Development of a Nursing Practice Scale for Measuring Support for Surrogate Decision-makers of Terminal Care in the Intensive and Critical Care Unit

Abstract

The aim of this study was to develop a valid and reliable new nursing practice scale for measuring support for surrogate decision-makers, such as family members and close relatives, of terminal care in the intensive and critical care unit. Methods: Based on a review of the literature, a new scale was drafted and its content validity was evaluated. Next, a survey using an self-administered questionnaire was conducted at intensive and critical care units in emergency and critical care centers in Japan on 473 clinical nurses. All responses were then subjected to statistical analysis, including item analysis, item-total correlation, good-poor analysis, exploratory factor analysis，validation of criterion-related validity，knowngroups method, and the test-retest method. The ethical behavior scale for nurses was used for criterion-related validity. Results: Exploratory factor analysis using the maximum likelihood method and promax rotation was performed to extract factors, resulting in a four-factor solution with 18 items. The four extracted factors were named as follows based on their content: Factor 1, " Interprofessional Collaboration"; Factor 2, "Preparation for surrogate decision-making"; Factor 3,"Evenly unbiased attitudes and checks on Doctor's explanation"; and Factor 4,"Facilitation of surrogate decisionmaker thinking". Cronbach's alpha coefficient was 0.89 for the total score and varied between 0.74-0.84 for the four factors. The correlation coefficient for the retest survey was 0.71, while that for the ethical behavior scale for nurses was 0.54. Known-groups method resulted that the group of certified nurse specialists and certified nurses showed significantly higher score than nurses except them, and so did the group with learning experience. Conclusion: The validity and reliability of the nursing practice scale developed in this study to measure support for surrogate decision-makers of terminal care in the intensive and critical care unit were confirmed.

Values and self-perception of behaviour among critical care nurses

“…First, we extracted 82 items regarding nursing ethics, morals and dilemmas by reviewing 12 (4 in English, 8 in Japanese) articles. 25–36 Second, we conducted semi-structured interviews with eight nurses working in the ICU with an average experience as a nurse of 9.8 years (range: 4–15 years). Among the eight participants, one nurse was a certified nursing specialist in critical care and three nurses had Master of Science in nursing.…”