Development and psychometric testing of an instrument to assess critical care nurses' level of comfort in withdrawing life support

Date of Completion

January 2006


Health Sciences, Nursing|Psychology, Psychometrics




Critical care nursing and the critical care unit model of care delivery has evolved from advances in biomedical technologies that are used to provide curative or rescue therapies to acutely and critically ill patients. Current data demonstrates that the majority of critical care patients die following the withholding or withdrawal of life supporting therapies. This is a change in the trajectory of dying and death has been cited as a major stressor to critical care nurses (CCNs), as they now face transitioning to comfort-oriented end of life care. Until now there were no instruments to assess how CCNs felt during this transition. The Critical Care Nurses' Comfort in Withdrawing Life Support Instrument (CCN-CIWLS) was developed to assess CCNs' level of comfort withdrawing life support in adult critical care settings. The purpose of this study was to develop, evaluate and refine the CCN-CIWLS instrument through psychometric analysis. ^ A convenience sample of 426 CCNs who actively practiced in adult critical care settings and had withdrawn life support within the last year participated in this study. Psychometric testing of the CCN-CIWLS provided evidence to support the validity and reliability of the instrument. Content validity was supported by a content validity index of .90. Exploratory factor analysis revealed a 9-factor solution that explained 68% of the variance. Moderate factor intercorrelations and conceptual meaningfulness lead to the combination of 6-factor pairs to form 4-subscales. The 4-subscales were: Communication, Withdrawal Procedures, Human Connection, and CCNs' Psychological Self-Care Activities. Reliability coefficient alphas ranged from .84 to .94 for the subscales and .95 for the total instrument. Stability reliability of the instrument was analyzed through test-retesting of 43 participants. There was a strong positive correlation between testings (r = .63; p < .001). ^ The participants of the CCN-CIWLS study reported the most comfort in performing withdrawal procedures, followed by promoting human connections and then communication activities. They were least comfortable in performing activities related to their psychological well being. The CCN-CIWLS instrument has the potential to be used in nursing education, clinical practice and research. ^