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

  • Laurent, Alexandra1, 2
  • Fournier, Alicia1, 3
  • Lheureux, Florent4
  • Martin Delgado, Maria Cruz5, 6
  • Bocci, Maria G.7, 8
  • Prestifilippo, Alessia8
  • Aslanian, Pierre9
  • Henriques, Julie10
  • Paget-Bailly, Sophie10
  • Constantin, Jean-Michel11
  • Besch, Guillaume12
  • Quenot, Jean-Pierre13
  • Anota, Amelie10
  • Bouhemad, Belaid2
  • Capellier, Gilles14
  • 1 University of Bourgogne Franche-Comté, Dijon, France , Dijon (France)
  • 2 University Hospital of Dijon Bourgogne, Dijon, France , Dijon (France)
  • 3 MSHE Ledoux, University of Bourgogne Franche-Comté, Dijon, France , Dijon (France)
  • 4 Laboratory of Psychology EA3188, University of Bourgogne Franche-Comté,, Dijon, France , Dijon (France)
  • 5 Hospital Universitario de Torrejón, Intensive Care Unit, Madrid, Spain , Madrid (Spain)
  • 6 Universidad Francisco de Vitoria, Madrid, Spain , Madrid (Spain)
  • 7 Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy , Rome (Italy)
  • 8 Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy , Rome (Italy)
  • 9 Intensive Care Unit of Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada , Montreal (Canada)
  • 10 University Hospital of Besançon, Besançon, France , Besançon (France)
  • 11 Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France , Paris (France)
  • 12 University Hospital of Besançon, University of Franche-Comte EA3920, Besançon, France , Besançon (France)
  • 13 Service de Médecine Intensive-Réanimation, University Hospital of Dijon Bourgogne, Dijon, France , Dijon (France)
  • 14 University Hospital of Besançon, University of Franche-Comte EA 3920, Besançon, France , Besançon (France)
Published Article
Annals of Intensive Care
Springer (Biomed Central Ltd.)
Publication Date
Apr 10, 2021
DOI: 10.1186/s13613-021-00846-0
Springer Nature


BackgroundThe intensive care unit is increasingly recognized as a stressful environment for healthcare professionals. This context has an impact on the health of these professionals but also on the quality of their personal and professional life. However, there is currently no validated scale to measure specific stressors perceived by healthcare professionals in intensive care. The aim of this study was to construct and validate in three languages a perceived stressors scale more specific to intensive care units (ICU).ResultsWe conducted a three-phase study between 2016 and 2019: (1) identification of stressors based on the verbatim of 165 nurses and physicians from 4 countries (Canada, France, Italy, and Spain). We identified 99 stressors, including those common to most healthcare professions (called generic), as well as stressors more specific to ICU professionals (called specific); (2) item elaboration and selection by a panel of interdisciplinary experts to build a provisional 99-item version of the scale. This version was pre-tested with 70 professionals in the 4 countries and enabled us to select 50 relevant items; (3) test of the validity of the scale in 497 ICU healthcare professionals. Factor analyses identified six dimensions: lack of fit with families and organizational functioning; patient- and family-related emotional load; complex/at risk situations and skill-related issues; workload and human resource management issues; difficulties related to team working; and suboptimal care situations. Correlations of the PS-ICU scale with a generic stressors measure (i.e., the Job Content Questionnaire) tested its convergent validity, while its correlations with the Maslach Burnout Inventory-HSS examined its concurrent validity. We also assessed the test–retest reliability of PS-ICU with intraclass correlation coefficients.ConclusionsThe perceived stressors in intensive care units (PS-ICU) scale have good psychometric properties in all countries. It includes six broad dimensions covering generic or specific stressors to ICU, and thus, enables the identification of work situations that are likely to generate high levels of stress at the individual and unit levels. For future studies, this tool will enable the implementation of targeted corrective actions on which intervention research can be based. It also enables national and international comparisons of stressors’ impact.

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