Background: Job stress is a serious health problem in the 21st century because of its high incidence and impact. Nurses are known as a profession that has high risks of stress, has distinctive characteristics, and hence requires a work stress assessment instrument that suits its peculiarities. The Expanded Nursing Stress Scale (ENSS) is a nurse-specific stress assessment instrument that has high validity and reliability (Cronbach's alpha = 0.96) and is widely used in many countries but is not yet available in Indonesian. This study aims to obtain the Indonesian version of ENSS and evaluate its reliability and validity.

Method: We applied the 10 steps of ISPOR's (International Society for Pharmacoeconomics and Outcomes Research) transcultural adaptation method, followed by validity and reliability tests on 104 nurses at a private hospital in Jakarta.

Result: The Indonesian version of the ENSS questionnaire, consisting of 57 items, was obtained. All of the items were valid, with r values ranging from 0.362 to 0.793. Cronbach's alpha was 0.956, and the reliability test value using test-retest was 0.939.

Conclusion: The Indonesian version of the ENSS has proven to be valid and reliable and has excellent internal consistency. The instrument can be used to assess job stress among Indonesian nurses.

Keywords: ENSS; Indonesian; work stress; nurse


  1. Maxon R. Stress in the workplace: a costly epidemic. Fairleigh Dickinson University Magazine. 1999. Downloaded at http://www.fdu.edu /newspubs/magazine/99su/stress.html on 20 November 2016.
  2. Hurrell JJ. Occupational Stress in: Levy BS, Wegman DH, Baron SL, Sokas RK. Occupatioanl health recognizing and preventing work-related disesase injury 6th edition. Oxford University Press. New York. 2011: 295-313.
  3. Smedley J, Dick F, Sadhra S. Oxford handbook of occupational health 2nd ed. Oxford University Press. Oxford. 2013: 307.
  4. Sukmaretnawati C, Rosa EM, Wahyuningsih SH. The influence of nurses' work stress on patient safety implementation behavior in the emergency room at Panembahan Senopati Hospital, Bantul. Magister Thesis. University of Muhammadiyah. Yogyakarta.
  5. Ministry of Health of the Republic of Indonesia. Indonesia health profile 2015
  6. French ES, Lenton R, Walters V, Eyles J. An empirical evaluation of an expanded nursing stress scale. Journal of Nursing Measurement, vol 8, no 2, 2000: 160-79.
  7. Gray-Toft P, Anderson JG. The nursing stress scale: development of an instrument. Journal of psychopathology and behavioral assessment. 1981.3(1):11-23.
  8. Sarafis P, Rousaki E, Tsounis A et al. The impact of occupational stress on nurses caring behavior and their helth related quality of life. BMC Nursing (2016) 15:56.
  9. Damit AR. Identifying sources of stress and level of job satisfaction amongst registered nurses within the first three years of work as a registered nurse in Brunei Darussalam. Queensland University of Technology School of Nursing. Queensland, 2007.
  10. Chun LL. Job satisfaction and stress of nurses and their association with turnover intention rate in an acute public hospital. Pamela Youde Nethersole Eastern Hospital. The HKU Scholars hub. University of Hong Kong. 2013
  11. Milutinovic D, Golubovic B, Brikic N, Prokes B. Proffesional stress and health among critical care nurses in Serbia. Arh Hig Rada Toksikol 2012;63:171-80.
  12. Kim KM, Nam KA, Lee E, Jeong GH. Validity and Reliability of the Korean Version of the Expanded Nursing Stress Scale. Journal of Korean Academy of Nursing Administration /v.21, no.5, 2015 , pp. 542-51.
  13. Mehta RK, Singh IK. Stress among nurses working n critical care areas at tertiary care teaching hospital Nepal. Journal of Chitwan College 2014; 4(10):42-48.
  14. Maslakpak MH, Farhadi M, Fereidoni J. The effect of neuro-linguistic programming on occupational stress in critical care nurses. Iranian Journal of Nursing and Midwifery Research. 2016 Jan-Feb;21(1)38-44.
  15. Andal EN. A pilot study quantifying Filipino nurses perception on stress. Californian journal of health promotion. 2006:l4;(4);88-95.
  16. Retnawati H. Validity, reliability and characteristics of items, a guide for students, researchers and psychometricians . Parama publishing. Yogyakarta. 2016.
  17. Swarjana IK. Health statistic. ANDI publishing. Yogyakarta. 2016: 39-45.
  18. Wild D, Grove A et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value in Health 2005:8;(2)94-104.
  19. Nunnally, Jum C, Jr. Introduction to Psychological Measurement. McGraw-Hill Book Company. New York. 1970.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.