Translation and validation of the anticipated turnover scale for the Portuguese cultural context

Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers

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.

Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care

BACKGROUND

Nursing practice environment has impact on the quality of nursing care and on patients' and nurses' outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients' outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.

METHODS

We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.

RESULTS

Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients' safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients' safety.

CONCLUSIONS

The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses' outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

The mediating role of organizational commitment between workplace bullying and turnover intention among clinical nurses in China: a cross-sectional study

BACKGROUND

Workplace bullying experienced by clinical nurses is a critical and pervasive issue that not only detrimentally impacts nurses but also poses a significant threat to the overall quality of nursing services and patient care. This study aimed to determine the mediating role of organizational commitment in the relationship between workplace bullying and turnover intention among clinical nurses in China.

METHODS

Participants were recruited from 40 hospitals in various provinces of China from December 2, 2021 to February 25, 2023, using convenience sampling. After obtaining hospital ethical approval and participants' informed consent, clinical nurses (n = 585) from different nursing departments in different hospitals completed the questionnaire. The Socio-demographic Questionnaire, Negative Acts Qestionnaire, Chinese Workers' Organizational Commitment Scale and Turnover Intention Questionnaire were used to collect general demographic data of nurses and assess workplace bullying they experienced, their level of organizational commitment and turnover intention. Descriptive statistics, Pearson correlation analyses and structural equation model were adopted to analyze the data.

RESULTS

Pearson's correlation analysis showed that that workplace bullying was significantly negatively correlated with organizational commitment (r = - 0.512, P<0.01) and significantly positively correlated with turnover intention (r = 0.558, P<0.01), organizational commitment was significantly negatively correlated with turnover intention (r = - 0.539, P<0.01). Mediation analysis indicated organizational commitment partially mediated the association between workplace bullying and turnover intention. The total effect (β = 0.69) of workplace bullying on turnover intention consisted of its direct effect (β = 0.41) and the indirect effect mediated through organizational commitment (β = 0.280), with the mediating effect accounting for 40.58% of the total effect.

CONCLUSION

Organizational commitment mediated the associations of workplace bullying and turnover intention. Therefore, healthcare organizations and nursing managers should develop appropriate strategies to enhance nurses' organizational commitment in order to reduce their turnover intention.

Turnover Intention and Organizational Commitment of Primary Healthcare Nurses

Turnover intention is a predictor of the decision to leave an organization, which, if carried out, affects the quality of care provided. There is an association between turnover intention and organizational commitment. The more committed nurses are to the unit in which they work, the more committed they become to the unit's organizational goals; thus, they tend to continue working for the organization. Aiming to assess the turnover intention and the organizational commitment of nurses in primary healthcare, we conducted a quantitative, observational, descriptive, and cross-sectional study. The Intention of Turnover Scale and the Organizational Commitment Scale were applied in a sample of 297 nurses. Data were analyzed based on descriptive statistics. About 92.8% of the nurses intend to stay at their current workplace and only 7.3% plan to leave soon, suggesting low turnover intention; 84.5% of the nurses are willing to make an effort beyond what is normal to help their organization succeed, and 88.7% feel really interested in the destiny of the organization, which shows high organizational commitment. Pearson's Coefficient revealed the existence of a significant negative correlation between the factors "Intention to leave" and "Committed to the organization" (r = -0.51, p < 0.01). These findings suggest that, when nurses are more committed to their work and to the organization, they display less intention to leave, keeping the teams committed and motivated towards the organizational goals Our findings may guide nurse managers and policy-makers to develop strategies that retain nurses in organizations, keeping them motivated and engaged, and focusing on higher organizational commitment due to the influence it may have on the turnover intention.

Translation and Validation of the Individual Workload Perception Scale-Revised for Portuguese Nurses

(1) Background: In Portugal, there is no scale to assess nurses' satisfaction with their workload. Therefore, this study aimed to culturally/linguistically adapt and validate the IWPS-R scale, with 29 items, to produce a Portuguese version. (2) Methods: A quantitative, descriptive and cross-sectional study was conducted in two phases: translation and adaptation of the IWPS-R into Portuguese, following the steps recommended by Beaton; and evaluation of its psychometric properties in a non-probability sample of 323 nurses working in a hospital centre of reference in Portugal. (3) Results: The final scale obtained a total explained variance of 62.3% and a KMO of 0.88. The reliability was assured through the determination of an internal consistency of 0.88. The construct validity was determined through confirmatory factor analysis. The factorial model presented a good quality fit (X²/df = 2.118; CFI = 0.925; GFI = 0.900; RMSEA = 0.059; p (RMSEA ≤ 0.05) = 0.041; RMR = 0.078; MECVI = 1.525; SRMR = 0.0631) with five factors. (4) Conclusions: The Individual Workload Perception Scale-Revised-Portuguese version (IWPS-R-PT) is a 21-item tool with five dimensions: Nurse Manager Support, Team Support, Workload, Organizational Resources and Intent to Stay. The IWPS-R-PT was found suitable for hospital-based nurses and may be useful in other settings where nurses work.

Translation and Validation of the Indicators of Quality Nursing Work Environments in the Portuguese Cultural Context

The Indicators of Quality Nursing Work Environment scale (IQN-WE) with 65 items, developed by Chiou-Fen Lin, Meei-Shiow Lu, and Hsiu-Ying Huang in 2016, aimed to create a set of quality indicators of the nursing work environment. The translation and validation for the Portuguese cultural context of the IQN-WE scale was performed in this study.

OBJECTIVES

culturally and linguistically adapt the IQN-WE scale, originating from the Portuguese version, and evaluate its psychometric characteristics.

METHODS

it is a descriptive, cross-sectional, observational and quantitative study. The IQN-WE scale was validated in a sample of 542 nurses belonging to a hospital center in Portugal. The study obtained a response of 21.69%, of whom 78.0% were women and 22% men. The mean age of the sample was 39 years and a standard deviation of 8.1 years. All nurses who work have a bachelor's degree, and 13.5% have a master's degree.

RESULTS

the study obtained an instrument with a total explained variance of 52.67% and KMO = 0.843. It found a strong-to-moderate linear correlation matrix between the dimensions. The pre-test and the team of experts ensured the content validity. The determination of internal consistency guaranteed reliability, with 0.95. Confirmatory factor analysis validated the construct. The factorial model presented a goodness of fit index, with five factors.

CONCLUSION

the study achieved an instrument with 50 items in five dimensions: Team Support and Professional Development; Team Organization and Management; Safe Nursing Work Environment; Information Systems and Risk Control; Salary and Welfare. The IQN-WE-PT scale proved to be an appropriate instrument to be applied in health organizations in Portugal.

Translation, Adaptation, and Validation of the Self-Efficacy Scale for Clinical Nurse Leaders for the Portuguese Culture

Studies related to the competencies of clinical nurse leaders as an advanced practice demonstrate that they are an asset to health organizations. However, it is pertinent to use an instrument to measure the self-efficacy of clinical nurse leaders in Portugal to facilitate managers’ decision-making. In this study, we aimed to translate, adapt, and validate the Clinical Nurse Leader Self-Efficacy Scale for the Portuguese cultural context. This is a quantitative, observational, and descriptive cross-sectional study. The sample of this study was non-probabilistic and intentional, consisting of 329 nurses responsible for shift and specialist nurses. The translation and validation process followed the internationally recognized guidelines on the psychometric properties of measurement instruments. The factor analysis explained 62.1% of the variance and had a seven-dimensional structure. The seven factors were: Patient-Centred Care; Unit Management; Clinical Leadership; Strategic Leadership; Team Management; Cost Reduction; and Care Planning. The confirmatory analysis showed that the seven-factor model achieved a suitable adjustment in the Portuguese context. The self-efficacy scale for clinical nurse leaders can be considered a valid and reliable instrument for application in Portugal in any care context. This scale allows the assessment of the nurse’s perception of their ability to intervene effectively as a clinical leader in their care team.

Hospital patient safety at the emergency department - a systematic review

Abstract Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses’ perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses’ perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses’ perception on patient safety culture in emergency services, contributes to improving the quality of care provided.

Hospital patient safety at the emergency department - a systematic review

Patient safety in health care is the cornerstone of quality in nursing care. It is a duty of nurses and an objective of the health organizations. This article aims to analyze the scientific evidence on the nurses' perception and opinion on patient safety in the emergency department. Systematic literature review with 3 steps. 1) Primary search at CINHAL and MEDLINE. 2) A broader search, using the same keywords and search terms in the remaining database of the EBSCOHost platform. 3) Search the bibliographic references of the selected articles. The selected studies were published between 2014 and 2019. Five articles were selected. The nurses' perception reveal that the work environment, teamwork and matters related to the leadership of hierarchical superiors are fundamental factors to improve the quality of care provided and patient safety. Promoting teamwork improves patient care, reduces adverse events and improves quality. Recognizing the nurses' perception on patient safety culture in emergency services, contributes to improving the quality of care provided.

Validation of Psychometric Properties of the Nursing Work Index-Revised Scale in Portugal

The use of instruments designed to assess the nursing practice environment is crucial to improve the quality of nursing care, to anticipate problems and difficulties that may arise in organizations, and allow nurse managers to implement changes and improvements in key areas. In this study, we aimed to evaluate the psychometric properties of the Nursing Work Index—Revised Portuguese version (NWI-R-PT) scale. A quantitative, observational, descriptive, and cross-sectional study was conducted. Methods: The sample consisted of 767 nurses from 4 public Portuguese hospitals. Exploratory and confirmatory factor analysis techniques were used to test the distinct structural models. The scale’s accuracy was evaluated through internal consistency, using Cronbach’s alpha. Results: NWI-R-PT internal consistency was 0.91. The NWI-R-PT model with six factors, namely “Management Support,” “Professional Development,” “Fundamentals of Nursing,” “Nurse–Physician Relationship,” “Endowments,” and “Organization of Nursing Care,” was supported by exploratory and confirmatory factor analysis. The NWI-R-PT scale presents adequate goodness-of-fit indices concerning the final factorial model and the convergent validity. Conclusions: The NWI-R-PT scale has a competent and reliable structure. The scale’s validity is confirmed; therefore, it may be employed in all contexts in clinical practice, research, and nursing management. The NWI-R-PT is a useful and valid instrument to assess the nursing environment in hospitals, primary care, long-term care, and nursing homes. The scale has significance in improving the quality of nursing care and patient safety, the professional development of nurses, and organizational results.

Validation of the Psychometric Properties of the Practice Environment Scale of Nursing Work Index in Primary Health Care in Portugal

Studies related to the work environment in primary health care are scarce in the literature. The present study aimed to validate the psychometric properties of the Practice Environment Scale of Nursing Work Index (PES-NWI) in primary health care (PHC) and to evaluate its construct validity through exploratory and confirmatory factor analyses in a sample of Portuguese nurses. A quantitative, cross-sectional, and validation study design was implemented. Methods: The sample consisted of 1059 nurses from the PHC units of all 55 health center groups (HCGs) in mainland Portugal, 15 health centers in the Autonomous Region of Madeira, and 6 health centers in the Autonomous Region of the Azores. The study tested different structural models using exploratory and confirmatory factor analysis techniques. The reliability of the scale was tested by determining Cronbach’s alpha coefficient. Results: The internal consistency of the PES-NWI was 0.91. Exploratory and confirmatory factor analyses were performed on the PES-NWI model in PHC with five factors: NPOA, NFQC, NMALSN, SRA, and CNPR. The results show that the scale presents acceptable fit quality indexes in the final factorial solution and adequate convergent validity. Conclusion: The PES-NWI in PHC has an adequate, robust, and reliable five-factor structure. The scale is valid and can be used in clinical practice, nursing management, and PHC research.

The development of a shortened, Korean version of the Anticipated Turnover Scale for hospital nurses

This study was a psychometric validation of a Korean version of the Anticipated Turnover Scale (ATS) involving translation, transcultural adaptation, and validation. We used data from a cross-sectional online survey of 287 Korean practicing nurses in hospitals. Confirmatory factor analysis (CFA) assessed the validity of the one-factor structure that was hypothesized in the original version. We removed any items that did not enhance the scale's reliability and validity. Test and retest reliability was performed on 206 of the nurses who completed the survey again two weeks later. The mean age of the 287 nurses was 33 years, and 278 (97%) of them were female. The final 6-item Korean version of the ATS demonstrated a satisfactory model fit in the CFA (χ²  = 22.67; degree of freedom = 9; goodness-of-fit index= 0.97; comparative fit index = 0.98; Tucker-Lewis Index = 0.97; root mean square error of approximation = 0.07; and standard root mean residual = 0.03). The intraclass correlation coefficient with the test-retest reliability for the 2-week interval was 0.81, with a good internal consistency (Cronbach's alpha = 0.85; McDonald's omega coefficient reliability = 0.92). The 6-item revised ATS is a reliable and valid scale to assess the turnover intention of Korean nurses who work in hospitals. It can be used in an acute setting and predict the anticipated turnover rate for monitoring purposes.