Cent Eur J Nurs Midw 2026, 17(1):2365-2375

The Norwegian version of Patient Observation Skills in Critical Care Nursing (POS-CCN) instrument: a cross-cultural adaptation of the instrument and nurses’ self-assessed level of patient observation skills

Edmar Agustin1, Toni Haapa1, Mika Alastalo2, Monica Evelyn Kvande1
1 Lovisenberg Diaconal University College, Oslo, Norway
2 Laurea University of Applied Sciences, Master School, Vantaa, Finland

Aim: To translate and cross-culturally adapt the instrument “Patient Observation Skills in Critical Care Nursing” into Norwegian.

Design: A cross-sectional survey was conducted to assess the psychometric properties of the instrument and Norwegian critical care nurses (CCNs’) self-assessed patient-observation skills.

Methods: Ninety-five Norwegian critical care nurses completed an electronic survey, and the results were statistically analyzed.

Results: Exploratory factor analysis produced a seven-factor model with Cronbach alpha values ranging from 0.62 to 0.94, and the instrument’s content validity was high (S-CVI/Ave 0.96). The instrument “Patient Observation Skills in Critical Care Nursing” was successfully modified for the Norwegian context and showed outstanding psychometric qualities. Nurses rated their patient observation skills as excellent in respiratory, renal, and metabolic areas (which had the highest scores). Gastrointestinal and coagulation observations had the lowest scores.

Conclusion: The instrument is valuable for nurse educators and managers as it provides knowledge to facilitate the development of nursing competence.

Keywords: critical care nursing, cross-cultural adaptation, intensive care unit, instrument patient observation skills, self-assessment

Received: June 10, 2025; Revised: January 13, 2026; Accepted: January 14, 2026; Published: March 6, 2026  Show citation

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Agustin E, Haapa T, Alastalo M, Kvande ME. The Norwegian version of Patient Observation Skills in Critical Care Nursing (POS-CCN) instrument: a cross-cultural adaptation of the instrument and nurses’ self-assessed level of patient observation skills. Central European Journal of Nursing and Midwifery. 2026;17(1):2365-2375.
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    References

    1. Alastalo, M. (2021). Patient observation skills in critical care nursing: a theoretical construction and evaluation [Doctoral dissertation, University of Turku]. University of Turku Repository. https://urn.fi/URN:ISBN:978-951-29-8458-9
    2. Alastalo, M., Salminen, L., Jeon, Y., Vahlberg, T., & Leino-Kilpi, H. (2019). Critical care nurses' self-assessed patient observation skills: a cross-sectional survey study. Nursing in Critical Care, 24(5), 268-275. https://doi.org/10.1111/nicc.12412 Go to original source... Go to PubMed...
    3. Alastalo, M., Salminen, L., Lakanmaa, R. L., & Leino-Kilpi, H. (2017). Seeing beyond monitors - critical care nurses' multiple skills in patient observation: descriptive qualitative study. Intensive and Critical Care Nursing, 42, 80-87. https://doi.org/10.1016/j.iccn.2017.03.004 Go to original source... Go to PubMed...
    4. Alastalo, M., Salminen, L., Vahlberg, T., & Leino-Kilpi, H. (2021). Knowledge of patient observation among critical care nurses. Nursing in Critical Care, 26(5), 341-351. https://doi.org/10.1111/nicc.12573 Go to original source... Go to PubMed...
    5. Alastalo, M., Salminen, L., Vahlberg, T., & Leino-Kilpi, H. (2022). Subjective and objective assessment in skills evaluation: a cross-sectional study among critical care nurses. Nordic Journal of Nursing Research, 43(1). https://doi.org/10.1177/20571585221089145 Go to original source...
    6. Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191. https://doi.org/10.1097/00007632-200012150-00014 Go to original source... Go to PubMed...
    7. Benner, P., Hooper-Kyriakidis, P., & Stannard, D. (2011). Clinical wisdom and interventions in acute and critical care: a thinking-in-action approach. Springer Publishing Company. Go to original source...
    8. Cowan, D. T., J, Wilson-Barnett, J., D., Norman, I. J., & Murrells, T. (2008). Measuring nursing competence: development of a self-assessment tool for general nurses across Europe. International Journal of Nursing Studies, 45(6), 902-913. https://doi.org/10.1016/j.ijnurstu.2007.03.004 Go to original source... Go to PubMed...
    9. DeVellis, R. F., & Thorpe, C. T. (2021). Scale development: Theory and applications. Sage publications.
    10. EfCCNa. (2013). EfCCNa competencies for European critical care nurses. European federation of Critical Care Nursing associations. https://www.efccna.org/images/stories/publication/competencies_cc.pdf
    11. Forsman, H., Jansson, I., Leksell, J., Lepp, M., Sundin Andersson, C., Engström, M., & Nilsson, J. (2020). Clusters of competence: relationship between self-reported professional competence and achievement on a national examination among graduating nursing students. Journal of Advanced Nursing, 76(1), 199-208. https://doi.org/10.1111/jan.14222 Go to original source... Go to PubMed...
    12. Gelling, L., Ersser, S., Heaslip, V., Tait, D., & Trenoweth, S. (2021). Ethical conduct of nursing research. Journal of Clinical Nursing, 30(23-24), e69-e71. https://doi.org/10.1111/jocn.16038 Go to original source... Go to PubMed...
    13. Giuliano, K. K. (2017). Improving patient safety through the use of nursing surveillance. Biomedical Instrumentation & Technology, 51(s2), 34-43. https://doi.org/10.2345/0899-8205-51.s2.34 Go to original source... Go to PubMed...
    14. Helsedirektoratet. (2021). Forskrift om nasjonal retningslinje for intensivsykepleierutdanning [Regulation on the National Guideline for Intensive Care Nursing Education]. https://lovdata.no/dokument/SF/forskrift/2021-01-01-1
    15. Henriksen, K. F., Hansen, B. S., Wøien, H., & Tønnessen, S. (2021). The core qualities and competencies of the intensive and critical care nurse: a meta-ethnography. Journal of Advanced Nursing, 77(12), 4693-4710. https://doi.org/10.1111/jan.15044 Go to original source... Go to PubMed...
    16. Humburg, M., & Van der Velden, R. (2015). Self-assessments or tests? Comparing cross national differences in patterns and outcomes of graduates' skills based on international large-scale surveys. Studies in Higher Education, 40(3), 482-504. https://doi.org/10.1080/03075079.2015.1004237 Go to original source...
    17. Jeon, Y., Lakanmaa, R. L., Meretoja, R., & Leino-Kilpi, H. (2017). Competence assessment instruments in perianesthesia nursing care: a scoping review of the literature. Journal of PeriAnesthesia Nursing, 32(6), 542-556. https://doi.org/10.1016/j.jopan.2016.09.008 Go to original source... Go to PubMed...
    18. Jones, A., & Johnstone, M. J. (2017). Inattentional blindness and failures to rescue the deteriorating patient in critical care, emergency and perioperative settings: four case scenarios. Australian Critical Care, 30(4), 219-223. https://doi.org/10.1016/j.aucc.2016.09.005 Go to original source... Go to PubMed...
    19. Kisiel, M., & Perkins, C. (2006). Nursing observations: knowledge to help prevent critical illness. British Journal of Nursing, 15(19), 1052-1056. https://doi.org/10.12968/bjon.2006.15.19.22105 Go to original source... Go to PubMed...
    20. Kvande, M., Delmar, C., Lykkeslet, E., & Storli, S. L. (2015). Foresight and awareness of incipient changes in a patient's clinical conditions - perspectives of intensive care nurses. Intensive and Critical Care Nursing, 31(5), 261-268. https://doi.org/10.1016/j.iccn.2015.06.002 Go to original source... Go to PubMed...
    21. Kvande, M., Delmar, C., Lykkeslet, E., & Storli, S. L. (2017). Assessing changes in a patient's condition - perspectives of intensive care nurses. Nursing in Critical Care, 22(2), 99-104. https://doi.org/10.1111/nicc.12258 Go to original source... Go to PubMed...
    22. Landsverk, N. G., Olsen, N. R., Titlestad, K. B., Pripp, A. H., & Brovold, T. (2024). Adaptation and validation of the evidence-based practice profile (EBP2) questionnaire in a Norwegian primary healthcare setting. BMC Medical Education, 24(1), 841. https://doi.org/10.1186/s12909-024-05842-z Go to original source... Go to PubMed...
    23. Liljamo, P., & Kaakinen, P. (2009). Cross-mapping the Finnish classification of nursing diagnosis, nursing interventions and the Oulu patient classification. Studies in Health Technology and Informatics, 146, 774-775. https://doi.org/10.3233/978-1-60750-024-7-774 Go to original source...
    24. MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84-99. https://doi.org/10.1037/1082-989X.4.1.84 Go to original source...
    25. Marshall, J. C., Bosco, L., Adhikari, N. K., Connolly, B., Diaz, J. V., Dorman, T., Fowler, R. A., Meyfroidt, G., Nakagawa, S., & Pelosi, P. (2017). What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care, 37, 270-276. https://doi.org/10.1016/j.jcrc.2016.07.015 Go to original source... Go to PubMed...
    26. Meretoja, R., Isoaho, H., & Leino-Kilpi, H. (2004). Nurse Competence Scale: development and psychometric testing. Journal of Advanced Nursing, 47(2), 124-133. https://doi.org/10.1111/j.1365-2648.2004.03071.x Go to original source... Go to PubMed...
    27. Mikkonen, K., Tomietto, M., & Watson, R. (2022). Instrument development and psychometric testing in nursing education research. Nurse Education Today, 119, 105603. https://doi.org/10.1016/j.nedt.2022.105603 Go to original source... Go to PubMed...
    28. Milhomme, D., Gagnon, J., & Lechasseur, K. (2018). The clinical surveillance process as carried out by expert nurses in a critical care context: a theoretical explanation. Intensive Critical Care Nursing, 44, 24-30. https://doi.org/10.1016/j.iccn.2017.07.010 Go to original source... Go to PubMed...
    29. Miller, E. M., & Hill, P. D. (2017). Intuition in clinical decision making: differences among practicing nurses. Journal of Holistic Nursing, 36(4), 318-329. https://doi.org/10.1177/0898010117725428 Go to original source... Go to PubMed...
    30. Mowbray, F. I., Manlongat, D., & Shukla, M. (2022). Sensitivity analysis: a method topromote certainty and transparency in nursing and health research. Canadian Journal of Nursing Reearch, 54(4), 371-376. https://doi.org/10.1177/08445621221107108 Go to original source... Go to PubMed...
    31. Perinelli, E., & Gremigni, P. (2016). Use of social desirability scales in clinical psychology: a systematic review. Journal of Clininical Psychology, 72(6), 534-551. https://doi.org/10.1002/jclp.22284 Go to original source... Go to PubMed...
    32. Pfrimmer, D. M., Johnson, M. R., Guthmiller, M. L., Lehman, J. L., Ernste, V. K., & Rhudy, L. M. (2017). Surveillance: a nursing intervention for improving patient safety in critical care environment. Dimensions of Critical Care Nursing, 36(1), 45-52. https://doi.org/10.1097/DCC.0000000000000217 Go to original source... Go to PubMed...
    33. Raymaekers, K., Luyckx, K., & Moons, P. (2020). A guide to improve your causal inferences from observational data. European Journal of Cardiovascular Nursing, 19(8), 757-762. https://doi.org/10.1177/1474515120957241 Go to original source... Go to PubMed...
    34. Romare, C., Anderberg, P., Sanmartin Berglund, J., & Skär, L. (2022). Burden of care related to monitoring patient vital signs during intensive care; a descriptive retrospective database study. Intensive Critical Care Nursing, 71, 103213. https://doi.org/10.1016/j.iccn.2022.103213 Go to original source... Go to PubMed...
    35. Rosli, S. N., Soh, K. L., Ong, S. L., Halain, A. A., Abdul Raman, R., & Soh, K. G. (2023). Physical assessment skills practised by critical care nurses: a cross-sectional study. Nursing in Critical Care, 28(1), 109-119. https://doi.org/10.1111/nicc.12748 Go to original source... Go to PubMed...
    36. Takase, M., Yamamoto, M., & Sato, Y. (2018). The factors related to self-other agreement/disagreement in nursing competence assessment: comparative and correlational study. International Journal of Nursing Studies, 80, 147-154. https://doi.org/10.1016/j.ijnurstu.2018.01.011 Go to original source... Go to PubMed...
    37. Tipton, E., Hallberg, K., Hedges, L. V., & Chan, W. (2016). Implications of small samples for generalization: adjustments and rules of thumb. Evaluation Review, 41(5), 472-505. https://doi.org/10.1177/0193841x16655665 Go to original source... Go to PubMed...
    38. University of Oslo. (n.d.). Nettskjema. https://nettskjema.no/?lang=en
    39. Vincent, J.-L., Lefrant, J. Y., Kotfis, K., Nanchal, R., Martin-Loeches, I., Wittebole, X., Sakka, S. G., Pickkers, P., Moreno, R., Sakr, Y., ICON and SOAP investigators, & SOAP investigators. (2018). Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP). Intensive Care Medicine, 44(3), 337-344. https://doi.org/10.1007/s00134-017-5043-2 Go to original source... Go to PubMed...
    40. Vincent, J.-L., Slutsky, A. S., & Gattinoni, L. (2017). Intensive care medicine in 2050: the future of ICU treatments. Intensive Care Medicine, 43(9), 1401-1402. https://doi.org/10.1007/s00134-016-4556-4 Go to original source... Go to PubMed...
    41. von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2008). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology, 61(4), 344-349. https://doi.org/10.1016/j.jclinepi.2007.11.008 Go to original source... Go to PubMed...
    42. Wangensteen, S., Finnbakk, E., Adolfsson, A., Kristjansdottir, G., Roodbol, P., Ward, H., & Fagerström, L. (2018). Postgraduate nurses' self-assessment of clinical competence and need for further training. A European cross-sectional survey. Nurse Education Today, 62, 101-106. https://doi.org/10.1016/j.nedt.2017.12.020 Go to original source... Go to PubMed...
    43. Welch, T. D., & Carter, M. (2018). Deliberate practice and skill acquisition in nursing practice. Journal of Continuing Education Nursing, 49(6), 269-273. https://doi.org/10.3928/00220124-20180517-07 Go to original source... Go to PubMed...
    44. Windsor, C., Douglas, C., & Harvey, T. (2012). Nursing and competencies - a natural fit: the politics of skill/competency formation in nursing. Nursing Inquiry, 19(3), 213-222. https://doi.org/10.1111/j.1440-1800.2011.00549.x Go to original source... Go to PubMed...
    45. World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053. Go to original source... Go to PubMed...
    46. Yusoff, M. S. B. (2019). ABC of content validation and content validity index calculation. Educational Resource, 11(2), 49-54. https://doi.org/10.21315/eimj2019.11.2.6 Go to original source...

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