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J Social Behav Communit Health 2025, 9(2): 1615-1624 |
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Barazandeh A, khorasani M, Tahmasebi M, Farahzadi M, Fazeli S. Relationship between Emotional Exhaustion and Chronic Fatigue in Nurses: The Moderating Role of Health-Promoting Lifestyles. J Social Behav Communit Health 2025; 9 (2) :1615-1624
URL: http://sbrh.ssu.ac.ir/article-1-279-en.html
URL: http://sbrh.ssu.ac.ir/article-1-279-en.html
1- Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran
2- Department of Human Resources, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
3- Department of psychiatry, Research center of addiction and behavioral sciences, Shahid Sadoughi, University of medical sciences, Yazd, Iran ,h.farahzadi@ssu.ac.ir
4- Faculty of Educational Sciences and Psychology, Department of Clinical Psychology, Alzahra University, Tehran, Iran
2- Department of Human Resources, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
3- Department of psychiatry, Research center of addiction and behavioral sciences, Shahid Sadoughi, University of medical sciences, Yazd, Iran ,
4- Faculty of Educational Sciences and Psychology, Department of Clinical Psychology, Alzahra University, Tehran, Iran
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a Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran
b Department of Human Resources, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
c Department of psychiatry, Research center of addiction and behavioral sciences, Shahid Sadoughi, University of medical sciences, Yazd, Iran
d Faculty of Educational Sciences and Psychology, Department of Clinical Psychology, Alzahra University, Tehran, Iran
Introduction
Given that the Cronbach's alpha value of all variables is higher than 0.7 (Al-Mugheed et al., 2022), it can therefore be said that all latent variables in the model are unidimensional. Because Cronbach's alpha provides a more rigorous estimate of the internal consistency reliability of latent variables (alpha), in structural path models another measure called composite reliability (p_c) is used; when this value is greater than 0.7, the block is unidimensional. The composite reliability values are also shown in Table (2). The results show that the model blocks have the required composite reliability(Table2).
After examining the validity and reliability of the research instrument, model evaluation was considered. In the present study, the effect size criterion was used to evaluate the model. For each effect in the path model, the effect size can be evaluated using Cohen'sf 2 
. The effect size f 2 R 2 
to the part of the variance of the endogenous latent variable that remains unexplained in the model. Accordingly, in structural equation analysis, after estimating the parameters and before interpreting them, the fitness of the model must be ensured(Table3).
As shown in Table (4), the direct paths of health-promoting lifestyle and emotional exhaustion to the criterion variable of chronic fatigue are 0.39 and 0.146, respectively, which are significant at the 0.05 level. According to these findings, it can be shown that the effect of emotional exhaustion on chronic fatigue of nurses through the moderating variable of health-promoting lifestyle is significant at the 0.05 level (p>0.05) due to the obtained T score (1.98) which is greater than 1.96. Therefore, it can be stated that increasing health-promoting lifestyle can play a moderating role in the relationship between reducing emotional exhaustion and chronic fatigue of nurses, and hence the research hypothesis that health-promoting lifestyle moderates the relationship between the frequency of emotional exhaustion and chronic fatigue in nurses is confirmed (Table 4).
Figure 1. Estimation of path coefficients of the research model with determinants
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Relationship between Emotional Exhaustion and Chronic Fatigue in Nurses: The Moderating Role of Health-Promoting Lifestyles
Amin Barazandeh a, Maedeh Khorasani a, Moluk Tahmasebi b,
a Department of Psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Isfahan Branch (Khorasgan), Isfahan, Iran
b Department of Human Resources, Faculty of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
c Department of psychiatry, Research center of addiction and behavioral sciences, Shahid Sadoughi, University of medical sciences, Yazd, Iran
d Faculty of Educational Sciences and Psychology, Department of Clinical Psychology, Alzahra University, Tehran, Iran
| A R T I C L E I N F O | A B S T R A C T | |
| ORIGINAL ARTICLE | Background: The present study aims to investigate the moderating role of health-promoting lifestyle in the relationship between emotional exhaustion and chronic fatigue in nurses. Methods: This was a descriptive correlational study and the statistical population of this study included nurses at Sinai Hospital and Heart Center in Isfahan who were working in the winter of 2022. Based on the Krejci and Morgan’s table, 280 questionnaires were distributed among the sample members, of which 266 questionnaires could be analyzed statistically. The data collection tools included the Maslach Emotional Exhaustion Questionnaire, the Chalder Chronic Fatigue Questionnaire, and the Walker Health-Promoting Lifestyle. Data analysis was conducted using two software programs: SPSS and Smart PLS. Results: The results demonstrated that nurses' chronic fatigue was significantly improved by emotional exhaustion (β = 0.146, p < 0.05). Furthermore, it was discovered that a healthier lifestyle had a greater impact on lowering chronic fatigue (β = -0.393, p < 0.001). An acceptable fit was shown by the model fit indices (SRMR = 0.080, NFI = 0.928, R2 = 0.42). Furthermore, the moderating effect of a healthy lifestyle was validated, showing that increased participation in healthy behaviors lessened the effect of emotional exhaustion on chronic fatigue. Conclusion: The results showed that a health-promoting lifestyle can play a moderating role in the relationship between emotional exhaustion and chronic fatigue in nurses; therefore, paying attention to factors affecting the increase in a health-promoting lifestyle can be considered in improving the conditions of nurses who are exposed to burnout and chronic fatigue and improve their performance. Keywords: Emotional exhaustion, Chronic fatigue, Health-promoting lifestyle, Nurses. |
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Article History: Received: 8 January 2025 Revised: 13 September 2025 Accepted: 1 October 2025 |
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*Corresponding Author: Mohammadhadi Farahzadi Email: Dr.h.farahzadi@ssu.ac.ir Tel: +98 913 351 3197 |
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Citation: Barazandeh A, Khorasani M, Tahmasebi M, Farahzadi M, Fazeli S. Relationship between Emotional Exhaustion and Chronic Fatigue in Nurses: The Moderating Role of Health-Promoting Lifestyles. Journal of Social Behavior and Community Health (JSBCH). 2025; 9(2): 1615-1624. |
Introduction
Hospitals, medical centers, and nurses are an integral part of the healthcare process in any country (Akbarian et al., 2021; Al-Mugheed et al., 2022), and their performance is therefore of great importance. In almost all hospital cases, nurses are the first group patients encounter who are with them until the end of the recovery period(Elham et al., 2019). Since nurses are the closest people in contact with patients and are considered the largest member of the health system, they play a fundamental role in the continuity of care, promotion, and maintenance of health at different levels of the health service delivery system (Artz AF, 1997). According to studies, on average, 50% of all healthcare system employees in Iran are nurses, and this figure reaches 80% in some countries(Mohaisen & Mohammed, 2024). Therefore, conducting research to identify and investigate the factors affecting nurses' performance is of great importance. One of the important factors to investigate in the nursing community is chronic fatigue. Nurses today experience high levels of chronic fatigue, which affects patient care outcomes and imposes significant costs on the health care system (Al-Mugheed et al., 2022). Chronic fatigue is a persistent and debilitating symptom that is associated with physical, psychological, behavioral, and cognitive problems and persists for 6 months or more and is felt almost every day (Barazandeh A, 2017). In other words, chronic fatigue refers to a type of fatigue that people feel extremely tired even after adequate rest and sleep. According to studies conducted by Rafat et al., the prevalence of fatigue in nurses was 91.9%, and two-thirds of nurses experienced fatigue at most times(Mohaisen & Mohammed, 2024). There are studies that link fatigue with poor performance (Barazandeh et al., 2023). Therefore, fatigue is an unpleasant mental feeling that disrupts a person's physical and mental performance and can prevent them from performing their daily tasks (Bulto LN, 2024), and factors such as job dissatisfaction or chronic fatigue can lead to psychological problems, in a way that provides the basis for experiences such as emotional exhaustion, increased levels of anxiety, stress, and depression (Calder et al., 1996)Moreover, the concepts of work and life have the strongest and most powerful connection with the individual and society, and creating interaction between them is of great importance, and due to the vital role of nurses and the impact of scientific advances in nursing, providing nursing services of optimal quality is not possible without becoming familiar with new techniques and influential factors, and one of the basic measures to improve the quality of care is to determine what effects the individual's own health can have on his or her work (Al-Mugheed et al., 2022). Health promotion is one of these influential concepts that examines the biological, psychological, and social factors that surround individuals and depicts the multidimensional and complex factors that individuals interact with to achieve good health. Health promotion, or the desire to improve health and achieve the best level of health, is the pioneer of the healthy people plan for all nations. Therefore, examining a health-promoting lifestyle is an important factor in the field of nursing practice. Nurses face many stressors in the workplace every day which can affect their general health, and since the decline in nurses' health is associated with medical accidents and errors (Al-Mugheed et al., 2022; Chang et al., 2019), a health-promoting lifestyle is an important factor in improving the quality of work life of employees that can reduce emotional exhaustion and chronic fatigue of employees (Charlier et al., 2020); thus, paying attention to health promotion in medical centers is essential and must be considered. Health-promoting behaviors include any activity which is carried out to increase or maintain the level of health and self-sufficiency of individuals or groups and include health responsibility, spiritual growth, physical activity, nutrition, interpersonal relationships, and stress control (Chen et al., 2024). In this regard, valuing the health and well-being of employees, including restaurant workers, can help reduce burnout and chronic fatigue of employees and promote their competence and self-worth (Chen et al., 2019). In this regard, emotional exhaustion is one of the many factors that exist in the workplace and had had lasting and serious consequences in workplaces (Borle et al., 2017). Emotional exhaustion is one of the representations of burnout that has been proposed by Maslach and Jackson (1981) (Dugger, 2024). According to a report, emotional exhaustion is a feeling of widespread emotional pressure accompanied by feelings of fatigue and energy depletion (Ebrahemzadih et al., 2020). Research has shown that workers in health care and social services are particularly at risk of emotional burnout (Fang & Mushtaque, 2024).
In other words, emergency room and other healthcare workers generally face more physical and psychological challenges due to their exposure to unpredictable situations such as medical and treatment emergencies, which ultimately leads to greater waste of time and energy (firouzkouhi berenj abadi & pourhossein, 2022). Emotional burnout is known as a psychological response accompanied by an impersonal response to service recipients and a reduced sense of competence and success at work, which is often associated with high turnover rates, poor employee performance, and low organizational effectiveness (Golparvar M, 2008), leading to job dissatisfaction and negative impacts on employees' personal, social, and family lives. Several studies show that nurses experience more job burnout and emotional burnout than other occupations, with healthcare occupations being associated with the highest rates of occupational injuries, including occupational and emotional burnout. Obvious signs of emotional exhaustion include increased absenteeism from work, withdrawal, and fear of returning to work after withdrawal and absence(Al Sabei et al., 2025).
Nurses who spend considerable time and energy helping others easily suffer from this condition and are exposed to constant physical and mental stress. Stress is a well-known component in nursing and causes many problems for both the nurses and the patients. This problem imposes high costs and job burnout. One of the axes of assessing the health of different societies is the mental health of that society. Considering the issues raised in the statement of the issues, the implementation of this plan is of particular importance. Also, the analysis of the factors affecting the growth and development of advanced societies indicates that all these countries have had efficient and effective treatment centers. Understanding the personality, psychological and emotional characteristics of nurses can be the conditions for planning in hospitals. The results of the present study can be used by medical and educational center departments, higher institutions, psychology students and future researchers.
Methods
This study is a descriptive correlational study in which chronic fatigue is the criterion variable, emotional exhaustion is the predictor variable, and lifestyle plays the role of a moderator variable. The study population was 477 nurses working at Sina Hospital and Heart Center in Isfahan in the winter of 2022. Based on Morgan's table (1970), the required sample size for a population of 480 is 142 (Kim & Yun, 2017). Accordingly, and in order to predict the possibility of some questionnaires being distorted, 280 questionnaires were distributed among the sample members, of which 266 could be analyzed statistically (return rate 0.95). SPSS version 26 and Smart PLS software were used to analyze the research data.
• Research tools
1) Health-promoting lifestyle questionnaire: This questionnaire was designed in 1990 by Walker et al. in Spain. This model was presented to determine the extent to which individuals perform health-promoting behaviors. This questionnaire contains 52 questions, and after reading each question, the respondent selects one of the 4 options based on the Likert scale: never, often, some, and always. Scoring is based on the answers as follows: the answer never: 1 point, some: 2 points, often: 3 points, and always: 4 points. The health-promoting lifestyle score is obtained by calculating the average of the individual's responses to all 52 items. Walker et al. have estimated the reliability of this questionnaire at 94% (Calder et al., 1996). The Health Promoting Lifestyle Questionnaire in Iran has been approved by Mohammadi Zaidi and Pakpour (2011), and its reliability for the entire questionnaire based on Cronbach's alpha coefficient has been reported to be 82% (Kwon, 2023).
2) Emotional Burnout Questionnaire: A 9-question questionnaire presented by Maslach and Jackson (1981) was used for emotional burnout (Kwon & Oh, 2023). The response scale used in this study was a five-point questionnaire ranging from never (1) to always(Mohaisen & Mohammed, 2024). This questionnaire, which measures the level of emotional burnout of employees, has validity and reliability according to the report of Mulki et al. (2006). Confirmatory factor analysis shows that the 9 questions of this questionnaire as a factor in the study by Mulki et al. (2006) have a Cronbach's alpha of 0.86 (Ebrahemzadih et al., 2020). Golparvar et al. (2008) translated and prepared a version of this questionnaire in Iran and reported a Cronbach's alpha of 0.91 for this questionnaire(Lu et al., 2023). The scoring method of this scale is as follows: two scores are considered for each question for the individual. Frequency score and severity score: If the subject has marked the box “never”, he/she will get a score of zero in both frequency and severity. Otherwise, depending on the mark he/she has placed in the frequency and severity section, he/she will get a score of 1 to 6 in frequency (from several times a year to every day) and a score of 1 to 7 in severity section (from very little to very much). When the scores of the subjects in each question are known, the four subtests can be calculated by adding the scores. In fact, by adding the scores, two scores can be obtained for this subtest in the two scales of frequency and severity (Marczak & Milecka, 2024).
3) Chronic Fatigue Questionnaire: The Chalder scale (1993) will be used to measure chronic fatigue (Maslach & Jackson, 1981). This scale is a short instrument with 14 items, and by adding up the scores, the total score of the individual can be obtained. According to Chalder's report, this questionnaire has an internal consistency coefficient of 89% for the entire scale (Mohammadi Zeidi et al., 2011). This scale was translated for the first time in Iran by Nasri in 2010, and its reliability coefficient was reported to be 83%(Mohaisen & Mohammed, 2024). In the study by Homayuni et al. (2015), the reliability coefficients of this questionnaire were obtained by two methods: Cronbach's alpha and split-half, respectively, as 0.91 and 0.87 (mohammadyari et al., 2022).
Results
The enrolled participants consisted of both men and women, and most of them were between the ages of 20 and 40. The majority of them were highly educated, with some having diplomas when they began their careers and many holding bachelor's degrees or higher. The range of work experience vary from highly experienced staff with over 20 years of service to new hires with less than a year. This diversity of varying in` ages, educational backgrounds, and work experience helps to ensure that the study's findings are more generalizable (Table 1).
In other words, emergency room and other healthcare workers generally face more physical and psychological challenges due to their exposure to unpredictable situations such as medical and treatment emergencies, which ultimately leads to greater waste of time and energy (firouzkouhi berenj abadi & pourhossein, 2022). Emotional burnout is known as a psychological response accompanied by an impersonal response to service recipients and a reduced sense of competence and success at work, which is often associated with high turnover rates, poor employee performance, and low organizational effectiveness (Golparvar M, 2008), leading to job dissatisfaction and negative impacts on employees' personal, social, and family lives. Several studies show that nurses experience more job burnout and emotional burnout than other occupations, with healthcare occupations being associated with the highest rates of occupational injuries, including occupational and emotional burnout. Obvious signs of emotional exhaustion include increased absenteeism from work, withdrawal, and fear of returning to work after withdrawal and absence(Al Sabei et al., 2025).
Nurses who spend considerable time and energy helping others easily suffer from this condition and are exposed to constant physical and mental stress. Stress is a well-known component in nursing and causes many problems for both the nurses and the patients. This problem imposes high costs and job burnout. One of the axes of assessing the health of different societies is the mental health of that society. Considering the issues raised in the statement of the issues, the implementation of this plan is of particular importance. Also, the analysis of the factors affecting the growth and development of advanced societies indicates that all these countries have had efficient and effective treatment centers. Understanding the personality, psychological and emotional characteristics of nurses can be the conditions for planning in hospitals. The results of the present study can be used by medical and educational center departments, higher institutions, psychology students and future researchers.
Methods
This study is a descriptive correlational study in which chronic fatigue is the criterion variable, emotional exhaustion is the predictor variable, and lifestyle plays the role of a moderator variable. The study population was 477 nurses working at Sina Hospital and Heart Center in Isfahan in the winter of 2022. Based on Morgan's table (1970), the required sample size for a population of 480 is 142 (Kim & Yun, 2017). Accordingly, and in order to predict the possibility of some questionnaires being distorted, 280 questionnaires were distributed among the sample members, of which 266 could be analyzed statistically (return rate 0.95). SPSS version 26 and Smart PLS software were used to analyze the research data.
• Research tools
1) Health-promoting lifestyle questionnaire: This questionnaire was designed in 1990 by Walker et al. in Spain. This model was presented to determine the extent to which individuals perform health-promoting behaviors. This questionnaire contains 52 questions, and after reading each question, the respondent selects one of the 4 options based on the Likert scale: never, often, some, and always. Scoring is based on the answers as follows: the answer never: 1 point, some: 2 points, often: 3 points, and always: 4 points. The health-promoting lifestyle score is obtained by calculating the average of the individual's responses to all 52 items. Walker et al. have estimated the reliability of this questionnaire at 94% (Calder et al., 1996). The Health Promoting Lifestyle Questionnaire in Iran has been approved by Mohammadi Zaidi and Pakpour (2011), and its reliability for the entire questionnaire based on Cronbach's alpha coefficient has been reported to be 82% (Kwon, 2023).
2) Emotional Burnout Questionnaire: A 9-question questionnaire presented by Maslach and Jackson (1981) was used for emotional burnout (Kwon & Oh, 2023). The response scale used in this study was a five-point questionnaire ranging from never (1) to always(Mohaisen & Mohammed, 2024). This questionnaire, which measures the level of emotional burnout of employees, has validity and reliability according to the report of Mulki et al. (2006). Confirmatory factor analysis shows that the 9 questions of this questionnaire as a factor in the study by Mulki et al. (2006) have a Cronbach's alpha of 0.86 (Ebrahemzadih et al., 2020). Golparvar et al. (2008) translated and prepared a version of this questionnaire in Iran and reported a Cronbach's alpha of 0.91 for this questionnaire(Lu et al., 2023). The scoring method of this scale is as follows: two scores are considered for each question for the individual. Frequency score and severity score: If the subject has marked the box “never”, he/she will get a score of zero in both frequency and severity. Otherwise, depending on the mark he/she has placed in the frequency and severity section, he/she will get a score of 1 to 6 in frequency (from several times a year to every day) and a score of 1 to 7 in severity section (from very little to very much). When the scores of the subjects in each question are known, the four subtests can be calculated by adding the scores. In fact, by adding the scores, two scores can be obtained for this subtest in the two scales of frequency and severity (Marczak & Milecka, 2024).
3) Chronic Fatigue Questionnaire: The Chalder scale (1993) will be used to measure chronic fatigue (Maslach & Jackson, 1981). This scale is a short instrument with 14 items, and by adding up the scores, the total score of the individual can be obtained. According to Chalder's report, this questionnaire has an internal consistency coefficient of 89% for the entire scale (Mohammadi Zeidi et al., 2011). This scale was translated for the first time in Iran by Nasri in 2010, and its reliability coefficient was reported to be 83%(Mohaisen & Mohammed, 2024). In the study by Homayuni et al. (2015), the reliability coefficients of this questionnaire were obtained by two methods: Cronbach's alpha and split-half, respectively, as 0.91 and 0.87 (mohammadyari et al., 2022).
Results
The enrolled participants consisted of both men and women, and most of them were between the ages of 20 and 40. The majority of them were highly educated, with some having diplomas when they began their careers and many holding bachelor's degrees or higher. The range of work experience vary from highly experienced staff with over 20 years of service to new hires with less than a year. This diversity of varying in` ages, educational backgrounds, and work experience helps to ensure that the study's findings are more generalizable (Table 1).
| Table 1. Distribution of Survey Respondents by Sex, Age, Service Record, and Education Level (N=266) | |||||||
| No. | Education | No. | Service record | No. | Age | No. | Sex |
| 81 | Diploma and postgraduate diploma | 23 | Under 1 year | 97 | 20- 30 | 92 | Man |
| 67 | 1-5 years | 84 | 31-40 | ||||
| 84 | 6- 10 years | 74 | 41- 50 | ||||
| 109 | Bachelor's degree | 46 | 11-15 years | 12 | More than 50 | 174 | Woman |
| 76 | Master's degree and above | 31 | 16- 20 years | ||||
| 15 | Over 20 years | ||||||
| 266 | Total | 266 | Total | 266 | Total | 266 | Total |
Given that the Cronbach's alpha value of all variables is higher than 0.7 (Al-Mugheed et al., 2022), it can therefore be said that all latent variables in the model are unidimensional. Because Cronbach's alpha provides a more rigorous estimate of the internal consistency reliability of latent variables (alpha), in structural path models another measure called composite reliability (p_c) is used; when this value is greater than 0.7, the block is unidimensional. The composite reliability values are also shown in Table (2). The results show that the model blocks have the required composite reliability(Table2).
| Table 2. Assessment of the Measurement Model: Internal Consistency, Reliability, and Convergent Validity | ||||
| Subscription index | AVE values (convergent validity) | Composite reliability values ( |
Cronbach's alpha values | Variables |
| 0/518 | 0/518 | 0/806 | 0/701 | Emotional burnout |
| 0/425 | 0/525 | 0/865 | 0/834 | Health promotion lifestyle |
| 0/567 | 0/567 | 0/791 | 0/700 | Chronic fatigue |
After examining the validity and reliability of the research instrument, model evaluation was considered. In the present study, the effect size criterion was used to evaluate the model. For each effect in the path model, the effect size can be evaluated using Cohen's
. The effect size is the ratio of the changes in to the part of the variance of the endogenous latent variable that remains unexplained in the model. Accordingly, in structural equation analysis, after estimating the parameters and before interpreting them, the fitness of the model must be ensured(Table3).| Table 3. Model Fit Summary for the Hypothesized Structural Equation Model | ||
| Amount obtained | Description | Test name |
| 0/080 | Standardized root square residual | SRMR |
| 1580/69 | Chi-square coefficient | Chi-square |
| 0/928 | Standardized goodness-of-fit index | NFI |
| 0/42 | Coefficient of determination | |
As shown in Table (4), the direct paths of health-promoting lifestyle and emotional exhaustion to the criterion variable of chronic fatigue are 0.39 and 0.146, respectively, which are significant at the 0.05 level. According to these findings, it can be shown that the effect of emotional exhaustion on chronic fatigue of nurses through the moderating variable of health-promoting lifestyle is significant at the 0.05 level (p>0.05) due to the obtained T score (1.98) which is greater than 1.96. Therefore, it can be stated that increasing health-promoting lifestyle can play a moderating role in the relationship between reducing emotional exhaustion and chronic fatigue of nurses, and hence the research hypothesis that health-promoting lifestyle moderates the relationship between the frequency of emotional exhaustion and chronic fatigue in nurses is confirmed (Table 4).
| Table 4. Effect coefficients of emotional exhaustion and the effect of the moderating role of health-promoting lifestyle on chronic fatigue |
|||||
| Meaningfulness | T | Standard deviation |
Modified impact size |
Overall impact level |
Route |
| 0/000 | 6/485 | 0/061 | -0/395 | -0/393 | Health-promoting lifestyle <-- Chronic fatigue |
| 0/049 | 1/983 | 0/098 | 0/145 | 0/146 | Emotional exhaustion <-- Chronic fatigue |
• Model estimation
After evaluating the model, the data were entered into the SmartPLS software. The visual output of the model in path coefficient estimation mode is shown in Figure along with the observed variables. As can be seen, the above figure shows the path coefficients between the research variables. The path coefficients are the standardized beta values. (Figure1)
After evaluating the model, the data were entered into the SmartPLS software. The visual output of the model in path coefficient estimation mode is shown in Figure along with the observed variables. As can be seen, the above figure shows the path coefficients between the research variables. The path coefficients are the standardized beta values. (Figure1)
Figure 1. Estimation of path coefficients of the research model with determinants
Discussion
According to the findings , emotional exhaustion is a significant predictor of chronic fatigue in nurses which were in line with previous research showing that high levels of workplace stress, including heavy workloads, emotional demands, and a lack of support, contribute to burnout and emotional depletion in nursing professionals(El-Ashry et al., 2023; Poku et al., 2020).For example, a study on nurses in Ghana discovered that nearly 40% of the variation in emotional exhaustion was caused by unhealthful work environments(Poku et al., 2020).Similarly, critical care nurses involved in high-stress procedures such as CPR exhibited higher levels of compassion fatigue and secondary traumatic stress, contributing to chronic fatigue and diminished well-being(El-Ashry et al., 2023).
This research emphasizes the connection between chronic fatigue and lifestyle choices that promote health. This result is consistent with the strong advantages found in systematic reviews of workplace interventions which meant to enhance nurses' mental and physical health, especially in areas like nutrition, stress management, and exercise(Moghimi et al., 2024; Stanulewicz et al., 2020). According to a cross-sectional study conducted in Taiwan, nurses' self-perceived health and quality of life are significantly mediated by their lifestyle choices, which accounts for more than 42% of the variation(Wang et al., 2023).This highlights the central role of behaviors in sustaining well-being.
Particularly, the moderating effect of a healthy lifestyle, which attenuates fatigue even when emotional exhaustion is high is noticeable. It is consistent with data showing that programs focusing on nutrition, stress reduction, and physical activity improve nurses' health outcomes.(Moghimi et al., 2024; Stanulewicz et al., 2020). This suggests that learning resilience through lifestyle interventions can act as a protector against the negative effects of occupational stress.
Multimodal intervention designs, which combine behavioral education with practical support for change, appear to be more effective than purely educational approaches, as evidenced by the inconsistent results of lifestyle interventions (e.g., diet, stress, body composition, and job-related metrics)(Stanulewicz et al., 2020).
Research supports linking health-promoting behaviors, well-being, and job environment satisfaction into comprehensive frameworks. One model (the NHJS) demonstrated strong psychometric validity, underscoring how lifestyle and well-being improvements align with greater job satisfaction and retention(Chung et al., 2020).
There are a few limitations to take into account, though. First off, because the study was carried out in a private hospital in Isfahan, its conclusions might not apply directly to nurses working in public hospitals or in other areas with distinct socioeconomic circumstances. By using a larger and more varied sample, future studies could investigate these differences. Furthermore, even though self-reported data offer insightful information, objective health metrics like wearable technology or biometric data could be included in future research to confirm the results. Finally, adding more variables to the model—like workplace climate, staffing levels, and organizational support—might yield a more thorough understanding of the elements affecting nurses' well-being. Future studies could also examine the psychological processes that underlie compassion fatigue, which would serve as the foundation for focused therapies meant to address various phases of emotional exhaustion.
Conclusion
This study presents strong empirical evidence that health-promoting lifestyle serves as a significant protective factor, reducing the negative relationship between emotional exhaustion and chronic fatigue among nurses. The findings confirm that although emotional exhaustion is a direct and powerful predictor of chronic fatigue, its influence is not one-way. Adopting health-promoting behaviors such as stress management, physical exercise, and good nutrition indeed buffers this relationship, preventing the flow from psychological burnout to general physical depletion.
There are significant practical ramifications. Healthcare organizations need to incorporate proactive, organizationally supported wellness initiatives in place of reactive ones. These should go beyond sporadic workshops to include structural adjustments like making dietary advice accessible, setting up areas for exercise, putting stress-reduction initiatives into place (like mindfulness-based stress reduction), and cultivating an environment where staff members' well-being is truly valued. Hospitals can lessen individual suffering, improve patient safety, raise the standard of care, and cut expenses related to absenteeism and staff turnover by systematically investing in the health of their nursing staff.
Acknowledgements
The authors would like to thank all those who completed the questionnaires and helped to achieve the study’s goal. They would also like to thank the referees who with their comments made this article more effective.
Conflict of interest
There are no conflicts of interest in this article.
Funding
This study was done without any financial grant from any public or private institution.
Ethical considerations
In order to observe ethics in research, before distributing the questionnaires, necessary explanations were given to the individuals about how the study was conducted and how to answer the questions, and it was emphasized that they had the right to withdraw from conducting the research or answering the questions. All individuals were assured that all information would be obtained confidentially and anonymously.
Code of Ethics
IR.IAU.KHUISF.REC.1402.054
Authors' contributions
The idea conception, the literature review, and the data collection were all done by M.K. As the corresponding author, A.B. oversaw the project, created the methodology, and planned the study. M.T. conducted the data analysis, analyzed the results, and made critical revisions to the manuscript. M.F. approved the final manuscript, reviewed and edited it, and offered clinical and medical advice. S.F. contributed to the preparation of tables and figures, and assistance in drafting the manuscript.
Open Access Policy
JSBCH does not charge readers and their institutions for access to its papers. The full-text download of all new and archived papers is free of charge.
References
Akbarian, M., Mohammadi Shirmahleh, F., Borjali, A., Hasanabadi, H., & Abolghasemi, S. (2021). Effect of acceptance and commitment therapy on depression, chronic fatigue, and pain intensity in patients with fibromyalgia syndrome: A study with expectancy effect. Internal Medicine Today, 28(1), 70-85.[persian]
Al-Mugheed, K., Bayraktar, N., Al-Bsheish, M., AlSyouf, A., Jarrar, M., AlBaker, W., & Aldhmadi, B. K. (2022). Patient Safety Attitudes among Doctors and Nurses: Associations with Workload, Adverse Events, Experience. Healthcare (Basel), 10(4). https://doi.org/ 10. 3390/healthcare10040631
Al Sabei, S., Qutishat, M., Labrague, L., Al-Rwajfah, O., Burney, I., & AbulRub, R. (2025). The Relationship Between Staffing, Nurses' Emotional Exhaustion, and Adverse Patient Events in Critical Care Units in Sultanate of Oman. J Nurs Manag, 2025(1), 1977327. https:// doi.org/10.1155/jonm/1977327
Artz AF, A.-T. E. (1997). Mathematical problem solving in small groups: exploring the interplay of student’smetacognitionbehaviors, perception and ability level. JMB, 16(1), 63–74.
Barazandeh, A., Samavatyan, H., Nouri, A., & Abedi, M. R. (2023). The Effectiveness of Quality of Work Life Improvement Training Program on Employee Work-Family Conflict and Self-actualization Based on the Moderating Role of Perceived Job Security and Optimism. Career and Organizational Counseling, 15(3), 169–192.[persian] https://doi.org/10.48308/jcoc.2021.100604
Barazandeh A, S. H., Abedi M. (2017). Identifying indicators affecting the quality of working life of production employees: a qualitative research based on the phenomenological method. Knowledge and research in applied psychology, 19(4), 13–26. [persian]
Borle, P. S., Parande, M. A., Tapare, V. S., Kamble, V. S., & Bulakh, P. C. (2017). Health-promoting lifestyle behaviours of nursing students of a tertiary care institute. International Journal Of Community Medicine And Public Health, 4(5), 1768–1773. https://doi.org/ 10. 18203/2394-6040.ijcmph20171799
Bulto LN, R. J., Noonan S, Pinero de Plaza MA, Champion S, Dafny HA, Hendriks JM. (2024). Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis. Eur J Cardiovasc Nurs, 23(1), 21–32.
Calder, A. J., Young, A. W., Perrett, D. I., Etcoff, N. L., & Rowland, D. (1996). Categorical perception of morphed facial expressions. Visual Cognition, 3(2), 81–118.
Chang, Y. P., Lee, D. C., Chang, S. C., Lee, Y. H., & Wang, H. H. (2019). Influence of work excitement and workplace violence on professional commitment and turnover intention among hospital nurses. J Clin Nurs, 28(11-12), 2171–2180. https://doi.org/10.1111/jocn.14808
Charlier, N., Van Der Stock, L., & Iserbyt, P. (2020). Comparing student nurse knowledge and performance of basic life support algorithm actions: An observational post-retention test design study. Nurse Educ Pract, 43, 102714. https://doi.org/10.1016/j.nepr.2020.102714
Chen, J., Xiao, Y., Yan, C., Li, X., Zhang, Y., Chen, Y., Huang, Y., & Deng, R. (2024). The Relationship Between the Number of Chronic Diseases and Health-Related Quality of Life Among Middle-Aged and Older Adults in Rural Areas of Yunnan Province, China: moderating Effect of Health Lifestyle. J Multidiscip Healthc, 17, 2425–2439. https://doi.org/10.2147/ jmdh. S463640
Chen, K.-Y., Chang, C.-W., & Wang, C.-H. (2019). Frontline employees’ passion and emotional exhaustion: The mediating role of emotional labor strategies. International Journal of Hospitality Management, 76, 163–172. https://doi.org/https://doi.org/10.1016/j.ijhm.2018.05.006
Chung, H.-C., Chen, Y.-C., Chang, S.-C., Hsu, W.-L., & Hsieh, T.-C. (2020). Nurses’ Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction Correlation: A Psychometric Study for Development of Nursing Health and Job Satisfaction Model and Scale. International Journal of Environmental Research and Public Health, 17(10), 3582.
Dugger, J. (2024). Predictive and Associated Factors of Burnout in Nursing Faculty:
An Integrative Review. Nurse Educ, 49(3),
E142–e146. https://doi.org/10.1097/nne. 0000000000001533
Ebrahemzadih, M., Jam barsang, S., Soltani gerdfaramarzi, r., Ashrafzadeh, H., Halvani, G., & Ebrahimzadeh, M. (2020). The relation between shift work and chronic fatigue among educational hospital nurses in Yazd [Research]. Occupational Medicine Quarterly Journal, 12(2), 1–7. [persian]https://doi.org/10.18502/ tkj. v12i2.4368
El-Ashry, A. M., Elsayed, S. M., Ghoneam, M. A., & Atta, M. H. R. (2023). Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses’ experiences. BMC Nursing, 22(1), 482. https://doi.org/10.1186/s12912-023-01640-y
Elham, B., Abbas, A., Mohamad Taghi, Y., Ali, K., Soosan, S., Soheila, K., & Hamid, S. (2019). Job Burnout and Related Factors among Health Sector Employees. Iranian Journal of Psychiatry, 14(4). [persian]https://doi.org/ 10. 18502/ijps.v14i4.1982
Fang, S., & Mushtaque, I. (2024). The Moderating Role of Health Literacy and Health Promoting Behavior in the Relationship Among Health Anxiety, Emotional Regulation, and Cyberchondria. Psychol Res Behav Manag, 17, 51–62. https://doi.org/10.2147/prbm.S446448
firouzkouhi berenj abadi, m., & pourhossein, m. (2022). The Effect of Job Stress on Resilience: The moderating Role of Job Engagement in Nurses [Research]. Faslname-i mudiriyyat-e parastari, 11(3), 26–37. [persian]
Golparvar M, M. A., Nairi S. . (2008). The relationship between stress, job burnout and organizational deviant behaviors in Zob Ahan Joint Stock Company (evidence for the burnout (imbalance)-compensation stress model). Journal of new findings in psychology, 2(8), 19–34. [persian]
Kim, M. S., & Yun, S. Y. (2017). Effects of eating habits and self-efficacy on nursing students' health promotion behaviors: in convergence era. Journal of Convergence for Information Technology, 7(2), 111-117.
Kwon, J. (2023). Misconduct Mismanagement: Independent Oversight, Accountability, and the Rule of Law. University of Toronto (Canada)].
Kwon, M., & Oh, J. (2023). The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19. Medicine (Baltimore), 102(6), e32809. https://doi.org/10. 1097/md.0000000000032809
Lu, J., Xu, P., Ge, J., Zeng, H., Liu, W., & Tang, P. (2023). Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies. Inquiry, 60, 469580231155296. https://doi.org/ 10.1177/00469580231155296
Marczak, P., & Milecka, D. (2024). Professional burnout of nurses and the level of rationing of nursing care: an observational preliminary study. BMC Nurs, 23(1), 269. https://doi.org/10.1186/ s12912-024-01940-x
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https:// doi.org/https://doi.org/10.1002/job.4030020205
Moghimi, A., Saberi Isfeedvajani, M., Javanbakht, M., & Khedmat, L. (2024). Health-promoting lifestyle behaviors and its association with sociodemographic characteristics in hospital clinical staff [Original Research]. Frontiers in Public Health, Volume 12 - 2024. https:// doi.org/10.3389/fpubh.2024.1391094
Mohaisen, A., & Mohammed, Q. (2024). Relationship Between Emotional Exhaustion and Job Satisfaction among Nurses. South Eastern European Journal of Public Health, 743–751. https://doi.org/10.70135/seejph.vi.1556
Mohammadi Zeidi, I., Pakpour Hajiagha, A., & Mohammadi Zeidi, B. (2011). Reliability and Validity of Persian Version of the Health-Promoting Lifestyle Profile [Research(Original)]. Journal of Mazandaran University of Medical Sciences, 20(1), 102–113. [persian]
mohammadyari, z., poortaghi, s., pashaepoor, s., & haghani, s. (2022). The relationship between health promotion behaviors of nurses and quality nursing of care [Community Health Nursing]. Iranian Journal of Nursing Research, 17(3), 16–26. [persian]https://doi.org/https:// doi.org/ 10. 22034/IJNR.17.3.16
Poku, C. A., Donkor, E., & Naab, F. (2020). Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study. BMC Nursing, 19(1), 116. https://doi.org/10.1186/s12912-020-00512-z
Stanulewicz, N., Knox, E., Narayanasamy, M., Shivji, N., Khunti, K., & Blake, H. (2020). Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. International Journal of Environmental Research and Public Health, 17(1), 17.
Wang, K.-Y., Chien, C.-M., Lee, H.-F., & Yobelina, Y. (2023). The mediation of health-promoting lifestyle on self-perceived health status and quality of life among nurses: a cross-sectional study. BMC Nursing, 22(1), 447. https://doi.org/10.1186/s12912-023-01608-y
According to the findings , emotional exhaustion is a significant predictor of chronic fatigue in nurses which were in line with previous research showing that high levels of workplace stress, including heavy workloads, emotional demands, and a lack of support, contribute to burnout and emotional depletion in nursing professionals(El-Ashry et al., 2023; Poku et al., 2020).For example, a study on nurses in Ghana discovered that nearly 40% of the variation in emotional exhaustion was caused by unhealthful work environments(Poku et al., 2020).Similarly, critical care nurses involved in high-stress procedures such as CPR exhibited higher levels of compassion fatigue and secondary traumatic stress, contributing to chronic fatigue and diminished well-being(El-Ashry et al., 2023).
This research emphasizes the connection between chronic fatigue and lifestyle choices that promote health. This result is consistent with the strong advantages found in systematic reviews of workplace interventions which meant to enhance nurses' mental and physical health, especially in areas like nutrition, stress management, and exercise(Moghimi et al., 2024; Stanulewicz et al., 2020). According to a cross-sectional study conducted in Taiwan, nurses' self-perceived health and quality of life are significantly mediated by their lifestyle choices, which accounts for more than 42% of the variation(Wang et al., 2023).This highlights the central role of behaviors in sustaining well-being.
Particularly, the moderating effect of a healthy lifestyle, which attenuates fatigue even when emotional exhaustion is high is noticeable. It is consistent with data showing that programs focusing on nutrition, stress reduction, and physical activity improve nurses' health outcomes.(Moghimi et al., 2024; Stanulewicz et al., 2020). This suggests that learning resilience through lifestyle interventions can act as a protector against the negative effects of occupational stress.
Multimodal intervention designs, which combine behavioral education with practical support for change, appear to be more effective than purely educational approaches, as evidenced by the inconsistent results of lifestyle interventions (e.g., diet, stress, body composition, and job-related metrics)(Stanulewicz et al., 2020).
Research supports linking health-promoting behaviors, well-being, and job environment satisfaction into comprehensive frameworks. One model (the NHJS) demonstrated strong psychometric validity, underscoring how lifestyle and well-being improvements align with greater job satisfaction and retention(Chung et al., 2020).
There are a few limitations to take into account, though. First off, because the study was carried out in a private hospital in Isfahan, its conclusions might not apply directly to nurses working in public hospitals or in other areas with distinct socioeconomic circumstances. By using a larger and more varied sample, future studies could investigate these differences. Furthermore, even though self-reported data offer insightful information, objective health metrics like wearable technology or biometric data could be included in future research to confirm the results. Finally, adding more variables to the model—like workplace climate, staffing levels, and organizational support—might yield a more thorough understanding of the elements affecting nurses' well-being. Future studies could also examine the psychological processes that underlie compassion fatigue, which would serve as the foundation for focused therapies meant to address various phases of emotional exhaustion.
Conclusion
This study presents strong empirical evidence that health-promoting lifestyle serves as a significant protective factor, reducing the negative relationship between emotional exhaustion and chronic fatigue among nurses. The findings confirm that although emotional exhaustion is a direct and powerful predictor of chronic fatigue, its influence is not one-way. Adopting health-promoting behaviors such as stress management, physical exercise, and good nutrition indeed buffers this relationship, preventing the flow from psychological burnout to general physical depletion.
There are significant practical ramifications. Healthcare organizations need to incorporate proactive, organizationally supported wellness initiatives in place of reactive ones. These should go beyond sporadic workshops to include structural adjustments like making dietary advice accessible, setting up areas for exercise, putting stress-reduction initiatives into place (like mindfulness-based stress reduction), and cultivating an environment where staff members' well-being is truly valued. Hospitals can lessen individual suffering, improve patient safety, raise the standard of care, and cut expenses related to absenteeism and staff turnover by systematically investing in the health of their nursing staff.
Acknowledgements
The authors would like to thank all those who completed the questionnaires and helped to achieve the study’s goal. They would also like to thank the referees who with their comments made this article more effective.
Conflict of interest
There are no conflicts of interest in this article.
Funding
This study was done without any financial grant from any public or private institution.
Ethical considerations
In order to observe ethics in research, before distributing the questionnaires, necessary explanations were given to the individuals about how the study was conducted and how to answer the questions, and it was emphasized that they had the right to withdraw from conducting the research or answering the questions. All individuals were assured that all information would be obtained confidentially and anonymously.
Code of Ethics
IR.IAU.KHUISF.REC.1402.054
Authors' contributions
The idea conception, the literature review, and the data collection were all done by M.K. As the corresponding author, A.B. oversaw the project, created the methodology, and planned the study. M.T. conducted the data analysis, analyzed the results, and made critical revisions to the manuscript. M.F. approved the final manuscript, reviewed and edited it, and offered clinical and medical advice. S.F. contributed to the preparation of tables and figures, and assistance in drafting the manuscript.
Open Access Policy
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References
Akbarian, M., Mohammadi Shirmahleh, F., Borjali, A., Hasanabadi, H., & Abolghasemi, S. (2021). Effect of acceptance and commitment therapy on depression, chronic fatigue, and pain intensity in patients with fibromyalgia syndrome: A study with expectancy effect. Internal Medicine Today, 28(1), 70-85.[persian]
Al-Mugheed, K., Bayraktar, N., Al-Bsheish, M., AlSyouf, A., Jarrar, M., AlBaker, W., & Aldhmadi, B. K. (2022). Patient Safety Attitudes among Doctors and Nurses: Associations with Workload, Adverse Events, Experience. Healthcare (Basel), 10(4). https://doi.org/ 10. 3390/healthcare10040631
Al Sabei, S., Qutishat, M., Labrague, L., Al-Rwajfah, O., Burney, I., & AbulRub, R. (2025). The Relationship Between Staffing, Nurses' Emotional Exhaustion, and Adverse Patient Events in Critical Care Units in Sultanate of Oman. J Nurs Manag, 2025(1), 1977327. https:// doi.org/10.1155/jonm/1977327
Artz AF, A.-T. E. (1997). Mathematical problem solving in small groups: exploring the interplay of student’smetacognitionbehaviors, perception and ability level. JMB, 16(1), 63–74.
Barazandeh, A., Samavatyan, H., Nouri, A., & Abedi, M. R. (2023). The Effectiveness of Quality of Work Life Improvement Training Program on Employee Work-Family Conflict and Self-actualization Based on the Moderating Role of Perceived Job Security and Optimism. Career and Organizational Counseling, 15(3), 169–192.[persian] https://doi.org/10.48308/jcoc.2021.100604
Barazandeh A, S. H., Abedi M. (2017). Identifying indicators affecting the quality of working life of production employees: a qualitative research based on the phenomenological method. Knowledge and research in applied psychology, 19(4), 13–26. [persian]
Borle, P. S., Parande, M. A., Tapare, V. S., Kamble, V. S., & Bulakh, P. C. (2017). Health-promoting lifestyle behaviours of nursing students of a tertiary care institute. International Journal Of Community Medicine And Public Health, 4(5), 1768–1773. https://doi.org/ 10. 18203/2394-6040.ijcmph20171799
Bulto LN, R. J., Noonan S, Pinero de Plaza MA, Champion S, Dafny HA, Hendriks JM. (2024). Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis. Eur J Cardiovasc Nurs, 23(1), 21–32.
Calder, A. J., Young, A. W., Perrett, D. I., Etcoff, N. L., & Rowland, D. (1996). Categorical perception of morphed facial expressions. Visual Cognition, 3(2), 81–118.
Chang, Y. P., Lee, D. C., Chang, S. C., Lee, Y. H., & Wang, H. H. (2019). Influence of work excitement and workplace violence on professional commitment and turnover intention among hospital nurses. J Clin Nurs, 28(11-12), 2171–2180. https://doi.org/10.1111/jocn.14808
Charlier, N., Van Der Stock, L., & Iserbyt, P. (2020). Comparing student nurse knowledge and performance of basic life support algorithm actions: An observational post-retention test design study. Nurse Educ Pract, 43, 102714. https://doi.org/10.1016/j.nepr.2020.102714
Chen, J., Xiao, Y., Yan, C., Li, X., Zhang, Y., Chen, Y., Huang, Y., & Deng, R. (2024). The Relationship Between the Number of Chronic Diseases and Health-Related Quality of Life Among Middle-Aged and Older Adults in Rural Areas of Yunnan Province, China: moderating Effect of Health Lifestyle. J Multidiscip Healthc, 17, 2425–2439. https://doi.org/10.2147/ jmdh. S463640
Chen, K.-Y., Chang, C.-W., & Wang, C.-H. (2019). Frontline employees’ passion and emotional exhaustion: The mediating role of emotional labor strategies. International Journal of Hospitality Management, 76, 163–172. https://doi.org/https://doi.org/10.1016/j.ijhm.2018.05.006
Chung, H.-C., Chen, Y.-C., Chang, S.-C., Hsu, W.-L., & Hsieh, T.-C. (2020). Nurses’ Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction Correlation: A Psychometric Study for Development of Nursing Health and Job Satisfaction Model and Scale. International Journal of Environmental Research and Public Health, 17(10), 3582.
Dugger, J. (2024). Predictive and Associated Factors of Burnout in Nursing Faculty:
An Integrative Review. Nurse Educ, 49(3),
E142–e146. https://doi.org/10.1097/nne. 0000000000001533
Ebrahemzadih, M., Jam barsang, S., Soltani gerdfaramarzi, r., Ashrafzadeh, H., Halvani, G., & Ebrahimzadeh, M. (2020). The relation between shift work and chronic fatigue among educational hospital nurses in Yazd [Research]. Occupational Medicine Quarterly Journal, 12(2), 1–7. [persian]https://doi.org/10.18502/ tkj. v12i2.4368
El-Ashry, A. M., Elsayed, S. M., Ghoneam, M. A., & Atta, M. H. R. (2023). Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses’ experiences. BMC Nursing, 22(1), 482. https://doi.org/10.1186/s12912-023-01640-y
Elham, B., Abbas, A., Mohamad Taghi, Y., Ali, K., Soosan, S., Soheila, K., & Hamid, S. (2019). Job Burnout and Related Factors among Health Sector Employees. Iranian Journal of Psychiatry, 14(4). [persian]https://doi.org/ 10. 18502/ijps.v14i4.1982
Fang, S., & Mushtaque, I. (2024). The Moderating Role of Health Literacy and Health Promoting Behavior in the Relationship Among Health Anxiety, Emotional Regulation, and Cyberchondria. Psychol Res Behav Manag, 17, 51–62. https://doi.org/10.2147/prbm.S446448
firouzkouhi berenj abadi, m., & pourhossein, m. (2022). The Effect of Job Stress on Resilience: The moderating Role of Job Engagement in Nurses [Research]. Faslname-i mudiriyyat-e parastari, 11(3), 26–37. [persian]
Golparvar M, M. A., Nairi S. . (2008). The relationship between stress, job burnout and organizational deviant behaviors in Zob Ahan Joint Stock Company (evidence for the burnout (imbalance)-compensation stress model). Journal of new findings in psychology, 2(8), 19–34. [persian]
Kim, M. S., & Yun, S. Y. (2017). Effects of eating habits and self-efficacy on nursing students' health promotion behaviors: in convergence era. Journal of Convergence for Information Technology, 7(2), 111-117.
Kwon, J. (2023). Misconduct Mismanagement: Independent Oversight, Accountability, and the Rule of Law. University of Toronto (Canada)].
Kwon, M., & Oh, J. (2023). The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19. Medicine (Baltimore), 102(6), e32809. https://doi.org/10. 1097/md.0000000000032809
Lu, J., Xu, P., Ge, J., Zeng, H., Liu, W., & Tang, P. (2023). Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies. Inquiry, 60, 469580231155296. https://doi.org/ 10.1177/00469580231155296
Marczak, P., & Milecka, D. (2024). Professional burnout of nurses and the level of rationing of nursing care: an observational preliminary study. BMC Nurs, 23(1), 269. https://doi.org/10.1186/ s12912-024-01940-x
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https:// doi.org/https://doi.org/10.1002/job.4030020205
Moghimi, A., Saberi Isfeedvajani, M., Javanbakht, M., & Khedmat, L. (2024). Health-promoting lifestyle behaviors and its association with sociodemographic characteristics in hospital clinical staff [Original Research]. Frontiers in Public Health, Volume 12 - 2024. https:// doi.org/10.3389/fpubh.2024.1391094
Mohaisen, A., & Mohammed, Q. (2024). Relationship Between Emotional Exhaustion and Job Satisfaction among Nurses. South Eastern European Journal of Public Health, 743–751. https://doi.org/10.70135/seejph.vi.1556
Mohammadi Zeidi, I., Pakpour Hajiagha, A., & Mohammadi Zeidi, B. (2011). Reliability and Validity of Persian Version of the Health-Promoting Lifestyle Profile [Research(Original)]. Journal of Mazandaran University of Medical Sciences, 20(1), 102–113. [persian]
mohammadyari, z., poortaghi, s., pashaepoor, s., & haghani, s. (2022). The relationship between health promotion behaviors of nurses and quality nursing of care [Community Health Nursing]. Iranian Journal of Nursing Research, 17(3), 16–26. [persian]https://doi.org/https:// doi.org/ 10. 22034/IJNR.17.3.16
Poku, C. A., Donkor, E., & Naab, F. (2020). Determinants of emotional exhaustion among nursing workforce in urban Ghana: a cross-sectional study. BMC Nursing, 19(1), 116. https://doi.org/10.1186/s12912-020-00512-z
Stanulewicz, N., Knox, E., Narayanasamy, M., Shivji, N., Khunti, K., & Blake, H. (2020). Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. International Journal of Environmental Research and Public Health, 17(1), 17.
Wang, K.-Y., Chien, C.-M., Lee, H.-F., & Yobelina, Y. (2023). The mediation of health-promoting lifestyle on self-perceived health status and quality of life among nurses: a cross-sectional study. BMC Nursing, 22(1), 447. https://doi.org/10.1186/s12912-023-01608-y
Type of Study: Original Article |
Subject:
Psychology
Received: 2025/01/8 | Accepted: 2025/10/1 | Published: 2025/11/29
Received: 2025/01/8 | Accepted: 2025/10/1 | Published: 2025/11/29
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