***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study aim ed at exploring nurses ' views of the characteristics of severely demented patients , the difficulties these characteristics produced and the emotional reactions they evoked during the provision of care . Also , it aim ed at exploring any changes in these aspects during a year of regular systematic clinical supervision combined with the implementation of individualized care at an  experimental ward ( EW ) ( n = 19 ) and at a control ward ( CW ) ( n = 19 ) . Data were collected by means of the Strain in Nursing Care scale , assessing the presence of certain characteristics in the patients , and how difficult each characteristic can be to h and le . The Emotional Reactions in Nursing Care scale was also used , assessing 18 pairs of emotions . The analysis showed that agitation , not being responsive and unruly behaviour were the most common features while emptiness and agony turned out to be the most difficult problems to h and le in the provision of care . Feelings of defeat and dissociation were reported to be almost as common as feelings of control and association . The EW nurses saw the patients as significantly more responsive , and victims of nihilation to a lesser degree and also patients ' willfulness and emptiness was significantly easier to h and le during the year of intervention . There were no significant changes on the CW . The mean values improved significantly in several aspects on the EW in comparison to the CW ; patients seen as victims of nihilation , easier to h and le agony , obediency , willfulness , evaluation and improved feelings of devotion and beneficence in the nurses . Thus the intervention seemed to improve the nurse-patient relationship and to decrease the experience of strain in the nurses The purpose of the study was to examine the effectiveness of assertiveness training in improving self-perceived levels of stress and assertiveness among nurses in Taiwan , Republic of China . The two-group experimental design was conducted in a 2,000-bed veteran general hospital . A sample of 60 volunteer Chinese-speaking nurses participated in the study . Subjects were r and omly assigned to one of two treatments : assertiveness training ( AT ) or alternate treatment control ( ATC ) , which served as a control and contained up date d knowledge of new computer technology for in patient setting s. Subjects in each group participated in six 2-hour workshops in the same two-week period . All subjects were pre- , post- , and follow-up posttested for stress and assertiveness with the Perceived Stress Scale ( PSS ) and Rathus Assertiveness Schedule ( RAS ) , respectively . Results revealed the following : ( 1 ) subjects in both groups of pretest were clearly subassertive and under considerable stress ; ( 2 ) by the end of training , the AT group scored significantly higher on the rating of assertiveness than those in the ATC group , and had successfully maintained their improvement by the 4-week follow-up ; and ( 3 ) by the end of training , the AT group reported significantly lower levels of stress than the ATC group as indicated on the PSS , and successfully maintained their improvements at the 4-week follow-up . Overall , the results indicate clear support for the effectiveness of assertiveness training for treating subassertive behaviors and stress in a population of professional nurses in Taiwan The usefulness of psychological training programs ( P.T.P. ) in health care setting s devoted to cancer care is beginning to be recognised but their content , form and effectiveness need further investigation . Seventy-two oncology nurses were r and omly assigned to a 24-h P.T.P. or to a waiting list period .  Attitudes were assessed by a  semantic differential question naire ,  occupational stress was assessed by the  Nursing Stress Scale  and communication skills were assessed by st and ardised videotaped role-playing exercises . These were used to compare trained ( T.S. ) and control subjects ( C.S. ) . The results show a significant training effect on attitudes ( P = 0.05 ) , especially on those related to self concept ( P = 0.004 ) , and on the level of occupational stress related to inadequate preparation ( P = 0.02 ) . Limited changes were found regarding post-training communication skills . T.S. were significantly more in control of the interview than C.S. ( P = 0.02 ) . The results indicate that 24-h P.T.P. assessed here are effective . The data also demonstrate the need to consoli date the skills acquired by regular post-training sessions The aim of this study was to study creativity and innovative climate , tedium and burnout among the nurses on two wards during 1 year of  systematic clinic supervision combined with the implementation of individualized care on an experimental ward ( EW ) for severely demented patients , as compared with a similar control ward ( CW ) . EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned , documented and evaluated . The intervention was evaluated by means of the  Creative Climate Question naire , Burnout Measure and the Maslach Burnout Inventory . Creativity and innovative climate improved significantly among the EW nurses ( n = 19 ) in eight out of 10 factors during the year of intervention while there was no change on the control ward ( n = 20 ) . Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses . It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care . It also increases nurses ' creativity , which , in turn , may benefit patient care . The findings of this study point to the necessity for a support system that focuses on the work itself , i.e. the nursing care . Individualized planned care and systematic clinical supervision may offer this kind of support This study was set up to test the effectiveness of primary nursing on the burnout level of psychiatric nurses .  It was expected that , under certain conditions , such as a primary nursing care delivery with an adequate feedback system , the burnout level would decrease . In a quasi-experimental research design , a cohort of 161 psychiatric nurses was followed for 2.5 years . Results showed that although the burnout level did not change as a result of primary nursing , psychiatric nurses and the practical nurses seemed able to work according to the principles of primary nursing . Strong indications were found that the job turnover decreased as a result of the introduction of primary nursing . Because two main problems were encountered in this study , a high drop-out due to job turnover among nurses and the imitation of the intervention by the control group , several additional analyses were performed The purpose of this study was to test the effectiveness of relaxation training , which was based on the cognitive-behavioral model and specifically focused on helping Chinese registered nurses employed in large teaching hospitals to reduce their work stress in Taiwan , Republic of China . The study design was a pretest-posttest control design with two posttest points . The 137 subjects were selected r and omly from three first-ranked teaching hospitals . Twenty-three subjects in the experimental group and 23 in the control group from each hospital participated in the study . The treatment of the experimental group consisted of two sessions of relaxation training based on Smith 's ( 1988 ) cognitive behavioral model of relaxation at weeks 1 and 2 , with a follow-up session in the fifth week . The control group had the same sequence of sessions with a presentation by the research er on theory analysis in nursing . The mean scores on the Nurse Stress Checklist ( NSC ) and the Chinese General Health Question naire ( CGHQ ) differed significantly between the experimental and control group in posttest 2 at week 5 . These results supported the hypotheses that the relaxation training decreased the  Chinese nurses ' self-reported work stress as measured by NSC and increased the  Chinese nurses ' self-reported psychophysiologic health as measured by CGHQ . The significant difference on means of the CGHQ in posttest 1 at week 2 showed that the self-reported psychophysiologic health level responded to the relaxation training earlier than to the self-reported work stress level . In the relaxation treatment , duration of practice was an important factor of the effectiveness of the treatment on the dependent variable of NSC . It is suggested that even brief teaching of relaxation techniques may reduce work stress levels and promote a sense of psychophysiologic health in Chinese nurses who are employed in large teaching hospitals in Taiwan 
    Output:
    
There is more evidence for the effectiveness of programmes based on providing personal support than environmental management to reduce stressors .