Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK, Dundee DD1 4HJ, UK.
J Affect Disord. 2019 May 15;251:31-38. doi: 10.1016/j.jad.2019.03.017. Epub 2019 Mar 7.
Currently, relatively little is known regarding the sources and levels of stress experienced by nursing students in China. This is largely because there is no reliable and valid, culturally appropriate measure of student nurse' stress. A culturally acceptable, Chinese Version of the Student Nurse Stress Index Scale (SNSI-CHI), with established reliability and validity, is needed to identify sources of stress in Chinese nursing students.
This validation study used a cross-sectional descriptive survey design. Stratified cluster random sampling was used to collect data from August 2017 to January, 2018 from 1100 nursing students in Henan Province, China. A demographic questionnaire, SNSI-CHI and Perceived Stress Scale (PSS-14) were administered. Exploratory and confirmatory factor analysis was carried out on two randomly selected samples (each N = 538) from the overall return. The content, construct, predictive and concurrent validity of the translated SNSI-CHI were examined.
1076 nursing students returned the survey (97.82% response rate). The average total score of SNSI-CHI was 58.455 ± 13.903. The internal consistency, test-retest reliability and content validity of the SNSI-CHI was excellent with a content validity index of 0.954. A four factor simple structure was revealed and confirmed using exploratory (explaining 75% of the variance) and confirmatory factor analysis (x/df = 1.347, GFI = 0.956, AGFI = 0.945, RMR = 0.032, RMSEA = 0.025, NFI = 0.974, IFI = 0.993, TLI = 0.992, CFI = 0.993). This structure, i.e. academic load, clinical concerns, interface worries and personal problems compared well with the original SNSI. The SNSI-CHI totals and subscales showed good concurrent and predictive validity with the PSS-14 as comparator or criterion. A score of higher than 65 on the SNSI-CHI indicates high levels of perceived stress symptoms. Some 10.5% of respondents experience high levels of stressful demand. Sensitivity and specificity values of 71.7% and 75.1% respectively, demonstrated good predictive validity.
This study sample was confined to the Henan Province, which may limit its generalizability. A larger and more diverse sample is needed in the future research.
The SNSI-CHI is both reliable and valid and culturally appropriate for use in China and its structure enables cross-cultural comparison.
目前，人们对中国护理学生所经历的压力源和压力水平知之甚少。这主要是因为没有可靠和有效的、文化上适当的学生护士压力测量工具。为了确定中国护理学生的压力源，需要有一个文化上可接受的、中文版的学生护士压力指数量表（SNSI-CHI），并具有既定的信度和效度。
本验证性研究采用了横断面描述性调查设计。2017 年 8 月至 2018 年 1 月，采用分层整群随机抽样方法，从中国河南省的 1100 名护理学生中抽取数据。采用一般资料问卷、SNSI-CHI 和知觉压力量表（PSS-14）对随机抽取的两个样本（每个样本 N=538）进行了测试。对整体返回的两个随机样本（每个样本 N=538）进行了探索性和验证性因子分析。考察了翻译后的 SNSI-CHI 的内容、结构、预测和同时效度。
1076 名护理学生完成了调查（应答率为 97.82%）。SNSI-CHI 的平均总分是 58.455±13.903。SNSI-CHI 的内部一致性、重测信度和内容效度均为极好，内容效度指数为 0.954。通过探索性（解释方差的 75%）和验证性因子分析（x/df=1.347、GFI=0.956、AGFI=0.945、RMR=0.032、RMSEA=0.025、NFI=0.974、IFI=0.993、TLI=0.992、CFI=0.993），揭示并确认了一个四因素简单结构。该结构包括学术负荷、临床问题、界面担忧和个人问题，与原始 SNSI 相比具有良好的一致性。SNSI-CHI 总分和分量表与 PSS-14 作为比较或标准具有良好的同时和预测效度。SNSI-CHI 得分高于 65 分表示知觉压力症状较高。约 10.5%的受访者经历了较高水平的压力需求。敏感性和特异性分别为 71.7%和 75.1%，表明具有良好的预测效度。
本研究样本仅限于河南省，这可能限制了其普遍性。未来的研究需要更大和更多样化的样本。
SNSI-CHI 在中国既可靠又有效，且具有文化适宜性，其结构能够进行跨文化比较。
