Table 1 Summary of the four sequential phases of the study

Phase 1 Item Generation

Semi-structured interviews with nursing assistants (n = 25)

Transcribed texts

Themes – categories – item pool: 51 knowledge items, 48 skill items and 36 attitudes items.

Phase 2 Instrument Development

Survey method

Four groups of experts (n = 9–12): academics in the field of palliative/aged care; industry representatives with responsibility for training and development; RNs supervising the direct care provided by nursing assistants in RACFs; and, nursing assistants with a Certificate IV in Aged Care and/or at least five years’ experience in their role.

Content Validity Index (CVI) two rounds and one face validation; CVI value for items rated on a four-point ordinal scale: 1 = not clear, not relevant 2 = not quite clear, not quite relevant (requires major revision); 3 = clear, relevant (with minor revision); 4 very clear, very relevant

Draft questionnaires within one instrument titled PANA (Palliative Approach for Nursing Assistants) (85 items) Dichotomous/scaled variables

Phase 3 Pilot Testing

Survey method

Two RACFs, purposive sampling (n = 61)

Inclusion: Group 1: less than or equal to two years’ experience in role; Group 2: between two and five years’ experience in role; Group 3: more than five years’ experience in role

Descriptive statistics, mean scores, standard deviations, confidence intervals, summary tables

Refinements of items and response options

Phase 4 Instrument Testing

Survey method

17 RACFs, random sample (n = 348)

Inclusion: Group 1: less than or equal to two years’ experience in role; Group 2: between two and five years’ experience in role; Group 3: more than five years’ experience in role

Descriptive statistics, Individual item analysis, mean scores, Kendall’s Tau Correlation, analysis of variance, factor analysis, Cronbach’s Alpha, Pearson’s product moment correlation coefficient, Final instrument: PANA_Knowledge Questionnaire; PANA_Skills Questionnaire; PANA_Attitudes Questionnaire