ITALIAN VALIDATION OF THE PEDIATRIC NURSES’ KNOWLEDGE AND ATTITUDES SURVEY REGARDING PAIN: A CROSS-SECTIONAL STUDY

INTRODUCTION Pediatric pain management remains a critical issue in clinical practice, with underassessment and suboptimal management frequently reported, often due to healthcare providers' limited knowledge and cultural misconceptions. This leads to long-term physical, emotional, and psychological consequences. In Italy, no validated tool currently exists to systematically assess nurses’ knowledge and attitudes regarding pediatric pain. This study aimed to translate, culturally adapt and validate the Italian version of the PNKAS, revised by Riemann et al. (2007), applicable to nurses who care for pediatric patients not only in the oncology setting. METHODS The study followed ISPOR guidelines (Wild et al., 2005) for the linguistic and cultural validation process. A cross-sectional multicenter validation study was then conducted with a convenience sample of 298 Italian registered nurses working in pediatric settings. Psychometric analyses included item difficulty, internal consistency, Confirmatory Factor Analysis (CFA), and test-retest reliability using Intraclass Correlation Coefficients (ICC). RESULTS The Italian version PNKAS demonstrated good psychometric properties. Internal consistency reached a satisfactory level (Cronbach’s α = 0.728) and test-retest reliability showed high stability (r = 0.712; ICC = 0.801). CFA supported a three-factor model (assessment, treatment, epidemiology), with strong fit indices (CFI = 0.92; TLI = 0.91; RMSEA = 0.06). The scale demonstrated good item coherence (Infit/Outfit MnSq between 0.85–1.35) with difficulty ranging from −2.64 to 2.51. Despite this, the proportion of correct answers was 59.8%, with no respondent scoring ≥80%. Items related to pharmacology and pain assessment were particularly challenging. Notably, pediatric specialization was associated with higher scores compared to general nursing education or years of experience alone. CONCLUSIONS The Italian PNKAS is a valid and reliable tool to evaluate pediatric pain management knowledge and attitudes among Italian nurses. Findings underscore significant educational gaps, particularly in pharmacologic management and objective assessment of pediatric pain, highlighting the urgent need for targeted training and continuous professional development.