Design and Psychometric Properties of Nurses’ Professional Flourishing Tool Based on the PERMA Model: Protocol of a Mixed-Methods Study

Abstract

Amid increasing global attention to nurses’ well-being and retention, there is a growing need for a comprehensive and culturally sensitive instrument to assess professional flourishing among nurses. This construct encompasses emotional, relational, and purposeful dimensions of well-being, aligning with Seligman’s PERMA model (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment). However, existing measures fail to capture the context-specific characteristics of flourishing in the nursing profession, particularly within diverse cultural and clinical settings. Therefore, this study aims to develop and psychometrically evaluate a valid and reliable instrument to measure nurses’ professional flourishing. A mixed-methods approach with a sequential exploratory design will be employed, consisting of qualitative and quantitative phases. In Phase 1 (Qualitative Phase), a directed content analysis of in-depth, semi-structured interviews will be conducted to define and conceptualize professional flourishing from the perspective of Iranian nurses. In Phase 2 (Quantitative Phase), findings from Phase 1 will guide the development and psychometric testing of the Nurses’ Professional Flourishing Tool (NPFT), following the Waltz and Bausell model for instrument development. The scale’s face validity, content validity, construct validity, and reliability will be rigorously examined using appropriate statistical methods. Given the absence of a specialized tool for assessing professional flourishing in nursing, this study will contribute to the creation of a psychometrically sound, culturally adapted instrument that captures the multidimensional essence of flourishing. The NPFT will enable researchers, educators, and policymakers to design evidence-based interventions that enhance nurses’ well-being, engagement, and resilience, ultimately improving healthcare quality and workforce sustainability.

Introduction

In the demanding landscape of modern healthcare, nurses play a pivotal role as frontline providers, delivering compassionate care while navigating high-stakes environments characterized by emotional labor, long hours, and resource constraints. However, the profession is plagued by escalating rates of burnout, compassion fatigue, and turnover, which not only compromise patient outcomes but also erode the well-being of nurses themselves (Miao et al., 2024). Recent studies indicate that over 60% of nurses experience moderate to severe burnout, exacerbated by global events such as the COVID-19 pandemic, leading to diminished job satisfaction and increased attrition (Firdous, 2024). Amid these challenges, the concept of professional flourishing emerges as a vital counterbalance, representing a state where individuals thrive in their work, achieving optimal functioning through positive psychological resources. Flourishing extends beyond mere absence of distress to encompass holistic well-being, enabling nurses to sustain resilience, engagement, and fulfillment in their roles (Weziak-Bialowolska et al., 2021). This paradigm shift from deficit-focused models to strength-based approaches is increasingly recognized in healthcare, where promoting flourishing can enhance retention, improve care quality, and foster organizational health (Shdaifat et al., 2024).

Professional flourishing in nursing is multifaceted, integrating emotional, relational, and purposeful dimensions that align with positive psychology frameworks. Martin Seligman’s PERMA model, introduced in 2011, provides a robust theoretical foundation for understanding and cultivating well-being (M. Seligman, 2018). PERMA acronymizes five core elements: Positive Emotion (experiencing joy and optimism), Engagement (flow states in meaningful activities), Relationships (supportive connections), Meaning (sense of purpose), and Accomplishment (achieving goals and mastery) (Kovich et al., 2023). This model posits that flourishing arises from the synergistic interplay of these elements, promoting not just hedonic pleasure but eudaimonic fulfillment—optimal human functioning that transcends transient happiness (M. Seligman, 2018). In nursing, where emotional demands are inherent, PERMA offers a lens to address professional self-concept, which encompasses nurses’ perceptions of their roles, competencies, and contributions to patient care (Barnard & Coetzee, 2025). Nurses with high professional self-concept exhibit greater resilience, reduced negative emotions, and enhanced quality of life, underscoring the model’s relevance (Wei et al., 2025).

Empirical applications of PERMA in nursing have gained traction in recent years, particularly in educational and clinical settings. For instance, interventions based on PERMA have been shown to mitigate stress and boost subjective well-being (SWB) among nursing undergraduates in China, where a structured program improved positive emotions and reduced negative affect through targeted activities like gratitude exercises and strength-building (Yang et al., 2024). Similarly, a 2024 study demonstrated that PERMA-oriented positive psychological interventions enhanced emotional regulation in vocational nursing students, yielding higher positive emotion rates and alleviating anxiety (Zhu & Zhu, 2025). In clinical practice, PERMA has been adapted for postoperative care, such as in breast cancer patients, where psychological interventions reduced stress and improved psychological adaptation by fostering meaning and accomplishment (Wang et al., 2024). Among practicing nurses, PERMA frameworks have correlated with better professional quality of life, countering burnout and secondary traumatic stress in high-pressure environments (Firdous, 2024). Furthermore, comparative studies highlight disparities in flourishing levels between health and non-health profession students, with nursing students often reporting lower scores due to academic and clinical stressors, yet showing potential for improvement through PERMA-based strategies (Shdaifat et al., 2024).

Despite these advances, a critical gap persists in the measurement of nurses’ professional flourishing. Existing tools, such as the Flourishing Scale (FS) and Secure Flourish Index (SFI), have demonstrated strong psychometric properties in general populations, including reliability, validity, and factorial structure across diverse samples (Liu et al., 2021; Weziak-Bialowolska et al., 2021). For example, the FS has been validated in older adults and healthcare settings, confirming its utility in assessing holistic well-being (De la Fuente et al., 2017; Fassih-Ramandi et al., 2020). However, these instruments are not tailored specifically to nursing contexts, lacking domain-specific items that capture the unique aspects of professional flourishing in this field, such as patient-nurse dynamics, ethical dilemmas, and interdisciplinary collaboration. A scoping review of flourishing measures emphasizes the need for context-specific adaptations to ensure cultural and occupational relevance, particularly in adolescents and adults within high-stress professions like nursing (Rule et al., 2024).

Although the PERMA model has been applied in various nursing studies, the tools utilized in these contexts have not been specifically designed for nursing and lack profession-specific adaptations. This study marks the first effort to develop a dedicated instrument for measuring professional flourishing tailored exclusively to the nursing profession. This study addresses this lacuna by designing and evaluating the psychometric properties of a novel Nurses’ Professional Flourishing Tool (NPFT) grounded in the PERMA model. By integrating PERMA’s elements with nursing-specific constructs, the tool aims to provide a reliable, valid instrument for assessing and promoting flourishing among nurses. The aim of this study is to define the concept of professional flourishing, identify its dimensions, and develop and validate an instrument for assessing professional flourishing.

The following research questions guide our study:

(1) How do nurses define their experience and perception of professional flourishing based on PERMA model?

(2) What are the dimensions of professional flourishing based on PERMA model?

(3) What are the content and face validity (both quantitative and qualitative) of the instrument measuring professional flourishing based on PERMA model?

(4) What is the construct validity and internal consistency reliability of the instrument measuring professional flourishing based on PERMA model?

(5) What is the absolute, relative stability, and test-retest reliability of the instrument measuring professional flourishing based on PERMA model?

(6) How do the qualitative themes identified through directed content analysis inform the development of quantitative items in the professional flourishing instrument based on PERMA model?

(7) To what extent do the quantitative results from the psychometric evaluation of the instrument align with the qualitative findings on nurses’ perceptions of professional flourishing based on PERMA model?

(8) How can the integration of qualitative and quantitative data provide a more comprehensive understanding of the construct of professional flourishing based on PERMA model?

(9) What discrepancies, if any, exist between the qualitative themes and the quantitative factor structure of the professional flourishing instrument based on PERMA model?

(10) How can the mixed-method approach enhance the validity and reliability of the instrument in measuring professional flourishing across diverse populations based on PERMA model?

Methods

Study Design

This study employs a sequential exploratory mixed-methods design to develop and psychometrically evaluate the Nurses’ Professional Flourishing Tool (NPFT) grounded in the PERMA model. The process integrates qualitative exploration to conceptualize professional flourishing and generate items, followed by quantitative validation to confirm the tool’s reliability and validity. This approach ensures cultural adaptation to Iran’s healthcare context, where nursing is shaped by societal norms, resource challenges, and professional demands.

Setting

Data collection will occur in diverse healthcare settings across Iran, including academic hospitals, primary care centers, and rural clinics in regions such as Tehran, Kashan, Isfahan, and Shiraz, to reflect varied socio-cultural influences on nursing practice.

Phases of the Study

This study adopts a sequential exploratory mixed-methods design, grounded in the pragmatism paradigm, to develop and evaluate the psychometric properties NPFT. By integrating qualitative and quantitative methodologies, this approach capitalizes on the strengths of both paradigms to achieve a comprehensive and culturally grounded understanding of professional flourishing among nurses. Such a design enables the exploration of subjective experiences in the initial qualitative phase, followed by empirical testing of the conceptual model through quantitative validation, thus ensuring both theoretical depth and psychometric rigor (Polit & Beck, 2010). The overall aim of this research is to define, conceptualize, and operationalize professional flourishing in nursing, drawing upon Seligman’s PERMA model as the guiding theoretical framework. The study is implemented in two distinct yet interconnected phases that collectively ensure the development of a valid, reliable, and contextually appropriate measurement instrument. Phase I focuses on qualitative exploration through directed content analysis to identify the underlying meaning, dimensions, and attributes of professional flourishing as experienced by Iranian nurses. This phase seeks to generate an operational definition of the construct by analyzing participants’ narratives within the cultural and professional context of nursing in Iran. Phase II involves the quantitative development and psychometric evaluation of the NPFT, incorporating findings from Phase I to design and refine the scale. This phase includes item generation, assessment of content and face validity, and statistical evaluation of the tool’s reliability and construct validity through exploratory and confirmatory factor analyses (see Figure 1).

Figure 1.

The process of instrument development for nurses’ professional flourishing

Phase 1: Qualitative Exploration

In this initial stage, a qualitative content analysis method will be applied to establish an operational definition of professional flourishing in nursing and uncover personal, professional, and cultural factors that shape it. This will involve pinpointing precursors, characteristics, and outcomes of flourishing, laying a conceptual groundwork for tool creation. Data analysis will be performed using the deductive content analysis method, as outlined by Hsieh and Shannon (2005). This framework allows for testing and refining established theories—such as the PERMA model—in a targeted cultural setting, enriching them with nuanced, context-specific qualitative insights (M. E. P. Seligman, 2011). Based on an extensive literature synthesis on PERMA and nursing well-being, key interview prompts and dimensions of professional flourishing will be outlined. The concept and its components will then be deeply investigated, with essential tool items extracted via deductive content analysis aligned with literature-derived insights. This ensures the NPFT is anchored in both theoretical principles and real-world evidence, encompassing the comprehensive aspects of flourishing in nursing.

Participant Selection

Participants will be chosen through purposeful sampling, focusing on registered nurses who offer substantial experiential knowledge and express interest in involvement. Recruitment will be led by the primary investigator, who will approach potential participants in professional environments like hospital wards, nursing conferences, and online professional groups commonly used by nurses. Eligibility criteria include nurses aged 25 or older, with at least 2 years of active practice, able to communicate their insights effectively, and agreeing to participate.

To promote diverse viewpoints, maximum variation sampling will be utilized, considering factors such as age, gender, work setting (urban vs. rural), educational attainment, and clinical specialty. This strategy aims to encompass a wide array of experiences, supporting the creation of a thorough and adaptable tool for evaluating professional flourishing.

Data Collection

Information will be obtained via one-on-one, in-person or virtual interviews as appropriate. The process will proceed iteratively until saturation is reached, where further interviews yield no novel substantial details.

For broad experiential coverage, interviews will take place in accessible locations for nurses, such as break rooms or virtual platforms. Individuals will be contacted, provided with a full study overview, and asked for informed consent from those interested. Consent for audio recording will also be implicitly obtained. Scheduling and venues will prioritize participant convenience to maintain confidentiality and ease.

Interview Process

To build rapport and encourage candid sharing, sessions will start with broad, exploratory questions, enabling nurses to voice their views openly. After establishing comfort, core research inquiries will be posed, with follow-up probes to deepen understanding, resolve ambiguities, and gather detailed responses. Interviews will persist until participants indicate completeness. Additional meetings may be arranged if needed to accommodate scheduling or expand on points. Post-interview, participants will be encouraged to add any missed thoughts. All sessions will be recorded audio-wise, supplemented by researcher notes on subtle elements like body language, vocal inflections, and emotional tones to enrich analysis depth.

Directed Qualitative Content Analysis

A deductive content analysis strategy will systematically investigate professional flourishing through these stages:

(1) Review and curation of pertinent literature, informed by core theory on PERMA and flourishing. Key reference include Seligman (2011). An in-depth examination of empirical works will define central ideas and facets of professional flourishing. Interview prompts will stem from these, addressing PERMA domains: Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment.

(2) Creation of a structuring grid to categorize main ideas and dimensions from the literature, acting as an analytical scaffold.

(3) Formulation of a semi-structured interview protocol to comprehensively address all primary concepts, definitions, and dimensions, synchronized with the theoretical base and categorization grid.

(4) Isolation of meaningful segments and code derivation, where the overarching research aim and theoretical constructs direct the pinpointing of data units. Preliminary codes will emerge from participant narratives.

(5) Placement of codes into the structuring grid, organizing extracted codes to match predefined categories and theoretical alignments

(6) Refinement of operational definitions, assigning precise meanings to core concepts drawn from qualitative outcomes, cross-referenced with theoretical benchmarks for coherence and enhancement.

This methodical process guarantees a disciplined, theory-guided examination, yielding a profound grasp of professional flourishing while upholding analytical rigor and consistency (Hsieh & Shannon, 2005).

Trustworthiness

In qualitative inquiries, data integrity is evaluated via criteria including credibility, confirmability, dependability, transferability, and authenticity (Schaufeli & Salanova, 2006). These elements safeguard the accuracy, durability, and reliability of outcomes. For credibility, ample duration will be dedicated to gathering and scrutinizing data for a thorough comprehension of flourishing. Multiple data origins will be tapped, and analyses will leverage suitable frameworks to bolster finding validity. By including nurses from assorted regions and demographic profiles, experiential diversity is embraced, improving result applicability. To support confirmability, an independent collaborator uninvolved in collection will cross-check transcripts against recordings for accuracy. Selected coded sessions will be shared back with participants for affirmation, enabling them to validate response fidelity. The lead investigator will monitor and mitigate personal preconceptions to avoid skewing processes (Polit & Beck, 2010). Although generalization isn’t primary in qualitative work, transferability is fortified by intentional design. Participants will be chosen to span varied profiles in age, gender, education, and roles, per maximum variation principles. Rich descriptions of experiences and settings will be offered, aiding others in gauging relevance to comparable groups (Pandey & Patnaik, 2014). Authenticity will be upheld by capturing the intricate nuances of viewpoints and promoting shared insight between researcher and nurses. Dialogic engagement will facilitate joint meaning-making, ensuring outcomes mirror authentic experiences over assumptions. Biases will be curbed, with complete, unbiased documentation of discoveries (Waltz et al., 2016). These integrated measures affirm the study’s rigor, credibility, and practical value, preserving transparency and scholarly standards. Figure 2 shows the details regarding the details in this regard.

Figure 2.

Framework of research trustworthiness in qualitative inquiry

Phase 2: Tool Development and Validation

Insights from the qualitative exploration will inform the NPFT’s construction through a structured sequence. This begins with framework building, where an inductive strategy extracts practical definitions from emergent themes to guarantee full theoretical and empirical representation of professional flourishing. Next, assessment goals are outlined from the discerned dimensions, ensuring the instrument aligns precisely with the concept’s foundational theory derived from PERMA elements. This is followed by schema creation, in which domains are systematically linked to quantifiable areas and corresponding items, all rooted in the qualitative derivations for contextual relevance. Finally, tool assembly involves polishing the elements and establishing clear response guidelines to facilitate ease of use and accurate measurement.

Item Derivation and Formulation

Items for the NPFT will be developed using a dual deductive and inductive approach to ensure comprehensiveness and cultural fit (Morgado et al., 2017). In the deductive component, items will be formulated based on established theoretical frameworks from the PERMA model, drawing directly from its five core elements to maintain alignment with positive psychology principles (M. E. P. Seligman, 2011). Complementing this, the inductive approach will extract items from the codes and themes identified during the qualitative phase, incorporating real-world insights from Iranian nurses to capture context-specific nuances such as workload dynamics or cultural values influencing flourishing. To enhance clarity, comprehensibility, and overall validity, verbatim responses from participants will be integrated into item wording wherever appropriate, making the language relatable and reducing potential misinterpretation. The item development process will proceed in stages: first, compiling a preliminary item pool from the qualitative findings and literature; second, conducting a collaborative review and refinement with the research team to assess relevance and redundancy; third, eliminating overlapping or conceptually similar items to promote clarity, conciseness, and non-redundancy; and finally, concluding the domains and final item set for subsequent validation (Boateng et al., 2018). This structured methodology ensures that the NPFT is conceptually solid, empirically grounded, and procedurally robust, resulting in an initial pool of approximately 40–50 items rated on a 5-point Likert scale.

Psychometric Assessment

This section details the comprehensive methodological strategy for verifying the NPFT’s validity and reliability, ensuring its scholarly soundness, applicability in nursing research, and ability to accurately measure professional flourishing in diverse settings (Mikkonen et al., 2022).

Face and Content Validity

Face validity will be established by engaging 10–15 target nurses, distinct from the main sample, to appraise each item for straightforwardness, pertinence to professional flourishing, and overall ease of understanding, thereby confirming that the tool appears suitable for its intended purpose on initial inspection. Their qualitative feedback will prompt targeted adjustments to wording or structure, while they will also quantitatively score item significance on a 5-point Likert scale to compute an impact value (calculated as Frequency × Importance), with only those exceeding 1.5 retained to prioritize essential content. For content validity, a specialized panel of 10 experts in nursing practice, positive psychology, psychometrics, and Iranian healthcare will thoroughly review the instrument’s syntax, explicitness, item formulation, logical positioning, and scaling system, incorporating revisions based on their consensus to enhance precision. Quantitative evaluation of content validity will encompass multiple metrics: first, the Content Validity Ratio (CVR) following Lawshe’s method, where items deemed “essential” by experts must achieve a CVR greater than 0.62 for retention (Lawshe, 1975); second, the Content Validity Index (CVI), with items rated on a 1–4 relevance scale such that Item-CVI (I-CVI) above 0.79 is accepted, between 0.70–0.79 requires revision, and below 0.70 leads to discard, while the Scale-CVI (S-CVI) should exceed 0.90 for overall acceptability; and third, the adjusted Kappa coefficient to correct for random agreement among raters, with values above 0 indicating progressively stronger inter-rater reliability and minimizing chance influences (Polit et al., 2007).

Item Analysis

An iterative refinement loop, known as the loop method, will be implemented to systematically enhance item quality and performance. Initially, the overall reliability coefficient for the questionnaire will be calculated using preliminary data to establish a baseline. A pilot test involving 50 nurses from similar demographics will then be conducted to simulate real-world application, allowing for the identification of problematic items through statistical scrutiny. Specifically, items exhibiting negative correlations with the total score or correlation coefficients below 0.3 will be flagged for elimination or substantial revision, as these thresholds indicate poor contribution to the construct or potential measurement error (Zijlmans et al., 2018). This process will be repeated in cycles if necessary, incorporating feedback from the pilot to refine phrasing, reduce ambiguity, and ensure each item discriminates effectively between varying levels of flourishing, ultimately yielding a more cohesive and efficient instrument (Wilson, 2023).

Construct Validity

Exploratory Factor Analysis (EFA) will be performed to uncover and delineate the underlying latent patterns within the item responses, providing empirical evidence for the tool’s dimensional structure. Prior to EFA, sampling adequacy will be verified using the Kaiser-Meyer-Olkin (KMO) test (targeting values above 0.7) and Bartlett’s test of sphericity to confirm the correlation matrix’s suitability for factorization. Factors will be extracted by clustering items with strong intercorrelations via principal axis factoring and varimax rotation, retaining those with eigenvalues greater than 1 and item loadings of at least 0.40, while adhering to a minimum sample size of five participants per item as per established guidelines (Sharma, 2022). To further substantiate the structure, Confirmatory Factor Analysis (CFA) will be executed in a separate subsample, following a rigorous six-step protocol (MacCallum et al., 1999; Mokkink et al., 2010): first, specifying a theory-based measurement model informed by PERMA and qualitative themes; second, screening data for normality, multicollinearity, and other assumptions using tools like skewness/kurtosis checks; third, estimating the model and assessing overall fit through indices such as Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) greater than 0.90, Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) less than 0.08; fourth, verifying factor loadings at or above 0.50 and convergent validity via Average Variance Extracted (AVE) exceeding 0.50; fifth, evaluating composite reliability (CR) above 0.70 and discriminant validity by comparing AVE to squared inter-factor correlations; and sixth, refining the model iteratively based on modification indices, theoretical justifications, and cross-validation to avoid overfitting. This comprehensive approach ensures the NPFT’s construct validity is robust, reflecting the multifaceted nature of professional flourishing.

Reliability

The NPFT’s consistency and steadiness will be rigorously evaluated through multiple complementary metrics to confirm its reproducibility across administrations and internal coherence. Internal consistency will be assessed using Cronbach’s alpha, with a minimum acceptable threshold of 0.7 for the overall scale and subscales, indicating that items measure the same underlying construct without excessive redundancy (Tavakol & Dennick, 2011). For temporal stability, test-retest reliability will involve a subgroup of participants retaking the instrument 2–4 weeks after the initial administration to allow for natural variability while minimizing recall bias, with Pearson’s correlation coefficient above 0.74 signifying acceptable stability and intraclass correlation coefficients (ICC) providing additional insight into agreement levels (Koo & Li, 2016). Furthermore, the Minimum Detectable Change (MDC) and Minimum Important Change (MIC) indices will be calculated using standard error of measurement and distribution-based methods, respectively, to determine the smallest detectable differences due to true change versus error and the clinically meaningful shifts in flourishing scores, enhancing the tool’s utility in intervention studies or longitudinal tracking (Suijker et al., 2017).

Item Weighting

Following the completion of Exploratory Factor Analysis (EFA), item weights will be derived to reflect their relative importance within the scale, promoting accurate scoring. Each item’s factor loading will be multiplied by the proportion of variance explained by its corresponding factor, quantifying its contribution to the respective subscale. These weights will then be standardized across the instrument to ensure comparability and equitable influence, allowing for a weighted sum scoring approach that accounts for differential item impacts while maintaining interpretability for users in clinical or research settings (DiStefano et al., 2009).

Interpretability

The NPFT’s interpretability will be systematically assessed to ensure it is user-friendly and yields meaningful results in practical applications. Ceiling and floor effects will be examined by calculating the proportion of participants achieving the highest or lowest possible scores, with thresholds below 20% considered acceptable to indicate sufficient scale sensitivity and avoid clustering at extremes. Response pattern analysis will involve evaluating missing data rates (aiming for less than 5% per item) and examining distribution skewness or kurtosis to detect potential biases, inconsistencies, or response sets that could undermine validity. Additionally, feasibility will be gauged through metrics such as average completion time (targeting under 15 minutes) and participant ratings of item clarity on a feedback survey, ensuring the tool is practical for busy nursing professionals and adaptable to various administration modes like paper or digital (DiStefano et al., 2009).

Scoring

Items will be scored on a standardized 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), with reverse-scoring applied to negatively worded items if included to maintain directional consistency (Sullivan & Artino, 2013). Total and subscale scores will be computed via summation, followed by a linear transformation to standardize them on a 0-100 scale using the formula: Standardized Score = [(Raw Score - Minimum Possible Score)/(Maximum Possible Score - Minimum Possible Score)] × 100. In this metric, a score of 0 indicates minimal professional flourishing, while 100 represents maximal levels, facilitating easy interpretation, comparison across studies, and tracking of changes over time in nursing populations (Lindner & Lindner, 2024). Additionally, a scoring and interpretation manual will be developed to accompany the instrument, providing detailed guidance on item scoring, handling of missing data, and interpretation of both total and subscale scores to ensure consistent application across research and practice settings.

Data Analysis

All quantitative data will be processed using SPSS software for descriptive statistics, including means, standard deviations, and frequency distributions to summarize sample characteristics and item responses, as well as for Exploratory Factor Analysis (EFA) to explore latent dimensions and inter-item relationships through techniques like scree plots and parallel analysis. Confirmatory Factor Analysis (CFA) will be conducted in AMOS version 26 to validate the hypothesized factor structure via maximum likelihood estimation and hypothesis testing, which is particularly advantageous when the structure is theoretically predefined, allowing for precise model fit assessment and refinement (Kim et al., 2016).

Discussion

The development and psychometric evaluation of NPFT based on the PERMA model represent a critical step toward addressing the well-being needs of nurses in culturally diverse contexts, particularly within Iran’s unique socio-cultural and healthcare landscape. This protocol outlines a rigorous mixed-methods approach to create a tailored instrument that captures the multifaceted nature of professional flourishing, encompassing positive emotions, engagement, relationships, meaning, and accomplishment (Al-Hendawi et al., 2024). By grounding the tool in Seligman’s PERMA framework, the study responds to the growing recognition that traditional deficit-oriented measures fail to fully encapsulate the strengths-based aspects of well-being essential for sustaining a resilient nursing workforce (Donaldson et al., 2022). Recent research highlights the urgency of such tools, as nurses worldwide face escalating burnout and attrition, with studies indicating that PERMA-based interventions can significantly enhance subjective well-being and reduce anxiety in nursing students and other populations (Yao et al., 2024; Zhu & Zhu, 2025). In Iran, where nursing is influenced by Islamic values, family-centric support systems, and resource constraints, Western-developed scales often lack cultural resonance, underscoring the need for localized adaptations to ensure relevance and accuracy. This is echoed in recent cross-cultural validations of nursing competence and leadership scales in Persian contexts, which emphasize the importance of emic adaptations for psychometric integrity (Abad et al., 2025; Jalali et al., 2025).

A key strength of this protocol lies in its sequential exploratory mixed-methods design, which integrates qualitative insights from Iranian nurses to inform item generation, followed by quantitative validation adhering to COSMIN guidelines. This hybrid approach not only enhances the tool’s content validity by incorporating emic perspectives—such as the role of communal relationships and spiritual meaning in flourishing—but also ensures robust psychometric properties through exploratory and confirmatory factor analyses (Qi et al., 2022). Similar methodologies have proven effective in validating PERMA-derived measures in educational and clinical settings, where deductive content analysis guided by Hsieh and Shannon’s framework has refined constructs for cultural fit (Jie Yang et al., 2024). For instance, a 2024 study on PERMA’s psychometric properties in diverse populations demonstrated high internal consistency (Cronbach’s alpha >0.80) and convergent validity, supporting its adaptability to professional contexts like nursing (Al-Hendawi et al., 2024). The inclusion of maximum variation sampling across urban and rural Iranian settings further bolsters generalizability within the country, addressing limitations seen in prior validations that overlooked geographic diversity (Jalali et al., 2025). Moreover, the emphasis on trustworthiness criteria—credibility through member checking, confirmability via audit trails—aligns with best practices in qualitative nursing research, minimizing bias and enhancing the tool’s reliability (Fassih-Ramandi et al., 2020).

Despite these strengths, potential challenges inherent to the protocol must be acknowledged. The reliance on purposive and convenience sampling may introduce selection bias, particularly if participants from high-stress environments are underrepresented, though the targeted recruitment from varied specialties aims to mitigate this (Rueger et al., 2023). Additionally, while the deductive-inductive item generation fosters cultural sensitivity, external validity beyond Iran could be limited, necessitating future cross-cultural comparisons similar to those conducted for Persian adaptations of leadership and critical thinking scales in healthcare. The 2–4 week test-retest interval balances memory effects and stability but may not capture long-term fluctuations in flourishing amid dynamic healthcare demands, as noted in longitudinal studies of resilience scales.

Upon successful validation, the NPFT holds substantial implications for nursing practice, education, and policy. It could facilitate targeted interventions to foster flourishing, as evidenced by PERMA-based programs that improved professional quality of life and reduced compassion fatigue among nursing students (Firdous, 2024; Kulandaiammal et al., 2025). In Iran, where nurse retention is challenged by workload and societal expectations (Ahmadi Chenari et al., 2020), this tool may inform organizational strategies to enhance engagement and meaning, potentially lowering turnover rates observed in recent surveys.

Future directions include testing the NPFT in international cohorts for broader applicability and integrating it into digital platforms for real-time well-being monitoring, building on latent profile analyses that link PERMA profiles to health outcomes in nurses (Qi et al., 2022). Ultimately, this protocol paves the way for a culturally attuned measure that empowers nurses to thrive, contributing to sustainable healthcare systems globally.

Conclusion

In conclusion, this protocol for designing and evaluating the psychometric properties of NPFT based on the PERMA model addresses a pivotal gap in measuring well-being tailored to the nursing profession, particularly within Iran’s socio-cultural framework. By employing a sequential mixed-methods approach, the study ensures the development of a culturally sensitive instrument that captures the PERMA elements—positive emotions, engagement, relationships, meaning, and accomplishment—while incorporating local nuances such as communal support and spiritual dimensions of fulfillment. The anticipated outcomes include a validated tool with strong reliability and validity metrics, enabling accurate assessment of flourishing to inform interventions that mitigate burnout and enhance retention in nursing. Recent validations of PERMA-based measures, such as the PERMA Profiler’s factorial validity in normative studies, underscore the model’s robustness for professional contexts, supporting its adaptation here.

The broader implications of this work extend to nursing education, practice, and policy, where the NPFT could facilitate PERMA-oriented programs shown to improve professional quality of life and reduce anxiety among nursing students. In Iran and similar settings, this tool may drive organizational changes to foster thriving work environments, aligning with global calls for positive psychology in healthcare. Future research should explore the NPFT’s cross-cultural applicability, longitudinal predictive validity, and integration into digital health platforms, building on comparative analyses of flourishing measures. Ultimately, by promoting nurses’ flourishing, this instrument contributes to resilient healthcare systems, empowering professionals to deliver optimal care amid ongoing challenges.