Journal of Neonatal Nursing xxx (xxxx) xxx Please cite this article as: Mansoureh Ashghali Farahani et al., Journal of Neonatal Nursing, https://doi.org/10.1016/j.jnn.2023.10.007 1355-1841/© 2023 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. Cross-cultural adaptation and psychometric properties testing of the Persian version of the neonatal palliative care attitude scale Mansoureh Ashghali Farahani a , Hamid Sharif-Nia b, e , Aida Safaiee Fakhr c , Marjan Banazadeh d, * a Nursing and Midwifery Care Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran b Traditional and Complementary Medicine Research Center, Addiction Institute, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran c Department of Public Health and Paraclinics, Qazvin University of Medical Sciences, Qazvin, Iran d School of Nursing, Alborz University of Medical Sciences, Karaj, Iran e Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran A R T I C L E INFO Handling Editor: Ms L Altimier Keywords: Neonatal palliative care Nurses’ attitude Neonatal intensive care unit Psychometric testing Validity Reliability ABSTRACT This study aimed to translate/validate NiPCAS for use among Iranian NICU nurses. The 26-item NiPCAS was translated into Persian and evaluated for validity and reliability. 230 nurses participated. The NiPCAS-P demonstrated satisfactory face/content validity, with appropriate, clear, and relevant items. The overall test- retest reliability was good. Cronbach’s alpha for the three factors (“resources,” “organization,” and “personal experiences/beliefs”) were acceptable. Out of 26 items, 15 loaded on the three factors, explaining 35.75% of the variance. The 15-item NiPCAS-P is a valid tool for examining the attitudes of Iranian NICU nurses towards neonatal palliative care barriers/facilitators. However, the “personal experiences/beliefs” factor may not be as reliable as the other two factors. Developing a context-specifc questionnaire to assess nurses’ experiences/beliefs in this area is recommended. Similar implications exist for countries with comparable contexts. Research needs to adapt NiPCAS for cross-cultural use and create additional tools to explore multi-dimensional factors affecting the implementation of neonatal palliative care factors. 1. Introduction Medical advances in neonatology have improved survival for high- risk newborns, but they still face health issues that can impact their quality of life (Wolke et al., 2019). Neonatal palliative care (NPC) is crucial in providing holistic care for critically ill newborns and their families (Grauerholz et al., 2020). It takes an interdisciplinary approach, bringing together various healthcare professionals to address the phys- ical, emotional, social, and spiritual needs of seriously ill neonates and provide psychosocial support for their families. The implementation of NPC involves obtaining a prenatal or postnatal diagnosis, with approval from both the multidisciplinary team and the parents (Organization, 2018). The primary goal of NPC is to comfort and enhance a child’s quality of life, not hasten or prolong death (Ferrell and Coyle, 2002). And can be combined with curative treatments (Parravicini, 2017). The initiation of NPC depends on the neonate’s condition, caregiver attitudes, family preferences, and hospital policies (Banazadeh and Rafi, 2021; Beckstrand et al., 2019; Hamdan Alshehri et al., 2020). Research shows Barriers include lack of knowledge, acceptance of neonatal death, institutional constraints, environment, and resources (Quinn and Gephart, 2016; Sadeghi et al., 2021). As frontline caregivers, neonatal intensive care unit (NICU) nurses play a vital role in imple- menting palliative care (Haug et al., 2020). Their attitudes and potential knowledge gaps regarding NPC may impact its implementation (Carter et al., 2011). Therefore, investigating their attitudes toward palliative care and the infuential factors seems important (Akay and ¨ Ozdemir, 2021). Validated tools to assess NICU nurses’ attitudes are needed. Kain et al., (2009), developed the Neonatal Palliative Care Attitude Scale (NiPCAS) to investigate the NICU nurses’ attitudes toward the imple- mentation of NPC (Kain et al., 2009). This scale has been used inter- nationally by Azizzadeh in Iran (Azzizadeh Forouzi et al., 2017), Chen in * Corresponding author. Alborz University of Medical Sciences (ABZUMS), Taleghani Boulevard, Taleghani Square, Karaj, Iran. E-mail addresses: m_negar110@yahoo.com (M. Ashghali Farahani), h.sharifnia@mazums.ac.ir (H. Sharif-Nia), a.safaei@qums.ac.ir (A. Safaiee Fakhr), m. banazadeh@abzums.ac.ir, banazadeh54@yahoo.com (M. Banazadeh). Contents lists available at ScienceDirect Journal of Neonatal Nursing journal homepage: www.elsevier.com/locate/jnn https://doi.org/10.1016/j.jnn.2023.10.007 Received 24 August 2023; Received in revised form 6 October 2023; Accepted 30 October 2023