Nursing home social workers' leadership competence in end-of-life care: Development and validation of an instrument

Date of Completion

January 2010


Social Work




The goal of this study was to develop and validate an instrument to measure nursing home social workers' leadership competence in end-of-life care. In the last decade several initiatives have been established to create educational and training opportunities for social workers to become leaders in end-of-life and palliative care practice. The development of a validated instrument provides a brief, easy-to-use tool to assess whether nursing home social workers have the leadership competence to be effective leaders in order to meet the end-of-life care needs of seriously-ill residents and their families. ^ The instrument was developed through a series of steps including a review of the literature, in-depth interviews with experts in the areas of nursing home social work practice in end-of-life care, interdisciplinary care and leadership. The instrument was reviewed by a panel of experts, and later piloted with five clinical social workers to determine face and content validity. The final 26-item instrument was administered to a random sample of nursing home social workers in Connecticut. Using factor analysis, 26 items loaded onto five factors, accounting for 66% of the variance, with a total scale Cronbach's Alpha coefficient of 0.94. ^ The validated scale was then administered in a small, exploratory study to test several hypotheses to identify the determining variables of whether a nursing home social worker becomes a leader on the interdisciplinary care team. The Theory of Planned Behavior [FOB) was used for this study. The composite score from the validated measure of nursing home social workers' leadership competence was examined as a determining variable to leadership behavior, in addition to the three central determinants of the TPB (perceived behavioral control, attitudes, and subjective norms). ^