|Year : 2018 | Volume
| Issue : 2 | Page : 19-23
The effect of assertiveness training program on nurses
The Department of Psychiatric & Mental Health Nursing, Faculty of Nursing, DE. Society’s S.K. Jindal College of Nursing, Pune, India
|Date of Web Publication||9-Jul-2019|
Source of Support: None, Conflict of Interest: None
Background: Assertiveness is one of the essential skills in the modern working environment, there are many benefits of being assertive such as; better time management, increased self-esteem and the ability to negotiate more effectively. Nurses are confronted with the daily responsibility of assessing, intervening and evaluating client responses to stress and client interactions. Some nurses may have learned to express their needs honestly, to use anger constructively, to improve personal and work relationships and to build self-confidence through assertive behaviour. So the aim of this study was to assess the effect of assertiveness training program on nurses’ self-esteem. Methods: The study was conducted at selected Hospitals of the Pune city on 60 nurses (30 in control groups and 30 in experimental groups), tools were used for data collection, namely: Socio-demographic data structured interview schedules, self-esteem inventory, assertive communication skills checklist (ACs-list). Results: Highly statistically significant difference was noticed between before and after training program regarding practice about communication skills and assertiveness. Also s a significant change was found in self-esteem of nurses after the training program. Conclusion: Implementation of assertiveness training program had positive effect on their self-esteem.There is need to implementassertiveness training program for nurse.
Keywords: Assertiveness skills, Self-esteem, Training program.
|How to cite this article:|
Kanade A. The effect of assertiveness training program on nurses. Indian J Psy Nsg 2018;15:19-23
| Introduction|| |
Self-esteem reflects a person’s overall evaluation or appraisal of his or her own worth. Individuals with high self-esteem feel they are worthwhile despite their errors and flows Self-esteem is widely recognized as a central aspect of psychological functioning during adolescence. It plays a significant role in the development of a variety of mental disorders.Self-esteem has been found to be the most dominant and powerful predictor of happiness and life satisfaction. Self-esteem is an important factor in mental health that affects human functions, especially job performance. The number of nurses with low self-esteem is increasing and this is mostly due to role conflict. In addition, self-esteem has long been identified as an important predictor of adjustment to stress, high levels of self-esteem are considered important in terms of both managing the demands placed on nurses during their training and for developing a strong and therapeutic relationship with a patient. Further more, self-esteem influences how nurses think, feel, and motivate themselves and act which undoubtedly impacts on the care patients receive. It was reported that nurses with low self-esteem have an effect on the level and the quality of patient care in a negative direction. Nurses’ with high level of self-esteem are confident, take pride in their work, and demonstrate respect and concern for patients and colleagues. Assertiveness is a substantial communication style that enhances successful relationships with patients, families, and colleagues. Assertiveness is an expression of self-esteem. Studies have shown that individuals who have assertive behaviours generally have higher self-worth and are more successful in life. Assertive persons maintain self-respect and respect for others by assertive behaviour which directly expresses one’s true, basic feelings, needs, desires, opinions and personal rights in a positive, productive way without denying the rights of others. It enables one to act in her or his interests without undue anxiety. Assertive individuals claim their own rights, make requests of others, can say no to things they do not want, accept praise and can easily verbalizes their feelings. All of these make individuals’ lives easier and experience positive responses from others. This in turn can decrease anxiety and increase confidence in interpersonal relations. Assertiveness is thought to be a healthy form of behaviour. Becoming more assertive can lead to increased respect and recognition as a person and as a nurse. It can get individual more of what his/her want . Assertiveness is considered to be an essential skill for nurses. It is a key attribute for nurses without it true autonomy and personal empowerment cannot be achieved.Assertive behaviour demands control over outbursts of anger, crying or other behaviour patterns that exhibit lack of professionalism. Assertiveness skills can be seen as “valuable component” for successful professional nursing practice, with which many conflicts in a nursing situation can be successfully ruled out . Nurses are confronted with the daily responsibilities of assessing, intervening and evaluating client responses to stress and client reactions (Sullivan, 2013), assertive communication is an essential component of palliative care; communication difficulties are recognized stress factor among health professionals especially nurses (Katz, 2007)· A communication skill is the ability to use language (receptive) and express (expressive) information, which is the set of skills that enables person to convey information so that it is received and understood. Nurses interact with patients, colleagues and other health care professionals on a daily basis; such an interaction is improved when nurses have good communication skills. The potential benefits of assertive behaviour to nurses are enormous where it enhanced self-awareness, improved staff performance, improved patient care and interdisciplinary collaboration and cohesiveness .
Need for the study: The current trend in health care settings is inclined towards team working with a multi disciplinary approach. The nurse within a multi disciplinary team can play a pivotal role in providing quality care to the patients under his/her care. There are several misconceptions about assertiveness but nurses need to be assertive in order to be an effective patients’ advocate and empower them. Non assertiveness can lead to stress, low self-esteem, helplessness and poor job satisfaction leading to poor job retention and high staff turnover. It is therefore very crucial that nurses are taught and encouraged to be assertive in their practice, nurses who have poor self-esteem and poor interpersonal skills without a doubt exhibit negative professional attitudes and behaviours. In order for nurses to become more influential in the improvement of health care delivery system, more competent in the provision of quality patient care, more comfortable in their communication within society and more effective in using their professional knowledge and skills, it is necessary for them to be more assertive and have high self-esteem. Accordingly, it is significantly important to enhance assertiveness and self-esteem of nurses through implementing an assertiveness skills training.
Objectives of the study were
- To assess the self-esteem of nurses before and after assertiveness training program in experimental and control groups.
- To evaluate the effectiveness of assertiveness training program on Self-esteem of nurses before and after assertiveness training program in control and experimental groups.
- To find out association between the Self-esteem scores with selected demographic variables.
H0:-There is no significant effect of assertiveness training programme on self-esteem of nurses.
H1:-There is significant effect of assertiveness training programme on self-esteem of nurses.
Research design: Quasi-experimental research design (non-equivalent control group design) was used to achieve the aim of the study.
Research setting: The study was conducted on a selected hospital of Pune city.
Subjects: The subjects were selected by convenience sampling method which consisted of 60 nurses (30 in control groups and 30 in experimental groups)
The period of implementation was two months. Implementation of the study passed into three phases (measure 1 assessment phase, implementation phase and measure 2 assessment phase).
Subjects were interviewed individually at their places where pre assessment was done using modified Rosenberg’s Global Self-esteem Scale.
The training program aimed at enhancing the assertive skills of nurses. This training program has a set of specific objectives for each of the 8 sessions. This was achieved through several teaching methods such: lectures interweaved with group discussion, brainstorming, and examples from real life, modelling, role playing / behavioural rehearsal, getting participants’ feedback, providing feedback, providing corrective feedback, and assigning homework.
The content of the training program sessions was as follows:
- Introduction about the concept of assertiveness; the importance of the assertiveness for nurses and nursing students; and the comparison of passive, aggressive, passive-aggressive and assertive behaviour.
- The individual’s basic rights of assertive behaviour.
- How to say “No” assertively.
- How to make a request assertively.
- How to respond and give criticism assertively; and give constructive criticism.
- Handle and express anger assertively.
- How to give and accept compliments assertively; and how to make apology assertively.
- How to promote self-esteem.
Evaluation was done using modified Rosenberg’s Global Self-esteem Scale.
The questionnaire used in the study was administered by the researchers. The nurses were briefed about the study, encouraged to participate and motivated to express their experiences. The nurses give fully informed consent to participate. It was emphasized that all data collected was strictly confidential and the data would be used for scientific purposes only. Data collection for this study was carried out in the period from September 2015 to November 2015. An official approval was obtained from the administration of selected hospitals of the study.
Statistical analysis: The data were compiled and verified using the SPSS (statistical package for social science) version 16.0 to perform tabulation and statistical analysis.
| Results|| |
Description of subjects
As given in [Table 1] that in the present study, 60% of the study group was 30 years of age. As regards to sex, more than half of the study group were women, 80% were single, while 20% of them were married. More than two third (73.3%) of the study group lived in rural area, while 26.7% of them lived in urban area. About two third (70%) of the study group worked at general ward and 30% of them were at private ward. Most (83.3%) of the study group had no training courses about communication skills, only 16.7% of them attended training courses about communication skills.
|Table 1: Socio-demographic characteristics of the Experimental group (n-30)|
Click here to view
As shown in [Table 1] that there is significant difference between pre-test self-esteem levels. From post-test scores in study group of experimental group it be concluded that assertiveness training programme was effective on self-esteem of nurses in experimental group.
As shown in [Table 2] and [Figure 1] that is significant difference between post-test self-esteem levels. thus it is can be concluded that assertiveness training programme was effective on self-esteem of nurses in experimental group than control group.
|Table 2: Difference of level of self-esteem in nurses in experimental group before and after administration of assertiveness training programme (n=30)|
Click here to view
|Figure 1: Significance difference between post-test self-esteem level in experimental and control group.|
Click here to view
|Table 3: Difference between post-test scores of selfesteem of study group in experimental and control group. (n1=30 +n2=30)=60|
Click here to view
Association of level of self-esteem with demographic variables
Comparison was done by ANOVA test there is no significant association of self-esteem with the demographic variables.
| Discussion|| |
Assertiveness training programs help the individual to self-actualize without abusing the rights of others. Therefore, it is more appropriate to assist nurses to learn assertion skills through assertive training program. Previous researches on assertiveness training have supported that attainment of assertiveness skills has been linked to increased assertiveness, and self-esteem. The nurses who have poor self-esteem and poor interpersonal skills without a doubt exhibit negative professional attitudes and behaviours. In order for nurses to become more influential in the improvement of health care delivery system, more competent in the provision of quality patient care, more comfortable in their communication within society and more effective in using their professional knowledge and skills, it is necessary for them to be more assertive and have high self-esteem. Accordingly, it is significantly important to enhance assertiveness and self-esteem of nurses through implementing an assertiveness skills training program17.
The present study aimed to assess the effect of assertiveness training program on nurses’ self-esteem. There were more than half female. The type of subjects differed in previous studies that the male nurses had high degree of assertiveness compared to female nurses.18 Also concluded that in general girls were found to be skilled in expressing and dealing with personal limitation and more assertive than boy. As regards staff nurses years of experience, more than half of them had or more than ten years of experience.19 Additionally, the current result was in line with who added that, age maturity and increase numbers of years of experience are important in development of assertiveness, because the old nurses had ability to solve problem and negotiate work situations.20 On the contrary 21who reported that the oldest and most experiences nurses are least assertive, because the old nurses continue to practice nursing in most dependent roles and least influenced by present change in women roles in general, and mentioned that supportive working condition help young nurses to established assertive behaviours. While other studies do not go with these results,22who stated that the effects of gender, ethnicity and race differences were not significant among nurses. Also, found that there were no significant differences between the mean of age and working years of the intervention.23
Related to assertive communication skills training program, the present study showed that there were a highly significant difference were noticed after implementation of training program. This result goes with the findings of 24who stated that an overall statistically significant improvement in assessment skills between pre-test and post-test scores of communication skills program, which allows nurses to explore their attitudes, raise self-awareness and develop knowledge and skills, is most effective in preparing them to communicate with patients. Also, in the study of 25 when using methods for communication training program as role playing exercise, group discussion, videotapes demonstrations of key communication skills, exchange of experiences among nurses, case study discussion, found that during combination of practical and theoretical communication training for nurses promote nurse’s post-training communication skills. Concerning communication skills levels of the studied group, the present study revealed that the total score of communication skills level were significantly higher after training program. This finding is consistent with 26 who stated that communication skills level were improved significantly after the training program. As regards the effect of training program on nurse’s self-esteem, the present study showed that there were significant changes of nurse’s self-esteem after implementation of training program. This results accordance with27 found that the nurse’s self-esteem had improved after the assertiveness training. This corresponded also, with the previous studies which indicated that assertiveness contributed to self-esteem among American firefighters , and that assertiveness training reduced stress reaction among Hospital Nurses  .
| Conclusion|| |
Based upon the study results, it is concluded that implementation of assertiveness training program with nurses has a positive effect on improving their self-esteem and communication skills.
- That assertiveness is an important behaviour for today’s professional nurses, so use of assertiveness training program is recommended for all nurses to improve and enhance their self-esteem and assertiveness.
- Also the concepts of assertiveness, assertiveness technique should be included in basic undergraduate nursing curriculum.
- Nurse educators have an important role in the development and implementation of assertiveness training/education program for undergraduate nursing students.
| References|| |
Bos A., Huijding J., Muris P., Et Al.: Contingent And Implicit Self-Esteem And Psychopathological Symptoms In Adolescents. J. Pers. Indi. Diff., 48: 311, 2010.
Moksnes U., Moljord I., Espnes G. And Byrne D.: The Association Between Stress And Emotional States In Adolescents: The Role Of Gender And Self-Esteem. J. Pers. Indi. Diff. Available At: Www.Elsevier.Com/Locate/ Paid, 2010.
Civitci N. And Civitci A.: Self-Esteem As Mediator And Moderator Of The Relationship Between Loneliness And Life Satisfaction In Adolescents. J. Pers. Indi. Diff., 47: 954-58, 2009.
Cowin L. And Sims C.: New Graduate Nurse Self-Concept And Retention: A Longitudinal Survey. Inter. J. Nurs. Stud., 43: 59-70, 2006.
Unsar S. And Issever H.: Examination Of Factors Affecting The Self-Esteem Of Students At Trakya University Occupational School For Health Services. Nurs. Foru. J., 6 (1): 7-11, 2003.
Mahmoud A.S., Al-Kalaldeh M.T. And Abed Elrahman M.: The Effect Of Assertiveness Training Program On Jordanian Nursing Students’ Assertiveness And Self-Esteem. Inter. J. Nurs. Pract. Educ., 2, 2013.
Shimizu T., Kubota S., Mishima N., Et Al.: Relationship Between Self-Esteem And Assertiveness Training Among Japanese Nurses. J. Occu. Heal., 46: 296, 2004.
Sudha R.: How To Be An Assertive Nurse? Nurs. J. Indi., 96 (8): 182-3, 2005.
Begley C. And Glacken M.: Irish Nursing Students’ Changing Levels Of Assertiveness During Their Preregistration Program. J. Nurs. Educ. Today, 24 (7): 501-10, 2004.
Sanders R.: Assertive Communication Skills With Nurses In A Rural Setting. Published Master Dissertation. University Of Wyoming. Available At: Http://Proquest.Umi.Com/ Pqdweb?
Sullivan P.J.: Occupational Stress In Psychiatric Nursing. Advanced Nurse, 18: 591-601, 1993.
Katz L.: Communication Skills Training Programs For Imgs. Update In Medical Education/Interpersonal And Communication Skills. Academic Internal Medicine Insight. Pp: 5-3. Www. Communication Skills. Com. In.2010, 2007.
Macaden L., M.Sc.: Assertiveness In Nursing. Indi. J. Cont. Nurs. Educ. July-December, 6 (2), 2005.
16-Mccabe C. And Timmins F.: Teaching Assertiveness To Undergraduate Nursing Students. J. Nurs. Educ. Prac., 3 (1): 3042 21, 2003.
Hamoud S.A., El Dayem S.A. And Ossman L.H.: The Effect Of An Assertiveness Training Program On Assertiveness Skills And Self-Esteem Of Faculty Nursing Students. J. Am. Sci., 7 (12), 2011.
K. Higashiguchi, Y. Morikawa, K. Miura, M. Nishijo, M. Tabata M. And H. Kakagawa: Burnout And Related Factors Among Hospital Nurses. J. Occup. Health, 41: 215-24, 1999.
Takashi S., Tetsuja M. And Shinya K.: Relationship Between Burnout And Communication Skill Training Among Japanese Hospital Nurses: A Pilot Study. J. Occup. Health, 45: 185-90, 2004.
A. Miki: Stress Management In Hospitals. San Eishi, 44: 219-223 In Japanese With Abstract, 2002.
Mohammed H.: Assertiveness Among Nursing Personal Working At Ain Shams University Hospital, Unpublished Master Thesis, High Institute Of Nursing, Ain Shams University, Cairo, Egypt, 1999.
Kenton S.: Speaker Credibility In Persuasive Business Communication: A Model Which Explains Gender Difference. J. Busin. Comm., 26 (2): 143-57, 2003.
Weert J.C.M. Van, Jansen J., Spreeuwenberg P.M.M., Et Al.: Effects Of Communication Skills Training And A Question Prompt Sheet To Improve Communication With Older Cancer Patients: A Randomized Controlled Trial. Critical Reviews In Oncology Hematology, 2010.
Zavertnik, Tanya A. And Cindy L.: Innovativeapproach To Teaching Communication Skills To Nursing Students. Journal Of Nursing Education. Vol. 49, No.2, 65-71, 2010.
Wilkinson, Susie, Roberts, Et Al.: Nurse-Patient Communication In Palliative Care: An Evaluation Of A Communication Skills Programme. Palliative Medicine, 12 (1): 13-22, 1998.
Tao M. And Kubo M.: Theory And Researches Of Burnout (Burnout No Riron To Zissai). Tokyo: Seishin-Shobo, 15-95 (In Japanese), 1996.
Takashi S., Shinya K., Norio M., Et Al.: Relationship Between Self-Esteem And Assertiveness Training Among Japanese Hospital Nurses. Journal Of Occupational Health, 46: 296-8, 2004.
J.J. Hurrell And M.A. Mclaney: Exposure To Job Stress-Anew Psychometric Instrument. Scand J. Environ. Health, 14: 27-8, 1988.
[Table 1], [Table 2], [Table 3]