Translation and cultural adaptation of the DE-STRESS survey into Danish – Measuring stress, coping, and intention to leave among Emergency department Nurses, Nurse Assistants, and Physicians

Aim: This study aimed to translate and culturally adapt the DE-STRESS (Emergency Department Stress, Coping, and Intention to Leave Survey) to the Danish emergency context. Background: Clinicians (nurses, nurse assistants, and physicians) in an emergency department (ED) undertake psychologically demanding work, and the high-pressure environment combined with occupational stressors has made retention of ED clinicians a major issue. A suitable measure of stress and coping would contribute to the development of practices to support clinicians working in these high-stress environments. Method: The translation process was undertaken using the ISPOR principles of good practice for the translation and cultural adaptation of patient-reported outcomes, including forward translation, back translation, and cognitive debriefing through individual interviews with ED clinicians (n = 5). The study took place in a large teaching hospital in Southern Denmark and involved three forward translators, two backward translators, a key in-country person from both Australia and Denmark, and a project lead. Results: The translation and cultural adaptation process was successfully conducted. Some concepts were difficult to translate, such as the terms ED and organization and the role of an ED supervisor. It was necessary to omit some demographic questions to ensure respondent anonymity, so the final Danish version has 123 questions versus the original 133 questions. Conclusion: The ED clinicians found the survey relevant and comprehensive as it addressed key factors in their work. We concluded that the Danish version of DE-STRESS is appropriate for use; however, a future study employing confirmatory factor analysis and assessing internal reliability is necessary to further investigate its psychometric properties.