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1.  Instrument Development Measuring Critical Care Nurses’ Attitudes and Behaviors with End-of-Life Care 
Nursing research  2010;59(4):234-240.
Background
Although critical care nurses are expected to focus on providing life-sustaining measures, many intensive care patients actually receive end-of-life care.
Objectives
To develop an instrument to measure nursing attitudes and behaviors with end-of-life care.
Method
Phase I was focused on item development from a content analysis of the literature and qualitative interviews of critical care nurses. Phase II consisted of content validity assessment and pilot testing. Phase III included field testing, factor analysis, and reliability estimation.
Results
The Values of Intensive Care Nurses for End-of-Life (INTEL-Values; n = 695) was found to have four factors: Self-appraisal, Appraisal of Others, Emotional Strain, and Moral Distress. Reliability estimates (alpha) were acceptable at .59–.78, but the interitem (.12–.78) range was wider than desirable. Test-retest reliability was deemed adequate based on Pearson’s correlations (.68–.81) and intraclass correlation coefficients (.65–.79) but less so when considering kappa (.05–.30). The Behaviors of Intensive Care Nurses for End-of-Life (INTEL-Behaviors; n = 682) was found to have two factors: Communication and Nursing Tasks. Reliability estimates were adequate when considering internal consistency (alpha .67 and .78, respectively), item total correlations (.30–.61) and test-retest as judged by Pearson’s and ICCs (.77–.81), but not when Kappa was considered (.02–.40). The interitem correlations (.20–.35) were also lower than desirable.
Discussion
Both the INTEL-Values and the INTEL-Behaviors were found to have conceptually linked factors and acceptable internal consistency estimates (alpha). However, test-retest estimates were inconsistent, suggesting further work needs to be done on the stability of these instruments.
doi:10.1097/NNR.0b013e3181dd25ef
PMCID: PMC2897010  PMID: 20467339
instrument development; critical care; end-of-life care; values; behaviors; attitudes
2.  Test of a Conceptual Model of Uncertainty in Children and Adolescents with Cancer 
Research in nursing & health  2010;33(3):179-191.
Despite recognition as a significant stressor in childhood cancer, illness-related uncertainty from the perspective of children remains under-studied. We tested a conceptual model of uncertainty, derived from Mishel’s uncertainty in illness theory, in 68 school-aged children and adolescents with cancer. As hypothesized, uncertainty was significantly related to psychological distress, but only one hypothesized antecedent (parental uncertainty) significantly predicted children’s uncertainty. An alternative model incorporating antecedent developmental factors (age and illness-specific expertise) explained 21% of the variance in child uncertainty; controlling for stage of treatment, uncertainty was higher in children with shorter time since diagnosis, older age, lower cancer knowledge, and higher parental uncertainty. These findings provide the foundation for further studies to understand children’s management of uncertainty and its contribution to psychological adjustment to illness.
doi:10.1002/nur.20374
PMCID: PMC2943336  PMID: 20229520
Uncertainty; parent-child relationship; cancer; growth and development; adolescence
3.  Psychometric Evaluation of a New Instrument to Measure Uncertainty in Children with Cancer 
Nursing research  2010;59(2):119-126.
Background
Although uncertainty has been characterized as a major stressor for children with cancer, it has not been studied systematically.
Objectives
To describe the development and initial psychometric evaluation of a measure of uncertainty in school-aged children and adolescents with cancer.
Methods
Interview data from the first author’s qualitative study of uncertainty in children undergoing cancer treatment were used to generate 22 items for the Uncertainty Scale for Kids (USK), which were evaluated for content validity by expert panels of children with cancer and experienced clinicians (Stewart, Lynn, & Mishel, 2005). Reliability and validity were evaluated in a sample of 72 children aged 8 to 17 years undergoing cancer treatment.
Results
The USK items underwent minor revision following input from content validity experts and all 22 were retained for testing. The USK demonstrated strong reliability (Cronbach’s alpha = .94, test-retest r = .64, p = .005) and preliminary evidence for validity was supported by significant associations between USK scores and cancer knowledge, complexity of treatment, and anxiety and depression. Exploratory factor analysis yielded 2 factors, not knowing how serious the illness is and not knowing what will happen when, which explained 50.4% of the variance.
Discussion
The USK, developed from the perspective of children, performed well in the initial application, demonstrating strong reliability and preliminary evidence for construct and discriminant validity. It holds considerable promise for moving the research forward on uncertainty in childhood cancer.
doi:10.1097/NNR.0b013e3181d1a8d5
PMCID: PMC2870996  PMID: 20216014
child; uncertainty; measurement; cancer
4.  Reliability and Validity of the Perspectives of Support From God Scale 
Nursing research  2010;59(2):102-109.
Background
Existing spiritual support scales for use with cancer survivors focus on the support believed to come from a religious community, clergy, or health care providers.
Objective
The objective of this study was to evaluate the reliability and validity of a new measure of spiritual support believed to come from God in older Christian African American cancer survivors.
Methods
The Perceived Support From God Scale was administered to 317 African American cancer survivors aged 55–89 years. Psychometric evaluation involved identifying underlying factors, conducting item analysis and estimating reliability, and obtaining evidence on the relationship to other variables or the extent to which the Perceived Support From God Scale correlates with religious involvement and depression.
Results
The Perceived Support From God Scale consists of 15 items in two subscales (Support From God and God’s Purpose for Me). The two subscales explained 59% of the variance. Cronbach’s α coefficients were .94 and .86 for the Support From God and God’s Purpose for Me subscales, respectively. Test–retest correlations were strong, supporting the temporal stability of the instrument. Pearson’s correlations to an existing religious involvement and beliefs scale were moderate to strong. Subscale scores on Support From God were negatively correlated to depression.
Discussion
Initial support for reliability and validity was demonstrated for the Perceived Support From God Scale. The scale captures a facet of spirituality not emphasized in other measures. Further research is needed to evaluate the scale with persons of other racial/ethnic groups and to explore the relationship of spirituality to other outcome measures.
doi:10.1097/NNR.0b013e3181d1b265
PMCID: PMC2867661  PMID: 20216012
African Americans; cancer; spiritual support

Results 1-4 (4)