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Table of Contents
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 91-94

Impact of Nurse-Led Assertiveness Tutelage on Raising Self-esteem among Adolescent Girls

1 Nursing Tutor, School of Nursing, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
2 Department of Research, Madras Medical Collge, Chennai, Tamil Nadu, India

Date of Submission02-Oct-2020
Date of Decision17-Dec-2020
Date of Acceptance26-Dec-2020
Date of Web Publication08-Feb-2021

Correspondence Address:
Ms. Abirami Venkatesan
School of Nursing, Thanjavur Medical College, Thanjavur, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iopn.iopn_37_20

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Background: Adolescence is a transition period where they are confused about what they need and experience dissatisfaction toward bodily changes, especially female adolescent girls. Self-esteem is evaluated by how one feels about one's self-concept. Low self-esteem constitutes negative outcomes such as hopelessness, uselessness, depression, and adjustment problems. Vulnerability stress model suggests that low self-esteem leads to depression. Self-esteem is acquired by undergoing specific training, such as “Assertiveness Tutelage” which fosters communication skill, assertive behavior, and assertiveness in raising self-esteem. Aim: The aim of the study was to evaluate the effectiveness of nurse lead assertiveness tutelage among adolescent girls. Methodology: Quantitative approach and quasi-experimental design was adopted. By nonprobability purposive sampling, 60 adolescent girls were included in the study from a selected school in Chennai. The level of self-esteem was measured by the State Self-Esteem Scale. After collecting the pretest data from experimental and control groups, assertiveness tutelage intervention was provided to the experimental group at 1st week, reinforced for the next 2 weeks, and posttest was collected at the end of 4th week from both the groups. Data Analysis: SPSS software was used for the data analysis. Results: In the experimental group at pretest level, the mean self-esteem score of adolescent girls was 60.40 and at posttest level, it was 83.47. This mean difference in gain of self-esteem was 23.07 which was statistically significant, with t = 10.40 (P = 0.001). Conclusion: This study has proven that nurse-led assertiveness tutelage raised the self-esteem among adolescent girls and strengthened their ability and helps them to develop coping and problem-solving skills, etc.

Keywords: Adolescent girls, assertiveness tutelage, self-esteem

How to cite this article:
Venkatesan A, Rajendran SS. Impact of Nurse-Led Assertiveness Tutelage on Raising Self-esteem among Adolescent Girls. Indian J Psy Nsg 2020;17:91-4

How to cite this URL:
Venkatesan A, Rajendran SS. Impact of Nurse-Led Assertiveness Tutelage on Raising Self-esteem among Adolescent Girls. Indian J Psy Nsg [serial online] 2020 [cited 2021 Sep 21];17:91-4. Available from: https://www.ijpn.in/text.asp?2020/17/2/91/308830

  Introduction Top

Adolescence is a crucial period of development, tries to mimic the adulthood. They are more sensitive and expect others to treat them as adults. Development of secondary sexual characters and hormonal changes, causes confusion in their role. At this prime period, they need support, encouragement, and guidance. All these aid them to develop good self-esteem level. Since low self-esteem leads to hopelessness, inferiority, stress, depression, etc., self-esteem can be obtained through assertiveness tutelage, which helps in standing for their own rights and achieving personal and interpersonal goals, etc. This article is intended to raise self-esteem of adolescent girls through assertiveness tutelage.

Background of the study

Adolescence in Latin means to grow to maturity. According to the American Psychological Association,[1] adolescent grow physically, mentally, cognitively emotionally, and sexually. Rogers[2] had explained this period as a process of achieving the attitudes and beliefs needed for effective participation in the society. Tiny incidents also create impacts in them, this impact lays the foundation and guides them for future experiences. Hence, they have to be recognized and encouraged. At present, the prevailing circumstances force them to become anxious and stressful. Hence, this period can be called as “stress and storm.”

Zaky[3] stated that it is a transitional period, they are confused about what they really want to do. Adolescents experience satisfaction and dissatisfaction toward these bodily changes, achievements, social relations, etc. If they appreciate satisfaction toward their changes, they develop favorable self-concept and self-esteem. If not, they develop negative perseverance toward their changes, feel dissatisfied, and lack self-esteem.

Townsend[4] reported that self-esteem is evaluating how one feels about one's self-concept. Self-esteem is the decision made by the individual toward the self. Self-esteem finds to be effective in social and psychological development of individuals. Park and Yang[5] stresses the importance of self-esteem during adolescent period and the role of self-concept in promoting the self-esteem among adolescents. Giovanna manna[6] in his article pointed the vulnerability stress model that during the adolescent period low self-esteem constitutes negative outcomes such as hopelessness, uselessness, anxiety, depression, adjustment problems, inferiority, and delinquency. He had mentioned that by encouraging them to find out their specific interests and helping to reach such resources aid them to gain self-esteem.

According to Robins et al.,[7] nature of self-esteem is not the same for all ages and gender. Adolescent period is a transitional period where the child appreciates childhood characteristics meanwhile evolves adulthood nature. During childhood, the rate of self-esteem is high, whereas during adolescence, it finds to be fluctuating. Self-esteem when cultivated from the adolescent period itself can help them to cope with stressful situations to act in a positive manner.

Self-esteem can be inherited or can be acquired by undergoing specific tutelages. Assertiveness involves appropriately expressing ideas, feelings, maintaining positive effects, and aids to achieve personal and interpersonal goals. According to Emigarner,[8] an assertiveness style helps us to do the things what we want to do so that an individual feels confident and has high self-esteem. Without balanced and healthy self-esteem, one cannot be clear about what one deserves. Hence, assertiveness is one of the skills and style aids in developing a good self-esteem. At this juncture, school health nurses play a vital role in assessing and promoting the self-esteem of adolescent girls.

Need for the study

Adolescent period is a transition period and they are confused of what they really want to do, especially adolescent girls experience satisfaction or dissatisfaction toward their bodily changes, emotional disturbances, sexual abuses, etc., all these factors encircle them around stress, anxiety, and adjustment problems. School health nurses play a vital role in assessing and promoting the self-esteem of adolescent girls in building their self-concept and self-confidence. Hence, this study was initiated to assess the impact of nurse lead assertiveness tutelage in raising self-esteem of adolescent girls.

Study design and participants

The study was conducted among adolescent girls studying in 9th standard at St. Joseph Higher Secondary School, Chennai, for the period of 1 month. It was a quasi-experimental nonrandomized control group design; samples were selected by purposive sampling method with a sample size of 60 numbers. The samples were equally divided into two groups with 30 girls in the experimental group and 30 numbers in the control group. Adolescent girls from sections A and B were assigned as the experimental group and from sections C and D were the control group. The inclusion criteria were adolescent girls studying in 9th standard between the age group of 14 and 15 years and girls who have not undergone the training already. The exclusion criteria were boys, girls of age 14–15 years from other than 9th standard, and girls who were not well and unable to attend the training.


The data were collected by using tools consist of two sections, namely section A consists of sociodemographic variables and section B includes State Self-Esteem Scale (SSES). Sociodemographic tool consists of age, parent's education and occupation, family income, area of residence, birth order of participants, academic performance of girls, and body mass index. The standardized tool consists of 20-item Likert scale questions designed for measuring individual self-esteem. The 20 questionnaires are divided into three elements, namely performance self-esteem, appearance self-esteem, and social self-esteem. The maximum score for a question is 5, minimum score is 1, and the total score for 20 questions is 100. The reliability of the tool was determined by using test–retest method and index of reliability for this tool was being 0.76 in this study.

Ethical consideration

The study was approved by the Institutional Ethical Committee, Chennai. Necessary permission from the school authority was obtained. Prior to data collection, written consent was obtained from the subject legal guardian and assent was obtained from the participants. Individual anonymity was maintained throughout the study.


The investigator selected 60 participants by purposive sampling method as per the inclusion and exclusion criteria. Introductory session about the aim, importance, and purpose of the study was explained to both the groups. Pretest was given to both the experimental and control group. Assertiveness tutelage was provided to the experimental group and routine activities were carried out in the control group during 1st week. The experimental group was divided into three groups and the investigator demonstrated tutelage to each group by role play, explanations, demonstrations, activity sessions under the topics and types of assertive behavior, assertiveness application, assertive communication, and social relations. Assertiveness tutelage intervention was reinforced during 2nd and 3rd weeks. At the end of 4th week, posttest data were collected from both the groups.

Data analysis

SPSS software (Armonk, NY: IBM Corp) was used for analyzing descriptive and inferential statistics. Self-esteem score were analyzed using mean, percentage mean and standard deviation. Association between demographic variables and self-esteem posttest score was interpreted by Chi-square test. Moreover, Student's paired t-test was used to analyze self-esteem scores between pretest and posttest.

  Results Top

The study results reveal that there was a statistically significant difference found in experimental group than the control group. This states that assertiveness tutelage was effective in raising the self-esteem of adolescent girls.

At posttest level, the mean score was 83.47 when compared to pretest level of mean score of 60.40 among experimental groups. The difference in the mean score was 23.07 between pre- and post-test levels among the experimental group. This difference was statistically significant with t = 10.40 (P = 0.001). The study findings showed an association with selected sociodemographic variables and posttest level of self-esteem score. The association was found with 14 years' adolescent girls with significance (χ2 = 4.50) P = 0.03, then nuclear family type with significance (χ2 = 4.33) P = 0.04, considering the birth order of participants more than one birth order in the family gained more significance (χ2 = 9.13) with P = 0.01, and finally, academic performance of students also gained significance (χ2 = 8.55) with P = 0.04.

[Table 1] shows that in the experimental group at pretest level, adolescent girls' mean score was 60.40 and in posttest, they scored 83.47, this difference in mean score was 23.07 and statistically significant with t = 10.40 (P = 0.001).
Table 1: Comparison of pretest and posttest mean self-esteem score in the experimental group

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  Discussion Top

The present study showed the importance of assertiveness tutelage in raising self-esteem. This program aids students to develop self-confidence and trust in themselves. As girls, they face more problems nowadays which lead to have stress, anxiety, depression, etc. These factors lower their potentiality and self-esteem. Assertiveness tutelage will be very effective in raising those potentials as well as self-esteem. Eslami et al.[9] conducted a study on assertiveness training in reducing the stress and depression and it is statistically significant with P = 0.002. Similarly, Pandey et al.[10] carried out preexperimental study to assess the effectiveness of assertiveness training on self-esteem among adolescent girls in selected schools in Nepal proved that assertiveness training was effective and statistically significant. In the current study at pretest level, 62% of girls secured social self-esteem but after posttest, 84.20% secured high social self-esteem. This result was supported by another study conducted by Manesh et al.[11] It was reported that the assertiveness training had reduced the social anxiety among students.

Among adolescent girls, it was found that age and educational performance of girls had a major influence in developing self-esteem. This significant association with academic performance was supported by another study conducted by Ogot[12] who found there was a relationship between self-esteem and academic performance and found that achievements were in favor of high self-esteem. It is understood that student's self-esteem was related with their academic performance also.

The positive side of this study was a standardized tool (SSES) which intended to measure temporary changes of self-esteem at the moment. As adolescents also mimic childhood as well as adults, they also exhibit the transitional level of self-esteem. Hence, this scale finds to be an appropriate tool for measuring self-esteem among adolescent groups. The short time and small sample size were the limitations of the present study. Moreover, this study can also be conducted as a comparable study between urban and rural adolescent girls. This study can also be conducted to assess the effectiveness of other variables.

  Conclusion Top

The findings of the present study reveal that the nurse lead assertiveness tutelage has a promising effect on raising self-esteem among adolescent girls. As adolescent age is a crucial period among developmental stages, this program put a step forward to create awareness among adolescent girls to enhance their self-concept and self-confidence which, in turn aids, in raising their self-esteem level. School health nurse-led assertiveness training fosters the coping skills, develops mental ability and problem-solving skills, and builds self-confidence to compete with the present era.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

American Psychological Association. Developing Adolescent: Washington: American Psychological Association; 2002. Available from: http:/www.apa.org/. [Last assessed on 2019 Jul 21].  Back to cited text no. 1
Rogers D. Adolescents a Psychological Perspective. 2nd ed. US: Brooks/Cools Publishers; 1972.  Back to cited text no. 2
Zaky EA. Adolescence: A crucial transitional stage in human life. J Child Adolesc Behav 2017;4:2.  Back to cited text no. 3
Townsend MC. Psychiatric Mental Health Nursing: Concepts of Care in Evidenced Based Practice. 8th ed. New Delhi: Jaypee Publishers; 2017.  Back to cited text no. 4
Park K, Yang TC. The long-term effects of self-esteem on depression: The roles of alcohol and substance uses during young adulthood. Sociol Q 2017;58:429-46.  Back to cited text no. 5
Manna G, Falgares G, Ingoglia S, Como MR, De Santis S. The relationship between self-esteem, depression and anxiety comparing vulnerability and scar model in the Italian context. Mediterr J Clin Psychol 2016;4:1-12.  Back to cited text no. 6
Robins RW, Trzesniewski KH, Tracy JL. Global Self-Esteem across the lifespan. J Psychol Ageing 2002;17:423-34.  Back to cited text no. 7
Garner E. Assertiveness – Reclaim your Assertive Birthright. 1st ed. California: Goodreads LLC; 2008.  Back to cited text no. 8
Eslami AA, Rabiei L, Afzali SM, Hamidizadeh S, Masoudi R. The effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students. Iran Red Crescent Med J 2016;18:36-9.  Back to cited text no. 9
Pandey S, Judey SJ. A pre-experimental study to evaluate the effectiveness of assertiveness training on self-esteem among adolescent girls in selected school in Nepal. Int J Health Sci Res 2016;6:241-6.  Back to cited text no. 10
Manesh RS, Fallahzadeh S, Eshagh Panah MS, Koochehbiuki N. The effectiveness of assertiveness training on social anxiety of health volunteers of Yazd. Sci Res Publ 2015;6:782-7.  Back to cited text no. 11
Ogot AW. Relationship between Self-esteem and Academic performance of students in selected high schools in Njoro district. Kenya. Int J Sci Res 2017;6:78-96.  Back to cited text no. 12


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