Evaluating The Effectiveness of Schema Therapy on the Resilience and Psychological Well-being of Nurses Working in Intensive Care Unit

Nurses are one of the important links in delivering the service and promoting the quality of care. Nurses' exposure to individual, communication, and organizational stresses reduces their psychological well-being; this leads to a decline in positive psychological characteristics and resilience. Resilience is an individual's ability to respond appropriately to the vicissitudes of life and increase psychological wellbeing, resulting in quality care and job satisfaction. Schemas as the underlying variables affect individuals' cognitive processing, coping strategies, and lifestyles. Schema therapy is a therapeutic approach that, through cognitive, behavioral, interpersonal and empirical interventions, targets maladaptive schemas that are memories of childhood rigidities and lead to irrational thinking. While mental health is a sign of success in coping with adverse conditions, the nurses of the intensive care units are exposed to a higher rate of stressful events. Our research determines the effect of schema therapy on the resilience and psychological well-being of intensive care unit nurses.

The research method was quasi-experimental with a pretest-posttest design, a control group and a two-month follow-up. Its statistical population included all nurses working in the intensive care unit of Shohada Tajrish and Shahid Taleghani hospitals in Tehran City, Iran, in 2021. We recruited 40 nurses at convenience in the study based on the inclusion and exclusion criteria from 86 nurses. Then, they were randomly divided into experimental and control groups. The inclusion criteria were as follows: willingness to participate in the research and delivering informed consent, employment for at least one year in the intensive care unit, not receiving psychological treatment or participating in other educational sessions at the same time, not taking certain medications, lacking stressful events such as divorce, death, etc. in close relatives in the last six months, obtaining a lower than average score in Psychological Well-Being Scale (average score=45) and Connor-Davidson Resilience Scale (average score=55). Also, the exclusion criteria were unwillingness to continue cooperation during the research, not attending more than two consecutive sessions out of 11 training sessions, and unwillingness to do homework. The experimental group received 11 sessions of 75-90 minutes per week of schema therapy. The control group did not receive any intervention. Data collection tools were the Connor-Davidson Resilience Scale (Connor and Davidson, 2003) and Psychological Well-Being Scale (Ryff, 1989). We used them in three stages of pretest, posttest, and follow-up. The obtained data were analyzed using descriptive statistics, including mean, standard deviation, and inferential statistics, including repeated measures analysis of variance and Bonferroni post hoc test in SPSS software version 25. The significance level of statistical tests was set at 0.05.

There was a significant difference between the experimental group and the control groups in resilience (p=0.008) and psychological well-being (p<0.001). In the experimental group, resilience (p<0.001) and psychological well-being (p<0.001) had a significant difference from the posttest stage to the follow-up stage. The mutual effect of the test stages with the group also determined that resilience (p<0.001) and psychological well-being (p<0.001) had a significant difference. In other words, schema therapy significantly increased the resilience and psychological well-being of nurses working in intensive care units. The findings of the Bonferroni follow-up test in the experimental group indicated significant differences between the pretest and posttest stages (p=0.001) and between the pretest and follow-up (p=0.001) in the resilience variable. Also, there were significant differences between pretest and posttest (p=0.001) and between pretest and follow-up (p=0.002) regarding the psychological well-being variable. Also, there was the stability of the effect of the treatment schema in the follow-up stage on the variables of resilience (p=0.910) and psychological well-being (p=0.488).

According to the findings, schema therapy increases the resilience and psychological well-being of intensive care unit nurses. Therefore, this treatment is usable as an effective intervention for improving the psychological capabilities and mental health of nurses.