|Budget Amount *help
¥2,860,000 (Direct Cost: ¥2,200,000、Indirect Cost: ¥660,000)
Fiscal Year 2009: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
Fiscal Year 2008: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2007: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
1) We conducted a pilot study to clarify the effect of assertiveness training on reduction of burnout of novice nurses to develop an assertiveness training program for them. The result showed no clear effect and indicated the necessity of involving nurse managers and promoting assertiveness of the whole ward staff. Therefore, we conducted an assertiveness training program for nurse managers first. After confirming that the program successfully promoted assertiveness of nurse managers, we applied the same program to novice nurses and studied its effect on reduction of their burnout.
2) The assertiveness and non-assertive situations among nurse administrators in facilities for persons with severe physical disabilities : The purpose of this study was to clarify the actual state of assertiveness and the reality of non-assertive situations among nurse administrators in facilities for persons with severe physical disabilities. A questionnaire was distributed to 102 participants in a workshop
for nurse administrators working in such facilities all over Japan. We investigated their gender, age, position, experience, assertiveness (Japanese version of Rathus assertiveness schedule), and the situations where they could not be assertive. The respondents were 72 nurse administrators with an average age of 51.4 and the average assertiveness score of -8.5. A content analysis based on Krippendorff's method was carried out on their descriptions of non-assertive situations between nurse administrators and their staff. The situations where they felt "I wanted to say/decline, but I could not do so" yielded six categories : 1) "I can't educate nurse managers," 2) "I can't adjust working schedule/staffing," 3) "I can't control the dress and appearance of the staff," 4) "I can't improve the relation among the staff," 5) "I can't coordinate the work appropriately," and 6) "I can't teach the staff how to receive the patient." The situations where they felt "I should not have said/forced it" also yielded six categories : 1) "I can't give enough consideration to human relations between the staff," 2) "I can't respect the staff in personal consultation," 3) "I can't respect the staff in adjusting working schedule/staffing," 4) "I can't respect the staff in continuing education," 5) "I can't act appropriately as an administrator," and 6)"I can't respect the staff in work coordination." The nurse administrators tended to claim "I could not say it" in the situation where cautioning someone seemed to be natural and even necessary for their duty. Furthermore, their strong sense of responsibility and reflection of their performance were characteristic to the situation where "I should not have said so."
3) Relationship between assertiveness and burnout among nurse managers : We aimed to clarify the relationship between assertiveness and burnout of nurse managers at university hospitals. The directors at three university hospitals accepted our request for cooperation. During a one-month period from May to June 2007, a self-administered questionnaire was distributed to 203 nurse managers (head and sub-head nurses) who agreed to participate in present study. The Japanese version of Rathus Assertiveness Schedule (J-RAS) and the Japanese version of Maslach Burnout Inventory (MBI) were employed as scales. Burnout was operationally defined as having a total MBI score in the highest tertile. Valid responses were obtained from 172 nurse managers. The mean J-RAS of the burnout group (-14.3) was significantly lower than that of the non-burnout group (-3.3). Responses about work experience and age showed no significant group difference. Total MBI was inversely correlated with J-RAS (R=-0.30, p<0.01). Multiple logistic regression analyses indicated the decrease of the risk of burnout by 26% (0.74 times) for every 10 point increase in J-RAS, and by 60% (0.40 times) for greater satisfaction with own care provision. The results indicate the possibility that increasing assertiveness and satisfaction with own care provision contributes to prevention of burnout among nurse managers.
4) Comparison of burnout scores before and after assertiveness training among nurse managers : The purpose of this study was to examine the possibility of reducing the burnout of nurse managers by assertiveness training. The nurse managers in university hospitals were asked to fill a questionnaire just before and three months after the assertiveness training. The questionnaire included questions about demographic attributes, workplace satisfaction, transfer preference, stress coping, thought on their work, assertiveness (J-RAS), and burnout (MBI). A total of 77 respondents (15 head nurses, 62 sub-head nurses) provided valid data for analysis. The pre-intervention average age, J-RAS, and MBI were 40.9, -5.0, and 10.8, respectively. For total data, t-tests detected a tendency of increase for J-RAS and a significant decrease for MBI. The stratified examinations showed that J-RAS increased significantly, or tended to increase, and MBI reduced significantly among those who had low pre-intervention J-RAS and those who intended to keep assertiveness after the training. The same tendencies, partly with statistical significance, were observed among those who were unsatisfied with their workplace or own care and those who could not consult with fellow workers, the boss, or any other persons in their work place. The results showed that the assertiveness training could reduce burnout of nurse managers. The reduction was apparent among persons who intended to keep assertiveness after the training, and those with low pre-intervention J-RAS. The reduction of burnout was also observed among those who lacked social support.
5) Reducing burnout in novice nurses by assertiveness training : The purpose of this study was to clarify the change of the burnout of novice nurses assertiveness training. We assigned 50 participants to the training group and 28 participants to the control group. Participants of both groups were asked to fill a questionnaire just before and three months after the training (June and October, 2008). The questionnaire included questions about demographic attributes, workplace satisfaction, transfer preference, stress coping, assertiveness (J-RAS), and burnout (J-MBI). A total of 66 respondents (training group 43, control group 23) provided valid data for analysis. The pre-intervention average age, J-RAS, and MBI were 23.3, -4.0, and 11.6, respectively for the training group and 22.3, -0.8, 11.5, respectively for the control group. The result showed no significant effect of assertiveness training. A multiple regression analysis showed that work load affected burnout. In our previous study, assertiveness significantly affected burnout of novice nurses. In the present study, however, the assertiveness training neither promoted assertiveness nor reduced burnout of novice nurses while it promoted assertiveness of nurse managers. The major cause of this discrepancy seems to be existence of overlooked confounding factors specific to the first year of employment other than work load, although inappropriateness of the length, period, or contents of the training program could be also responsible for it. Less