Nursing Practice Today

Cross-cultural adaptation and validation of the advanced practice nursing assessment instrument for the Portuguese context: A methodological study

Ivo Filipe Dias da Costa — 2026-06-09

Background & Aim: Advanced Practice Nursing plays a crucial role in improving healthcare access, quality, and efficiency, being increasingly recognized in Portugal as a growing professional field. However, no validated instrument exists in Portugal to rigorously assess advanced practice nursing competencies. The Advanced Practice Nursing Competency Assessment Instrument, originally developed and validated in Spain, represents a robust tool for this purpose. This study aimed to cross-culturally adapt and validate the Advanced Practice Nursing Competency Assessment Instrument for the Portuguese context.
Methods & Materials: This methodological study was conducted in two phases. Cross-cultural adaptation followed established stages: two independent forward translations, synthesis, two back-translations, expert committee review, pre-test, and feedback to the original author. Psychometric evaluation used a cross-sectional sample of nurses from a local health unit in Northern Portugal. Analyses included descriptive statistics, exploratory factor analysis through principal component analysis, and internal consistency calculated by Cronbach’s alpha, item–total, and inter-item correlations.
Results: Expert consensus was achieved during the review process. The pre-test with a sample size of thirty-five nurses confirmed instrument clarity and usability. The validation sample included two hundred and sixty-four nurses and specialist nurses. Seven factors explained sixty-six percent of the total variance, representing a reduction from the original eight-factor structure. Two dimensions, Quality Management and Care Management, converged into a single factor in the Portuguese version. The scale demonstrated excellent reliability, with a total Cronbach’s alpha of 0.960, factor alphas ranging from 0.821 to 0.916, and adequate corrected item–total correlations.
Conclusion: The Portuguese version demonstrates adequate content validity, a coherent factor structure, and excellent reliability, supporting its use to assess advanced practice nursing competencies in the Portuguese health system.

Effectiveness of nurse-implemented nonpharmacologic interventions on delirium incidence in cardiac surgical ICU patients: A systematic review and meta-analysis

Dikki Saputra — 2026-06-09

Background & Aim: Delirium is a common, serious postoperative complication in cardiac surgery. This study evaluated the impact of nurse-implemented multimodal nonpharmacologic bundles on delirium incidence and severity in adult cardiac surgery ICU patients.
Methods & Materials: A systematic review and meta-analysis were conducted. A systematic literature search was performed across PubMed, Scopus, ScienceDirect, and Cochrane Library from inception to September 15, 2025. Data from eligible studies were extracted for narrative synthesis and meta-analysis. Pooled Odds_Ratios and 95% Confidence Intervals were calculated to evaluate delirium incidence, and statistical heterogeneity was assessed using the I² statistic.
Results: Thirteen studies were included, with eight studies (N=3,831) suitable for meta-analysis. Nurse-implemented bundles were associated with a reduced incidence of delirium (OR 0.56; 95% CI: 0.41–0.75; I2=14%). Narrative synthesis of five additional studies indicated that interventions such as early mobilization and sensory-based bundles (eye masks/earplugs) may mitigate delirium severity. Furthermore, physical frailty was identified as a significant risk factor (Adj. OR 1.61), and Scenario-Based Learning was found to be a viable approach for enhancing nurse competency.
Conclusion: Nurse-implemented multimodal non-pharmacological bundles contribute to reducing delirium incidence in cardiac surgery ICUs. These findings suggest that such protocols serve as a relevant secondary prevention strategy. However, given the diversity of intervention components and geographical settings, these results should be interpreted with caution. Clinical protocols should consider integrating frailty screening and environmental modifications, while future research should prioritize standardized continuous outcomes like Delirium-Free Days.

Methodological considerations in psychometric validation: Distinguishing between principal components and latent factors

Reza Ghanei Gheshlagh — 2026-06-06

N/A

Effectiveness of an integrated nursing program on anxiety, uncertainty in illness, and self-care ability among patients undergoing cardiac catheterization: A quasi-experimental study

Siriwan Turongruang — 2026-05-20

Background & Aim: Patients undergoing cardiac catheterization commonly experience elevated anxiety, illness uncertainty, and self-care challenges. This study evaluated the effectiveness of an integrated nursing program on anxiety, uncertainty in illness, and self-care ability among patients undergoing first-time cardiac catheterization.
Methods & Materials: A quasi-experimental study with repeated measures was conducted among 60 middle-aged adults (40–65 years) scheduled for first-time cardiac catheterization at a tertiary hospital in Bangkok, Thailand. Participants were consecutively enrolled and allocated using systematic alternating assignment (intervention n=30; control n=30). The intervention comprised a four-phase integrated nursing program based on Mishel's Uncertainty Theory and Orem's Self-Care Theory. Primary outcomes were measured using STAI, MUIS-A, and SCHFI at four time points.
Results: Baseline characteristics revealed no significant differences between groups (p>0.05). Mixed ANOVA revealed significant Group × Time interaction effects for all primary outcomes: anxiety [F(3,174)=39.796, p<.001, ηp²=0.407], uncertainty in illness [F(3,174)=13.827, p<.001, ηp²=0.193], and self-care ability [F(3,174)=4.485, p=.005, ηp²=0.072]. The intervention group demonstrated progressive reductions in anxiety and uncertainty in illness alongside sustained improvements in self-care ability. The intervention group experienced fewer complications (3.3% vs. 20.0%, p=0.044) and higher satisfaction scores (142.8±6.2 vs. 118.5±8.7, p<0.001).
Conclusion: The integrated nursing program effectively reduced anxiety and uncertainty while enhancing self-care ability among cardiac catheterization patients, demonstrating clinical utility for improving perioperative outcomes.
Trial Registration: Thai Clinical Trials Registry (Registration pending - Request No. TCTR 20260210)

Improving early detection of breast cancer in Iran: Identifying barriers and proposing policy solutions

Maryam Janatolmakan — 2026-05-04

Background & Aim: Delays in early breast cancer detection increase late-stage presentation, treatment burden, mortality, and costs. Barriers are systemic (access, affordability), individual (fear, awareness), and socio-cultural (stigma, beliefs). This policy brief aims to improve early detection in Iran by identifying barriers and proposing solutions.
Methods & Materials: This policy brief was developed through a multi-phase, evidence-informed study with a multidisciplinary panel. Phase 1 employed a scoping review to identify factors contributing to delayed breast cancer diagnosis globally. Phase 2 utilized semi-structured qualitative interviews with Iranian patients and healthcare providers to explore real-world barriers to early detection. Phase 3 applied an expert consensus approach to prioritize evidence-based, context-specific policy recommendations for improving early breast cancer diagnosis in Iran. The expert panel in Phase 3 comprised specialists from Radiation Oncology, Public Health, Health Education & Promotion, Medical Oncology, and Nursing.
Results: Policy recommendations were derived across five key priority areas: Enhancing equitable access to screening services; Strengthening follow-up and continuity of care systems; Improving health education and awareness; Promoting intersectoral coordination and multisectoral governance; and Ensuring sustainability of resources and digital infrastructure.
Conclusion: Initiating strategies to address these public health recommendations could substantially improve early breast cancer detection rates, reduce mortality, improve patient quality of life, and enhance the overall efficiency of the health system. Moreover, this framework may serve as a scalable model for managing non-communicable diseases in resource-limited settings.