Cross-cultural validation of self-reported measurement instruments for research is a long and complex process, which involves specific risks of bias that could affect the research process and results. Furthermore, it requires researchers to have a wide range of technical knowledge about the translation, adaptation and pre-test aspects, their purposes and options, about the different psychometric properties, and the required evidence for their assessment and knowledge about the quantitative data processing and analysis using statistical software. This article aimed: 1) identify all guidelines and recommendations for translation, cross-cultural adaptation, and validation within the healthcare sciences; 2) describe the methodological approaches established in these guidelines for conducting translation, adaptation, and cross-cultural validation; and 3) provide a practical guideline featuring various methodological options for novice researchers involved in translating, adapting, and validating measurement instruments. Forty-two guidelines on translation, adaptation, or cross-cultural validation of measurement instruments were obtained from "CINAHL with Full Text" (via EBSCO) and "MEDLINE with Full Text". A content analysis was conducted to identify the similarities and differences in the methodological approaches recommended. Bases on these similarities and differences, we proposed an eight-step guideline that includes: a) forward translation; 2) synthesis of translations; 3) back translation; 4) harmonization; 5) pre-testing; 6) field testing; 7) psychometric validation, and 8) analysis of psychometric properties. It is a practical guideline because it provides extensive and comprehensive information on the methodological approaches available to researchers. This is the first methodological literature review carried out in the healthcare sciences regarding the methodological approaches recommended by existing guidelines.
BACKGROUND: Quality assessment in oncology nursing care has been a growing topic in the literature, gaining relevance as oncological nursing care becomes more complex as the science progresses. However, there are no instruments that assess the perception of the quality of oncology nursing care from the point of view of patients for the Portuguese population. Thus, the cross-cultural translation and validation of the Quality of Oncology Nursing Care Scale (QONCS) was performed for the Portuguese context. This instrument allows nurses to assess patients' self-perception of the quality of nursing care provided in an oncological setting. It also allows researchers to compare the results obtained internationally with the application of this scale. METHODS: This is a methodological study, with two distinct phases: the first corresponded to the translation and cultural adaptation of the scale to the Portuguese context, and the second consisted of the psychometric validation of the QONCS, which included factor analysis and the evaluation of the psychometric properties of the instrument. We obtained responses from 402 patients from a Portuguese oncology hospital. RESULTS: The Portuguese version of the Quality of Oncology Nursing Care Scale (QONCS_PT) consists of 34 items inserted into a tetra-factorial model, which explains a total variance of the instrument of 69.8%. A Cronbach's alpha of 0.93 was obtained for the complete instrument. CONCLUSIONS: QONCS_PT has a competent and reliable structure. The scale's validity was assured and can be used in the Portuguese population, as it is useful for direct care provision but also for researchers and managers.
Nurse managers need culturally adapted assessment instruments to support the implementation of change to Nursing Bedside Handover (NBH) in healthcare institutions. This study aimed to cross-culturally adapt the Bedside Handover Attitudes and Behaviours (BHAB) questionnaire to the Portuguese context and evaluate the methodological approaches used for this purpose. To guide this study, we followed a guideline for cross-cultural translation and adaptation measurement instruments in healthcare. The results of the content validity testing suggested that the BHAB questionnaire is a valid instrument for use in the Portuguese context. To obtain these results we showed 1) using of a new methodological approach, the dual focus, to resolve the divergences and ambiguities in the translators' committee and the multi-professional committee; 2) the lack of a conceptual definition of the construct of the instrument as a requirement to retain items with I-CVI <0.70 after validity relevance pretesting and 3) the cognitive debriefing and relevance pretesting as methodological approaches which can be used alone or together to reinforce the evaluation of cultural relevance of the items. We concluded there is a need for guidelines to support the decision-making process of healthcare researchers with comprehensive information about the different methodological approaches they can follow.
Nursing Bedside Handover (NBH) is acknowledged as a nursing practice implemented at the patient's bedside to improve communication safety during the shift change, but it is vulnerable due to inconsistent application among nurses. This synthesis of qualitative evidence aims to review and synthesize the perceptions and experiences of nurses regarding the factors that, in their perspective, influence NBH practice. We will follow the thematic synthesis methodology of Thomas and Harden and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement guidelines. A search will be conducted through the databases of MEDLINE, CINAHL, Web of Science, and Scopus, and we will follow the three-step search process to identify primary studies with qualitative or mixed-method research designs and projects of quality improvement. The screening and selection of the studies will be carried out by two independent reviewers. We will use the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the screening, search, and selection of studies. To assess its methodological quality, two reviewers will independently use the CASM Tool. The extracted data will be reviewed, categorized, and summarized in tabular and narrative formats. The findings obtained will allow us to inform future research and change management led by nurse managers.
Background: Globalisation, wars, competitiveness, and technological innovation have increased workplace diversity, requiring leaders to conduct multinational projects, lead people from different cultural backgrounds, and deliver appropriate services that meet the needs of clients from different cultures. Several concepts are interchangeably used to define and describe leadership in culturally-diverse work environments; one such concept is transcultural leadership. Because of nurses' global migration and care delivery to patients from different cultural backgrounds, this concept is of interest in the nursing field. While some nurses have been identified as transcultural leaders, no definition of transcultural nursing leadership has been found in the literature. Objective: This study aimed to develop an operational definition of transcultural nursing leadership. Design: A concept analysis was performed using Walker and Avant's method. Methods: A literature search was conducted using electronic databases, including CINAHL and MEDLINE, books, and encyclopaedias. Quantitative, qualitative, mixed- design studies and literature reviews; master's and doctoral theses; interviews; and text and opinion papers published in English, Spanish, or Portuguese that focused on leadership in multicultural work environments overall and in nursing in particular were included. To identify differences and similarities between the concepts, a Correspondence Factor Analysis with the support of the software IRaMuTeQ was undertaken. Results: A total of 45 documents with definitions or descriptions of the concepts was included, of which five were in the nursing area and 40 in other areas of study. The defining attribute of transcultural nursing leadership is guiding the delivery of culturally-congruent care. Its antecedents were culturally-diverse populations, multicultural nursing teams, and the need to prepare healthcare workers, administrators, academics, professors, researchers, and minorities for transcultural nursing. The consequences identified included culturally-congruent care for patients and optimal health outcomes for all populations. The identified attributes, antecedents, and consequences did not cover the complexity of a culturally-diverse nursing work environment. Thus, the antecedents, attributes, and consequences of transcultural leadership identified in the literature were considered and added. Conclusions: Transcultural nursing leadership is a concept grounded in nursing theory that has significant implications for nursing management, education, research, and policy. This holds great promise for advancing culturally-congruent care, addressing health disparities, and building highly inclusive and productive nursing teams in an increasingly diverse world.
Introdução. Os enfermeiros gestores dos países de língua portuguesa necessitam de instrumentos validados e fidedignos para gerir eficazmente a mudança para aPassagem de Turno à Centrada no Cliente. O questionário Bedside Handover attitudes and Behaviours é um instrumento de 32 itens desenvolvido em inglês, que permite monitorizar a consistência das práticas dos enfermeiros na implementação desse tipo de Passagem de Turno. Objetivos. Adaptar e validar transculturalmente o questionário para o contexto português e avaliar as suas propriedades psicométricas. Metodologia. Foi implementados um desenho de estudo quantitativo, descritivo, transversal e de validação. O questionário foi adaptado transculturalmente através de tradução, síntese das tarduções, retroversão, harmonização em comiss~so de peritos e de 2 pré-testes. Uma amostra de 241 enfermeiros de um hospital de cuidados agudos português participou no teste de campo. Resultados. O questionário mostrou índices de concordância excelentes durante o pré-teste de clareza (S-CVI/Med=.99, S-CVI/UA=.91) e de relevância dos itens (S-CVI/Med=.93, S-CVI/UA=.84). Na análise fatorial exploratória foi obtido um modelo que explicou 53,6 % da variância total, de 18 itens distribuídos por quatro componentes: Abordagem Individualizada, Interação Pessoal, Partilha de Informação e Envolvimento Direto. A análise fatorial confirmatória suportou a estrutura de 4 componentes para o questionário (XZ/df =1.440; CFI = .953; GFI =.926; RMSEA=.043; P[rmsea] < .001; MECVI=1.175). O alfa de Cronbach demonstrou valores aceitáveis para o questionário total (a=.790) e para as 4 dimensões (a=.654 a .816). Conclusão. O questionário é válido e fidedigno e pode ser utilizado pelos Enfermeiros Gestores nos países de língua portuguesa.
Introduction. Nurses Manager of Portuguese-speaking countries needs validated and reliable instruments for the success of change management in the Nursing Bedside Handover implementation. The Bedside Handover Attitudes and Behaviours questionnaire is a 32-item instrument developed in the English language that allows Nurse Managers to follow up on the consistency of nurses" practice during this kind of change shift implementation. Aims. To adapt and cross-culturally validate the questionnaire into the Portuguese context and to evaluate their psychometric proprieties. Methodology. A quantitative, descriptive, cross-sectional, and validation study was implemented. The questionnaire was cross-culturally adapted through translation, translation synthesis, and back-translation procedures, an expert committee harmonization, and 2 pre-tests. A sample of 241 nurses of a Portuguese acute care hospital participated in the field test. Results. The questionnaire showed excellent agreement indexes during pretesting of clarity (S-CVI/Med=.99, S-CVI/UA=.91) and items" relevance (SCVI/Med=.93, S-CVI/UA=.84). We obtained one factorial solution through exploratory factor analysis that explained 53,5% of the total variance with 18 items distributed by four new components: Direct Involvement, Personal Interaction, Information Sharing, and Individualized Approach. Confirmatory factor analysis supported the four-factor factorial structure for the questionnaire (=1.440; CFI = .953; GFI = .926; RMSEA = .043; P[rmsea] < .001; MECVI = 1.175). The alpha Cronbach showed acceptable values for the total questionnaire (a=.790) and the 4 components (a=.654 to .816). Conclusion. The questionnaire is valid and reliable and can be used by Nurse Managers during change management in Portuguese-speaking countries.
Nursing/organization & administration , Total Quality Management , Patient Handoff , Patient Safety , Change Management
