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Aims: The aim of the present study was to develop a tool, the Psychiatric Nurse Job Stressor Scale (PNJSS), for measuring the stress of psychiatric nurses, and to evaluate the reliability and validity of the PNJSS.
Methods: A total of 302 psychiatric nurses completed all the questions in an early version of the PNJSS, which was composed of 63 items and is based on past literature of psychiatric nurses' stress.
Results: A total of 22 items from four factors, ‘Psychiatric Nursing Ability’, ‘Attitude of Patients’, ‘Attitude Toward Nursing’ and ‘Communication’, were extracted in exploratory factor analysis. With regard to scale reliability, the item–scale correlation coefficient was r = 0.265–0.570 (P < 0.01), the Cronbach alpha coefficient was 0.675–0.869, and the test–retest correlation coefficient was r = 0.439–0.771 (P < 0.01). With regard to scale validity, the convergent validity of the ‘job stressor’ scale was r = 0.172–0.420 (P < 0.01), and the predictive validity of the ‘job reaction’ scale was r = 0.201–0.453 (P < 0.01). The compatibility of the factor model to the data was 1.750 (χ2/d.f., 343.189/196, P < 0.01), the goodness of fit index was 0.910, the adjusted goodness of fit index was 0.883, the comparative fit index was 0.924, and the root mean square error of approximation was 0.050.
Conclusions: The PNJSS has sufficient reliability and validity as a four-factor structure containing 22 items, and is valid as a tool for evaluating psychiatric nurse job stressors.
PSYCHIATRIC NURSING IS regarded as one of the most stressful occupations in the world.1–3 It has been reported that medical workers in psychiatry departments have a higher burnout rate than medical workers in other departments.4–7 Stress causes mental health disorders for psychiatric nurses and has a negative effect on health-care services,8–10 and it has been suggested that it is the main cause of job resignation.11,12 A research report by the Japanese Nursing Association showed that the resignation rate of new graduate nurses in psychiatry departments is higher than in other hospital departments in general.13 For example, the resignation of psychiatry nurses is related to stress from ‘the violence from a patient’, which is not observed in the general hospital.11 Attempting to decrease psychiatric nurses' stress is considered to be beneficial for the mental health of Japanese psychiatric nurses. Furthermore, because there are approximately 85 000 psychiatric nurses working in Japan at present,14 improving the mental health care of psychiatric nurses is an important industrial problem.
In foreign countries there is a standardized scale based on findings concerning psychiatric nurses' job stressors.8,15 In Japan, in contrast, the Nursing Job Stressor Scale (NJSS) of Higashiguchi et al.16 and the Nursing Stress Scale (NSS) of Gray-Toft and Anderson17 have generally been used in the study of psychiatric nurses' mental health. These scales, however, are not standardized scales based on knowledge about the stressors of the psychiatric nurses. To our knowledge, there are no scales with adequate reliability and validity that can measure and evaluate psychiatric nursing stressors in Japan.18 When we use the existing scales8,15 for Japanese psychiatric nurses, it is difficult to determine the stressors adequately because of the differences in historical background of the country where the scale was developed. For example, in Japan, psychiatric treatment is usually carried out by private hospitals,19 and the psychiatric nurse is typically a certified nurse specialist (CNS), a qualification that was established by the Japanese Nursing Association in 1995. In order to ensure high-quality treatment, assertive community treatment (ACT) was established,20 but deinstitutionalization was delayed due to lack of social resources.
In addition, in Japan there are comparatively fewer nurses per sickbed than in Europe,21 and the average length of hospitalization is longer than in any other developed countries.22 These differences in background influence the job stressors of psychiatric nurses. Therefore, in considering Japanese psychiatric nurses' mental health care, it is necessary to devise a new scale with adequate reliability and validity to measure and evaluate psychiatric nurses' stressors. This new scale, the Psychiatric Nurse Job Stressor Scale (PNJSS), would have adequate reliability and validity and would enable objective evaluation of nurses' stressors in individual psychiatry departments, thereby contributing to the self-care of psychiatric nurses and the line-care of managerial staff. This is expected to protect psychiatric nurses' mental health and to prevent a reduction in the quality of patient care.9 The purpose of the present study was therefore to develop this new standard scale that focuses on the viewpoint of the psychiatry-related stressors, and to evaluate the reliability and validity of the scale.