Reliability and Validity of an Instrument Assessing Advance Directives for Nurse

Purpose: This methodological study was conducted to test the reliability and validity of an instrument that measures attitudes of advance directives (ADs) among nurses. Methods: 1) Sixteen items related to attitudes in the English version of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) were forward/backward translated into Korean. 2) The content was validated by an expert panel (three nursing professors and eight hospice nursing specialists). 3) The preliminary 12 items were selected as a tool to assess the Korean version of Nurses’ Attitudes towards Advance Directives (NAADK). 4) The instrument was validated by a survey (n=216). 5) It was confirmed to use the 12 items for the final version of the instrument. Results: NAAD-K was shown to be valid in terms of factors, items and content. The three factors extracted from the factor analysis were named as follows: Caring for patients with an AD (factor 1), nurses’ role in informing patients (factor 2) and patient right (factor 3). The three factors explained total variance 57.796%. Factor loadings of the 12 items ranged from 0.47 to 0.93. For the 12 items, Cronbach’s alpha was 0.81, and Guttman split-half coefficient was 0.78. Conclusion: This instrument was identified to be applicable with satisfactory reliability and validity for further use in measuring nurses’ attitudes towards ADs in hospice and palliative care.