Effect of Web-based Career Identity and Assertion Training for Stress Management among Japanese Nurses-A Randomized Controlled Trial-

本研究的目的是通过在网站上研究压力应对和主张的方法来减轻日本医院护士的压力，并改善护士的心理健康状况。参照正式员工压力管理计划，制定了护士网络学习计划。问卷由护士职业认同(CI)和断言技能(AS)两部分组成。采用护士随机对照试验(RCT)评价CI项目的学习效果。将受试者随机分为干预组和对照组，分别在研究前、研究后和研究后一个月进行问卷调查。干预组在3周内接受了70分钟的基于网络的学习课程，之后又给了对照组。结果，研究后干预组的几项CI有所改善，而对照组的几项CI恶化。虽然干预组的压力源之间的人际关系困难有所改善，但对照组的人际关系困难程度更严重。采用护士随机对照试验评价AS项目的学习效果。结果，干预组的AS知识在研究结束后立即上升，但在一个月后下降。尽管在一个月后，干预组的“坦率”有所提高，但控制组并没有意识到关于思想和行动的变化。在压力和心理健康状况方面，干预组在研究结束后立即减少了“刺激性”，一个月后减少了“定量负荷”。经ANCOVA检验，干预组的“AS知识”得分显著高于对照组，而干预组的“抑郁”有改善的趋势，说明日本医院护士网络学习后的CI、AS、工作压力和心理健康状况均有改善。

The purpose of this study is to reduce the stress among Japanese hospital nurses by studying stress coping and assertion methods on a web-site, and to improve nurses' mental health status.1. The web-based learning program for nurses was made referring to the stress management program for regular workers. The program was composed of nurse's career identity (CI) and assertion (AS) skill.2. The learning effect of the CI program was evaluated with randomized control trial (RCT) for nurses. Participants were randomly assigned to the intervention and the control groups, and given a questionnaire before and after study, and one month post-study. A seventy-minute web-based learning session was given to the intervention group over 3 weeks and thereafter to the control group. As a result, several CI improved in the intervention group after study, while several CI worsened in the control group. Though "Interpersonal relationship difficulty" among stressors improved in the intervention group, it worsened in the control group.3. The learning effect of the AS program was evaluated with RCT for nurses. As a result, "Knowledge of AS" rose just after study, but decreased one month later in the intervention group. No change was recognized in the control group regarding AS mind and action, though "Frankness" rose in the intervention group one month later. Concerning stress and mental health status, "Irritation" decreased just after the study, and "Quantitative load" decreased one month later in the intervention group. Using ANCOVA, "Knowledge of AS" in the intervention group was found to be significantly higher than that in the control group, and "Depression" in the intervention group tended to improve.These results indicate that CI, AS, job stress, and mental health status improved after web-based learning program among Japanese hospital nurses.