Skip to main content
NCBI home page
Journal of Research in Nursing logoLink to Journal of Research in Nursing
. 2019 Apr 30;24(7):500–512. doi: 10.1177/1744987119839102

Optimism and distress tolerance in the social adjustment of nurses: examining resilience as a mediator and gender as a moderator

Mehrdad F Falavarjani 1,✉, Christine J Yeh 2
PMCID: PMC7932233  PMID: 34394568

Abstract

Background

As nursing is recognised as one of the most stressful occupations in healthcare organisations, nurses are vulnerable to adjustment challenges.

Aims

The authors examine the association between optimism, distress tolerance and social adjustment through the mediating role of resilience and the moderating role of gender among Iranian nurses.

Methods

The sample consisted of 183 nurses working in six private hospitals in Iran. The authors employed structural equation modelling to test a moderation–mediation model of social adjustment.

Results

Findings reveal that: (a) resilience partially mediates the association between distress tolerance and social adjustment and the link between optimism and social adjustment – nurses with high levels of optimism and distress tolerance are significantly more likely to report greater resilience and subsequently report higher social adjustment; and (b) gender plays a moderating role in the model – women reported higher levels of optimism and lower levels of both resilience and distress tolerance than men. However, men reported higher levels of both distress tolerance and resilience as well as better social adjustment in comparison to female nurses.

Conclusions

The promotion of resilience may contribute to increased social adjustment, optimism and distress tolerance at work.

Keywords: distress tolerance, gender, nursing, optimism, resilience, social adjustment

Introduction

Nursing is recognised as one of the most stressful occupations among health professions throughout the world (Abdollahi et al., 2014). In particular, nurses encounter a great deal of negative, traumatic experiences at work, which may be associated with low psychosocial adjustment (Chuang and Kuo, 2018). Research in Iran shows that 72% of nurses experienced high levels of stress (Faraji et al., 2012), which may contribute to decreases in productivity and to occupational burnout (Chuang and Kuo, 2018; Laker et al., 2018). Burnout due to job stress in nursing is detrimental to both nurses and patients because it leads to poor occupational performance (Johnson et al., 2018).

Factors contributing to nursing job stress include lack of social support and job clarity, supervisor problems, patient loss, shortage of nurses and increased workload (Abdollahi et al., 2014; Faraji et al., 2012). Exposure to stressful events leads to a range of emotions, such as excitement, anger, anxiety and depression (Scheier et al., 2001). Controlling these feelings is associated with nurses' levels of optimism or pessimism (Chang and Chan, 2015; Luthans et al., 2008; Scheier et al., 2001) and resilience (Caldeira and Timmins, 2016; Delgado et al., 2017).

Optimists expect to have positive experiences, even when confronting negative life events (Scheier et al., 2001). This self-positive feeling contributes to a range of more general positive feelings. Pessimists expect to have negative experiences, which are associated with other negative feelings such as anxiety, guilt, anger, sadness or despair (Scheier et al., 2001). Hence optimism is the inclination to believe in positive versus negative outcomes in life (Scheier et al., 2001).

Optimism and pessimism may be related to psychosocial adjustment as the absence of negative feelings and the presence of positive states leads to psychosocial adjustment (Desrumaux et al., 2015). Psychosocial adjustment at work is interrelated with a number of different factors and outcomes. Hence the onset of psychological problems on the job cannot be solely attributed to individuals' personal dispositions. Such problems also arise from a deleterious job and work environment and health factors, at organisational, psychosocial and personal levels (Desrumaux et al., 2015).

The effects of optimism may also be explained by higher self-esteem and greater appreciation of one's work and social environment (i.e. feeling challenged rather than threatened can generate positive feelings) as well as by gaining control over unsatisfactory work conditions, which are not perceived as inevitable by optimistic people (Scheier et al., 2001). Among employees, optimism is associated with better adjustment (Cleary et al., 2012) and greater resilience (Delgado et al., 2017). This pattern of optimism and distress coping are shown to be different among men and women (Helweg-Larsen et al., 2011). Hence it is expected that optimism predicts higher levels of distress tolerance as well as resilience to difficult job conditions.

Resilience is a dynamic mechanism used to cope with life stressors (Connor and Davidson, 2003), and the ability to cope with negative events (Bonanno, 2004) and maintain a psychological balance during difficult events (Aburn et al., 2016). Resilience can mediate the association between adverse life circumstances and psychological adjustment (Tugade et al., 2004), underscoring the need for increased optimism under stress (Delgado et al., 2017; Hart et al., 2014). Thus resilience may mediate the association between optimism and adjustment (Aburn et al., 2016; Chang and Chan, 2015; Delgado et al., 2017).

Resilience is critical, yet largely unrecognised within nursing (McGee, 2006). Jackson et al. (2007) propose the development and strength of personal resilience as a means for nurses to cope better with work-related stress and to protect themselves from workplace adversity. The association between distress, optimism and adjustment has also been confirmed in research on European Americans. In addition, a significant proportion of Iranian nurses (72%) experience high levels of stress (Faraji et al., 2012).

Nurses in the context of Iran

Since 1979 Iran has allowed the baccalaureate to serve as the only avenue via which to be certified as a professional nurse (Khomeiran and Deans, 2007). High school graduates are admitted to these programmes on the basis of their ranking in the competitive National Higher Education Entrance Examination (NHEEE). According to Zarea et al. (2009), healthcare facilities need at least 220,000 nurses in order to present optimal healthcare (Hajbaghery and Salsali, 2005). Therefore, due to the shortage of nurses, security of the nursing profession and high employability in Iran, compared with other occupations nursing is recognised as an important profession with high college enrollment (Zarea et al., 2009).

Core hypotheses

Our hypotheses are as follows: (a) a positive relationship exists between optimism and adjustment; (b) a positive relationship exists between distress tolerance and adjustment; (c) resilience mediates the relationship between distress tolerance and social adjustment; (d) resilience mediates the relationship between optimism and social adjustment; and (e) gender moderates the relationship between exogenous variables, such as distress tolerance, optimism, resilience and social adjustment as an endogenous variable.

Methods

Ethical considerations

The research was approved by the ethics committee in the Department of Psychology at the University of Isfahan in Esfahan, Iran. Participants were informed about the aims of the research, that participation was voluntary and anonymous, and that participants could withdraw from the study at any time.

Participants

A total of 183 working nurses out of 250, working in 10 different units across various hospitals, participated in this study (women: 122, 66.67%, men: 61, 33.33%; aged 25–45 years, mean (M) 30.12, standard deviation (SD) 6.85). The majority of the participants were married (68.3%, n = 125), and had worked an average of 8.5 years as a nurse. Participants came from a range of educational backgrounds (see Table 1 for a summary of demographic information).

Table 1.

Demographic information of participants (n = 183).

Demographic background N %
Women 122 66.67
Men 61 33.33
Educational levels
 High school diploma 83 43.00
 Associate's degree 43 23.49
 Bachelor's degree 32 17.48
 Master's degree 25 13.66
Hospital units
 Medical/surgical 44 24.04
 Emergency room 29 15.84
 Maternity/obstetrics 25 13.66
 Psychiatric/mental health 23 12.56
 Operating room/postoperative care 19 10.38
 Intensive care 18 9.83
 Paediatrics 17 9.28
 Othersa 8 4.37
Open in a new tab
a

Others includes long-term care, gerontology and consultation.

Procedure

Nursing department heads were given a survey packet including an introductory letter and four questionnaires. After they gave permission for the researchers to collect data from informed and consenting employees, the package was distributed to the nurses. Overall, 183 (73.2%) survey packets were returned. No financial compensation was provided to any of the participants. All of the items were written in Persian and had been standardised in terms of reliability and validity with Iranian samples.

Measures

Social adjustment (Bell, 1979) was measured using the social adjustment subscale of the Bell adjustment inventory, a 160-item self-report inventory measuring individuals’ adjustment in five domains: family, health, social, occupation and emotional adjustment. The social subscale consisted of 32 items on a 3-point scale that required one of the following responses: ‘Yes’, ‘No’ or ‘I don't know’. Sample questions includes ‘Do you enjoy social gatherings just to be with people?’. The social subscale has been used to measure social adjustment in various Iranian research studies with high reliability and validity. For example, Hosseinizadeh (2014) reported an alpha of 0.88 for social adjustment. The reliability coefficient for the current study was strong (α = 0.81).

Optimism was measured using the revised life orientation scale (Scheier et al., 1994) in Persian (Hassanshahi, 2002). This scale assesses optimism and pessimism with 10 items, including three optimism items, three pessimism items and four filler items. Participants report the degree to which they agreed with each item using a five-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. Hassanshahi (2002) validated the test in Persian and reported that Cronbach's alpha ranged between 0.65 and 0.74. In the current study, the reliability coefficient was strong (α = 0.71).

Distress was measured using the emotional distress tolerance scale (Simons and Gaher, 2005), a 15-item self-report scale measuring the extent to which participants experience adverse emotions (e.g. ‘I can't handle feeling distressed or upset’). Items use a five-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. The low score indicates a tendency to experience psychological distress as unacceptable. A strong alpha coefficient was reported on the sample of Iranians (Azizi, 2010: α = 0.93). In the current study the reliability coefficient was strong (α = 0.85).

Resilience was assessed using the Connor–Davidson resilience scale (Connor and Davidson, 2003) in Persian form (Khoshouei, 2009). This is a 25-item questionnaire developed as a clinical measure to assess the positive effects of treatment for stress reactions, anxiety and depression. We selected this scale because it consists of items that illustrate not only challenge, commitment and control, but also other aspects of resilience, such as goal setting, patience, faith, tolerance of negative affect, and humour. Subjects indicated their opinion on a 5-point Likert scale ranging from 0 (‘not true at all’) to 4 (‘true nearly all the time’). Sample items included ‘I am able to handle unpleasant or painful feelings like sadness, fear and anger’ and ‘Under pressure, I stay focused and think clearly’. The internal consistency of the scale for Iranian samples has been reported as high (Khoshouei, 2009). Similarly, the current study had a strong alpha (α = 0.85).

Analysis

Statistical analyses were conducted using SPSS Statistics 21 and AMOS 20. Scale reduction and calculation of descriptive statistics were conducted in SPSS. For the scale reduction, factor analyses were conducted using Direct Oblimin rotation to allow correlation between the scales. Internal consistency of the scales was assessed using Cronbach's alpha, and bivariate associations among the main study variables were examined using Pearson's correlation coefficient. The path modelling in AMOS employed maximum likelihood estimation implementation, with the following fit indices considered: the χ2 statistic, the χ2 statistic divided by the degrees of freedom (CMIN/df), as well as the related p value, the comparative fit index (CFI) and the goodness of fit index (GFI) were used. These are considered suitable if the indices are equal to or greater than 0.90 (Kline, 2010). The root mean square error of approximation (RMSEA) and finally the Akaike information criterion (AIC) were also assessed, with cut-off criteria for good fit below 0.90 for the CFI, below 0.60 for the RMSEA, and below 0.08 for the SRMR (Hu and Bentler, 1999). The AIC does not have a strict criterion to assess fit; the size of the AIC is compared across models, with the smallest usually indicating the best fit. In addition, the group value SEM was used for comparison between the groups for men and women.

Results

We present descriptive and correlational statistics followed by an analysis of the various mediating and moderating relationships among the variables: distress tolerance, optimism, resilience and social adjustment.

Descriptive and correlational analysis

Basic descriptive statistics (e.g. means, standard deviations, skewness and kurtosis) of the target variables and inter-correlation among variables are shown in Table 2. Inspection reveals that the mean scores of social adjustment conglomerate around the centres of the scales. However, participants show high ceiling effects on other scales; high scores of resilience (M = 55.07, SD = 11.24) and distress tolerance (M = 41.79, SD = 12.03) and low levels of optimism (M = 14.73, SD = 5.05). The skewness (γ1) and kurtosis values (γ2) are well within the acceptable range (–1 to 1).

Table 2.

Descriptive statistics and correlations among variables.

1 2 3 4
1. Social adjustment – 0.15* 0.30** 0.45**
2. Optimism – 0.24** 0.10
3. Resilience – 0.32**
4. Distress tolerance –
M 32.54 14.73 55.07 41.79
SD 7.23 5.05 11.24 12.03
γ1 0.53 –0.08 0.13 0.30
γ2 –0.58 –0.98 –0.43 –0.23
No. of items (range) 32 (3–45) 10 (6–24) 15 (17–72) 25 (27–92)
Open in a new tab

1*<0.05; **<0.000.

2N = 183.

3γ1 = sknewness; γ2 = kurtosis.

Table 2 captures the correlations among the study's variables. None of the correlations are very large, except for that between distress tolerance and social adjustment (r = 0.45, p < 0.000). Further inspection reveals that the correlation between optimism and social adjustment was significant but not large (r = 0.15, p < 05). In addition, the association between resilience, distress tolerance and social adjustment was moderate (r = 30 and r = 0.32, p < 0.000).

Path analysis

Our models, including structural, mediation and moderation models, show the goodness of fit indices: χ2 = 80.68, df = 6, CMIN/df = 13.45, p < 0.000, CFI = 1.0, GFI = 0.81, RMSEA = 0.26, AIC 88.68 all with an acceptable fit (Kline, 2010).

Structural model

The model included optimism and distress tolerance as exogenous variables, and resilience and social adjustment as endogenous variables, and revealed that optimism did not predict social adjustment (β = –0.07, p = 0.29), rejecting the first hypothesis (Figure 1). However, distress tolerance strongly predicts social adjustment (β = 0.40, p < 0.000), providing support for the second hypothesis. Moreover, resilience positively predicted social adjustment (β = 0.15, p = 0.02).

Figure 1.

Figure 1.

Open in a new tab

Path analysis of all study variables. No *non-significant, *significant at p < 0.05, **significant at p < 0.001, resilience R2 = 0.15 and social adjustment R2 = 0.24.

Mediation model

To test the third hypothesis, there are three steps to show that resilience plays a mediating role between the association between distress tolerance (exogenous variable) and social adjustment as an endogenous variable (Kline, 2010). First, the exogenous variable (social adjustment) must significantly relate to the mediator (resilience). Second, the exogenous variable (distress tolerance) must significantly relate to the endogenous variable (resilience). Third, the mediator (resilience) must significantly relate to the endogenous variable (social adjustment). If the relationship between the exogenous and endogenous variable is zero when the mediator is included, there is full mediation. However, if the relationship between the exogenous variable (distress tolerance) and endogenous variable (resilience) is reduced when the mediator is added, then there is partial mediation.

As distress tolerance predicts social adjustment (β = 0.40, standard error (SE) = 0.04, CR = 5.83, p < 0.000) and resilience (β = 0.30, SE = 0.08, CR = 4.38, p < 0.000), and resilience predicts social adjustment (β = 0.15, SE = 0.03, CR = 2.18, p < 0.029) in the full mediation and direct models, distress tolerance predicts social adjustment (β = 0.44, SE = 0.04, CR = 6.75, p < 0.000). In addition, the full mediation model CMIN (χ2 = 1.13, p > 0.05, AIC = 19.11) is significantly smaller than the indirect model CMIN (χ2 = 32.37, p > 0.00, AIC = 48.36), and the PNFI of the full mediation model is 0.20 bigger than the Parsimony Normed fit Index (PNFI), 0.16, of the indirect model. Resilience partially mediates the association between distress tolerance and social adjustment (Kline, 2010).

Although optimism did not predict social adjustment, we examined the indirect effect of resilience on the association between optimism and social adjustment as optimism is associated with resilience (β = 0.21, p < 0.000) and resilience is a predictor of social adjustment (β = 0.15, p < 0.029). To test the indirect effects of optimism, we ran the indirect effect analysis using the bootstrapping method. According to bootstrapping results, the indirect effect of optimism on social adjustment through resilience was confirmed (N = 5000), as zero was out of range of CI for both paths (optimism–resilience CI: LB = –0.07, UB = –0.10 and resilience–adjustment CI: LB = –0.09, UB = –0.01), while both are significant (p = 0.016 and p = 0.012, respectively). Overall, the fit indices illustrate a fit model (χ2(df) = 35.96(3), p = 0.000, AGFI = 0.984, GFI = 0.911, CFI = 0.583, RMSEA = 0.23).

Moderation model: Tests of group differences (gender)

Invariance test of measurement model

We draw a comparison between ‘the unconstrained model’ and ‘the measurement residuals model’. The results illustrate that the unconstrained model with CMIN/df, 7.28 (Δχ2 (87.37), df = 12, p = 0.000, AGFI = 0.98, GFI = 0.91, CFI = 0.98, RMSEA = 0.18) and the measurement residuals model with (Δχ2 (95.82), df = 12, p = 0.000, RMSEA = 0.21, CFI = 0.98, GFI = 0.863, NFI = 0.881) are significant. However, as the χ2 of the unconstrained model is smaller, we conclude that the unconstrained model is a better fit than the measurement residuals model (Hair et al., 2010). Hence the likelihood of gender differences is significant over the model.

Invariance test of structural model

While women show higher levels of optimism and lower levels of resilience and distress tolerance than men, men show higher levels of distress tolerance and higher levels of resilience than women. In this regard, men in the sample show higher levels of perceived social adjustment than women (Figure 2).

Figure 2.

Figure 2.

Open in a new tab

Standardised estimates of multi-group analysis with resilience testing as mediation and gender as moderation are presented as men (women). No *non-significant, *significant at p < 0.05 and **significant at p < 0.001.

Discussion

The findings revealed that distress tolerance directly predicts social adjustment levels among nurses. Resilience also predicts social adjustment and partially mediates the association between distress tolerance and social adjustment. The increase in resilience levels leads to better social adjustment (Scardillo et al., 2016), and low levels of distress tolerance may contribute to maladaptive behaviours as found in a sample of Iranians (Nezhad and Besharat, 2010). Similarly, individuals with higher levels of resilience also demonstrate positive mental health and a reported higher quality of life and lower risk-taking (Tugade et al., 2004). Hence a person with higher levels of resilience may be flexible in adapting to environmental changes and able to manage and tolerate challenges from daily stressors (Authors, 2018).

In contrast, individuals with lower levels of resilience may not effectively adapt and may remove themselves from daily stressful situations. These individuals over time reveal less efficacy in controlling and enduring disturbances. Individuals with higher levels of resilience often return to normal with positive emotions after stressful confrontations (Waugh et al., 2008). Moreover, these individuals will endure stressful events and find the right fit for their environment (Tugade et al., 2004). Thus resilience can be conceptualised as deterring nursing-related adjustment problems and promoting positive social adjustment (Jackson et al., 2007).

Although previous studies support the association between optimism and social adjustment (Chang and Chan, 2015; Luthans et al., 2008; Sheu et al., 2002), we found that optimism has an indirect effect on nurses' social adjustment through resilience. According to Luthans et al. (2008), optimistic individuals practice active or problem-focused methods to cope with distress, showing more resilience in mastering difficult jobs such as nursing in comparison with pessimists. These inclinations might contribute to positive effects in the long run, such as greater success and accomplishments at work. These instances of active coping may lead to better psychosocial adaptation as well, further reinforcing the impact of optimism on the variables such as work performance (Luthans et al., 2008) and lower work burnout (Chang and Chan, 2015).

The importance of optimism and resilience is reinforced in research. Among a sample of nurse practitioners, Glass (2007) revealed that optimism is more likely exhibited when individuals are hopeful and resilient. In addition, Jackson et al. (2007) emphasised that having a vision for the future as well as optimistic thinking can be associated with resilience. For example, Mealer et al. (2012) concluded that in order to increase resilience, interventions emphasising optimistic thinking such as coping strategies are needed. Therefore, optimism is recognised as an important factor in the association between resilience and social adjustment (Aburn et al., 2016). As Jackson et al. (2007) reported, optimism and resilience are key components of nurse case management resulting in successful work-related adjustment (Cline et al., 2004). In addition, Sheu et al. (2002) emphasised promoting an optimistic view as it has positive effects on the physio-psycho-social adjustment of nurses.

In addition, both male and female Iranian nurses showed relatively lower levels of optimism than previously found in a sample of North Americans. North Americans are considered to be part of an individualistic culture associated with higher levels of optimism (Jacobsen et al., 2008). Our findings add to the literature indicating that unrealistic optimism levels are greater for North Americans in comparison to Asian cultures. Chang (1996) argued that Asian individuals, such as the Chinese, would be less prone to unrealistic optimism – a disposition to predict more favourable, personal future outcomes than a relevant, objective standard, which is unlikely to offer the health benefits (Shepperd et al., 2015) – than their American counterparts because they are characterised by pessimistic thinking (Hofstede, 1990). Lower levels of optimism were pronounced among our sample of Iranian nurses.

We also found a moderating role of gender over a mediating model; as explained, the women unexpectedly showed higher levels of optimism, perhaps related to the notion of interdependence in women (Gabriel and Gardner, 1999), which may then impact unrealistic optimism. However, in our sample, female nurses revealed higher levels of optimism but lower levels of resilience and distress tolerance than men, suggesting lower levels of perceived social adjustment than men.

In accordance with social role theory (Eagly, 2013), we posited that gender role expectations, skills and beliefs lead to gender differences in behaviour. For example, Iran is a male-dominated society, thus men are expected publicly to show enhanced social adjustment and higher resilience than women. Women may in fact have equal or higher levels of social adjustment and resilience, but may not feel any social pressure to share this outwardly. In fact, Iranian women may feel more comfortable sharing challenges with adjustment and distress tolerance.

However, why do women show higher levels of optimism? According to Abdollahi et al. (2014), women reported higher levels of perceived stress, which may be due to womens' traditional dual duties at home and work as sources of stress. Some research contends that men hold resilience recovery factors such as hardiness (Abdollahi et al., 2014; Nezhad and Besharat, 2010), but this may demonstrate how men are socialised to tolerate stress in the context of work and as a result may self-report better social adjustment. In addition, there may be a number of work-setting factors such as high workloads, inadequate medical equipment, unclear job descriptions, non-supportive working environments and managers, physicians subordinate (Faraji et al., 2012; Hajbaghery and Salsali, 2005; Zarea et al., 2009).

Limitations

The most important limitation of this study lies in the reasons why questionnaires may not have been completed accurately. The study would have been more efficient if the performance-based measures of optimism, resilience, distress tolerance and adjustment had been applied. In addition, the participants were only chosen from private hospitals from one of the largest cities in Iran, Isfahan City, which differs from public hospitals in the smaller towns in terms of job security, levels of expertise, etc. Also, participants were not selected randomly, limiting the generalisability of the findings. Social desirability may also influence how nurses may respond to the survey.

Conclusions

Nurses are at high risk of experiencing social adjustment difficulties, given they are frequently exposed to challenging duties and work in a stressful occupation. The authors investigated the impact of optimism and distress tolerance on nurses' social adjustment levels through the mediating role of resilience. They also examined the moderating role of gender in the model. The results indicate that resilience partially mediates the association between distress tolerance and social adjustment and the link between optimism and social adjustment. We also found that nurses with high levels of optimism and distress tolerance are significantly more likely to report greater resilience and subsequently report higher social adjustment. Moreover, gender plays a moderating role in the model; women reported higher levels of optimism and lower levels of both resilience and distress tolerance than men. However, men reported higher levels of both distress tolerance and resilience as well as better social adjustment in comparison to women.

Key points for policy, practice and/or research

  • Resilience is an important factor contributing to social adjustment and could also be enhanced with supportive educational efforts for nurses during their educational training and at the workplace.

  • Training efforts may contribute to the development of optimism and an increase in ability to deal with distress at work. This may include the use of interdependent coping strategies for daily work-related stressors.

  • More systematic programmes at workplaces are needed in order to support the development of nurses' help-seeking and coping strategies for dealing with stressors that occur on the job. These programmes can also discuss the development of resilience and how it can support social adjustment and tolerating distress.

Biography

Mehrdad F Falavarjani is a young researcher in the field of Social Psychology. He received his Bachelor's degree from the Department of Psychology, University of Isfahan, Iran, in 2009, and his Master's degree from Universiti Putra Malaysia in Social Psychology in 2014. His research focuses on psychosocial adjustment, acculturation and creativity. He also holds several training workshops on statistics and research tools in Universities of Malaysia and Iran. Further, he extends his research area into Peace Studies, Nursing and Heroism. Currently, he is a researcher at University of Isfahan, Iran.

Christine J Yehs is a professor of Counseling Psychology in the School Counseling Program at the University of San Francisco. She received her PhD in Counseling Psychology from Stanford University and her MA in Counseling and Clinical Psychology at Harvard University. Previously, she was associate professor at Teachers College, Columbia University. Her research focuses on immigrant youths' cultural navigations, ethnic identities, and psychological experiences.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethics

The research was approved by the ethics committee in the Department of Psychology at the University of Isfahan in Esfahan, Iran.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

  1. Abdollahi A, Abu Talib M, Yaacob S, et al. (2014) Hardiness as a mediator between perceived stress and happiness in nurses. Journal of Psychiatric and Mental Health Nursing 21(9): 789–796. [DOI] [PubMed] [Google Scholar]
  2. Aburn G, Gott M, Hoare K. (2016) What is resilience? An Integrative Review of the empirical literature. Journal of Advanced Nursing 72(5): 980–1000. [DOI] [PubMed] [Google Scholar]
  3. Azizi AR. (2010) Reliability and validity of the Persian version of distress tolerance scale. Iranian Journal of Psychiatry 5(4): 154–164. [PMC free article] [PubMed] [Google Scholar]
  4. Bell HM. (1979) The Adjustment Inventory, Stanford, CA: Stanford University Press. [Google Scholar]
  5. Bonanno GA. (2004) Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?. American Psychologist 59(1): 20–32. [DOI] [PubMed] [Google Scholar]
  6. Caldeira S, Timmins F. (2016) Resilience: Synthesis of concept analyses and contribution to nursing classifications. International Nursing Review 63(2): 191–199. [DOI] [PubMed] [Google Scholar]
  7. Chang EC. (1996) Evidence for the cultural specificity of pessimism in Asians vs Caucasians: A test of a general negativity hypothesis. Personality and Individual Differences 21(5): 819–822. Available at: 10.1016/0191-8869(96)00110-9 (accessed 11 March 2019). [DOI] [Google Scholar]
  8. Chang Y, Chan HJ. (2015) Optimism and proactive coping in relation to burnout among nurses. Journal of Nursing Management 23(3): 401–408. [DOI] [PubMed] [Google Scholar]
  9. Chuang YH, Kuo LM. (2018) Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey. International Journal of Mental Health Nursing 26(6): 1767–1775. Available at: 10.1111/inm.12483 (accessed 11 March 2019). [DOI] [PubMed] [Google Scholar]
  10. Cleary M, Horsfall J, O'Hara-Aarons M, et al. (2012) Mental health nurses' views on therapeutic optimism. International Journal of Mental Health Nursing 21(6): 497–503. [DOI] [PubMed] [Google Scholar]
  11. Cline D, Reilly C, Moore JF. (2004) What's behind RN turnover? Uncover the “real reason” nurses leave. Holistic Nursing Practice 18(1): 45–48. [Google Scholar]
  12. Connor KM, Davidson JR. (2003) Development of a new resilience scale: The Connor–Davidson resilience scale (CD-RISC). Depression and Anxiety 18(2): 76–82. [DOI] [PubMed] [Google Scholar]
  13. Delgado C, Upton D, Ranse K, et al. (2017) Nurses' resilience and the emotional labour of nursing work: An integrative review of empirical literature. International Journal of Nursing Studies 70: 71–88. [DOI] [PubMed] [Google Scholar]
  14. Desrumaux P, Lapointe D, Sima MN, et al. (2015) The impact of job demands, climate, and optimism on well-being and distress at work: What are the mediating effects of basic psychological need satisfaction?. Revue Européenne De Psychologie Appliquée/European Review of Applied Psychology 65(4): 179–188. Available at: 10.1016/j.erap.2015.06.003 (accessed 11 March 2019). [DOI] [Google Scholar]
  15. Eagly AH. (2013) Sex Differences in Social Behavior: A Social-role Interpretation, New York: Psychology Press. [Google Scholar]
  16. Falavarjani, MF and Yeh CJ (2018) A phenomenological study of adaptability, multiple identities, and acculturative strengths as an Iranian immigrant in Malaysia. International Journal of Social Science Research 6(2). DOI:10.5296/ijssr.v6i2.13405.
  17. Faraji O, Valiee S, Moridi G, et al. (2012) Relationship between job characteristic and job stress in nurses of Kurdistan University of Medical Sciences educational hospitals. Iranian Journal of Nursing Research 7(25): 54–63. [Google Scholar]
  18. Gabriel S, Gardner WL. (1999) Are there “his” and “hers” types of interdependence? The implications of gender differences in collective versus relational interdependence for affect, behavior, and cognition. Journal of Personality and Social Psychology 77(3): 642–655. [DOI] [PubMed] [Google Scholar]
  19. Glass N. (2007) Investigating women nurse academics' experiences in universities: The importance of hope, optimism, and career resilience for workplace satisfaction. Annual Review of Nursing Education 5: 111–136. [Google Scholar]
  20. Hair JF, Black WC, Babin BJ, et al. (2010) Multivariate Data Analysis: A Global Perspective. 7th edn. Upper Saddle River, NJ: Pearson. Available at: http://digitalcommons.kennesaw.edu/ (accessed 21 May 2013). [Google Scholar]
  21. Hajbaghery MA, Salsali M. (2005) A model for empowerment of nursing in Iran. BMC Health Services Research 5(1): 24–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hart PL, Brannan JD, De Chesnay M. (2014) Resilience in nurses: An integrative review. Journal of Nursing Management 22(6): 720–734. [DOI] [PubMed] [Google Scholar]
  23. Hassanshahi MM. (2002) The relationship between optimism and coping strategies in university students. The Quarterly Journal of Fundamentals of Mental Health 1(4): 86–98. [Google Scholar]
  24. Helweg-Larsen M, Harding HG, Klein WM. (2011) Will I divorce or have a happy marriage? Gender differences in comparative optimism and estimation of personal chances among US college students. Basic and Applied Social Psychology 33(2): 157–166. Available at: 10.1080/01973533.2011.568874 (accessed 11 March 2019). [DOI] [Google Scholar]
  25. Hofstede GH. (1990) Cultures and Organizations: Software of the Mind, London: McGraw-Hill. [Google Scholar]
  26. Hosseinizadeh M. (2014) Examining the relationship between differentiation of self components and social adjustment. Procedia–Social and Behavioral Sciences 113: 84–90. [Google Scholar]
  27. Hu L-t, Bentler PM. (1999) Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal 6(1): 1–55. Available at: 10.1080/10705519909540118 (accessed 11 March 2019). [DOI] [Google Scholar]
  28. Jackson D, Firtko A, Edenborough M. (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review. Journal of Advanced Nursing 60(1): 1–9. [DOI] [PubMed] [Google Scholar]
  29. Jacobsen B, Lee J, Marquering W. (2008) Are Men More Optimistic?. (1 February 2008). Available at: SSRN: https://ssrn.com/abstract=1030478 (accessed 11 March 2019). [Google Scholar]
  30. Johnson J, Hall LH, Berzins K, et al. (2018) Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International Journal of Mental Health Nursing 27(1): 20–32. [DOI] [PubMed] [Google Scholar]
  31. Khomeiran RT, Deans C. (2007) Nursing education in Iran: Past, present, and future. Nurse Education Today 27(7): 708–714. [DOI] [PubMed] [Google Scholar]
  32. Khoshouei MS. (2009) Psychometric evaluation of the Connor–Davidson resilience scale (CD-RISC) using Iranian students. International Journal of Testing 9(1): 60–66. [Google Scholar]
  33. Kline R. (2010) Principles and Practice of Structural Equation Modeling, 3rd edn. New York: Guilford Press. [Google Scholar]
  34. Laker C, Cella M, Callard F, et al. (2018) Why is change a challenge in acute mental health wards? A cross-sectional investigation of the relationships between burnout, occupational status and nurses' perceptions of barriers to change. International Journal of Mental Health Nursing 28(1): 1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Luthans KW, Lebsack SA, Lebsack RR. (2008) Positivity in healthcare: Relation of optimism to performance. Journal of Health Organization and Management 22(2): 178–188. [DOI] [PubMed] [Google Scholar]
  36. McGee EM. (2006) The healing circle: Resiliency in nurses. Issues in Mental Health Nursing 27(1): 43–57. [DOI] [PubMed] [Google Scholar]
  37. Mealer M, Jones J, Moss M. (2012) A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses. Intensive Care Medicine 38(9): 1445–1451. [DOI] [PubMed] [Google Scholar]
  38. Nezhad MAS, Besharat MA. (2010) Relations of resilience and hardiness with sport achievement and mental health in a sample of athletes. Procedia–Social and Behavioral Sciences 5 757–763. Available at: 10.1177/0031512516631056 (accessed 11 March 2019). [DOI] [Google Scholar]
  39. Scardillo, J., Dunn, K. S., & Piscotty Jr, R. (2016). Exploring the relationship between resilience and ostomy adjustment in adults with a permanent ostomy. Journal of Wound Ostomy & Continence Nursing 43(3): 274–279. [DOI] [PubMed]
  40. Scheier MF, Carver CS, Bridges MW. (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology 67(6): 1063–1078. [DOI] [PubMed] [Google Scholar]
  41. Scheier MF, Carver CS, Bridges MW. (2001) Optimism, pessimism, and psychological well-being. In: Chang EC. (ed) Optimism and Pessimism: Implications for Theory, Research, and Practice, Washington, DC: American Psychological Association, pp. 189–216. [Google Scholar]
  42. Shepperd JA, Waters EA, Weinstein ND, et al. (2015) A primer on unrealistic optimism. Current Directions in Psychological Science 24(3): 232–237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Sheu S, Lin HS, Hwang SL. (2002) Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: The effect of coping behaviors. International Journal of Nursing Studies 39(2): 165–175. [DOI] [PubMed] [Google Scholar]
  44. Simons JS, Gaher RM. (2005) The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion 29(2): 83–102. Available at: 10.1007/s11031-005-7955-3 (accessed 11 March 2019). [DOI] [Google Scholar]
  45. Tugade MM, Fredrickson BL, Feldman Barrett L. (2004) Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality 72(6): 1161–1190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Waugh CE, Fredrickson BL, Taylor SF. (2008) Adapting to life's slings and arrows: Individual differences in resilience when recovering from an anticipated threat. Journal of Research in Personality 42(4): 1031–1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Zarea K, Negarandeh R, Dehghan-Nayeri N, et al. (2009) Nursing staff shortages and job satisfaction in Iran: Issues and challenges. Nursing and Health Sciences 11(3): 326–331. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Research in Nursing: JRN are provided here courtesy of SAGE Publications

RESOURCES