Origial Article Prit ISSN: 2321-6379 Olie ISSN: 2321-595X DOI: 10.17354/ijssI/2017/2 Effect of stress ioculatio program o self-esteem of Irashahr hemodialysis patiets Kordi Mehri 1, Darba Fatemeh 2, Safarzai Eayatollah 3, Kahrazei Farhad 4, GHaderi Maryam 5 Msc of Cliical Psychology, ursig office, irashahr Uiversity of Medical Scieces. Irashahr. Ira, 2 Msc of Psychiatric Nursig, Nursig ad Midwifery school, irashahr Uiversity of Medical Scieces. Irashahr, Ira, 3 Master studet of Medical- Surgical Nursig, zaheda Uiversity of Medical Scieces,Zaheda, Ira, 4 Assistat professor, Departmet of Psychology, Uiversity of Sista ad Baluchesta, Zaheda, Ira, 5 Bsc of ursig. ursig office, irashahr Uiversity of Medical Scieces. Irashahr. Ira Abstract Itroductio ad Objective: Hemodialysis is a stressful process that egatively affect patiet s health ad reduces their selfesteem; therefore, the use of prevetive ad efficiet stress maagemet approaches is essetial. The aim of this study was to determie the effect of stress ioculatio program o self-esteem of Irashahr hemodialysis patiets. Methods: This radomized cliical trial was carried out o 60 hemodialysis patiets i Irashahr Khatamolabia hospital who were selected usig purpose-based samplig method. Data Collectio tools were demographic characteristic questioaire, ad Eyseck s stadard self-esteem questioaire that were completed i two stages, before ad oe moth after the itervetio. Itervetio icluded stress ioculatio program, cosistig of a 2-day 8-hour workshop (icludig stress coceptualizatio, acquisitio ad skills practice stages) that was admiistered for the itervetio group with oe week iterval. Results: Results showed that average of self-esteem score i stress ioculatio group sigificatly icreased from 8.92 ± 49.2 score at the stage before itervetio to 14.13 ± 56.1 score i the stage oe moth after the itervetio (p<0.005). I the cotrol group, self-esteem score i the stages before ad oe moth after the itervetio was ot sigificatly differet (p>0.005). Coclusio: The fidigs of this study showed that stress ioculatio program is a fuctioal, safe ad affordable method to improve self-esteem i hemodialysis patiets. Keywords: stress ioculatio, self-esteem, Hemodialysis INTRODUCTION Chroic real failure is a life-threateig disease i which a perso eeds a log-term treatmet such as hemodialysis kidey replacemet to save his life (1). Although hemodialysis ca icrease a patiet s life, it caot alter atural course of the uderlyig disease ad is ot cosidered as a complete replacemet for kidey fuctio (2); hece, problems i patiets with kidey failure have ot bee resolved ad the patiet is exposed to umerous complicatios ad problems ad has to make chages i diet, food ad medicial supplemets, restrictios o fluid www.ijss-s.com Access this article olie Moth of Submissio : 06-2017 Moth of Peer Review : 06-2017 Moth of Acceptace : 07-2017 Moth of Publishig : 07-2017 itake ad frequet hemodialysis sessios. These patiets ot oly cofrot various physiological chages, but they face with umerous psychological stresses that each of which ca i tur impair their metal ad persoality, such that most of them do ot become compatible with difficulties ad tesios ad experiece umerous behavioral chages such as isolatio, axiety, depressio, disease deial ad lack of self-esteem (3, 4 ad 5). Oe factor that plays a importat role i idividuals metal health is the beefit from self-esteem(6 ad 7) that udergoes chage i hemodialysis patiets uder the ifluece of multiple stressors. Self-esteem implies acceptace ad worthiess that a perso feels about himself.a perso who has a high self-esteem, evaluates himself positively ad has a appropriate behavior towards himself ad others. I fact, self-esteem is the value that a idividual gives himself (7 ad 8). The results of various studies show that a damaged self-esteem makes it impossible to tolerate difficult situatios that people, whether or ot, ecouter i their everyday life ad brigs a lot of metal ad physical Correspodig Author: Darba Fatemeh, Msc of Psychiatric Nursig, Nursig ad Midwifery school, irashahr Uiversity of Medical Scieces. Irashahr, Ira. Tel: +98 5437220480, E-mail: fatemehdarba@gmail.com Iteratioal Joural of Scietific Study July 2017 Vol 5 Issue 4 6
cosequeces for them (6 ad 7 ad 8).Self-esteem is the fourth level of Maslow s eeds ad this eed gives people cofidece ad idepedece (9). Sice stress ad the rate of copig with this disease ca affect self-esteem of patiets udergoig hemodialysis, stress maagemet programs ca probably be used to improve patiets self-esteem ad cosequetly be helpful to ehace their metal health. Oe of the methods that is very importat i reducig stress ad axiety caused by the disease ad its treatmet is immuizatio stress which was iovated by Meichebaum et al (1986) (10 ad 11). Stress ioculatio traiig is predicated to therapeutic model composed of semi-structured ad cliically sesitive traiig program. This traiig was desiged to develop copig skills ad icludes three stages: coceptualizatio, acquisitio ad traiig of skills (12). I the first phase, the mai focus is o the establishmet of a collaboratiobased commuicatio with people ad helpig them for a better uderstadig of the ature of stress ad its effects o excitemet ad performace (12 ad 13). I the secod phase, idividual s copig skills are stregtheed ad ew skills are taught to him. The traiig has a wide rage which icludes relaxatio traiig, cogitive exercises, problem solvig, behavioral exercises ad cogitivebehavioral techiques (11, 12, ad 13). I the third phase, idividual applies his skills to icrease his ability to cope with ay stress as well as more strog oes (12,13, ad 14). The results of Shihi ad Hora (2004) showed that ioculatio improves stress, axiety ad irratioal beliefs ilaw freshme (15)So far, may studies have show the effectiveess of this method i reducig pai, axiety ad depressio ad improvig professioal performace (16 ad 17); It was also reported that stress ioculatio methods such as cogitive behavioral therapy ad support group are more effective i cotrollig the stress (18). But give the extesive search that was doe, o study was foud which could measure the impact of ioculatio o self-esteem i hemodialysis patiets. Researchers pla to study whether stress ioculatio program i hemodialysis patiets is effective o self-esteem or ot? MATERIALS AND METHODS This was a cliical trial study carried out i 1394 o hemodialysis patiets iirashahr Khatamalabi hospital. Iclusio criteria for this study were willigess to participate i research, beig uder hemodialysis for at least 6 moths ago, lack of cosumig drugs affectig the psyche, ad its exclusio criteria were: uwilligess to cotiuatio of presece at this study, absece of more tha 10% of the time i the workshop, participatig i other stress maagemet workshops, patiet death ad exposure to major stress (death of someoe close, divorce, etc.) whe ruig the study. The sample size of this study, with cofidece coefficiet of 95%,accuracy of 50% ad test power of 80%,was obtaied patiets i each group (60 patiets i total) selected radomly ad usig objective-based samplig. They divided ito two groups amelycotrol ( = ) ad experimet ( = ) based o the registratio umber.the istrumet used i this study icluded demographic characteristic form ad the -item Eyseck self-esteem questioaire. Demographic characteristics questioairecotaied 12 questios about demographic characteristics ad disease which had bee preparedaccordig to research objectives ad study of the latest related articles ad resources. Self-esteem questioaire cotais phrases ad scorig of each phrase is by the phrases No (1), I do ot kow (2), ad Yes (3).I this Self-Esteem questioaire, miimum score is ad the maximum is 90; i this questioaire, phrases of the umbers 28,27,26,25,24,21,20,19,18,17,1 5,14,13,12,8,7, 6,4,3 are scoredreversely. The higher the score obtaied from the questioaire idicates the better self-esteem situatio. The validity of the questioaire was approved by 10 professors of the Medical Uiversity of Zaheda i Sista ad Baluchesta Uiversity. Hormoziejad (1380) used costruct validity method to determie validity of the test. He has reported calculated validity equal to 0.74 ad 0.79 for female ad male studets respectively. The reliability coefficiet of the test has bee reported equal to 0.88 ad 0.87 usig Crobach s alpha ad split-half methods respectively (19). Data collectio was performed simultaeously for both groups i two stages: before itervetio ad oe moth after itervetio. After approval of Research Coucil of Uiversity ad approved by the ethics committee, itervetio was coducted accordig to stress ioculatio process durig two sessios (each sessio lastig 4 hours) with oe week of iterval from each other, by a researcher ad i collaboratio with a cliical psychologist usig lecture, questio ad aswer, group discussio ad metal imagery methods for the itervetio group ad two moths after the ed of the study for cotrol group i order for moral cosideratios. The first sessio icluded a explaatio regardig the ature ad cosequeces of stress, idetifyig participats commo copig skills ad relaxatio traiig. At the ed of the first sessio, participats were give practical assigmets to do durig the week. Participats were asked to say the differece betwee stress ad axiety. They were also asked to fid the best image which represets stress ad record stressful factors that 7 Iteratioal Joural of Scietific Study July 2017 Vol 5 Issue 4
they ecouter durig the week, ad practice relaxatio techique daily. I the secod sessio, participats were taught cogitive restructurig ad relaxatio techiques. The, usig metal imagery, participats were cofroted with a stressor; at this stage, subjects were asked to imagie that they are i dialysis ward ad feel fatigue. The, they were asked to use their best copig skill i the face of this situatio.subjects were followed up for a period of oe moth after the itervetio. Durig this period, researcher also telephoed the participats i the itervetio group by every two weeks ad did the ecessary followig-up ad boost regardig followig traiig program. For data aalysis,spss software versio 14 was used. The meas ad stadard deviatios were calculated for quatitative variables. Pre- ad post- compariso of cotrol group i terms of self-esteem (itragroup compariso) was doe usig paired t-test. The idepedet t-test was used i order to compare the self-esteem betwee the two groups. I carried out tests, the cofidece degree of 95% ad sigificace level of a= 0.05 was cosidered. RESULTS 50% of subjects i both groups were male ad 50% were female with a mea age of 3.35 years of old.i terms of educatio, 50% of subjects were i the itervetio group ad 56.7 of them were i the cotrol group with a academic degree. The mea of hemodialysis history i the itervetio ad cotrol group was 7.9 ad 6.5 years respectively. There was o sigificat differece betwee the two groups i terms of all uderlyig variables (Table 1). Table 2 shows itergroup compariso of self-esteem mea score i two group. The average of self-esteem i itervetio group was chaged from 8.92 ± 49.2 score at the stage before itervetio to 14.3 ± 56.1 score at the stage after itervetio that these chages were sigificat (p =0.000). Based o paired t-test results, the hemodialysis patiets self-esteem score average i stress ioculatio program group at the stage after itervetio icreased sigificatlycompared to the stage before itervetio ad this icrease cotiued util oe moth after the itervetio. I the cotrol group, the average of self-esteem score chaged from 5.08 ± 47.2score at the stage before itervetio to 8.73 ± 0.47 score after the itervetio that this was ot sigificat (p<0.05). Table 3 shows iter-group compariso of the average of self-esteem score i two groups. Idepedet t-test results showed that the average of self-esteem score before the itervetio i cotrol ad experimetal groups had o sigificat differece (p =0.290); while, the differece was sigificat after the itervetio (p <0.05). Accordig to results of the test, the average of self-esteem score i hemodialysis patiets i the stress ioculatio program groupsigificatly icreased after the itervetiocompared to cotrol group. Two-way ANOVA test results showed that the rate of chage i self-esteem score i pre-test ad post-test i two groups has o sigificat differece i terms of uderlyig variables uder study. DISCUSSION Accordig to the study, the average self-esteem score i group ofstress ioculatio programwas sigificatly icreased at the later stage. This reflects the impact of stress ioculatio program o hemodialysis patiets self-esteem. This itervetio will ot oly lead to idividual s beeficial cofrotatio with problems ad stress, but alsothey will have a more positive cogitive assessmet of themselves for successful behavior i dealig with these factors ad cosequetly they will experiece more positive emotios ad their self-esteem ad self-cofidece will icrease (10 ad 18). Table 1: Compare the backgroud variables i the itervetio ad cotrol groups Backgroud variable Geder male female Age marital status sigle married Hemodialysis history Groups (%) Itervetio 65.8±5.38 12 (0.40) 18 (0.60) 18.6±9.7 Cotrol 45.7±4.34 11 (7.36) 19 (3.63) 27.5±5.6 Test result (P) 063.0 687.0 000.1 885.0 Table 2: Withi group compariso of the mea score of self steam i the itervetio ad cotrol groups at the stages pre itervetio ad post itervetio variablegroups stage (=) Post itervetio Pre itervetio Depeded t test result Self steam Itervetio 3.14±1.56 92.8±2.49 P=0.879 t=0.154,df=29 Cotrol 73.8±0.47 08.5±2.47 P=0.008 t=2.859, df=29 Iteratioal Joural of Scietific Study July 2017 Vol 5 Issue 4 8
Table 3 : Compariso betwee groups the mea score of self steam i the itervetio ad cotrol groups, at the stages pre itervetio ad post itervetio Stage Pre-itervetio Post-itervetio 60 60 Cotrol 3.7±2.48 6.12±5.51 Groups Itervetio 92.8±2.49 3.14±1.56 Total 08.5±2.47 73.8±0.47 Idepedet t test t=1.068- df=58 P=0.290 F=2.870 t=2.932 df=58 P=0.005 F=3.236 The results of studies carried out by Darba et al showed that stress ioculatio program improves the quality of life ad public health of urses workig i the metal ward (12 ad 20).Sice axiety ad stress egatively affect a perso s quality of life ad geeral health over time ad leads to metal ad emotioal problems, stress ioculatio program leads to decrease of these problems, ad cosequetly,by icreasig satisfactio ad worthiess, it rehabilitates ad improves patiets selfesteem (11 ad 13).The stress ioculatio program, by stregtheig copig skills, causesa idividual be aware of cogitive, emotioal elemets as well as his capabilities i relatio to others,ad by havig metal balace, ca overcome daily stress more tha ever ad cosequetly idividuals self-esteemicreases (11 ad 14). Give the above, it ca be cocluded that the more patiets cotrol over their stress maagemet skill, the better their selfesteem will be; because, the stress cotrol skill is a skill that a perso applies cosiderig locatio as well as serious ad detailed assessmet of his feeligs (15). Lazar & Folksma believe that people who believe that have subsidiary resources i copig with stress, they will be less vulerable to stress (21) ad stress ioculatio program stregthes this belief i the idividual. I the follow-up period that patiets had the opportuity to apply the skills leared i their real-life eviromet ad to stabilize this program i their daily performace with the follow-up ad cotiuous traiig, their self-esteem icreased meaigfully. The study fidigs of Folksma & Bed (2010), Kawaharada, et al (2009), Rahgoy, et al (2006), Shihi & Hoora (2004), Darba, et al (2016) also show that stress ioculatio program causes public health improvemet, commitmet ad receptivity icreases, performace improvemet, improvemet of faulty attitude, icreasig metal flexibility, ad improvemet of their problem-solvig skills (22, 23, 24, 15, 13). The stress ioculatio program subjects a perso to movemets that have eough power to motivate but the movemets are ot powerful eough to defeat them (25). I this way, the perso ca make a sese of competece leared through successful experieces i copig with his maageable stress-levels ad ca take prospective defese mechaisms icludig positive skills ad expectatios i effective ad useful copig with stressful situatios (26) ad evetually, it causes improvemet i sese of self-efficacy ad icreases self-esteem i idividual. O Doell, et al i their study foud that the higher selfesteem, has a relatioship with the lower levels of stress (27). The study fidigs of Pruesser also showed that people who have higher self-esteem ad source of iteral cotrol, the secretio of Cortisol is sigificatly lower i stressful situatios (28). The study fidigs of Campbell & Lavalee, Housto, Matzicopoulos, ad Johso, et al showed positive correlatio betwee the self-esteem ad ability to cope with stressful situatios that is cosistet with our study (29,, 31, ad 32).People who use active ad effective problem solvig ad stress maagemet skills, have higher self-esteem, while patiets who use passive ad avoidat emotio-focused copig methods, have lower selfesteem (). Hall et al i a cliical trial foud thatimprovig ability of people to cope with stressors, boost patiet s self-esteem ad plays a sigificat role i protectig people agaist experiecesgaiig from axiety ad threats (33). Limitatios of this study iclude the followig: 1. sice all subjects were selected from oe hospital ad the sample size was small, the results of this study ca be geeralized oly to this eviromet. 2. Patiets idividual differeces i perceptio of self-esteem ad impressioability from the workshop that was attempted groups become equal partly i this term by radom allocatio of cotrol ad itervetio groups. 3. Lack of full cotrol over the exchage of iformatio betwee itervetio ad cotrol groups that experimetal group was also asked to refrai dissemiatig iformatio util ed of the study to reduce dissemiatio of iformatio ad cotrol group was assured for holdig stress ioculatio program workshop 9 Iteratioal Joural of Scietific Study July 2017 Vol 5 Issue 4
after the itervetio, ad through which exchage of iformatio was cotrolled as far as practicable. CONCLUSION Accordig to the fidigs of this study, it ca be cocluded that implemetatio of stress ioculatio program creates a sigificat differece i hemodialysis patiets self-esteem such that implemetatio of this program is accompaied with icreased self-esteem i hemodialysis patiets.hece, it ca be said thatby implemetig larger studies i other cliical eviromets ad i hemodialysis patiets, the applicatio of stress ioculatio program could have positive results o their cliical ad psychological state. ACKNOWLEDGMENT Authors of this study appreciate cooperatio of all patiets who sicerely helped us ad thak hemodialysis ward urses workig iirashahr Khatamalabia (p) hospital. REFERENCE 1. Daviso SN. Ed of Life Care Prefereces ad Needs Perceptio of Patiets withchroic Kidey Disease. Cli J Am Soc Nephrology. 2010;5: 195-204. 2. Ko B_ Khuraa A, Space J, Scott B,Hah M. Religious Belief ad Quality of Life a America Ier-City Hemodialysis. Oxford J medicie Nephrology Dialysis Trasplatatio 2005; 22: 2985-90. 3. Hojjati H, Qorbai M, Nazeri R, Sharifia S, Akhudzadeh G. [The relatioship betwee prayer frequecy ad spiritual health i patiets uder hemodialysis]. FudamMet Health. 2010;12: 514-21. 4. Kimmel PL, Emot SL, Newma JM, Dako H, Moss AH. ESRD patiet quality of life: symptoms, spiritual beliefs,psychosocial factors, ad ethicity. Am J Kidey Dis. 2003; 42 (4): 713-21. 5. Hagre B, Petterse IM, Severisso E, Clye N, Lutze K. Maitai HemodialysisPatiets Experieces of Their Life Situatio. Cli J Nurse 2005; 14: 294-0. 6. Ghasemzadeh A, YoueciHamzehKhalou RA. [ComparativeStudy of Metal Health ad Self-Esteem of Freshma ad JuiorStudets]. J Educ Psychol. 2010;1: 39-58. 7. Rezaei L. [The Effect of self-esteem o metal health i employed wome workig i Zimes factory ad uemployed wome]. Joural of Moder Idustrial/Orgaizatio Psychology. 2010: 19-27 8. Rajabi G, Buhlul N. [Assess the reliability ad validity of the scaleof self_ esteem i First Year Studets martyr Chamra Uiversity].Educatioal ad Psychological researches. 2008;3: 48-33. 9. Marashi SA, Mehrabiya T. The Relatioship of Prayer ad Spiritual Health with Self-Esteem of Patiets Treated with Hemodialysis i Ilam. Military Carig Scieces. 2016;2(4).214-220. 10. meichebam D. stress ioculati traiig: a prevetitive ad treatmet approach. 3rd edi. guilford press, 2007 11. Ogde J. Health Psychology. Spai: McGraw-Hill; 2004:70 12. Mazloum SR, Darba F,KashaiLotfabadi M. The Effect of Stress Ioculatio Program o the Quality of Life of Nurses Workig i Psychiatric Wards. Ira Joural of Nursig (IJN) 2012; 25(76): 42-54 13. Safarzei1 E, Darba F, Mazloum SR. effect of stress o the urses work life quality i psychiatric ward. IIOABJ. 2016; 7 (10): 16 21 14. Kiai R, Sodai M, Seidia M, ShafiAbady A. [2010] The effectiveess of stress ioculatio group traiig o Somatizatio ad Axiety of the coroary heart disease patiets. Sci Med J 9(5):495-506 15. Sheehy R, Hora J. Effects of Stress Ioculatio traiig for first year law studets. iteratioal joural of stress maagemet 2004;11:41-55 16. Rasouli R, Razmizade H. Effectiveess of stress ioculatio traiig i reducig axiety ad stress i studets. J Behav Sci. 2013;7(1):13-4. 17. Jamshidifara, Z., SalehiMoghadama, N., &Mohammadizadeha, S. (2014). Effectiveess of Group Traiig of Stress Ioculatio i Reducig Perceived Stress.Procedia Social ad Behavioral Scieces 159, 4 432. 18. Flaxma PE, Bod FE. A radomised worksite comparsio of acceptace ad commitmet therapy ad stress ioculatio traiig.behaviour Research ad Therapy 2010;48(8): 816 19. Hormozi, M. Relatioship betwee self-esteem, social axiety ad perfectioism ad self-expressio i studets of ShahidChamra Uiversity, upublished MA thesis, Ahvaz.2001 20. Darba F,Mazloum SR The Effect of Stress Ioculatio Program o the geeral health of Nurses Workig i Psychiatric Wards.Scietific Joural of Kurdista Uiversity of Medical Scieces. 2013;18(1):68-74 21. Lazarus RS, Folkma S. Stress, appraisal, ad copig. New York: Spriger Publishig Compay; 1984. 22. Flaxma PE,Bod FE. a radomised worksite comparsio of acceptace ad commitmet therapy ad stress ioculatio traiig. Behaviour research ad therapy 2010;48: 816-20 23. Kawaharada M, Yoshioka E, Saijo Y, Fukui T, Ueo T, Kishi R. The Effects of a Stress Ioculatio Traiig Program for Civil Servats i Japa: a Pilot Study of a No-radomized Cotrolled Trial. Idustrial Health 2009; 47: 173 82 24. Rahgooy A, Fallahi Khshkab M, Karimloo M, Gaeei M. The effect of applicatio method of stress ioculatio o Stress of Nurses. Joural of Rehabilitatio 2004;7(2):61-5 25. Abolghasemi A, Mehrabizadeh Hoarmad M, Najjaria B, Shokrko H. effectiveess of stress ioculatio traiig ad systematic desesitizatio therapy i the studets with test axiety. Joural of Psychology 2002;22:3-21 26. Fausel DF.stress ioculatio traiig for step couples. Marriage & family review 1995; 21(1-2): 135-155 27. Specer M. stress ioculatio traiig for sigle mothers.phd thesis, Uiversity of Hartford, 2010 28. O Doell K, Brydo L, Wright CE, Steptoe A. Self-esteem levels ad cardiovascular ad iflammatory resposes to acute stress. Brai BehavImmu 2008;22(8):1241-7. 29. Pruesser JC, Hellhammer DH, Kirschbaum C. Low self-esteem, iduced failure ad the adreocortical stress respose. PersIdiv Differ 1999;27(3):477-89.. Campbell JD, Lavallee LF. Who am I? The role of self-cocept cofusio i uderstadig the behavior of people with low self-esteem. New York: Pleum Press, 1993 31. Housto JP. Cheatig behavior, aticipated success-failure, cofidece, ad test importace. J EducPsychol 1977;69(1):55-60. 32. Matzicopoulos P. Copig with school failure: Characteristics of studets employig successful ad usuccessful copig strategies. Psychol Schools 1990;27(2):138-43 33. Johso RJ, Lud DA, Dimod MF. Stress, self-esteem ad copig durig bereavemet amog the elderly. SocPsychol Quart 1986:273-9. 34. Hall PL, Tarrier N. The cogitive-behavioural treatmet of low self-esteem i psychotic patiets: a pilot study. Behav Res Ther 2003;41(3):317-32. How to cite this article: Mehri K, Fatemeh D, Eayatollah S, Farhad K, Maryam G. Effect of stress ioculatio program o self-esteem of Irashahr hemodialysis patiets. It J Sci Stud 2017;5(4):6-10. Source of Support: Nil, Coflict of Iterest: Noe declared. Iteratioal Joural of Scietific Study July 2017 Vol 5 Issue 4 10