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. 2023 May 12;2023(5):CD002892. doi: 10.1002/14651858.CD002892.pub6

Zarvijani 2021.

Study characteristics
Methods Study design: randomised controlled trial
Study grouping: parallel group
Participants Baseline characteristics
Acceptance and Commitment Therapy (ACT)

  • Age (mean ± SD): NR

  • Sex (N (% female)): 19 (54%)

  • Sample size: 35

  • Years of experience (mean ± SD): NR


Control (no intervention ‐ routine support)

  • Age (mean ± SD): NR

  • Sex (N (% female)): 18 (51%)

  • Sample size: 35

  • Years of experience (mean ± SD): NR


Overall

  • Age (mean ± SD): NR

  • Sex (N (% female)): 37 (53%)

  • Sample size: 70

  • Years of experience (mean ± SD): NR


Included criteria: ‐ having a bachelor’s or higher degree in nursing, ‐ at least 2 years of work experience in psychiatric wards, ‐ attending intervention sessions based on ACT for the first time, and ‐ no history of taking psychiatric drugs in the past and present.
Excluded criteria: ‐ not completing the questionnaires, ‐ absenteeism in more than one intervention session, and ‐ the occurrence of stressful events during the study.
Pretreatment: statistical difference not reported. Only numbers and proportions were reported which were similar on most variables but no statistical reporting.
Compliance rate: 94%. two out of 35 participants in the intervention group were excluded since they missed more than one session out of eight, i.e. 33 of the participants attended 6 or more sessions.
Response rate: NR. 84 psychiatric nurses from all 23 wards in the hospital were randomly selected and screened for eligibility proportional to the required sample size for the study. However, the total number of nurses in the facility is not reported.
Type of healthcare worker: psychiatric nurses
Interventions Intervention characteristics
Acceptance and Commitment Therapy (ACT)

  • Type of the intervention: Intervention type 1 ‐ to focus one’s attention on the experience of stress

  • Description of the intervention: ACT‐based training according to Steven Hayes model in eight two‐hour sessions conducted by an ACT therapist

  • The number of sessions: 8

  • Duration of each session on average: 2 hours

  • Duration of the entire intervention: NR

  • Duration of the entire intervention short vs long: NR

  • Intervention deliverer: Therapist

  • Intervention form: Face‐to‐face


Control (no intervention ‐ routine support)

  • Type of the intervention: NA

  • Description of the intervention: Routine interventions such as stress control, life skills, and anger control workshops, which are normally held by the educational deputy of the centre for the staff.

  • The number of sessions: NR

  • Duration of each session on average: NR

  • Duration of the entire intervention: NR

  • Duration of the entire intervention short vs long: NR

  • Intervention deliverer: NR

  • Intervention form: NR
Outcomes Perceived Stress Scale (PSS)

  • Outcome type: ContinuousOutcome
Identification Sponsorship source: Islamic Azad University, Tehran.
Country: Iran
Setting: One large psychiatric hospital
Comments: NR
Authors name: Ladan Fattah Moghaddam
Institution: Tehran University of Medical Sciences, Islamic Azad University, Tehran, Iran
Email: lfatah@iautmu.ac.ir
Address: Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Islamic Azad University, Tehran, Iran
Time period: 2018
Notes PSS included in analysis 1.1.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote: "Of the 84 nurses selected, fourteen were excluded due to lack of inclusion criteria, and 70 remaining nurses were each assigned a number and were randomly divided into experimental and control groups, each consisting of 35 participants. (Fig. 1).
Sequence generation process insufficiently described.
Allocation concealment (selection bias) Unclear risk Allocation concealment not recorded. Difficult to judge whether participants and/or investigators could possibly foresee assignment
Blinding of participants and personnel (performance bias)
All outcomes High risk Participants were not blinded.
Blinding of outcome assessment (detection bias)
All outcomes High risk Participants were not blinded whereas outcomes are self‐reported.
Incomplete outcome data (attrition bias)
All outcomes Low risk Attrition rate was less than 20% and a priori outcomes were reported.
Selective reporting (reporting bias) Low risk Trial registration IRCT20180506039557N1. No indication of selective reporting
Other bias Unclear risk Response rate could not be calculated since total number of nurses was not provided. Statistical differences if any on baseline parameters not reported.

ACT: Acceptance and Commitment Therapy; BP: blood pressure; BSI: Brief Symptom Inventory; DCWs: Direct Care Workers' ERT: Emotion regulation training; ESRT‐1: Enhanced stress resilience training‐1; GHQ: General Health Questionnaire; HCW: healthcare worker; HR: heart rate; ICU: intensive care unit; MBI: Maslach Burnout Inventory; MBSR: Mindfulness‐based stress reduction; NLGNs: newly incensed graduate nurses; PSQ: Perceived Stress Questionnaire; PSS: Perceived Stress Scale; SD: standard deviation; SMI: Stress Management Intervention; TTI: Transfer Technique Intervention; PTSD: Post‐traumatic stress disorder; STAI: State‐Trait Anxiety Inventory; WCG: waitist control group