2026 Volume 30 Issue 1 Pages 5-23
Objective: The aim of this study was to develop quality indicators that Certified Nurses in Dysphagia Nursing (CNs) can utilize in a transdisciplinary team approach in hospitals.
Methods: The draft quality indicators were developed based on literature and other sources, focusing on the process aspect of healthcare quality assessment. They were categorized into two domains: technical (A) and interpersonal (B). They comprised 21 items grouped under four concepts in aspect A (e.g., screening) and 39 items under ten concepts in aspect B (e.g., organizational culture), totaling 60 items. To assess content validity and face validity, a questionnaire survey and expert panel review were conducted with CNs. Additionally, to further examine content validity among the multidisciplinary team members, a questionnaire survey was administered to council members of the Japanese Society of Dysphagia Rehabilitation. Known-group validity, construct validity, and reliability were assessed through a web-based survey of CNs working in hospitals regarding the frequency of implementation of the quality indicators, followed by statistical analysis. The significance level was set at 5%.
Results: Nine CNs evaluated the validity, importance, appropriateness, and feasibility of the indicators using a nine-point scale, resulting in median values (Mdn) ranging from 5 to 9. Items with Mdn values of 5 or 6 were reviewed and revised by the expert panel.
Among 45 council members surveyed, 59 items received Mdn values between 7 and 9. One item with an Mdn of 6 remained unchanged, and a new item, “Coordination with Other Teams,” was added, increasing the total indicators to 61.
Among 200 CNs surveyed (valid response rate: 24.4%), a ceiling effect was observed in five items under aspect B. The item.total correlation, excluding two items with commonality below .16, ranged from r＝.37 to .60 for aspect A and from r＝.55 to .81 for aspect B. Good.poor analysis indicated significantly higher scores in the upper group for 58 items. The total scores for aspects A and B were significantly higher in known groups where CNs were part of a team, teams had five or more professional roles and at least nine members, on-the-job training frequency was high, and team-based reimbursement was applied. Exploratory factor analysis revealed five factors for aspect A and four factors for aspect B, with interpretable item structures. Cronbach’s α was .875 for aspect A and .980 for aspect B.
Conclusion: The 61 developed quality indicators demonstrated acceptable validity and reliability.
