The development and validation of an instrument measuring attitudes, subjective norms, and behavioral intentions of nurses toward dying patients and their families

The purposes of this study were to: (a) develop and validate an instrument entitled Attitudes, Subjective Norms, and Behavioral Intentions of Nurses Toward the Care of Dying Patients and Their Families (ASBID) and (b) examine the relationships and differences among selected demographic and psychological variables on the behavioral intentions of nurses toward the dying. The Ajzen-Fishbein theory of reasoned action was used as the conceptual framework for this study. Nursing behaviors toward the dying included in the ASBID were developed from interviews with bereaved family members. Three hundred and seventy-two registered nurses who were caring for dying patients were used as the sample population for testing the ASBID and for examining relationships with the ASBID. Internal consistency reliability coefficients for ASBID achieved satisfactory standards for reliability. Factor analysis of the Behavioral Intentions subscale of ASBID suggested three factors were being measured: General Acute Care Measures for the Dying, Open Communication with the Dying, and Continuing Care for Bereaved Family Members. Results of the study supported the Ajzen-Fishbein theory. Attitudes toward specific behaviors were the major determinants of behavioral intentions toward the dying, and subjective norms were the second major determinants. General attitudes toward death and dying as measured by Templer\u27s Death Anxiety Scale were not related to behavioral intentions toward the dying. The only other variables significantly predicting behavioral intentions of nurses were age and social desirability response set. There were significant differences among ages, educational levels, employment status, place of employment, area of work, and personal death experiences of nurses on behavioral intentions toward the dying. Findings of the study have major implications for nurse educators. Educational programs planned to influence nursing care of the dying should focus on specific behaviors of nurses rather than focusing on death anxiety in nurses; should include nursing supervisors as well as nurses providing direct care for the dying; and should be individualized to meet the specific learning needs of the nurses in attendance