Adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version to Italian language

Adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version to Italian language



ethical conflict, moral distress, questionnaire, reliability, validity, critical care


Background and aim of the work

Ethical conflict in Intensive Care Unit (ICU) can lead to poor quality health care and attention. Knowing the level of exposure to ethical conflict in health professionals allows to design strategies for improve the ethical environments and making decisions process. To study ethical conflict in health professionals it is necessary to have valid and reliable instruments that can be applied to different health and cultural contexts. No tool existed in Italian context still now. Therefore, the aim of this study was to adapt and validate the Ethical Conflict Nursing Questionnaire-Critical Care Version to the Italian sociocultural context.


This is a two-phase psychometric study, including one translation-back-translation phase, and an analysis phase for determining the content and construct validity, by means respectively Content Validity Index, Principal Component Analysis (PCA) and Confirmatory Factor Analysis(CFA), and reliability of the instrument, by means Cronbach's α calculation.


The sample included 286 nurses from critical care units of four hospitals in (deleted for review) (Italy). Translation-back-translation phase was successful. A Content Validity Index of 95.39 was obtained. The overall Cronbach's α value was 0.866. When an item was eliminated, this value oscillated between 0.871 and 0.881. As the original tool, Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) confirmed a single factor capable of explaining more than 30% of the variance.


The ECNQ-CCV Italian version is a valid and reliable instrument for measuring the exposure of ICU nursing professionals to ethical conflict.


Author Biographies

Loris Bonetti, ASST- FATEBENEFRATELLI- SACCO- Università degli studi di Milano

PhD, RN, MsN. Clinical Expert in Nursing research, Lecturer

Stefano Terzoni, San Paolo Bachelor School of Nursing, San Paolo teaching hospital – ASST Santi Paolo e Carlo, Milan, Italy.

PhD, MSc, RN. Acting chair.

Paolo Ferrara, San Paolo Bachelor School of Nursing, San Paolo teaching hospital – ASST Santi Paolo e Carlo, Milan, Italy.

PhD student, RN, MsN. Tutor Nurse

Anne Destrebecq, University of Milan, Department of Biomedical Sciences for Health, Milan, Italy

RN, MsN. Full Professor of Nursing

Esperanza Zuriguel-Pérez, Multidisciplinary Nursing Research Group. VHIR. Hospital Vall d’Hebron, Barcelona, Spain.

PhD, RN, MsN. Head of the Multidisciplinary Nursing Research Group.

Anna Falcó-Pegueroles, Department of Fundamental Care and Medical-Surgital Nursing. School of Nursing. Faculty of Medicine and Health Sciences. Consolidated Research Group SGR 269 Quantitative Psychology. University of Barcelona (Spain).

PhD, RN, MsN, Associate Professor


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Original articles: Health Professions 3/2021

How to Cite

Bonetti L, Terzoni S, Ferrara P, Destrebecq A, Zuriguel-Pérez E, Falcó-Pegueroles A. Adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version to Italian language. Acta Biomed [Internet]. 2021 Dec. 22 [cited 2024 Jul. 21];92(S2):e2021505. Available from: