Pressure-related injuries continue to be a significant burden during hospitalization, despite substantial local and international efforts to reduce them (Amir et al., 2017; Li et al., 2020). The complications associated with pressure injuries among hospitalized patients include prolonged hospital stays, increased healthcare costs, and an increased risk of infections, which can adversely affect patient outcomes and quality of life (McEvoy et al., 2021; Roussou et al., 2023). In this context, nurses play a pivotal role to improve to reduce pressure injury (PI) through implementation of PI's clinical guidelines (Khojastehfar et al., 2020). Therefore, assessing and promoting nurses' adherence to these guidelines is critical for improving patient safety and care quality.

The implementation of PI's clinical guidelines has been a persistent challenge for years (Wan et al., 2023). Although Ruzafa-Martínez et al. (2011) emphasized the importance of continuous monitoring of staff adherence to clinical guidelines, validated instruments specifically designed to measure nurses' adherence are still limited. Several existing instruments were evaluated using only a single indicator, such as Cronbach's alpha (Khojastehfar et al., 2020; Kim & Lee, 2019), or assessed content validity alone without comprehensive psychometric testing (Sari et al., 2022; Sari et al., 2023; Tayyib et al., 2016). Moreover, two studies utilized instruments that lacked a clearly defined construct to specifically measure the level of nurses' compliance with clinical guideline implementation (Moore & Price, 2004; Nasreen et al., 2017; Sari et al., 2021).

Considering the gap in instruments that measure nurses' adherence to PI prevention guidelines, coupled with the limited assessment of psychometric properties, this study aimed to cross-culturally translate and adapt the QARPPU into Bahasa Indonesian and assess its psychometric properties among Indonesian-speaking nurses. There were two phases conducted to reach the objective. The first phase included translation, adaptation, and content validation. The translation was carried out to gain an accurate and culturally proper Indonesian version. Then this process was strengthened with an adaptation stage to have appropriate wording in the Indonesian context without changing the original meaning. Content validation was performed to ensure all the translated items captured the intended constructs with good relevance, clarity, and comprehensiveness. Finally, the second phase was a psychometric validation, which was conducted to ensure the translated instrument accurately and consistently measured the intended construct in the Indonesian context.