Yearbook on Journal of the Japan Society of Nursing Research 2013

Developing a Scale for Evaluating Stressors on Teachers of Nursing Schools
Keiko Sakai 1)
Key Words :stressstressor scalenurse teacher
reliability
validity

ABSTRACTThe present study was undertaken to develop a stressor scale for evaluating stressors to which teachersat nursing schools are occupationally exposed. The author prepared a conceptual framework of stressors
for nurse teachers by analyzing and reviewing the literature. In a pilot study using this framework, theauthor asked 50 nursing-school teachers to describe answers to each item. Then, the author prepared aquestionnaire on stressors and conducted a questionnaire survey to investigate stressors to which theteachers were exposed. The questionnaire was prepared with a scale of four choices to measure the degreeof the 169 stressor items for nurse teachers.
The survey involved 450 teachers working at nursing schools across the country. Responses were collectedfrom 227 teachers. The average age of the responders was 41.9 years (SD=7.1). On the basis of the resultsfrom factor analysis, the author created a stressor scale for nurse teachers composed of 9 factors and
57 items. The 9 factors were “dealing with students”, “work environments”, “teachers’ qualifications”,“workload”, “dealing with problems”, “educational methods”, “relationships among teachers”, “researchresources” and “improving teaching skills”. This scale was highly reliable (α=0.82~0.96). The validity ofthis scale had a close correlation with the other related scales (r=0.54 with anxiety scale and r=0.56 withburnout scale).

I. Introduction

activities, lose motivation toward nursing education, and havemore feelings of inferiority about their educational skills. This
would limit the growth of the nursing profession. Therefore,
identifying the job-related stressors among nurse teachers
would help to establish preventive measures of stress. Studies of stress among nurse teachers; however, have not beenfound, although some studies reported regarding the measurement method and scale of stress in general,4) and occupational stress among staff members in nursing facilities suchas nurses and health nurses.5)-7)
The purpose of this study is to identify factors of occupational stress among nurse teachers, using a questionnaire, andto develop a stressor scale which measures the stress factorsof nurse teachers in nursing schools.

Basic Nursing Education is an official program to provide
a solid foundation of nursing covering a wide range, in orderto develop the practical and characteristic skills of nursing.
Nurse teachers engaged in basic nursing education have a rolein elevating the nursing profession, and they are required tounderstand the necessary skills for the nursing profession.
They are also required to have skills as professional nurses
and nurse educators, for educational engagement with nurse
students. However, if nurse teachers are not confident or confront dilemmas with their qualifications or skills, this mightcause major stress among the teachers.

Examples of stressors (stress factors) among nurse teachers are the following concerns associated with teaching
methods in nursing education: which area of academic skill isnecessary for nurse students; which basic knowledge should
be provided for them to learn the skills and attitudes in orderto obtain such academic skills; how application methods ofthe knowledge and skills can be taught; how to educate nurse
students to establish therapeutic relationships between nurse
students and patients; how to understand mutual reactions inthe student-patient relationships; and how to evaluate educational effects from the educational contents and methods afterplanning and performing. According to the Japanese Nursing
Association Research Report, some situations or conditions
becoming stressors for nurse teachers are as follows: nurse
teachers have many students for whom they have responsibility; there are many tasks other than teaching; and they feela lack of skills and qualifications.1) In addition, the previous
studies of the author identified concerns of beginning nurse
teachers about: educational skills; mutual trust; time availability; educational qualifications; profession; and student
guidance.2) 3)
Depending on their strength and quality, those concernsand stressors can cause nurse teachers to decrease their

II. Presumption of a conceptual framework of stressbased on a literature review(1) Previous studies of stress among nurse teachers

The concept of stress was first used to describe hardship,
straits, adversity, and affliction in the 14th century.8) According
to Cannon (1932), stress is a condition of disruption in the
body’s homeostasis. Selye(1936) has described stress as
the General Adaptation Syndrome(GAS), which is a responseof the body to harmful stimuli for its protection, and thisis explained as a physiological reaction and its process
generated by stressors.
A central role in the theoretical study of stress is currently
the stress theory of Lazarus et al, in which stress is arubric consisting of many variables and processes, not one
variable, and an individual’s cognitive appraisal of stressdetermines whether a relationship between the person andthe environment is stressful.9)10) According to the definitionof stress, stress varies in the extent to which they emphasize
stressful stimulus and events, individual appraisals ofsituations, or stress responses.11) The present study focuses
on stressful stimuli and events, which are stressors.
Occupational stressors are broadly divided into thefollowing six concepts: 1. Work itself, 2. Role in organization,
3. Interpersonal relationships at work, 4. Issues in career

1) Kanazawa Medical University School of Nursing

Corresponding author. Tel.: +81 76 218 8421.
E-mail address: slope-k@kanazawa-med.ac.jp (K. Sakai)

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This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.

Yearbook on Journal of the Japan Society of Nursing Research 2013

development, 5. Issues of organizational structure andclimate, and 6. Common problems at home and work.12)
Referring to those, concepts of possible stressors for nurse
teachers are suggested below.

performance and attractiveness of schools are often asked
for, the improvement of the education contents and methods
are required of nurse teachers by changes in social needs andamendments of the curriculum. As a result, the associatedconferences, education plan, and evaluation lead to roleambiguity from the complexity, and the situation is not
sufficiently organized for nurse teachers to accommodate theincrease in work. In the latter case of role conflict, because of
the characteristics of nursing schools, which are educational
institutions and develop medical professionals, nurse teachers
are required to have roles as nurses and educators. However,their experience and skills of teaching may not be enough yet
for them to build education and careers to meet the roles.

1. Stressors from work itself

Stressors caused from the work itself are considered to be
associated with ① Job contents, and ② workload.
① Job contents of nurse teachers:

The primary role of nurse teachers is to perform educational
activities such as lectures and practical training. In the study
by Kumagai, 89 % of the nurse teachers who participated in
the survey had concerns about lectures and training, and the
major concerns are listed below in descending order.13)
Concerns about lectures: “difficulty of teaching to facilitate
deeper thinking by students”, “not knowing teaching methods
to motivate students”, “difficulty of teaching a small group”,
and “not knowing course contents and structures”
Concerns in the practical training: “a large number ofstudents”, “difficulty of enhancing nurse students’ learningand thinking through the nursing process”, “no joy orsatisfaction in nursing practice”, “no actual scene for training”,
and “difficulty of adjustment with students and instructors”
The conditions associated with the number of students,
levels of skills and qualifications as teachers, and insufficiencyof studying teaching materials interfere with nurse teachers’
primary educational activities. Those are considered to be
stressors, since nurse teachers cannot sufficiently plan,
perform, or evaluate their educational activities.

② Future and Prospects of Nursing Schools:

The trend for university education of basic nursing has
accelerated. There were 9 nursing universities in 1991 and
91 schools in 2001.14) The master’s and doctoral programs
have been also increasing. On the other hand, there has beena reduction of nursing schools, which involves consolidating
and closing schools, and stopping recruiting new students.
Those changes in education form and schools give nurse
teachers concerns about aptitude, future, and prospect, whichhave been their occupational stressors.
③ Autonomy of nurse teachers:

Autonomy is required as one of the conditions of profession.
Some nurse teachers; however, seem to be low in autonomy
although studies reporting the fact cannot be found. According
to the related study by Hamada et al, differences in active andpassive involvement in nursing educational activities reflect
their awareness of work performance.15-17) This indicatesthat passive teachers have concerns about educational
activities, while active teachers have concerns about aspectsof education management such as guidance and support forjunior faculty. Despite nurse teachers having the same roles
in nursing schools, universities and colleges, it is assumed
that nurse teachers in nursing schools face various issues andtheir autonomy is suppressed.

② Workload of nurse teachers:

The survey report by the Japanese Nursing Association
Research Department, has pointed out the issue of heavy
workload in all nursing training programs, such as a large
number of students for whom teachers have responsibility,
heavy workload, overtime work, and no time for classpreparation.1)
Because of the limited number of nurse teachers, andthe workload for supporting a large number of students
and doing tasks other than their educational activities, theycannot complete their work. This is causing nurse teachers
to suffer from dilemmas and frustration.

④ Research activities of nurse teachers:

Research activities are not clearly put up as nurse teachers’
work in nursing schools. However, when the future of nursing
education is looked into, research efforts are expected. Whenthe nurse teachers conduct research, the following issues arethought to be stressors: no budget, insufficient support system
for research activities, lack of teachers’ research abilities,
etc. It is also said that nurse teachers even in university havechallenges in making time for research and progressing inresearch.18)

2. Stressors associated with roles in organizations

The institutions to provide basic nursing education are
workplaces of nurse teachers, and they are various schools suchas universities, junior colleges, vocational schools, and highschools. Depending on the institutional entity and educational
philosophy of the school organizations where nurse teachers
belong, stressors can occur from ① role, ② future andprospect, ③ autonomy, and ④ research activities.

While nurse teachers engage in educational activities
with their own roles and responsibilities, 90% of them haveanxieties, and many teachers fall into burnout.19) According
to Inaoka, burn-out rates of nurse teachers are 6.2 % in
nursing universities, 10.2% in nursing colleges, and 16.3%
in nursing schools, and the high burnout rate in nursing
schools is caused from the issues in the schools such asvague education, organizational issues, and ambiguous rolesof teachers.20) Stressors resulting from nurse teachers’ work

① Roles in nursing school:

There are particular stressors in nursing schools. Stressors
associated with their roles in the organizations are generallyclassified into role ambiguity and role conflict.
With respect to role ambiguity, while educational
24

This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.

Yearbook on Journal of the Japan Society of Nursing Research 2013itself and their roles within the organizations mentioned
above are considered to be factors of burnout.

class performance; practical training guidance; educational
improvement; study of teaching materials; research guidance;
educational guidance; dealing with issues; teacher’s role
performance; coordination with other occupations; andclarifying perspectives on education.26) Although thoseskills are necessary requirements for nurse teachers, fromanother perspective, nurse teachers face pressures fromthose many requirements, which can be stressors. Hayashi
has found that nurse teachers who feel job satisfaction are
75.2% in universities; 62.3% in colleges; 59.2% in nursing
high schools; 56.7% in two-year nursing schools; and 51.3%
in three-year nursing schools, and nurses who were more
motivated to become nurse teachers tended to have higher
satisfaction.27) It would appear to be necessary for nurse
teachers to contemplate how they will develop their careers.

3. Stressors from interpersonal relationships at work

As for stressors of interpersonal relationships, relationships
with students are raised at first. Issues seen in students are:poor social development; few interpersonal experiences todevelop mind and ability to make their living; attitude tochoose enjoyment, rather than effort toward their goals; lackof patience for accomplishment; blaming others, rather thanreflecting on themselves; poor emotional control, etc.21)
In that case, those students need personal development
before professional education, and this brings difficulty for the
involvement of nurse teachers, which can become educational
stressors for nurse teachers. It is time consuming to solve
those associated issues, and this would become a pain for
the nurse teachers, which can also be educational stressors.
Secondly, relationships with their bosses and colleagues
at work can be stressors. It is considered that the differencein education background could enhance nurse teachers’
competitive consciousness, and there is a lack of cooperation
and unity among them. Although nurse teachers are involvedin professional education, many do not have university
education. They feel a sense of inferiority and inadequacy,
and it is difficult for them to receive continuous education forcareer development, which is causing stressors. In addition,
stressors can be associated with whether nurse teachers
have bosses or seniors as role models for nurse teachers,
and receive their guidance and support. Relationships with
doctors, as well as patients and instructors in nursing practicefacilities can also become stressors. Stressors would bestronger if nurse teachers have more students with problems.

5. Stressors from issues of organizational structure and climate

A survey from the Japanese Nursing Association research
department produced 21 items related to issues on
educational activities to ask nurse teachers, and reported
the 8 items which more teachers in any nursing training
courses pointed out: “a large number of students”, “shortageof school budget”, “teachers’ requests are not reflected onschool budget”, “lack of research funding for teachers”, “notime for own research and training”, “too many tasks otherthan teaching and the related educational tasks”, “low salaryfor nurse teachers”, and “lack of skills and qualifications asteachers”.1) Many other issues were also described in thecomment space on the survey. Nurse teachers in universities
and colleges raised more issues about curriculums andsystems that were related to educational contents. On theother hand, teachers in the two-year, three-year, and nurse
assistant courses, raised more issues associated with school
management as well as their own concerns and complaints.
The combination of organizational structure and climate, andpersonal issues is suggested to be stressors among nurse
teachers in nursing schools.

4. Stressors from career development issues

Even a nurse teacher who has a good career as a nurse
can have significant stress. Michael mentions that firstyear teachers may experience reality shock in an unknown
world.22) It is considered that beginning teachers are shocked
by the difference in demands and roles between a nurse
teacher and a nurse, when becoming a nurse teacher froma being only a nurse. Marcy states that, in reality, beginningteachers receive limited protection from the management
side and instructional supports related to skill development,
despite the reality shock of entering the academic world fromthe clinical field.23) Suzuki has pointed out some beginningteachers’ complaints, such as “Less salary”, “Less free time”,
and “Frustration from being behind medical development by
being away from clinical areas”.24)
The problems of students related to nursing education
are found in “the Heisei 13 year (2001) Nursing Education
Workshop”, and they are: “inadequate skill acquisition innursing practice”; “undeveloped basic knowledge to be a
medical professional”; “undeveloped basic knowledge to be
an advocate for a patient”; and “lack of communication skills
with patients “, etc.25)

6. Stressors from common problems at home and work

By becoming a nurse teacher from being a nurse, a low
salary with the workload and increase in self-pay burden has
been pointed out as their distress associated with working
conditions and salary.28)
After the review on the six concepts of stress among nurse
teachers, the following conceptual frameworks of 10 factors
are presumed to be reasonable: ① Work content, ② Workload,③ Role, ④ Future and Prospects, ⑤ Autonomy, ⑥ Research
activities, ⑦ Relationship, ⑧ Career development, ⑨ Workclimate, and ⑩ Working condition and Salary.

III. Research Method

After the presumption of the conceptual framework basedon the literature study, a pilot study was conducted to prepare
the draft of stress items, and the main survey was further
taken to develop a stressor scale (Table 1).

Needless to say, the basic solution to solve those issues isenhancement of nurse teachers’ own skills and qualifications
to establish nursing educational activities. Ito et al haveinductively identified skills and capabilities required to benurse teachers, which are associated with: curriculum design;

1. Pilot study

1) Preparation of draft questions

In June 2001, the conceptual framework of the 10 factors

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Yearbook on Journal of the Japan Society of Nursing Research 2013

Table1. 3 stages for developing a stressor scale
Stage
1

2

3

PurposePresumption of conceptual
framework of stress

Pilot study for drafting stress
items

Main study for developing a
stressor scale

Literature review

MethodOpen questionnaire survey about 10 factors (100 nurse
teachers, 50 responses from university, college, and vocational
school across the country)
Content validity and surface validity assessments

Questionnaire survey among nurse teachers across thecountry[stressor questionnaire, Burnout scale, STAI, Attribute](450 nursing teachers in nursing schools across the country,
Assessment of:Factor analysis
Response distribution bias
Discriminant validity
Criterion-related validity
Reliability of scales

Presumption of 10 stressor factors
13 factors 212 items selected
13 factors 169 items selected

9 factors, 57 items determined fora stressor scale

listed above was presented to 50 nurse teachers (employeesof the basic nursing educational institutions: universities,
colleges, and vocational schools across the country).
They were asked to describe and itemize stress matterscorresponding to each factor, and a total of 636 responses
were obtained. By reviewing the responses, 13 component
factors of stressors were suggested to be more reasonable
than 10 factors. The factors were further subdivided asfollows:① educational content, 13 items, ② teaching methods,
15 items, ③ faculty organization, 21 items, ④ educational
environment, 10 items, ⑤ qualifications and skills as teachers,
31 items, ⑥ future and prospects of nursing education,
14 items, ⑦ autonomy, 7 items, ⑧ research, 14 items,⑨ workload and work quality, 13 items, ⑩ relationships
with students, 18 items, ⑪ relationships among teachers,
29 items, ⑫ relationships with patients and instructors, 7
items, ⑬ working condition and salary, 18 items. The draft
questionnaire consisted of 210 items.

agree”, and “do not agree at all”. When the data was being
processed, up to 4 points were scored based on the strength ofagreement. The scores ranged from 1 point for “do not agree
at all” to 4 points for “strongly agree”.
2. Main study

1) Distribution of questionnaire

Subjects for the survey were nurse teachers working
in nursing schools across the country. A stratified random
sampling method was used from the ratio of three-year
and two-year nursing schools. The questionnaires were
distributed to 450 nurse teachers in 208 facilities out of 884
nursing schools.
2) Ethical considerations

A written request for the survey was sent to the school
executives and nurse teachers in nursing schools. In therequest, the following items were addressed: the purpose of
the study; the survey method; voluntariness of participation;
anonymity of participants by removing all names to ensure
privacy protection; and publication of the study. Based on
their agreement with the contents, the potential participants
were asked to complete the survey and return their answer
sheet in the enclosed envelope.

2) Assessment of content validity

Two researchers in the nursing field examined thecontents of the 210 items to find any duplication of contents,
deficiencies in measurement items, and ambiguities in thedescriptions. As a result, the draft containing the 210 items
was revised to have the 13 factors consisting of 169 items.
3) Assessment of surface validity

Using the revised draft, the stress survey was conductedamong three nurse teachers with more than 10 years of
nursing education experience (one teacher in age 30s andtwo teachers in age 40s, who attended the teacher training
session). During the survey, they were asked to find similar
items, and contents and descriptions difficult to understand,in order to evaluate the usability of the survey. The averagetime spent to answer the questions in the entire survey was
25 minutes.
Based on their findings, the question items were further
revised, and the final version of the questionnaire contained
13 factors consisting of 169 items. To measure the degreeof concern about each item, a scale of four choices to selectanswers was also added into the questionnaire, and the
choices were: “strongly agree”, “somewhat agree”, “slightly

Result3) Background survey of the subjects

To understand the background of the participants,
questions about the following items were asked: age; gender;course section; institutional entity; job title; final education(general, professional); attendance of the training session(yesor no); years of clinical nursing experience; and years of
nursing education experience.
4) Burnout scale and STAI (State Trait Anxiety Inventory)26

In addition to the stressor questionnaire, Burnout scale and
STAI surveys were conducted to examine criterion-related
validity. A burnout questionnaire was used to measureburnout, and this was developed by Tao, based on the Maslach
Burnout Inventory (MBI), consisting of 2 factors (“emotional
exhaustion factor” and “personal accomplishment factor”)

This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.

Yearbook on Journal of the Japan Society of Nursing Research 2013

(5) Assessment of reliability of scaleswith 21 items.29) 30) It has a 7-point Likert scale with response
options ranging from “Always” to “Never”, and a score of morethan 4 points indicates burnout. STAI is a Japanese version of
Spielberger’s State-Trait Anxiety Inventory (STAI), developed
by Shimizu et al.31) 32)
The STAI is designed to measure the temporary or
circumstantial condition of “state anxiety”, associated withthe arousal of the autonomic nervous system, and, “trait
anxiety” which is referred to as the tendency to perceive
stressful situations. Because of the long-standing personality
characteristics related to anxiety, the trait scale of the STAI
was used in this present study. In the trait scale, emotional
states are evaluated from 20 anxiety-related items, and the
response options with scores are: Never, 1 point; Sometimes,
2 points; Often, 3 points; and Always, 4 points. Higher scoresindicate a tendency to feel anxiety. In order to use thosescales, permission from the authors was obtained.

Internal consistency was assessed by calculating the
Cronbach α coefficients for every overall scale and subscale.
7) Statistical processing

In order to analyze the data results, statistical software
SPSS (Ver.10 for Windows) was used to calculate the factor
analysis, Pearson’s product-moment correlation coefficient,
Cronbach’s α coefficient, etc.
IV. Results

1. Background of the subjects

Out of the total of 450 nurse teachers who were sent
the questionnaires, 227 of them responded to the survey(response rate 50.4%). The average age of the researchsubjects was 41.9 years (SD = 7.1). Their average years ofclinical nursing experience and nursing education experience
were 9.9 years and 8.7 years, respectively (Table 2).

5) Survey period and method

From October 18 to November 20 in 2001, a mail survey
was conducted.
6) Analytical method

2. Assessment of factorial validity(1) Assessment of factorial validity

A factor analysis for the total 169 items of responses
from the 227 nurse teachers was conducted. Since the 13
factors were predicted previously, the number of factors
was set up at 13 for the factor analysis. The analysis was
repeated accordingly by decreasing the number of factors.
The following criteria for determining the validity of theitems were applied: eigenvalues ≥ 1, factor loadings ≥ 0.4,
and interpretability.
From the results of assessment using the primaryfactor method and varimax rotation, 9 stress factors wereconsidered reasonable. By excluding the residual items fromfurther assessment, the factor structure was determined tobe the 9 factors (Table 3).
The 9 factors were found to comprise of a total of 57
items: 1st factor, 8 items; 2nd factor, 8 items; 3rd factor,
8 items; 4th factor, 7 items; 5th factor, 6 items; 7th factor,
5 items; 8th factor, 5 items; and 9th factor, 4 items. The
cumulative contribution rate for the 57 items was 59.5% of
the all items (169 items) included in the survey questionnaire.

Factor analysis (Principal Factor Method, maximum
likelihood method, principal component method, eachvarimax rotation) was used to examine the factorial
validity of the stressor items. The process was repeateduntil an acceptable and interpretable factor structure wasobtained. The criterion for determining the items was theinterpretability of the factor with a minimum required
eigenvalue of 1 and factor loading of 0.4.
(2) Assessment of response distribution bias

In order to exclude the items having extreme response
distributions, the response distribution for each item wasassessed. In addition, normality of distribution for the
stressors scores of the nurse teachers was tested using
kurtosis and skewness.
(3) Assessment of discriminant validity

The 1st factor had contents related to student guidance, andit was named the “dealing with students” factor from the 8item contents such as “guidance to self-centered students”,“guidance to difficult students”, “lifestyle guidance to students
who do not have social skills”, and “dealing with students who
have problems”.
The 2nd factor was related to the social environment at theworkplace, and named the “work environment” factor fromthe 8 items such as “work environment to speak freely andopenly”, “obtaining guidance and advice from boss in case ofissues at work”, “being recognized and evaluated by boss”,
and “having opportunities to demonstrate own abilities andskills”.
The 3rd factor had contents essential to teachers’
qualifications such as empathy, heart, enthusiasm, sense of
mission. This was named the “teachers’ qualification” factor
from the 8 items such as “accepting and understanding
students’ feeling and thought”, “teaching students with heart,”

For assessment of discriminant validity, good-poor analysis(GP analysis) was used to determine item discrimination ofeach stressor item. Based on the total scores of the stressscale, the items were divided into four groups, and thedifference in the averages of scores for good and poor groups
was examined for every item.
(4 ) Assessment of criterion-related validity

In the present study, three types of scores were obtained
from the stressor scale in this study, the burnout scale andthe trait scale of STAI, which had been developed based on asimilar theory of the conceptual framework in this study. In
order to find correlation between the scores from the scales,
the Pearson’s correlation coefficient was used to assess thecriterion-related validity.
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Yearbook on Journal of the Japan Society of Nursing Research 2013

Table 2. Background of the subjects
Attribution classification
Age
Sex
CourseClassification

41~50

51~60
61 or over1

Female216

2-year course
N/A

64

Male

11

3-year course

162
1

Attendance of
training session
Clinical nursing
experience(years)

Nursing education
experience (years)( 0.4)(95.2)( 4.8)(71.4)(28.2)( 0.4)(12.8)

Japanese Red Cross3( 1.3)

61
37

Social Welfare Organization, Welfare Federation of Agricultural
Cooperative,and Hokkaido Social Work Association

16

Medical association

19

Employees’ Pension Welfare Corporation Seamen’s Insurance Association
National Federation of Health Insurance Societies, and Mutual Aid
Association, and Federation of Social Insurance Association

9

6

Dean and Director of Academic Affairs Office
Full time teacher( 4.0)( 8.4)( 2.6)( 1.8)( 8.8)(0 )30(13.2)

152(67.0)

4

High school graduate
Junior college graduate( 7.0)

4

189

Others

(16.3)(11.9)

0Vice President(26.9)

27
20

President

Professional(13.2)

29

Medical corporation

General( 2.6)(42.7)

National government

School Corporation
OthersFinal education(41.0)

30

Municipal Government

Job title

93

97

Prefectural and city governments

Institutional Entity

Rate(%)

6

Below 30

31~40

29

(83.3)( 1.8)(12.8)

University graduate

42(18.5)

Nursing schools

157(69.2)

Health sciences, Midwifery degree28(12.3)

Yes
No

195

(85.9)

11~20
21 or over75

Master’s graduate

2

N/A

2

Junior college

28

University graduate

11

Master’s graduate

2

Others1

32

Below 5

( 0.9)( 0.9)(12.3)( 4.8)( 0.9)( 0.4)(14.1)

45(19.8)

6( 2.6)

6~10

101

Below 22~3

1233

(14.5)

11~2050(22.0)

4~5

34

6~10

85

21 or over

N=227

Number of people

1328This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.

(44.6)(33.0)( 5.3)(15.0)(37.4)( 5.7)

Yearbook on Journal of the Japan Society of Nursing Research 2013

Table 3. Factor Analysis Result of Stressor Scale for Nurse Teacher
Factors

Items

1

2

3

4

5

6

7

8

9

1. guidance to self-centered students.715 .008 .223 .108 .009 .182 .123 .001 .155
2. guidance to difficult students.715 .106 .294 .130 .010 .107 .296 -.006 .008
3. lifestyle guidance to students who do not have social skills.705 .139 .007 .198 .271 .163 .141 .008 .100
4. dealing with students who have problems.684 .118 .282 .114 .139 .180 .234 -.000 .005
5. guidance to students who need counseling.620 .140 .003 .179 .330 .132 .137 .118 .007
6. guidance to students who do not respond to teachers’ effort.618 .196 .264 .009 .112 .115 .158 -.002 .005
7. guidance to passive students.586 .147 .008 .217 .263 .139 .199 .220 .136
8. guidance to students who have a low tolerance for stress.579 .164 .103 .174 .294 .193 .008 .009 .118
1. work environment to speak freely and openly.007 .698 -.006 .006 .189 -.000 .227 .002 .010
2nd Factor:
2. obtaining guidance and advice from boss in case of issues at work.005 .656 .169 .128 .010 .008 .008 .115 .131
Work
environment 3. being recognized and evaluated by boss
.008 .645 .112 .008 .007 .010 .008 -.002 -.003
4. having opportunities to demonstrate own abilities and skills.168 .639 .256 .223 .121 .000 .106 .003 .142
5. understanding and respecting between teachers.112 .627 .137 .005 .010 .008 .102 .009 -.004
6. giving and receiving positive feedback and support between teachers .005 .614 .008 .006 .002 .204 .156 .105 .108
7. being assigned for work based on own Skills.199 .606 .186 .207 .140 .003 .010 .002 .168
8. having own role and contributing at Work
.253 .455 .250 .280 .199 .007 .010 .004 .212
1. accepting and understanding students’ feeling and thought.220 .224 .685 .110 .192 .137 .010 .004 -.005
3rd Factor:
2. teaching students with heart.228 .222 .681 .169 .205 .110 .008 .006 -.008
Teachers’qualifications 3. having enthusiasm about nursing education.187 .166 .602 .191 .008 .119 .002 .272 .138
4. paying attention to students’ responses in class.304 .252 .590 .173 .118 .166 .130 -.003 .178
5. cultivating the essence of nursing.007 .006 .578 .167 .160 .179 .006 -.000 .299
6. performing discipline as teacher.212 .008 .544 .292 .197 .193 .158 .130 .296
7. having confidence in own physical strength.119 .325 .456 .173 .005 -.001 -.005 .213 .006
8. having awareness of own role as teacher and possessing a sense of mission .317 .124 .416 .340 .287 .008 .218 .009 .244
1. completing tasks during regular working hours.141 .108 .009 .701 .005 .009 .009 .005 -.002
4th Factor:
2. preparing for lectures and practice training during regular working hours .008 .003 .124 .639 .005 .139 .180 .151 .126
Workload
3. doing endless work with patience.180 .208 .269 .597 .202 .235 -.000 .105 -.004
4. having necessary time to complete Work.006 .150 .002 .571 .007 .124 .002 .009 .146
5. over time working and working not during regular working hours.222 .116 .203 .563 .008 .001 .001 .009 -.001
6. preparing for satisfying educational contents and methods.126 .144 .210 .543 .108 .145 .206 .132 .193
7. always balancing between workload and quality.201 .265 .299 .478 .234 .009 .135 .228 .008
1. being responsible in case of trouble from temporary instructors .180 .312 .146 .104 .784 .183 .003 .003 .003
5th Factor:
assigned to give guidance and instruction in nursing practice
Dealing with
2. identifying causes of students’ troubles during training.205 .239 .010 .132 .770 .191 .008 .102 .009
problems
3. dealing with problems in case of misdirection in nursing practice from clinical side .198 .148 .237 .227 .707 .110 .160 .114 -.003
4. Dealing with disagreement with head nurse.316 .111 .146 .005 .583 .149 .162 .004 .181
5. promptly dealing with problems caused by students during practice training .288 .000 .215 .148 .541 .210 .127 .007 .229
6. dealing with disagreement between students and training instructors .275 .112 .191 .006 .508 .292 .151 -.004 .009
1. guidance leading students to deep thinking.185 .006 .010 .114 .168 .818 .003 .001 .165
6th Factor:
2. guidance motivating students.251 .006 .010 .010 .182 .804 -.001 .000 .009
Educational
methods
3. guidance developing independency of students.213 .005 .005 .140 .009 .783 .007 -.007 .106
4. guidance for activities in small group.108 .133 .124 .126 .141 .715 .008 .005 .005
5. studying educational contents before class.001 .149 .220 .360 .007 .448 .135 -.001 .003
6. guidance for gaining nursing Skills.008 .137 .162 .147 .240 .439 .106 .158 .006
1. interacting with teachers having emotional responses.260 .206 -.000 .133 .008 .007 .829 .008 .005
7th Factor:.235 .213 .009 .008 .172 .007 .802 .167 .104
Relationships 2. cooperating among teachers having different goals and valuesamong
3. dealing with teachers having various tendencies.240 .139 .007 .118 .189 .005 .742 .226 .128
teachers
4. dealing with assertive teachers.173 .197 .009 .164 .009 .009 .684 .002 .006
5. considering relationships with Colleagues.146 .367 .254 .009 .003 .009 .449 .007 -.001
1. having advisers for research-.002 .004 .006 .007 .005 -.001 .008 .915 .006
8th Factor:
2. research fund is being distributed to conduct research.003 .004 .009 .148 .005 -.002 .119 .800 .004
Research
Resources
3. having a research field.006 .002 .006 .004 .005 -.004 .005 .793 .104
4. receiving support and guidance system for teacher’s career progress .006 .227 .006 .310 .125 .190 .157 .423 .007
5. Participating in seminar and academic conference as business trip
.007 .010 .009 .199 .001 .101 .008 .410 -.196
1. evaluating educational activities.258 .257 .172 .146 .007 .197 .157 .008 .665
9th Factor:
2. using theory in practical training guidance.177 .195 .268 .008 .135 .239 .007 .009 .594
Improvingteaching
3. evaluating curriculum.299 .309 .004 .247 .223 .135 .131 -.000 .479
skills4. planning to expand concepts and theories in class.153 .007 .107 .368 .269 .229 .143 .002 .400
9.0 8.0 7.0 7.0 6.8 6.7 6.0 5.3 3.6
Contributing rate
Cumulative contribution rate (%)
9.0 17.0 24.1 31.0 37.9 44.6 50.6 55.9 59.5
1st Factor:
Dealing withstudents

29
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Yearbook on Journal of the Japan Society of Nursing Research 2013

Table 4. GP Analysis of Stressor Items for Nurse Teachers

Subscale

Dealing with students

Work environment

Teachers’ qualifications

Workload

Dealing with problems

Educational methods

Relationships withteachers

Research resources

Improving teaching skills

1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
1
2
3
4
5
1
2
3
4

Number of respondents who “strongly feel stress”
Good group
Poor group
Comparison of difference
N=56
N=56
t test(average score)(average score)1(2.39)38(3.64)
11.8602(2.30)44(3.75)
13.3165(2.43)46(3.82)
12.5521(2.39)46(3.79)
13.9325(2.48)49(3.88)
12.5224(2.41)44(3.77)
11.9790(2.29)42(3.75)
15.9594(2.32)35(3.63)
11.5342(2.00)17(3.02)
7.234
1(1.95)23(3.25)9.554
2(1.93)16(3.02)7.402
0(2.00)15(3.13)10.6881(2.05)14(3.04)7.805
2(1.96)16(3.05)7.755
1(2.09)15(3.14)9.314
1(2.23)29(3.48)
11.5680(1.61)13(2.89)9.646
0(1.55)12(2.89)
10.1910(1.98)24(3.21)9.270
0(2.11)25(3.38)
11.3432(2.09)20(3.05)
6.247
0(1.95)24(3.34)
12.3160(2.02)22(3.13)7.735
0(1.96)27(3.43)
14.0116(2.48)39(3.66)
9.389
8(2.46)45(3.77)
9.194
3(2.36)44(3.71)
11.58311(2.66)
41(3.64)6.639
3(2.25)29(3.39)
8.198
3(2.20)33(3.52)
10.4961(2.04)30(3.48)
12.7070(1.88)36(3.54)
12.7750(1.86)32(3.46)
12.2760(1.91)31(3.41)
11.1145(2.41)46(3.79)
11.1335(2.34)37(3.61)9.246
3(2.02)33(3.50)
10.8973(2.36)36(3.54)8.837
5(2.43)38(3.64)
9.122
11(2.63)40(3.66)
7.319
2(2.18)20(3.23)
7.800
4(2.30)26(3.36)7.269
1(2.00)20(3.07)7.335
13(2.64)42(3.73)
7.687
7(2.48)41(3.73)9.717
6(2.30)38(3.66)
10.21213(2.59)
36(3.64)7.401
4(2.20)21(3.23)
7.909
13(2.41)
33(3.29)
4.276
8(2.20)31(3.25)
5.398
11(2.41)31(3.25)4.400
4(2.20)36(3.52)8.594
5(1.70)13(2.59)
4.695
2(2.21)28(3.48)
11.2083(2.30)30(3.50)9.600
1(2.34)33(3.54)
10.4366(2.41)34(3.61)
9.494

testing

***
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***
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***
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***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
***
t test ***p<.001

30This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.

Yearbook on Journal of the Japan Society of Nursing Research 2013

5. Assessment of criterion-related validity“having enthusiasm about nursing education”, and “paying
attention to students’ responses in class”.
The 4th factor was related to time, workload, work quality,and endless work, and it was named the “workload” factor
from the 7 items such as “completing tasks during regular
working hours”, “Preparing for lectures and practical training
during regular working hours”, “doing endless work withpatience”, and “having necessary time to complete work”
The 5th factor was related to dealing with problems,
and this was named the “dealing with issues” factor fromthe 6 items such as “being responsible in case of trouble
from temporary instructors assigned to give guidance
and instruction in nursing practice”, “identifying causes ofstudents’ troubles during training”, “dealing with problems
in case of misdirection in nursing practice from clinical side”.
The 6th factor was associated with the educational methods,
and it was named the “educational methods” factor from the
6 items such as “guidance leading students to deep thinking”,“guidance motivating students”, and “guidance developing
autonomy of students”
The 7th factor was particularly about relationships between
teachers, and this was named the “relationships among
teachers” factor, from the 5 items such as “interacting withteachers having emotional responses”, “cooperating among
teachers having different goals and values”, and “dealing withteachers having various tendencies”.
The 8th factor was named the “research resources” factor
from the 5 items such as “having advisers for research”,“research fund is being distributed to conduct research”, and“having a research field”.
The 9th factor was named the “improving teaching skills”
factor from the 4 items such as “evaluating educational
activities”, “using theory in practical training guidance”,“evaluating curriculum”, and “planning to expand concepts
and theories in class”.

A high positive correlation was observed between thescores from the 57 stressor items and both scales: the burnout
scale r=.558(p<.001), and trait scale of STAI r=.542(p<.001).
The burnout result was the following: no burnout with scores< 3 (72 teachers, 31.7%); mild burnout with scores ≥3 or < 4(81 teachers, 35.7%); and burnout with scores > 4 (74 teachers, 32.6%)
6. Assessment of reliability

Reliability coefficient (Cronbach α factor) for each stressor
factor was in the range of 0.82 to 0.92, and this showed sufficient internal consistency for each of the 9 factors (Table 5).
V. Discussion

1. Reliability and validity of the developed stressor scale

In this study, a stressor scale was developed to measure
work stress factors among nurse teachers in nursing schools.
In the process of preparing a questionnaire consisting of 13
factors and 169 items, the literature review, pilot study on
50 nurse teachers, and assessment of internal validity andexternal validity were performed, in order to select the final
items. Through the process, appropriate stress items for nurse
teachers were obtained. The questionnaire was distributed to
450 nurse teachers, and responses were obtained from 227
nurse teachers. As a result of assessment using factor analysis,
9 factors, 57 items (4 to 8 items for each factor) were determined to be valid.
In the factor analysis, while the criteria were set at: eigenvalues ≥ 1, factor loadings ≥ 0.4, the eigenvalues for more than
10 factors were lower than 1, and those factors were excluded.
In addition to the process of factor analysis, 9 factors wereconsidered to be reasonable from the interpretability of thenumber of items in each factor and their contents. The cumulative contribution rate of 9 factors with 57 items was 59.6%,
and this indicates that the scale finds approximately 60% of
the stress conditions for nurse teachers.
This scale was found to be related to the Maslach Burnout
Inventory (MBI) and State-Trait Anxiety Inventory (STAI). The
MBI scale is used to measure burnout. Burnout is caused bylong-term stress beyond the coping capacity of an individual,
and it is an emotional and physical condition marked by tiredness and loss of interest after the tension is loosened. The
high positive correlation between stressors and burnout was

3. Response distribution bias

Regarding the 57 items extracted by the factor analysis, thehighest possible score indicating maximum stress intensity
and the lowest possible score indicating minimum stressintensity for all the items were 228 points and 57 points,
respectively. As for the results of this study, the highest
and the lowest scores for the 57 items were 223 points
and 77 points, respectively. The average score was 160.6(SD=27.2) points. In addition, the kurtosis was -0.194 andthe skewness was -0.092. Kurtosis is the degree of peakednessof a distribution, and skewness quantifies how symmetricalthe distribution is compared with the normal distribution.
When both the absolute values exceed 10, the distribution
is not within the acceptable range of a normal distribution.
Both the values in this study, however, were less than 10.
Therefore, it was decided to exclude no items, and all of the
57 items were accepted.

Table 5. Factor Analysis Result of Stressor Scale and reliability
Items
Factors
1st Factor:8 Dealing with students
2nd Factor:8 Work environment
3rd

4. Assessment of discriminant validity

4th

To assess discriminant validity, good-poor analysis (GPanalysis) was conducted on each stressor item which was
obtained from the factor analysis. The result has shown thatthe level of significant difference was 1% among all the 57
items, which indicated adequate discriminative power, andall the items cannot be rejected (Table 4).

5th

6th

7

th

8th

9th

Factor:8 Teachers’ qualifications
Factor:7 Workload

Factor:6 Dealing with problems

Factor:6 Educational methods

Factor:5 Relationships among teachers

Factor:5 Research Resources

Factor:4 Improving teaching skills

31This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.

Cronbach α factor
0.92
0.88

0.89
0.86

0.90

0.88
0.90

0.82
0.82

Yearbook on Journal of the Japan Society of Nursing Research 2013

observed, and this indicates that nurse teachers who havestrongly recognized stressors are more likely to suffer burnout.
The measurement of trait anxiety of the STAI is to examine
the arousal of anxiety under the stress conditions. The positive correlation between trait anxiety and stressors found in
this study implies that nurse teachers with high anxiety would
strongly feel stressed. Thus, since the stressor scale developedin this study was correlated with the burnout and trait anxiety
measurements, this scale appears to be a valid measurement
for stress.
In addition, the Cronbach’s α coefficients of each stressfactor obtained in this study were 0.82 to 0.92. This indicateshigh internal consistency between the items included in eachof the 9 factors, and ensures reliability. Therefore, the stressor
scale consisting of the 9 factors and 57 items in the questionnaire is proposed as a measurement for stressors amongnurse teachers.

When they were practical nurses, patient support and nursing
care were actual practices. As nurse teachers, however,they are required to deal with and teach students while
understanding and corresponding to each individual student.
This comes to educational activities for everyday, which
can be stressors. Similar items were causing great stress toteachers in general.34) It is pointed out that the popularizationof universities led to lower the quality of students,35) andteachers in any educational institution cannot avoid the effort
required in dealing with students and developing teaching
methods to correspond to each individual student, although
this is challenging.
The two factors of ③teachers’ qualifications, and⑨improvement of teaching skills are personal and internal
factors for nurse teachers, and nurse teachers are underpressure to develop and improve their qualifications andskills. By following “Guidelines for managing nursing training
schools”, the qualifications required for nursing school
teachers are: licensed nurse, more than five years of clinicalexperience, and attendance of the nurse teacher training
session. The session is 8 to 12 months nursing education
training of nurse teachers, and this is useful for establishinga basis to become a nurse teacher from being a nurse. Whenselecting enrollees, it would be necessary to find whether sheor he has qualifications and abilities as nurse teachers.
After the session, further continuing education as
nurse teachers is necessary while finding a way for selfdevelopment, in order to improve their qualifications as nurse
teachers. This would be an immediate challenge.

2. Stress factors in the stressor scale and challenges

Although 13 factors was originally proposed as stressfactors among nurse teachers, 9 factors were identified as aresult of the factor analysis. The 9 factors are: ① dealing withstudents, ② work environment, ③ teachers’ qualification,④ workload, ⑤ dealing with problems, ⑥ educational
methods, ⑦ relationships among teachers, ⑧ researchsources, ⑨ improving teaching skills. The other 3 factorsof “educational contents”, “future and prospects of nursing
education”, and “relationship with patients and instructors”
were excluded, and the rest of the original 10 factors werereorganized and integrated into the 9 factors.
First, the three excluded factors can be analyzed. The factorof “education contents” contained only one item, “studying
educational contents before class”, but this item fit into the
6th factor “educational methods” (Table 3).
Educational content is the basis for nurse teachers’
educational activities, and studying educational contents isthe most important for nurse teachers.

The factors of② workenvironment,④ workload,⑤ dealing with problems, ⑦ relationships among teachers,

and ⑧ research resource are external factors surrounding
nurse teachers, and they are situational and environmental
factors. The preferred work environment would be where
nurse teachers can have their own philosophy and passion
for nursing education; build respect and trust each other; andhave warm and open atmospheres to face individual students
closely. However, their work environment is assumed to be
still inadequate.
This indicates that basic nursing education is influenced
by the management idea of the business owners, due to thehistorical background in which basic nursing education was
vocational education in the apprentice system, althoughbasic nursing education is said to be education for a special
profession. It may be necessary to recognize the uniquenessof the nursing education system and culture in developing anurse teacher. Some nurse teachers may also need to improvetheir work environment on their own, in order to respect anddevelop each other. Teachers in general also have concerns
about relationships with their colleagues,38) and this could be
influenced by the characteristics of the teaching job.

The reason for the “educational contents” factor notshowing enough in the survey is, however, unknown. Perhaps
it was not remarked on because the nurse teachers did nothighly recognize the importance of educational contents,or they were much more concerned about classroom
management and relationships with students.
The “future and prospects of nursing education “ factor
seems not to be identified as a stressor factor, probably
because the prediction of the future was uncertain; the nurse
teachers have the possibility of returning to the clinical field;or they do not have enough work motivation to continue
working as nurse teachers and leading nurse education.
With respect to the “relationships with patients andinstructor” factor, patient care and support for nursing
practice instructors would be less likely to be new stressors,since the nurse teachers used to be practical nurses.
Secondly, the 9 factors are analyzed. The two factors of① dealing with students, and ⑥ educational methods arestressors from nurse teachers’ work itself. Those factors
correspond to the findings in Sasaki’s study which has shown
nurse teachers’ concerns about educational methods andguidance to students having problems.33) Factor ① and ⑥ arealso immediate requirements for becoming nurse teachers.

3. Use of the stressor scale for nurse teachers

The use of the stressor scale is described as follows. The
stressor scale would be useful for each nurse teacher to
identify their stressor factors and measure the strength oftheir stress. By doing this, nurse teachers can be objectively
aware of their stress; prevent the stressors; or challenge thestressors positively. In this study, the burnout group has beenfound at a high rate of 32.6%, and this is much higher than one
in the prior literature. Before their burnout becomes serious,
32

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Yearbook on Journal of the Japan Society of Nursing Research 2013

References

some effort could be made by using the information gained
from the stressor scale. In addition, the scale would also be
useful to support beginning nurse teachers. When beginning
nurse teachers are assigned to the basic nursing educational
fields, their bosses can use the stressor scale to understandpossible stressors among the beginning nurse teachers. Theirbosses and senior teachers can also use the scale for stressrelease and guidance support for beginning nurse teachers. In
terms of usefulness for recognition of stressors and support
for beginning nurse teachers, the scale is usable.

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4. Limitations and challenges

The cumulative contribution rate was approximately
60%, and this indicates that the scale found only 60% of all
the stressors among nurse teachers. The social conditions
dramatically change, and this also influences the basic nursing
education. Because of that, nurse teachers are exposed tochange over time, and they will have new stress. Thus, arevision of the stressor scale will be necessary. In addition,a new stressor scale by adding specific issues for nurse
teachers in universities and colleges may be necessary, since
the nurse teachers in nursing schools were the subjects forthe stressor survey in this study. If the stressor scale is further
developed, this will be the objective indicator to identify anddifferentiate stressors among nurse teachers in universities
and nursing schools. In the future, the stressor scale would
need to be developed in order to enhance inclusiveness andbe applicable to all nurse teachers.
VI. Conclusion

The stress survey consisting of 169 items was conducted
on 450 nurse teachers in nursing schools across the country.
As a result of factor analysis of the data from 227 teachers’
responses, 9 stressor factors consisting of 57 items (4 to8 items for each factor) were obtained. The 9 factors are:“dealing with students”, “work environment”, “teachers’
qualifications”, “workload”, “dealing with problems”,“educational methods”, “relationships among teachers”,“research resources”, and “improving teaching skills”. The
questionnaire was prepared with a scale of four choices tomeasure the degree of the 57 stressor items for each nurse
teacher, and this was proposed as a stressor scale for nurse
teachers.
Acknowledgment

I would like to thank the nurse teachers who gave theirtime to participate in the study. This is a revised study which
was originally conducted during my master’s program at
Toyama Medical and Pharmaceutical University, Graduate
School of Medical Sciences. When I was attending themaster’s program, I received guidance from Professor Shizuko
Takama at Toyama Medical and Pharmaceutical University(currently, working at Japanese Red Cross Hokkaido College
of Nursing). This original study was reported in the 28th
research conference of the Japan Society of Nursing Research(Yokohama, the year of 2002).

33
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This paper was published at “the Japan Society of Nursing Research” Vol.28 No.5 in 2005.