Iran Journal of Nursing

1. Introduction
One of the health-related problems in the workplace is job-related stress. Nursing is a stressful profession. Job stress is a physical and emotional response when job demands conflict with one's ability, resources, or needs. Some things that lead to stress in nurses are high workload, long working hours, dissatisfaction with wages and benefits, engaging with patients and their relatives, communication with doctors and other nurses, and working on holidays. Long-term work stress negatively affects nurses' physical and mental health and reduces their psychological wellbeing. According to Ryff's studies, psychological wellbeing is one of the most important components of health. Psychological wellbeing can be defined as a positive psychological function that includes self-acceptance, a sense of autonomy, purpose in life, environmental mastery, personal growth, and positive relations with others. Cognitive flexibility is the ability to adapt cognitive and behavioral strategies in response to environmental changes. This flexibility allows people to react more adaptable to stressors or life events, resulting in psychological wellbeing. Therefore, this study investigated the relationship between job stress and psychological wellbeing with the mediating role of cognitive flexibility.
2. Materials and Methods
The present study was a cross-sectional correlational study. The study population included all nurses working in hospitals in Isfahan City, Iran, in 2019. Using the cluster sampling method, we selected four hospitals in Isfahan (Kashani, Chamran, Khorshid, and Hojjatieh). Then four wards were randomly selected from each hospital, and 150 questionnaires were distributed among all nurses of those wards. To observe ethical considerations, the research samples voluntarily entered the research and signed written consent. They were also assured that the information in their questionnaire would remain confidential. In addition, this study obtained an ethical research code. The research tool consisted of four questionnaires. The first one is a demographic questionnaire. The second is the HSE job stress questionnaire with 35 questions designed to measure work-related stress by the UK safety and health executive. It is scored on a 5-point Likert-type scale from never (score 5) to always (score 1). Some questions are scored in reverse. Higher scores indicate high levels of stress. In Iran, the reliability of the questionnaire was 0.78 using the Cronbach α coefficient. The third is a short form of the Ryff psychological wellbeing questionnaire, which included 18 questions. A higher score indicates better psychological wellbeing. In Iran, the Cronbach α value for the whole scale was 0.71. The last one is the cognitive flexibility questionnaire. It is a short 20-item self-report tool. This questionnaire assesses a person's progress in creating flexible thinking. In Iran, the total test-retest reliability coefficient has been reported to be 0.71. To test the mediating role of cognitive flexibility in the relationship between job stress and psychological wellbeing, we used the proposed steps of Baron and Kenny by the hierarchical regression method. All analyses were done in SPSS version 16.
3. Results
Demographic data revealed that 111 nurses (74%) were women, and 39 (26%) were men. Also, 46 (30.7%) were single, and 104 (69.3%) were married. The highest frequency of nurses' education was 119 related to a bachelor's degree (79.3%). The Mean±SD values of study variables were 89.94±16.97 for job stress, 102.41±14.69 for cognitive flexibility, and 78.28±9.44 for psychological wellbeing. The results of the Pearson correlation showed that job stress has a negative relationship with two variables of cognitive flexibility and psychological wellbeing, but cognitive flexibility has a positive relationship with psychological wellbeing. The regression analysis results showed that in the first stage, job stress with β=-0.42 is a significant predictor of psychological wellbeing. In the second stage, the variables of job stress and cognitive flexibility predicted psychological wellbeing with β=-0.21 and β=0.54, respectively. Because the β value of job stress decreased in the second stage, the partial mediating role of cognitive flexibility in the relationship between job stress and psychological wellbeing was confirmed.
4. Conclusion
Most people can cope with stress for a short time, but chronic stress causes changes in physiological and psychological status, the consequences of which can decrease psychological wellbeing. It seems that some factors play a mediating role between job stress and psychological wellbeing, including cognitive flexibility, which was examined and confirmed in this study. More flexible persons can consider difficult situations and life events as manageable situations and think of alternative solutions. Such cases increase a person's capacity to cope, adapt, and get rid of stress and difficulties in life. The nursing profession requires the observation of various events and information, each of which may require a different response. For example, in addition to paying attention to the patient's emotional, behavioral, and physiological states, they should respond to the diagnostic and therapeutic information obtained for each patient. Their work environment can be accompanied by sudden changes that require vigilance and the ability to shift attention from one job to another. Thus, cognitive flexibility, which includes changing mindsets to adapt to changing environmental stimuli, helps nurses respond to the ever-changing work environment. It should be noted that part of the negative relationship between job stress and psychological wellbeing is affected by reduced cognitive flexibility. Therefore, when it is not possible to eliminate the source of stress, promoting cognitive flexibility can reduce the adverse effects of stress. In this regard, sessions should be held to train cognitive flexibility in nurses and examine its impact on increasing psychological wellbeing.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethical Committee of the Yazd University (Code: IR.YAZD.REC.1399.040). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information. They were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
The paper was extracted from the MA. thesis of the second author at the Department of Psychology, Faculty of Psychology and Educational Sciences, Yazd University, Yazd.

Authors' contributions
Conceptualization, methodology, analysis and finalization: Fahimeh Dehghani; Data collection, drafting: Zahra Bahari.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The present article is taken from a bachelor's thesis in psychology. Thank you to all the nurses who helped the researchers in completing the study by completing the questionnaire.


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