Psychometric validation and cultural adaptation of the Persian version of the Post-Code Stress Scale among Iranian nurses

Abstract Background Post-code stress represents a unique set of psychological challenges for nurses directly involved in cardiopulmonary resuscitation, encompassing professional, emotional, interpersonal, and organizational stressors. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the PCSS for use among Iranian clinical nurses. Methods This methodological, cross-sectional study was conducted among 500 Iranian nurses between March and August 2025. The original 20-item PCSS was translated into Persian using forward–backward procedures and reviewed by expert panels. Face and content validity were evaluated using qualitative feedback, impact scores, CVR, and CVI. Construct validity was examined through exploratory factor analysis (EFA, n = 200) and confirmatory factor analysis (CFA, n = 300) using robust maximum likelihood estimation. Reliability was assessed via internal consistency (Cronbach’s α, composite reliability, McDonald’s ω) and test–retest stability (intraclass correlation coefficient over a two-week interval). Results EFA on the first subsample supported a four-factor solution after removal of two weak items, explaining 61.9% of the variance. CFA on the second subsample confirmed excellent model fit (χ² (129) = 144.81, p = 0.162; CFI = 0.993; TLI = 0.992; RMSEA = 0.020; SRMR = 0.037). All standardized loadings exceeded 0.71. Reliability was acceptable to excellent across factors (α = 0.81–0.90; CR = 0.82–0.90; ω = 0.82–0.90), and test–retest analysis demonstrated high temporal stability (ICC = 0.899, 95% CI 0.790–0.952). Conclusion The Persian version of the PCSS demonstrated a robust four-factor, 18-item structure with strong validity and reliability. The scale captures both professional and organizational dimensions of post-code stress, reflecting the cultural and systemic realities of Iranian nursing. It can serve as a practical tool for assessing stress and guiding interventions, although future studies should confirm measurement invariance across subgroups and settings.