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Intensive and Critical Care Nursing (2011) 27, 202—210

available at www.sciencedirect.com

journal homepage: www.elsevier.com/iccn

ORIGINAL ARTICLE

Development of a scale for ‘‘difficulties felt by ICU nurses providing end-of-life care’’ (DFINE): A survey study Satomi Kinoshita a,∗, Mitsunori Miyashita b
a

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 b Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan Accepted 25 April 2011

KEYWORDS
Intensive care unit; End-of-life care; Difficulties felt by ICU nurses; Scale development

Summary Objectives: To develop a scale for assessing ‘‘difficulties felt by intensive care unit (ICU) nurses providing end-of-life care’’ (DFINE). Design and setting: A questionnaire survey of nurses in ICUs at general hospitals in the Kanto region, Japan. Main outcome measures: The scale was evaluated by exploratory factor analysis, calculation of Cronbach’s ˛ 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 ˛ 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. Conclusion: DFINE demonstrated acceptable reliability and validity. However, additional surveys need to be conducted with a larger sample to further characterise the scale. © 2011 Elsevier Ltd. All rights reserved.



Corresponding author. Tel.: +81 46 828 2634; fax: +81 46 828 2635. E-mail address: kinoshita-s@kuhs.ac.jp (S. Kinoshita).

0964-3397/$ — see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.iccn.2011.04.006

Difficulties felt by ICU nurses providing end-of-life care

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Table 1 Preliminary domains for ‘‘difficulties felt by ICU nurses providing end-of-life care’’. 1. 2. 3. 4. 5. 6. 7. 8. 9. The purpose of ICU is recovery and survival. Time and/or nursing staff for end-of-life care. Education and nursing system for end-of-life care. Model nurses in providing end-of-life care. Building confidence in end-of-life care. Caring for patients. Caring for families. Physicians’ attitudes about end-of-life. Converting from curative care to end-of-life care.

Introduction
In recent years, one of the issues under debate in the Japanese Society of Intensive Care Medicine has been endof-life care in the intensive care unit (ICU) (Gando and Marukawa, 2009). Within the Society, there has been an initiative to create ‘‘End-of-Life Care Guidelines’’ that incorporate criteria for suspension of treatment, but these have not yet been conclusively determined. In Japan, the law and the difficulty of knowing the will of the patient make it difficult to develop criteria for withholding or withdrawing treatment (Gando and Marukawa, 2009). At the same time, many nurses have doubts about excessive treatment to prolong life in ICU settings (Kinoshita, 2009)....
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