jurnal stres kerja

Regular Article
Development of the Psychiatric Nurse Job Stressor
Scale (PNJSS)pcn_2258 567..575
Hironori Yada, RN, BA,1
Hiroshi Abe, PhD,2
Yayoi Funakoshi, MA,1
Hisamitsu Omori, MD, PhD,1
Hisae Matsuo, MA,2
Yasushi Ishida, MD, PhD2
and
Takahiko Katoh, MD, PhD1
*
1
Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, and 2
Department of Psychiatry,
Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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, ‘Psy-
chiatric Nursing Ability’, ‘Attitude of Patients’, ‘Atti-
tude 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 valid-
ity 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 (c2
/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.
Key words: investigation, psychiatric nurse, stressor,
brief job stress questionnaire, visual analogue scale.
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 resig-
nation.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
*Correspondence: Takahiko Katoh, MD, PhD, Department of Public
Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjou,
Kumamoto 860-8556, Japan. Email: katoht@gpo.kumamoto-u.ac.jp
Received 27 September 2010; revised 26 June 2011; accepted 20 July
2011.
Psychiatry and Clinical Neurosciences 2011; 65: 567–575 doi:10.1111/j.1440-1819.2011.02258.x
567© 2011 The Authors
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology

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 Ander-
son17
have generally been used in the study of psy-
chiatric 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 reliabil-
ity and validity that can measure and evaluate psy-
chiatric 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 back-
ground 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 depart-
ments, thereby contributing to the self-care of psychi-
atric 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
Preparation of the questionnaire
To understand the basic characteristics of the par-
ticipants, 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 evalu-
ate 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 Commit-
tee of Kumamoto University Graduate School of Life
Sciences.
Subjects
The respondents were 385 nurses and associate
nurses in six psychiatry hospitals. They included psy-
chiatric nurses in the areas of acute and chronic
mental disease, dementia, alcohol dependence,
physical complications, and adolescent mental
disease. Responses were received from 347 psychiat-
ric 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
568 H. Yada et al. Psychiatry and Clinical Neurosciences 2011; 65: 567–575
© 2011 The Authors

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 Ϯ 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 depart-
ments, 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 Ϯ 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
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 Ϯ 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 con-
firmed. 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 appro-
priate.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.
Reliability of the PNJSS
To determine the reliability of the PNJSS, we calcu-
lated 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 correla-
tion 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 reli-
ability 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.
Psychiatry and Clinical Neurosciences 2011; 65: 567–575 Development of PNJSS 569
© 2011 The Authors

Table 1. Factor loading of the PNJSS for psychiatric nurses (n = 302)
No. Content of items Mean SD F1 F2 F3 F4 Communality
Item–scale
correlation (r)
55 I think that I can nurse and correspond
as the case requires.
50.8 24.9 0.763 0.010 -0.054 -0.113 0.547 0.562
50 I think that I can explain the nursing
that I am doing.
43.8 27.8 0.697 0.046 -0.175 0.037 0.470 0.507
26 I think that I have psychiatric nursing
ability.
61.3 23.7 0.652 -0.078 -0.020 0.122 0.449 0.443
63 I think that my experience has been
made use of on the job.
45.8 28.2 0.637 -0.029 0.066 0.065 0.448 0.517
12 I feel that my role as a nurse is
well-defined.
49.5 23.5 0.625 -0.076 0.133 -0.070 0.426 0.517
25 I think that I understand the patients. 50.5 22.6 0.585 -0.047 -0.016 0.030 0.338 0.524
32 I think that I can express my opinion in
front of others.
45.5 29.0 0.555 0.175 -0.073 -0.051 0.339 0.524
57 I think that I have knowledge about the
laws, the institutions and the policies
necessary for nursing.
63.0 25.7 0.505 -0.057 -0.012 0.157 0.297 0.480
11 I feel that the direction my nursing is
advancing in is not clearly defined.
56.9 26.0 0.404 0.064 0.332 -0.037 0.352 0.570
6 I feel that patients are negative about
me.
35.0 25.7 0.172 0.706 -0.201 0.012 0.553 0.415
5 I feel that there are patients who have an
unpleasant attitude toward me.
50.6 31.7 -0.015 0.701 -0.066 0.038 0.492 0.450
21 I feel that there are patients who are
threatening and make me afraid.
42.4 30.3 0.047 0.644 0.002 -0.043 0.416 0.426
19 I feel that I might get entangled in
patients’ behavior.
54.2 29.4 -0.060 0.488 0.164 0.001 0.277 0.355
23 I feel that I am pressured by patients’
demands.
48.7 28.0 -0.131 0.481 0.165 0.044 0.278 0.450
20 I feel that patients make impossible
demands on me.
47.6 27.1 -0.091 0.467 0.116 -0.008 0.234 0.376
35 I feel that the there is a difference
between the philosophy of the
institution and the reality.
74.3 22.9 -0.088 0.119 0.643 0.082 0.456 0.454
34 I feel that there is a gap between my
ideal and actual nursing.
72.4 23.4 0.019 0.136 0.636 -0.046 0.441 0.427
54 I feel that there is difference among
nurses in the way of thinking about of
nursing.
76.5 22.0 -0.042 -0.088 0.508 0.052 0.257 0.487
61 I feel that I have a difference of opinion
with my superior.
57.3 28.7 -0.016 0.004 0.469 0.028 0.224 0.265
53 I feel that I can do integrated nursing. 65.1 24.3 0.397 -0.082 0.417 -0.091 0.388 0.325
52 I think it is difficult to communicate
with the family of patients.
62.4 28.6 0.019 -0.005 0.020 0.992 0.999 0.463
51 I think it is difficult to communicate
with patients.
57.6 29.9 0.066 0.034 0.052 0.695 0.539 0.478
Explained variance (%) 22.012 12.760 9.484 7.003
Correlation of factors F1 1.000
F2 0.162 1.000
F3 0.266 0.141 1.000
F4 0.193 0.214 0.224 1.000
All item–scale correlations (r) are significant at P < 0.01.
Bold, factor loadings with absolute values Ն 0.40.
F1, Psychiatric Nursing Ability; F2, Attitude of Patients; F3, Attitude Toward Nursing; F4, Communication; PNJSS, Psychiatric Nurse Job
Stressor Scale.
© 2011 The Authors

Validity of the PNJSS
To determine the validity of the PNJSS, the correla-
tion 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 predic-
tive 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 environ-
ment (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 (c2
/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 correla-
tion 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 correla-
tion. 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: c2
/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: c2
/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).
DISCUSSION
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
Table 2. Test–retest reliability and internal consistency of the PNJSS
Test–retest correlation Internal consistency
r (n = 181) Cronbach alpha (n = 302)
Psychiatric Nursing Ability (9 items) 0.771 0.869
Attitude of Patients (6 items) 0.547 0.761
Attitude Toward Nursing (5 items) 0.662 0.675
Communication (2 items) 0.439 0.843
PNJSS Total (22 items) 0.717 0.816
All test–retest correlations (r) significant at P < 0.01.
PNJSS, Psychiatric Nurse Job Stressor Scale.
Table 3. PNJSS and Brief Job Stress Questionnaire subscale
correlations
Job
stressor
Stress
reaction
r (n = 296) r (n = 296)
Psychiatric Nursing Ability (9 items) 0.276 0.265
Attitude of Patients (6 items) 0.234 0.368
Attitude Toward Nursing (5 items) 0.413 0.332
Communication (2 items) 0.172 0.201
PNJSS Total (22 items) 0.420 0.453
All r significant at P < 0.01.
PNJSS, Psychiatric Nurse Job Stressor Scale.
© 2011 The Authors

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 espe-
cially 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 advance-
ments 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 consid-
ered that they related to the discomfort that the psy-
chiatric 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 psychi-
atric nurses.33
PNJSS reliability and validity
In general, when developing a scale the Cronbach
coefficient should be >0.6 to ensure sufficient inter-
nal 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 Ն0.2.40
In the present study, the item–scale
correlation coefficient was Ն0.2 (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
e1
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F1
F2
F3
F4
PNJS
0.708
0.361
0.197
0.198
0.443
0.229
0.305
0.308
0.661
0.617
0.677
0.633
0.520
0.566
0.3990.555
0.434
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0.570
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0.400
0.712
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0.342
0.854
0.853
0.307
e23
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Figure 1. Fit indices of the proposed models for the Psychi-
atric Nurse Job Stressor Scale (PNJSS). The PNJSS was found
to fit a four-factor structure consisting of 22 items. c2
/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.
© 2011 The Authors

(r = 0.717, P < 0.01) in the overall scale. This indi-
cates 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 ‘Communica-
tion’ 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 sub-
scale 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 corre-
lation coefficient of a developed scale in a previous
study was also weak–medium,15
therefore it was con-
sidered 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: c2
/ 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 satis-
factory, and we considered that the PNJSS was appro-
priate 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 com-
paratively 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 devel-
opment process, it was considered that the PNJSS is
not a scale that can measure all job stressors of psy-
chiatric nurses. In addition, because the present sub-
jects 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 neces-
sary for psychiatric nurses to take preventive mea-
sures 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 work-
shops 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 commu-
nication 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
This study was supported by the medical doctors
(Hiroshi Taniguchi, Hiroyuki Hashiguchi, Izumi
Wakimoto, Jyungo Nakamura, Ryoei Miyoshi,
Shigeki Kurayama, Syouhei Makita, Yoshio Mit-
suyama, Youko Tsuyama) and the nurses in the
psychiatric departments of six hospitals. We are
deeply grateful for their cooperation in this study.
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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 all YesQuestion items
1) Are you happy?
Question items Not at all Yes
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 item Total 22 items
© 2011 The Authors

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