The white peaceful death measure: Development, refinement and psychometric testing of an instrument

While peaceful death has been a term closely associated with nursing practice, this concept has not been clearly described and measured. This study proposed to develop a valid and reliable instrument, the White Peaceful Death Measure (WPDM), to measure the concept of peaceful death. The purpose was twofold: (a) to estimate the content validity, internal consistency and stability of the WPDM and (b) to determine if underlying dimensions of peaceful death exist within the WPDM. To address this purpose, a methodological study was conducted with a sample of 107 hospice and palliative care nurses. Phase 1 of the study focused on the refinement of three vignettes describing the dying experience of three patients and on the development of WPDM items and estimation of their content validity by 5 end-of-life experts. Phase 2 focused on data collection and analysis for estimating the instrument's reliability (i.e., internal consistency and stability) and construct validity. Nurse participants used the three vignettes to respond to the WPDM. The exercise was repeated by 18 of the participants approximately two weeks later to estimate stability of the instrument. Statistical analysis related to the major study purposes included Cronbach's alpha for internal consistency, Person's r for stability, and principal components factor analysis with varimax rotation for determining any underlying dimensions (i.e., construct validity). While data were analyzed for the three vignettes separately, the responses to the three combined seem to capture the dying experience more comprehensively. Results, therefore, are based on the combined vignette scores. The WPDM was reduced form 25 to 19 items. Cronbach's alpha was high (a= .93), stability was moderate (r = .61), and - content validity was high (CVI = .84). Four clear underlying dimensions were identified: (a) Assistance the patient received from others, (b) Resolution, (c) Condition and comfort of the patient, and ( d) Pain control. The study findings contribute a better understanding of peaceful death and indicate that the WPDM is a valid and reliable instrument for its measurement. Further testing needs to be done with other samples and a variety of patient situations to determine if the findings replicate.