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Instrument Development Measuring Critical Care Nurses' Attitudes and Behaviors with End-of-life Care

Zomorodi, Meg; Lynn, Mary R.

doi: 10.1097/NNR.0b013e3181dd25ef

Background: Although critical care nurses are expected to focus on providing life-sustaining measures, many intensive care patients actually receive end-of-life care.

Objectives: The aim of this study was to develop an instrument to measure nursing attitudes and behaviors regarding end-of-life care.

Method: Phase 1 was focused on item development from a content analysis of the literature and qualitative interviews of critical care nurses. Phase 2 consisted of content validity assessment and pilot testing. Phase 3 included field testing, factor analysis, and reliability estimation.

Results: The Values of Intensive Care Nurses for End-of-Life (n = 695) was found to have four factors: Self-appraisal, Appraisal of Others, Emotional Strain, and Moral Distress. Reliability estimates (α) were acceptable at .59-.78, but the interitem range (.12-.78) was wider than desirable. Test-retest reliability was deemed adequate based on Pearson's correlations (.68-.81) and intraclass correlation coefficients (.65-.79) but less so when considering κ (.05-.30). The Behaviors of Intensive Care Nurses for End-of-Life (n = 682) was found to have two factors: Communication and Nursing Tasks. Reliability estimates were adequate when considering internal consistency (α = .67 and .78, respectively), item total correlations (.30-.61), and test-retest as judged by Pearson's and intraclass correlations (.77-.81) but not when κ was considered (.02-.40). The interitem correlations (.20-.35) were also lower than desirable.

Discussion: Both the Values of Intensive Care Nurses for End-of-Life and the Behaviors of Intensive Care Nurses for End-of-Life were found to have conceptually linked factors and acceptable internal consistency estimates (α). However, test-retest estimates were inconsistent, suggesting that further work needs to be done on the stability of these instruments.

Meg Zomorodi, PhD, CNL, RN, is Clinical Assistant Professor; and Mary R. Lynn, PhD, is Professor, University of North Carolina at Chapel Hill School of Nursing.

Accepted for publication March 3, 2010.

This research was supported by the T32 NR07091: Interventions to Prevent and Manage Chronic Illness, Sigma Theta Tau Alpha Alpha Chapter, and the American Association of Critical Care Nurses.

Corresponding author: Meg Zomorodi, PhD, CNL, RN, CB7460 Carrington Hall, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599-7460 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.