The mediating role of ambiguity intolerance and worry in the relationship between resilience and fatigue compassion in the nurses

Document Type : Original Article

Authors

1 Master's student in General Psychology, Department of Psychology, Malard Branch, Islamic Azad University, Tehran, Iran, Iran.

2 Master of Science in General Psychology, Department of Psychology, Armenian Branch, Payam Noor University, Yerevan, Armenia.

Abstract

This study aimed to determine the mediating role of ambiguity intolerance and worry in the relationship between resilience and fatigue compassion in nurses. The research method employed a descriptive-correlational design, and the statistical population of this study consisted of all nurses working in hospitals in Tehran Province in 2024. A convenience sampling method was used to select 220 nurses from this population. The study tools were included Connor-Davidson Resilience Scale (2003), the Compassion Fatigue Inventory by Saberi et al. (2017), Penn State Worry Questionnaire by Meyer et al. (1990), and the Ambiguity Tolerance Scale-II by McLain (2009). Structural equation modeling was used to analyze the data. The results showed that worry mediates the relationship between resilience and fatigue compassion negatively and significantly (β=-0.096, P=0.001). Ambiguity intolerance mediates the relationship between resilience and fatigue compassion negatively and significantly (β=-0.050, P=0.029). Based on the results of the present study, it seems that the lack of resilience among nurses in ambiguous and worrying situations causes burnout and fatigue compassion.

Keywords


1-Ahmadi, G., Sayyahi, A. (2017). An investigation intothe predictive role of psychological hardiness and tolerance of ambiguity in the resiliency of military personnel. Journal of military Psychology, 8(30), 81-90.
2-Aktar, E., Nikolic, M., Bogels, S. M. (2017). Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty. Dialogues in clinical neuroscience, 19(2), 137-47.
3-Bair, A., Reyes del Paso, G. A., Duschek, S. (2020). Parasympathetic cardiac control and attentional focus in trait worry. International Journal of Psychophysiology.
4-Bonanno, G. A. (2004). Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol, 59(1), 20-8.
5-Borkovec, T. (1994). The nature, functions, and origins of worry. Worrying: Perspectives on Theory, Assessment and Treatment.
6-Borkovec, T. D., Alcaine, O. M., Behar, E. (2004). Avoidance Theory of Worry and Generalized Anxiety Disorder.  Generalized anxiety disorder: Advances in research and practice. New York, NY, US: Guilford Press. p. 77-108.
7-Borkovec, T. D., Ray, W. J., Stober, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22(6), 561-76.
8-Britton, G. I., Neale, S.E., Davey, G. C. L. (2019). The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry. Journal of Behavior Therapy and Experimental Psychiatry, 62, 65-71.
9-Charney, D. S. (2003). The psychobiology of resilience and vulnerability to anxiety disorders: implications for prevention and treatment. Dialogues Clin Neurosci, 5(3), 207-21.
10-Chen, S., Yao, N., Qian, M. (2018). The influence of uncertainty and intolerance of uncertainty on anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 61, 60-5.
11-Clark, D. A., Beck, A. T. (2012). The Anxiety and Worry Workbook: The Cognitive Behavioral Solution: Guilford Press.
12-Clarke, P. J. F., Sprlyan, B. F., Hirsch, C. R., Meeten, F., Notebaert, L. (2020). tDCS increases anxiety reactivity to intentional worry. Journal of Psychiatric Research, 120, 34-9.
13-Connor, K., Davidson, J. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and anxiety, 18, 76-82.
14-Davey, G. C., Wells, A. (2008). Worry and its Psychological Disorders: John Wiley & Sons Ltd.
15-Dehshiri, G. R., Golzari, M., Borjali, A., Sohrabi, F. (2009). Psychometrics particularity of Farsi Version of Pennsylvania State Worry Questionnaire for college students. Journal of Clinical Psychology, 1(4), 67-75.
16-Durning, S. J., Dong, T., Artino, A. R., van der Vleuten, C., Holmboe, E., Schuwirth, L. (2015). Dual processing theory and experts' reasoning: exploring thinking on national multiple-choice questions. Perspect Med Educ, 4(4), 168-75.
17-Feizi, A., Mahbobi, T., Zare, H., Mostafaei, A. (2012). The relationship of cognitive intelligence and ambiguity tolerance with entrepreneurship among students of West Azarbayjan Payam Noor University, Iran. Research in Behavioural Sciences,10(4), 276-84.
18-Fialko, L., Bolton, D., Perrin, S. (2012). Applicability of a cognitive model of worry to children and adolescents. Behav Res Ther, 50(3), 341-9.
19-Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder. United Kingdom: Routledge Taylor & Francis Group.
20-Figley, C. R., Figley, K. R. (2017). Compassion Fatigue Resilience. United Kingdom: The Oxford Handbook of Compassion Science.
21-Froutan, R., Mahroughi, N., Malekzadeh, J., Mazlom, S. R. (2018). The effect of stress management training on anxiety and resilience of emergency medical staff. Journal of Nursing Education, 6(3), 46-53.
22-Huang, C-C., Chen, Y., Greene, L., Cheung, S., Wei, Y. (2019). Resilience and emotional and behavioral problems of adolescents in China: Effects of a short-term and intensive mindfulness and life skills training. Children and Youth Services Review, 100, 291-7.
23-Kapoulitsas, M., Corcoran, T. (2014). Compassion fatigue and resilience: A qualitative analysis of social work practice. Qualitative Social Work, 14(1), 86-101.
24-Kertz, S., Woodruff-Borden, J. (2013). The role of metacognition, intolerance of uncertainty, and negative problem orientation in children's worry. Behav Cogn Psychother, 41(2), 243-8.
25-Keyhani, M., Taghvaei, D., Rajabi, A., Amirpour, B. (2015). Internal Consistency and Confirmatory Factor Analysis of the Connor-Davidson Resilience Scale (CD-RISC) among Nursing Female. Iranian Journal of Medical Education, 14(10), 857-65.
26-Khodayarifard, M., Mansouri, A., Besharat, M. A., Gholamali Lavasani, M. (2017). A review of conceptual models for worry and generalized anxiety disorder. Clinical Excellence, 6(2), 23-38.
27-Khoshnazary, S., Hosseini, M., Fallahi Khoshknab, M., Bakhshi, E. (2016). The Effect of Emotional Intelligence (EI) Training on Nurses' Resiliency in Department of Psychiatry. Journal of Nursing Education, 3(4), 28-37.
28-Kline, R. B. (2011). Principles and practice of structural equation modeling. 3rd ed. New York: Guilford press.
29-Kraft, B., Jonassen, R., Stiles, T. C., Landrø, N. I. (2017). Dysfunctional metacognitive beliefs are associated with decreased executive control. Frontiers in Psychology, 8(593).
30-Lee, A. H., Woodruff-Borden, J. (2018). Roles of emotional reactivity, intolerance of uncertainty, and negative problem orientation on developing childhood worry. Personality and Individual Differences, 135, 25-30.
31-Lenzo, V., Sardella, A., Martino, G., Quattropani, M. C. (2020). A Systematic review of metacognitive beliefs in chronic medical conditions. Frontiers in Psychology, 10(2875).
32-Lynch, S. H., Lobo,  M. L. (2012). Compassion fatigue in family caregivers: a Wilsonian concept analysis. J Adv Nurs, 68(9), 2125-34.
33-Majidpoor Tehrani, L., Aftab, R. (2021). The mediating role of cognitive emotion regulation strategies and worry in the relationship between resilience and anxiety of being infected by COVID-19. Journal of Clinical Psychology.
34-McDermott, K. A., Cougle, J. R. (2020). Disengagement training for the treatment of pathological worry: A preliminary test. Behavior Therapy.
35-McLain, D. L. (2009). Evidence of the properties of an ambiguity tolerance measure: the Multiple Stimulus Types Ambiguity Tolerance Scale-II (MSTAT-II). Psychological reports, 105(3 Pt 1), 975-88.
36-Meyer, T. J., Miller, M. L., Metzger, R. L., Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487-95.
37-Newman, M. G., Cho, S., Kim, H. (2017). Worry and Generalized Anxiety Disorder: A Review.  Reference Module in Neuroscience and Biobehavioral Psychology: Elsevier.
38-Osmanagaoglu, N., Creswell, C., Dodd, H. F. (2018). Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis. Journal of affective disorders, 225, 80-90.
39-Prout, T., Malone, A., Rice, T., Hoffman, L. (2019). Resilience, defense mechanisms, and implicit emotion regulation in psychodynamic child psychotherapy. Journal of Contemporary Psychotherapy.
40-Ranjbar Noushari, F., Mohadesi, H., Asadi Majareh, S., Hashemi, S.(2013). Psychological correlates of cancer: Worry, life style, self-eficacy. Nursing and Midwifery Journal, 11(9), 698-705.
41-Sabery, M., Tafreshi, M. Z., Hosseini, M., Mohtashami, J., Ebadi, A. (2017). Development and Psychometric Evaluation of the Nurses' Compassion Fatigue Inventory. J Nurs Meas, 25(3), 185-201.
42-Salimi, S., Pakpour, V., Feizollahzadeh, H., Rahmani, A. (2017). Resilience and its association with the intensive care unit nurses’ intention to leave their profession. Hayat, 23(3), 254-65.
43-Sarboozi Hosein Abadi, T., Askari, M., Miri, K., Namazi Nia, M. (2020). Depression, stress and anxiety of nurses in COVID-19 pandemic in Nohe-Dey Hospital in Torbat-e-Heydariyeh city, Iran. Journal of Military Medicine, 22(6), 526-33.
44-Sepahvand, R., Momeni Mofrad, M., Taghipour, S. (2020).  Identifying and prioritizing the psychological consequences of the Covid 19 virus in nurses. Hospital, 19(2), 25-32.
45-Shabahang, R., Khosrojavid, M., Ahmadi, A. (2018). The Role of Attitude and Resiliency in Predicting the Quality of Life of Parents of Children with Special Needs. Quarterly Journal of Child Mental Health, 5(3), 11-21.
46-Sica, C., Steketee, G., Ghisi, M., Chiri, L. R., Franceschini, S. (2007). Metacognitive beliefs and strategies predict worry, obsessive–compulsive symptoms and coping styles: A preliminary prospective study on an Italian non-clinical sample. Clinical Psychology & Psychotherapy, 14(4), 258-68.
47-Thielsch, C., Andor, T., Ehring, T. (2015). Metacognitions, intolerance of uncertainty and worry: An investigation in adolescents. Personality and Individual Differences, 74, 94-8.