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Keywords:

  • investigation;
  • psychiatric nurse;
  • stressor;
  • brief job stress questionnaire;
  • visual analogue scale

Abstract

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix

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.

METHOD

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix

Preparation of the questionnaire

To understand the basic characteristics of the participants, the questionnaire collected data on age, gender, job position, qualifications and experience of working in other departments. Then, from 10 years of literature dealing with the stressors of psychiatric nurses,23–33 we selected 63 question items, which we confirmed with a nurse and university staff who had experience of working in a psychiatry department. We ensured the following for each question: (i) the subject and the predicate were unified as ‘I think-/feel-’; (ii) the verb tense was unified to the present tense; and (iii) multiple sentences were not included in one question item. A visual analogue scale (VAS) was used to record answers. A sentence instructed the respondents thus: ‘These questions refer to your present psychiatry department work. Please make a circle ○ on the place on the line that best matches your response.’ The VAS was 100 mm long, and points were set at every 1 mm. For each question, the score was highest toward ‘Yes, I think/feel so’ and indicated a high job stressor. The final version of the PNJSS is given in Appendix I.

Procedure

Anonymous self-administered questionnaires that had been sent out by mail between 17 November 2009 and 10 March 2010 were investigated. To evaluate test–retest reliability, questionnaires from the same respondents were investigated twice. The first investigation period was from 17 November 2009 to 21 December 2009, and the second investigation period was from 9 February 2010 to 10 March 2010. The participants were informed of the aim of the investigation, and written consent was obtained. The study protocol was approved by the Ethics Committee of Kumamoto University Graduate School of Life Sciences.

Subjects

The respondents were 385 nurses and associate nurses in six psychiatry hospitals. They included psychiatric nurses in the areas of acute and chronic mental disease, dementia, alcohol dependence, physical complications, and adolescent mental disease. Responses were received from 347 psychiatric nurses in the first investigation (recovery rate 90.1%). Among the respondents, 302 people who gave their informed consent of the investigation were accepted as subjects for analysis (effective response rate 87.0%). Among the 302 people who gave consent for the first investigation, 181 people who had obtained agreement were accepted as subjects for analysis in the second investigation (effective response rate 59.9%). The mean age of the 302 people who gave consent for the first investigation was 42.47 ± 11.19 years. A total of 96 were male (31.8%), 197 were female (65.2%), and nine left this unanswered (3.0%). Forty-two were managers (head nurse or chief nurse; 13.9%), 233 were non-managers (77.2%), and 27 left this unanswered (8.9%). With regard to qualifications, 200 were nurses (66.2%), 92 were associate nurses (30.5%), and 10 left this unanswered (3.3%). A total of 201 people (66.6%), answered yes to having experience in other departments, 91 people answered no (30.1%), and 10 left this unanswered (3.3%). The mean number of years of psychiatry department experience was 13.43 ± 10.57 years.

Statistical analysis

SPSS version 17.0 for Windows (SPSS, Chicago, IL, USA) was used for the item analysis, extraction of factors, calculation of reliability, and calculation of convergent and predictive validity. Amos version 17.0 for Windows (Amos Development Corporation) was used for the calculation of factorial validity. In two-tailed T-test of good–poor (G-P) analysis in item analysis, and Pearson's correlation analysis (two-tailed) of reliability and convergent and predictive validity, the significance level was set at P < 0.01.

RESULTS

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix

Item analysis

Each of the 63 item scores were divided into the upper 25% (high group) and the lower 25% (low group). Next, the discriminative power was analyzed on G-P analysis. In addition, the mean and standard deviation were calculated, eliminating items with a ceiling effect and floor effect. On G-P analysis for each item score, a significant difference (P < 0.01) between groups was confirmed in all 63 items, and the discriminative power was demonstrated for each item. Items 13, 46, and 47, which had a ceiling effect and floor effect of ± 1SD, were then deleted from the analysis. Furthermore, because item 28 had missing data in 24 questionnaires (7.9%), it was deleted from analysis. After deleting the aforementioned items, the number of missing answers in each item was 0–3, which we judged to be small. Thus, the mean value was substituted for the missing data in statistical analysis. In the second investigation, the number of missing answers in each item was also 0–3, and the same analysis was done.

Exploratory factor analysis

The factor structure of the PNJSS was identified using exploratory factor analysis (EFA). In the process of conducting EFA, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was confirmed. The maximum likelihood method was used in the extraction of factors, and promax rotation was conducted. The scree test34 was used to decide the number of factors. Items that showed less than 0.40 in one factor and 0.40 in plural factors were deleted, and EFA was repeated. Table 1 lists the results of EFA. The KMO measure of sampling adequacy was 0.788, showing that EFA was appropriate.35 Four factors and 22 items were extracted. The first factor was named ‘Psychiatric Nursing Ability’, and it included items related to the ability of psychiatric nurses. The second factor was named ‘Attitude of Patients’, and it included items related to patients’ attitude toward psychiatric nurses. The third factor was named ‘Attitude about Nursing’, and it included items related to the nurses' attitude toward psychiatric nursing. The fourth factor was named ‘Communication’, and this referred to items related to communicating with patients and the patients' families.

Table 1.  Factor loading of the PNJSS for psychiatric nurses (n = 302)
No.Content of itemsMeanSDF1F2F3F4CommunalityItem–scale correlation (r)
  1. All item–scale correlations (r) are significant at P < 0.01.

  2. Bold, factor loadings with absolute values ≥ 0.40.

  3. F1, Psychiatric Nursing Ability; F2, Attitude of Patients; F3, Attitude Toward Nursing; F4, Communication; PNJSS, Psychiatric Nurse Job Stressor Scale.

55I think that I can nurse and correspond as the case requires.50.824.90.7630.010−0.054−0.1130.5470.562
50I think that I can explain the nursing that I am doing.43.827.80.6970.046−0.1750.0370.4700.507
26I think that I have psychiatric nursing ability.61.323.70.652−0.078−0.0200.1220.4490.443
63I think that my experience has been made use of on the job.45.828.20.637−0.0290.0660.0650.4480.517
12I feel that my role as a nurse is well-defined.49.523.50.625−0.0760.133−0.0700.4260.517
25I think that I understand the patients.50.522.60.585−0.047−0.0160.0300.3380.524
32I think that I can express my opinion in front of others.45.529.00.5550.175−0.073−0.0510.3390.524
57I think that I have knowledge about the laws, the institutions and the policies necessary for nursing.63.025.70.505−0.057−0.0120.1570.2970.480
11I feel that the direction my nursing is advancing in is not clearly defined.56.926.00.4040.0640.332−0.0370.3520.570
6I feel that patients are negative about me.35.025.70.1720.706−0.2010.0120.5530.415
5I feel that there are patients who have an unpleasant attitude toward me.50.631.7−0.0150.701−0.0660.0380.4920.450
21I feel that there are patients who are threatening and make me afraid.42.430.30.0470.6440.002−0.0430.4160.426
19I feel that I might get entangled in patients' behavior.54.229.4−0.0600.4880.1640.0010.2770.355
23I feel that I am pressured by patients' demands.48.728.0−0.1310.4810.1650.0440.2780.450
20I feel that patients make impossible demands on me.47.627.1−0.0910.4670.116−0.0080.2340.376
35I feel that the there is a difference between the philosophy of the institution and the reality.74.322.9−0.0880.1190.6430.0820.4560.454
34I feel that there is a gap between my ideal and actual nursing.72.423.40.0190.1360.636−0.0460.4410.427
54I feel that there is difference among nurses in the way of thinking about of nursing.76.522.0−0.042−0.0880.5080.0520.2570.487
61I feel that I have a difference of opinion with my superior.57.328.7−0.0160.0040.4690.0280.2240.265
53I feel that I can do integrated nursing.65.124.30.397−0.0820.417−0.0910.3880.325
52I think it is difficult to communicate with the family of patients.62.428.60.019−0.0050.0200.9920.9990.463
51I think it is difficult to communicate with patients.57.629.90.0660.0340.0520.6950.5390.478
Explained variance (%)  22.01212.7609.4847.003  
Correlation of factorsF1 1.000     
 F2 0.1621.000    
 F3 0.2660.1411.000   
 F4 0.1930.2140.2241.000  

Reliability of the PNJSS

To determine the reliability of the PNJSS, we calculated an item–scale correlation coefficient for each item and a Cronbach alpha coefficient for each scale and subscale. Next, a correlation coefficient for each scale and subscale score between the first and second investigation was calculated to evaluate the test–retest reliability coefficient. The item–scale correlation coefficients for each item are listed in Table 1. Table 2 lists the Cronbach alpha coefficients and the test–retest reliability coefficients. The Cronbach alpha coefficient was 0.816 for the scale and from 0.675 to 0.869 for each subscale. The test–retest reliability coefficient ranged from 0.439 to 0.771 (P < 0.01) for each subscale, a level from weak to medium. The test–retest reliability coefficient was 0.717 (P < 0.01) for the scale, a strong level.

Table 2.  Test–retest reliability and internal consistency of the PNJSS
 Test–retest correlationInternal consistency
r (n = 181)Cronbach alpha (n = 302)
  1. All test–retest correlations (r) significant at P < 0.01.

  2. PNJSS, Psychiatric Nurse Job Stressor Scale.

Psychiatric Nursing Ability (9 items)0.7710.869
Attitude of Patients (6 items)0.5470.761
Attitude Toward Nursing (5 items)0.6620.675
Communication (2 items)0.4390.843
PNJSS Total (22 items)0.7170.816

Validity of the PNJSS

To determine the validity of the PNJSS, the correlation coefficient with external variables was calculated for each scale and subscale score. In consideration of the convergent validity, the ‘job stressor’ scale of the Brief Job Stress Questionnaire (BJSQ)36 was used as an external variable. The ‘stress reaction’ scale of the BJSQ was used as an external variable for the predictive validity. The ‘job stressor’ scale was composed of quantitative overload (items 1–3), mental demand (items 4–6), physical workload (item 7), job control (items 8–10), utilization of techniques (item 11), interpersonal relations (items 12–14), work environment (item 15), fit to the job (item 16) and reward of work (item 17). The ‘stress reaction’ scale consisted of the psychological and physical stress reaction scales. The psychological stress reaction scale was composed of lack of vigor (items 1–3), irritability (items 4–6), fatigue (items 7–9), anxiety (items 10–12), and depression mood (items 13–18). The physical stress reaction scale was composed of somatic symptoms (items 19–29). The BJSQ had sufficient reliability and validity in the development process. To confirm the factorial validity, the compatibility of the factor model to the data was analyzed on confirmatory factor analysis (CFA), and six goodness-of-fit indices were used (χ2/d.f. ratio, goodness-of-fit index, GFI; adjusted goodness-of-fit index, AGFI; comparative fit index, CFI; root mean square error of approximation, RMSEA; and Akaike information criterion, AIC).37

Table 3 lists the results for the validity of the PNJSS. For convergent validity, the correlation coefficient ranged from 0.172 to 0.413 (P < 0.01) between each PNJSS subscale score and ‘job stressor’ scale score, indicating a weak–medium correlation. The correlation coefficient between the PNJSS score and the ‘job stressor’ scale score was 0.420 (P < 0.01), which was a medium-level correlation. For predictive validity, the correlation coefficient ranged from 0.201 to 0.368 (P < 0.01) between each PNJSS subscale score and the ‘stress reaction’ scale score, indicating a weak correlation. The correlation coefficient between the PNJSS score and the ‘stress reaction’ scale score was 0.453 (P < 0.01), which was a medium-level correlation. For factorial validity, EFA confirmed a weak correlation between factors (Table 1), therefore a second-order factor model was assumed in the CFA. The results were as follows: χ2/d.f. (494.195/203) ratio = 2.434 (P < 0.01), GFI = 0.869, AGFI = 0.837, CFI = 0.849, RMSEA = 0.069 and AIC = 594.195. The goodness of fit of the model was not high. Therefore, we assumed that there was an error variable and developed a revised model that fitted the data.37 The results were as follows: χ2/d.f. (343.189/196) ratio = 1.750 (P < 0.01), GFI = 0.910, AGFI = 0.883, CFI = 0.924, RMSEA = 0.050, and AIC = 457.189 (Fig. 1).

Table 3.  PNJSS and Brief Job Stress Questionnaire subscale correlations
 Job stressorStress reaction
r (n = 296)r (n = 296)
  1. All r significant at P < 0.01.

  2. PNJSS, Psychiatric Nurse Job Stressor Scale.

Psychiatric Nursing Ability (9 items)0.2760.265
Attitude of Patients (6 items)0.2340.368
Attitude Toward Nursing (5 items)0.4130.332
Communication (2 items)0.1720.201
PNJSS Total (22 items)0.4200.453
image

Figure 1. Fit indices of the proposed models for the Psychiatric Nurse Job Stressor Scale (PNJSS). The PNJSS was found to fit a four-factor structure consisting of 22 items. χ2/d.f. (343.189/196, P < 0.01) = 1.750. Goodness-of-fit index, 0.910; adjusted goodness-of-fit index, 0.883; comparative fit index, 0.924; root mean square error of approximation, 0.050; Akaike information criterion, 457.189. F1, Psychiatric Nursing Ability; F2, Attitude of Patients; F3, Attitude Toward Nursing; F4, Communication. PNJS, psychiatric nurse job stressors.

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DISCUSSION

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix

The purpose of the present study was to develop the PNJSS and to confirm its reliability and validity. An examination of the factors extracted from the PNJSS and the reliability and the validity of scale are described as follows.

Examination of extracted factors

On EFA of the PNJSS, four extracted factors related to the job stressors of psychiatric nurses were suggested: ‘Psychiatric Nursing Ability’, ‘Attitude of Patients’, ‘Attitude Toward Nursing’ and ‘Communication’. Thus, it was considered that the PNJSS can measure the stressors related to those factors. In the existing scales,8,15 there are some question items related to stressors in psychiatric nursing ability, but they do not have the same meaning as the present ‘Psychiatric Nursing Ability’ factor. A recent feature of psychiatric medicine in Japan is that Japanese psychiatric nurses consider issues in psychiatric nursing ability especially to be a problem. The factor ‘Psychiatric Nursing Ability’ included items that relate to practical ability, knowledge and attitude about psychiatric nursing, and it was interpreted that the stressors of psychiatric nurses are related to those items. In recent years, the role and the service demanded of nurses have become diverse and complex because of the advancements in medical science, the aging of patients and severity of illnesses, and the reduction of the average length of hospital stay in psychiatric departments.38 As a result, the community demands nursing based on certain knowledge and techniques, and this becomes a burden on psychiatric nurses and is related to their job stressors.21 The factor ‘Attitude of Patients’ included items related to the attitude of patients toward psychiatric nurses. When the patients were negative or coercive, or made impossible demands on, or there was much pleading with psychiatric nurses, they became job stressors and it was considered that they related to the discomfort that the psychiatric nurses felt.26 The factor ‘Attitude Toward Nursing’ was chiefly composed of items about the differences in the attitudes about nursing among medical workers. It was suggested that the differences between self and others in the attitudes to nursing were related to job stressors.33 The ‘Communication’ factor included items that related to communication with patients and patients' families. In particular, it is predicted that patients with psychiatric disorders manifest positive symptoms and negative symptoms, resulting in many situations in which it is hard to communicate, relating to the job stressors of psychiatric nurses.33

PNJSS reliability and validity

In general, when developing a scale the Cronbach coefficient should be >0.6 to ensure sufficient internal consistency.39 The Cronbach alpha coefficient ranged from 0.675 to 0.869 for each subscale and was 0.816 for the overall scale in the PNJSS in the present study, indicating that this requirement was met. For item–scale correlation, correlation coefficients should be ≥0.2.40 In the present study, the item–scale correlation coefficient was ≥0.2 (P < 0.01) for all items. It was considered that internal consistencies were guaranteed in each subscale and in the overall scale. The level of the test–retest reliability coefficient was medium–strong (r = 0.439–0.771, P < 0.01) in each subscale, and maintained the level of strong (r = 0.717, P < 0.01) in the overall scale. This indicates that the PNJSS has sufficient reliability.

We also considered the validity of the PNJSS. With regard to convergent validity, it was suggested that the level of the correlation coefficient between each subscale score in the PNJSS and the ‘job stressor’ scale score in the BJSQ was weak–medium (r = 0.172–0.412, P < 0.01). The correlation coefficient between the subscale score of the fourth factor ‘Communication’ and ‘job stressor’ was weak, but the level of the correlation coefficient between the PNJSS score and the ‘job stressor’ scale score was medium (r = 0.420, P < 0.01). Given that the correlation coefficient of a developed scale in a previous study had a strength of weak–medium,15 it was considered that the PNJSS could measure the job stressors satisfactorily. With regard to predictive validity, it was suggested that there was a weak–medium correlation coefficient (0.201–0.368, P < 0.01) between each PNJSS subscale score and the ‘job reaction’ scale score in the BJSQ. The level of the correlation coefficient between the PNJSS score and the ‘job reaction’ scale score was medium (r = 0.453, P < 0.01). The level of the correlation coefficient of a developed scale in a previous study was also weak–medium,15 therefore it was considered that the PNJSS could predict job reaction satisfactorily. With regard to factorial validity, in the compatibility of the factor model to the data, the following are generally preferable: χ2/ d.f. ratio < 2.0,41 GFI > 0.90, AGFI > 0.85, CFI > 0.95 and RMSEA < 0.08.42 In the present study, CFA improved the model based on the modification index (Fig. 1), and although the CFI was a little low, the AIC was decreased compared with that before the model was improved. The compatibility of the model was satisfactory, and we considered that the PNJSS was appropriate as a four-factor structure containing 22 items.

Future issues

The PNJSS had sufficient reliability and validity as a four-factor structure containing 22 items; from comparatively few question items we could infer that the burden on the subjects in the present study was light. The PNJSS is a valid tool to evaluate psychiatric nurses' job stressors, but because many question items from the first version were deleted in the development process, it was considered that the PNJSS is not a scale that can measure all job stressors of psychiatric nurses. In addition, because the present subjects were psychiatric nurses from six psychiatric hospitals in a certain prefecture in Japan, there is a possibility that the data contained a selection bias with regard to regional characteristics. In future studies it is necessary to have a repeated selection of items for the PNJSS and to examine the cross-validity of psychiatric nurses in other prefectures. It is necessary for psychiatric nurses to take preventive measures against stressors related to ‘Psychiatric Nursing Ability’, ‘Attitude of Patients’, ‘Attitude Toward Nursing’ and ‘Communication’ as extracted in the present study. Regarding the stressors of ‘Psychiatric Nursing Ability’ and ‘Communication’, active workshops are necessary to raise confidence in psychiatric nursing. For the stressor ‘Attitude of Patients’, the establishment of a labor safety committee is needed to raise the confidence of psychiatric nurses. Meeting rooms are needed so that nurses can share their opinions of psychiatric nursing. For the stressor of ‘Attitude Toward Nursing’, opportunities for communication are necessary for individual psychiatric nurses to share their attitude about nursing. In conclusion, the PNJSS has sufficient reliability and validity, and is valid as a tool to evaluate psychiatric nurses' job stressors.

ACKNOWLEDGMENTS

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix

This study was supported by the medical doctors (Hiroshi Taniguchi, Hiroyuki Hashiguchi, Izumi Wakimoto, Jyungo Nakamura, Ryoei Miyoshi, Shigeki Kurayama, Syouhei Makita, Yoshio Mitsuyama, Youko Tsuyama) and the nurses in the psychiatric departments of six hospitals. We are deeply grateful for their cooperation in this study.

REFERENCES

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix
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Appendix

  1. Top of page
  2. Abstract
  3. METHOD
  4. RESULTS
  5. DISCUSSION
  6. ACKNOWLEDGMENTS
  7. REFERENCES
  8. Appendix

APPENDIX I

Psychiatric Nurse Job Stressor Scale (PNJSS)

These questions ask about your present psychiatry department work. Please make a circle ○ on the place on the line that best matches your response.

Example)Not at allYes
Question items
 1) Are you happy?  
Question itemsNot at allYes
 1) I think that I can nurse and correspond as the case requires.†  
 2) I think that I can explain the nursing that I am doing.†  
 3) I think that I have psychiatric nursing ability.†  
 4) I think that my experience has been made use of on the job.†  
 5) I feel that my role as a nurse is well-defined.†  
 6) I think that I understand the patients.†  
 7) I think that I can express my opinion in front of others.†  
 8) I think that I have knowledge about the laws, the institutions and the policies necessary for nursing.†  
 9) I feel that the direction my nursing is advancing in is not clearly defined.  
10) I feel that patients are negative about me.  
11) I feel that there are patients who have an unpleasant attitude toward me.  
12) I feel that there are patients who are threatening and make me afraid.  
13) I feel that I might get entangled in patients' behavior.  
14) I feel that I am pressured by patients' demands.  
15) I feel that patients make impossible demands on me.  
16) I feel that the there is a difference between the philosophy of the institution and the reality.  
17) I feel that there is the gap between my ideal and actual nursing.  
18) I feel that there is difference among nurses in the way of thinking about of nursing.  
19) I feel that I have a difference of opinion with my superior.  
20) I feel that I can do integrated nursing.†  
21) I think it is difficult to communicate with the family of patients.  
22) I think it is difficult to communicate with patients.  
†Reversal itemTotal 22 items