title: Development of a scale for "difficulties felt by ICU nurses providing end-of-life care" (DFINE): a survey study.
abstract: OBJECTIVE
  To develop a scale for assessing "difficulties felt by intensive care unit (ICU) nurses providing end-of-life care" (DFINE).
  
  
  METHODS
  A questionnaire survey of nurses in ICUs at general hospitals in the Kanto region, Japan.
  
  
  METHODS
  The scale was evaluated by exploratory factor analysis, calculation of Cronbach's α and test-retest reliability. The Frommelt Attitudes Toward Care of the Dying Scale (FATCOD-B-J) and the Nursing Job Stressor Scale (NJSS) were used to investigate concurrent validity.
  
  
  RESULTS
  Respondents were 224 ICU nurses (response rate, 78%) at 18 hospitals. Five factors comprising 28 items were identified, involving difficulties related to: "the purpose of the ICU is recovery and survival"; "nursing system and model nurse for end-of-life care"; "building confidence in end-of-life care"; "caring for patients and families at end-of-life"; and "converting from curative care to end-of-life care". Cronbach's α for each factor ranged from 0.61 to 0.8. In terms of test-retest reliability, intraclass correlations for each factor ranged from 0.62 to 0.72. "Building confidence in end-of-life care" in DFINE showed a negative correlation with "positive attitudes towards caring for dying patient" in the FATCOD-B-J (r=-0.4). "Nursing system and model nurse for end-of-life care" in DFINE showed a positive correlation with "conflict with other nursing staffs" (r=0.32) and "conflict with physicians/autonomy" (r=0.31) in the NJSS.
  
  
  CONCLUSIONS
  DFINE demonstrated acceptable reliability and validity. However, additional surveys need to be conducted with a larger sample to further characterise the scale.
authors.affiliation: Department of Nursing, Kanagawa University of Human Services, Faculty of Health & Social Work, School of Nursing, 1-10-1 Heiseicho, Yokosuka city, Kanagawa 238-8522, Japan. kinoshita-s@kuhs.ac.jp
authors.forename: Satomi
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007564:Japan; D008297:Male; D009726:Nurses / Q000523:psychology*; D013315:Stress, Psychological; D013727:Terminal Care