Development of a scale for “difficulties felt by ICU nurses providing end-of-life care” (DFINE): A survey study

SummaryObjectivesTo develop a scale for assessing “difficulties felt by intensive care unit (ICU) nurses providing end-of-life care” (DFINE).Design and settingA questionnaire survey of nurses in ICUs at general hospitals in the Kanto region, Japan.Main outcome measuresThe 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.ResultsRespondents 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.ConclusionDFINE demonstrated acceptable reliability and validity. However, additional surveys need to be conducted with a larger sample to further characterise the scale.