Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. e207-e213 (doi:10.1542/peds.2008-2774)
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ARTICLE

Neonatal Palliative Care Attitude Scale: Development of an Instrument to Measure the Barriers to and Facilitators of Palliative Care in Neonatal Nursing

Victoria Kain, RN, PhD, Glenn Gardner, RN, PhD and Patsy Yates, RN, PhD

School of Nursing, Queensland University of Technology, Brisbane, Australia

OBJECTIVE. The aim of this research project was to obtain an understanding of the barriers to and facilitators of providing palliative care in neonatal nursing. This article reports the first phase of this research: to develop and administer an instrument to measure the attitudes of neonatal nurses to palliative care.

METHODS. The instrument developed for this research (the Neonatal Palliative Care Attitude Scale) underwent face and content validity testing with an expert panel and was pilot tested to establish temporal stability. It was then administered to a population sample of 1285 neonatal nurses in Australian NICUs, with a response rate of 50% (N = 645). Exploratory factor-analysis techniques were conducted to identify scales and subscales of the instrument.

RESULTS. Data-reduction techniques using principal components analysis were used. Using the criteria of eigenvalues being >1, the items in the Neonatal Palliative Care Attitude Scale extracted 6 factors, which accounted for 48.1% of the variance among the items. By further examining the questions within each factor and the Cronbach's {alpha} of items loading on each factor, factors were accepted or rejected. This resulted in acceptance of 3 factors indicating the barriers to and facilitators of palliative care practice. The constructs represented by these factors indicated barriers to and facilitators of palliative care practice relating to (1) the organization in which the nurse practices, (2) the available resources to support a palliative model of care, and (3) the technological imperatives and parental demands.

CONCLUSIONS. The subscales identified by this analysis identified items that measured both barriers to and facilitators of palliative care practice in neonatal nursing. While establishing preliminary reliability of the instrument by using exploratory factor-analysis techniques, further testing of this instrument with different samples of neonatal nurses is necessary using a confirmatory factor-analysis approach.

Key Words: neonatal palliative care • neonatal end-of-life care • instrument development • attitude scales • factor analysis

Abbreviations: NiPCAS—Neonatal Palliative Care Attitude Scale • PCA—principle components analysis

Accepted Nov 7, 2008.


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