Cross-Cultural Adaptation and Psychometric Evaluation of the Chinese Version of the Pediatric Atraumatic Care Attitude Scale (C-PACAS) for Pediatric Nurses: A Cross-Sectional Study

Background As a core intervention to alleviate children’s suffering and improve their medical experience, the quality assessment of atraumatic care has become increasingly important. Currently, China lacks standardized, sinicized and psychometrically validated tools for evaluating pediatric nurses’ attitudes toward atraumatic care — a gap that makes it difficult to objectively quantify nurses’ attitude levels and provide evidence for clinical practice improvement. Objective This study aimed to translate the Pediatric Atraumatic Care Attitude Scale (PACAS) into Chinese, conduct cross-cultural adaptation, and measure the attitudes of Chinese pediatric nurses toward atraumatic care. Methods The Brislin translation model was used to translate the PACAS from English into Chinese. The study was conducted from July to December 2025, recruiting 351 pediatric nurses from hospitals in Northeast, Southwest, and East China. Item analysis was performed to evaluate discriminability and screen valid items. The Delphi method was adopted to analyze content validity and refine items through expert consultation. For construct validity, exploratory factor analysis (EFA) was first used to clarify the latent structure, followed by confirmatory factor analysis (CFA) for verification. Reliability was assessed by calculating Cronbach’s alpha coefficient, split-half reliability, and test-retest reliability to ensure the robustness of results. Results All 31 items of the original scale were retained after item analysis of the Chinese version of the Pediatric Atraumatic Care Attitude Scale. The item-level content validity index (I-CVI) of individual items ranged from 0.880 to 1.000. The overall Cronbach’s alpha coefficient was 0.964, split-half reliability was 0.637, and test-retest reliability was 0.840. Two common factors (Knowledge and Awareness, Practice and Family Involvement) were extracted, explaining 72.995% of the total variance. The results of CFA were as follows: χ²/df = 2.033, standardized root mean square residual (SRMR) = 0.0726, incremental fit index (IFI) = 0.905, Tucker-Lewis index (TLI) = 0.896, comparative fit index (CFI) = 0.905, and root mean square error of approximation (RMSEA) = 0.072. Both EFA and CFA results indicated that the translated scale had good reliability and validity. Conclusion The C-PACAS is a reliable and valid measurement tool for assessing pediatric nurses’ knowledge and attitudes toward atraumatic care.