An Evaluation of the NiPCAS

Topic: Pediatrics


Objective: The rigor of the Neonatal Palliative Care Attitude Scale (NiPCAS), developed by Victoria Kain (2009), was evaluated to provide information about a measurement relative to the area of palliative care implementation in the Neonatal Intensive Care Unit (NICU).

Background: Infants can live for various periods of time with life-limiting conditions, and focus of hospital care can shift from rescue to palliation. The NiPCAS was developed to measure NICU nurses' attitudes about palliative care, which remains underutilized in the neonatal population. 

Evaluation: After a review of the literature, the conceptual framework of diffusion of innovations was used to guide creation of a scale with demographical and attitudinal items. Face and content validity were established by an expert panel. Reliability was established through test-retest, and calculation of Cronbach’s alpha (.87).

Results: Exploratory factor analysis classified scales and subscales within the measurement, establishing three factors that either promoted or hindered palliative care: organization, resources, and clinical. Facilitators and barriers to implementation of palliative care were identified. Other research projects had similar findings.

Conclusion and Implications: Small sample size of the pilot study limited verification of reliability. Additional projects, which use confirmatory factor analysis, are required, and should include other practitioners, such as physicians and nurse practitioners. Evidenced-based care guidelines that are adaptable to individual NICUs, whose settings, cultures, and practices demand systematically unique standards, are desirable, as are implementation of formal training programs and supportive measures for clinicians. 



  • Deborah A. Lawrence, MS, RNC-OB
  • Diane Shimborske, BSN, RNC-NIC

If you need assistance, please use the customer support form.