Iran Journal of Nursing

 Introduction
Nursing process may include a long-term care of patients and night shifts, which can cause problems in fulfilling family responsibilities, in addition to physical and occupational problems. Many family problems are caused by incompatibility of nursing and family roles, which is called work-family conflict. In this conflict, the individual’s job performance is affected by pressures caused by family problems or vice versa. People with shift work are more likely to have work-family conflicts. 
One of the variables that can affect the work-family conflict is self-differentiation. Self-differentiation is an ability to differentiate thoughts and emotions, manage emotions, and be rational when facing problems. In fact, the balance between rational and emotional processes and staying calm and managing stress, as the features of self-differentiation, makes people better able to describe and identify their emotions. By self-differentiation, a nurse can reduce work pressures, manage the workplace problems, and go home after work with a free mind and away from conflict.
Another variable that is assumed to affect the work-family conflict is moral distress. Moral distress refers to a condition when a person knows what the right action is to do, but organizational constraints make it impossible to have the right action or prevent the person from pursuing the right direction. Moral distress in nurses can cause job dissatisfaction, maladaptation, and stress, and even can lead to fatigue and burnout over time; this burnout in turn increases their work-family conflict.
Another variable that can affect the work-family conflict is a phenomenon known as compassion fatigue. It is a type of burnout that occurs in caregivers of injured patients and is caused by constant interactions with their patients which has mental, physical and psychological impacts. Compassion fatigue and moral distress cause occupational stress and job dissatisfaction which can be associated with increased work-family conflict in nurses.
Due to the interference of work-family conflict with job performance and nursing care quality, it is important to determine the factors affecting the work-family conflict in nurses. The present study aims to determine the mediating role of self-differentiation in the relationship between moral distress, compassion fatigue, and work-family conflict in nurses.
Materials and Methods
This is a descriptive-correlational study. The study population includes all married nurses who working in public hospitals in Kerman, Iran (290 nurses from 8 hospitals). The sample size was estimated using the Cochran’s formula proportional to the population size. A total of 159 nurses were selected using a convenience sampling method from October to December 2019. To measure the work-family conflict, Carlson’s 9-item work-family conflict scale was used. The subscale of compassion fatigue in the professional quality of life scale was used to measure compassion fatigue in nurses. The moral distress scale was used to assess the moral distress of nurses, and the Self-Differentiation Inventory-Short Form was used to measure self-differentiation of the nurses. The validity and reliability of these questionnaires have been confirmed in previous studies. In this study, Structural Equation Modeling (SEM) was performed in AMOS v. 16 software for data analysis.
Results
The results showed that compassion fatigue (r=0.32, P<0.05) and moral distress (r=0.22, P<0.05) had a direct and significant relationship with the work-family conflict in nurses. In addition, compassion fatigue (r=-0.41, P<0.05) and moral stress (r=-0.30, P<0.05) had an indirect and significant relationship with self-differentiation. The path coefficient between self-differentiation and work-family conflict was also negative and significant (r=-0.35, P<0.05).
The fit indices showed that the tested model had a good fit and self-differentiation had a significant mediating role in the relationship between moral distress, compassion fatigue, and work-family conflict. Regarding the indirect path coefficients using the bootstrap method, results showed that the indirect path between moral distress and work-family conflict through self-differentiation (r= 0.11, P<0.05) and between compassion fatigue and work-family conflict through self-differentiation (r=0.14, P<0.05) were significant.
Discussion
The purpose of this study was to determine the mediating role of self-differentiation in the relationship between moral distress, compassion fatigue, and work-family conflict in nurses. Findings showed that self-differentiation had a significant mediating role in this relationship. This finding is consistent with previous studies. The results of a study showed that self-differentiation training had a significant effect on cognitive emotion regulation and psychosomatic symptoms in nurses. Another study showed that the high self-differentiation is a powerful factor to control nurses’ stress in the workplace. Evidence shows that individuals with self-differentiation feel more self-controlled and competent because they are more successful in controlling negative emotions and act responsibly. A person with high self-differentiation ability is able to understand and manage stressful situations using available resources. Self-differentiation among nurses is important because of its role in providing them with a sense of support and security. Nurses with high self-differentiation are more responsible for their behaviors and decisions, as well as family, work, and marital roles. It is recommended that hospitals managers conduct educational interventions to increase nurses’ awareness of the occupational and family roles, reduce their work-family conflicts, and improve their self-differentiation ability. The focus of this study was only on the psychological factors affecting the work-family conflict; the work-family conflict can also be related to environmental, organizational and managerial factors. In this study, the effects of these intervening variables were not studied.

Ethical Considerations
Compliance with ethical guidelines
All participants signed the informed consent form. This study was approved by the Medical Ethics Committee of Yazd University (Code: IR.YAZD.REC.1399.025)

Funding
This study was extracted from the MA. thesis of the first author at Department of Psychology, Faculty of Humanities and Social Sciences, University of Ardakan, Ardakan. 

Authors' contributions
Data collection and literature search: Maliheh Hosseinjanizadeh; Design, editing, data analysis: Yasser Rezapour Mirsaleh; Editing: Fatemeh Behjati; Literature search and preparing the final draft: Mehrnoosh Bagheriayn.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We would like to thank all the participants.
 

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