Volume 32, Issue 1 (3-2025)
RJMS 2025, 32(1): 1-8 |
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Research code: فاقد کد
Ethics code: IR.IAU.SHK.REC.1400.076
Clinical trials code: فاقد کد
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Azadi H, Ghazanfari A, Chorami M, Sharifi T. Comparison of the Effectiveness of Acceptance and Commitment and Paradoxical Time Table Therapy on Occupational Stress in Emergency Nurses. RJMS 2025; 32 (1) :1-8
URL: http://rjms.iums.ac.ir/article-1-7639-en.html
URL: http://rjms.iums.ac.ir/article-1-7639-en.html
1- Faculty of Humanities, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran, Shahrekord branch of Islamic Azad University
2- Faculty of Humanities, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran, Shahrekord branch of Islamic Azad University ,aghazan5@yahoo.com
2- Faculty of Humanities, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran, Shahrekord branch of Islamic Azad University ,
Abstract: (301 Views)
Background: Emergency department nurses, as an important part of the nursing community, are in direct contact with patients, and disorder, unpredictable situations, high-pressure atmosphere, lack of control, and limited time frame for evaluating the effect of therapeutic interventions are stressful issues for emergency department nurses (2). Emergency department nurses usually bear a lot of stress due to the working conditions and resulting psychological burden (3), as it gradually causes them to experience occupational stress (5). Occupational stress is defined as an emotional, perceptual, behavioral and physiological reaction pattern to unfavorable aspects of the occupational, organizational and environmental content of the workplace (9) and causes concerns about people's mental health (8).
Treatment based on acceptance and commitment is one of the treatment methods that can be used to improve the communication, emotional and psychological components of nurses (11). In this treatment, the therapist is taught that any action to avoid or control unwanted mental experiences (thoughts and feelings) is ineffective or has the opposite effect and causes them to intensify, and that these experiences should be accepted in order to remove them without any internal or external reaction (15). This treatment seeks to teach different people how to stop inhibiting thoughts, how to get rid of disturbing thoughts and how to tolerate unpleasant emotions more (17).
Another treatment method used in this study is paradoxical schedule treatment. This method is a new model of paradoxical psychotherapy that was presented by Basharat in 2016 (18). This therapeutic model originates from the principles of psychodynamic, psychoanalytical, cognitive and systemic theories (19), but in practice and therapeutic measures, it is faithful to behavioral techniques. This treatment method consists of two components or two techniques: paradox and schedule. Based on this dual combined technique, the same symptoms of the disease are prescribed for the patient (paradox) and the patient is obliged to take these symptoms, according to the instructions prescribed by the therapist with the opinion and cooperation of the patient, reconstruct and experience at certain times of the day and night and for a certain period of time (schedule) (18).
The present study aims to answer the question of which of these two treatments is more effective on reduction of occupational stress and its components in nurses by comparing two treatments of acceptance and commitment and paradoxical schedule treatment on the occupational stress of emergency department nurses?
Method: The current research was semi-experimental and its design was pre-test-post-test with a control group and a two-month follow-up period. The statistical population studied in this research was made up of all the nurses working in the emergency departments of Isfahan hospitals in the second half of 2019. To select the sample, 45 nurses were selected as convenience sampling and randomly assigned to 2 experimental groups of treatment based on acceptance and commitment, the experimental group of paradoxical schedule treatment and a control group (15 people in each group). The inclusion criteria included working as a nurse in the emergency department of one of the government hospitals in Isfahan city, age range from 25 to 55 years, and willingness to participate in the research. The exit criteria included absence of more than 3 sessions and unwillingness to continue cooperation. The experimental group of treatment based on acceptance and commitment received 8 90-minute sessions and the paradoxical schedule treatment group received 6 90-minute sessions online and virtually, but no intervention was done for the control group. Participants responded to Gray-Taft and Anderson's (1981) occupational stress questionnaire in three stages. This questionnaire has 34 questions and 7 components of patient suffering and death, conflict with doctors, insufficient preparation, lack of support, conflict with other nurses, work pressure and uncertainty of treatment. Scores range from 34 to 102, and higher scores indicating greater nursing stress. The retest reliability of the nursing stress questionnaire was reported by Lee et al. as 0.81 (29). The obtained data were analyzed using the method of analysis of variance with repeated measurements in SPSS-26 software.
Results: The results of the analysis of variance showed that with the significance of calculated F, the source of occupational stress group (F=4/00), Components of patient suffering and death (F=4/49), conflict components with doctors (F=13/86), insufficient preparation (F=19/86), conflict with other nurses (F=5/97) and work pressure (F=8/06); It can be said that there is a significant difference between the average scores of the nurses of the experimental and control groups in the components of occupational stress and its components (conflict with doctors, insufficient preparation, conflict with other nurses and work pressure) (P<0.05). Also, the results of the post hoc Bonferroni test showed that both methods of intervention reduced job stress and the two components of work pressure and the feeling of suffering and death of patients, and only in job stress and work pressure, the effect of the two interventions remained constant over time. Also, the paradoxical schedule has been able to effectively reduce conflicts with doctors and conflicts with other nurses, and the effect of the paradoxical schedule has remained constant over time only in the component of conflict with other nurses. Finally, in the component of insufficient preparation, only the therapeutic intervention based on acceptance and commitment was effective in the post-test stage, and its effect did not remain stable over time.
Conclusion: In the explanation obtained in relation to the effectiveness of treatment based on acceptance and commitment, it can be said that this approach has a lot of emphasis on identifying values and commitment to them (33), which causes nurses to once again identify job values, goals, ways to achieve and the internal or external obstacles that prevent them from reaching them and find commitment to these values. Also, in this method, people learn to be able to separate themselves from reactions, memories and unpleasant thoughts with the techniques of faulting and acceptance, so that instead of fighting the discomfort associated with fear, hostility and blaming others for work issues by engaging in activities that make them closer to the chosen goals of life (values), exercise their control. Also, in the explanation obtained in relation to the effectiveness of the paradoxical schedule, it can be said that the therapist asks the nurses, at the designated times in each treatment session, the signs of occupational stress that are activated in professional and executive situations or according to the visualization of those situations; out of their control and will and they make them anxious, scared and desperate; reconstruct and experience with their own will (structuralization) and then according to the therapist's instructions, they should artificially play and experience the signs and behaviors that are real (artificialization) (21). Performing the task reduces or eliminates the anxiety of doing the task and increases the chance of artificial reconstruction of the disease symptom (22). Repetition of assignments also provides nurses with the opportunity to retest and re-experience the ineffectiveness of stress symptoms, which ultimately leads to reinforcement and strengthening me.
One of the limitations of the present study was the lack of control over the conditions and characteristics related to economic and family conditions (which are effective factors in reducing occupational stress symptoms). It is also suggested that by holding treatment courses and workshops based on acceptance and commitment and paradoxical schedule in hospitals, clinics and treatment centers, it helps to increase the job adaptability and reduce the stress of nurses and medical staff.
Conflicts of interest: None
Funding: None
Treatment based on acceptance and commitment is one of the treatment methods that can be used to improve the communication, emotional and psychological components of nurses (11). In this treatment, the therapist is taught that any action to avoid or control unwanted mental experiences (thoughts and feelings) is ineffective or has the opposite effect and causes them to intensify, and that these experiences should be accepted in order to remove them without any internal or external reaction (15). This treatment seeks to teach different people how to stop inhibiting thoughts, how to get rid of disturbing thoughts and how to tolerate unpleasant emotions more (17).
Another treatment method used in this study is paradoxical schedule treatment. This method is a new model of paradoxical psychotherapy that was presented by Basharat in 2016 (18). This therapeutic model originates from the principles of psychodynamic, psychoanalytical, cognitive and systemic theories (19), but in practice and therapeutic measures, it is faithful to behavioral techniques. This treatment method consists of two components or two techniques: paradox and schedule. Based on this dual combined technique, the same symptoms of the disease are prescribed for the patient (paradox) and the patient is obliged to take these symptoms, according to the instructions prescribed by the therapist with the opinion and cooperation of the patient, reconstruct and experience at certain times of the day and night and for a certain period of time (schedule) (18).
The present study aims to answer the question of which of these two treatments is more effective on reduction of occupational stress and its components in nurses by comparing two treatments of acceptance and commitment and paradoxical schedule treatment on the occupational stress of emergency department nurses?
Method: The current research was semi-experimental and its design was pre-test-post-test with a control group and a two-month follow-up period. The statistical population studied in this research was made up of all the nurses working in the emergency departments of Isfahan hospitals in the second half of 2019. To select the sample, 45 nurses were selected as convenience sampling and randomly assigned to 2 experimental groups of treatment based on acceptance and commitment, the experimental group of paradoxical schedule treatment and a control group (15 people in each group). The inclusion criteria included working as a nurse in the emergency department of one of the government hospitals in Isfahan city, age range from 25 to 55 years, and willingness to participate in the research. The exit criteria included absence of more than 3 sessions and unwillingness to continue cooperation. The experimental group of treatment based on acceptance and commitment received 8 90-minute sessions and the paradoxical schedule treatment group received 6 90-minute sessions online and virtually, but no intervention was done for the control group. Participants responded to Gray-Taft and Anderson's (1981) occupational stress questionnaire in three stages. This questionnaire has 34 questions and 7 components of patient suffering and death, conflict with doctors, insufficient preparation, lack of support, conflict with other nurses, work pressure and uncertainty of treatment. Scores range from 34 to 102, and higher scores indicating greater nursing stress. The retest reliability of the nursing stress questionnaire was reported by Lee et al. as 0.81 (29). The obtained data were analyzed using the method of analysis of variance with repeated measurements in SPSS-26 software.
Results: The results of the analysis of variance showed that with the significance of calculated F, the source of occupational stress group (F=4/00), Components of patient suffering and death (F=4/49), conflict components with doctors (F=13/86), insufficient preparation (F=19/86), conflict with other nurses (F=5/97) and work pressure (F=8/06); It can be said that there is a significant difference between the average scores of the nurses of the experimental and control groups in the components of occupational stress and its components (conflict with doctors, insufficient preparation, conflict with other nurses and work pressure) (P<0.05). Also, the results of the post hoc Bonferroni test showed that both methods of intervention reduced job stress and the two components of work pressure and the feeling of suffering and death of patients, and only in job stress and work pressure, the effect of the two interventions remained constant over time. Also, the paradoxical schedule has been able to effectively reduce conflicts with doctors and conflicts with other nurses, and the effect of the paradoxical schedule has remained constant over time only in the component of conflict with other nurses. Finally, in the component of insufficient preparation, only the therapeutic intervention based on acceptance and commitment was effective in the post-test stage, and its effect did not remain stable over time.
Conclusion: In the explanation obtained in relation to the effectiveness of treatment based on acceptance and commitment, it can be said that this approach has a lot of emphasis on identifying values and commitment to them (33), which causes nurses to once again identify job values, goals, ways to achieve and the internal or external obstacles that prevent them from reaching them and find commitment to these values. Also, in this method, people learn to be able to separate themselves from reactions, memories and unpleasant thoughts with the techniques of faulting and acceptance, so that instead of fighting the discomfort associated with fear, hostility and blaming others for work issues by engaging in activities that make them closer to the chosen goals of life (values), exercise their control. Also, in the explanation obtained in relation to the effectiveness of the paradoxical schedule, it can be said that the therapist asks the nurses, at the designated times in each treatment session, the signs of occupational stress that are activated in professional and executive situations or according to the visualization of those situations; out of their control and will and they make them anxious, scared and desperate; reconstruct and experience with their own will (structuralization) and then according to the therapist's instructions, they should artificially play and experience the signs and behaviors that are real (artificialization) (21). Performing the task reduces or eliminates the anxiety of doing the task and increases the chance of artificial reconstruction of the disease symptom (22). Repetition of assignments also provides nurses with the opportunity to retest and re-experience the ineffectiveness of stress symptoms, which ultimately leads to reinforcement and strengthening me.
One of the limitations of the present study was the lack of control over the conditions and characteristics related to economic and family conditions (which are effective factors in reducing occupational stress symptoms). It is also suggested that by holding treatment courses and workshops based on acceptance and commitment and paradoxical schedule in hospitals, clinics and treatment centers, it helps to increase the job adaptability and reduce the stress of nurses and medical staff.
Conflicts of interest: None
Funding: None
Type of Study: Research |
Subject:
Clinical Psychiatry
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