Background Training in the use of cost-conscious strategies for medical students may prepare new physicians to deliver health care in a more sustainable way. Recently, a role-modeling cost-conscious behaviors scale (RMCCBS) was developed for assessing students’ perceptions of their teachers’ attitudes to cost consciousness. We aimed to translate the RMCCBS into Brazilian Portuguese, adapt the scale, transculturally, and validate it. Methods We adopted rigorous methodological approaches for translating, transculturally adapting and validating the original scale English version into Brazilian Portuguese. We invited all 400 undergraduate medical students enrolled in the 5th and 6th years of a medical course in Northeast Brazil between January and March 2017 to participate. Of the 400 students, 281 accepted to take part in the study. We analyzed the collected data using the SPSS software version 21 and structural equation modeling (SEM) was performed using AMOS SPSS version 18. We conducted exploratory factor analysis (EFA), varimax rotation, with Kaiser Normalization and Principal Axis Factoring extraction method. We conducted confirmatory factor analysis (CFA), using the SEM. We used the following indexes of adherence of the model: Comparative fit index (CFI), Goodness-of-fit index (GFI) and Tucker-Lewis Index (TLI). We considered the Bayesian Information Criterion (BIC) for Sample-size adjusted. The root mean square error of approximation was calculated. Values below 0.08 were considered acceptable. Composite reliability analyzes were performed to evaluate the accuracy of the instrument. Values above 0.70 were considered satisfactory. Results Of the 281 undergraduate medical students, 195 (69.3%) were female. Mean age of participants was 25.0 ± 2.6 years. In the EFA, the KMO was 0.720 and the Bartlett sphericity test was significant ( p < 0.001). We conducted the EFA into two factors: role-modeling cost-conscious behaviors in health (seven items) and health waste behaviors (six items). The 13 item-scale was submitted to composite reliability analyzes, obtaining values of 0.813 and 0.761 for the role-modeling cost-conscious behaviors and the health waste behaviors factors, respectively. Conclusions We concluded that the cost-conscious behaviors scale has good psychometric properties and is a valid and reliable instrument for evaluating medical students’ perception of their teachers’ cost-conscious behaviors.

BACKGROUND AND OBJECTIVES: Spirituality is intrinsically involved in nursing care. Despite being a topic that, in recent years, has attracted the interest of researchers, there is still little evidence to prove the effect of spirituality in reducing pain and associated anxiety. In this sense, the aim of this study was to identify the state of science related to the use of spirituality as a nursing intervention to control patients' pain and anxiety in different health problems. CONTENTS: An integrative literature review in the following databases: Pubmed, Cochrane, Web of Science and Biblioteca Virtual da Saúde (BVS -Virtual Health Library). Data collection was carried out in May and updated in September 2021. Scientific articles with full text available published in the last 10 years that addressed spirituality in nursing care to patients with pain and anxiety were included. Ten articles were included in the analysis, including six randomized clinical trials, two quasi--experimental studies and two systematic reviews. The following interventions based on spirituality that guided nursing in pain reduction were identified: prayer meditation, prayer, positive thinking training, active listening, among others. All articles showed a positive effect in reducing pain and anxiety, as well as improving vital parameters. CONCLUSION: Nursing interventions based on spiritual care techniques seem to be effective in reducing pain and anxiety. Nevertheless, further studies should be carried out in order to validate that spirituality as nursing care is effective in reducing pain and associated anxiety.

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