Development and psychometric testing of nursing students’ perceptions of clinical stressors scale: an instrument design study

Foozieh Rafati, Hamid Sharif Nia, Zohreh Khoshnood, Kelly Ann Allen

Research output: Contribution to journalArticleResearchpeer-review


Background: In clinical environments, nursing students experience a range of stressors that can affect their health, learning, and quality of patient care. This study aimed to develop a Nursing Students’ Perceptions of Clinical Stressors Scale (NSPCSS) and to evaluate its psychometric properties. Methods: This exploratory, sequential mixed-method study was conducted in 2 phases. In the qualitative (item generation) phase, NSPCSS items were generated using the data collected from semi-structured interviews and a literature review. In the quantitative (psychometric evaluation) phase, face, content, construct, convergent, and discriminant validity and reliability of the scale were tested. To evaluate construct validity, exploratory and confirmatory factor analyses were performed on the data collected from 430 nursing students. Reliability was also assessed through internal consistency and composite reliability. Results: In this study, 6 factors were extracted from 30 itemes through exploratory factor analysis: (1) instructor’s limited competence in clinical environments, (2) inappropriate clinical environment, (3) inadequate knowledge and skills, (4) inefficient education in clinical planning, (5) instructor’s inappropriate conduct, and (6) concerns about the characteristics of nursing career. These factors accounted for 58.8% of the total variance. The results of the confirmatory factor analysis suggested the goodness-of-fit indices was acceptable. Furthermore, the internal consistency and composite reliability indices of all factors were greater than 0.7. Conclusions: The NSPCSS is a valid and reliable instrument for assessing clinical stressors among nursing students.

Original languageEnglish
Article number1
Number of pages10
JournalBMC Psychiatry
Issue number1
Publication statusPublished - 2021


  • Factor analysis
  • Nursing students
  • Reliability and validity
  • Workplace stress

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