title: Instrument development measuring critical care nurses' attitudes and behaviors with end-of-life care.
abstract: BACKGROUND
  Although critical care nurses are expected to focus on providing life-sustaining measures, many intensive care patients actually receive end-of-life care.
  
  
  OBJECTIVE
  The aim of this study was to develop an instrument to measure nursing attitudes and behaviors regarding end-of-life care.
  
  
  METHODS
  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 ([alpha]) 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 [kappa] (.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 ([alpha] = .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 [kappa] was considered (.02-.40). The interitem correlations (.20-.35) were also lower than desirable.
  
  
  CONCLUSIONS
  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 ([alpha]). However, test-retest estimates were inconsistent, suggesting that further work needs to be done on the stability of these instruments.
authors.affiliation: University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599-7460, USA. Meg_Zomorodi@unc.edu
authors.forename: Meg
authors.initials: M
authors.lastname: Zomorodi
authors.forename: Mary R
authors.initials: MR
authors.lastname: Lynn
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000209:etiology / Q000523:psychology; D002983:Clinical Competence; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009014:Morals; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D010865:Pilot Projects; D036301:Qualitative Research; D012647:Self-Assessment; D011795:Surveys and Questionnaires / Q000592:standards*; D013727:Terminal Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology; D014481:United States
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