The Effects of "Three Good Things" Positive Psychotherapy on Nurses' Burnout

This scale was developed by Maslach and Jackson (1981) and consists of 16 items over three metrics: emotional exhaustion (EE, five items), cynicism (CY, five items) and reduced professional efficacy (RPE, six items). The items were scored on a Likert scale from 0 (never) to 6 (everyday) (Schaufeli et al. 1996). The higher the scores on the three metrics, the higher level of burnout indicated. The Chinese version of the MBI-GS, developed by Li & Shi (2003), also has a good validity and reliability. In this study, Cronbach alpha coefficients for EE, CY and RPE were 0.93, 0.83 and 0.82, respectively.

The CD-RISC was used to measure nurses' resilience level (Connor & Davidson 2003). This scale comprises 25 items over three metrics (tenacity, strength and optimism) that assess resilience or capacity to change and cope with adversity. Nurses were asked to rate each item with reference to the previous month. A 5-point Likert scale was used (0 = not true at all, 4 = true all the time.). The total score ranges from 0 to 100, with higher scores indicating higher levels of resilience. The Cronbach alpha coefficients of the Chinese version were 0.91 for the total score, 0.88, 0.80 and 0.60 for the three factors (Yu & Zhang 2007).

Self-efficacy was defined as the average score on the General Self-efficacy Scale. The scale is a single-dimension scale with 10 questiona. Each question is assigned points from 1 to 4, and the final score is the total score of the 10 questions. The Chinese versison also has a good validity and reliability with a Cronbach alpha is 0.88.

The TCSS consists of 20 items over two metrics: positive coping style (PCS, 10 items) and negative coping style (NCS, 10 items). The items were scored on a five-point Likert scale from 1 to 5. The final scores of PCS and NCS were the total scores of their items. The Cronhach alpha coefficients of the two metrics were 0.70 and 0.69, respectively.

The Turnover Intention Scale was developed by Michaels and Spector (1982). The Chinese version was translated by Li and Li (2000). It includes three metrics ( the possibility to resign the job, the possibility to find another job and the possibility to get another job) and 6 items. A 4-Likert scale from 1 (never) to 4 (always) was used to score each item. The higher the score was, the stronger the turnover intention is.

The Job Satisfaction Scale, developed by Tao et al. (2009), includes 38 items. A 5-Likert scale from 1 (totally agree) to 5 (totally disagree) were used to score each item. The total score of job satisfaction ranges from 38 to 190, with higher score indicating higher levels of job satisfaction. The Cronbach alpha was 0.783 in this study.

The Job Performance Scale consists 16 items and 3 metrics (job denotion, task performance and interpersonal promotion). A 6-Likert scale from 1 to 6 was used to score nurses' job performance. The final score of the three metrics were the total score of their items. The Cronbach alpha of the three metrics in this study were 0.842, 0.904 and 0.927, respectively.

The blood sample were collected on a day during the third to the tenth day of the menstrual cycle. Participants were instructed not to eat or drink anything other than water, and not to undertake any strenuous exercise 2 h or smoking 30 min before a blood sample was taken. Five trained researchers drew the blood samples between 7am-9am at an experimental lab. Nurses were instructed to take a blood sample at their convenient time. Blood was collected using vacuum blood collection tubes (Hubei Jin Xing Technology Co. Wuhan) and sent to an endocrinology laboratory for biochemical analysis at no cost to the participants (Endocrinology Laboratory, The Second Xiangya Hospital of Central South University, Dr. Z.X. Gui). Blood samples were centrifuged at 4000 rpm for 2 min in order to get a clear supernatant. Blood cortisol was measured using an immunoassay with chemiluminescence detection (ADVIA Centaur XP Immunoassay System, Siemens, Germany).