The Development Of Nurse Stressor Scale

Objective: To develop a measuring scale for standardized Chinese nurses'stressor, to analyze and toexamine the items in the scale for reliability and validity,and to establish Chinese nurses' work-stressor model and norm of this scale so thatone can completely, concretely and precisely understand the true and intrinsiccharacters of nurses' stressor and provide better evaluation tools for identifying,measuring and monitoring nurses' stressors in China..Methods:1. The development of NSS was based on the frame work of CPT by Lazaras andJDR by Demerouti et al, combining theories and experience, a great deal of studies onrelated researches and consulting experts, having learnt from famous internationalsimilar scales such as OSI, OSI-R, GJSQ, McLean's Stressor Questionares, NSS ofGray-Toft and Andreson, the model and developing strategy of the NSEQ by Bianchi.2. The construction of NSS:The NSS consists of six factors. Theyare SS related with the nature of nursing work, the work load, nurses' expectation, thecontact with patients close to death, the confliction of work and family andinterpersonal relationship respectively.3. Standardization:(1) To build the item database: based on commom practice of developing NSSinternationally, we had an open-ended questionnaire to 352 nurses with different areas,hospitals, ages, technical ranks, length of service.(2) The generation, measurement and analysis of samples: Select therepresentative contents from the information acquired by open questionnaire togenerate the evaluation index of NSS, and make expert consultation for the selecteditems to form the samples of NSS. Make measurements based on 387 nurses, andanalyze the returned information. The analysis mainly includes the correlation of items and scores, decision value, exploration factor and expert assessment, and thepreliminary samples composed of the six NSS is generated.(3) The measurement and analysis of the preliminary samples: the targeted objectis 469 nurses. Randomly select 161 people from the returned information and retest intwo weeks; additionally randomly select 200 people and make measurement withMBI, SCL-90, Pressure response questionnaire, LES, Social support scale andSimplified coping style questionnaire, then make reliability verification based on allthe information. The indexes of reliability verification include retest reliability,internal consistency reliability, split-half reliability, and generalizabilitycoefficient; The validity verification applies the factor analysis to verify the structurevalidity, and use the correlation of MBI, SCL-90, Pressure response questionnaire,LES, Social support scale and Simplified coping style questionnaire to verify theactual validity.(4) Generate the formal quantitative table and build the norm: The norm wasbuilt with the modification of measurement items based on the analysis of the index ofreliability and validity; Apply the NSS to make measurement for the three major areasin China, and the samples should cover the diverse districts, hospitals, sections, titlesand working years etc. The age, marriage, education background should also be takeninto account. The total samples are 3091 people.(5) Research of nurses' stress model: make asseessment with nurses' stresssource, working fatigue, self-assess psychology, press reaction, life events, socialsupport etc. based on the path analysis, and validate the NSS model proposed by us.Results:1. Item analysis: The item analysis shows that the correlation coefficientsbetween each items and total scores range from 0.36 to 0.75. The high-score groupand the low-score one of each item show the decision value has statistical meaning (P＜0.001). The degree of differentiation is good.2. Reliability verfication: (1) The retest reliability: coeffiecients for subscale ranges from 0.61 to 0.80, and 0.81 for the total scale; (2) Split-half reliability:coefficients(Adjusted by Spearman-Brown formula) is 0.87-0.93 for subscale, and0.95 for total scale; (3) Cronbach' a coefficient: 0.88-0.93 for subscale, and 0.97 fortotal scale; (4) The consistency of item tables: the correlation coefficient betweeneach item and subscale is 0.47-0.84, the correlation coefficient between subscale is0.52-0.83 and the correlation coefficient between subscale and total scale is 0.76-0.91.(5) Generalization research shows that the generalization coefficient Ep~2, reliabilityindexΦand error varianceσ~2 ranged from 0.8858 to 0.9303, from 0.8625 to 0.9217and from 0.0894 to 0.3041 respectively for subscale, and are 0.9798, 0.9751 and0.0986 for total scale.3. Validity verification: (1) Structure validity: extract six first-order factors whichaccount for 56.28％of the accumulated variance; extract one second-order factorwhich accotmts for 82.59％; IFI,TLI,GFI,CFI,IFI,TLI,GFI,NFI in the first-orderand second-order factors are all acceptable; (2) Criterion-related validity: Thecorrelation coefficients between the NSS and Stressor reaction, MBI, and SCL-90respectively were 0.463, 0.510, and 0.421. (P＜0.01)4. Norm: Raw score norm of the total scale, each factors, areas, different age anddifferent technical ranksare established. The percentage norm and T norm are alsoestablished. The analysis of covadance and logistic regression result shows thatworking years, working sections, technical ranks, working characteristics, marriageand work areas are the main factors, which influenced theNSS ordinally.5. Theory modeling: nurses' NSS has significant effect on pressure reaction,working fatigue and psychological symptoms in ascending order. Nurses' passivestyle of dealing with NSS is a significant variable in the process of work stressor,since it could affect the maladjustment in three ways: affecting pressure reaction,fatigue, affecting the engenderment of ill psychological symptoms via NSS indirectly,and affecting life events and ill psychological symptoms directly. Life events affect NSS in two ways: affect maladjustment directly and collaborate with NSS indirectly.Social support affects NSS and the consequence of stress adaptation via life events.Conclusions: The NSS meets the requirement of psychometrics with the gooddegree of discrimination. The index of reliability achieves the demand ofpsychometrics; The structure validity is good and tallies with the design plan; TheNSS can reflect the status and characteristic of nurse working stress in China andverified with the theory model and can be used to explain the process of nurseworking stress. Psychometric properties analysis shows that NSS was a reliable,consistent and effective instrument for the assessment of nurse working stress inChina.