Psychometric properties of the Person-Centered Palliative Care Nursing Instrument (PPCNI): validity and reliability study

Abstract

Introduction

The most effective approach for patients and healthcare professionals to manage multiple symptoms during treatment or care is palliative care support focused on symptom control. This study aimed to evaluate the validity and reliability of the Turkish version of the Person-Centered Palliative Care Nursing Instrument.

Methods

A methodological and descriptive cross-sectional study was conducted at a city hospital in Istanbul. The sample included 200 nurses who worked in the intensive care unit. Data were collected using the Person-Centered Palliative Care Nursing Instrument and the Frommelt Attitude Toward Care of the Dying Scale.

Results

The content validity index of the scale was calculated as 0.84. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.918, and Bartlett’s Test of Sphericity yielded a χ² value of 8395.116 (p < 0.001). Item-total correlation coefficients ranged from 0.519 to 0.762, while factor loadings varied between 0.514 and 0.866. Confirmatory Factor Analysis revealed acceptable goodness-of-fit indices: χ² = 2355.612, df = 0.8, RMSEA = 0.07, GFI = 0.92, CFI = 0.97, and AGFI = 0.87. The internal consistency reliability of the subscales ranged from 0.905 to 0.965, with a Cronbach’s alpha coefficient of 0.98 for the overall scale. Exploratory Factor Analysis confirmed the original structure of the scale, consisting of 37 items and four factors.

Discussion

Families of people with chronic illness often struggle to provide adequate care, increasing the demand for professional support. Poor satisfaction levels of palliative patients, families and health care providers indicate the need for improvements in the palliative care system. Assessing the quality of palliative care provided by nurses is essential to improve the quality of patient care.

Conclusion

The Turkish version of the scale was found to be a valid and reliable instrument for clinical use, enabling nurses to deliver palliative care tailored to patients’ needs and preferences.

Introduction

With the global rise in the elderly population and the prevalence of chronic diseases, the demand for palliative care is also increasing [1, 2]. Furthermore, the recognition of end-of-life support as a fundamental human right underscores the necessity for accessible and high-quality palliative care [3]. Palliative care is an approach designed to improve the quality of life for individuals with life-threatening illnesses and their families by preventing and alleviating suffering through early diagnosis, comprehensive assessment, and effective management of physical, psychosocial, and spiritual distress [4]. Its primary goal is to enhance patients’ well-being by addressing symptoms and challenges through a holistic, individualized approach that respects personal beliefs and cultural values [2, 5]. However, despite its growing importance, access to effective palliative care remains limited. According to the World Health Organization (2020), approximately 56.8 million people require palliative care annually, including 25.7 million in their last year of life, yet only 14% receive adequate services worldwide [4].

Palliative care emphasizes symptom management, multidisciplinary collaboration, patient- and family-centered approaches, effective communication, bereavement support, and accessibility [6, 7]. A specialized healthcare team is essential to ensure quality care, necessitating ongoing education and skill development for healthcare professionals [6]. In Turkey, families of chronically ill patients often face challenges in providing adequate care, which increases the demand for professional support [2]. Studies indicate that intensive care unit (ICU) care is costly, and satisfaction levels among patients, families, and healthcare providers remain low, underscoring the urgent need for improvements in the palliative care system [7].

Nurses play a crucial role in palliative care, requiring advanced skills in assessment, symptom management, and emotional support [2]. Palliative nursing involves not only routine patient care but also decision-making assistance and interventions aimed at enhancing patient comfort [8, 9]. Beyond addressing physical symptoms, nurses must also manage social, psychological, financial, and existential challenges [10]. Several instruments have been developed to evaluate the quality of palliative care in Turkey, including the Palliative Care Self-Reported Practices Scale (PCPS), the Palliative Care Difficulties Scale (PCDS), and the Palliative Nursing Care Quality Scale (PNCQS-T) [2]. Other tools, such as the Neonatal Palliative Care Attitude Scale, the Integrated Palliative Care Outcome Scale, and the Palliative Care Outcome Scale, assess various aspects of patient and caregiver needs [11–13].

Person-centered care is a holistic approach in healthcare that recognizes and respects the individuality of each person by considering their values, beliefs, preferences, and cultural context. This approach emphasizes addressing the person not solely in terms of their illness but as a whole, encompassing physical, psychological, social, cultural, and spiritual dimensions [14]. A person-centered approach ensures that patients receive care tailored to their preferences, values, and beliefs. Enabling patients to actively participate in their care enhances both the quality and effectiveness of palliative care [15]. Palliative care acknowledges that individuals have fundamental common needs, including physical, mental, social, and spiritual well-being. Therefore, it is crucial for palliative care to be person-centered to ensure that individuals receive care that promotes the best possible quality of life according to their own needs and preferences, in line with evidence and current legislation. Palliative care can evolve over time, influenced by prevailing social values and norms, as well as an individual’s personal perspective and interpretation of life. Consequently, there are many interpretations of what a “good death” means for different individuals [16]. Providing patients with the opportunity to co-create their care increases the likelihood that care is truly person-centered and shaped by the patient’s own values, beliefs, and preferences. Furthermore, person-centered palliative care aims to maximize an individual’s chances of living their remaining days as fully as possible, regardless of whether that time is short or long [15].

As a result of the literature review, it was found that there is a limited number of measurement tools available to evaluate the provision of palliative care in our country. Therefore, the development of new instruments with established validity and reliability to assess person-centered palliative care emerges as a significant need to address an important gap in the field. This study aimed to evaluate the validity and reliability of the Turkish version of the Person-Centered Palliative Care Nursing Instrument. Designed specifically for ICU nurses, this self-report scale assesses palliative care practices based on patient needs and preferences. Ensuring patient-centered nursing care in Turkish palliative care units may enhance the quality of care and more effectively meet the critical needs of patients and their families.

Methods

Study design

A methodological and descriptive cross-sectional design was used to evaluate the psychometric properties of the Turkish adaptation of the Person-Centered Palliative Care Nursing Instrument.

Population and sample

The study population consisted of nurses working in the intensive care units of a city hospital in Istanbul (N = 210). The sample size was calculated to be at least five times and at most ten times the total number of items in the scale (37 items × 5 = 185, n = 185). Therefore, the sample group was determined to include at least 185 nurses. The study was conducted between June and July 2024 and encompassed the entire population of 200 nurses who met the inclusion criteria, with no sampling method employed. Additionally, a post-hoc power analysis using the observed correlation coefficient (r = 0.346), α = 0.05, and n = 200 indicated a statistical power of 0.93, confirming that the study was sufficiently powered to detect low-to-moderate effect sizes.

Inclusion criteria comprised nurses who were actively employed in a clinical setting during the data collection period, had a minimum of six months’ experience in the ICU, and provided informed consent to participate in the study. Exclusion criteria included nurses who were on annual, maternity, or sick leave during the data collection period, as well as those who declined participation.

Data collection

Data were collected through face-to-face interviews conducted by the researchers. To assess the reproducibility (test-retest reliability) of the instrument, the scale was re-administered to 30 nurses from the study sample two weeks after the initial application. Test-retest reliability was performed to determine whether the measurement tool produces consistent results when administered to the same individuals at different time points [17].

Measurements

Personal Information Form, Frommelt Attitude Toward Care of the Dying Scale (FATCOD) and Person-Centered Palliative Care Nursing Instrument (PPCNI) were used for data collection.

Personal information form

This form was used to collect data on the sociodemographic characteristics of nurses working in the intensive care unit, as well as their knowledge and practices related to palliative care.

Person-Centered Palliative Care Nursing Instrument

The PPCNI was developed by Soriano et al. [15] in 2023 to support nurses working in critical care settings in delivering palliative care aligned with patients’ needs and preferences. The scale comprises 37 items across three sub-dimensions: “Caring as Maintaining Person’s Dignity” (13 items), “Caring as Empowerment of Person’s Autonomy” (14 items), and “Caring as Understanding Person’s Momentary Concerns” (10 items). It is a five-point Likert-type scale, with responses ranging from 1 (Never) to 5 (Always). The overall Cronbach’s alpha coefficient for the scale was reported as 0.98, indicating excellent internal consistency. The final score is calculated by averaging all item responses, and scores are interpreted as follows: 1.00–2.33: low level; 2.34–3.66: medium level; 3.67–5.00: high level.

Frommelt attitude toward care of the dying scale

The scale was originally developed by Frommelt [18] in 1991, and its Turkish adaptation, including validity and reliability testing, was carried out by Çevik [19] in 2010. This five-point Likert-type scale consists of 30 items, with response options ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Scoring is performed by reversing the negatively worded items and then summing them with the positively worded ones. Total scores range from 30 to 150, with higher scores indicating a more positive attitude toward caring for individuals with terminal illness. The Cronbach’s alpha coefficient for the original scale was reported as 0.73, while in the present study, it was calculated as 0.70, indicating acceptable internal consistency.

Language validity

To ensure linguistic accuracy, the scale was first translated from English to Turkish by three bilingual experts. The translations were reviewed and synthesized to produce a unified Turkish version of the scale. This version was then back-translated into English by an independent expert to verify its consistency with the original version. For content validity, 15 nursing academicians evaluated the scale using the Davis method, assessing each item for relevance, clarity, and specificity. The Content Validity Index (CVI) was calculated as 0.84. Items that received at least 80% agreement from the experts were retained in the final version of the scale [20, 21].

Validity and reliability analysis of the scale

The construct validity of the scale was assessed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), with expert opinions contributing to the evaluation of content validity. Stability was examined through the test-retest method, and the Kaiser-Meyer-Olkin (KMO) measure was used to determine the suitability of the data for factor analysis [22, 23].

For reliability, internal consistency was evaluated using Cronbach’s alpha. The scale’s repeatability was tested by calculating Intraclass Correlation Coefficients (ICC) and Pearson correlation coefficients, with coefficients ≥ 0.70 considered indicative of acceptable reliability. Additionally, the scale’s discriminative power and difficulty levels were analyzed to identify the most appropriate logistic model for its structure.

Statistical analysis

In this study, descriptive and reliability analyses were conducted using SPSS version 29.0.0.1.0, while validity analyses were performed with SPSS AMOS version 29.0.0.0. Descriptive statistics, including frequencies, percentages, minimum and maximum values, mean, and standard deviation, were utilized for data analysis. For validity assessment, both Content Validity (language validity) and Construct Validity tests were carried out. Confirmatory Factor Analysis was conducted, and multiple fit indices were evaluated to determine the model’s adequacy.

Ethical considerations

The study was approved by the Non-Interventional Ethics Committee of Istanbul Cemil Taşcıoğlu City Hospital on 07.05.2024, under decision number 514.99-243107316. Permission to use the scale was also obtained from its original author. Participants were informed that all collected data would be used exclusively for academic purposes. Prior to participation, nurses were provided with an informed consent form and asked to give their voluntary consent. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki, ensuring the anonymity and confidentiality of all participants. All data were stored in a password-protected digital file on a secure computer accessible only to the research team. Personal identifiers were removed to maintain participant confidentiality. This study was conducted and reported in alignment with the Guidelines for Reporting Reliability and Agreement Studies (GRRAS).

Results

Descriptive characteristics

The mean age of the participants was 27.39 ± 4.76 years (range: 21.00–45.00). Of the participants, 81.0% were female, 82.5% held an undergraduate degree, and 68.5% were single. The majority (46.5%) had been working both in the nursing profession and in the intensive care unit for 1–5 years. Additionally, 45.5% of the participants were employed in the anesthesia and reanimation intensive care unit, and 84.0% worked in a shift-based system.

Validity analysis

Content validity

The scale was evaluated by 15 expert academicians in the field of nursing. Using the Davis method, the CVI was calculated as 0.84, indicating an acceptable level of agreement among the experts.

Construct validity (confirmatory factor analysis)

To assess the suitability of the dataset for factor analysis, the KMO test and Bartlett’s Test of Sphericity were conducted. The KMO coefficient was found to be 0.918, and Bartlett’s Test yielded a chi-square value of 8395.116 (p = 0.001), confirming that the data were appropriate for factor analysis (Table 1).

Table 1.

KMO ve Bartlett’s test results

KMO Sampling Adequacy	0.918
Bartlett’s Test	X 2 P df	8395.116 0.000 666

KMO Kaiser-Meyer-Olkin

The factor structure validity of the scale was evaluated using CFA, and goodness-of-fit indices were calculated. CFA, a structural equation modeling technique, is used to examine the relationship between observed variables and underlying latent constructs [24]. It is commonly employed to confirm the hypothesized factor structure of a measurement instrument. This study utilized widely accepted goodness-of-fit indices reported in the literature.

As shown in Table 2, with Promax rotation, the eigenvalues for the four extracted factors were greater than 1 [17], which is a commonly used criterion for factor retention. The total variance explained by these four factors was 72.757%. According to Kline [25], an explained variance exceeding 40% is considered acceptable; therefore, the result in this study demonstrates strong construct validity.

Table 2.

Results of EFA

Total Variance Explained
Component	Initial Eigenvalues			Rotation Sums of Squared Loadings
	Total	% of Variance	Cumulative %	Total	% of Variance	Cumulative %
1	17.780	48.055	48.055	9.134	24.687	24.687
2	5.384	14.551	62.605	8.032	21.709	46.395
3	2.405	6.499	69.105	6.093	16.467	62.863
4	1.351	3.652	72.757	3.661	9.894	72.757

EFA Exploratory Factor Analysis

The CFA results show that the goodness-of-fit statistics for the model without adjustment are within acceptable ranges (Table 3). The structural model diagram resulting from CFA is presented in Fig. 1.

Table 3.

The fit indices of CFA findings of the scale

χ2	df	χ2/SD	GFI	AGFI	TLI	CFI	SRMR	RMSEA
2355.612	0.8	2.8	0.92	0.87	0.90	0.97	0.04	0.07

χ2 Chi-square, df Degrees of freedom, GFI Goodness of Fit Index, AGFI Adjusted Goodness of Fit Index, TLI Turker-Lewis Index, CFI Comparative Fit Index, SRMR Standardized Root Mean Square Residual, RMSEA Root Mean Square Error of Approximation

Fig. 1.

Diagram of CFA

Factor loadings and regression coefficients for items

An examination of the standardized coefficients revealed that the factor loadings were high, the t-values were statistically significant (p < 0.001), and the R² values were substantial. These results support the construct validity of the predetermined factor structure. The original PPCNI consists of 37 items. In the EFA, no item demonstrated a factor loading below 0.30, indicating that all items meaningfully contributed to their respective factors. The analysis confirmed that the scale retains a four-factor structure: Factor 1: Caring as Maintaining Person’s Dignity – Items 1–6 and 8–13; Factor 2: Caring as Understanding Person’s Momentary Concerns – Items 28–37; Factor 3: Caring as Empowerment of Person’s Autonomy – Items 20–27; Factor 4: Caring as Participating in Person’s Decision-Making – Items 7 and 14–19.

When analyzing the factor loadings in the EFA, it was found that the “Caring as Maintaining Person’s Dignity” subdimension ranged from 0.515 to 0.866. The “Caring as Understanding Person’s Momentary Concerns” subdimension had values between 0.616 and 0.827. Additionally, the “Caring as Empowerment of Person’s Autonomy” subdimension showed coefficients ranging from 0.524 to 0.861, while the “Caring as Participating of Person’s Decision Making” subdimension had scores between 0.514 and 0.813.

Reliability analysis

Test-retest reliability

To evaluate the reliability of the scale, a Pearson correlation analysis was performed. Participants (n = 200) had a mean score of 4.10 ± 0.64 in the initial assessment and 4.13 ± 0.57 in the retest. The results indicated a statistically significant and strong correlation between the two measurements (Table 4).

Table 4.

Test-retest pearson correlation value

	Person-Centered Palliative Care Nursing Instrument Retest
Person-Centered Palliative Care Nursing Instrument Test	Correlation Coefficient	0.991
	Sig. (2-tailed)	< 0.001

Pearson Correlation Coefficient Anaylsis, p < 0.001

Internal consistency

To determine the internal consistency of the scale, item-total correlation coefficients and Cronbach’s alpha values were examined. The Cronbach’s alpha coefficient was 0.969 for the initial test and 0.961 for the retest, indicating high internal consistency and strong reliability. The Cronbach’s alpha values for the subdimensions were as follows: 0.955 for “Caring as Maintaining Person’s Dignity,” 0.965 for “Caring as Understanding Person’s Momentary Concerns,” 0.954 for “Caring as Empowerment of Person’s Autonomy,” and 0.905 for “Caring as Participating in Person’s Decision-Making.” The overall Cronbach’s alpha for the PPCNI scale was 0.969 (BootSE = 0.005, 95% CI [0.956, 0.976]).

Parallel forms reliability

The parallel forms reliability method was utilized to assess the scale’s consistency. A statistically significant low-to-moderate positive correlation was observed between the total FATCOD and PPCNI scores (r = 0.346; p = 0.000), indicating that improvements in attitudes toward palliative care are associated with higher PPCNI scores (Table 5). This result aligns with Cohen’s [26] effect size conventions and is further supported by Hinkle et al. [27], who define the 0.30–0.50 range as moderate. Additionally, given that PPCNI and FATCOD measure related but distinct constructs (practice vs. attitude), this level of correlation is theoretically expected and appropriate for convergent validity.

Table 5.

Correlation between PPCNI Sub-dimensions and FATCOD total score

		FATCOD
		r	p
PPCNI	F1	0.437	0.000
	F2	0.344	0.000
	F3	0.325	0.000
	F4	0.242	0.000
	Toplam	0.346	0.000

Pearson Correlation Coefficient Anaylsis, p < 0.001

PPCNI Person-Centered Palliative Care Nursing Instrument, FATCOD Frommelt Attitude Toward Care of the Dying Scale

Discussion

This study demonstrates that the Turkish version of the PCNI performance scale is a valid and reliable measurement tool within the Turkish healthcare system. The content validity of the scale was assessed using the Davis technique, and the content validity index was determined to be 0.84. This value exceeds the minimum threshold of 0.80 recommended in the literature, indicating that the scale has an adequate level of content representativeness [28, 29].

From a structural perspective, the analyses revealed a KMO value of 0.918, and the Bartlett’s test of sphericity was statistically significant (χ² = 8395.116; p < 0.001). These findings indicate that factor analysis can be reliably applied and that there is a sufficient level of correlation among the variables. The KMO values reported by Mastroianni et al. [30], Soriano et al. [15], and Liu et al. [31] were 0.907, 0.98, and 0.96, respectively, aligning closely with the value obtained in this study. This consistency suggests that the structural validity of the scale yields stable results across different samples.

As a result of the Exploratory Factor Analysis, all 37 items of the PCNI scale were retained; however, a four-factor structure emerged, differing from the original form. Although validity and reliability studies of the PCNI scale in Turkey are limited, the scale was adapted into Turkish by Özalp et al. [32]. In their study, four items (items 14, 17, 18, and 21) were removed from the scale due to their cross-loading characteristics, resulting in a three-factor structure with the remaining 33 items. Furthermore, the four-factor structure identified in the current study also differs from the three-factor model proposed by Soriano et al. [15], the developers of the original scale. In this context, it can be inferred that the factor structure of the concept of person-centered care may vary significantly depending on the cultural and clinical contexts in which it is applied. These findings suggest that the conceptual structure of the PCNI scale demonstrates a certain degree of contextual sensitivity and may exhibit structural flexibility in culture-specific applications. Therefore, testing the scale in broader and more diverse samples across different clinical settings is crucial for assessing the robustness of its factor structure.

The model fit indices obtained in the study (RMSEA = 0.07, GFI = 0.92, CFI = 0.97, TLI = 0.90) indicate that, according to structural equation modeling, the four-factor structure of the scale demonstrates an overall acceptable and, in some aspects, strong model fit. The RMSEA value being below 0.08 and the CFI exceeding 0.95 suggest that the model is statistically robust [33]. These findings are important as they show that the structural validity of the Turkish version of the scale is preserved. Similarly, in the study by Özalp et al. [32], the CFA results for the 32-item, three-factor model were also found to be at an acceptable level (CMIN/DF = 2.428, RMSEA = 0.078, CFI = 0.92, TLI = 0.94, NFI = 0.93, AGFI = 0.90). These values are fairly close to those in our study, particularly in terms of TLI (0.90), though a higher model fit was achieved in our study with respect to CFI (0.97). A similar level of model fit was reported by Liu et al. [31] in a study conducted with a different sample (χ²/df = 2.267, RMSEA = 0.077, CFI = 0.912, TLI = 0.901). Collectively, these studies suggest that the construct validity of the PCNI scale is generally maintained across samples with different characteristics, although partial variations may occur in the factor structure and fit indices. In this context, the fact that the model demonstrates strong fit both statistically and structurally supports the meaningful functioning of the factor structure in the Turkish version of the scale. Future research is recommended to re-test the PCNI scale in various healthcare fields, cultural subgroups, and institutional settings to better understand the sources of such differences.

The Cronbach’s Alpha coefficient obtained in this study (α = 0.969) indicates a high level of internal consistency, demonstrating that the scale offers a reliable structure. This value is comparable to those reported in the original study by Soriano et al. [15] (α = 0.977) and the study by Özalp et al. [32] (α = 0.953), suggesting that the Turkish version exhibits stable internal reliability. Although the overall Cronbach’s alpha coefficient obtained in this study was 0.969, which may initially raise concerns regarding potential item redundancy, closer inspection of the item-total statistics indicated that the removal of any item would lead to a reduction in the reliability coefficient. This suggests that each item contributed meaningfully to the internal consistency of the scale. We elected to retain all 37 items in order to preserve the conceptual breadth and ensure comparability with the original structure of the PPCNI. It is important to note, however, that very high alpha values can sometimes reflect content overlap rather than true internal consistency [34]. To address this, we recommend that future studies further investigate the dimensional efficiency of the scale using more granular methods, such as Item Response Theory or item-level factor loading diagnostics. Such approaches could offer deeper insights into item performance and inform potential revisions aimed at optimizing psychometric parsimony without compromising construct coverage. Moreover, the very high correlation coefficient found in the test-retest analysis (r = 0.991, p < 0.001) indicates that the scale produces consistent results over time. This result surpasses the test-retest reliability reported by Mastroianni (2015) for the FATCOD scale (ICC = 0.87) and the reliability values reported by Liu et al. [31] (r > 0.70). Additionally, the moderate correlation observed in the parallel form analysis between the PCNI and the Frommelt scale suggests that, despite conceptual similarities, the constructs measured by the two instruments are meaningfully distinct. This finding points to the PCNI scale’s ability to preserve its unique conceptual structure.

Limitations and strengths

The study’s findings are limited to data collected from nurses at a single city hospital in Istanbul, which may affect the generalizability of the results. Cultural and linguistic differences could also account for variations in the factor structure compared to the original PPCNI. Despite these limitations, the study has notable strengths, including high item-total correlations, strong internal consistency, and robust test-retest reliability. Furthermore, the hospital’s tertiary multi-bed ICU setting, the high volume of end-of-life care patients, and nurses’ experience ranging from 1 to 5 years enhance the reliability and applicability of the results. However, the use of self-report instruments by participants may limit the objectivity of the measurements. Because this method depends on subjective evaluations and memory recall, it may introduce bias that could negatively impact the accuracy of the results.

Conclusion

This study adapted the PPCNI for the Turkish context by evaluating its validity and reliability. The findings confirm that the Turkish version, consisting of 37 items and four subdimensions, is both valid and reliable. The scale can be effectively used in clinical practice to support nurses in delivering person-centered palliative care and assessing their related perceptions. It is also suitable for incorporation into in-service training programs.

The implementation of this instrument can significantly contribute to improving the quality of care by promoting a more individualized and compassionate approach, benefiting not only nurses but also supporting the fulfillment of the essential needs of patients and their families. It is recommended that future research employ this version to investigate nurses’ attitudes toward palliative care across varied clinical settings. Furthermore, additional validation studies involving larger and more diverse samples are warranted to enhance the generalizability and applicability of the scale within different healthcare contexts.

Authors’ contributions

Conception and design: M.Ş.Y, A.K., Data collection or processing: D.Ö.Ü., Data analysis and interpretation: M.Ş.Y, A.K., S.K., Literature search: M.Ş.Y, A.K., S.K., G.Y., Writing: M.Ş.Y, A.K., S.K., GY., Critical revision of the article: M.Ş.Y, A.K., S.K., D.Ö.Ü., G.Y.

Funding

None.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

The study received ethical approval from the Istanbul Cemil Taşcıoğlu City Hospital Non-Interventional Ethics Committee on 07.05.2024 (approval number 514.99-243107316). Permission was obtained from the author of the scale. Before the study commenced, nurses were asked to review and sign the informed consent form. The study procedure performed in this research was compatible with the Helsinki Declaration.

Consent for publication

All participants provided informed consent for publication via an informed consent form before data collection.

Competing interests

The authors declare no competing interests.