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.

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.

Globalisation, wars, competitiveness, and technological innovation have increased workplace diversity, requiring leaders to conduct multinational projects, lead people from different cultural backgrounds, and deliver appropriate services that meet the needs of clients from different cultures. Several concepts are interchangeably used to define and describe leadership in culturally-diverse work environments; one such concept is transcultural leadership. Because of nurses’ global migration and care delivery to patients from different cultural backgrounds, this concept is of interest in the nursing field. While some nurses have been identified as transcultural leaders, no definition of transcultural nursing leadership has been found in the literature. This study aimed to develop an operational definition of transcultural nursing leadership. A concept analysis was performed using Walker and Avant's method. A literature search was conducted using electronic databases, including CINAHL and MEDLINE, books, and encyclopaedias. Quantitative, qualitative, mixed- design studies and literature reviews; master's and doctoral theses; interviews; and text and opinion papers published in English, Spanish, or Portuguese that focused on leadership in multicultural work environments overall and in nursing in particular were included. To identify differences and similarities between the concepts, a Correspondence Factor Analysis with the support of the software IRaMuTeQ was undertaken. A total of 45 documents with definitions or descriptions of the concepts was included, of which five were in the nursing area and 40 in other areas of study. The defining attribute of transcultural nursing leadership is guiding the delivery of culturally-congruent care. Its antecedents were culturally-diverse populations, multicultural nursing teams, and the need to prepare healthcare workers, administrators, academics, professors, researchers, and minorities for transcultural nursing. The consequences identified included culturally-congruent care for patients and optimal health outcomes for all populations. The identified attributes, antecedents, and consequences did not cover the complexity of a culturally-diverse nursing work environment. Thus, the antecedents, attributes, and consequences of transcultural leadership identified in the literature were considered and added. Transcultural nursing leadership is a concept grounded in nursing theory that has significant implications for nursing management, education, research, and policy. This holds great promise for advancing culturally-congruent care, addressing health disparities, and building highly inclusive and productive nursing teams in an increasingly diverse world.

Cultural diversity among patients and healthcare workers in the Portuguese healthcare organizations will increasingly challenge nurse managers to develop favorable nursing work environments and to improve culturally congruent care. Aim: This study aimed to identify nurse managers’ interventions that improve favorable nursing work environments in multicultural nursing teams and culturally congruent care for patients, based on Portuguese nurse leaders’ experience in international settings. Methods: A qualitative and exploratory study was conducted as the first stage of a sequential exploratory mixed study design. A convenience sample of Portuguese nurses with leadership experience of multicultural teams was recruited to participate in one focus group. Qualitative data were recorded and transcribed for content analysis. Text segments were organized into themes and categories with the support of the qualitative software IRaMuTeQ. Results: Nurse managers’ interventions, such as adapting the leadership style, thanking nurses for their work, adjusting the unit to attend to patients’ worship practices, and supporting foreign nurses in learning the local language, were categorized into three main themes and five categories—transcultural nursing leadership assumptions, capitalizing nurses, improving culturally congruent care, team problems and strategies, and improving effective communication. Conclusions: These findings corroborate international studies, advocate for capable nurse managers to lead in a globalized world, and are suitable to develop a transcultural nursing leadership questionnaire.

Background: The nursing practice environment significantly influences nurses’ job satisfaction, turnover, and burnout; therefore, it is essential to promote favorable environments to ensure the retention of qualified professionals. Improving the nursing practice environment is a low-cost organizational strategy associated with satisfaction, retaining professionals, and reducing burnout. The aim of this study was to assess the relationship between the nursing practice environment and job satisfaction, turnover, and burnout among primary healthcare nurses in Portugal. Methods: A descriptive, cross-sectional, and correlational study was carried out based on data from the RN4CAST Portugal Project. The Nurse Survey Instrument (Core Nurse Survey) of the RN4Cast Project (2018) was used for data collection. The sample consisted of 1059 nurses from fifty-five health center groups in mainland Portugal, fifteen health centers in the Autonomous Region of Madeira, and six health centers in the Autonomous Region of the Azores. Results: Primary healthcare nurses in Portugal rated the nursing practice environment as unfavorable or mixed, with an average ($\overline{\mathrm{x}}$) of 2.5 (standard deviation (SD) = 0.4), which is associated with lower job satisfaction, with an average of 2.0 (SD = 0.4), moderate intention to leave, with 40.3%, and low levels of burnout, with an average of 1.6 (SD = 0.8). There was also a negative correlation between the nursing practice environment and burnout (r = −0.28) and its dimensions. Emotional exhaustion (r = −0.35) represents the individual dimension of stress and physical exhaustion, corresponding to feelings regarding the depletion of emotional and physical resources, depersonalization (r = −0.18) represents the interpersonal context dimension of burnout, and a lack of personal accomplishment (r = −0.15) represents the self-assessment dimension of burnout and refers to feelings of incompetence and a lack of confidence and self-efficacy at work. Conclusions: The quality of the work environment is associated with greater job satisfaction and a reduction in burnout. For this reason, improving the work environment has therefore been associated with increased job satisfaction and reduced burnout among primary healthcare nurses, promoting nurse retention and the well-being of healthcare teams.

Nurse managers need culturally adapted assessment instruments to support the implementation of change to Nursing Bedside Handover (NBH) in healthcare institutions. This study aimed to cross-culturally adapt the Bedside Handover Attitudes and Behaviours (BHAB) questionnaire to the Portuguese context and evaluate the methodological approaches used for this purpose. To guide this study, we followed a guideline for cross-cultural translation and adaptation measurement instruments in healthcare. The results of the content validity testing suggested that the BHAB questionnaire is a valid instrument for use in the Portuguese context. To obtain these results we showed 1) using of a new methodological approach, the dual focus, to resolve the divergences and ambiguities in the translators’ committee and the multi-professional committee; 2) the lack of a conceptual definition of the construct of the instrument as a requirement to retain items with I-CVI < 0.70 after validity relevance pretesting and 3) the cognitive debriefing and relevance pretesting as methodological approaches which can be used alone or together to reinforce the evaluation of cultural relevance of the items. We concluded there is a need for guidelines to support the decision-making process of healthcare researchers with comprehensive information about the different methodological approaches they can follow.