Validation of Turkish Translation of the Nurses' Occupational Stressors Scale: A Methodological Study

Validation of Turkish Translation of the Nurses' Occupational Stressors Scale: A Methodological Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validation of Turkish Translation of the Nurses' Occupational Stressors Scale: A Methodological Study Fatma BİRGİLİ, Nezihe Bulut UĞURLU This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8508532/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Nurses have heavy responsibilities, primarily because they deal with people's health, pain, grief, and death. They work for hours in physically and mentally demanding roles that can affect their own health. Therefore, nurses face many challenges and risks due to the characteristics of the institution, the community, their colleagues, patients, and their families while providing care, which leads to occupational stress. Identifying the levels of occupational stress and stress factors among nurses, developing coping mechanisms, and minimizing stress factors are crucial. Objective This study was conducted using a methodological design to first determine the validity and reliability of the "Nurses' Occupational Stressors Scale (NOSS)" in Turkish, with the aim of identifying occupational stress factors for nurses. Methods Research data were collected using the "Nurses' Demographic Form" and the "NOSS" scale. The sample consisted of 296 volunteer nurses working at Muğla Training and Research Hospital. Data were collected between October and December 2022. The scale's linguistic and content validity was ensured, and Confirmatory Factor Analysis (CFA) was applied. Item-total correlation analyses and Cronbach's α coefficient were calculated to assess the reliability of the NOSS. Results The Turkish version of NOSS, consisting of 21 items and three dimensions, has been validated. Factor loading values ​​of the scale items ranged from 0.44 to 0.81. The model fit measures were RMR = 0.027 ≤ 0.08, GFI = 0.978 ≥ 0.9, AGFI = 0.972 ≥ 0.9, NFI = 0.969 ≥ 0.9, RFI = 0.965 ≥ 0.9, and PNFI = 0.852 ≥ 0.5. These results show good fit indices for the 21 items and the three-factor CFA model. All item-total score correlations ranged from 0.27 to 0.71. The Cronbach α coefficient of NOSS is 0.91. NOSS was determined to have excellent internal consistency. The ICC value of NOSS is higher than 0.80, showing excellent fit. Furthermore, the correlation between test and retest is between 0.45 and 0.85, and all correlations are statistically significant (p < 0.05). Conclusion The Turkish form of "NOSS" has been determined to be valid and reliable. This tool can be used to identify occupational stressors for nurses. nurse occupational stress factor work environment scale Figures Figure 1 Introduction In many countries around the world, the importance of nursing care is increasing day by day due to developments in the health field. These developments can lead to increased expectations of patients regarding the quality of nursing care they receive. At this point, nurses play a key role in providing safe and quality care by keeping up with the changing nature of diseases, the rapid development of technology in medicine and the advancements in nursing science [ 1 ]. The ability of nurses to provide adequate and quality care can also vary depending on the conditions and situations experienced in their working environment. Positive and healthy work environments are defined by the International Council of Nurses as contexts that support the excellence and adequate performance of professionals [ 2 ]. These environments ensure the health, safety, and well-being of professionals and promote the provision of quality care. This increases the motivation, productivity, and performance of both employees and organizations [ 2 ]. The nursing practice environment has the greatest impact on perceptions of the quality of care provided and nursing outcomes [ 3 ]. In the current context, these issues have gained even greater importance due to the global crisis that has affected the world in recent years [ 4 , 5 ]. According to different authors, the nursing practice environment can affect nurses through multiple external or internal variables [ 6 , 7 ]. Stress, which is at the forefront of these variables, is defined as a non-specific response to an individual's influence and can manifest itself with different responses to similar situations [ 8 ]. This stress, which significantly affects nurses in the work environment, stems from a perceived imbalance between workplace stressors and the employee's coping strategies and can lead to negative health outcomes [ 9 ]. Work-related stress experienced by nurses is considered one of the main occupational health problems for patients. Workplace stress can affect satisfaction between healthcare professionals and the care provided to patients. Therefore, the coordination of care provided by nurses can be disrupted, and patients' lives can be endangered [ 10 , 11 ]. The high workload of nurses can lead to high rates of occupational stressors and burnout [ 9 , 12 , 13 ], decreased job satisfaction [ 14 , 15 ], exposure to workplace bullying [ 16 , 17 ], and the likelihood of experiencing mental health problems [ 18 , 19 ]. As a result, these negative effects can lead to a decrease in the quality of nursing care and nurses leaving their jobs [ 5 ]. It is accepted that occupational stress in nursing can affect nurses' job satisfaction and intention to leave [ 5 ]. Determining the occupational stress levels and stress factors of nurses, developing coping methods for stress, and minimizing stress factors are important [ 20 , 21 ]. Reducing occupational stress involves identifying the existing occupational stress factors in nurses' work environments and developing methods on how to eliminate these stress factors. Occupational stress in nursing is a concept that can vary from person to person and from culture to culture. Examining the occupational stress levels of nurses with an occupational stress scale specific to nurses will make a significant contribution to the literature. In addition, although different scales have been developed to measure nursing stress factors, these scales cover burnout, job dissatisfaction, and intention to leave to a limited extent [ 5 ]. Therefore, this study aims to translate the "NOSS", which determines comprehensive nursing stress factors, into Turkish and to determine its Turkish validity and reliability. Material and methods Study design and participants This study is a methodological research. The target population of the research was composed of 612 nurses in a university hospital in Turkey where the study was conducted. The literature states that 300–500 people or 5 or 10 times the number of items on the scale should be reached [ 22 ]. Based on this information, the sample of the study consisted of 267 nurses who had volunteered to participate in the study Measurement Nurses' Introductory Form This form, which was prepared by researchers based on the literature [ 2 , 19 , 20 , 23 ], consists of questions related to the nurses' age, gender, marital status, educational status, professional experience, unit of work, position, whether they willingly chose the nursing profession, satisfaction with working as a nurse, and being under intense stress in relation to their profession. NOSS “NOSS,” which was developed by Chen et al. in 2020, is a 21-item, 4‐point Likert‐type scale designed to measure the occupational stress factors of nurses. The scale is scored between 21 and 84. The scale consists of nine subdimensions (job requirements, work‐family conflict, insufficient support from colleagues or caregivers, violence and bullying in the workplace, organizational issues, occupational hazards, difficulty in taking time/day off, lack of strength, and not meeting basic physiological needs) [ 5 ]. As a result of adapting the scale into Turkish, the "NOSS" scale has been finalized with 21 items and three dimensions ("Working Conditions", "Working Environment", "Work Load"). Data collection The research data were collected in a university hospital in Turkey during the period covering October–December 2022. To collect the data, “Nurses' Introductory Information Form” and “NOSS” were used. The research data were collected by the researchers using face-to‐face interview method. The data collection took an average of 15–20 min Ethical considerations This study was conducted with the approval of the XXXXX University Health Sciences Ethics Committee (date: 14/04/2021, protocol no: 210057, decision no: 65). Permission for the Turkish adaptation of NOSS was obtained via email from Yi-Chuan Chen, one of the developers of NOSS. The research was conducted in accordance with the principles of the Helsinki Declaration. Nurses who agreed to participate in the research were informed about the research process and their informed consent was obtained. Data analysis Data analysis were performed using SPSS 22 and AMOS 22. Demographic characteristics of the participants were investigated according to frequencies, percentages for categorical variable, mean and standard deviation for the continuous variables. Item-total score correlations were calculated to decide whether the item(s) was not compatible with the scale. The item(s) with the correlation value equal to or less than 0.2 was removed from the scale [ 24 ]. Kaiser-Meyer-Olkin (KMO) and Bartlett’s test was used to test the sample adequacy for the factor analysis. The sample was accepted as adequacy if KMO value is higher than 0.6 and the p-value of Barlett’s test is lower than 0.05 [ 25 – 29 ]. Explanatory factor analysis (EFA) was performed to determine the factor structure of the NOSS scale. Unweighted least squares extraction and varimax rotation methods were used to clarify the factors. The factors with eigen value equal to or higher than 1 were considered. It was checked whether all factor loadings are 0.3 and above [ 30 ]. Confirmatory Factor Analysis (CFA) was conducted to confirm the factor structure obtained from the EFA. The goodness of fit index (GFI), adjusted goodness of fit index (AGFI), normed fit index (NFI), relative fit index (RFI), Parsimony Normed Fit Index (PNFI) and root mean square residual (RMR) indexes were used to confirm the model fit. RMR value \(\:\le\:\) 0.08 and GFI value \(\:\ge\:\) 0.9, AGFI value \(\:\ge\:\) 0.9, NFI value \(\:\ge\:\) 0.9, RFI value \(\:\ge\:\) 0.9 and PNFI value \(\:\ge\:\) 0.5 are considered good fit [ 31 ]. Internal consistency was investigated by using Cronbach’s \(\:\alpha\:\) coefficient and item-total score correlations. Cronbach’s \(\:\alpha\:\) values higher than 0.8 are accepted as good internal consistency [ 32 ]. Test-retest analysis was performed in order to test the time invariance of the NOSS scale and subscales. For this analysis, the scale was re-applied to 35 participants two weeks later. Pearson and Spearman correlation coefficients were used for the scales having normal and no normal distribution, respectively. Results Demographic characteristics of the nurses A total of 296 nurses were collected for this study, of which 75% (n = 222) were female, 59.1% were between the ages of 20–32 (n = 175), 50% were single (n = 148), 82.1% had a bachelor’s degree (n = 243), 58.4% had no children (n = 173), 58.1% (n = 172) had normal weight, 52.0% worked in the service (n = 154), 60.1% had worked between 1 and 9 years (n = 178), 77.7% (n = 230) have been working in the clinic they are currently in between 1 and 5 years, 91.2% (n = 270) were clinic nurse. Besides, the number of monthly seizures of 92.2% (n = 273) of the nurses increased during the pandemic, the number of nurses in the unit where 41.9% (n = 124) of the nurse’s work was between 10 and 12 and the number of beds in the unit where 36.8% (n = 109) of the nurse’s work was 5 and 15. Their mean age was 32.41 (SD = 7.36) years, their mean of working years was 9.25 (7.43), the mean of working years in the clinic where nurses’ work was 3.86 (3.83), their mean working hours/ day was 18.68(6.44), their mean working hours /week was 56.79 (12.73) and their mean sleeping hours/day was 7.16 (1.02) (Table 1 ). Table 1 Demographic characteristics of the nurses Variables Group n % X̄±Ss Age(Years) 20–32 175 59.1 32.41 \(\:\pm\:\) 7.36 33–45 108 36.5 46–58 13 4.4 Gender Female 222 75.0 Male 74 25.0 Marital Status Single 148 50 Married 148 50 Educational Level Vocational School of Health 15 5.1 Associate degree 23 7.8 Bachelor 243 82.1 Postgraduate 15 5.1 Number of Children 0 173 58.4 1 46 15.5 2 65 22.0 3 12 4.1 Body Mass Index Underweight 6 2.0 Normal 172 58.1 Overweight 107 36.1 Obese 11 3.7 Working Unit Intensive Care/Operating Room 93 31.4 Service 154 52.0 Pandemic Service 35 11.8 Pandemic Intensive Care 14 4.7 Working Years 1–9 178 60.1 9.25 \(\:\pm\:\) 7.43 10–19 77 26.0 >=20 41 13.9 Years of work in the clinic 1–5 230 77.7 3.86 \(\:\pm\:\) 3.83 6–10 41 13.9 >=11 25 8.4 Number of monthly seizures during the pandemic Decreased during the pandemic 11 3.7 Same as before the pandemic 12 4.1 Increased during the pandemic 273 92.2 Position Supervisor Nurse 26 8.8 Clinic Nurse 270 91.2 The number of nurses worked in the service 4–6 22 7.4 7–9 44 14.9 10–12 124 41.9 >=13 106 35.8 The number of beds in the working unit 5–15 109 36.8 16–25 59 19.9 26–35 86 29.1 >=36 42 14.2 Working hours/Day 18.68 \(\:\pm\:6\) .44 Working hours/Week 56.79 \(\:\pm\:\) 12.73 Sleeping hours/Day 7.16 \(\:\pm\:\) 1.02 Shift Intensity Yes 218 73.6 No 78 26.4 Overtime Yes 219 74.0 No 77 26.0 Understaffed Yes 237 80.1 No 59 19.9 Workload Yes 177 59.8 No 119 40.2 Fatigue Yes 121 40.9 No 175 59.1 Work Stress Yes 152 51.4 No 144 48.6 Inequality Yes 122 41.2 No 174 58.8 Job complexity Yes 131 44.3 No 165 55.7 Fear of being suddenly called to job while on leave Yes 23 7.8 No 273 92.2 Inability to express oneself at work Yes 46 15.5 No 250 84.5 Conflicts at work Yes 64 21.6 No 232 78.4 Covid-19 transmission Yes 51 17.2 No 245 82.8 Are you experiencing burnout? Yes 219 74.0 No 77 26.0 If you are experiencing burnout, what is the source? Personal 62 20.9 Patient 74 25.0 Administrative 104 35.1 Peripheral 28 9.5 Communicational 28 9.5 Do you want to quit your job? Yes 173 58.4 No 123 41.6 Did you choose your profession willingly? Yes 139 47.0 No 157 53.0 Language Validity Linguistic validity of the scale in its Turkish adaptation was established using the translation-back-translation method. The original English version of the scale was translated into Turkish by two language experts. The two resulting translations were then edited by the researchers to create a single form. To determine if the scale had changed from its original version, the scale form was translated again from Turkish to English, and it was found that it had not changed. Based on this, the scale was finalized. Content Validity To assess the content validity of the items in the scale, they were submitted to the opinions of 10 academics who are experts in the field. Each expert was asked to evaluate the statements in the scale in terms of comprehensibility, appropriateness, and scope according to the Davis technique [ 33 ]. In this evaluation, each expert scored the statements in the scale on a scale of 1–4 (1 point: Not appropriate; 2 points: Should be seriously reviewed; 3 points: Should be somewhat reviewed; 4 points: Appropriate). The Content Validity Index (CVI) was calculated by dividing the number of experts who scored each statement in the scale as 3 and 4 according to the evaluation results from each expert by the total number of experts. In this study, no experts scored the scale below 3 points. The content validity ratios for the scale items were found to range between 0.84 and 1.00, and the CVI value was calculated as 0.97. To measure the agreement between the scores given by each expert evaluating the items on the scale, Kendall's Coefficient of Agreement (Wa) was calculated, with Kendall's Wa = 0.149, χ2 = 33.664, df = 27, p = 0.624. The calculation showed that each expert's score was not statistically different and that there was agreement between the expert opinions. Subsequently, a pilot application of the scale was conducted with 10 nurses. According to the pilot application results, the items on the scale were found to be understandable. Construct Validity Item-total score correlation was found as 0.08 for item 18 and it was decided that item 18 was not compatible for the Turkish version of the scale and was removed from the scale. The correlations of the items were found to be between 0.252 and 0.696. After item 18 was removed, the item-total scale correlations were found to be 0.266 and 0.707. KMO measure was found as 0.904, Bartlett’s test of sphericity was 3075.386 and p-value was 0.000 < 0.05. According to these results, it was decided that sample is adequacy for the factor analysis. As a result of EFA, three factors having eigen value is greater than one were found. The variance explained by the first factor was 39.887%, by the second factor explained was 11.453%, and by the third factor explained was 6.488%. The scale explained 57.819% of the total variance. Table 2 shows the factor loadings. Table 2 Factor Loadings of NOSS-20 scale Item Working Conditions Working Environment Work Load 1 I need to transport patients or equipment 0.561 2 I cannot ask for leaves for household emergencies. 0.538 3 I have to bear negative sentiment from patients or their relatives 0.323 4 The on-call system affects my life 0.404 5 I have to maintain professional units other than my own 0.597 6 Not achieving a promotion (e.g., level 1 or 2) within the expected period affects my income. 0.563 7 I cannot take an uninterrupted 30-minute mealtime break 0.680 8 I cannot excuse myself for feeling strong discomfort 0.673 9 It upsets me if patients’ conditions do not improve 0.553 10 The burden of work makes it difficult for me to undertake my personal chores and/or engage in hobbies. 0.770 11 Excessive duties in the workplace prevent me from attending to patients. 0.708 12 I feel stressed because primary caregivers do not execute their tasks appropriately. 0.486 13 Doctors’ temperamental nature agitates me 0.505 14 I have no time to fulfill my personal needs (e.g., water consumption and toilet breaks). 0.770 15 I worry that my colleagues’ incompetence will affect patient safety. 0.433 16 I feel stressed due to psychological abuse such as threats, discrimination, bullying, and harassment. 0.550 17 I have insufficient time to offer mental health care to patients during working hours. 0.722 19 I feel stressed considering that my patients might be have contagious diseases such as SARS or AIDS. 0.682 20 The burden of work affects my domestic life 0.808 21 I have to adapt my schedule for family activities/outings to accommodate my work responsibilities. 0.830 When Table 2 is examined, it can be seen that the factor loadings of the items were found to be between 0.323 and 0.830. All factor loadings are bigger than 0.3. Therefore, no item was removed from the scale at this step. CFA was conducted to verify the model fit for the 3-factor NOSS scale. Figure 1 shows the CFA path diagram. As can be seen from Fig. 1 , standardized factor loadings are between 0.44 and 0.81. The model fit measures were RMR = 0.027 \(\:\le\:\) 0.08, GFI = 0.978 \(\:\ge\:\) 0.9, AGFI = 0.972 \(\:\ge\:\) 0.9, NFI = 0.969 \(\:\ge\:\) 0.9, RFI = 0.965 \(\:\ge\:\) 0.9 and PNFI = 0.852 \(\:\ge\:\) 0.5. These results show good fit indices for 21 items and three factors CFA model. Reliability Table 3 shows the results of reliability for the NOSS scale and its subscales. Table 3 Results of Reliability Item No Item-Total Correlations NOSS Working Conditions Working Environment Work Load 1 0.60 0.60 2 0.27 0.44 3 0.39 0.35 4 0.52 0.52 5 0.68 0.70 6 0.61 0.66 7 0.41 0.60 8 0.42 0.61 9 0.63 0.66 10 0.69 0.79 11 0.71 0.79 12 0.64 0.61 13 0.59 0.52 14 0.48 0.67 15 0.57 0.43 16 0.40 0.40 17 0.68 0.76 19 0.70 0.73 20 0.64 0.72 21 0.62 0.70 Cronbach’s \(\:\varvec{\alpha\:}\) 0.91 0.93 0.68 0.76 As can be seen from Table 2 , all item-total score correlations are above 0.2. The item-total correlations range between 0.27 and 0.71, item- Working Conditions correlations range between 0.60 and 0.79, item- Working Environment correlations range between 0.40 and 0.52 and lastly item- Work Load correlations range between 0.35 and 0.67. Cronbach’s \(\:\alpha\:\) coefficient is found as 0.91 for NOSS scale, 0.93 for the subscale of Working Conditions, 0.68 for the subscale of Working Environment and 0.76 for factor subscale of Work Load, respectively. The results show the scales and subscales have an excellent internal consistency. ICC, 95% confidence interval (CI) of ICC and correlation coefficients were calculated for the test-retest analysis. Table 4 presents the results of the test-retest analysis. Table 4 The results of test-retest analysis Scale Application Mean \(\:\pm\:\) S.D Correlation ICC [%95 CI] NOSS First 60.25 \(\:\pm\:\) 6.14 0.85** 0.83** [0.67 0.91] Second 61.71 \(\:\pm\:\) 6.96 Working Conditions First 35.17 \(\:\pm\:\) 3.37 0.75** 0.70** [0.43 0.85] Second 36.51 \(\:\pm\:\) 3.87 Working Environment First 11.63 \(\:\pm\:\) 1.59 0.45** 0.65** [0.40 0.81] Second 11.63 \(\:\pm\:\) 1.78 Work Load First 13.46 \(\:\pm\:\) 2.58 0.64** 0.64** [0.40 0.80] Second 13.57 \(\:\pm\:\) 2.30 According to Table 4 , NOSS scale have the excellent agreement since its ICC value is higher than 0.80 while the subscales have the good agreement with 0.70, 0.65 and 0.64 ICC values. Besides, the correlation between first and second applications range between 0.45 and 0.85 and all correlations are statistically significant (p < 0.05). These results show that Turkish version of NOSS scale are time invariance. Discussion Occupational stress is defined as “a harmful, physical and emotional state that arises when the requirements of the profession do not match the employee’s abilities, resources and needs” [ 11 , 34 ]. It is difficult to generalize the diversity of stressors found in different nursing fields and the stress-inducing factors in nurses from one environment to another. However, stress factors that cause occupational stress in nurses [ 35 ] include: difficulties arising from relationships between nurses, between nurses and doctors, or between nurses and other team members; the clinical leadership ability of managers; challenges related to patient care (especially violent incidents); and organizational issues such as change, administrative demands, organizational structure, and the cultural environment of workplaces. Therefore, understanding and resolving occupational stress factors is considered extremely important for nurses to cope with these problems. Having appropriate assessment tools is essential for effectively managing the process. For this reason, the research was conducted to examine the suitability of “NOSS”, developed by Chen et al. (2020), to the Turkish language and culture. In adapting an improved measurement tool, the tool must meet the validity and reliability criteria [ 25 , 26 , 36 ]. The first goal to be considered in questionnaire adaptation studies is language adaptation. Therefore, first, the language validity of “NOSS” was ensured, then the scale was re-evaluated according to expert opinions, and the Turkish form of the scale was created by conducting a pilot study with 20 nurses. For the content validity of the scale, the CVI value must be at least 0.80 [ 37 ]. In the original "NOSS", the CVI value was 0.81 [ 5 ], while in this study, the CVI value was calculated as 0.97 > 0.80, and the content validity of the scale was ensured. This value shows that "NOSS" is a scale that reflects the occupational stress factors of nurses. After ensuring the linguistic and content validity of "NOSS," the construct validity of the scale was evaluated. Construct validity is conducted to prove the extent to which the items in the questionnaire accurately measure the qualities that are intended to be answered. In other words, the components of the construct that the questionnaire aims to measure should actually measure what they intend to measure in practice [ 30 , 31 ]. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) techniques are commonly used to evaluate construct validity. CFA is recommended if there is a tested relationship between the questionnaire items or if the items are grouped under the determined factors; EFA is recommended if the opposite is true. However, in validity and reliability studies, factors and the items contained within the factors may vary when the culture of the population is taken into consideration. In these cases, the use of EFA may be preferred [ 31 ]. To determine whether the measurement results are affected by the sample size and to determine whether the sample size is sufficient and appropriate for factor analysis, it is necessary to first perform the Kaiser-Meyer-Olkin (KMO) measurement and the Bartlett sphericity test [ 28 , 29 ]. The KMO value is evaluated as “average” between 0.50–0.70; “good” between 0.70–0.80; “very good” between 0.80–0.90; and “excellent” above 0.90 [ 25 , 26 ]. The Bartlett Sphericity test p-value is expected to be below 0.05 and the “Anti-image” correlation value above 0.50 [ 28 ]. The original “NOSS” KMO value is 0.93. In this study, the KMO value of “NOSS” is 0.904, and this value being higher than 0.80 indicates that the research sample is at a very good level for factor analysis. Furthermore, Bartlett’s test of sphericity was 3075.386 and the p-value was 0.000 < 0.05, indicating that the Bartlett test was highly significant and a significant relationship was determined between the “NOSS” variables/factors. To assess the structural validity of the questionnaire based on the results of these tests, EFA was used. For a structure to be considered a factor, its eigenvalue must be greater than 1 [ 30 ] and the variance it explains must be greater than 5% [ 38 ]. In this context, the EFA of “NOSS” was examined using the principal components method and evaluated with varimax rotation. Thus, it was determined that the questionnaire formed a three-factor structure and that the eigenvalue for each structure was greater than 1. However, a shift was observed in the distribution of items to factors compared to the original questionnaire. In the original scale, the Varimax method was used and the factor loading values ​​ranged from 0.380 to 0.870. These values ​​were found to be at acceptable levels when compared with the analysis coefficients. Similarly, in this study, the factor loading values ​​of the “NOSS” scale ranged from 0.323 to 0.830. In addition, the eigenvalue coefficient is also taken into account during factor analysis. In factor analysis, factors with eigenvalue threshold values ​​of one and above are considered [ 30 ]. These values ​​were found to be at acceptable levels when compared with the analysis coefficients. Following the analyses, 21 items were identified with three dimensions that explained 57.819% of the total variance of the scale (the first factor 39.887%, the second factor 11.453%, and the third factor 6.488%). It was reported that an exploratory variance of 40–60% is acceptable [ 31 ]. In scale studies, CFA is used to test the accuracy of EFA results. In nursing literature, the structures of scales determined after EFA are accepted as a model, and the accuracy of this model is tested with CFA [ 31 ]. The structure of the “NOSS” scale was examined within the scope of CFA with X²/SD, GFI, AGFI, CFI, RMSEA and SRMR goodness-of-fit tests. According to the literature, an X²/SD value of 5 or less means that the tested model has a good level of fit [ 39 ]. In the original “NOSS” scale, the GFI value is 0.92, the AGFI value is 0.92 and the CFI value is 0.91. In this study, RMR = 0.027 ≤ 0.08, GFI = 0.978 ≥ 0.9, AGFI = 0.972 ≥ 0.9, NFI = 0.969 ≥ 0.9, RFI = 0.965 ≥ 0.9 and PNFI = 0.852 ≥ 0.5. These indices are considered acceptable values ​​when they are equal to or greater than 0.90 [ 31 ]. Other goodness-of-fit index values ​​of "NOSS" were determined as 0.06 for RMSEA and 0.027 for RMR. An RMSEA value < 0.08 indicates a good fit. An SRMR value of 0.05 ≤ RMR ≤ 0.10 means that the model has a reasonable fit [ 31 ]. Reliability analyses are conducted to evaluate the internal consistency of a questionnaire and the fit of scale items. In this study, item analysis and Cronbach's alpha coefficient were used to evaluate the reliability analysis of the scale. The item-total correlation results are expected to be positive. In the original scale, item-total correlations are above 0.40, and in this study, the item-total correlations of the "NOSS" scale are above 0.30. This result shows that each item of the scale is similar and that internal consistency is ensured [ 24 ]. The internal consistency coefficient of the original scale is 0.91. In this study, the internal consistency coefficient of the "NOSS" scale is 0.81, and the Cronbach's alpha values ​​being higher than 0.80 indicates that the scale has high reliability. The higher the Cronbach's alpha reliability coefficient of the scale, the more consistent the items in the scale are with each other, and the more it explains that the scale consists of items testing elements of the same characteristic [ 32 ]. Accordingly, the items in “NOSS” are consistent with each other, and “NOSS” consists of items that test elements of the same characteristic. Based on this information, it was determined that the item-total correlation coefficient values ​​of “NOSS” were positive. It is expected that the upper and lower 27% groups, grouped according to the total score in the scales, can show discrimination. In addition, the floor and ceiling effect of the questionnaire, in other words, the proportion of the same answers given, should not exceed 10% [ 24 ]. In this study, it was determined that item discrimination was achieved and no floor/ceiling effect was observed. In order to determine the reliability of the scale in terms of its stability over time, a retest was performed on 27.02% (n = 80) of the nurses who participated in the pilot application 15 days after the test application. The correlation between the first and second applications ranged from 0.45 to 0.85, and all correlations were found to be statistically significant (p < 0.05). It was determined that the Turkish version of the NOSS scale is stable over time. A correlation coefficient of 0.80 and above indicates high correlation, 0.60–0.80 indicates strong correlation, 0.40–0.59 indicates moderate correlation, 0.20–0.39 indicates low correlation, and below 0.20 indicates weak correlation [ 37 ]. Accordingly, it has been shown that the scale has high reliability and consistent measurements that are independent of time. Limitations of the study This study had some limitations. First, since the current study was conducted only with nurses working in a single training and research hospital, the results obtained cannot be directly generalized to nurses or other health disciplines in various countries. These results are limited to the sample group participating in this study. Second, the pandemic occurred during the study period. Due to the high stress factors during this period, the study was suspended for a year to allow the acute phase to pass. Afterwards, data was collected face-to-face using personal protective equipment. Even during this extraordinary period, their participation in the study and their support in data collection can be considered a factor that strengthens the reliability of the study data. Conclusions and recommendations In this study, the Turkish version of the NOSS scale, which identifies occupational stress factors in nursing practice settings and predicts personal burnout, patient-related burnout, job dissatisfaction, and intention to leave, was validated with 21 items and 3 dimensions (“Working Conditions”, “Working Environment”, “Work Load”). This scale can be used to identify occupational stressors for nurses. Abbreviations AGFI: Adjusted goodness of fit index CFA: Confirmatory factor analysis CI: Confidence interval CVI: Content Validity Index EFA: Explanatory factor analysis GFI: The goodness of fit index ICC: Interval correlation coefficients KMO: Kaiser-Meyer-Olkin NFI: Normed fit index NOSS: Nurses' Occupational Stressors Scale RFI: Relative fit index RMR: Root mean square residual PNFI: Parsimony Normed Fit Index Declarations Author Contribution Fatma BİRGİLİ: Conceptualization, Methodology, Software, Investigation, Data curation, Writing – original draft, Project administration.Nezihe BULUT UĞURLU: Conceptualization, Investigation, Data curation, Writing –review & editing, Project administration.All authors meet the authorship criteria according to the guidelines of the International Committee of Medical Journal Editors, and all authors agree with the manuscript. Acknowledgement We sincerely thank the nurses who participated in the study. References Flodén A, Lepp M, Tilander P, Svensson A, Nilsson J. Nurses' Self-reported professional competence: A cross‐sectional study at a regional teaching hospital in Sweden. J Clin Nurs. 2025;1–16. https://doi.org/10.1111/jocn.70057 . International Council of Nurses. Nuses: A Force for Change-A Vital Resource for Health: International Nurses Day 2014; International Council of Nurses. Switzerland: Geneva; 2014. Lucas P, Jesus É, Almeida S, Costa P, Cruchinho P, Teixeira G, Araújo B. The nursing practice environment and job satisfaction, intention to leave, and burnout among primary healthcare nurses: A cross-sectional study. Nurs Rep. 2025;15(7):224. https://doi.org/10.3390/nursrep15070224 . Lambrou P, Merkouris A, Middleton N, Papastavrou E. Nurses’ perceptions of their professional practice environment in relation to job satisfaction: A review of quantitative studies. Health Sci J. 2014;8(3):298–317. https://hdl.handle.net/20.500.14279/8572 Chen YC, Guo YLL, Lin LC, Lee YJ, Hu PY, Ho JJ, Shiao JSC. Development of the nurses’ occupational stressor scale. Int J Environ Res Public Health. 2020;17(2):649. https://doi.org/10.3390/ijerph17020649 . Bautista JR, Lauria PAS, Contreras MCS, Maranion MMG, Villanueva HH, Sumaguingsing RC, Abeleda RD. Specific stressors relate to nurses’ job satisfaction, perceived quality of care, and turnover intention. Int J Nurs Pract. 2020;26(1):e12774. https://doi.org/10.1111/ijn.12774 . Kowalski M, Basile C, Bersick E, Cole D, McClure D, Weaver S. What do nurses need to practice effectively in the hospital environment? An integrative review with implications for nurse leaders. Worldviews Evid Based Nurs. 2020;17(1):60–70. https://doi.org/10.1111/wvn.12401 . Gangloff EJ, Greenberg N. Biology of stress. Health and welfare of captive reptiles. Cham: Springer International Publishing; 2023. pp. 93–142. Aydın GÇ, Aytaç S, Şanlı Y. The effects of job related emotions, job stress, and burnout on the ıntention to leave: A study on nurses. Journal of Social Policy Conferences. 2021;80:1–35. https://doi.org/10.26650/jspc.2021.80.000011 Parveen R, Hussain M, Afzal M, Parveen MK, Majeed MI, Tahira F, Sabir M. The impact of occupational stress on nurses caring behavior and their health related quality of life. Saudi J Med Pharm Sci. 2017;3(9):1016–25. https://doi.org/10.36348/sjmps.2017.v03i09.012 . Eroğlu Y, Karaaziz M. Review of stress coping strategies on how to predict your relationship with happiness. Pearson J Social Sci Humanit. 2024;8(28):1347–61. https://doi.org/10.5281/zenodo.11613570 . Wang J, Okoli CTC, He H, Feng F, Li J, Zhuang L, Lin M. Factors associated with compassion satisfaction, burnout, and secondary traumatic stress among Chinese nurses in tertiary hospitals: A cross-sectional study. Int J Nurs Stud. 2020;102:103472. https://doi.org/10.1016/j.ijnurstu.2019.103472 . Kupcewicz E, Jó´zwik M. Positive orientation and strategies for coping with stress as predictors of professional burnout among Polish nurses. Int J Environ Res Public Health. 2019;16(21):4264. https://doi.org/10.3390/ijerph16214264 . Tamer E, Öztürk H. Determination of Nurses’ quality life and influencing factors. Ege Univ Fac Nurs J. 2021;37(2):107–19. https://doi.org/10.53490/egehemsire.748208 . Khamisa N, Peltzer K, Ilic D, Oldenburg B. Work related stress, burnout, job satisfaction and general health of nurses: A follow-up study. Int J Nurs Pract. 2016;22(6):538–45. https://doi.org/10.1111/ijn.12455 . Şantaş G, Tekin R, Şantaş F. The effect of psychological contract and workplace bullying on ıntention to leave: A research in nurses. Cumhuriyet Univ J Econ Administrative Sci. 2020;21(1):183–202. https://doi.org/10.53434/gbesbd.1312817 . Giorgi G, Mancuso S, Fiz Perez F, Castiello D'Antonio A, Mucci N, Cupelli V, Arcangeli G. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160–8. https://doi.org/10.1111/ijn.12376 . Chin WS, Chen YC, Ho JJ, Cheng NY, Wu HC, Shiao JS. Psychological work environment and suicidal ideation among nurses in Taiwan. J Nurs Scholarsh. 2019;51(1):106–13. https://doi.org/10.1111/jnu.12441 . Kurtulgan İF, Bozkurt A. A Phenomenological study onthe social and environmental factors affecting the mental health of intensive care unit nurses. J Organizational Behav Stud. 2025;5(1):46–65. .https://doi.org/10.5281/zenodo.15777896 . Alkhawaldeh JFMA, Soh KL, Mukhtar FBM, Ooi CP. Effectiveness of stress management interventional programme on occupational stress for nurses: A systematic review. J Nurs Manag. 2020;28(2):209–20. https://doi.org/10.1111/jonm.12938 . Choi MY, So HS, Ko E. Influences of occupational stress, ethical dilemma, and burnout on turnover intention in hospital nurses. J Korean Acad Nurs. 2019;26(1):42–51. https://doi.org/10.7739/jkafn.2019.26.1.42 . Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams and Wilkins; 2012. Mert İS. The investigation of the most stressful critical incidents that experienced by nurses and intern nurses by using quantitative research metod. Electron J Social Sci. 2018;17(67):1043–59. https://doi.org/10.17755/esosder.343043 . Yeşilyurt S, Çapraz C. A road map for the content validity used in scale development studies. J Erzincan Univ Fac Educ. 2018;20(1):251–64. https://doi.org/10.17556/erziefd.297741 . Awang Z. Research Methodology for Business and Social Sciences. Kelantan: UniversitiTeknologi; 2012. Awang Z. Structural equation modeling using AMOS graphic. Penerbit UniversitiTeknologi. 2012, MARA. Hoque ASMM, Awang Z. The Exploratory Factor Analysis (EFA) of Entrepreneurial Marketing Scale - Development and Validation. Tourism Conference. 2016a:20 – 2. Hoque ASMM, Awang Z. Exploratory factor analysis of entrepreneurial marketing: scale development and validation in the SME context of Bangladesh, International Social Sciences and Tourism Research Conference, Terengganu, UniSZA, 2016b:20 – 2. Hoque ASMM, Awang Z, Siddiqui BA. Technopreneurial Intention among University Students of Business Courses in Malaysia: A structural equation modeling. Int J Entrepreneurship Small Medium Enterp (IJESME). 2017b;4:1–16. Grove SK, Burns N, Gray J. The practice of nursing research: Appraisal, synthesis and generation of evidence. Elsevier Health Sciences; 2012. Nguyen H, Doherty KV, Eccleston CEA, Bindoff A, Tierney L, Mason R, Robinson A, Vickers J, Mclnerney F. Consumer access, appraisal, and application of services and information for dementia (CAAASI-Dem): a validation study. Aging Ment Health. 2022;26(12):2489–95. https://doi.org/10.1080/13607863.2021.1991277 . Arslan I, Aydınoğlu S. Turkish version of the faces version of the Modified Child Dental Anxiety scale (MCDAsf): translation, reliability and validity. Clin Oral Investig. 2022;26(2):2031–42. https://doi.org/10.1007/s00784-021-04184-0 . Davis LL. Instrument review: getting the most from a panel of experts. Appl Nurs Res. 1992;5(4):194–7. https://doi.org/10.1016/S0897-1897(05)80008-4 . Girma B, Nigussie J, Molla A, Mareg M. Occupational stress and associated factors among health care professionals in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):1–10. https://doi.org/10.1186/s12889-021-10579-1 . Konstantinos N, Christina O. Factors influencing stress and job satisfaction of nurses working in psychiatric units: a research review. Health Sci J. 2008;2(4). http://hdl.handle.net/11400/1207 Erkuş A. Psikolojide ölçme ve ölçek geliştirme 1: Temel kavramlar ve işlemler. [Measurement and scale development in psychology 1: Basic concepts and procedures]. 8. Print. Pegem Academy. 2025. Karasar N. Scientific research method concepts principles techniques with scientific will perception framework. Nobel Acad. 2020. Büyüköztürk Ş. Data analysis handbook for social sciences statistics, research pattern Spss applications and interpretation. Pegem Academy. 2020. Alavi M, Visentin DC, Thapa DK, Hunt GE, Watson R, Cleary M. Exploratory factor analysis and principal component analysis in clinical studies: Which one should you use? J Adv Nurs. 2020a;76(8):1886–89. https://doi.org/10.1111/jan.14377 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8508532","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571646022,"identity":"64e3e9d1-0ff0-4510-a98b-5247a828b874","order_by":0,"name":"Fatma BİRGİLİ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACA2YgkVAgwc8vAeZLyBCpxUBCcuYMBsYGoBYewlqgpOSGG2AtDIS1mLPzPn7xwMBCwvh28/FHN2oseBjYDx/dgE+LZTO7mQXQYRJmd44lNuccAzqMJy3tBl6HHWZjMwBqqTO7kWPYnMMG1CLBY0aUFgnjGSAt/4jTwvwApMVAAqglt40ILZbNbGygQJaQuJGWODu3T4KHjZBfzPmPMX/8UVEnwT8j+cDnnG91cvzsh4/h1QIEbBKoXALKQYD5AxGKRsEoGAWjYCQDAD1LP0jvd72uAAAAAElFTkSuQmCC","orcid":"","institution":"Muğla Sıtkı Koçman University","correspondingAuthor":true,"prefix":"","firstName":"Fatma","middleName":"","lastName":"BİRGİLİ","suffix":""},{"id":571646023,"identity":"c8629957-d1b6-4457-a94b-0e6b95d41a63","order_by":1,"name":"Nezihe Bulut UĞURLU","email":"","orcid":"","institution":"Muğla Sıtkı Koçman University","correspondingAuthor":false,"prefix":"","firstName":"Nezihe","middleName":"Bulut","lastName":"UĞURLU","suffix":""}],"badges":[],"createdAt":"2026-01-03 18:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8508532/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8508532/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100022915,"identity":"ff0b2cd6-f832-4b43-ade5-6fb68d96824d","added_by":"auto","created_at":"2026-01-12 08:10:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":400600,"visible":true,"origin":"","legend":"\u003cp\u003eCFA path diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8508532/v1/feabcebac575008e95b3ea48.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eValidation of Turkish Translation of the Nurses' Occupational Stressors Scale: A Methodological Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn many countries around the world, the importance of nursing care is increasing day by day due to developments in the health field. These developments can lead to increased expectations of patients regarding the quality of nursing care they receive. At this point, nurses play a key role in providing safe and quality care by keeping up with the changing nature of diseases, the rapid development of technology in medicine and the advancements in nursing science [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The ability of nurses to provide adequate and quality care can also vary depending on the conditions and situations experienced in their working environment.\u003c/p\u003e \u003cp\u003ePositive and healthy work environments are defined by the International Council of Nurses as contexts that support the excellence and adequate performance of professionals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These environments ensure the health, safety, and well-being of professionals and promote the provision of quality care. This increases the motivation, productivity, and performance of both employees and organizations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The nursing practice environment has the greatest impact on perceptions of the quality of care provided and nursing outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the current context, these issues have gained even greater importance due to the global crisis that has affected the world in recent years [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to different authors, the nursing practice environment can affect nurses through multiple external or internal variables [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Stress, which is at the forefront of these variables, is defined as a non-specific response to an individual's influence and can manifest itself with different responses to similar situations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This stress, which significantly affects nurses in the work environment, stems from a perceived imbalance between workplace stressors and the employee's coping strategies and can lead to negative health outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Work-related stress experienced by nurses is considered one of the main occupational health problems for patients. Workplace stress can affect satisfaction between healthcare professionals and the care provided to patients. Therefore, the coordination of care provided by nurses can be disrupted, and patients' lives can be endangered [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The high workload of nurses can lead to high rates of occupational stressors and burnout [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], decreased job satisfaction [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], exposure to workplace bullying [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and the likelihood of experiencing mental health problems [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. As a result, these negative effects can lead to a decrease in the quality of nursing care and nurses leaving their jobs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is accepted that occupational stress in nursing can affect nurses' job satisfaction and intention to leave [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Determining the occupational stress levels and stress factors of nurses, developing coping methods for stress, and minimizing stress factors are important [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Reducing occupational stress involves identifying the existing occupational stress factors in nurses' work environments and developing methods on how to eliminate these stress factors. Occupational stress in nursing is a concept that can vary from person to person and from culture to culture. Examining the occupational stress levels of nurses with an occupational stress scale specific to nurses will make a significant contribution to the literature. In addition, although different scales have been developed to measure nursing stress factors, these scales cover burnout, job dissatisfaction, and intention to leave to a limited extent [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, this study aims to translate the \"NOSS\", which determines comprehensive nursing stress factors, into Turkish and to determine its Turkish validity and reliability.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eThis study is a methodological research. The target population of the research was composed of 612 nurses in a university hospital in Turkey where the study was conducted. The literature states that 300\u0026ndash;500 people or 5 or 10 times the number of items on the scale should be reached [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Based on this information, the sample of the study consisted of 267 nurses who had volunteered to participate in the study\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurement\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eNurses' Introductory Form\u003c/h2\u003e \u003cp\u003eThis form, which was prepared by researchers based on the literature [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], consists of questions related to the nurses' age, gender, marital status, educational status, professional experience, unit of work, position, whether they willingly chose the nursing profession, satisfaction with working as a nurse, and being under intense stress in relation to their profession.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNOSS\u003c/h3\u003e\n\u003cp\u003e\u0026ldquo;NOSS,\u0026rdquo; which was developed by Chen et al. in 2020, is a 21-item, 4‐point Likert‐type scale designed to measure the occupational stress factors of nurses. The scale is scored between 21 and 84. The scale consists of nine subdimensions (job requirements, work‐family conflict, insufficient support from colleagues or caregivers, violence and bullying in the workplace, organizational issues, occupational hazards, difficulty in taking time/day off, lack of strength, and not meeting basic physiological needs) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As a result of adapting the scale into Turkish, the \"NOSS\" scale has been finalized with 21 items and three dimensions (\"Working Conditions\", \"Working Environment\", \"Work Load\").\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe research data were collected in a university hospital in Turkey during the period covering October\u0026ndash;December 2022. To collect the data, \u0026ldquo;Nurses' Introductory Information Form\u0026rdquo; and \u0026ldquo;NOSS\u0026rdquo; were used. The research data were collected by the researchers using face-to‐face interview method. The data collection took an average of 15\u0026ndash;20 min\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e This study was conducted with the approval of the XXXXX University Health Sciences Ethics Committee (date: 14/04/2021, protocol no: 210057, decision no: 65). Permission for the Turkish adaptation of NOSS was obtained via email from Yi-Chuan Chen, one of the developers of NOSS. The research was conducted in accordance with the principles of the Helsinki Declaration. Nurses who agreed to participate in the research were informed about the research process and their informed consent was obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData analysis were performed using SPSS 22 and AMOS 22. Demographic characteristics of the participants were investigated according to frequencies, percentages for categorical variable, mean and standard deviation for the continuous variables.\u003c/p\u003e \u003cp\u003eItem-total score correlations were calculated to decide whether the item(s) was not compatible with the scale. The item(s) with the correlation value equal to or less than 0.2 was removed from the scale [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Kaiser-Meyer-Olkin (KMO) and Bartlett\u0026rsquo;s test was used to test the sample adequacy for the factor analysis. The sample was accepted as adequacy if KMO value is higher than 0.6 and the p-value of Barlett\u0026rsquo;s test is lower than 0.05 [\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Explanatory factor analysis (EFA) was performed to determine the factor structure of the NOSS scale. Unweighted least squares extraction and varimax rotation methods were used to clarify the factors. The factors with eigen value equal to or higher than 1 were considered. It was checked whether all factor loadings are 0.3 and above [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Confirmatory Factor Analysis (CFA) was conducted to confirm the factor structure obtained from the EFA. The goodness of fit index (GFI), adjusted goodness of fit index (AGFI), normed fit index (NFI), relative fit index (RFI), Parsimony Normed Fit Index (PNFI) and root mean square residual (RMR) indexes were used to confirm the model fit. RMR value \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\le\\:\\)\u003c/span\u003e\u003c/span\u003e0.08 and GFI value \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9, AGFI value\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9, NFI value \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9, RFI value\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9 and PNFI value \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.5 are considered good fit [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternal consistency was investigated by using Cronbach\u0026rsquo;s \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\alpha\\:\\)\u003c/span\u003e\u003c/span\u003e coefficient and item-total score correlations. Cronbach\u0026rsquo;s \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\alpha\\:\\)\u003c/span\u003e\u003c/span\u003e values higher than 0.8 are accepted as good internal consistency [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Test-retest analysis was performed in order to test the time invariance of the NOSS scale and subscales. For this analysis, the scale was re-applied to 35 participants two weeks later. Pearson and Spearman correlation coefficients were used for the scales having normal and no normal distribution, respectively.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of the nurses\u003c/h2\u003e \u003cp\u003eA total of 296 nurses were collected for this study, of which 75% (n\u0026thinsp;=\u0026thinsp;222) were female, 59.1% were between the ages of 20\u0026ndash;32 (n\u0026thinsp;=\u0026thinsp;175), 50% were single (n\u0026thinsp;=\u0026thinsp;148), 82.1% had a bachelor\u0026rsquo;s degree (n\u0026thinsp;=\u0026thinsp;243), 58.4% had no children (n\u0026thinsp;=\u0026thinsp;173), 58.1% (n\u0026thinsp;=\u0026thinsp;172) had normal weight, 52.0% worked in the service (n\u0026thinsp;=\u0026thinsp;154), 60.1% had worked between 1 and 9 years (n\u0026thinsp;=\u0026thinsp;178), 77.7% (n\u0026thinsp;=\u0026thinsp;230) have been working in the clinic they are currently in between 1 and 5 years, 91.2% (n\u0026thinsp;=\u0026thinsp;270) were clinic nurse. Besides, the number of monthly seizures of 92.2% (n\u0026thinsp;=\u0026thinsp;273) of the nurses increased during the pandemic, the number of nurses in the unit where 41.9% (n\u0026thinsp;=\u0026thinsp;124) of the nurse\u0026rsquo;s work was between 10 and 12 and the number of beds in the unit where 36.8% (n\u0026thinsp;=\u0026thinsp;109) of the nurse\u0026rsquo;s work was 5 and 15. Their mean age was 32.41 (SD\u0026thinsp;=\u0026thinsp;7.36) years, their mean of working years was 9.25 (7.43), the mean of working years in the clinic where nurses\u0026rsquo; work was 3.86 (3.83), their mean working hours/ day was 18.68(6.44), their mean working hours /week was 56.79 (12.73) and their mean sleeping hours/day was 7.16 (1.02) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the nurses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX̄\u0026plusmn;Ss\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge(Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e32.41\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e7.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u0026ndash;58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVocational School of Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eNumber of Children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBody Mass Index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eWorking Unit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntensive Care/Operating Room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePandemic Service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePandemic Intensive Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWorking Years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e9.25\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e7.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eYears of work in the clinic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.86\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e3.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eNumber of monthly seizures during the pandemic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased during the pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSame as before the pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased during the pandemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePosition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupervisor Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinic Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eThe number of nurses worked in the service\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eThe number of beds in the working unit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking hours/Day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.68\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:6\\)\u003c/span\u003e\u003c/span\u003e.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking hours/Week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.79\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e12.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleeping hours/Day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.16\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eShift Intensity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eOvertime\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUnderstaffed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWorkload\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFatigue\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWork Stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eInequality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eJob complexity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFear of being suddenly called to job while on leave\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eInability to express oneself at work\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eConflicts at work\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCovid-19 transmission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAre you experiencing burnout?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eIf you are experiencing burnout, what is the source?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdministrative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeripheral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunicational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDo you want to quit your job?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDid you choose your profession willingly?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLanguage Validity\u003c/h2\u003e \u003cp\u003eLinguistic validity of the scale in its Turkish adaptation was established using the translation-back-translation method. The original English version of the scale was translated into Turkish by two language experts. The two resulting translations were then edited by the researchers to create a single form. To determine if the scale had changed from its original version, the scale form was translated again from Turkish to English, and it was found that it had not changed. Based on this, the scale was finalized.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eContent Validity\u003c/h2\u003e \u003cp\u003eTo assess the content validity of the items in the scale, they were submitted to the opinions of 10 academics who are experts in the field. Each expert was asked to evaluate the statements in the scale in terms of comprehensibility, appropriateness, and scope according to the Davis technique [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In this evaluation, each expert scored the statements in the scale on a scale of 1\u0026ndash;4 (1 point: Not appropriate; 2 points: Should be seriously reviewed; 3 points: Should be somewhat reviewed; 4 points: Appropriate). The Content Validity Index (CVI) was calculated by dividing the number of experts who scored each statement in the scale as 3 and 4 according to the evaluation results from each expert by the total number of experts. In this study, no experts scored the scale below 3 points. The content validity ratios for the scale items were found to range between 0.84 and 1.00, and the CVI value was calculated as 0.97. To measure the agreement between the scores given by each expert evaluating the items on the scale, Kendall's Coefficient of Agreement (Wa) was calculated, with Kendall's Wa\u0026thinsp;=\u0026thinsp;0.149, χ2\u0026thinsp;=\u0026thinsp;33.664, df\u0026thinsp;=\u0026thinsp;27, p\u0026thinsp;=\u0026thinsp;0.624. The calculation showed that each expert's score was not statistically different and that there was agreement between the expert opinions. Subsequently, a pilot application of the scale was conducted with 10 nurses. According to the pilot application results, the items on the scale were found to be understandable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConstruct Validity\u003c/h2\u003e \u003cp\u003eItem-total score correlation was found as 0.08 for item 18 and it was decided that item 18 was not compatible for the Turkish version of the scale and was removed from the scale. The correlations of the items were found to be between 0.252 and 0.696. After item 18 was removed, the item-total scale correlations were found to be 0.266 and 0.707.\u003c/p\u003e \u003cp\u003eKMO measure was found as 0.904, Bartlett\u0026rsquo;s test of sphericity was 3075.386 and p-value was 0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05. According to these results, it was decided that sample is adequacy for the factor analysis. As a result of EFA, three factors having eigen value is greater than one were found. The variance explained by the first factor was 39.887%, by the second factor explained was 11.453%, and by the third factor explained was 6.488%. The scale explained 57.819% of the total variance. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the factor loadings.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor Loadings of NOSS-20 scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorking Conditions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorking Environment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWork Load\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI need to transport patients or equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI cannot ask for leaves for household emergencies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have to bear negative sentiment from patients or their relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe on-call system affects my life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have to maintain professional units other than my own\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot achieving a promotion (e.g., level 1 or 2) within the expected period affects my income.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI cannot take an uninterrupted 30-minute mealtime break\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI cannot excuse myself for feeling strong discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt upsets me if patients\u0026rsquo; conditions do not improve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe burden of work makes it difficult for me to undertake my personal chores and/or engage in hobbies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcessive duties in the workplace prevent me from attending to patients.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI feel stressed because primary caregivers do not execute their tasks appropriately.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctors\u0026rsquo; temperamental nature agitates me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have no time to fulfill my personal needs (e.g., water consumption and toilet breaks).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI worry that my colleagues\u0026rsquo; incompetence will affect patient safety.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI feel stressed due to psychological abuse such as threats, discrimination, bullying, and harassment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have insufficient time to offer mental health care to patients during working hours.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI feel stressed considering that my patients might be have contagious diseases such as SARS or AIDS.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe burden of work affects my domestic life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI have to adapt my schedule for family activities/outings to accommodate my work responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e is examined, it can be seen that the factor loadings of the items were found to be between 0.323 and 0.830. All factor loadings are bigger than 0.3. Therefore, no item was removed from the scale at this step. CFA was conducted to verify the model fit for the 3-factor NOSS scale. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the CFA path diagram.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs can be seen from Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, standardized factor loadings are between 0.44 and 0.81. The model fit measures were RMR\u0026thinsp;=\u0026thinsp;0.027 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\le\\:\\)\u003c/span\u003e\u003c/span\u003e0.08, GFI\u0026thinsp;=\u0026thinsp;0.978\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9, AGFI\u0026thinsp;=\u0026thinsp;0.972\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9, NFI\u0026thinsp;=\u0026thinsp;0.969 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9, RFI\u0026thinsp;=\u0026thinsp;0.965\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.9 and PNFI\u0026thinsp;=\u0026thinsp;0.852\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e0.5. These results show good fit indices for 21 items and three factors CFA model.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of reliability for the NOSS scale and its subscales.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of Reliability\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eItem-Total Correlations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorking Conditions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorking Environment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWork Load\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCronbach\u0026rsquo;s\u003c/b\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varvec{\\alpha\\:}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.91\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs can be seen from Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, all item-total score correlations are above 0.2. The item-total correlations range between 0.27 and 0.71, item- Working Conditions correlations range between 0.60 and 0.79, item- Working Environment correlations range between 0.40 and 0.52 and lastly item- Work Load correlations range between 0.35 and 0.67. Cronbach\u0026rsquo;s \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\alpha\\:\\)\u003c/span\u003e\u003c/span\u003e coefficient is found as 0.91 for NOSS scale, 0.93 for the subscale of Working Conditions, 0.68 for the subscale of Working Environment and 0.76 for factor subscale of Work Load, respectively. The results show the scales and subscales have an excellent internal consistency.\u003c/p\u003e \u003cp\u003eICC, 95% confidence interval (CI) of ICC and correlation coefficients were calculated for the test-retest analysis. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the results of the test-retest analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of test-retest analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003eS.D\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCorrelation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eICC [%95 CI]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNOSS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.25\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.85**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.83** [0.67 0.91]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.71\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWorking Conditions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.17\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.75**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.70** [0.43 0.85]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.51\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWorking Environment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.63\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.45**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.65** [0.40 0.81]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.63\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWork Load\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.46\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.64**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.64** [0.40 0.80]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.57\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, NOSS scale have the excellent agreement since its ICC value is higher than 0.80 while the subscales have the good agreement with 0.70, 0.65 and 0.64 ICC values. Besides, the correlation between first and second applications range between 0.45 and 0.85 and all correlations are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These results show that Turkish version of NOSS scale are time invariance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOccupational stress is defined as “a harmful, physical and emotional state that arises when the requirements of the profession do not match the employee’s abilities, resources and needs” [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It is difficult to generalize the diversity of stressors found in different nursing fields and the stress-inducing factors in nurses from one environment to another. However, stress factors that cause occupational stress in nurses [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] include: difficulties arising from relationships between nurses, between nurses and doctors, or between nurses and other team members; the clinical leadership ability of managers; challenges related to patient care (especially violent incidents); and organizational issues such as change, administrative demands, organizational structure, and the cultural environment of workplaces. Therefore, understanding and resolving occupational stress factors is considered extremely important for nurses to cope with these problems. Having appropriate assessment tools is essential for effectively managing the process. For this reason, the research was conducted to examine the suitability of “NOSS”, developed by Chen et al. (2020), to the Turkish language and culture.\u003c/p\u003e \u003cp\u003eIn adapting an improved measurement tool, the tool must meet the validity and reliability criteria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The first goal to be considered in questionnaire adaptation studies is language adaptation. Therefore, first, the language validity of “NOSS” was ensured, then the scale was re-evaluated according to expert opinions, and the Turkish form of the scale was created by conducting a pilot study with 20 nurses.\u003c/p\u003e \u003cp\u003eFor the content validity of the scale, the CVI value must be at least 0.80 [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In the original \"NOSS\", the CVI value was 0.81 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], while in this study, the CVI value was calculated as 0.97 \u0026gt; 0.80, and the content validity of the scale was ensured. This value shows that \"NOSS\" is a scale that reflects the occupational stress factors of nurses.\u003c/p\u003e \u003cp\u003eAfter ensuring the linguistic and content validity of \"NOSS,\" the construct validity of the scale was evaluated. Construct validity is conducted to prove the extent to which the items in the questionnaire accurately measure the qualities that are intended to be answered. In other words, the components of the construct that the questionnaire aims to measure should actually measure what they intend to measure in practice [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) techniques are commonly used to evaluate construct validity. CFA is recommended if there is a tested relationship between the questionnaire items or if the items are grouped under the determined factors; EFA is recommended if the opposite is true. However, in validity and reliability studies, factors and the items contained within the factors may vary when the culture of the population is taken into consideration. In these cases, the use of EFA may be preferred [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. To determine whether the measurement results are affected by the sample size and to determine whether the sample size is sufficient and appropriate for factor analysis, it is necessary to first perform the Kaiser-Meyer-Olkin (KMO) measurement and the Bartlett sphericity test [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The KMO value is evaluated as “average” between 0.50–0.70; “good” between 0.70–0.80; “very good” between 0.80–0.90; and “excellent” above 0.90 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The Bartlett Sphericity test p-value is expected to be below 0.05 and the “Anti-image” correlation value above 0.50 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The original “NOSS” KMO value is 0.93. In this study, the KMO value of “NOSS” is 0.904, and this value being higher than 0.80 indicates that the research sample is at a very good level for factor analysis. Furthermore, Bartlett’s test of sphericity was 3075.386 and the p-value was 0.000 \u0026lt; 0.05, indicating that the Bartlett test was highly significant and a significant relationship was determined between the “NOSS” variables/factors. To assess the structural validity of the questionnaire based on the results of these tests, EFA was used. For a structure to be considered a factor, its eigenvalue must be greater than 1 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and the variance it explains must be greater than 5% [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In this context, the EFA of “NOSS” was examined using the principal components method and evaluated with varimax rotation. Thus, it was determined that the questionnaire formed a three-factor structure and that the eigenvalue for each structure was greater than 1. However, a shift was observed in the distribution of items to factors compared to the original questionnaire. In the original scale, the Varimax method was used and the factor loading values ​​ranged from 0.380 to 0.870. These values ​​were found to be at acceptable levels when compared with the analysis coefficients. Similarly, in this study, the factor loading values ​​of the “NOSS” scale ranged from 0.323 to 0.830. In addition, the eigenvalue coefficient is also taken into account during factor analysis. In factor analysis, factors with eigenvalue threshold values ​​of one and above are considered [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. These values ​​were found to be at acceptable levels when compared with the analysis coefficients. Following the analyses, 21 items were identified with three dimensions that explained 57.819% of the total variance of the scale (the first factor 39.887%, the second factor 11.453%, and the third factor 6.488%). It was reported that an exploratory variance of 40–60% is acceptable [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn scale studies, CFA is used to test the accuracy of EFA results. In nursing literature, the structures of scales determined after EFA are accepted as a model, and the accuracy of this model is tested with CFA [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The structure of the “NOSS” scale was examined within the scope of CFA with X²/SD, GFI, AGFI, CFI, RMSEA and SRMR goodness-of-fit tests. According to the literature, an X²/SD value of 5 or less means that the tested model has a good level of fit [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the original “NOSS” scale, the GFI value is 0.92, the AGFI value is 0.92 and the CFI value is 0.91. In this study, RMR = 0.027 ≤ 0.08, GFI = 0.978 ≥ 0.9, AGFI = 0.972 ≥ 0.9, NFI = 0.969 ≥ 0.9, RFI = 0.965 ≥ 0.9 and PNFI = 0.852 ≥ 0.5. These indices are considered acceptable values ​​when they are equal to or greater than 0.90 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Other goodness-of-fit index values ​​of \"NOSS\" were determined as 0.06 for RMSEA and 0.027 for RMR. An RMSEA value \u0026lt; 0.08 indicates a good fit. An SRMR value of 0.05 ≤ RMR ≤ 0.10 means that the model has a reasonable fit [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eReliability analyses are conducted to evaluate the internal consistency of a questionnaire and the fit of scale items. In this study, item analysis and Cronbach's alpha coefficient were used to evaluate the reliability analysis of the scale. The item-total correlation results are expected to be positive. In the original scale, item-total correlations are above 0.40, and in this study, the item-total correlations of the \"NOSS\" scale are above 0.30. This result shows that each item of the scale is similar and that internal consistency is ensured [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The internal consistency coefficient of the original scale is 0.91. In this study, the internal consistency coefficient of the \"NOSS\" scale is 0.81, and the Cronbach's alpha values ​​being higher than 0.80 indicates that the scale has high reliability. The higher the Cronbach's alpha reliability coefficient of the scale, the more consistent the items in the scale are with each other, and the more it explains that the scale consists of items testing elements of the same characteristic [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Accordingly, the items in “NOSS” are consistent with each other, and “NOSS” consists of items that test elements of the same characteristic. Based on this information, it was determined that the item-total correlation coefficient values ​​of “NOSS” were positive. It is expected that the upper and lower 27% groups, grouped according to the total score in the scales, can show discrimination. In addition, the floor and ceiling effect of the questionnaire, in other words, the proportion of the same answers given, should not exceed 10% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this study, it was determined that item discrimination was achieved and no floor/ceiling effect was observed. In order to determine the reliability of the scale in terms of its stability over time, a retest was performed on 27.02% (n = 80) of the nurses who participated in the pilot application 15 days after the test application. The correlation between the first and second applications ranged from 0.45 to 0.85, and all correlations were found to be statistically significant (p \u0026lt; 0.05). It was determined that the Turkish version of the NOSS scale is stable over time. A correlation coefficient of 0.80 and above indicates high correlation, 0.60–0.80 indicates strong correlation, 0.40–0.59 indicates moderate correlation, 0.20–0.39 indicates low correlation, and below 0.20 indicates weak correlation [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Accordingly, it has been shown that the scale has high reliability and consistent measurements that are independent of time.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThis study had some limitations. First, since the current study was conducted only with nurses working in a single training and research hospital, the results obtained cannot be directly generalized to nurses or other health disciplines in various countries. These results are limited to the sample group participating in this study. Second, the pandemic occurred during the study period. Due to the high stress factors during this period, the study was suspended for a year to allow the acute phase to pass. Afterwards, data was collected face-to-face using personal protective equipment. Even during this extraordinary period, their participation in the study and their support in data collection can be considered a factor that strengthens the reliability of the study data.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusions and recommendations","content":"\u003cp\u003eIn this study, the Turkish version of the NOSS scale, which identifies occupational stress factors in nursing practice settings and predicts personal burnout, patient-related burnout, job dissatisfaction, and intention to leave, was validated with 21 items and 3 dimensions (“Working Conditions”, “Working Environment”, “Work Load”). This scale can be used to identify occupational stressors for nurses.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAGFI: Adjusted goodness of fit index\u003c/p\u003e\n\u003cp\u003eCFA: Confirmatory factor analysis\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCVI: Content Validity Index\u003c/p\u003e\n\u003cp\u003eEFA: Explanatory factor analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGFI: The goodness of fit index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICC:\u0026nbsp;Interval correlation coefficients\u003c/p\u003e\n\u003cp\u003eKMO: Kaiser-Meyer-Olkin\u003c/p\u003e\n\u003cp\u003eNFI: Normed fit index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNOSS: Nurses\u0026apos; Occupational Stressors Scale\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRFI: Relative fit index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRMR: Root mean square residual\u003c/p\u003e\n\u003cp\u003ePNFI: Parsimony Normed Fit Index\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eFatma BİRGİLİ: Conceptualization, Methodology, Software, Investigation, Data curation, Writing \u0026ndash; original draft, Project administration.Nezihe BULUT UĞURLU: Conceptualization, Investigation, Data curation, Writing \u0026ndash;review \u0026amp; editing, Project administration.All authors meet the authorship criteria according to the guidelines of the International Committee of Medical Journal Editors, and all authors agree with the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe sincerely thank the nurses who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFlod\u0026eacute;n A, Lepp M, Tilander P, Svensson A, Nilsson J. Nurses' Self-reported professional competence: A cross‐sectional study at a regional teaching hospital in Sweden. J Clin Nurs. 2025;1\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jocn.70057\u003c/span\u003e\u003cspan address=\"10.1111/jocn.70057\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Council of Nurses. Nuses: A Force for Change-A Vital Resource for Health: International Nurses Day 2014; International Council of Nurses. Switzerland: Geneva; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucas P, Jesus \u0026Eacute;, Almeida S, Costa P, Cruchinho P, Teixeira G, Ara\u0026uacute;jo B. The nursing practice environment and job satisfaction, intention to leave, and burnout among primary healthcare nurses: A cross-sectional study. Nurs Rep. 2025;15(7):224. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/nursrep15070224\u003c/span\u003e\u003cspan address=\"10.3390/nursrep15070224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambrou P, Merkouris A, Middleton N, Papastavrou E. Nurses\u0026rsquo; perceptions of their professional practice environment in relation to job satisfaction: A review of quantitative studies. Health Sci J. 2014;8(3):298\u0026ndash;317. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hdl.handle.net/20.500.14279/8572\u003c/span\u003e\u003cspan address=\"https://hdl.handle.net/20.500.14279/8572\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen YC, Guo YLL, Lin LC, Lee YJ, Hu PY, Ho JJ, Shiao JSC. Development of the nurses\u0026rsquo; occupational stressor scale. Int J Environ Res Public Health. 2020;17(2):649. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph17020649\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17020649\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBautista JR, Lauria PAS, Contreras MCS, Maranion MMG, Villanueva HH, Sumaguingsing RC, Abeleda RD. Specific stressors relate to nurses\u0026rsquo; job satisfaction, perceived quality of care, and turnover intention. Int J Nurs Pract. 2020;26(1):e12774. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ijn.12774\u003c/span\u003e\u003cspan address=\"10.1111/ijn.12774\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKowalski M, Basile C, Bersick E, Cole D, McClure D, Weaver S. What do nurses need to practice effectively in the hospital environment? An integrative review with implications for nurse leaders. Worldviews Evid Based Nurs. 2020;17(1):60\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/wvn.12401\u003c/span\u003e\u003cspan address=\"10.1111/wvn.12401\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGangloff EJ, Greenberg N. Biology of stress. Health and welfare of captive reptiles. Cham: Springer International Publishing; 2023. pp. 93\u0026ndash;142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAydın G\u0026Ccedil;, Ayta\u0026ccedil; S, Şanlı Y. The effects of job related emotions, job stress, and burnout on the ıntention to leave: A study on nurses. Journal of Social Policy Conferences. 2021;80:1\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.26650/jspc.2021.80.000011\u003c/span\u003e\u003cspan address=\"10.26650/jspc.2021.80.000011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParveen R, Hussain M, Afzal M, Parveen MK, Majeed MI, Tahira F, Sabir M. The impact of occupational stress on nurses caring behavior and their health related quality of life. Saudi J Med Pharm Sci. 2017;3(9):1016\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.36348/sjmps.2017.v03i09.012\u003c/span\u003e\u003cspan address=\"10.36348/sjmps.2017.v03i09.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEroğlu Y, Karaaziz M. Review of stress coping strategies on how to predict your relationship with happiness. Pearson J Social Sci Humanit. 2024;8(28):1347\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5281/zenodo.11613570\u003c/span\u003e\u003cspan address=\"10.5281/zenodo.11613570\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Okoli CTC, He H, Feng F, Li J, Zhuang L, Lin M. Factors associated with compassion satisfaction, burnout, and secondary traumatic stress among Chinese nurses in tertiary hospitals: A cross-sectional study. Int J Nurs Stud. 2020;102:103472. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnurstu.2019.103472\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnurstu.2019.103472\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKupcewicz E, J\u0026oacute;\u0026acute;zwik M. Positive orientation and strategies for coping with stress as predictors of professional burnout among Polish nurses. Int J Environ Res Public Health. 2019;16(21):4264. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph16214264\u003c/span\u003e\u003cspan address=\"10.3390/ijerph16214264\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamer E, \u0026Ouml;zt\u0026uuml;rk H. Determination of Nurses\u0026rsquo; quality life and influencing factors. Ege Univ Fac Nurs J. 2021;37(2):107\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.53490/egehemsire.748208\u003c/span\u003e\u003cspan address=\"10.53490/egehemsire.748208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhamisa N, Peltzer K, Ilic D, Oldenburg B. Work related stress, burnout, job satisfaction and general health of nurses: A follow-up study. Int J Nurs Pract. 2016;22(6):538\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ijn.12455\u003c/span\u003e\u003cspan address=\"10.1111/ijn.12455\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŞantaş G, Tekin R, Şantaş F. The effect of psychological contract and workplace bullying on ıntention to leave: A research in nurses. Cumhuriyet Univ J Econ Administrative Sci. 2020;21(1):183\u0026ndash;202. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.53434/gbesbd.1312817\u003c/span\u003e\u003cspan address=\"10.53434/gbesbd.1312817\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiorgi G, Mancuso S, Fiz Perez F, Castiello D'Antonio A, Mucci N, Cupelli V, Arcangeli G. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ijn.12376\u003c/span\u003e\u003cspan address=\"10.1111/ijn.12376\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChin WS, Chen YC, Ho JJ, Cheng NY, Wu HC, Shiao JS. Psychological work environment and suicidal ideation among nurses in Taiwan. J Nurs Scholarsh. 2019;51(1):106\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jnu.12441\u003c/span\u003e\u003cspan address=\"10.1111/jnu.12441\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurtulgan İF, Bozkurt A. A Phenomenological study onthe social and environmental factors affecting the mental health of intensive care unit nurses. J Organizational Behav Stud. 2025;5(1):46\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.https://doi.org/10.5281/zenodo.15777896\u003c/span\u003e\u003cspan address=\".10.5281/zenodo.15777896\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkhawaldeh JFMA, Soh KL, Mukhtar FBM, Ooi CP. Effectiveness of stress management interventional programme on occupational stress for nurses: A systematic review. J Nurs Manag. 2020;28(2):209\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jonm.12938\u003c/span\u003e\u003cspan address=\"10.1111/jonm.12938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi MY, So HS, Ko E. Influences of occupational stress, ethical dilemma, and burnout on turnover intention in hospital nurses. J Korean Acad Nurs. 2019;26(1):42\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7739/jkafn.2019.26.1.42\u003c/span\u003e\u003cspan address=\"10.7739/jkafn.2019.26.1.42\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams and Wilkins; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMert İS. The investigation of the most stressful critical incidents that experienced by nurses and intern nurses by using quantitative research metod. Electron J Social Sci. 2018;17(67):1043\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17755/esosder.343043\u003c/span\u003e\u003cspan address=\"10.17755/esosder.343043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeşilyurt S, \u0026Ccedil;apraz C. A road map for the content validity used in scale development studies. J Erzincan Univ Fac Educ. 2018;20(1):251\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17556/erziefd.297741\u003c/span\u003e\u003cspan address=\"10.17556/erziefd.297741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAwang Z. Research Methodology for Business and Social Sciences. Kelantan: UniversitiTeknologi; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAwang Z. Structural equation modeling using AMOS graphic. Penerbit UniversitiTeknologi. 2012, MARA.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoque ASMM, Awang Z. The Exploratory Factor Analysis (EFA) of Entrepreneurial Marketing Scale - Development and Validation. Tourism Conference. 2016a:20\u0026thinsp;\u0026ndash;\u0026thinsp;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoque ASMM, Awang Z. Exploratory factor analysis of entrepreneurial marketing: scale development and validation in the SME context of Bangladesh, International Social Sciences and Tourism Research Conference, Terengganu, UniSZA, 2016b:20\u0026thinsp;\u0026ndash;\u0026thinsp;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoque ASMM, Awang Z, Siddiqui BA. Technopreneurial Intention among University Students of Business Courses in Malaysia: A structural equation modeling. Int J Entrepreneurship Small Medium Enterp (IJESME). 2017b;4:1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrove SK, Burns N, Gray J. The practice of nursing research: Appraisal, synthesis and generation of evidence. Elsevier Health Sciences; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen H, Doherty KV, Eccleston CEA, Bindoff A, Tierney L, Mason R, Robinson A, Vickers J, Mclnerney F. Consumer access, appraisal, and application of services and information for dementia (CAAASI-Dem): a validation study. Aging Ment Health. 2022;26(12):2489\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13607863.2021.1991277\u003c/span\u003e\u003cspan address=\"10.1080/13607863.2021.1991277\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArslan I, Aydınoğlu S. Turkish version of the faces version of the Modified Child Dental Anxiety scale (MCDAsf): translation, reliability and validity. Clin Oral Investig. 2022;26(2):2031\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00784-021-04184-0\u003c/span\u003e\u003cspan address=\"10.1007/s00784-021-04184-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis LL. Instrument review: getting the most from a panel of experts. Appl Nurs Res. 1992;5(4):194\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0897-1897(05)80008-4\u003c/span\u003e\u003cspan address=\"10.1016/S0897-1897(05)80008-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGirma B, Nigussie J, Molla A, Mareg M. Occupational stress and associated factors among health care professionals in Ethiopia: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-021-10579-1\u003c/span\u003e\u003cspan address=\"10.1186/s12889-021-10579-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonstantinos N, Christina O. Factors influencing stress and job satisfaction of nurses working in psychiatric units: a research review. Health Sci J. 2008;2(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://hdl.handle.net/11400/1207\u003c/span\u003e\u003cspan address=\"http://hdl.handle.net/11400/1207\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErkuş A. Psikolojide \u0026ouml;l\u0026ccedil;me ve \u0026ouml;l\u0026ccedil;ek geliştirme 1: Temel kavramlar ve işlemler. [Measurement and scale development in psychology 1: Basic concepts and procedures]. 8. Print. Pegem Academy. 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarasar N. Scientific research method concepts principles techniques with scientific will perception framework. Nobel Acad. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026uuml;y\u0026uuml;k\u0026ouml;zt\u0026uuml;rk Ş. Data analysis handbook for social sciences statistics, research pattern Spss applications and interpretation. Pegem Academy. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlavi M, Visentin DC, Thapa DK, Hunt GE, Watson R, Cleary M. Exploratory factor analysis and principal component analysis in clinical studies: Which one should you use? J Adv Nurs. 2020a;76(8):1886\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jan.14377\u003c/span\u003e\u003cspan address=\"10.1111/jan.14377\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"nurse, occupational stress factor, work environment, scale","lastPublishedDoi":"10.21203/rs.3.rs-8508532/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8508532/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNurses have heavy responsibilities, primarily because they deal with people's health, pain, grief, and death. They work for hours in physically and mentally demanding roles that can affect their own health. Therefore, nurses face many challenges and risks due to the characteristics of the institution, the community, their colleagues, patients, and their families while providing care, which leads to occupational stress. Identifying the levels of occupational stress and stress factors among nurses, developing coping mechanisms, and minimizing stress factors are crucial.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study was conducted using a methodological design to first determine the validity and reliability of the \"Nurses' Occupational Stressors Scale (NOSS)\" in Turkish, with the aim of identifying occupational stress factors for nurses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eResearch data were collected using the \"Nurses' Demographic Form\" and the \"NOSS\" scale. The sample consisted of 296 volunteer nurses working at Muğla Training and Research Hospital. Data were collected between October and December 2022. The scale's linguistic and content validity was ensured, and Confirmatory Factor Analysis (CFA) was applied. Item-total correlation analyses and Cronbach's α coefficient were calculated to assess the reliability of the NOSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Turkish version of NOSS, consisting of 21 items and three dimensions, has been validated. Factor loading values ​​of the scale items ranged from 0.44 to 0.81. The model fit measures were RMR\u0026thinsp;=\u0026thinsp;0.027\u0026thinsp;\u0026le;\u0026thinsp;0.08, GFI\u0026thinsp;=\u0026thinsp;0.978\u0026thinsp;\u0026ge;\u0026thinsp;0.9, AGFI\u0026thinsp;=\u0026thinsp;0.972\u0026thinsp;\u0026ge;\u0026thinsp;0.9, NFI\u0026thinsp;=\u0026thinsp;0.969\u0026thinsp;\u0026ge;\u0026thinsp;0.9, RFI\u0026thinsp;=\u0026thinsp;0.965\u0026thinsp;\u0026ge;\u0026thinsp;0.9, and PNFI\u0026thinsp;=\u0026thinsp;0.852\u0026thinsp;\u0026ge;\u0026thinsp;0.5. These results show good fit indices for the 21 items and the three-factor CFA model. All item-total score correlations ranged from 0.27 to 0.71. The Cronbach α coefficient of NOSS is 0.91. NOSS was determined to have excellent internal consistency. The ICC value of NOSS is higher than 0.80, showing excellent fit. Furthermore, the correlation between test and retest is between 0.45 and 0.85, and all correlations are statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Turkish form of \"NOSS\" has been determined to be valid and reliable. This tool can be used to identify occupational stressors for nurses.\u003c/p\u003e","manuscriptTitle":"Validation of Turkish Translation of the Nurses' Occupational Stressors Scale: A Methodological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 08:09:55","doi":"10.21203/rs.3.rs-8508532/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55651fcb-1ac8-4aa2-80a9-6468ed3eb8bd","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T08:09:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 08:09:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8508532","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8508532","identity":"rs-8508532","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}