Occupational stress among Thai emergency department nurses : Development and validation of an instrument for measuring stressors in emergency departments

Abstract: Working at an emergency department has some characteristics, which may generate stress. In this thesis, the stressors for emergency nurses were evaluated and an instrument was developed for measuring their impact. In order to gain a deeper understanding regarding the occupational stress among emergency nurses, a descriptive qualitative design with semi-structured interviews were used in two studies (I, II), one at a private and the other at a public hospital in Thailand. Three main categories of stressors were identified, related to the activity at the emergency departments, to human factors and to perceived consequences of these factors. Nurses in both private and public hospitals frequently experienced occupational stress, which influenced their psychophysiological health, and resulted in incomplete nursing care. Since no validated instrument had been published for measuring stressors in emergency nurses’ workplace, a scoping literature review was performed and a questionnaire for this purpose was developed, based on the review and the results from the interviews (I and II). The questionnaire was validated (III) and the influence of socio-economic factors were evaluated (IV). Four-hundred and five emergency nurses in Thailand completed a questionnaire containing 59 items. The responses were analyzed using 1) item generation, 2) content and face validity and test-retest reliability and 3) evaluation of the internal consistency and construct validity of the instrument. An exploratory factor analysis was performed on 200 of these responses and a confirmatory factor analysis on the remaining 205. The analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients’ and families’ actions and reactions, Technical and formal support, and Conflicts. The statistical evaluation (Cronbach’s alpha and intra-class correlation coefficient) indicated good homogeneity and stability. The type of organization, educational level and average income were associated with stressor related to Life and Death situations. Stressor related to Patients’ and families’ actions and reactions was predicted by educational level. While sociodemographic variables had no influence on stressor related to Technical and formal support and Conflicts. Future research regarding patient safety should focus on both emergency nurses’ and patients’ perspectives regarding consequences of occupational stress related to patient safety. Different perspectives may create a knowledge-base which can be used to develop guidelines or protocols aiming at reducing nurses’ stress and prevent its consequence, such as poor patient safety.