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Korean J Hosp Palliat Care 2019; 22(3): 134-143
Reliability and Validity of an Instrument Assessing Advance Directives for Nurse
Hojung Cheon, M.S.N. and Eunha Kim, D.S.N.*
Palliative Care Unit, Pusan National University Hospital, *College of Nursing, Catholic University of Pusan, Busan, Korea
Correspondence to: Eunha Kim
College of Nursing, Catholic University of Pusan, 57 Oryundae-ro, Geumjunggu, Busan 46252, Korea
Tel: +82-51-510-0728
Fax: +82-51-510-0747
Received: April 18, 2019; Revised: August 6, 2019; Accepted: August 13, 2019; Published online: September 1, 2019.
© Korean Society for Hospice and Palliative Care. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Advance directives, Attitude, Nurses

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