Evaluating the Effect of Positive Self-Talk on Job Stress among Nurses Working in the Emergency Wards

Nursing, by its nature is ranked as one of the most stressful jobs. Emergency nurses are exposed to more stress. A lot of studies have shown that nurses who work in critical care environments; such as emergency departments experience high levels of occupational stress during working time. Job stress may result in anxiety, restlessness, hate of working, absenteeism, and even a lot of illnesses. Interventions to manage nurses’ stress are required in order to improve patient care. Positive self-talk is a psychological skill. In this technique, the person commands the mind to direct its own thoughts and behaviors and to prepare all sources in order to achieve success. This study was carried out to evaluate the impact of positive self-talk on the job stress of nurses working in emergency wards.

In this evaluation study, 62 nurses working in emergency wards of three teaching hospitals affiliated to Iran University of Medical Sciences, including Hazrat Rasool-e- Akram (PBUH), Firoozgar, and Shohada-ye Hafte Tir hospitals participated in this study and were divided into two groups; control group and intervention group. Data collection was started in September and finished at the end of December 2019. At first, the list of nurses working in the emergency department was prepared by referring to the nursing offices of each center, and then, considering the inclusion criteria (at least one year of experience in the emergency department), the list was reviewed again. Then, based on the final list of samples from each center, 11 were randomly assigned to the control group and 11 to the intervention group using lottery. Finally, 33 were placed in the intervention group and 33 in the control group. Towards the end of the study, 32 were in the control group and 30 in the intervention group due to attrition. After identifying the groups, the researcher first introduced himself / herself to the samples of the control group of all 3 centers, and after explaining the objectives of the study and ensuring the confidentiality of information and obtaining informed written consent, asked them to fill the demographics questionnaire form and Expanded Nursing Stress Scale (ENSS) (French et al, 2000). No intervention was provided to the control group. 3 weeks after the pretest, ENSS (posttest) was completed again by the control group. In the next stage, the nurses of the intervention group were selected and after completing the data collection tools, the experimental group participated in a positive self-talk workshop at the School of Midwifery Nursing for two weeks (one session per week) from 8 am to 2 pm. The workshop was administered through lecturing about positive self-talk with presenting scenarios and group discussion as well as role play. One week after the workshop, the data collection tools were completed again by the intervention group. Data analysis was performed using independent t-test and chi-square in SPSS software version 16. The Expanded Nursing Stress Scale (ENSS) (French et al., 2000) was used in this study. This is a self-administered instrument. The ENSS is an expanded and updated version of the classic Nursing Stress Scale (NSS), which contains 57 items in 9 subscales related to physical, psychological, and social working environments. 9 subscales include: death and dying, conflict with physicians, inadequate emotional preparation, problems with peers, problems with supervisors, work load, uncertainty concerning treatment, patients and their families, and discrimination. The 57 items were arranged in a 5 point Likert  scale including ‘does not apply’ (0) , “never stressful” (1), “occasionally stressful” (2), “Frequently stressful” (3), “extremely stressful” (4). The total and subscale mean score was derived from this instrument which ranged from 0-4. The score range was 0-228. The higher scores indicated that the situation was highly stressful.

Findings showed no statistically significant difference between the two groups in terms of demographic characteristics. The results of paired t-test indicated a statistically significant difference between stress and its 5 dimensions in the intervention group before and after the intervention, so that the total stress before the intervention was (119.5 ± 36.02) which decreased to (95.86 ± 40.08) after the intervention (P = 0.001). The results also showed that the mean stress score in the intervention group after the intervention (95.86 ± 40.08) was significantly lower than the control group (129.06 ±40.52), indicating that with positive self-talk training, the stress of the intervention group is reduced  significantly (P = 0.002). Also, the results of independent t-test showed a statistically significant difference between the two groups in terms of subscales of job stress, which indicates the effect of positive self-talk on reducing job stress.

It is important to know that stress might be to some extent productive, whereas higher stress in staff costs a lot in terms of individual well- being and quality of health care services. Therefore, it must be managed effectively. Positive self-talk reduced nurseschr('39') job stress in emergency departments. Given the significant decrease in the nurses’ stress using positive self-talk strategies, this approach can be suggested to nurses in critical care units in order to reduce their stress and increase their efficiency. It is suggested that managers and nursing officials hold cognitive-behavioral stress management workshops, including positive self-talk for nurses working in different wards, and help them to improve the quality of nursing services. Researchers suggest that future studies investigate the comparative effect of positive self-talk with other psychological intervention on problem-solving and decision making skills in nurses working in emergency departments.