1.000。量表的Cronbach's α系数为0.969，折半信度为0.868。

结论

中文版家庭访视护士伦理胜任力量表具有良好的信效度，可作为评估我国家庭访视护士伦理胜任力的有效工具。

家庭访视  /  护士  /  伦理胜任力  /  信度  /  效度  /  量表
Objective

To translate the Moral Competence Scale for Home Care Nurses(MCSHCN) into Chinese and to test its reliability and validity among community home-visit nurses.

Methods

According to the Brislin translation model,the MCSHCN was translated,back-translated,culturally adapted,and pre-surveyed to develop the Chinese version.A convenience sampling method was used to recruit 498 community home-visit nurses from Hangzhou city,Zhejiang province.The construct validity,content validity,internal consistency,and split-half reliability of the Chinese version of the MCSHCN were tested.

Results

The Chinese version of the MCSHCN consisted of 5 dimensions and 45 items.Exploratory factor analysis extracted 5 common factors,with a cumulative variance contribution rate of 66.856%.Confirmatory analysis model fitting indicators,χ²/ν=1.725,RMSEA=0.052,GFI=0.801,NFI=0.800,TLI=0.899,and CFI=0.904.The scale-level content validity index(S-CVI) was 0.985.The item-level content validity index(I-CVI) ranged from 0.833 to 1.000.The Cronbach's α coefficient of the scale was 0.969.The split-half reliability was 0.868.

Conclusions

The Chinese version of the MCSHCN for home care nurses has good reliability and validity.It could be used as an effective tool to evaluate the moral competence of home-visit nurses in China.

home visit  /  nurse  /  moral competence  /  reliability  /  validity  /  scale
韩诗楠, 马燕, 高雯, 朱雪娇. 家庭访视护士伦理胜任力量表的汉化及信效度检验. 护理研究, 2026 , 40 (15) : 2646 -2651 . DOI: 10.12102/j.issn.1009-6493.2026.15.009
Shinan HAN, Yan MA, Wen GAO, Xuejiao ZHU. Sinicization of the Moral Competence Scale for Home Care Nurses and its reliability and validity test[J]. Chinese Nursing Research, 2026 , 40 (15) : 2646 -2651 . DOI: 10.12102/j.issn.1009-6493.2026.15.009
正文
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伦理素养是医护人员职业素养的基石[1]，在国内伦理和道德因含义相似，经常交替使用[2]。家庭访视是指护士进入服务对象家庭中开展的照护工作，涉及个体、家庭以及社区等多个层面，常面临复杂的伦理困境[3]，需要在多样化的护理情景中作出伦理决策，要求具备一定的伦理胜任力。目前伦理胜任力的概念尚未统一，但大多都体现了道德行为四成分模型（道德敏感性、道德判断、道德动机和道德品性）的核心内涵[4]。已有学者将护士伦理胜任力定义为护士需系统掌握护理领域伦理原则，具备伦理敏感性、伦理感知及伦理判断等个人伦理素养，同时应具备伦理推理、伦理反思、伦理决策能力与伦理勇气，能够践行伦理行为，承担伦理责任[5]。我国Yu等[6-7]将中文版护士伦理胜任力量表应用于医院临床护士，但现有的量表并不适合在需求日益增加的家庭访视情景中使用。日本学者研制的家庭访视护士伦理胜任力量表（Moral Competence Scale for Home Care Nurses，MCSHCN）在日本家庭访视护士的研究中呈现出良好的信效度[8]。本研究旨在汉化该量表并检验其在我国社区家庭访视护士群体中应用的信效度和跨文化适应性，为我国家庭访视护士伦理胜任力的评估提供了有效的工具。本研究已通过杭州师范大学护理学院伦理委员会审批（编号：2025004）。
1　研究方法
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1.1　量表介绍
家庭访视护士伦理胜任力量表由日本学者Asahara等[8]于2013年基于五维度道德行为框架研制。该框架是在Rest道德行为四成分模型[9]中增加实施道德决策维度而形成。量表包括创设护理情景从而带给服务对象/家庭最佳效益（16个条目）、直面困境的坚强意志（11个条目）、基于护士价值观的判断（11个条目）、基于组织或外部标准的判断（4个条目）和对意图差异的认识（3个条目）5个维度，共45个条目。各条目采用Likert 5级评分法，从“强烈不同意”到“强烈同意”依次计1~5分，量表总分45~225分，得分越高表示受试者伦理胜任力越高。该量表已在日本等[8,10]国家的家庭访视护士等群体中应用，并显示出良好的信效度。
1.2　量表的汉化
1.2.1　翻译
获得原作者Asahara授权后，根据Brislin翻译模型[11]对原量表进行汉化。1）正译：由2名母语为中文并精通英语的护理学硕士研究生分别对原量表进行正向翻译，形成正译稿1和2，由第3名护理学博士研究生对2份正译版本及英文原量表进行比对和整合后形成正译综合版本，即家庭访视护士伦理胜任力量表-1。2）回译：由2名（1人为护理学博士研究生，1人为英语专业硕士研究生，曾在母语为英语的国家留学且未接触过该量表）研究者独立回译成英文，形成回译稿1和2。研究团队将2份回译版本与原量表进行比对，讨论修订后形成回译综合版本并提交原作者审核。研究团队对原量表和回译版本进一步修改优化，最终形成家庭访视护士伦理胜任力量表-2。
1.2.2　跨文化调适
邀请6名来自社区护理、护理教育及医学伦理领域的专家，通过函询对量表内容、语义表述等提出建议。6名专家中博士研究生4人；均为高级职称（主任护师2人、教授1人、副教授3人）；专家工作年限8~38（26.5±12.29）年。
1.2.3　预调查
根据预调查最适样本量原则[12]，于2025年6月选取杭州市某社区卫生服务中心的30名社区护士进行预调查。纳入标准：1）持有护士执业资格证，并通过社区护士岗位培训者；2）过去1年曾从事家庭访视工作者；3）知情同意并自愿参与研究者。排除调查期间不在岗护士。在取得调查对象知情同意后，邀请其填写中文版家庭访视护士伦理胜任力量表施测版，并记录量表的填写时间。
1.3　量表的信效度检验
1.3.1　调查对象
采用便利抽样法，选取2025年7月—10月浙江省杭州市上城区（n=7）、西湖区（n=6）、拱墅区（n=5）、余杭区（n=1）、萧山区（n=4）、钱塘区（n=3）共26所社区卫生服务中心的社区护士作为调查对象。纳入与排除标准同预调查。根据结构效度检验，探索性因子分析要求样本量为量表条目数的5~10倍[13]，中文版家庭访视护士伦理胜任力量表共45个条目，计算样本量为225~450人；验证性因子分析要求样本量至少为200人[14]，考虑10%的无效问卷，需要样本量248~495人。
1.3.2　调查工具
1）一般资料调查表：包括性别、年龄、工作年限、工作经历、学历、职称等；2）中文版家庭访视护士伦理胜任力量表：包括5个维度、45个条目。
1.3.3　资料收集方法
研究人员通过与各社区卫生服务中心负责人联系，采用纸质版问卷或问卷星平台（https://v.wjx.cn/vm/PbqksX4.aspx#）的形式，进行一对一、面对面的调查，保障问卷的质量及完整性。问卷发放前编写统一指导语，告知研究目的与意义。量表填写完成后，研究者将进行现场回收及核对。问卷星平台上的答卷将由2名研究者进行初步筛选，剔除作答时间<120 s的无效答卷。共发放问卷518份，回收有效问卷498份，有效回收率为96.14%。
1.3.4　统计学方法
采用Excel软件双人录入数据并进行一致性检查，以保证录入数据的准确性。采用SPSS 26.0和AMOS 26.0软件进行统计分析。检验水准α=0.05。
1.3.4.1　项目分析
1）临界比值法：将量表各条目得分按降序排列，前27%为高分组，后27%为低分组，对两组进行独立样本t检验[15]，以决断值<3.000为标准；2）相关系数法：计算各条目得分与量表总分的相关系数，删除相关系数<0.300的条目[16]。
1.3.4.2　效度检验
1）内容效度：包括量表条目水平的内容效度指数（I-CVI）及量表水平的内容效度指数（S-CVI），当I-CVI>0.780，S-CVI>0.800时，认为该量表具有良好的内容效度[17]；2）结构效度：运用探索性因子分析和验证性因子分析评价量表结构效度，检验验证性因子分析模型拟合情况，拟合指标包括卡方自由度比（Chi-square/degrees of freedom，χ²/ν）、近似误差均方根（root mean square error of approximation，RMSEA）、拟合优度指数（goodness of fit index，GFI）、比较拟合指数（comparative fit index，CFI）、规范拟合指数（normed fit index，NFI）、Tucker-Lewis指数（Tucker-Lewis index，TLI）；3）聚合效度：采用平均方差提取值（average variation extracted，AVE）和组合效度评价量表聚合效度[18]。
1.3.4.3　信度检验
1）内部一致性信度：采用Cronbach's α系数进行检验，Cronbach's α系数>0.700视为量表的内部一致性较好[19]；2）折半信度：以奇偶分半法计算量表的折半信度，折半信度>0.700为可接受[20]。
2　结果
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2.1　跨文化调试结果
研究团队根据专家反馈对7个条目进行了讨论和修改。在量表内容方面，如将条目15“我在长期参与的同时根据情况提供护理”调整为“我在长期照护中根据实际情况提供护理”；在语义表述方面，如将条目36“我想知道作为1名专业（护士）我应该如何参与”修改为“我会经常思考作为1名专业护士我参与（居家护理）的程度”，最终未删除或增加量表的条目，形成中文版家庭访视护士伦理胜任力量表施测版，共45个条目。
2.2　预调查结果
结果显示，调查对象反馈能够清晰理解量表各项内容，未对量表内容提出任何修改意见。
2.3　社区家庭访视护士的一般资料
498名社区家庭访视护士年龄22~58（39.28±7.74）岁，社区工作年限为1~39（13.94±9.35）年，其他一般资料见表1。
2.4　项目分析结果
1）临界比值法：各条目的决断值为9.737~16.539（均P<0.001），表明各条目区分度较好。2）相关系数法：各条目得分与量表总分的相关系数为0.563~0.727（均P<0.001），表明各条目与总量表一致性好，因此，保留量表的所有条目。
2.5　效度
2.5.1　内容效度
中文版家庭访视护士伦理胜任力量表的I-CVI为0.833~1.000，S-CVI为0.985，表明内容效度较好。
2.5.2　结构效度
2.5.2.1　探索性因子分析
选取2025年7月—8月调查的228份有效问卷进行探索性因子分析。中文版家庭访视护士伦理胜任力量表的KMO值为0.950（>0.600），Bartlett's球形检验显示，χ2=8 685.523，P<0.001，说明可以进行探索性因子分析。采用主成分分析法和最大方差正交旋转法，共提取出5个特征值≥1的公因子，累计方差贡献率为66.856%，各条目在其所属因子的载荷值为0.561~0.815，其中条目15、条目23、条目24、条目31存在双重载荷，但对任一双重载荷条目进行删除后，相应维度的Cronbach's α系数均降低，结合专家意见，保留以上条目，将其归属至高因子载荷因子。最终确定中文版家庭访视护士伦理胜任力量表保留原量表的5个维度，共45个条目。经探索性因子分析，条目26、条目27因子归属发生变动；因子命名与原量表相同，因子1为创设护理情景从而带给服务对象（家庭）最佳效益维度（条目1~条目16），因子2为基于护士价值观的判断维度（条目26~条目38），因子3为直面困境的坚强意志维度（条目17~条目25），因子4为基于组织或外部标准的判断维度（条目39~条目42），因子5为对意图差异的认识维度（条目43~条目45），详见表2。
2.5.2.2　验证性因子分析
选取2025年9月—10月调查的270份有效问卷进行验证性因子分析。采用最大似然法进行验证性因子分析，结果表明，5因子一阶模型拟合指标良好[20]，详见表3。
2.5.3　聚合效度
结果显示，因子1：AVE为0.493，组合效度为0.939；因子2：AVE为0.488，组合效度为0.925；因子3：AVE为0.548，组合效度为0.916；因子4：AVE为0.643，组合效度为0.878；因子5：AVE为0.651，组合效度为0.848，说明量表的聚合效度理想。
2.6　信度
中文版家庭访视伦理胜任力量表总的Cronbach's α系数为0.969，各维度的Cronbach's α系数为0.866~0.947；量表总的折半信度为0.868，各维度的折半信度为0.781~0.925，提示量表信度良好。
3　讨论
收起
3.1　中文版家庭访视护士伦理胜任力量表汉化过程具有科学性
本研究汉化的家庭访视护士伦理胜任力量表为我国家庭访视护士的伦理胜任力测量提供了特异性评估工具。在汉化过程中，本研究严格遵循Brislin翻译模型，邀请的翻译人员均精通中英文双语，保证了翻译的精确性。通过邀请熟悉本研究领域的高水平专家进行跨文化调适，使量表更符合我国文化背景和家庭护理实践。经预调查评估中文版家庭访视护士伦理胜任力量表的理解度和接受度，最终形成该量表中文版本，保留了原量表的5个维度，共45个条目。仅对条目26、条目27进行维度归属调整，未对原量表条目数量进行改动，保持了原量表的结构完整性与内容一致性。
3.2　中文版家庭访视护士伦理胜任力量表具有良好的信效度
本研究对498名社区家庭访视护士进行了调查，验证了中文版家庭访视护士伦理胜任力量表在我国社区家庭访视护士中应用的信效度。总量表和各维度的Cronbach's α系数和折半系数均>0.7，表明该量表具有较好的内部一致性。专家函询结果显示，I-CVI和S-CVI均达标，说明量表具有较好的内容效度。通过探索性因子分析共提取5个公因子，累计方差贡献率为66.856%，各条目因子载荷为0.561~0.815，提示中文版家庭访视护士伦理胜任力量表具有较好的结构效度。本研究结果显示，原量表中归属于直面困境的坚强意志维度的条目26、条目27在中文版家庭访视护士胜任力量表中被归类至基于护士价值观的判断维度。分析原因可能与文化背景差异有关，在我国文化背景及社区护理实践影响下，我国护士群体更倾向于将其理解为基于自身职业价值观的选择[21]，导致中文版家庭访视护士胜任力量表在因子归类上与原量表不同，该结果已获得原作者认可。各维度与理论框架的道德敏感性、判断、动机、行动与反思层面一一对应。创设护理情景以为服务对象（家庭）带来最优效益的维度体现了道德决策层面；基于护士价值观的判断维度以及基于组织或外部标准的判断维度反映了道德判断；直面困境的坚定意志维度反映了道德动机与品格；对意图差异的认知维度则对应道德敏感性。总体而言，该量表能够全面评价家庭护理中的伦理实践过程。
3.3　中文版家庭访视护士伦理胜任力量表具有良好的应用前景
目前，我国家庭护理的服务模式正从以社区护士家庭访视为主导向整合“互联网+护理服务”“长期护理保险”等多元化服务模式发展[22]。本研究以从事家庭访视工作的社区护士为研究对象，但“互联网+护理服务”护士、长期护理保险体系的护理人员也是居家上门服务的提供者，未来可进一步验证其在不同群体中的适用性。家庭访视护士伦理胜任力量表的使用可评估家庭访视护士在伦理敏感性、判断力及实践反思能力等伦理胜任力的现状与短板，为制订针对性家庭访视护士的伦理胜任力培养方案提供科学依据。
4　小结
收起
本研究严格按照量表汉化过程形成的中文版家庭访视护士伦理胜任力量表包括5个维度，共45个条目，具有良好的信效度，可用作我国家庭访视护士伦理胜任力的可靠评估工具。因本研究在浙江省杭州市开展，研究结果有待在其他地区和群体中进一步验证。

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doi: 10.12102/j.issn.1009-6493.2026.15.009
  • 接收时间：2025-12-02
  • 首发时间：2026-10-30
  • 出版时间：2026-08-10
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  • 收稿日期：2025-12-02
  • 修回日期：2026-06-29
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    1杭州师范大学公共卫生与护理学院，浙江 310000
    2浙江医院

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朱雪娇，E-mail:
ZHU Xuejiao, E-mail:
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