Table 1: Steps in translation and cultural adaptation.

Step Activities

(I) PreparationPermission obtained from the NICHE Benchmarking Service in July 2010. The NICHE research team was invited and involved in this process and helped to clarify any ambiguities and concepts. The adviser of the University of Aveiro supervised the researcher and assisted in the execution of the nine steps. Three experts in geriatric care from Portugal worked closely during the translation process.

(II) Forward translationsTwo English translators did independent translations.

(III) Reconciliation The adviser and one translator analyzed the two translations to define a single forward translation.

(IV) Back translationAn English translator translated the Portuguese version into English.

(V) Back translation reviewThe questionnaire was reviewed by the adviser and translated to ensure the conceptual equivalence of the translation. The discrepancies were discussed with NYU faculty from the NICHE Benchmarking Service, the adviser and the expert.

(VI) HarmonizationThe researchers and the translators shared and defined translation solutions to item discrepancies. The experts reviewed the solutions.

(VII) Cognitive debriefingThe Portuguese translation was tested with 30 RNs from Portuguese hospitals that showed no difficulty in understanding the items in the GIAP.

(VIII) Review of cognitive debriefing results and finalizationThe researcher reviewed the results and respondents suggested a few modifications to some words. The researchers and experts agreed with the changes and the translation was finished.

(IX) ProofreadingAt the end of the translation, a Portuguese language professor reviewed the Portuguese survey to correct any minor errors in the translation process.