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Ganbatta ("Well done!") is a term used frequently in Japan to praise children in medical settings when they have worked hard or made a courageous attempt. Therefore, the aim of this study was to clarify the factor structure of behaviors associated with ganbatta in young children (age 3-7 years) undergoing blood sampling or vaccine injection. A crosssectional questionnaire survey was carried out on 150 selected pediatric nursing educators holding a nursing license (age ≥20 years). An exploratory factor analysis was then conducted using the principal factor method with promax rotation to confirm the construct validity. Cronbach's α coefficients were calculated for each identified factor to verify the internal consistency of the item. The mean (standard deviation) lengths of pediatric nursing and pediatric nursing education experience were 7.8 (4.7) and 9.9 (8.1) years, respectively. The cumulative contribution rate was 70.4%. The KMO measure of sampling adequacy was 0.927. The p value of Bartlett's test of sphericity was <0.001%. Finally, among the children's behaviors, 5 factors were identified and 25 items were selected: Factor 1, Proactive participation, containing 7 items; Factor 2, Sense of relief and joy after needle removal, 6 items; Factor 3, Negative emotional expression, 4 items; Factor 4, Information-seeking, 5 items; and Factor 5, Moving on from the needle procedure, 3 items. These findings indicate that ganbatta is a complex concept that encompasses a variety of aspects in young children in relation to needle procedures. Evaluating a young child's ganbatta behaviors during a needle procedure can serve as an indicator to evaluate the quality of care provided by nurses. Sharing the evaluated results with children and their parents may serve as a foundation to open discussions in regard to higher-quality care. In addition, observing ganbatta behaviors during a needle procedure and providing feedback to the child could help them feel like they have done a good job.

Background This study aimed to develop a simplified version of the 25-item Ganbatta Scale (i.e., Ganbatta Scale-Short Form to objectively assess behaviors associated with “ganbatta” (“I did my best/I pushed myself/I tried hard”) in children aged 3–7 years who undergo blood sampling and vaccination. Methods A cross-sectional survey was conducted among 1143 nurses working in pediatric or outpatient clinics using a questionnaire with 11 items on the respondents' demographics and 25 items on behaviors associated with the “ganbatta” concept in children undergoing needle procedures. Data factor analysis was performed using the principal factor extraction method with promax rotation. Results Overall, 3 factors containing 16 items were extracted from the survey results. The three factors were a “Sense of relief and joy after needle removal” (seven items), “Proactive participation” (six items), and “Negative emotional expression” (three items). Reliability analysis revealed coefficients of 0.927 for all 16 items and 0.904, 0.893, and 0.912 for Factors 1, 2, and 3, respectively. We compared the “ganbatta” concept to the three factors; it encompassed various meanings, such as children’s post-procedure sense of joy associated with their successful efforts, as characterized by Factor 1. The children's positive behavior aimed to overcome their existing condition through a change of attitude, as characterized by Factor 2, and their behavior highlighted “perseverance” as a prerequisite skill associated with the “ganbatta” concept, as characterized by Factor 3. Conclusions This simplified version of the scale can be used in clinical practice owing to its reduced number of items (16). Trial registration: Not applicable

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