Volume 34, Issue 133 (December 2021)                   IJN 2021, 34(133): 16-27 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

dehghani F, Bahari Z. The Mediating Role of Cognitive Flexibility in the Relationship Between Job Stress and Psychological Wellbeing of Nurses. IJN 2021; 34 (133) :16-27
URL: http://ijn.iums.ac.ir/article-1-3220-en.html
1- Department of Psychology, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran. , f.dehghani@yazd.ac.ir
2- Department of Psychology, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran.
Full-Text [PDF 4816 kb]   (1347 Downloads)     |   Abstract (HTML)  (2324 Views)
Full-Text:   (1380 Views)
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.

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.

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.

  1. Harvey SB, Modini M, Joyce S, Milligan-Saville JS, Tan L, Mykletun A, et al. Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occup Environ Med. 2017; 74(4):301-10. [DOI:10.1136/oemed-2016-104015] [PMID]
  2. Sharma P, Davey A, Davey S, Shukla A, Shrivastava K, Bansal R. Occupational stress among staff nurses: Controlling the risk to health. Indian J Occup Environ Med. 2014; 18(2):52-6. [PMID] [PMCID]
  3. La Torre G, Sestili C, Mannocci A, Sinopoli A, De Paolis M, De Francesco S, et al. Association between work related stress and health related quality of life: The impact of socio-demographic variables. A cross sectional study in a region of central Italy. Int J Environ Res Public Health. 2018; 15(1):159. [DOI:10.3390/ijerph15010159] [PMID] [PMCID]
  4. Mohammadi M, Vaisi-Raygani A, Jalali R, Salari N. Prevalence of job stress in nurses working in Iranian hospitals: A systematic review, meta-analysis and meta- regression study. J Health Saf Work. 2020; 10(2):119-28. http://jhsw.tums.ac.ir/article-1-6295-en.html
  5. Mathew A, Thomas S. Occupational stress among nurses: Government versus private sector. Int J Nurs Care. 2019; 7(1):1-5. [DOI:10.5958/2320-8651.2019.00001.2]
  6. Novaes Neto EM, Xavier ASG, Araújo TM. Factors associated with occupational stress among nursing professionals in health services of medium complexity. Rev Bras Enferm. 2020; 73 (Suppl1):e20180913. [DOI:10.1590/0034-7167-2018-0913] [PMID]
  7. Idris MK. Over time effects of role stress on psychological strain among Malaysian public university academics. Int J Bus Soc Sci. 2011; 2(9):154-61. http://ijbssnet.com/journal/index/372
  8. Ryff CD. Beyond Ponce de Leon and life satisfaction: New directions in quest of successful ageing. International journal of behavioral development. 1989; 12(1):35-55. [DOI:10.1177/016502548901200102]
  9. Yu J, Song Y, Dong H, Su X, Zhang P. Factors associated with the general well-being of nurses in a tertiary Chinese hospital: A cross-sectional study. J Nurs Manag. 2020; 28(3):540-7. [DOI:10.1111/jonm.12954] [PMID]
  10. Lee TS, Sun HF, Chiang HH. Development and validation of the short-form Ryff’s psychological well-being scale for clinical nurses in Taiwan. J Med Sci. 2019; 39(4):157-62. [DOI:10.4103/jmedsci.jmedsci_191_18]
  11. Foster K, Roche M, Giandinoto JA, Furness T. Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study. Int J Ment Health Nurs. 2020; 29(1):56-68. [DOI:10.4103/jmedsci.jmedsci_191_18] [PMID]
  12. Sotoodeh H, Shakerinia I, Kheyrati M, Dargahi S, Ghasemi Jobaneh R. [Surveying the relationship between spiritual and moral intelligence and the psychological well-being of nurses (Persian)]. Med Ethics Hist Med. 2016; 9(1):63-73. http://ijme.tums.ac.ir/article-1-5703-en.html
  13. Aghli E, Ahi G, Mansouri A. [The role of dark triad of personality in predicting psychological well-being and humor styles in nurses (Persian)]. Iran J Psychiatr Nurs. 2018; 6(2):41-9. http://ijpn.ir/article-1-1045-en.html
  14. Dadkhah Tehrani T, Habibian N, Ahmadi R. The relationship between religious attitudes and psychological well-being of nurses working in health centers in Qom University of Medical Sciences in 2014. Health Spiritual Med Ethics. 2015; 2(4):15-21. http://jhsme.muq.ac.ir/article-1-24-en.html
  15. Li L, Ai H, Gao L, Zhou H, Liu X, Zhang Z, et al. Moderating effects of coping on work stress and job performance for nurses in tertiary hospitals: A cross-sectional survey in China. BMC Health Serv Res. 2017; 17(1):401. [DOI:10.1186/s12913-017-2348-3] [PMID] [PMCID]
  16. Babaei MR, Askarizadeh G, Towhidi A. The effectiveness of Stress Management and Resilience Training (SMART) on psychological well-being in patients with thalassemia major. Prev Care Nurs Midwifery J. 2019; 8(4):8-15. [DOI:10.29252/pcnm.8.4.8]
  17. Izquierdo A, Brigman JL, Radke AK, Rudebeck PH, Holmes A. The neural basis of reversal learning: An updated perspective. Neuroscience. 2017; 345:12-26. [DOI:10.1016/j.neuroscience.2016.03.021] [PMID] [PMCID]
  18. Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cogn Ther Res. 2010; 34(3):241-53. [DOI:10.1007/s10608-009-9276-4]
  19. Khorshidi G, DashtBozorgi Z. [Relationship of dark triad of personality, sexual assertiveness and cognitive flexibility with marital burnout in female nurses (Persian)]. Iran J Nurs Res. 2019; 14(1):65-71. http://ijnr.ir/article-1-2167-en.html
  20. Mahdavi Neysiani Z, Asgari M, Hosseni J, Tamananlo Z. [The relationship between cognitive flexibility and burnout and occupational injuries in female emergency nurses (Persian). Paper presented at: 7th International Conference on Psychology and Social Sciences. 16 February 2017; Tehran, Iran. https://civilica.com/doc/639010/certificate/print/
  21. Kruczek A, Basińska MA, Janicka M. Cognitive flexibility and flexibility in coping in nurses-the moderating role of age, seniority and the sense of stress. Int J Occup Med Environ Health. 2020; 33(4):507-21. [DOI:10.13075/ijomeh.1896.01567] [PMID]
  22. Crum AJ, Akinola M, Martin A, Fath S. The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety Stress Coping. 2017; 30(4):379-95. [DOI:10.1080/10615806.2016.1275585] [PMID]
  23. Hurtubise JL, Howland JG. Effects of stress on behavioral flexibility in rodents. Neuroscience. 2017; 345:176-92. [DOI:10.1016/j.neuroscience.2016.04.007] [PMID]
  24. Marko M, Riečanský I. Sympathetic arousal, but not disturbed executive functioning, mediates the impairment of cognitive flexibility under stress. Cognition. 2018; 174:94-102. [DOI:10.1016/j.cognition.2018.02.004] [PMID]
  25. Sung E, Chang JH, Lee S, Park SH. The Moderating effect of cognitive flexibility in the relationship between work stress and psychological symptoms in Korean air force pilots. Mil Psychol. 2019; 31(2):100-6. [DOI:10.1080/08995605.2018.1556083]
  26. Cardom RD. The mediating role of cognitive flexibility on the relationship between cross-race interactions and psychological well-being [PhD. dissertation]. Lexington: University of Kentucky; 2016. https://uknowledge.uky.edu/edp_etds/50/
  27. Jordan TR, Khubchandani J, Wiblishauser M. The impact of perceived stress and coping adequacy on the health of nurses: A pilot investigation. Nurs Res Pract. 2016; 2016:5843256. [DOI:10.1155/2016/5843256] [PMID] [PMCID]
  28. Charkhat Gorgich EA, Zare S, Ghoreishinia G, Barfroshan S, Arbabisarjou A, Yoosefian N. Job stress and mental health among nursing staff of educational hospitals in South East Iran. Thrita. 2017; 6(1):e45421. [DOI:10.1155/2016/5843256]
  29. Warner RM. Applied statistics: From bivariate through multivariate techniques. California: Sage Publications; 2013. https://www.google.com/books/edition/Applied_Statistics_From_Bivariate_Throug/b1bXhepuJOEC?hl=en&gbpv=0
  30. Cousins R, MacKay C, Clarke SD, Kelly C, Kelly PJ, McCaig RH. Management standards and work-related stress in the UK: Practical development. Work Stress. 2004; 18(2):113-36. [DOI:10.1080/02678370410001734322]
  31. Azad Marzabadi E, Gholami Fesharaki M. [Reliability and validity assessment for the HSE Job Stress Questionnaire (Persian)]. Int J Behav Sci. 2011; 4(4):291 -7. https://www.sid.ir/fa/journal/ViewPaper.aspx?ID=128653
  32. Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol. 1995; 69(4):719-27. [DOI:10.1037/0022-3514.69.4.719]
  33. Khanjani M, Shahidi Sh, Fathabadi J, Mazaheri MA, Shokri O. [Factor structure and psychometric properties of the Ryff’s scale of Psychological well-being, short form (18-item) among male and female students (Persian)]. J Thought Behav Clin Psychol. 2014; 9(32):27-36. https://jtbcp.riau.ac.ir/article_67_en.html
  34. Soltani E, Shareh H, Bahrainian SA, Farmani A. [The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression (Persian)]. Pejouhandeh. 2013; 18(2):88-96. http://pajoohande.sbmu.ac.ir/article-1-1518-en.html
  35. Esmaeili S, Ghanbari Panah A, KoochakEntezar R. [Prediction of psychological well-being based on health anxiety and perceived stress with the mediating role of self-handicapping in married women working in the school of Nursing and Midwifery, Tehran University of Medical Sciences in 2018 (Persian)]. Iran J Nurs Res. 2020; 14(6):45-52. http://ijnr.ir/article-1-2320-en.html
  36. Ayadi N, Dargahi S, Ghamari Givi H, Abbasi M. [The impact of job stress on subjective well-being, marital stress and empathy of nurses (Persian)]. J Med Ethics Hist Med. 2016; 9(2):67-79. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=547038
  37. Jafari A, Deghani Arani Z. [Predicting psychological wellbeing of women with hypertension based on Perceived stress with mediating role cognitive emotional regulation (Persian)]. Iran J Psychiatr Nurs. 2019; 7(2):39-47. http://ijpn.ir/article-1-1329-en.html
  38. Rahmani A, Merghati Khoei E, Sadeghi N, Allahgholi L. [Relationship between sexual pleasure and marital satisfaction (Persian)]. Iran J Nurs. 2011; 24(70):82-90. http://ijn.iums.ac.ir/article-1-988-en.html
  39. Chang EC, Tugade MM, Asakawa K. Stress and coping among Asian Americans: Lazarus and Folkman’s model and beyond. In: Wong PTP, Wong LCJ, editors. Handbook of multicultural perspectives on stress and coping. Washington: Spring Publications; 2006. p. 439-455. [DOI:10.1007/0-387-26238-5_19]
  40. Alioat SKH, El Keshky MES. Cognitive flexibility as the mediator between unemployment anxiety and psychological wellbeing among university students with disabilities. Art Humanit. 2020; 28:299 - 321. [DOI:10.4197/Art.28-14.10]
  41. Zhou X, Meng Y, Schmitt HS, Montag C, Kendrick KM, Becker B. Cognitive flexibility mediates the association between early life stress and habitual behavior. Pers Individ Dif. 2020; 167:110231. [DOI:10.1016/j.paid.2020.110231]
  42. Gabrys RL, Tabri N, Anisman H, Matheson K. Cognitive control and flexibility in the context of stress and depressive symptoms: The cognitive control and flexibility questionnaire. Front Psychol. 2018; 9:2219. [DOI:10.3389/fpsyg.2018.02219] [PMID] [PMCID]
  43. Cheng P, Tallent G, Bender TJ, Tran KM, Drake CL. Shift work and cognitive flexibility: Decomposing task performance. J Biol Rhythms. 2017; 32(2):143-53. [DOI:10.1177/0748730417699309] [PMID]
  44. Carbonella JY, Timpano KR. Examining the link between hoarding symptoms and cognitive flexibility deficits. Behav Ther. 2016; 47(2):262-73. [DOI:10.1016/j.beth.2015.11.003] [PMID]
  45. Kazemi N, Dadashloo F, Seyf FS. [Prediction of psychological well-being and resilience in mothers of children with autism spectrum disorder based on cognitive flexibility (Persian)]. J Disabil Stud. 2019; 9:12. http://jdisabilstud.org/article-1-1488-fa.html

Type of Study: Research | Subject: nursing
Received: 2021/04/16 | Accepted: 2021/07/13 | Published: 2022/01/1

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2015 All Rights Reserved | Iran Journal of Nursing

Designed & Developed by : Yektaweb