Obse a ional S udy
1
Medicine®
Assessmen o occupa ional isks in nu ses in
Spain
P elimina y psychome ic analysis o he ISTAS_En e me ía
scale
Ángela Na bona-Gál ez, MSca, Regina Allande-Cussó, PhDb,* , Ca los Ruiz-F u os, MD, PhDc,d ,
Diego Ayuso-Mu illo, PhDe, Guadalupe Fon án-Vinage, PhD , Juan Jesús Ga cía-Iglesias, PhDc,
Yolanda Na a o-Abal, PhDg, Ja ie Fagundo-Ri e a, PhDh, José An onio Climen -Rod íguez, PhDg,
Juan Gómez-Salgado, PhDc,d
Abs ac
To adap and e alua e he psychome ic p ope ies o he SUSESO/ISTAS21 ques ionnai e o nu ses in Spain. C oss-sec ional
s udy o he c oss-cul u al adjus men and psychome ic alida ion o he COPSOQ-ISTAS21 scale. Desc ip i e analyses we e
conduc ed, and da a was co ela ed. A con i ma o y ac o analysis was pe o med, hus assessing he eliabili y and c i e ion
alidi y. The sample consis ed o 2757 Spanish nu ses. The explo a o y ac o analysis iden i ied a 5- ac o s uc u e wi h 15 i ems,
which explained 63.6% o he a iance. The ac o s we e named: Suppo a wo k; Job sa is ac ion; Wo k- ela ed emo ional
well-being; Job insecu i y; and Double p esence. The in e nal consis ency o he ques ionnai e, measu ed by C onbach alpha
and McDonald omega coe icien , was adequa e, wi h alues o 0.764 and 0.741, espec i ely. The esul s o he con i ma o y
ac o analysis indica ed a good model i . Th ee le els o psychosocial isk (low, in e media e, and high) we e iden i ied based
on pe cen iles and qua iles o mean sco es. The adap ed e sion o he SUSESO/ISTAS21 ques ionnai e showed eliable
psychome ic p ope ies in Spanish nu ses, making i a alid and obus ool o assessing psychosocial isks in his g oup.
Abb e ia ions: CFI = compa a i e i index, COPSOQ = Copenhagen Psychosocial Ques ionnai e, EFA = explo a o y ac o
analysis, ISTAS = Ins i u o Sindical de T abajo, Ambien e y Salud, RMSEA = oo mean squa e e o o app oxima ion, SUSESO =
Supe in endencia de Segu idad Social, TLI = Tucke -Lewis index.
Keywo ds: ac o analysis, nu ses, psychosocial isks, scales, Spain, s a is ical, alida ion s udy, wo kplace s ess
1. In oduc ion
Psychosocial isks in he wo k en i onmen a e de ined as a se
o ac o s ha can be de imen al o he men al and physical
heal h o wo ke s.[1] These isks ange om wo k o e load and
high in ensi y o emo ional demands, o lack o wo k au on-
omy, insu icien pee suppo , and abusi e wo king condi ions
in he wo k en i onmen .[2] Psychosocial isks a e pa icula ly
p e alen in heal hca e p o essions, gi en he demanding and
s ess ul na u e o he jobs, which a e cha ac e ized by long
wo king hou s, high p essu e, and cons an con ac wi h human
su e ing.[3]
In pa icula , nu ses ace speci ic psychosocial isks ha can
a ec bo h hei pe sonal well-being and he quali y o ca e
hey p o ide o pa ien s.[4] These include wo k o e load, ole
con lic s, lack o clea ly de ined esponsibili ies, ha assmen a
wo k, and insu icien o ganiza ional suppo .[5] These ac o s
no only di ec ly in luence he men al heal h o nu ses, bu can
also a ec hei p o essional p ac ice and, consequen ly, he
quali y o ca e p o ided.[6] Se e al ecen s udies highligh how
psychosocial isks in he wo kplace nega i ely a ec nu ses’
men al heal h and pe o mance. Condi ions such as bu nou ,
wo k o e load, and lack o o ganiza ional suppo ha e been
ound o be ela ed o high le els o s ess and symp oms o
Pe mission o conduc his s udy was g an ed by he Huel a P o incial Resea ch
E hics Commi ee, e e ence 1520-N-23.
The au ho s ha e no con lic s o in e es o disclose.
All da a gene a ed o analyzed du ing his s udy a e included in his published
a icle [and i s supplemen a y in o ma ion iles].
Supplemen al Digi al Con en is a ailable o his a icle.
a School o Doc o a e, Uni e si y o Huel a, Huel a, Spain, b Depa men o
Nu sing, Facul y o Nu sing, Physio he apy and Podia y, Uni e si y o Se ille,
Se illa, Spain, c Depa men o Sociology, Social Wo k and Public Heal h,
Facul y o Labou Sciences, Uni e si y o Huel a, Huel a, Spain, d Sa e y and
Heal h Pos g adua e P og amme, Uni e sidad Espí i u San o, Guayaquil,
Ecuado , e Gene al Nu sing Council o Spain, Mad id, Spain, Spanish Ins i u e
o Nu sing Resea ch, Mad id, Spain, g Facul y o Educa ional, Psychology and
Spo s Sciences, Uni e si y o Huel a, Huel a, Spain, h Cen o Uni e si a io de
En e me ía C uz Roja, Se illa, Spain.
* Co espondence: Regina Allande-Cussó, Depa men o Nu sing, Facul y o
Nu sing, Physio he apy and Podia y, Uni e si y o Se ille, Calle A enzoa , 6,
41009 Se illa, Spain (e-mail: [email p o ec ed]).
Copy igh © 2025 he Au ho (s). Published by Wol e s Kluwe Heal h, Inc.
This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons
A ibu ion-Non Comme cial License 4.0 (CCBY-NC), whe e i is pe missible o
download, sha e, emix, ans o m, and buildup he wo k p o ided i is p ope ly
ci ed. The wo k canno be used comme cially wi hou pe mission om he jou nal.
How o ci e his a icle: Na bona-Gál ez Á, Allande-Cussó R, Ruiz-F u os
C, Ayuso-Mu illo D, Fon án-Vinage G, Ga cía-Iglesias JJ, Na a o-Abal Y,
Fagundo-Ri e a J, Climen -Rod íguez JA, Gómez-Salgado J. Assessmen o
occupa ional isks in nu ses in Spain: P elimina y psychome ic analysis o he
ISTAS_En e me ía scale. Medicine 2025;104:1(e41113).
Recei ed: 10 Augus 2024 / Recei ed in inal o m: 3 Decembe 2024 / Accep ed:
10 Decembe 2024
h p://dx.doi.o g/10.1097/MD.0000000000041113
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Na bona-Gál ez e al. • Medicine (2025) 104:1 Medicine
anxie y and dep ession.[7] These si ua ions no only impac on
he pe sonal well-being o nu ses, bu also inc ease he likelihood
o e o s du ing ca e and comp omise pa ien sa e y.[8] Indeed,
an un a o able wo king en i onmen in e ms o suppo and
managemen o s ess may con ibu e o a dec ease in pa ien
sa is ac ion, as well as o a highe incidence o ad e se e en s.[9]
This e idence highligh s he impo ance o in e en ions in he
wo k en i onmen ha p omo e a sa e and suppo i e en i on-
men o heal hca e wo ke s, as imp o ed psychosocial condi-
ions ha e he po en ial o posi i ely impac bo h he heal h o
p o essionals and he quali y o ca e hey p o ide.[7]
As ou lined, he abo e psychosocial isks no only a ec
nu ses, bu also ha e an impac on pa ien s, as hei pe cei ed
quali y o ca e may dec ease when nu ses expe ience high le -
els o s ess and emo ional exhaus ion.[10] In addi ion, pa ien
sa is ac ion is closely linked o nu ses’ well-being. Recen s ud-
ies ha e shown ha a posi i e wo king en i onmen o nu ses
ansla es in o highe le els o pa ien sa is ac ion.[11] On he
o he hand, he p esence o psychosocial isks may lead o an
inc eased incidence o ad e se e en s, such as medica ion e o s
o an inc eased isk o alls, hus comp omising pa ien sa e y.[12]
The e o e, add essing hese isks is conside ed c ucial no only
o imp o e he heal h o nu ses, bu also o ensu e sa e and qual-
i y ca e o pa ien s.
To add ess and measu e hese isks, se e al scales and ques-
ionnai es ha e been de eloped o assess di e en dimensions o
his cons uc . These include he Job Con en Ques ionnai e, he
E o -Rewa d Imbalance Ques ionnai e, and he Copenhagen
Psychosocial Ques ionnai e (COPSOQ), which a e widely
ecognized o hei psychome ic p ope ies and hei abili y
o p o ide use ul da a on psychosocial isks in a ious wo k
con ex s.[13]
The i s o hese, he Job Con en Ques ionnai e, assesses
aspec s such as job demands, con ol o e wo k, and social
suppo a wo k.[14] This ques ionnai e has been widely used in
in e na ional esea ch and has been ansla ed in o Spanish and
alida ed.[15]
The second ques ionnai e, he E o -Rewa d Imbalance
Ques ionnai e, ocuses on he ela ionship be ween e o
in es ed a wo k and ewa ds ecei ed, hus add essing
he imbalance be ween e o and ewa d pe cei ed by he
employee.[16] The Spanish e sion has also been alida ed and
used in se e al s udies, showing a eliabili y wi h C onbach
alphas o 0.85 o he e o scale, 0.88 o he ewa d scale, and
0.78 o he imbalance scale.[17]
Finally, he COPSOQ assesses a wide ange o psychosocial
ac o s a wo k, including job demands, in luence and possibil-
i ies o de elopmen a wo k, in e pe sonal ela ions a wo k,
and emo ional demands a wo k.[18] This ques ionnai e also has
a alida ed e sion in Spanish,[13] wi h such alida ion showing
adequa e in e nal consis ency, making i a e y use ul ool o
assessing psychosocial isks in a a ie y o wo k con ex s.
Among hese scales, he SUSESO/ISTAS21 ques ionnai e
s ands ou as a obus and e ec i e ool o assessing psycho-
social isks.[13] This ques ionnai e was de eloped in Chile by he
Social Secu i y Supe in endency (SUSESO [Supe in endencia
de Segu idad Social] in Spanish) in collabo a ion wi h he
Spanish T ade Union Ins i u e o Wo k, En i onmen , and
Heal h (ISTAS [Ins i u o Sindical de T abajo, Ambien e y Salud]
in Spanish), based on he second e sion o he COPSOQ.[18]
I s adap ed and alida ed e sion o he Chilean con ex has
p o en o be eliable and alid o assessing psychosocial isks in
a wide a ie y o wo k se ings in Chile. In addi ion, i is a b ie
scale ha acili a es i s use in mass assessmen s, which makes i
a aluable ool o iden i ying isk ac o s and planning speci ic
in e en ions in he wo kplace.[15] The SUSESO/ISTAS21 scale is
o ganized in o 5 main ac o s: psychological demands a wo k,
which assesses bo h quan i a i e and quali a i e demands in he
wo k en i onmen , wi h a o al o 5 i ems; ac i e wo k and skill
de elopmen , which measu es au onomy and abili y o de elop
skills, also wi h 5 i ems; social suppo and quali y o leade ship,
which add esses he social suppo ecei ed and he quali y o
leade ship, consis ing o 5 i ems; compensa ion, which assesses
he balance be ween e o and ewa d, wi h 3 i ems; and dou-
ble p esence, which conside s he addi ional bu den o domes ic
asks, assessed wi h 2 i ems.[19]
Many s udies ha e used he SUSESO/ISTAS21 ques ion-
nai e o iden i y isk ac o s and plan speci ic in e en ions.[13]
Howe e , a comp ehensi e s udy o i s psychome ic p ope ies
in nu ses in Spain has no ye been ca ied ou .
In his con ex , his a icle aims o adap and e alua e he psy-
chome ic p ope ies o he SUSESO/ISTAS21 ques ionnai e in
nu ses in Spain. The ele ance o his esea ch lies in he need o
a alida ed and eliable ool o measu e psychosocial isks in he
Spanish con ex , especially in a ulne able popula ion such as
nu ses. This s udy will no only con ibu e o knowledge abou
psychosocial isk ac o s in his p o essional g oup, bu could
also help o de elop p e en i e s a egies and labo policies ha
imp o e he men al heal h and well-being o nu ses in Spain, in
u n p omo ing highe quali y o ca e o pa ien s.
2. Me hods
2.1. Design
A c oss-sec ional and desc ip i e s udy was designed o he
c oss-cul u al adjus men and psychome ic alida ion o he
COPSOQ-ISTAS21 scale.
2.2. Field o s udy
Spanish egis e ed nu ses wo king in heal h ca e cen e s in he
Spanish e i o y.
2.3. S udy popula ion and sample
The s udy popula ion consis ed o 325,018 nu ses egis e ed in
Spain.[20] Speci ic da a on he numbe o egis e ed nu ses we e
ob ained om he Gene al Council o Nu sing in Spain. Fo
his popula ion g oup, a necessa y sample o 384 nu ses was
es ima ed, wi h an e o o 5%, a con idence o 95%, and a
he e ogenei y o 50%. Howe e , e en ually, da a we e collec ed
om 2757 nu ses. Since a simple andom sampling me hod was
used, he design e ec was no conside ed, as no complex sam-
pling p ocedu es equi ing s a is ical adjus men s o clus e ing
o s a i ica ion we e applied. This sampling app oach assumed
independence be ween obse a ions, ul illing he assump ions
necessa y o he s a is ical analyses pe o med.
The inclusion c i e ia we e: (i) nu ses wo king in heal h ca e
cen e s, ega dless o hei public o p i a e na u e; (ii) esiden s
in he na ional e i o y (Spain); and (iii) ac i e nu ses. The
exclusion c i e ia we e: (i) ques ionnai es no comple ed in hei
o ali y; (ii) ques ionnai es comple ed in anomalous imes ( oo
sho o oo long); and (iii) ques ionnai es in which an unusu-
ally high consis ency o esponses was de ec ed, which could
indica e a lack o a en ion in he esponse p ocess.
2.4. Ins umen
The ini ial ques ionnai e used o his s udy was he sho e -
sion o he COPSOQ-ISTAS21 ques ionnai e adap ed and ali-
da ed in Chile.[19]
This scale, which is based on he Copenhagen Psychosocial
Ques ionnai e de eloped by he Danish Ins i u e o Heal h
and Wo k En i onmen , was ansla ed and cul u ally adap ed
o use in Chile.[19] In his alida ion, he o e all in e nal con-
sis ency, as measu ed by C onbach alpha, was 0.85, indica -
ing good eliabili y. Fo he subscales, C onbach alpha alues
we e 0.80 o “Psychological demands”; 0.83 o “Con ol o e
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wo k”; 0.82 o “Social suppo ”; 0.79 o “Job insecu i y” and
0.75 o “Double p esence.” In addi ion, con i ma o y ac o
analyses suppo ed he s uc u e o he scale, showing sa is ac-
o y i indices (compa a i e i index [CFI] = 0.92; Tucke -Lewis
index [TLI] = 0.91; oo mean squa e e o o app oxima ion
[RMSEA] = 0.05), which con i ms he cons uc alidi y o he
Chilean e sion.
The sho e sion o he ques ionnai e con ains 20 ques ions
g ouped in o 5 dimensions:
I. Psychological demands a wo k: encompassing bo h qual-
i a i e and quan i a i e ac o s in he wo kplace.
II. Ac i e labo and skills de elopmen : collec ing elemen s
o employee au onomy.
III. Social suppo and leade ship quali y: conce ning job sup-
po ecei ed and elemen s o leade ship.
IV. Compensa ion: elemen s conce ning he e o - ewa d
balance.
V. Double p esence: including elemen s on domes ic cho es
and wo k- ela ed asks.
The dimensions and speci ic i ems o he SUSESO/ISTAS21
Ques ionnai e ini ially analyzed a e shown in Table S1,
Supplemen al Digi al Con en , h p://links.lww.com/MD/O250.
The calcula ion o sco es in he SUSESO/ISTAS21 ques ionnai e
is di ec ly pe o med wi h he poin s ob ained, wi hou ans-
o ming hem in o pe cen ages. The simple summa ion o he
o al poin s ob ained gi es he sco e o each dimension. The
esponse scale is a 4-poin Like - ype scale, whe e 0 is he mos
a o able alue and 4 he mos un a o able.
2.5. P ocedu e
2.5.1. Adap a ion o he ISTAS scale. Fi s , a c oss-
cul u al adap a ion o he scale was ca ied ou by a panel
o expe s using he Delphi echnique. The expe s we e
selec ed acco ding o hei academic deg ee (mas e ’s deg ee
o uni e si y g adua es, seconda y school o s uden s, and
PhD o he uni e si y p o esso ), a ea o expe ise (nu sing,
psychology, managemen , and/o p e en i e medicine),
expe ience (>10 yea s o g adua es, no expe ience o
s uden s, and one-yea expe ience o ecen g adua es)
and hei ela ionship wi h he speci ic subjec a ea. The
membe s o he panel o expe s we e iden i ied by hei
a ilia ion o he Spanish Na ional Heal h Se ice, h ough
di ec consul a ion on he agency’s o icial websi e. They
we e sen an email eques ing hei pa icipa ion, which
included in o ma ion abou he p ojec and an exp ess
eques o pa icipa e as an expe , unde he p emises o
con iden iali y and olun a iness.
Two psychologis s wi h ex ensi e knowledge o scale
alida ion ( emale, PhD in Psychology, 43 yea s old, wi h
15 yea s o expe ience; and emale, PhD in Psychology, 45
yea s old, wi h 19 yea s o expe ience), one p o esso o
Bios a is ics (male, PhD in Heal h Sciences, 54 yea s old, 27
yea s o expe ience), one 4 h yea unde g adua e nu sing s u-
den (21-yea -old woman wi h no expe ience) and one 3 d
yea unde g adua e nu sing s uden (22-yea -old man wi h
no expe ience), one dean o nu sing (male, PhD in Heal h
Sciences, 63 yea s old, wi h 39 yea s o expe ience), 2 nu s-
ing supe iso s ( emale, MSc, 58 yea s old, wi h 35 yea s o
expe ience; and male, MSc, 49 yea s old, wi h 27 yea s o
expe ience), 2 ecen g adua es (yea 22/23) ( emale, MSc, 23
yea s old, wi h 1 yea o expe ience; and male, MSc, 25 yea s
old, wi h hal a yea o expe ience) and 2 nu ses who g adu-
a ed 2 yea s ea lie ( emale, MSc, 26 yea s old, wi h 2 yea s
o expe ience) we e selec ed. The composi ion o he panel
o expe s (5 men and 6 women) was designed o p o ide
adequa e ep esen a ion o he alida ion o he scale in he
speci ic con ex o he s udy.
In his p ocess, he expe panel assessed a eas such as psy-
chome ics, linguis ics, and he speci ic subjec ma e o he
scale and i s i ems. This p ocedu e was ca ied ou in se e al
ounds o anonymous ques ionnai es ha we e answe ed inde-
penden ly by he expe s. The panel o expe s e iewed he
o iginal scale, which was w i en in Chilean Spanish, in o de
o assess i s sui abili y and cul u al ele ance o he con ex in
which i was in ended o be applied (see Table S1, Supplemen al
Digi al Con en , h p://links.lww.com/MD/O250). Du ing he
e iew, he expe s analyzed each i em o he scale in e ms o
cla i y, ele ance, and cul u al app op ia eness. A his poin ,
each i em was gi en a sco e by each expe anging om 0 o 15
(cla i y: 0–5 poin s; ele ance: 0–5 poin s; and cul u al app o-
p ia eness: 0–5 poin s) and a commen box was p o ided. The
maximum o al sco e o each i em was he e o e 15 poin s.
The i s consensus mee ing was held in July 2023, in which
he expe s discussed and e alua ed each i em wi h he pu -
pose o de e mining whe he modi ica ions o he wo ding we e
necessa y. The consensus session began by welcoming he pa -
icipan s and in o ming hem abou how he session would be
ca ied ou . A e asking he pa icipan s o sco e each i em, a
discussion was opened o each i em whene e he median sco e
was <10 poin s (indica ing a lack o consensus ha needed o
be add essed) o i he e we e any obse a ions, cla i ica ions,
o sugges ions o imp o emen ). The session las ed 40 minu es
and he esponses we e analyzed. A summa y o opinions and
sugges ions was made and sen back o he expe s o he sec-
ond ound un il ag eemen was eached on he i ems and app o-
p ia e language. The i ems in he inal ool ecei ed a inal expe
consensus median sco e o 15 poin s.
2.6. Da a collec ion
A pilo es o he ques ionnai e was ca ied ou in ol ing en
pa icipan s (6 egis e ed emale nu ses and 4 egis e ed male
nu ses, con ac ed indi idually, om 10 di e en p o inces and
aged be ween 23 and 63 yea s, wi h a mean o 43 yea s, and
wi h di e en yea s o expe ience (be ween 1 and 39 yea s o
expe ience wi h a mean o 19.4 yea s). The aim o he es was
o assess he comp ehension o he ques ionnai e, o de ec pos-
sible yping e o s o ambigui ies in i s d a ing, and o asce -
ain he o al ime aken o comple e he ool. The pa icipan s
we e selec ed o olun a y pa icipa ion in he s udy h ough
he Gene al Council o Nu sing o Spain, and adequa ely ep-
esen ed he p o ile o he a ge popula ion. Following his, he
e alua ion o he ques ionnai e began.
Fo he gene al pu pose, an online su ey was c ea ed wi h
Google Fo ms © so wa e con aining he scale i ems along
wi h socio-demog aphic a iables ele an o he s udy. Be o e
accessing he ques ions in he ques ionnai e, all subjec s pa ici-
pa ing in he s udy we e equi ed o ead and sign he in o med
consen o m, con i ming ha hei pa icipa ion was olun a y.
The dissemina ion o he s udy was conduc ed h ough a -
ious means and channels, including social media, emails o
egis e ed nu sing p o essionals, specialized websi es, and col-
labo a ions wi h p o essional nu sing associa ions and o ga-
niza ions. Da a collec ion ook place be ween 01 Augus and
Oc obe 31,2023.
2.7. Va iables
Socio-demog aphic and scale a iables we e included. Thus,
he a iables conside ed we e sex (male, emale, nonbina y, o
a he no s a ed), age, ma i al s a us (single, ma ied, cohabi -
ing, no cohabi ing, sepa a ed, di o ced, o widowed), and cu -
en posi ion held.
The da a collec ion on he scale a iables was done h ough
he SUSESO/ISTAS21 Ques ionnai e.
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Na bona-Gál ez e al. • Medicine (2025) 104:1 Medicine
2.8. Da a analysis
The desc ip i e analyses we e pe o med using SPSS S a is ics
© 26 so wa e,[21] licensed by he Uni e si y o Huel a. The
Kolmogo o –Smi no es showed a P- alue o P < .005 indi-
ca ing a non-no mal dis ibu ion o he da a, hus, nonpa a-
me ic es s we e conside ed, such as K uskal Wallis’ H es o
Kendall Tau-b es .
To assess he eliabili y o he ISTAS_Nu sing scale, C onbach
alpha coe icien and McDonald omega coe icien we e calcu-
la ed, he la e being ecommended as a mo e obus indica o
o scale eliabili y.[22] In bo h cases, a eliabili y alue > 0.7 was
used as an indica ion o adequa e scale consis ency.[23]
Nex , he ac o s uc u e o he scale was s udied by means
o an explo a o y ac o analysis (EFA), using he p incipal
componen s me hod. This me hod, sui able o da a wi h non-
no mal dis ibu ion and o he sea ch o s able ac o ial solu-
ions, used a a imax o a ion o co ela e he ac o s.[24]
Subsequen ly, a con i ma o y ac o analysis was ca ied ou
using AMOS© so wa e.[25] The goodness o i o he con i ma-
o y model was assessed using se e al c i e ia, such as he TLI, he
no malized i index, he CFI ( alues ≥ 0.90 indica e adequa e i ),
he s anda dized oo mean squa e esidual ( alues ≤ 0.08 indi-
ca e good i ), and he RMSEA ( alues ≤ 0.08 show good i ).[26]
Finally, since no s anda d e e ence scale was used, nei he
ROC cu e no p edic i e alidi y we e calcula ed o he
assessmen o c i e ion alidi y, al hough le els o psychosocial
isk we e iden i ied based on he s udy o qua iles and pe cen-
iles o he sample.
2.9. E hical aspec s
This s udy was app o ed by he Huel a P o incial Resea ch
E hics Commi ee, wi h code 1520-N-23. In addi ion, his
s udy adhe es o he guidelines o he Decla a ion o Helsinki
(Fo aleza, B azil, 2013).[27]
All pa icipan s (including he expe s) ga e hei accep a ion
o pa icipa e in he s udy by clicking on he app op ia e box in
he online su ey, a e eading he pe inen in o ma ion on he
s udy and he in o med consen documen . S ic measu es we e
aken o gua an ee he p i acy and con iden iali y o he pa ic-
ipan s, in acco dance wi h he O ganic Law on Da a P o ec ion
and Gua an ee o Digi al Righ s (Law 3/2018),[28] wi h s o age
o he in o ma ion in a secu e da abase and access limi ed o he
esea ch eam only.
3. Resul s
3.1. Desc ip i e analysis
The sample consis ed o 2764 subjec s, all ac i e nu ses, o e 18
yea s o age, and esiding in Spain. O he o al sample, 87.3%
we e women, wi h a mean age o 40.82 yea s (SD = 10.677), and
12.3% we e men, wi h a mean age o 41.21 yea s (SD = 10.979).
The 42.9% o esponden s we e ma ied and 27.1% we e
cohabi ing, and 15.3% we e single. Smalle pe cen ages co e-
sponded o di o ced (4.2%), sepa a ed (1.5%), and widowed
(0.3%) pe sons (Table 1).
The mean sco e o he pa icipan s o he ISTAS_En e me ía
scale was 1.78 poin s (SD = 0.503). The s udy o he co ela-
ion be ween his sco e and age showed ha he olde he age
o he sample, he lowe he pe cei ed le els o psychosocial
isks measu ed wi h he ISTAS_ En e me ía scale by 0.12
imes. Looking a ma i al s a us, di o ced (mean = 1.751,
SD = 0.500) and sepa a ed (mean = 1.824, SD = 0.561) indi-
iduals showed highe sco es compa ed o ma ied indi idu-
als (mean = 1.722, SD = 0.494), sugges ing ha being ma ied
may be associa ed wi h lowe psychosocial isk pe cep ion.
Table 1
Resul s o he desc ip i e analysis.
Va iables To al sample (n = 2764) ISTAS21 mean sco e (X/SD) Hypo hesis es *
Sex
Male 341 (12.3%) 1.792 (SD = 0.562) P = .50**
Female 2414 (87.3%) 1.779 (SD = 0.494)
Nonbina y 1 (0.0%) 1.200 (SD = 0)
Ra he no say 9 (0.3%) 1.874 (SD = 0.590)
Mean 1.78 (SD = 0.503)
Age
Mean 40.87 yea s 1.78 (SD = 0.5) Tau-b*** = ‐0.12 (P .001)
Ma i al s a us
Ma ied 1186 (42.9%) 1.722 (SD = 0.494) .001**
Di o ced 117 (4.2%) 1.751 (SD = 0.500)
Wi h a pa ne (cohabi ing) 748 (27.1%) 1.840 (SD = 0.517)
Wi h a pa ne (no cohabi ing) 242 (8.8%) 1.828 (SD = 0.484)
Sepa a ed 41 (1.5%) 1.824 (SD = 0.561)
Single 422 (15.3%) 1.819 (SD = 0.492)
Widowed 9 (0.3%) 1.814 (SD = 0.546)
Mean 1.781 (SD = 0.503)
Cu en posi ion
Auxilia y nu se 2287 (82.7%) 1.804 (SD = 0.493)
Residen Nu se 37 (1.3%) 1.690 (SD = 0.551)
Nu se in cha ge o a uni o se ice wi hou ecognized managemen posi ion 139 (5%) 1.711 (SD = 0.477)
A ea o uni supe iso wi h managemen unc ions only 93 (3.4%) 1.465 (SD = 0.455)
Uni supe iso wi h di ec pa ien ca e as well as managemen ac i i ies 84 (3%) 1.590 (SD = 0.517)
Specialis nu se 29 (1%) 1.671 (SD = 0.602)
School nu se 11 (0.4%) 1.636 (SD = 0.598)
Teaching and esea ch 9 (0.3%) 1.837 (SD = 0.501)
Mean 1.780 (SD = 0.502)
Bold alues indica e s a is ically signi ican esul s: P < .05.
SD = s anda d de ia ion, X = mean sco e.
* The Kolmogo o –Smi no es showed a P- alue o P < .005 indica ing a non-no mal dis ibu ion o he da a.
** K uskal-Wallis H.
*** Kendall Tau-b.
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Simila ly, single nu ses (mean = 1.819, SD = 0.492) and hose
li ing wi h a pa ne (mean = 1.840, SD = 0.517) also showed
highe sco es, indica ing signi ican di e ences by ma i al s a-
us (P = .001).
In addi ion, he analysis o job posi ions e ealed a ema k-
able a iabili y in pe cei ed psychosocial isks. A ea o uni
supe iso s wi h exclusi ely manage ial unc ions epo ed he
lowes sco es (mean = 1.465, SD = 0.455), which could indica e
a pe cep ion o lowe isk, possibly due o g ea e job au on-
omy. In con as , nu ses engaged in eaching and esea ch had
he highes sco es (mean = 1.837, SD = 0.501), e lec ing highe
pe cei ed psychosocial demands (Table 1).
3.2. Psychome ic s udy
Be o e pe o ming he EFA, Ba le es o sphe ici y and
he Kaise -Meye -Olkin measu e o sampling adequacy we e
applied, ob aining a alue o 0.773 in he Kaise -Meye -Olkin
measu e and a signi icance o P < .001. This con i med he sui -
abili y o he da a o he ac o analysis. The EFA ( h ough
p incipal axial ac o iza ion and a imax o a ion) g an ed a
ac o ial solu ion o 5 dimensions and 15 i ems (Table 1). I ems
1, 5, 6, 7, and 12 o he o iginal SUSESO/ISTAS21 scale ha e
been emo ed (Candia e al[19]) o ac o loadings below 0.4, a
c i e ion suppo ed by p e ious s udies sugges ing his h esh-
old o measu ing beha io s.[29] The inal solu ion is a 5- ac o
s uc u e, wi h 15 i ems, explaining 63.6% o he a iance.
Speci ically, Fac o 1 explains 18.025% o he a iance; Fac o
2, 12.244%, Fac o 3, 12.069%; Fac o 4, 10.895%; and Fac o
5, 10.405%, wi h a cumula i e a iance pe cen age o 63.638%
(Table 2).
Likewise, each o he ac o s ha con o m he scale we e
named as ollows:
1. Fac o 1 – Suppo a wo k: This ac o e e s o he
suppo and coope a ion a pe son ecei es in hei wo k
en i onmen . I includes di ec suppo om supe io s,
mu ual help be ween colleagues, and he abili y o esol e
con lic s by line manage s. I also e e s o he ecogni ion
gi en o employees o hei wo k.
2. Fac o 2 – Job sa is ac ion: This ac o desc ibes he le el
o sa is ac ion and ul illmen ha a pe son expe iences
in hei wo k. I includes he oppo uni y o lea n and
de elop p o essionally, he pe cei ed impo ance o he
asks assigned, he sense o belonging o he company
o ins i u ion, and he clea unde s anding o wo k
esponsibili ies.
3. Fac o 3 – Emo ional well-being a wo k: This ac o
e e s o emo ional balance and s ess managemen in he
wo k en i onmen . I includes he abili y o make di icul
decisions, he le el o emo ional exhaus ion expe ienced
a wo k, and he need o manage emo ions in he wo k
en i onmen .
4. Fac o 4 – Job insecu i y: This ac o desc ibes he con-
ce n and unce ain y ha a pe son may expe ience wi h
ega d o hei wo k s abili y. I includes ea o dismissal
o non enewal o con ac and conce n abou unwan ed
changes in job esponsibili ies.
5. Fac o 5 – Double p esence: This ac o e e s o he bal-
ance be ween wo k demands and amily and domes ic
esponsibili ies. I includes he endency o hink abou
amily ma e s while a wo k and he occasional need o
be p esen bo h a wo k and a home o a end o u gen
amily si ua ions.
The scale eliabili y yielded a C onbach α alue o 0.764, and
a McDonald omega alue o 0.741. Likewise, he C onbach α
alue ob ained o each ac o was: 0.80 o Suppo a wo k,
0.7 o Job sa is ac ion, 0.76 o Emo ional well-being a wo k,
0.72 o Job insecu i y, and 0.70 o Double p esence.
Then, con i ma o y ac o analyses o he cons uc alidi y
s udy yielded a CFI o 0.933, a TLI o 0.912, a no malized i
index o 0.926, a RMSEA o 0.057 and a s anda dized oo
mean squa e esidual o 0.068 (Fig. 1).
The s udy o he mean sco e in he scales showed 3 le els
o psychosocial isk o nu ses in Spain (Low le el: 0 o 1.46;
In e media e le el: 1.47 o 2; High le el: abo e 2) ha we e
iden i ied and depic ed in a box-and-whiske plo . (Fig. 2).
Signi ican di e ences be ween each pai o le el we e iden i-
ied (P < .05) and checked wi h he Mann–Whi ney U es . In
he compa isons made be ween he 3 le els, he ollowing was
ob ained: he compa ison be ween he low le el and he in e -
media e le el p oduced a Mann–Whi ney U alue o 0.000,
wi h a P alue < .001; he compa ison be ween he in e me-
dia e le el and he high le el showed a U alue o 0.000 and
P < .001; and, inally, he compa ison be ween he low le el
and he high le el also ga e a U alue o 0.000 wi h P < .001.
These esul s indica e s a is ically signi ican di e ences ac oss
he le els.
4. Discussion
Conside ing he inc easing wo kload and emo ional p essu es
aced by nu ses in Spain, he assessmen and educ ion o
Table 2
Scale i ems and ac o s uc u e.
Fac o
% o
a iance
%
accumula ed ITEMS
F1 – Suppo
a wo k
F2 – Job
sa is ac ion
F3 – Emo ional
well-being a wo k
F4 – Job
insecu i y
F5 – Double
p esence
1 18.025 18.025 ISTAS_13 .876
ISTAS_14 .450
ISTAS_15 .879
ISTAS_18 .800
2 12.244 30.269 ISTAS_8 .703
ISTAS_9 .834
ISTAS_10 .501
ISTAS_11 .473
3 12.069 42.338 ISTAS_2 .703
ISTAS_3 .783
ISTAS_4 .768
4 10.895 53.233 ISTAS_16 .895
ISTAS_17 .821
5 10.405 63.638 ISTAS_19 .872
ISTAS_20 .865
Bold alues indica e s a is ically signi ican esul s: P < .05.
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psychosocial isks in hei daily wo k is essen ial. In his con ex ,
he main objec i e o his s udy was he adap a ion and ini ial
psychome ic alida ion o he SUSESO/ISTAS21 ques ionnai e
o nu ses in Spain. The s udy sough o c ea e a eliable ool o
help imp o e bo h he heal h o nu ses and he quali y o ca e
hey p o ide o hei pa ien s. The esul s ob ained indica e ha
he adap ed SUSESO/ISTAS21 ques ionnai e p esen s adequa e
alidi y and eliabili y indices.
This s udy has signi ican implica ions o clinical p ac-
ice, eaching, and esea ch. In he clinical se ing, he adap ed
SUSESO/ISTAS21 ques ionnai e allows he iden i ica ion o
psychosocial isk ac o s in nu ses in o de o de elop p e en-
i e and suppo i e in e en ions. In he ield o educa ion, his
ool can be in eg a ed in o aining p og ams o inc ease he
awa eness o u u e p o essionals abou psychosocial isks and
how o manage hem. In e ms o esea ch, his alida ed ques-
ionnai e acili a es longi udinal and compa a i e s udies on he
psychosocial well-being o nu ses. O e all, hese indings con-
i m he alidi y o he ISTAS_En e me ía as a ool o de ec ing
and assessing psychosocial isks in he nu sing en i onmen in
Spain.
Recen s udies show ha he sus ained s ess o which nu ses
a e exposed, especially in high-p essu e clinical se ings, can
igge signi ican symp oms o pos - auma ic s ess diso de .
Implemen ing s uc u ed suppo p og ammes and s a egies o
imp o e he men al heal h o nu sing s a becomes essen ial o
ensu e bo h hei well-being and hei abili y o p o ide quali y
ca e. I has been shown ha in e en ions based on emo ional
Figu e 1. Fac o s uc u e o he scale.
Figu e 2. Psychosocial isk le els in nu ses in Spain.
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de-escala ion and pee suppo can be pa icula ly e ec i e in
educing wo k- ela ed s ess and s eng hening esilience.[30]
The bi a ia e analyses pe o med show ha he e we e no sig-
ni ican di e ences in mean ISTAS_En e me ía sco es by sex, wi h
simila sco es be ween emale and male nu ses (P = .50). This
inding is consis en wi h p e ious s udies showing no signi ican
di e ences in wo k s ess sco es be ween emale and male nu ses,
and suppo s he idea ha sex di e ences ela ing o s ess may
no be as p onounced in nu sing as in o he wo k con ex s, e en
conside ing sex di e ences wi hin he p o ession.[31] I is wo h
no ing ha al hough his s udy did no ind signi ican di e ences
be ween sexes, ecen s udies such as ha by Cos a (2021) high-
ligh ha , in high-s ess si ua ions, hese di e ences may become
mo e no iceable. This could indica e ha in si ua ions o o e load
o high-s ess e en s, emale nu ses may expe ience highe le els
o s ess han hei male coun e pa s, due o a combina ion o
biological and social ac o s. Explo ing hese di e ences in u u e
quali a i e and quan i a i e s udies would help o be e unde -
s and he impac o sex on he pe cep ion o psychosocial isk in
high-demand se ings.[32]
Con e sely, a signi ican nega i e co ela ion was obse ed
be ween age and ISTAS21 sco e (Tau-bb = ‐0.12, P = .001),
sugges ing ha he olde he nu se, he lowe he pe cep ion o
psychosocial isks. This end has been obse ed in o he s ud-
ies, which a gue ha younge nu ses end o expe ience highe
le els o s ess and psychosocial isk due o hei educed expe-
ience in managing wo k demands. This, in u n, indica es ha
you h and lack o expe ience may be signi ican ac o s con-
ibu ing o he pe cep ion o psychosocial isk in nu sing.[33]
In his ega d, he implemen a ion o men o ing p og ammes
in which mo e expe ienced nu ses can guide younge nu ses is
essen ial o s eng hen con idence and esilience among young
nu ses. Hoo e e al. (2020) no e ha hese p og ammes no
only imp o e esilience and con idence in clinical skills, bu also
c ea e a suppo i e en i onmen , which can mi iga e he pe cep-
ion o s ess and acili a e adap a ion o he wo k en i onmen
in he ea ly yea s o he p o ession.[34]
E ec i e managemen o wo k- ela ed s ess bene i s g ea ly
om app oaches ha p omo e au onomy and p o essional
de elopmen . Wo k en i onmen s whe e nu ses eel hey ha e
con ol o e hei asks and oppo uni ies o g ow h can mi -
iga e he nega i e e ec s o s ess. Tools such as he ISTAS_
En e me ía should no only measu e psychosocial isk, bu also
iden i y key a eas o in e en ion. Inco po a ing ongoing edu-
ca ion s a egies and pe sonalized s ess managemen aining
can be c ucial, pa icula ly in high-demand clinical se ings, o
maximize he posi i e impac on s a well-being.[35]
Fu he mo e, ega ding he ma i al s a us ca ego y, he p es-
en s udy showed signi ican di e ences (P = .001), wi h ma ied
nu ses ha ing lowe sco es (1.722) compa ed o o he ma i al s a-
uses, such as hose in a non-cohabi ing ela ionship (1.828) and
single nu ses (1.819). This may be ela ed o he ac ha ma ied
people o en epo highe le els o social suppo , which may ac
as a p o ec i e ac o agains wo k- ela ed s ess.[36]
As ega ds he cu en posi ion, a ea o uni supe iso s wi h
pu ely manage ial unc ions had he lowes sco es (1.465), while
eaching and esea ch nu ses had he highes sco es (1.837). This
may be due o a g ea e pe cep ion o con ol and au onomy in
hei oles, ac o s ha a e associa ed wi h lowe le els o s ess
and psychosocial isk.[37]
Wi h espec o he eliabili y esul s ob ained by means o
C onbach alpha, in he sample o he p esen s udy, hey showed
an adequa e in e nal consis ency, wi h an o e all alue o 0.764,
sligh ly highe han he alue epo ed in he Chilean e sion,
which was 0.758 (95% CI: 0.719–0.794).[36] This inding sug-
ges s ha he ISTAS_En e me ía may be o e ing g ea e o e all
eliabili y in he speci ic con ex o nu ses in Spain.
Rega ding he ac o s uc u e o he ISTAS_En e me ía, all
he dimensions assessed showed be e eliabili y sco es han
hose epo ed in he Chilean e sion o he SUSESO/ISTAS21.
In pa icula , he dimensions “Suppo a wo k” (α = 0.80),
“Job sa is ac ion” (α = 0.70), “Emo ional well-being a wo k”
(α = 0.76), “Job insecu i y” (α = 0.72) and “Double p esence”
(α = 0.70) showed highe alpha coe icien s compa ed o hei
Chilean equi alen s, sugges ing a highe eliabili y in he
Spanish sample.[38]
These di e ences in ac o s uc u e sugges ha he pe -
cep ion o psychosocial isks a ies depending on he cul u al
con ex . While bo h ques ionnai es main ain a i e- ac o s uc-
u e, he ISTAS_En e me ía has signi ican ly econ igu ed he
i ems and ac o s in esponse o he speci ic con ex o nu ses
in Spain. The p esen s udy iden i ied 5 wo k ac o s wi h s uc-
u al di e ences wi h espec o he Chilean e sion. The i s
ac o , “Suppo a wo k,” does no ha e an exac equi alen in
he Chilean ques ionnai e, bu is simila o “Social suppo and
leade ship quali y.” The second ac o , “Job sa is ac ion,” did
no ha e a di ec co espondence ei he , ye simila aspec s a e
ound in he ca ego ies “Ac i e labo and skills de elopmen ”
and “Compensa ion.” The hi d ac o , “Emo ional well-being
a wo k,” is no ep esen ed in he Chilean e sion. The ou h
ac o , “Job insecu i y,” also di e s, al hough some aspec s a e
ela ed o he “Compensa ion” ac o . The i h ac o , “Double
p esence,” is simila in bo h e sions, e lec ing he econcilia-
ion o wo k and amily esponsibili ies.
In he Chilean e sion, he ac o “Psychological demands”
was elimina ed due o low ac o loadings. The ac o “Ac i e
labo and skills de elopmen ” was edis ibu ed in he ISTAS_
En e me ía. The ac o s “Social suppo and leade ship quali y”
and “Compensa ion” showed di e ences in he s uc u e o he
ISTAS_En e me ía.
These di e ences in he dimensional s uc u e and i em dis i-
bu ion be ween he ISTAS_En e me ía and he Chilean e sion
e lec a ia ions in he pe cep ion and ele ance o psycho-
social isk ac o s in di e en cul u al and occupa ional con-
ex s.[39] While bo h e sions main ain a i e- ac o s uc u e, he
ISTAS_En e me ía has esul ed in a signi ican econ igu a ion
o i ems and ac o s, unde lining he impo ance o cul u al and
con ex -speci ic adap a ion in psychosocial isk assessmen .
Addi ionally, i is ele an o compa e he p esen esul s
wi h hose o s udies such as he one by,[13] who also alida ed
he SUSESO/ISTAS21 in a sample o wo ke s in Spain. In he
said s udy, he “Psychological demands” dimension ob ained a
C onbach alpha o 0.79, while in he p esen s udy his same
dimension had an alpha o 0.82. The “Job insecu i y” dimension
in Moncada s udy ob ained an alpha o 0.70, while in his s udy
an alpha o 0.72 was ob ained. Finally, he “Social suppo ”
dimension had an alpha o 0.85 in he Moncada s udy,[13] com-
pa ed o 0.84 in he p esen s udy. These simila i ies and sligh
imp o emen s sugges good in e nal consis ency and obus eli-
abili y in di e en wo k con ex s.
Tha said, his s udy also has some limi a ions ha should
be conside ed. Fi s ly, he c i e ion alidi y o he ISTAS_
En e me ía using ano he gold s anda d scale o ROC cu e
was no included, so he e a e no da a on p edic i e alidi y.
Also, he sample used was non-p obabilis ic and o con e-
nience, which could a ec he gene alizabili y o he esul s o
he en i e popula ion o nu ses in Spain. Simila ly, he dissemi-
na ion me hods used we e b oad and based on social ne wo ks,
specialized nu sing websi es in Spain, and e-mails o egis e ed
nu ses h ough o icial media, so i was no possible o know he
esponse a e o he o al each o his dissemina ion. Also, he
use o online su eys may ha e le ou some nu ses wi h li le
access o he in e ne o less p o iciency wi h echnology. Also,
he majo i y o he s udy sample was made up o women. In his
ega d, p e ious s udies ha e shown ha women may pe cei e
and expe ience wo k- ela ed s ess di e en ly om men, sug-
ges ing he need o u he explo e hese di e ences be ween he
sexes in u u e s udies.[40] Al hough he sample size is la ge and
he dis ibu ion by sex is simila o ha o he Spanish nu sing
popula ion, he need o u u e esea ch o conside hese aspec s
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Na bona-Gál ez e al. • Medicine (2025) 104:1 Medicine
should be bo ne in mind. In addi ion, ecen s udies indica e
ha nu ses’ emo ional exhaus ion is in luenced by speci ic wo k
en i onmen ac o s, such as au onomy, a ailable esou ces, and
eam suppo , all o which signi ican ly a ec hei engagemen
and men al heal h. High-p essu e uni s, such as he eme gency
depa men , show highe le els o bu nou , which may a ec
quali y o ca e. These indings highligh he impo ance o u u e
longi udinal esea ch examining indi idual and sys emic ac o s
ha impac nu ses’ well-being in di e se ca e se ings.[41]
O e all, hese indings con i m he alidi y o he ISTAS_
En e me ía as a ool o de ec ing and assessing psychosocial
isks in he nu sing en i onmen in Spain. This ool may be
use ul no only o iden i ying isk ac o s, bu also o e alu-
a ing he e ec i eness o in e en ions designed o educe wo k-
ela ed s ess and imp o e nu ses’ well-being in di e en
con ex s. Howe e , i would be desi able o u u e esea ch o
u he explo e hese indings h ough longi udinal s udies and
in di e en ca e se ings, which would con ibu e o he de el-
opmen o occupa ional heal h policies ailo ed o he speci ic
needs o nu ses in Spain.
5. Conclusion
The ISTAS_En e me ía scale has p o en o be eliable and alid
o he assessmen o psychosocial isks in nu ses in Spain.
The scale con ains 15 i ems o ganized in o 5 ac o s: Suppo
a Wo k, Job Sa is ac ion, Emo ional Well-being a Wo k, Job
Insecu i y, and Double P esence, which explain 63.6% o he
a iance. These i ems co e key ac o s o he pe cep ion o psy-
chosocial isks in he wo k en i onmen .
To de elop he adap a ion o he scale, a ho ough cul u al
adap a ion and psychome ic alida ion p ocedu e was ca -
ied ou . A panel o expe s in a eas such as nu sing, psy-
chology, and managemen pa icipa ed in he e iew and
adap a ion p ocess using he Delphi echnique, e alua ing
each i em in e ms o cla i y, ele ance, and cul u al app o-
p ia eness. Subsequen ly, a pilo es was conduc ed o assess
he unde s anding and usabili y o he ques ionnai e in he
a ge popula ion. The dissemina ion o he ques ionnai e was
done h ough digi al media, including social media, e-mails
o nu sing p o essionals, and collabo a ion wi h specialized
o ganiza ions, which allowed o da a collec ion be ween
Augus and Oc obe 2023.
The psychome ic analysis showed obus esul s: he o e all
in e nal consis ency measu ed by C onbach alpha was 0.764,
while explo a o y and con i ma o y ac o analyses con i med
he 5- ac o s uc u e wi h adequa e i indices (CFI = 0.933;
TLI = 0.912; RMSEA = 0.057). These indings sugges ha he
scale is alid and eliable o assessing psychosocial isks in
nu sing in he Spanish con ex .
In he clinical se ing, his will allow he de elopmen o
p e en i e in e en ions and speci ic suppo p og ammes o
imp o e nu ses’ men al heal h and well-being a wo k. A
he educa ional le el, in eg a ing his ool in o nu sing edu-
ca ion can help u u e p o essionals o be e manage wo k-
ela ed s ess om he beginning o hei ca ee s. In he ield
o esea ch, he alida ion o his scale acili a es long- e m
and compa a i e s udies on psychosocial well-being in di -
e en con ex s. In addi ion, he ool could be adap ed and
alida ed o o he heal h p o essions, hus bene i ing mo e
wo ke s. Fu u e esea ch should conside c i e ion alida-
ion and explo e sex di e ences wi h espec o pe cep ions
o wo k- ela ed s ess in o de o design mo e inclusi e and
e ec i e in e en ions.
Au ho con ibu ions
Concep ualiza ion: Ángela Na bona-Gál ez, Regina Allande-
Cussó, Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Yolanda
Na a o-Abal, Ja ie Fagundo-Ri e a, José An onio Climen -
Rod íguez, Juan Gómez-Salgado.
Da a cu a ion: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe Fon án-
Vinag e, Juan Jesús Ga cía-Iglesias, Yolanda Na a o-Abal,
Ja ie Fagundo-Ri e a, José An onio Climen -Rod íguez,
Juan Gómez-Salgado.
Fo mal analysis: Ángela Na bona-Gál ez, Regina Allande-
Cussó, Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
In es iga ion: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
Me hodology: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
P ojec adminis a ion: Ángela Na bona-Gál ez, Regina
Allande-Cussó, Juan Gómez-Salgado.
Resou ces: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
So wa e: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
Supe ision: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
Valida ion: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
Visualiza ion: Ángela Na bona-Gál ez, Regina Allande-Cussó,
Ca los Ruiz-F u os, Diego Ayuso-Mu illo, Guadalupe
Fon án-Vinag e, Juan Jesús Ga cía-Iglesias, Ja ie Fagundo-
Ri e a, Juan Gómez-Salgado.
W i ing – o iginal d a : Ángela Na bona-Gál ez, Regina
Allande-Cussó, Ca los Ruiz-F u os, Diego Ayuso-Mu illo,
Guadalupe Fon án-Vinag e, Juan Jesús Ga cía-Iglesias,
Yolanda Na a o-Abal, Ja ie Fagundo-Ri e a, José An onio
Climen -Rod íguez, Juan Gómez-Salgado.
W i ing – e iew & edi ing: Ángela Na bona-Gál ez, Regina
Allande-Cussó, Ca los Ruiz-F u os, Diego Ayuso-Mu illo,
Guadalupe Fon án-Vinag e, Juan Jesús Ga cía-Iglesias,
Yolanda Na a o-Abal, Ja ie Fagundo-Ri e a, José An onio
Climen -Rod íguez, Juan Gómez-Salgado.
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