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

Satomi Kinoshita, Mitsunori Miyashita

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


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 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. Conclusion: DFINE demonstrated acceptable reliability and validity. However, additional surveys need to be conducted with a larger sample to further characterise the scale.

Original languageEnglish
Pages (from-to)202-210
Number of pages9
JournalIntensive and Critical Care Nursing
Issue number4
Publication statusPublished - 2011 Aug


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

ASJC Scopus subject areas

  • Critical Care


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