Development and analysis of reliability and validity of Operating Room Nurses' Job Stressor Scale

doi:10.3969/j.issn.1674-8115.2021.08.014

Abstract

Abstract: Objective

·To develop a scale for measurement of operating room nurses′ job stressor in China and analyze its reliability and validity.

Methods

·According to the literature review, combined with the working characteristics of the nurses in operating rooms, the first draft with 47 items was formulated by two groups of focus interviews among the operating room nursing managers and the operating room nurses. And the items were demonstrated and modified by Delphi expert consultation method to formulate the test version of Operating Room Nurses′ Job Stressor Scale. A test was conducted among the 355 nurses in operating rooms in three tertiary level A hospitals in Shanghai. The items were further screened and the scale was optimized according to the results of item analysis and exploratory factor analysis, and the reliability and the validity of the scale were analyzed.

Results

·Twelve items were deleted and 8 items were modified by the first round of expert consultation. The test version of Operating Room Nurses′ Job Stressor Scale with 35 items was formulated by the second round of expert consultation. Item-level content validity indexes (I-CVI) were all ≥0.78 and scale-level average content validity index (S-CVI/Ave) was 0.91. A total of 355 questionnaires were distributed and the effective recovery rate was 100%. Thirty-five items were retained after item analysis. After 7 times of exploratory factor analyses, 6 items were deleted and 29 items were remained. A total of four factors were extracted ( ??problems in surgical nursing and patient nursing'' ??problems in working environment, workload and time allocation'' ??problems in nursing specialty and development'' and ??problems in management and interpersonal relationship''). The cumulative variance explanation rate of the four factors was 72.162%. The correlation coefficient between each dimension and the total score was higher than that between dimensions. S-CVI/Ave was 0.92. The internal consistency Cronbach′s α of the scale was 0.969, and those of the four dimensions were 0.936, 0.938, 0.872, and 0.943, respectively. The split-half reliability Spearman-Brown coefficient was 0.906. The retest reliability coefficient was 0.946.

Conclusion

·Operating Room Nurses′ Job Stressor Scale has good reliability and validity, which can be used to measure the source and degree of working pressure for the nurses in operating rooms.

Key words: operating room nurse, working pressure, job stressor, scale, reliability, validity

CLC Number:

R473.6

Wen-jing QIAN, Ya-qing ZHANG. Development and analysis of reliability and validity of Operating Room Nurses' Job Stressor Scale[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(8): 1081-1088.

Figures/Tables 3

TrendMD

References 14

1	郭莉, 米湘琦, 陈肖敏, 等. 全国2 039所医院手术室人力资源管理现状调查[J]. 中国护理管理, 2017, 17(8): 1014-1019.
2	李小妹, 刘彦君. 护士工作压力源及工作疲溃感的调查研究[J]. 中华护理杂志, 2000, 35(11): 645-649.
3	唐华, 王甦平, 龚睿婕, 等. 挫败感量表对医学生焦虑抑郁态的信效度评估[J]. 上海交通大学学报(医学版), 2019, 39(1): 84-88.
4	王皓岑, 章雅青, 钱艳. 护士组织支持感问卷的编制与测评[J]. 中国护理管理, 2014, 14(6): 580-583.
5	吴明隆. 问卷统计分析实务:SPSS操作与应用[M]. 重庆: 重庆大学出版社, 2018: 266-272.
6	任志洪, 叶一舵. 核心自我评价量表的中文修订[J]. 福建师范大学学报(哲学社会科学版), 2009(4): 157-163, 172.
7	冯永辉, 李慧, 谌梦桂, 等. 青少年戒烟动机量表的汉化及信效度检验[J]. 上海交通大学学报(医学版), 2020, 40(11): 1509-1514.
8	Clough BA, March S, Chan RJ, et al. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review[J]. Syst Rev, 2017, 6(1): 144.
9	龙瑶, 章丽娜, 任冬梅, 等. 手术室护理人员留职意愿与工作压力源、职业疲溃感及工作家庭冲突相关性分析[J]. 中国实用护理杂志, 2020, 36(4): 303-307.
10	牛亮, 弓帅, 梅松丽, 等. 手术室护士疲劳与压力的影响因素分析[J]. 长春中医药大学学报, 2015, 31(6): 1259-1261.
11	Kennedy HP. A model of exemplary midwifery practice: results of a Delphi study[J]. J Midwifery Womens Health, 2000, 45(1): 4-19.
12	包玲, 王琳, 章雅青. 护士创新行为量表的研制及信度和效度检验[J]. 上海交通大学学报(医学版), 2012, 32(8): 1079-1082, 1087.
13	林思婷, 罗梦娜, 李泽楷. 护士心理韧性量表的编制及其信效度检验[J]. 解放军护理杂志, 2020, 37(8): 44-47.
14	刁华, 王宏, 杨连建, 等. 青春期儿童生活质量量表在留守儿童中的应用考评[J]. 上海交通大学学报(医学版), 2019, 39(10): 1188-1193.

Dimension	Item No.	Item	I-CVI
Problems in nursing profession and work（护理专业及工作方面的问题）	K1	The social status of nursing work is too low （护理工作的社会地位太低）	0.78
	K2	There are too few opportunities for further study （继续深造的机会太少）	0.89
	K3	Wages and other benefits are low （工资及其他的福利待遇低）	1.00
	K4	There are too few opportunities for promotion （晋升的机会太少）	1.00
	K5	Work shifts frequently （经常倒班）	1.00
	K6	The task of continuing education is heavy （继续教育任务繁重）	0.89
	K7	There is much work in teaching and scientific researches （教学、科研方面工作较多）	1.00
Problems in time allocation and workload （时间分配及工作量方面的问题）	K8	Too much work （工作量太大）	1.00
	K9	The number of nurses at work is small （上班的护士数量少）	1.00
	K10	There is no time to carry out preoperative and postoperative visit work and psychological nursing for patients （没有时间对患者实施术前、术后的访视工作及心理护理）	0.78
	K11	Overtime is too long （加班时间过长）	1.00
	K12	Too much useless recording （in writing and on computer）［无用的记录工作太多（书面、电脑）］	0.78
Problems in working environment， surgical instruments and equipments （工作环境及手术器械、仪器设备方面的问题）	K13	The working environment is poor， including many factors such as anesthetic exhaust gas， equipment noise， radiation， and blood borne occupational exposure （工作环境差，存在麻醉废气、设备噪音、辐射、血源性职业暴露等因素）	1.00
	K14	The surgical instruments and equipments needed in the work are insufficient （工作中所需的手术器械、仪器设备不足）	0.89
	K15	It is difficult to master the usage methods of all kinds of instruments and equipments （难以全面掌握各类仪器设备的使用方法）	0.89
Problems in operation nursing and patient nursing （手术护理及患者护理方面的问题）	K16	Worrying about mistakes and accidents in work （such as check， specimens， and count）［担心工作中出现差错事故（如核对、标本、清点等）］	0.89
	K17	The nursing work is not recognized by doctors （护士工作未被医生承认）	0.89
	K18	The operation you are involved in is too complicated and difficult （参与的手术过于复杂、疑难）	1.00
	K19	Emergency rescues during operations （such as massive hemorrhage and cardiac arrest）［术中突发意外抢救（如大出血、心跳骤停等）］	1.00
	K20	Standing for a long time with heavy physical load （长时间持续站立，体能负荷大）	1.00
	K21	Focused attention and high mental stress during operations （手术中注意力集中，精神高度紧张）	0.89
	K22	The long-term face of various surgical scenes leads to negative emotions （长期面对各类手术场景导致产生负性情绪）	1.00
	K23	The knowledge learned cannot meet the psychological needs of patients and their families （during visits）［所学的知识不能满足患者及家属的心理需要（访视时）］	0.78
	K24	Lack of professional knowledge and skills related to operation preparation and nursing cooperation （缺乏手术准备与护理配合相关的专业知识与技能）	0.89
	K25	Worrying about the patients' skin pressure injury and hypothermia during operations （担心手术中会引起患者皮肤压力性损伤、低体温等情况）	0.89
	K26	The patients undergoing surgeries die suddenly （手术的患者突然死亡）	1.00
Problems in management and interpersonal relationship （管理及人际关系方面的问题）	K27	Lack of understanding and respect from other health workers （缺乏其他卫生工作人员的理解及尊重）	0.78
	K28	Lack of understanding and support from nursing managers （护理管理者的理解与支持不够）	1.00
	K29	Too much criticism from nursing managers （护理管理者的批评过多）	1.00
	K30	Doctors are too fussy about nursing work （医生对护理工作过分挑剔）	0.89
	K31	Lack of understanding and support among colleagues （同事之间缺乏理解与支持）	0.89
	K32	Conflicts with nursing managers （与护理管理者发生冲突）	0.78
	K33	It is difficult to cooperate with some nurses in the ward （与病房的某些护士合作困难）	0.78
	K34	Conflicts with doctors （与医生发生冲突）	0.78
	K35	Lack of friendly and cooperative atmosphere among colleagues （同事之间缺乏友好合作的气氛）	0.89

Dimension	Item No.	Item	I-CVI
Problems in nursing profession and work（护理专业及工作方面的问题）	K1	The social status of nursing work is too low （护理工作的社会地位太低）	0.78
	K2	There are too few opportunities for further study （继续深造的机会太少）	0.89
	K3	Wages and other benefits are low （工资及其他的福利待遇低）	1.00
	K4	There are too few opportunities for promotion （晋升的机会太少）	1.00
	K5	Work shifts frequently （经常倒班）	1.00
	K6	The task of continuing education is heavy （继续教育任务繁重）	0.89
	K7	There is much work in teaching and scientific researches （教学、科研方面工作较多）	1.00
Problems in time allocation and workload （时间分配及工作量方面的问题）	K8	Too much work （工作量太大）	1.00
	K9	The number of nurses at work is small （上班的护士数量少）	1.00
	K10	There is no time to carry out preoperative and postoperative visit work and psychological nursing for patients （没有时间对患者实施术前、术后的访视工作及心理护理）	0.78
	K11	Overtime is too long （加班时间过长）	1.00
	K12	Too much useless recording （in writing and on computer）［无用的记录工作太多（书面、电脑）］	0.78
Problems in working environment， surgical instruments and equipments （工作环境及手术器械、仪器设备方面的问题）	K13	The working environment is poor， including many factors such as anesthetic exhaust gas， equipment noise， radiation， and blood borne occupational exposure （工作环境差，存在麻醉废气、设备噪音、辐射、血源性职业暴露等因素）	1.00
	K14	The surgical instruments and equipments needed in the work are insufficient （工作中所需的手术器械、仪器设备不足）	0.89
	K15	It is difficult to master the usage methods of all kinds of instruments and equipments （难以全面掌握各类仪器设备的使用方法）	0.89
Problems in operation nursing and patient nursing （手术护理及患者护理方面的问题）	K16	Worrying about mistakes and accidents in work （such as check， specimens， and count）［担心工作中出现差错事故（如核对、标本、清点等）］	0.89
	K17	The nursing work is not recognized by doctors （护士工作未被医生承认）	0.89
	K18	The operation you are involved in is too complicated and difficult （参与的手术过于复杂、疑难）	1.00
	K19	Emergency rescues during operations （such as massive hemorrhage and cardiac arrest）［术中突发意外抢救（如大出血、心跳骤停等）］	1.00
	K20	Standing for a long time with heavy physical load （长时间持续站立，体能负荷大）	1.00
	K21	Focused attention and high mental stress during operations （手术中注意力集中，精神高度紧张）	0.89
	K22	The long-term face of various surgical scenes leads to negative emotions （长期面对各类手术场景导致产生负性情绪）	1.00
	K23	The knowledge learned cannot meet the psychological needs of patients and their families （during visits）［所学的知识不能满足患者及家属的心理需要（访视时）］	0.78
	K24	Lack of professional knowledge and skills related to operation preparation and nursing cooperation （缺乏手术准备与护理配合相关的专业知识与技能）	0.89
	K25	Worrying about the patients' skin pressure injury and hypothermia during operations （担心手术中会引起患者皮肤压力性损伤、低体温等情况）	0.89
	K26	The patients undergoing surgeries die suddenly （手术的患者突然死亡）	1.00
Problems in management and interpersonal relationship （管理及人际关系方面的问题）	K27	Lack of understanding and respect from other health workers （缺乏其他卫生工作人员的理解及尊重）	0.78
	K28	Lack of understanding and support from nursing managers （护理管理者的理解与支持不够）	1.00
	K29	Too much criticism from nursing managers （护理管理者的批评过多）	1.00
	K30	Doctors are too fussy about nursing work （医生对护理工作过分挑剔）	0.89
	K31	Lack of understanding and support among colleagues （同事之间缺乏理解与支持）	0.89
	K32	Conflicts with nursing managers （与护理管理者发生冲突）	0.78
	K33	It is difficult to cooperate with some nurses in the ward （与病房的某些护士合作困难）	0.78
	K34	Conflicts with doctors （与医生发生冲突）	0.78
	K35	Lack of friendly and cooperative atmosphere among colleagues （同事之间缺乏友好合作的气氛）	0.89

Item No.	Critical value t	Item-total correlation		Homogeneity test
Item No.	Critical value t	Item-total correlation	Corrected item-total correlation	Cronbach's α after item deletion	Communality	Factor loading
K1	13.192	0.641	0.617	0.974	0.402	0.634
K2	12.447	0.630	0.607	0.974	0.393	0.627
K3	14.261	0.700	0.679	0.974	0.479	0.692
K4	14.412	0.695	0.675	0.974	0.474	0.689
K5	15.285	0.674	0.649	0.974	0.438	0.662
K6	15.299	0.704	0.683	0.974	0.484	0.696
K7	12.460	0.625	0.599	0.974	0.382	0.618
K8	20.019	0.776	0.758	0.973	0.584	0.764
K9	19.869	0.754	0.734	0.974	0.553	0.743
K10	15.412	0.704	0.682	0.974	0.490	0.700
K11	19.062	0.743	0.722	0.974	0.534	0.730
K12	19.441	0.747	0.726	0.974	0.542	0.736
K13	18.695	0.754	0.735	0.974	0.557	0.746
K14	21.528	0.784	0.767	0.973	0.611	0.782
K15	16.024	0.727	0.710	0.974	0.539	0.734
K16	19.010	0.752	0.732	0.974	0.565	0.752
K17	17.607	0.784	0.769	0.973	0.623	0.789
K18	18.488	0.783	0.769	0.973	0.626	0.791
K19	17.910	0.732	0.714	0.974	0.542	0.736
K20	25.241	0.794	0.778	0.973	0.621	0.788
K21	23.184	0.807	0.793	0.973	0.654	0.809
K22	19.083	0.768	0.750	0.974	0.592	0.770
K23	13.412	0.736	0.720	0.974	0.557	0.747
K24	12.923	0.686	0.668	0.974	0.486	0.697
K25	16.360	0.750	0.733	0.974	0.569	0.754
K26	12.700	0.587	0.559	0.974	0.345	0.588
K27	16.844	0.776	0.762	0.973	0.615	0.784
K28	22.377	0.798	0.783	0.973	0.638	0.799
K29	21.909	0.803	0.788	0.973	0.650	0.806
K30	20.536	0.826	0.814	0.973	0.694	0.833
K31	16.369	0.759	0.743	0.974	0.592	0.769
K32	17.743	0.754	0.737	0.974	0.581	0.762
K33	14.534	0.724	0.707	0.974	0.538	0.734
K34	14.591	0.715	0.697	0.974	0.526	0.726
K35	13.365	0.688	0.669	0.974	0.489	0.699

Item No.	Critical value t	Item-total correlation		Homogeneity test
Item No.	Critical value t	Item-total correlation	Corrected item-total correlation	Cronbach's α after item deletion	Communality	Factor loading
K1	13.192	0.641	0.617	0.974	0.402	0.634
K2	12.447	0.630	0.607	0.974	0.393	0.627
K3	14.261	0.700	0.679	0.974	0.479	0.692
K4	14.412	0.695	0.675	0.974	0.474	0.689
K5	15.285	0.674	0.649	0.974	0.438	0.662
K6	15.299	0.704	0.683	0.974	0.484	0.696
K7	12.460	0.625	0.599	0.974	0.382	0.618
K8	20.019	0.776	0.758	0.973	0.584	0.764
K9	19.869	0.754	0.734	0.974	0.553	0.743
K10	15.412	0.704	0.682	0.974	0.490	0.700
K11	19.062	0.743	0.722	0.974	0.534	0.730
K12	19.441	0.747	0.726	0.974	0.542	0.736
K13	18.695	0.754	0.735	0.974	0.557	0.746
K14	21.528	0.784	0.767	0.973	0.611	0.782
K15	16.024	0.727	0.710	0.974	0.539	0.734
K16	19.010	0.752	0.732	0.974	0.565	0.752
K17	17.607	0.784	0.769	0.973	0.623	0.789
K18	18.488	0.783	0.769	0.973	0.626	0.791
K19	17.910	0.732	0.714	0.974	0.542	0.736
K20	25.241	0.794	0.778	0.973	0.621	0.788
K21	23.184	0.807	0.793	0.973	0.654	0.809
K22	19.083	0.768	0.750	0.974	0.592	0.770
K23	13.412	0.736	0.720	0.974	0.557	0.747
K24	12.923	0.686	0.668	0.974	0.486	0.697
K25	16.360	0.750	0.733	0.974	0.569	0.754
K26	12.700	0.587	0.559	0.974	0.345	0.588
K27	16.844	0.776	0.762	0.973	0.615	0.784
K28	22.377	0.798	0.783	0.973	0.638	0.799
K29	21.909	0.803	0.788	0.973	0.650	0.806
K30	20.536	0.826	0.814	0.973	0.694	0.833
K31	16.369	0.759	0.743	0.974	0.592	0.769
K32	17.743	0.754	0.737	0.974	0.581	0.762
K33	14.534	0.724	0.707	0.974	0.538	0.734
K34	14.591	0.715	0.697	0.974	0.526	0.726
K35	13.365	0.688	0.669	0.974	0.489	0.699

Item No.	Factor 1 loading	Factor 2 loading	Factor 3 loading	Factor 4 loading
K19	0.831	0.068	0.066	0.040
K26	0.699	0.058	-0.160	-0.105
K18	0.677	0.040	0.153	-0.120
K24	0.673	- 0.168	0.159	-0.205
K25	0.637	0.073	0.141	-0.092
K23	0.616	-0.142	0.234	-0.228
K21	0.578	0.401	0.043	-0.006
K16	0.566	0.400	-0.090	-0.049
K15	0.565	0.093	0.138	-0.118
K22	0.545	0.241	0.183	-0.012
K11	0.042	0.854	0.010	-0.041
K9	-0.009	0.837	0.015	-0.111
K8	0.113	0.831	0.082	0.029
K20	0.262	0.734	-0.051	-0.059
K12	-0.168	0.667	0.196	-0.256
K13	0.184	0.594	0.138	-0.043
K5	0.120	0.583	0.210	0.040
K2	0.047	-0.111	0.887	-0.069
K4	-0.024	0.113	0.797	-0.073
K1	0.113	0.062	0.782	0.070
K3	-0.004	0.365	0.543	-0.042
K32	-0.070	0.094	0.023	-0.890
K35	0.052	-0.108	0.027	-0.883
K31	0.059	-0.027	0.062	-0.853
K33	0.202	-0.032	0.005	-0.713
K34	0.246	-0.040	-0.031	-0.703
K29	-0.068	0.351	0.028	-0.693
K28	-0.069	0.408	0.150	-0.528
K30	0.343	0.217	0.008	-0.456
Eigenvalue	15.841	2.358	1.429	1.298
Variance explained/%	54.625	8.132	4.928	4.477
Cumulative variance explained/%	54.625	62.758	67.685	72.162