Assessing the Palliative and End-of-Life Care Education-Practice-Competence Triad in Intensive Care Units: Content Validity,Feasibility,and Reliability of a New Tool
Restricted accessResearch articleFirst published online October, 2021
Assessing the Palliative and End-of-Life Care Education-Practice-Competence Triad in Intensive Care Units: Content Validity,Feasibility,and Reliability of a New Tool
To date, a comprehensive, psychometrically robust instrument to assess palliative and end-of-life (PEOL) care education, practice, and perceived competence among intensive care unit (ICU) nurses does not exist.
Objective:
To examine content validity and reliability of a proposed instrument to assess the PEOL care education-practice- competence triad among ICU nurses.
Methods:
An international modified e-Delphi and a cross-sectional pilot questionnaire survey. The Delphi involved 23 panelists from 11 countries. The pilot study involved 40 staff nurses and 3 nurse managers from 3 adult ICUs in a randomly selected hospital in Egypt. An instrument was developed and judged for content validity by international panelists, and then pretested in a pilot study, where data were collected at 2 time points using self-administered questionnaires, followed by cognitive interviews. Test-retest reliability was examined using intraclass correlation (ICC), standard error of measurement (SEM), and repeatability coefficient (RC).
Results:
The panelists confirmed content validity of the proposed instrument, and staff nurses confirmed its comprehensibility. At the level of the instrument’s total scores, the lowest ICC was .9 (95% confidence interval: .8-.9); and the highest SEM and RC were 4.8 and 13.3, respectively.
Conclusions:
The PEOL Care Index is a comprehensive, comprehensible, content valid, and reliable instrument to assess the PEOL care education-practice-competence triad among ICU nurses. Construct and criterion validities need to be confirmed in future studies. Applicability of the PEOL Care Index in different settings and cultures needs to be examined.
AthariFDavidsonPMHillmanKMPhillipsJ. Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?Int J Palliat Nurs. 2016;22(4):163–165.
3.
NelsonJEMathewsKSWeissmanDE, et al.Integration of palliative care in the context of rapid response: a report from the improving palliative care in the ICU advisory board. Chest. 2015;147(2):560–569.
4.
PenrodJDDebPLuhrsC, et al.Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. J Palliat Med. 2006;9(4):855–860.
5.
GadeGVenohrIConnerD, et al.Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med. 2008;11(2):180–190.
6.
PenrodJDDebPDellenbaughC, et al.Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973–979.
7.
MorrisonRSDietrichJLadwigS, et al.Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood). 2011;30(3):454–463.
8.
CasselJBWebb-WrightJHolmesJLyckholmLSmithTJ. Clinical and financial impact of a palliative care program at a small rural hospital. J Palliat Med. 2010;13(11):1339–1343.
9.
LillyCMSonnaLAHaleyKJMassaroAF. Intensive communication: four-year follow-up from a clinical practice study. Crit Care Med. 2003;31(5 suppl):S394–S399.
10.
QuenotJPRigaudJPPrinS, et al.Impact of an intensive communication strategy on end-of-life practices in the intensive care unit. Intensive Care Med. 2011;38(1):145–152.
11.
PenrodJDLuhrsCALivoteEECortezTBKwakJ. Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit. J Pain Symptom Manage. 2011;42(5):668–671.
12.
DalyBJDouglasSLO’TooleE, et al.Effectiveness trial of an intensive communication structure for families of long-stay ICU patients. Chest. 2010;138(6):1340–1348.
13.
SukraandiniNKKongsuwanWNilmanatK. Nurses caring for patients at the end of life in intensive care unit: a literature review. GSTF J Nurs Health Care. 2017;4(2):56–61.
14.
NoomeMDijkstraBMvan LeeuwenEVloetLC. Exploring family experiences of nursing aspects of end-of-life care in the ICU: a qualitative study. Intensive Crit Care Nurs. 2016;33:56–64.
15.
WalkerWDeaconK. Nurses’ experiences of caring for the suddenly bereaved in adult acute and critical care settings, and the provision of person-centred care: a qualitative study. Intensive Crit Care Nurs. 2016;33:39–47.
16.
FerrellBMazanecPMalloyPViraniR. An innovative end-of-life nursing education consortium curriculum that prepares nursing students to provide primary palliative care. Nurse Educ. 2018;43(5):242–246.
17.
DickinsonGEClarkDSqueM. Palliative care and end of life issues in UK preregistration, undergraduate nursing programmes. Nurse Educ Today. 2008;28(2):163–170.
18.
De VliegerMGorchsNLarkinPJPorchetF. A guide for the development of palliative nurse education in Europe: palliative nurse education: report of the EAPC Task Force. Published2004. Accessed June 4, 2019. https://wwwapcpcompt/uploads/NursingEducationRecommendationspdf
19.
American Association of Colleges of Nursing. Peaceful death: recommended competencies and curricular guidelines for end-of-life nursing care. Published1999. Accessed May 16, 2018. https://eric.ed.gov/?id=ED453706
20.
FerrellBMalloyPMazanecPViraniR. CARES: AACN’s new competencies and recommendations for educating undergraduate nursing students to improve palliative care. J Prof Nurs. 2016;32(5):327–333.
21.
TreecePDEngelbergRAShannonSE, et al.Integrating palliative and critical care: description of an intervention. Crit Care Med. 2006;34(11 suppl):S380–S387.
22.
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 4th ed. National Consensus Project for Quality Palliative Care; 2018.
23.
LippeMVolkerDJonesTCarterP. Evaluating end-of-life care education within nursing programs: a method for targeted curriculum evaluation. J Hosp Palliat Nurs. 2017;19(3):266–274.
24.
LippeM. Assessment of primary palliative care content within prelicensure nursing education. J Hosp Palliat Nurs. 2019;21(5):373–381.
25.
HoLAEngelbergRACurtisJR, et al.Comparing clinician ratings of the quality of palliative care in the intensive care unit. Crit Care Med. 2011;39(5):975–983.
26.
ShimizuMNishimuraMIshiiYKuramochiMKakutaNMiyashitaM. Development and validation of scales for attitudes, self-reported practices, difficulties and knowledge among home care nurses providing palliative care. Eur J Oncol Nurs. 2016;22:8–22.
27.
RanseKYatesPCoyerF. End-of-life care practices of critical care nurses: a national cross-sectional survey. Aust Crit Care. 2016;29(2):83–89.
28.
SlåttenKHatlevikOFagerströmL. Validation of a new instrument for self-assessment of nurses’ core competencies in palliative care. Nurs Res Pract. 2014;2014:1–8.
29.
MontagniniMSmithHBalistrieriT. Assessment of self-perceived end-of-life care competencies of intensive care unit providers. J Palliat Med. 2012;15(1):29–36.
30.
DesbiensJ-FFillionL. Development of the palliative care nursing self-competence scale. J Hosp Palliat Nurs. 2011;13(4):230–241.
31.
FarmaniAHMirhafezSRKavosiA, et al.Dataset on the nurses’ knowledge, attitude and practice towards palliative care. Data Brief. 2019;22:319–325.
32.
KassaHMuruganRZewduFHailuMWoldeyohannesD. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC Palliat Care. 2014;13(1):6.
33.
ThompsonSBottMBoyleDGajewskiBTildenVP. A measure of palliative care in nursing homes. J Pain Symptom Manage. 2011;41(1):57–67.
34.
RanseKYatesPCoyerF. End-of-life care in the intensive care setting: a descriptive exploratory qualitative study of nurses’ beliefs and practices. Aust Crit Care. 2012;25(1):4–12.
35.
NakazawaYMiyashitaMMoritaTUmedaMOyagiYOgasawaraT. The palliative care self-reported practices scale and the palliative care difficulties scale: reliability and validity of two scales evaluating self-reported practices and difficulties experienced in palliative care by health professionals. J Palliat Med. 2010;13(4):427–437.
36.
NguyenLYatesPOsborneY. Palliative care knowledge, attitudes and perceived self-competence of nurses working in Vietnam. Int J Palliat Nurs. 2014;20(9):448–456.
37.
StreinerDL. Being inconsistent about consistency: when coefficient alpha does and doesn’t matter. J Pers Assess. 2010;80(3):217–222.
38.
StreinerDLNormanGRCairneyJ. Health Measurement Scales: A Practical Guide to their Development and Use. 5th ed. Oxford University Press; 2015.
39.
BollenKRichardL. Conventional wisdom on measurement: a structural equation perspective. Psychol Bull. 1991;110(2):305–314.
40.
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 3th ed. National Consensus Project for Quality Palliative Care; 2013.
41.
DahlinCM. National consensus project for quality palliative care: promoting excellence in palliative care nursing. In: FerrellBRCoyleNPaiceJA, eds. Oxford Textbook of Palliative Nursing. 4th ed. Oxford University Press; 2015:11–19.
42.
National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. National Consensus Project for Quality Palliative Care; 2004.
43.
VernonW. The Delphi technique: a review. Int J Ther Rehabil. 2009;16(2):69–76.
44.
LynnMR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382–385.
45.
PolitDFBeckCTOwenSV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459–467.
46.
WyndCASchmidtBSchaeferMA. Two quantitative approaches for estimating content validity. West J Nurs Res. 2003;25(5):508–518.
47.
BeatonDEBombardierCGuilleminFFerrazMB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–3191.
KnaflKDeatrickJGalloA, et al.The analysis and interpretation of cognitive interviews for instrument development. Res Nurs Health. 2007;30(2):224–234.
50.
KarabenickSAWoolleyMEFriedelJM, et al.Cognitive processing of self-report items in educational research: do they think what we mean?Educ Psychol. 2007;42(3):139–151.
51.
KooTKLiMY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163.
52.
HopkinsWG. Measures of reliability in sports medicine and science. Sports Med. 2000;30(1):1–15.
53.
HempelSVazSParsonsRPassmoreAEAndreouPFalkmerT. Internal consistency, test–retest reliability and measurement error of the self-report version of the social skills rating system in a sample of Australian adolescents. PLoS One. 2013;8(9):e73924.
54.
BlandJMAltmanDG. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet. 1986;327(8476):307–310.
55.
BlandJMAltmanDG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003;22(1):85–93.
56.
KottnerJAudigeLBrorsonS, et al.Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. Int J Nurs Stud. 2011;48(6):661–671.
57.
ElmEVAltmanDGEggerMPocockSJGøtzschePCVandenbrouckeJP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for Reporting Observational Studies. Ann Intern Med. 2007;147(8):573–577.
58.
BeckCTGableRK. Ensuring content validity: an illustration of the process. J Nurs Meas. 2001;9(2):201–215.
59.
HardestyDMBeardenWO. The use of expert judges in scale development: implications for improving face validity of measures of unobservable constructs. J Bus Res. 2004;57(2):98–107.
60.
ThabaneLMaJChuR, et al.A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1.
61.
LancasterGADoddSWilliamsonPR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10(2):307–312.
62.
HoJQNguyenCDLopesREzeji-OkoyeSCKuschnerWG. Spiritual care in the intensive care unit: a narrative review. J Intensive Care Med. 2017;33(5):279–287.
LippeMJonesTBeckerHCarterP. Student preparation to care for dying patients: assessing outcomes across a curriculum. J Nurs Educ. 2017;56(10):633–637.
65.
EltaybaniSIgarashiAYamamoto-MitaniN. Palliative and end-of-life care in Egypt: overview and recommendations for improvement. Int J Palliat Nurs. 2020;26(6):284–291.
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