Introduction
Coronavirus disease-2019 (COVID-19) is a pandemic induced by severe acute respiratory syndrome (SARS)-CoV-2 virus (Acter et al. 2020). The World Health Organization (WHO) on 19 April 2020 stated that COVID-19 had affected more than 2.2 million individuals worldwide in 210 countries, with numbers dramatically increasing every day (World Health Organization 2020). COVID-19 is posing unprecedented challenges that have had a significant impact on economics, the health system and health practitioners (Restauri and Sheridan 2020). Nurses are always on the front lines of health care crises and facing more challenges from the COVID-19 pandemic (Li et al. 2021). During the COVID-19 crisis, nurses are confronting the overwhelming illnesses that stress nursing care capacity, unpredictable changes in their daily life routine, and unrealistic expectations from patients and their families, as well as facing the infectious risk to themselves (Tsay et al. 2020).
Material and methods
This research is a quasi-experimental study which was performed from July to November 2022 in educational hospitals affiliated to Jahrom University of Medical Science. Inclusion criteria were nurses working in the care wards of patients with COVID-19, a lack of any psychological problems and willingness to participate in the research. The exclusion criteria were incomplete questionnaire and incomplete participation in training sessions.
In this research, 80 nurses were selected based on the inclusion criteria using a census method and then randomly assigned to control (n = 40) and intervention groups (n = 40). There were 5 nurses excluded from the control group. One nurse did not participate in the training program in the intervention group; finally, 39 nurses remained in the intervention group and 35 individuals remained in the control group (Fig. 1). The census of nurses was such that in this research, all qualified nurses in the COVID-19 wards were included in the study.
The data were gathered using two scales consisting of demographic and psychological well-being. Ryff’s Psychological Well-Being Scale (RPWBS) was used to evaluate the psychological well-being before, immediately after and two months after intervention in both groups. The short form version of the RPWBS was designed by Ryff in 1989 and revised in 2002 (Ryff and Keyes 1995; Ryff 1989). It comprised 18 elements, divided into 6 dimensions: self-acceptance, purposeful life, positive relationship, personality, autonomy, and environmental status. Contributors were required to evaluate entries on a 6-point scale (1 – strongly disagree to 6 – strongly agree). The sum of the scores of six dimensions is calculated as the overall score of psychological well-being. Out of the total questions, 10 questions are scored directly and 8 questions are scored in reverse. The higher the value, the better is the subject’s psychological well-being. Correlation of the short version of the RPWBS with the main scale from 0.7 to 0.89 was reported. The validity of the scale was confirmed in Iran by Bayani et al. (2008), with Cronbach’s α being 0.88. In the present study, Cronbach’s α of the scale was 0.76.
In the intervention group, training and practice in the positive thinking program were performed through multimedia application (WhatsApp) in eight two-hour sessions held twice per week. Educational materials were based on the positive psychotherapy published by Seligman in his books (Seligman 2007, 2012). Sessions were conducted by one of the researchers and a psychologist. Table 1 presents the general contents discussed in each session. The educational approach included educational video clips and audio files according to the contents of each session. Nurses were assigned practice at the end of each session, which they did individually at home; previous assignments were discussed at the beginning of each session.
Data analysis
The data were analyzed by SPSS 21 using descriptive and inferential statistics at the significance level of p < 0.05. The Shapiro-Wilk test was conducted to determine the data distribution. Other tests used included the chi-square test, independent t-test, repeated measures ANOVA, and LSD post hoc test. The sphericity assumption was checked using Mauchly’s test of sphericity, so that this assumption was maintained in the present study to perform the desired test.
Ethical approval
This research was approved by the ethics committee of Jahrom University of Medical Sciences (Ethics Number: IR.JUMS.REC.1400.051). All nurses signed an informed consent form. The objectives and method of the research were explained to them and they were then given sufficient assurance regarding the confidentiality of the information.
Results
According to the results of Table 2, the distribution of demographic variables in both groups was homogeneous and did not show any significant between-group difference (p > 0.05).
The findings of the Shapiro-Wilk test showed that before, immediately and two months after the intervention, the variables of psychological well-being and its dimensions had normal distributions in both groups (p > 0.05).
Before the intervention, no significant difference was observed between the two groups in mean total scores of psychological well-being and the subscales of the scale (p > 0.05) (Table 3).
The mean total scores of psychological well-being and its dimensions did show a significant difference between the two groups immediately after the intervention (p < 0.05). Also, two months after the intervention, a significant difference was observed in the mean total scores of psychological well-being and its dimensions between the two groups, while the intervention group showed higher scores (p < 0.001). The results of intragroup repeated measures ANOVA showed that the mean total scores of psychological well-being and its dimensions increased significantly over time in the intervention group (p < 0.001) (Table 3).
Assessment of the LSD test showed that this significant difference was related to the mean scores (1) before and two months after the intervention, and (2) immediately after and two months after the intervention (p < 0.05).
Discussion
The results of the study revealed that the positive thinking program promoted psychological well-being in nurses. The results suggest that such programs helps enhance psychological well-being and its components over time in nurses, especially in the time of COVID-19.
The results of the current study were in line with the findings of the studies conducted by Bolier et al. (2013), Meyers et al. (2013) and Shaghaghi et al. (2019) on the effectiveness of positive-thinking programs in promoting the psychological well-being of people. Also, one meta-analysis showed the positive effect of positive psychotherapy interventions on improved mental health and psychological well-being, as well as reduced signs of depression (Carolan et al. 2017). The positive thinking interventions in the present research emphasized the nurses’ positive perspective toward themselves and others. In addition, emphasis was placed on specification of values and goals and practice of mindfulness meditation with the aim of increasing attention on the present time. It seems that these emphases have been able to stimulate nurses to plan for the future and improve their levels of well-being.
In line with the present study, the results of Lin’s study (2017) indicated that positive thinking made a significant unique contribution to psychological well-being, self-esteem, and depression (Lin 2017). Positive thinking itself represents a tendency to notice and appreciate the positive in life (i.e., cherishing blessings, appreciating hardship, cherishing the moment, and thanking God) (Lin and Yeh 2011). Correlation analysis by Bilong et al. (2021) showed a positive relationship between positive thinking and psychological well-being and happiness. This study supports the previous research’s conclusion that positive thinking is a positive way to enhance healthy psychological well-being and happiness in life. Also, according to Loi and Ng (2021), fostering a grateful mindset could enhance well-being. Positive thinking influences multiple positive changes in the emotional state, hence boosting the levels of psychological well-being of individuals (Măirean et al. 2019). Also, positive thinking contributes to psychological well-being by increasing the retrieval of positive memories or experiences of the persons (Sheldon et al. 2010). Hence, grateful individuals benefit from a pleasant memory of a positive event in their lives. Likewise, positive thinking creates positive emotions like joy, contentment, love, and satisfaction, and decreases negative emotions such as sadness, stress, and anxiety (Przepiorka and Sobol-Kwapinska 2021). Therefore, individuals pay more attention to positive emotions than the negative ones when they feel more grateful, therefore generating well-being.
One of the limitations of the study is that the participants were selected using a census method. However, future research could be conducted on more samples and using a random sampling method to be able to extend the results. Another limitation of the study was using only one method (questionnaire) to measure the variables. Therefore, to obtain more generalizable results, one suggestion is to carry out similar research in a wider geographical field with a qualitative method.
Conclusions
Conclusions
Availability of data and material
The datasets analyzed during the current study are not publicly available due to ethical and privacy reasons.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Funding statement
This study has been financially supported by the Research Department at Jahrom University of Medical Sciences.
Acknowledgments
We sincerely thank all COVID-19 patients who participated in this research.
Disclosure
The authors declare no conflict of interest.
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