Effect of forgiveness-based bibliotherapy on forgiveness, self-esteem and psychological symptoms in nursing students: A randomized controlled study

Abstract

Background

Although forgiveness is a crucial virtue for both nurses' self-care and holistic patient care, forgiveness education is underrepresented in most nursing curricula.

Aim

The primary outcome of the study was to assess the effect of bibliotherapy on forgiveness, while secondary outcomes included its effects on self-esteem, depression, anxiety, and stress in nursing students.

Methods

This parallel-group, single-blinded, randomized controlled trial was conducted with nursing students between January 2024 and June 2024. A total of 413 students were screened for eligibility, with the final sample comprising 85 participants. Bibliotherapy was administered over six weeks, with one 120-minute session per week. Data were collected using the Personal Information Form, the Heartland Forgiveness Scale, the Coopersmith Self-Esteem Inventory, and the Depression, Anxiety, and Stress Scale.

Results

Students in the bibliotherapy group had significantly higher forgiveness (η² = 0.828) and self-esteem (η² = 0.632) scores, and significantly lower depression (η² = 0.480), anxiety (η² = 0.501), and stress (η² = 0.741) scores in both the post-test and follow-up test, compared to the control group (p < 0.05). These effect sizes indicate large effects, suggesting that bibliotherapy had a substantial impact on all measured outcomes.

Conclusion

This study provides evidence that bibliotherapy can be an effective intervention to improve forgiveness and self-esteem, and to reduce psychological symptoms.