Family Presence During Invasive Procedures or Resuscitation, Nurse Perception and Preparedness Questionnaire (FPDIP/R-NPPQ): A Validity and Reliability Study

Background: Family presence during invasive procedures and resuscitation (FPDIP/R; FPDR) is increasingly advocated, yet no validated instrument assesses nurses' perceptions and preparedness including organisational readiness for implementation. Aim: To develop and psychometrically validate the FPDIP/R-NPPQ. Study design: A multicentre cross-sectional survey was conducted in three Italian hospitals (April-July 2024). Registered nurses (N = 212) completed a study-specific instrument initially comprising 52 items; psychometric analyses were performed on 37 Likert-type items. We applied a two-step strategy: exploratory factor analysis (EFA; parallel analysis, principal axis factoring, oblimin rotation, marker-index screening) followed by confirmatory factor analysis (CFA) using robust maximum likelihood for ordinal/non-normal data. Reliability was estimated via McDonald's ω. A grant from the Center of Excellence for Nursing Scholarship, Rome, March 2025, is funding this research. Results: EFA supported a 19-item, three-factor solution explaining 57.47% of variance: (1) emotional value and relational benefits of family presence (5 items); (2) communication skills and structured management (6 items); and (3) operational support through a dedicated staff member (8 items). CFA confirmed good fit (RMSEA = 0.05, 90% CI 0.04-0.06; CFit = 0.36; CFI = 0.93; TLI = 0.92; SRMR = 0.07), with standardised loadings ranging 0.24-0.92 and ω = 0.82-0.87 across factors. Model refinement improved fit without permitting cross-loadings, preserving construct distinctiveness while accounting for localised method effects. Conclusions: The FPDIP/R-NPPQ is a valid and reliable 19-item, three-factor instrument measuring nurses' readiness for family presence during invasive procedures and resuscitation. By distinguishing attitudes towards family presence, communication/management preparedness and organisational readiness (including the facilitator role), the tool enables services to identify implementation barriers and to plan targeted training and governance strategies prior to adopting FPDR/FPDIP policies. Relevance to clinical practice: The FPDIP/R-NPPQ supports clinical governance by providing actionable subscale profiles to guide implementation of FPDIP/R. It can be used to baseline readiness across units, identify specific training and protocol needs and inform organisational decisions such as the allocation of a trained family facilitator, thereby supporting safer and more standardised family presence practices during critical procedures.