Cross-cultural adaptation and psychometric validation of the ISBAR structured handover observation tool for ICU-to-ward patient transfer in China

Abstract

The Identity, Situation, Background, Assessment, Recommendation (ISBAR) framework is used to standardize clinical handovers. Effective ISBAR implementation requires both training and objective assessment of handover. In Chinese clinical settings, handover quality is commonly evaluated through self-reports or locally developed checklists, which provide limited information about the completeness and accuracy of information transfer. The absence of validated Chinese observational instruments restricts the identification of communication deficiencies, benchmarking of handover performance, and development of targeted workforce training and patient safety interventions. This study aimed to conduct a cross-cultural adaptation and psychometric validation of the ISBAR Structured Handover Observation Tool and evaluate its applicability in Chinese clinical practice. The study was conducted in two phases: cross-cultural adaptation and psychometric evaluation in clinical settings. Content validity was assessed using the content validity index (CVI). Inter-rater reliability was evaluated using the intraclass correlation coefficient (ICC) in a two-way mixed-effects model with absolute agreement. Known-groups validity was examined using the Mann-Whitney U test to compare scores across nurses with varying levels of experience. A total of 233 ICU-to-general ward handovers involving 84 nurses were observed and evaluated. The scale demonstrated good content validity, with item-level CVIs ranging from 0.86 to 1.00 and a scale-level CVI/Ave of 0.98. Based on 50 randomly selected handovers, inter-rater reliability was high, with an ICC of 0.885 for single-rater assessments and 0.939 for average-rater assessments. Known-groups validity analysis showed that nurses with more experience had significantly higher total scores than those with less experience (Z = -4.772, p < 0.001). The Chinese version tool demonstrates satisfactory validity and reliability for evaluating structured handover performance. The tool may be used to identify communication gaps, support competency-based training, monitor handover performance, and provide evidence for patient safety initiatives, facilitating its integration into nursing management and patient safety programs in Chinese clinical settings.

The authors' abstract, as published at the source. PLoS ONE, 2026 · DOI ↗