The Effect of Assertiveness Training on the Stress Response and Assertive Behavior of Nurses

주장훈련이 간호사의 스트레스 반응과 주장행동에 미치는 효과

This study was designed and carried out to investigate the effect of Assertiveness Training on the stress response and assertive behavior of emergency room nurses from September 22, to December 21. 1997. The subjects were 45 emergency room nurses of three general hospitals of Korea University Medical Center; 25 assigned for the experimental and 20 for the control group. The Assertive Training Program was composed of cognitive training, behavioral training and progressive muscle relaxation. The subjects of the experimental group carried out the 15-minute progressive muscle relaxation according to recorded-tape once a day for 6 weeks. The cognitive and the behavioural training were conducted by the investigator for 5-8 subjects at a time for 9 series, at an interval of 4-5 days. Post-measurement were administered to all sujects in two groups three weeks after the last session. The level of general stress (Cline, 1992), job stress (Kim & Koo, 1984), physiological response to stress (cortisol, epinephrine, norepinephrine), symptoms of stress (Lee, 1984) and assertive behavior (Kim, 1982) were measured before the first and after the last experiments. Data were analysed by x2, t, paired t, Wilcoxon signed rank tests Wilcoxon rank sums tests. The results are as follows : 1. The level of general stress of the experimental group was lower than that of the control group, however, no significant difference between the two groups (P=0.234) was revealed. 2. A significant reduction of job stress was revealed in the experimental group (P=0.017). 1) A significant reduction of interpersonal conflicts in the experimental group was revealed (P=0.018). 3. The physiological stress-response were analyzed as follows : 1) A decrease of Cortisol in both the experimental and the control groups was noticed, however, the difference between the two groups was not statistically significant (P=0.991). Pre-and post-measurement of the level of Corti sol revealed that a notable decrease in the experimental group and an increase in the control group with no significant difference in the day-day subjects (P=0.765), a significant decrease was noted on the level of Cortisol of the experimental group in the night-night nurses (P=0.036). 2) An increase of Epinephrine in both groups was noticed, however, a difference was not statistically significant between the two groups (P=0.082). Pre-and post-measurement of the level of Epinephrine revealed that a notable decrease in the experimental group and an increase in the control group with no significant difference in the day-day subjects (P=0.136). increases were noted on the level of Epinephrinel of both groups in the night-night nurses (P=0.136), 3) The level of Norepinephrine of the experimental group was significantly decreased (P=0.020). Pre-and post-measurement of the level of Norepinephrine revealed that a notable decrease in the experimental group and an increase in the control group with no significant difference in the day-day subjects (P=0.073). a significant decrease was noted on the level of Norepinephrine of the experimental group in the night-night nurses (P=0.036), 4. Symptoms of stress were reduced in both groups, with no significant differences between the groups (P=0.127). 1) The physical stress symptoms were reduced in both groups, with no significant difference (P=0.386), 2) The cognitive-behavioral stress symptoms were significantly reduced in the experimental group (P=0.037). 3) The emotional stress symptoms were reduced in both groups with no significant difference between the groups (P=0.110). 5. The assertive behavior was significantly increased in the experimental group (P=0.000). This study signified the Assertiveness Training as an effective mean of self intervention for the reduction of stress of nurses assigned to emergency rooms.