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J Korean Acad Nurs Vol.41 No.

6, 805-813
J Korean Acad Nurs Vol.41 No.6 December 2011 http://dx.doi.org/10.4040/jkan.2011.41.6.805

Effectiveness of an Interpersonal Relationship Program on


Interpersonal Relationships, Self-esteem, and Depression
in Nursing Students
Yoon, Hee Sang1 · Kim, Gyung-Hee2 · Kim, Jiyoung3
1
Assistant Professor, Seoul Women’s College of Nursing, Seoul
2
Associate Professor, Seoul Women’s College of Nursing, Seoul
3
Assistant Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Korea

Purpose: The purpose of this study was to examine the effectiveness of an interpersonal relationship program on interpersonal
relationships, self-esteem, and depression in nursing students. Methods: This was a quasi-experiment with a nonequivalent
control group pre-posttest design. Sixty-four nursing students participated in the study with 31 in the experimental group and
33 in the control group. They were from 3 different colleges of nursing located in Seoul. The interpersonal relationship program
was held 10 times over 10 weeks, taking 90 minutes per session. The interpersonal relationship change scale developed by
Schlein and Guemey, Rosenberg’s self-esteem scale, and CED-S for depression were the instruments used in the study. The
data collection period was from January 4 to March 8, 2011, and the collected data were analyzed with SPSS 14.0 using the
X2-test, t-test, and paired t-test. Results: The results showed a significant difference between the experimental group and the
control group in terms of the degree of interpersonal relationships, self-esteem, and depression. Conclusion: The results in-
dicate that interpersonal relationship programs have positive effects for improving interpersonal relationships and self-esteem,
and decreasing depression in nursing students.

Key words: Students, Nursing, Interpersonal relations, Self concept, Depression

INTRODUCTION Even though interpersonal skills are very important to the devel-
opment of college students, it is reported that Korean college students
People everywhere need to interact with other people to develop are experiencing many difficulties and are under heavy stress due to
their own identity and to satisfy their own personal needs for affec- a lack of these skills (Park, 2009; Song, 2008).
tion and a sense of belonging. Interpersonal relationships are impor- From the lack of both varied and satisfactory interpersonal experi-
tant in every stage of human development since they are one of the ences, university students undergo a wide range of emotional distress,
preconditions for a person’s survival, adaptation, and happiness. Col- suffering from feelings of depression, anxiety, frustration, isolation,
lege students, in particular, are at a stage in their growth where recog- and emptiness, among others. These psychological disorders can
nition and a sense of belonging attained through harmonious rela- cause further problems in adapting to university life and, at worst,
tionships within their peer group become critical factors (Lee, 2011). may result in complete failure at college life (Kim, 2009). While inter-
The interpersonal skills acquired during the college years are essen- personal skills are important for everyone in life, these skills take on
tial in maintaining a healthy and satisfying social and work life after a particular importance for nursing students, as the nursing profes-
college graduation (Ju, Park, & Jin, 2010). sion requires constant contact and interaction with patients and their
Address reprint requests to: Kim, Gyung-Hee
Seoul Women’s College of Nursing, 287-89 Hongje-dong, Seodaemun-gu, Seoul 120-742, Korea
Tel: +82-2-2287-1735 Fax: +82-2-395-8018 E-mail: wepeace@hanmail.net
Received: May 26, 2011 Revised: June 3, 2011 Accepted: December 19, 2011

© 2011 Korean Society of Nursing Science www.kan.or.kr | ISSN 2005-3673


806  Yoon, Hee Sang·Kim, Gyung-Hee·Kim, Jiyoung

families, colleagues, and other healthcare providers. High quality personal stress increases an individual’s sensitivity to interpersonal
nursing service should be built on good interpersonal relationships relationships and in turn, distorts situations, causing negative per-
(Suikkala, Leino-Kilpi, & Katajisto, 2008). ceptions. Eventually, interpersonal stress contributes to the incidence
In fact, nursing students experience more difficult interpersonal of depression. People with depression have poor interpersonal prob-
situations, and consequently, are under more stress than students lem solving skills, which causes more stress in interpersonal relation-
majoring in other subjects. In addition, relations with patients, their ships. This additional stress then reinforces the feelings of depression,
families, and nursing colleagues during clinical training are the main creating a vicious circle (Aanes, Mittelmark, Hetland, 2010; Berry &
contributors to stress (Magnussen & Amundson, 2003). On the other York, 2011).
hand, satisfactory and positive feedback from interpersonal relation- As discussed earlier, nursing students undergo significantly more
ships not only encourages nursing students to recognize their strengths stress than students in other fields and are vulnerable to depression.
and weaknesses, but also to be more confident. In particular, positive Taking these facts into consideration, an integrated and systematic
relationships with patients help nursing students to better under- program is necessary to enhance interpersonal relationships and self-
stand patients’ situations and points of view. Furthermore, these pos- esteem and to reduce depression among these students.
itive relationships also assist students to acquire other potential tech- Several previous studies have been done on the interpersonal rela-
niques necessary for high-quality nursing. In other words, positive tionships of nursing students, due to the growing importance of this
relationships have great influence on the growth of nursing students’ subject. These studies include Gordon’s parent effectiveness training
professional careers (Suikkala et al., 2008). Consequently, nursing (Yoon & Koh, 2004), as well as studies on therapeutic recreation (Kim
students need to be more skilled and confident in their interpersonal & Kim, 2008), solution-focused communication training (Kim, 2009),
relationships both for a better college life and to help them prepare and rational emotive training (Choi, Lee, Jung, & Lee, 2009). All of
for their future careers. these methods were proven to be effective in improving interper-
Successful interpersonal relationships are closely associated with sonal relationships. However, no research has yet been done on the
the various different social and psychological elements such as men- effect a program has on interpersonal relationships, self-esteem, and
tal cognition, emotion, behavioral characteristics, and types of inter- depression. Additionally, various programs have been implemented
actions (Kim & Park, 2010). Self-esteem and depression are elements to improve the interpersonal relationships of college students, but
most widely considered among these. these are focused on an individual’s specific personality or certain
Self-esteem is composed of both an appraisal of self-worth based features of interpersonal relationships. Thus, these programs have
on personal achievements and anticipation of evaluation by others. not incorporated the intrinsic nature of interpersonal relationships,
People, including college students, with low self-esteem tend to be less which are dynamic and complex (Park, 2009). From this perspective,
adaptable to interpersonal relationships. In contrast, high self-esteem the aim of the current study was to confirm the effect of interper-
gives people a competent and positive self-image, leading to self-confi- sonal relationship program designed by Park on interpersonal rela-
dence and active participation in interpersonal relationships (Murray, tionships, self-esteem, and depression in nursing students. This pro-
Holmes, & Collins, 2006). Self-esteem is therefore clearly associated gram is an integrated interpersonal relationship program developed
with interpersonal relationships (Eom & Choi, 2010). to address the limitations of previous programs. It applies a harmony
Depression is known to be one of the contributing factors limiting of concepts between an individual’s inner features, including percep-
the interpersonal relationships of college students. At the same time, tion, emotion, and behavior, and interrelations with others.
it is the most common psychological disorder, with an occurrence Specifically, the following hypotheses were tested: (a) nursing stu-
rate of over 20% in college students from Pacific Asian (Nelson & dents who participated in the interpersonal relationship program
Gregg, 2010; Steptoe, Tsuda, Tanaka, & Wardle, 2007). Among Ko- will show a significantly greater improvement in their interpersonal
rean nursing students, depression is also the top ranking psychologi- relationship scores than those in the control group; and (b) nursing
cal problem (Kim & Kim, 2006). students who participated in the interpersonal relationship program
A well-known predictor of depression is stress. In particular, inter- will show a significantly greater improvement in their self-esteem

www.kan.or.kr J Korean Acad Nurs Vol.41 No.6 December 2011


Effectiveness of an Interpersonal Relationship Program in Nursing Students 807

scores than those in the control group; and (c) nursing students who tional Review Boards) were obtained according to their regulations,
participated in the interpersonal relationship program will show a which protect research applicants (IRB 2010-7-3). the participants
significantly greater decrease in their depression scores than those in signed an informal consent that contained the following: The pur-
the control group. pose of the study, study procedure, and content of the intervention
program. Students were informed that participation was voluntary
METHODS and that they could quit the study at any time. They were also told
that their responses would remain confidential. After the study, the
1. Design participants in the control group were given 5 sessions with the ex-
perimental program.
This was a quasi-experiment with a nonequivalent control group
pre/posttest design to confirm the effectiveness of the interpersonal 3. Procedures
relationship program (Park, 2009) on improving interpersonal rela-
tionships and self-esteem and decreasing depression in nursing stu- The research was conducted between January 4, 2011 and March 8,
dents. 2011. The main intervention administrator was a psychiatric mental
health practitioner with a doctoral degree in psychiatric nursing, with
2. Sample previous experience in group therapy. The assistant was a psychiatric
mental health nurse with a master’s degree, with over 5 years of expe-
The participants in this study were nursing students from A, B, rience at a mental health clinic.
and C colleges located in Seoul. Students with no ongoing physical The study had three phases: a pre-program survey, the interper-
illnesses or history of mental illness were selected. Those who scored sonal relationship program, and a post-program survey. In the pre-
over 28 on a depression test were excluded and were provided refer- program survey, participants were asked to fill out a self-report ques-
rals for further evaluation. Ultimately, the experimental participants tionnaire describing their general characteristics, interpersonal rela-
were selected from among A college nursing students (35 participants), tionships, self-esteem, and symptoms of depression. The researchers
while the control participants were selected from among nursing collected the questionnaire sheets on-site as the participants finished.
students at B college (24 participants) and C college (11 participants). The same method was used for the control group.
Out of concern for spreading the effectiveness of the experiment, one The program was conducted for 10 weeks, with one 90-minute
group of college students was designated as the experimental group session held each week. Participants met every Tuesday in a lecture
and the other group of college students who were similar to the par- room at a college, and they were divided into 3 groups for morning
ticipants of the experimental group was designated as the control and afternoon sessions. Before each week’s presentation, the research-
group. ers met to confirm and re-examine the program contents and pur-
A power analysis was performed to detect the likelihood that the pose and to prepare for the session. Each session was divided into
study would yield a significant effect. In total, 34 participants for each three stages: introduction, development, and conclusion.
group were needed to detect the average difference between the two The introduction and conclusion took about 10 minutes each week;
groups with an effect size of .70, alpha set at .05 and power of the test most of the time was spent on developing the topic for that week. At
(1-beta) at .80. Based on this, 35 participants for each group, which the first session, participants were provided with refreshments, in-
allowed for possible dropouts, were selected. Four participants in the formed of the purpose of the research, and given the assignment for
experimental group dropped out because of illness or personal rea- next session. At the second session, they had their assignment checked,
sons. Two participants in the control group were excluded because with time provided to share it with the group, and then moved on to
they did not complete the post-program survey. Ultimately, 31 par- that week’s topic as scheduled. At the final session, the researchers
ticipants from the experimental group and 33 from the control group were given time for sharing experiences related to the program with
were included in the final analysis. Approvals from the IRBs (Institu- participants. The experimental group was given the post-program

J Korean Acad Nurs Vol.41 No.6 December 2011 www.kan.or.kr


808  Yoon, Hee Sang·Kim, Gyung-Hee·Kim, Jiyoung

survey right after the last program session ended. The control group (1971) and translated by Moon (1980) was used as a measure of inter-
also received the survey 10 weeks after the pre-program survey, using personal relationships. There were 25 questions with a 1 to 5 scale (1,
the same format about interpersonal relationships, self-esteem, and very dissatisfactory; 5, very satisfactory) with the total score ranging
depression. from 25 to 125. The higher the score is, the higher one’s interpersonal
relationship satisfaction is. The Cronbach’s α was .87.
4. Interpersonal relationship program
2) Self-esteem
Park’s interpersonal relationship program (2009) was used for this Rosenberg’s (1965) Self-Esteem Scale with a 4-point scale was used.
study. Park’s program aims to improve university students’ interper- This scale has 10 questions, with 5 questions each for positive and
sonal relationships by finding balance and harmony in one’s cogni- negative self-esteem. The scale ranges from 1 point for “strongly dis-
tion, emotion, behavior, and interaction with other people. The pro- agree” to 4 points for “strongly agree”, suggesting that the higher the
gram has been examined for its effectiveness, and the details are pro- score is the higher one’s self-esteems. The Cronbach’s α was .74.
vided in Table 1.
3) Depression
5. Instruments The Korean version of the CES-D translated by Chon and Rhee
(1992), which was originally conceived by Radloff (1977), was used.
The tools used in this study are publicly available at Seoul Mental This instrument has 20 questions in total, asking participants to rate
Health Center and Gyeonggi province Mental Health Center. symptoms on a scale ranging from “none” (0) to “sometimes” (1),
“moderate” (2), and “frequently” (3). Total scores ranged from 0 to 60,
1) Interpersonal relationships with higher scores indicating higher degrees of depression. The
The Relationship Change Scale developed by Schlein and Guerney Cronbach’s α was .77.

Table 1. Contents of Interpersonal Relationship Program


Session Purpose Theme Content
1 Orientation for the Inform members of the process Establishing rapport -Introduce group members, researchers, group rules,
groups and for the program purpose, content, and the process of each session
pre-experiment survey Pre-experiment survey Developing the unity of group members
Develop group members’ unity
2 Understanding oneself Understanding oneself Understanding oneself and the importance of interpersonal relationships
Understanding about positive by sharing the experience of positive and negative interpersonal
and negative interpersonal relationships
relationships
3 Expression of emotions from Showing emotions and reducing Expressing emotions from negative interpersonal relationships and
negative interpersonal relationships anxiety learning a muscle relaxation technique to reduce anxiety
4 Exploring interpersonal thinking Rational thinking (Ellis’s theory) Understanding irrational beliefs and turning them into positive thinking
by a rational-emotional approach
5 Understanding interpersonal Expressing oneself by using Acquiring skills for interpersonal relationships using “I-message”
relationship behavior “I-message”
6 Understanding others Understanding others by Promoting interpersonal interactions through empathizing and active
attentive hearing listening
7 Enhancing interpersonal Effective communication Understanding behaviors and thinking of oneself and others by practicing
interaction training: “Warm attitude” expressing one’s thoughts, emotions and opinions to others in a
“Empathize” respectful way
“Active listening”
8 Becoming “Together” Solving interpersonal problems Understanding countermeasures with interpersonal problems, coming up
with better relationships through negotiations
9 Turning to positive thinking Accepting oneself with Verbalizing a thankful mind to people, having positive thinking and
gratitude self-acceptance
10 Positive feedback Check achievement level Share opinions about participating in this program
Post-experiment survey Exchange positive feedback within the group

www.kan.or.kr J Korean Acad Nurs Vol.41 No.6 December 2011


Effectiveness of an Interpersonal Relationship Program in Nursing Students 809

6. Data analysis gram: 31 from the experimental group and 33 from the control group.
The homogeneity test for the two groups’ general characteristics
The collected data were analyzed using the SPSS 14.0 statistics pro- showed no significant differences in all 10 characteristics. This sug-
gram, and the detailed analyses are as follows. The general character- gests the groups were similar to each other (Table 2). Marital status
istics of the experimental group and control group were calculated by and monthly allowance under 500,000 won applied equally to both
frequency and percentage rate. A homogeneity test between the two groups, so these items were excluded from the analysis.
groups was done using the two-tailed test and χ -test with a signifi-
2

cance of .05. To verify the normality of the interpersonal relationship, 2. ‌Homogeneity in interpersonal relationships, self-esteem,
self-esteem, and depression data for each group, a homogeneity test and depression
was done using the two-tailed test and student’s t-test with a signifi-
cance of .05. The data normality verification done by t-test was used The homogeneity test results for interpersonal relationships, self-
to compare the intervention effects of the program on participants’ esteem, and depression before the start of the program are shown in
interpersonal relationships, self-esteem, and depression. Compari- Table 3. No significant difference was seen between the two groups
sons of interpersonal relationships, self-esteem, and depression before for interpersonal relationships: the experimental and control groups
and after the program were made with the paired t-test in each group. had mean scores of 83.32 and 85.49 (t= 0.85, p = .392), respectively.
Self-esteem scores also showed no significant difference: the experi-
RESULTS mental and control groups had mean scores of 27.55 and 28.67 (t=1.19,
p = .240), respectively. There was also no significant difference in de-
1. Homogeneity in general characteristics pression: the experimental and control groups had mean scores of
20.29 and 18.94 (t=1.18, p= .242), respectively. Consequently, the two
Sixty-four participants finished the interpersonal relationship pro- groups were the same in regards to the 3 variables with no significant

Table 2. Homogeneity Test of General Characteristics between Experimental and Control Groups  (N = 64)

Experimental Control
Variables (n = 31) (n = 33) χ2 p
n (%) n (%)
Age (yr) 19-20 25 (80.6) 24 (72.7) 4.05 .132
21-29 6 (19.4) 9 (27.3)
Education High school 29 (93.5) 32 (97.0) 0.42 .607
College/University 2 (6.5) 1 (3.0)
Religion Yes 18 (58.1) 18 (54.5) 0.08 .777
No 13 (41.9) 15 (45.5)
Perceived living status Middle 27 (87.1) 24 (72.7) 1.96 .162
Low 4 (12.9) 9 (27.3)
Health problem Yes 1 (3.2) 2 (6.1) 0.29 1.000
No 30 (96.8) 31 (93.9)
Regular exercise Yes 2 (6.5) 3 (9.1) 0.16 1.000
No 29 (93.5) 30 (90.9)
Distance to school -1 hr 16 (51.6) 18 (54.5) 0.06 1.000
Over 1 hr 15 (48.4) 15 (45.5)
Residence Own-home 27 (87.1) 24 (72.7) 2.39 .303
Non-owned house 4 (12.9) 9 (27.3)
Nursing satisfaction Yes 28 (90.3) 30 (90.9) 0.01 1.000
No 3 (9.7) 3 (9.1)
College satisfaction Yes 16 (51.6) 22 (66.7) 1.50 .309
No 15 (48.4) 11 (33.3)

J Korean Acad Nurs Vol.41 No.6 December 2011 www.kan.or.kr


810  Yoon, Hee Sang·Kim, Gyung-Hee·Kim, Jiyoung

differences prior to the intervention. These findings are consistent with those of Park (2009), who reported
that male and female college students who participated in the inter-
3. Effects of interpersonal relationship program personal relationship program experienced a significant increase in
interpersonal relationships compared to those in the control group.
The experimental group’s interpersonal relationship scores rose The results can be interpreted as the interpersonal relationship pro-
5.39 points over the pre-program scores, whereas the control group gram enabling participants to maintain balance between their cogni-
scores showed a decrease of 0.67 points. There was a significant dif- tion, emotion, and behavior, and to interact with other people with
ference between the two groups (t=3.38, p= .001) (Table 4). these processes functioning systematically (Kim & Park, 2010; Park).
The experimental group’s degree of self-esteem also rose, with post- These factors are thought to have influenced the students’ improve-
program scores 2.26 points higher than pre-program scores in the ment in interpersonal relations.
experimental group, while the control group demonstrated a decrease The current study results are also similar to the findings of other
of 0.15 points in scores. There was a significant difference between studies, such as Eom and Choi’s (2010) group counseling program
the two groups (t=3.18, p= .002) (Table 4). for Chinese college students in Korea, Song’s (2008) self-assertiveness
The experimental group’s degree of depression showed a decrease of training program for university students, Yoo’s (2008) communica-
5.13 points from pre-program scores to post-program scores, whereas tion training program, and Kim’s (2009) solution-focused communi-
control group scores only dropped 1.06 points. There was a signifi- cation training for nursing students, which have demonstrated im-
cant difference between the two groups (t=2.45, p= .017) (Table 4). provement in students’ interpersonal relations after the implementa-
tion of these programs.
DISCUSSION Key factors determining the quality of interpersonal relationships
are not how many times or how frequently one engages in social in-
This research was conducted to investigate the effectiveness of the teractions, but rather the experience of having caring relationships
interpersonal relationship program (Park, 2009) in improving inter- with others (Aanes, Mittelmar, & Hetland, 2010). Namely, the feeling
personal relationships and self-esteem and decreasing depression in of being understood, valued, and supported by other people helps es-
nursing students. tablish and maintain satisfactory relationships (Canevello & Crocker,
The experimental group showed a significant improvement in in- 2010). It is thought that the responsive relationship built among group
terpersonal relationships after the interpersonal relationship program. members while responding to and supporting each other’s thoughts
and feelings was a key contributing factor to overall better interper-
Table 3. Homogeneity Test of Interpersonal Relationships, Self-es- sonal relationships in the present study.
teem, Depression  (N = 64)
It has been suggested that avoiding self-expression and lacking un-
Experimental (n = 31) Control (n = 33)
t p derstanding of oneself are the main reasons for difficulties in build-
Mean (SD) Mean (SD)
ing good interpersonal relationships (Kim, 2009). In other words, the
Interpersonal 83.32 (8.85) 85.49 (11.03) 0.85 .392
relationships willingness to disclose personal information to others and verbally
Self-esteem 27.55 (3.02) 28.67 (4.36) 1.19 .240 communicate with others should be the foundation for developing
Depression 20.29 (4.56) 18.94 (4.58) 1.18 .242

Table 4. Effects of Interpersonal Relationship Program on Interpersonal Relationships, Self-esteem, and Depression  (N = 64)

Experimental (n = 31) Control (n = 33)


Pre Post Difference t (p) Pre Post Difference t (p) t (p)
Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Interpersonal 83.32 (8.85) 88.71 (10.07) 5.39 (6.65) 4.51 ( < .001) 85.49 (11.03) 84.82 (11.09) 0.67 (7.62) 0.50 (.619) 3.38 (.001)
relationships
Self-esteem 27.55 (3.02) 29.81 (3.25) 2.26 (2.56) 4.92 ( < .001) 28.67 (4.36) 28.52 (4.01) 0.15 (3.41) 0.26 (.80) 3.18 (.002)
Depression 20.29 (4.56) 15.16 (6.14) 5.13 (6.45) 4.43 ( < .001) 18.94 (4.58) 17.88 (6.52) 1.06 (6.84) 0.89 (.390) 2.45 (.017)

www.kan.or.kr J Korean Acad Nurs Vol.41 No.6 December 2011


Effectiveness of an Interpersonal Relationship Program in Nursing Students 811

and maintaining interpersonal relationships (Forgas, 2011; Place, The experimental group in the current study showed a significant
Todd, Penke, & Asendorph, 2009). In the current program, partici- decrease in depression scores after attending the interpersonal rela-
pants verbalized and shared their personal experiences and thoughts tionship program. Since no previous research has been done on de-
with one another during each session. This experience is believed to pression when using this program, the effectiveness cannot be ex-
have had a positive influence and helped participants to understand plained through direct comparison. However, decreased depression
other group members well. This program also provided them with was also reported by Kim and Kim (2008) in a study using therapeu-
communication skills training, focusing on concepts such as “I-mes- tic recreation with nursing students. In sessions 3 and 8 of the current
sage”, “delivering warm attitude”, “empathize”, and “active listening”, program, participants put themselves in a supportive and empathiz-
which are thought to have been contributing factors to improving in- ing interaction by exploring and verbalizing emotions and thoughts
terpersonal relationships. The effectiveness of these factors was al- from negative interpersonal experiences. Sharing, empathizing, and
ready investigated by Yoo’s (2008) research on communication train- accepting interpersonal experiences were considered to decrease the
ing programs including I-message, active listening, problem solving, level of depression. This view is supported by Kim, Kim, and Park’s
and assertiveness training, which resulted in better interpersonal re- (2011) study on a depression-reducing program for female university
lationship abilities. students: verbal interaction and teamwork in peer groups helped the
Since no previous research has been done on self-esteem using the students identify positive things about themselves and form construc-
program studied here, the effectiveness cannot be directly compared, tive views, which altogether contributed to reduced depression. Park,
and other interpersonal relationship programs used with college stu- Back, and Han’s (2007) study on rational emotive behavior group
dents will be discussed as a result. As mentioned earlier, the experi- counseling with nurses confirmed that turning irrational beliefs into
mental group’s self-esteem improved after the program compared to rational beliefs improved self-esteem and decreased depression, which
the control group. This was in agreement with the results of Kim and was also the case for the participants in the current study. In other
Kim’s (2009) study: freshmen in a women’s university had a higher words, it is thought that improvement in self-esteem is connected to
level of self-esteem after participation in a self-esteem improvement the relief of depression among nursing students in this study.
program. This also conforms to the study results of Kim and Kim The interpersonal relationship program used in the study discussed
(2008), who reported that a therapeutic recreation program enhanced here was found to be effective for reducing depression and enhancing
the self-esteem of nursing students. Eom and Choi’s (2010) study both self-esteem and interpersonal relationship competency.
suggested that a group counseling program including a method of Nursing students should have competency in interpersonal rela-
understanding oneself and others, as well as self-acceptance and tionships based on positive self-esteem, to enable them to provide
other-acceptance, was also effective in increasing self-esteem. In light high-quality nursing through relationships with various people in a
of the above research results, it is believed that the participants of this healthcare setting. Training and education to foster this competency
current study were trained to empathize, understand themselves and should start at an early stage in university education in a systematic
others, and accept themselves, since these factors play a key role in manner.
enhancing self-esteem. In the current program, participants were The program utilized here was able to help nursing students adapt
trained to explore and correct the emotions and irrational beliefs they to their college life and build up their vocational competence at an
experienced through negative interpersonal interactions in college early stage. This research is found to be worthwhile in this respect.
life or nursing practice. It is believed that the process of changing ir- Another point is that this program can offer the opportunity to learn
rational beliefs to rational beliefs worked positively to improve self- about interpersonal relationships to college students whose exposure
esteem in the current study. This result is in agreement with the re- to such relationships was limited due to excessive competition during
sults of Choi, Lee, Jung, and Lee’s (2009) study, which found that ra- their primary and secondary education. Because this study focused
tional emotive behavioral training, helping to maintain positive and on a small number of nursing students attending three colleges in a
self-advancing thinking instead of negative and self-defeating think- certain city, it has its limits and the study results may not be general-
ing, enhanced self-esteem. ized to all college nursing students.

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812  Yoon, Hee Sang·Kim, Gyung-Hee·Kim, Jiyoung

CONCLUSION nal of Personality and Social Psychology, 100, 449-461. doi: 10.1037/
a0021129
Ju, I. J., Park, D. Y., & Jin, M. S. (2010). The study of core competencies domains
The aim of this research was to investigate the effectiveness of the and levels. Seoul: Korea Research Institute for Vocational Education &
interpersonal relationship program in improving interpersonal rela- Training.
tionships and self-esteem and decreasing depression in nursing stu- Kim, G. H., & Kim, K. H. (2008). The effects therapeutic recreation on in-
terpersonal relationships and quality of life in nursing students. Journal
dents. The present study found that the interpersonal relationship of Korean Academy of Psychiatric and Mental Health Nursing, 17, 431-
program is useful as an intervention to improve interpersonal rela- 439.
tionships and self-esteem and to reduce depression among nursing Kim, G. H., & Kim, K. H. (2009). Effects of a self-esteem promotion pro-
gram on self-esteem and meaning of life among female freshmen.
students. We suggest the following, based on the results. Journal of Korean Academy of Psychiatric and Mental Health Nursing, 18,
First, this program can be introduced to novice nurses in their 431-438.
training program to help them decrease stress related to interpersonal Kim, G. H., Kim, K., & Park, H. (2011). Outcomes of a program to reduce
depression. Western Journal of Nursing Research, 33, 560-576. doi: 10.
relationships and adapt to the hospital system. Wider applications can 1177/0193945910386249
be suggested to more varied nursing situations with more diverse Kim, H. M. (2009). The effects of the solution-focused communication
subjects. training on the problem solving ability and interpersonal relationship
of nursing students. Journal of Korean Academy of Psychiatric and Men-
Second, future research using a quantitative approach mixed with tal Health Nursing, 18, 399-408.
a qualitative analysis can be conducted to understand which parts of Kim, K. H., & Kim, H. J. (2006). The effect of therapeutic recreation program
the program and content are felt by the participants to be most help- on the depression and self-esteem in nursing students. Journal of Ko-
rean Academy of Psychiatric and Mental Health Nursing, 15, 500-507.
ful so the program can be modified and supplemented.
Kim, S. H., & Park, G. H. (2010). The development of the interpersonal re-
Third, this program can be used as a basis for a practice program lationship harmony program for university students. The Korea Journal
in foundation courses at nursing schools, such as Human Relation- of Counseling, 11, 375-393.
Lee, M. S. (2011). The mediating effects of cognitive emotion regulation strate-
ship or Communication courses. Student counseling centers can also
gies on the relationship between self-esteem and interpersonal relationship
adopt this program as a regular program for maladjusted and mildly abilities. Unpublished master’s thesis, Sungshin Women’s University,
depressed nursing students. Seoul.
Magnussen, L., & Amundson, M. J. (2003). Undergraduate nursing student
experience. Nursing and Health Sciences, 5, 261-267. doi: 10.1046/j.1442-
REFERENCES 2018.2003.00158.x
Moon, S. M. (1980). A study on the effect of human relations training of
Aanes, M. M., Mittelmark, M. B., & Hetland, J. (2010). Interpersonal stress university students. Journal of Gyeongsang National University, 19, 195-
and poor health: The medicating role of loneliness. European Psycholo- 203.
gist, 15, 3-11. doi: 10.1027/1016-9040/a000003 Murray, S. L., Holmes, J. G., & Collins, N. L. (2006). Optimizing assurance:
Berry, D. M., & York, K. (2011). Depression and religiosity and/or spiritual- The risk regulation system in relationships. Psychological Bulletin, 132,
ity in college: A longitudinal survey of students in the USA. Nursing 641-666. doi: 10.1037/0033.2909.132.5.641
and Health Sciences, 13, 76-83. doi: 10.1111/j.1442-2018.2011.00584.x Nelson, J. M., & Gregg, N. (2010). Depression and anxiety among transition-
Canevello, A., & Crocker, J. (2010). Creating good relationships: Respon- ing adolescents and college students with ADHD, dyslexia, or comorbid
siveness, relationship quality, and interpersonal goals. Journal of Per- ADHD/dyslexia. Retrieved November 23, 2011, from http://jad.sage-
sonality and Social Psychology, 99, 78-106. doi: 10.1037/a0018186 pub.com/content/early/2010/10/08/1087054710385783
Choi, Y. J., Lee, G. W., Jung, C. H., & Lee, A. R. (2009). The effect of self-clo- Park, G. H. (2009). The development of interpersonal relationship harmony
sure and rational emotive training on communication ability, stress program for university students. Unpublished doctoral dissertation,
coping behavior, and self-efficacy of nursing students. Journal of Ko- Kyungbook National University, Daegu.
rean Academy of Psychiatric and Mental Health Nursing, 18, 186-196. Park, K. A., Back, H. S., & Han, J. S. (2007). The effects of REBT group coun-
Chon, K. K., & Rhee, M. K. (1992). Preliminary development of Korean seling on the job stress, positive affect, negative affect and self-esteem of
version of CES-D. Korean Journal of Clinical Psychology, 11(1), 65-76. nurses. The Korea Journal of Counseling, 8, 951-963.
Eom, H., & Choi, I. (2010). The effect of a group counseling program on Place, S. S., Todd, P. M., Penke, L., & Asendorpf, J. B. (2009). The ability to
self-esteem and interpersonal relationships of Chinese students in Ko- judge the romantic interest of others. Psychological Science, 20, 22-26.
rea. The Korea Journal of Counseling, 11, 903-927. doi: 10.1111/j.1467-9280.2008.02248.x
Forgas, J. P. (2011). Affective influences on self-disclosure: Mood effects on Radloff, L. S. (1977). The CES-D scale: A self-report depression scale or re-
the intimacy and reciprocity of disclosure personal information. Jour- search in the general population. Applied Psychology Measurement, 1,

www.kan.or.kr J Korean Acad Nurs Vol.41 No.6 December 2011


Effectiveness of an Interpersonal Relationship Program in Nursing Students 813

385-401. doi: 10.1177/014662167700100306 ioral Medicine, 14, 97-107. doi: 10.1080/10705500701471480


Rosenberg, M. (1965). Society and the adolescent self-image. Princeton. NJ: Suikkala, A., Leino-Kilpi, H., & Katajisto, J. (2008). Nursing student-patient
Princeton University Press. relationships: A descriptive study of students’ and patients’ view. Interna-
Schlein, A., & Guerney, B. G. (1971). Relationship enhancement. Sanfrancisco, tional Journal of Nursing Education Scholarship, 5(1), 1-12. doi: 10.2202/
CA: Josey-Bass. 1548-923X.1457
Song, S. W. (2008). The effects of self-assertiveness training program on col- Yoo, C. (2008). The effects of a communication training program on interper-
lege student’s depression, interpersonal relationships and self-assertive- sonal relations and self-esteem of vocational college students. Unpublished
ness. The Korea Journal of Youth Counseling, 16(1), 103- 117. master’s thesis, Chonnam National University, Gwangju.
Steptoe, A., Tsuda, A., Tanaka, Y., & Wardle, J. (2007). Depressive symptoms, Yoon, Y. H., & Koh, M. S. (2004). A study on the effects of ET training for
socio-economic background, sense of control, and cultural factors in the development of interpersonal relationship and self-identity. Journal
university students from 23 countries. International Journal of Behav- of Korean Academy of Nursing Administration, 10, 291-298.

J Korean Acad Nurs Vol.41 No.6 December 2011 www.kan.or.kr

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