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Developing a causal model of the relationship between psychological hardiness, psychological distress, distress tolerance with nursing stress mediated by sense of coherence in nurses with fibromyalgia syndrome
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Saeed Enayatian   , Ali Hosseinaei * , Sosan Rahimi , Alireza Rajaei |
| Department of Psychology and Counseling, Az.C., Islamic Azad University, Azadshahr, Iran , a_hosseinaei@iau.ac.ir |
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Abstract: (44 Views) |
Introduction: Nurses with fibromyalgia syndrome are exposed to high levels of nursing stress due to the chronic nature of the condition and the demanding characteristics of their profession. Therefore, investigating the psychological mechanisms underlying nursing stress is of particular importance. This study aimed to examine a causal model of the relationships among psychological hardiness, psychological distress, and distress tolerance with nursing stress, with sense of coherence as a mediating variable, among nurses with fibromyalgia syndrome.
Methods: This descriptive-correlational study employed structural equation modeling (SEM). The study population consisted of 798 nurses diagnosed with fibromyalgia syndrome working in hospitals in Mashhad, including Imam Reza, Ghaem, Razavi, Farabi, Khatam al-Anbia, and 17 Shahrivar hospitals. A total of 268 participants were selected using purposive sampling. Data were collected using the Kobasa Psychological Hardiness Questionnaire, the Mason et al. Psychological Distress Scale, the Distress Tolerance Scale (DTS) developed by Simons and Gaher, the Flesenberg-Madsen et al. Sense of Coherence (SOC) Scale, the Expanded Nursing Stress Scale (ENSS) developed by Gray-Toft and Anderson, and the Persian Revised Fibromyalgia Impact Questionnaire (FIQR). Data were analyzed using descriptive statistics and partial least squares structural equation modeling (PLS-SEM) in SmartPLS version 4.
Results: The findings indicated that psychological hardiness (−0.46, p < 0.001) and distress tolerance (−0.25, p < 0.001) were significantly and negatively associated with nursing stress, whereas psychological distress (0.34, p < 0.001) was significantly and positively associated with nursing stress. Furthermore, psychological hardiness (0.66, p < 0.001), distress tolerance (0.14, p < 0.001), and psychological distress (−0.26, p < 0.001) significantly predicted sense of coherence. Sense of coherence was also significantly and negatively associated with nursing stress (−0.31, p < 0.001). Overall, the final model demonstrated a satisfactory fit and explained a substantial proportion of the variance in nursing stress.
Conclusion: The findings suggest that higher levels of psychological hardiness and distress tolerance, together with lower levels of psychological distress, are associated with reduced nursing stress among nurses with fibromyalgia syndrome, particularly through enhanced sense of coherence. Therefore, sense of coherence appears to function as an important mediating mechanism in explaining nursing stress and should be considered in the development of psychological interventions tailored for nurses with fibromyalgia syndrome.
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| Keywords: Psychological hardiness, Psychological distress, Distress tolerance, Sense of coherence, Occupational stress, Fibromyalgia syndrome. |
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Type of Study: Research |
Subject:
Special
Received: 2026/01/11 | Accepted: 2026/07/1 | Published: 2026/07/1 | ePublished: 2026/07/1
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