Factorial Structure of Nursing Practices Related to Support for Decision-Making Regarding Consent for Surgery in Elderly Patients with Dementia

When elderly patients with dementia require highly invasive treatment or surgery for life-threatening conditions, decisions regarding consent for surgery are made based on informed consent provided by the family, which excludes the patient whose decision-making ability is deemed impaired due to the dementia. This study aimed to clarify the factorial structure of nursing practices related to support for decision-making regarding consent for surgery in elderly patients with dementia. An anonymous self-administered questionnaire survey was completed by nurses with three or more years of experience working in orthopedic surgery wards at secondary emergency hospitals in the Kinki area. The survey collected data on participant attributes and nursing practices related to decision-making support. Data were analyzed by exploratory factor analysis (promax rotation) using nursing practice items related to decision-making support as variables. Internal consistency was examined. Participants were 112 nurses including 108 women (96.4%) and four men (3.6%), with a mean age of 38.3 (±SD 9.8) years. Exploratory factor analysis of the nursing practice items related to decision-making support demonstrated the validity of the observed 24 variables, with a Kaiser-Meyer-Olkin value of 0.858 and a significant Bartlett's test of sphericity ( < 0.001). Five components with eigenvalues of 1 or more were extracted, including "achieving advocacy for elderly patients with dementia through cooperation among medical professionals," "advice considering the lifestyles and values of patients and their families," "support with a deeper understanding of elderly patients with dementia," "support that helps elderly patients with dementia to express their intentions," and "nurses' attendance in IC sessions for elderly patients with dementia." The Cronbach's α coefficient for the 24 nursing practice items related to decision-making support was high, at 0.926. The factorial structure of nursing practice related to support for decision-making regarding consent for surgery in elderly patients with dementia included five factors and 24 items. The reliability and construct validity of the factorial structure were also confirmed.