title: Measuring neonatal intensive care unit-related parental stress.
abstract: OBJECTIVE
  This paper reports a study: (1) to determine the validity and reliability of the Parent Stressor Scale:Neonatal Intensive Care Unit (PSS:NICU) for use with United Kingdom (UK) parents; (2) compare UK scores with those from a contemporary reference sample from the United States (US), (3) to identify the sources of greatest NICU-related stressors for parents and (4) to identify demographic or situational factors influencing NICU-related parental stress.
  
  
  BACKGROUND
  Evaluation of the adequacy of nursing care and psychosocial support services for parents of ill infants in the NICU requires valid and reliable measures of parental stress. The PSS:NICU is a well-validated scale developed in the US to measure NICU-related parental stress. However, it has not been tested in the UK.
  
  
  METHODS
  Consecutive samples of parents (n = 257) of infants in nine UK NICUs and two reference US units completed the PSS:NICU and the Spielberger State-Trait Anxiety Scale approximately 1 week after admission. Psychometric properties of the PSS:NICU, including internal consistency reliability and construct, concurrent and predictive validity, were evaluated.
  
  
  RESULTS
  PSS:NICU scores were similar in the UK and US samples and high internal consistency reliability was found for all metrics (e.g. Overall Stress: 0.94 for both samples). A three-factor principal components solution accounted for 66% of the variance in the scores, with the items grouped into the three a priori scales specified in the PSS:NICU (Infant Behaviour and Appearance, Parental Role Alterations, and Sights and Sounds). Stress Occurrence and Overall Stress were moderately correlated with State Anxiety in both samples (r = 0.46-0.61, P < 0.001). Thirty-one per cent of the variance in Stress Occurrence in the UK sample was explained by State Anxiety, infant severity of illness score, parent gender, and less frequent visitation.
  
  
  CONCLUSIONS
  The PSS:NICU demonstrated appropriate psychometrics in a large sample of parents from diverse NICUs in the UK. These findings support its wider use in research and clinical practice to identify parental distress and evaluate the effectiveness of nursing care and psychosocial support services for parents.
authors.affiliation: School of Nursing and Midwifery, King's College London; and Institute of Child Health, Centre for Nursing and Allied Health Professions Research, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK. l.franck@ich.ucl.ac.uk
authors.forename: Linda S
authors.initials: LS
authors.lastname: Franck
authors.forename: Susanne
authors.initials: S
authors.lastname: Cox
authors.forename: Alison
authors.initials: A
authors.lastname: Allen
authors.forename: Ira
authors.initials: I
authors.lastname: Winter
mesh_terms: D000328:Adult; D002673:Child, Hospitalized; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D015404:Nursing Methodology Research; D010290:Parents / Q000523:psychology*; D011237:Predictive Value of Tests; D011594:Psychometrics; D013315:Stress, Psychological; D011795:Surveys and Questionnaires