Scales Used to Measure Job Stressors in Intensive Care Units: Are They Relevant and Reliable? A Systematic Review

Abstract

Background: Many studies have been conducted in intensive care units (ICUs) to identify the stress factors involved in the health of professionals and the quality and safety of care. The objectives are to identify the psychometric scales used in these studies to measure stressors and to assess their relevance and validity/reliability. Methods: All peer-reviewed full-text articles published in English between 1997 and 2016 and focusing on an empirical quantitative study of job stressors were identified through searches on seven databases and editorial portals. Results: From the 102 studies analyzed, we identified 59 different scales: 17 "all settings scales" (16 validated scales), 20 "healthcare settings scales" (13 validated scales), and 22 "ICU settings scales" (two validated scales). All these scales used measured stressors from at least one of the following eight broad categories: High job demands, Problematic relationships with other professionals, Lack of control over work situations and career, Lack of organizational resources, Problematic situations with users and relatives, Dealing with ethical-and moral-related situations, Risk management issues, and Disadvantages in comparison to other occupational situations. The "all settings scales" and "healthcare settings scales," the most often validated, did not measure, or only slightly measured, the stressors most specific to ICUs. Where these were taken into account, the authors were forced to develop their own tools or modify existing scales without testing the validity of the tool used. Conclusions: This review highlights the lack of a tool that meets both the criteria of validity and relevance with regard to the specificity of work in ICUs. Future research must focus on developing reliable/valid tools covering all types of relevant stressors to ensure the quality of the studies carried out in this field.

The Moderator Role of Passion for Work in the Association between Work Stressors and Secondary Traumatic Stress: A Cross‐Level Diary Study among Health Professionals of Intensive Care Units

“…Moreover, ICUs are characterised by self‐defining traumatic tasks in which professionals engage during their work hours (Filho et al, 2019), and at the same time, these professionals may deal with time constraints and social pressure while performing those tasks (Mason et al, 2014), linked with a high workload related to the critical caring task (van Mol et al, 2015). These work stressors are considered to be relevant in the consequences of working in ICU (Laurent et al, 2020). In contrast, there are few studies that delve more deeply into the difficulties that health professionals may encounter on the day‐level, despite its undeniable relevance (Yoder, 2010).…”

An international tool to measure perceived stressors in intensive care units: the PS-ICU scale

“…Numerous studies have shown that complexity of care, ethics and the relationship with the patient and family are dimensions of stress that shape the identity of the unit and refer to strong emotional dimensions [ 7 , 35 , 36 ]. Therefore, it is essential to be able to take them into account when evaluating stress in the same way as more generic stressors, which is not possible with current generic scales such as the JCQ [ 14 ].…”

“…They decided to merge some factors and rename others to obtain a single consensual typology of stressors. This expert panel then grouped all the stressors into broad categories guided by the literature [ 14 ], and complemented, in case of ambiguities, by the experience of clinicians.…”

“…To examine the structure of the 50-item PS-ICU scale, we compared results from factor analyses using three methods of extraction (principal component, principal axis and maximum likelihood) and two rotation techniques (Oblimin and Varimax), applied on different numbers of factors (suggested by Cattell’s scree test, Horn’s parallel analysis, the systematic review of Laurent et al [ 14 ], and the qualitative results from the Phase 1). In the first round of analyses, four items (14, 1 22, 2 43, 3 47 4 ) frequently had low loadings (< 0.30) across techniques (Additional file 1 : Table S3).…”

“…However, the tools used to identify stressors remain inadequate, and the question of their relevance arises [ 13 ]. Indeed, as highlighted in a recent systematic review [ 14 ], available scales used in the field of ICU stress research lack metrological validity, or do not cover all the relevant ICU stressors. Out of 102 published studies (1997–2017) and dealing explicitly with the identification of ICU stressors, 35% of the studies used non-validated scales and 36% used generic scales, i.e., not specific to the ICU work environments (e.g., Job Content Questionnaire (JCQ) [ 15 ], Effort-Reward Imbalance [ 16 ]).…”