Psychometric evaluation of the Palliative Nursing Care Quality Scale (PNCQS) among ICU and oncology nurses in Iran

Background: Reliable and culturally adapted instruments are essential for assessing the quality of palliative nursing care. The Palliative Nursing Care Quality Scale (PNCQS) had not been psychometrically evaluated in Iran. This study aimed to translate the PNCQS into Persian and examine its validity and reliability among Iranian nurses. Methods: In this methodological study, the PNCQS was translated into Persian according to the World Health Organization (WHO) guidelines. A total of 620 nurses from oncology and intensive care units in teaching hospitals in Tehran, Tabriz, and Ardabil were recruited using a multi stage cluster sampling strategy with convenience sampling at the final stage. Face, content, and construct validity were evaluated. Construct validity was examined by first testing the original one-factor model using confirmatory factor analysis (CFA), followed by exploratory factor analysis (EFA) and cross-validation of the derived factor structure using CFA on an independent sample. CFA was conducted in AMOS using maximum likelihood estimation with bootstrapping (1,000 resamples). Reliability was assessed by internal consistency (Cronbach’s α) and two-week test–retest reliability using the intraclass correlation coefficient (ICC). Results: The scale showed excellent content validity (S-CVI = 0.99). The initial CFA demonstrated that the original 20-item unidimensional model did not adequately fit the Iranian data. Subsequent EFA identified a four-factor structure—Family-Centered Care, Empathic and Spiritual Care, Hope and Life Review, and Physical Symptom Management—explaining 51.41% of the total variance. This structure was confirmed by CFA in an independent sample (n = 400), demonstrating good model fit (χ²/df = 2.84, CFI = 0.95, TLI = 0.95, RMSEA = 0.06). Composite reliability exceeded 0.70 for all factors. Although the AVE for Family-Centered Care was slightly below the recommended threshold (0.42), its composite reliability was acceptable (0.81), and discriminant validity was established for all constructs. Cronbach’s α was 0.92 for the total scale (subscales: 0.76–0.83), and the two-week test–retest ICC was 0.76. Conclusion: The Persian PNCQS demonstrated satisfactory psychometric properties and a culturally appropriate four-factor structure for assessing the quality of palliative nursing care among Iranian nurses. It provides a reliable multidimensional instrument for clinical practice, research, and quality improvement initiatives in palliative care.