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PubMed1993

Assertiveness among professional nurses.

Assertiveness is considered healthy behaviour for all people that, when present, mitigates against personal powerlessness and results in personal empowerment. Nursing has determined that assertive behaviour among its practitioners is an invaluable component for successful professional practice. The purpose of this descriptive study was to determine assertiveness levels of a population of professional nurses and to determine if assertiveness levels are related to selected demographic factors including age, gender, years of nursing experience, basic nursing education, clinical nursing specialty, type of employer, highest educational level and prior assertiveness training. The sample was composed of 500 registered nurses (64% response rate), chosen randomly from the list of active licensees registered with the Minnesota (USA) State Board of Nursing, who completed and returned an assertiveness questionnaire. The questionnaire consisted of the Rathus Assertiveness Schedule (RAS) and a personal/professional data form. Data analysis included descriptive as well as inferential statistics. The results revealed that this group of nurses was more assertive than any other group of nurses or non-nurses reported in the literature using the RAS. The oldest group of nurses (60-76 years) was significantly less assertive than any of the younger groups of nurses. Nurses practising with a diploma as the highest level of education were significantly less assertive than nurses having a baccalaureate or above. And there was a significant difference in assertiveness between groups of nurses practising in different clinical specialties based on the ANOVA. It appears that the majority of nurses in this study are assertive. They believe in themselves and their abilities. It is hoped that the self-assertion generated by this belief will eventually lead to further personal and professional empowerment.

Adult↗
PubMed1995

Barriers to assertive skills in nurses.

The role of nursing involves interaction with clients, peers and other health professionals. This role is enhanced when nurses have a good command of communication skills. An essential component of effective communication is the ability to behave assertively. Several studies have indicated that nurses lack assertiveness skills. This lack of assertiveness results in diminished effectiveness of communication and compromised patient care. The purpose of this study was to examine the barriers, identified in the literature, that prevent nurses from being assertive and to determine nurses' perceptions of how these barriers prevent them behaving assertively. The design of the study was a cross-sectional, correlational survey whereby the relationships between identified variables could be systematically investigated. Assertiveness was assessed using the Assertiveness Behaviour Inventory Tool (ABIT), and the Barriers to Assertive Skills in Nurses (BASIN) were assessed using an instrument developed for the study by the investigators. The validity and reliability testing of the BASIN instrument is discussed. The results indicated that the 152 nurses sampled considered themselves to have moderate to low assertiveness skills, and a significant negative correlation was found between the level of assertiveness and the perception of barriers inhibiting assertive behaviour. The study concluded that assertiveness training is needed for qualified nurses and that further testing of the ABIT and BASIN instruments will result in reliable measures for research and educational evaluation of nurses following assertiveness training.

Adult↗
PubMed2004

Irish nursing students' changing levels of assertiveness during their pre-registration programme.

BACKGROUND: Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimization. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme. METHODS: Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part (n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data. RESULTS: In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme. DISCUSSION: The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level. CONCLUSIONS: The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.

Adolescent↗
PubMed2005

Nurses' and midwives' assertive behaviour in the workplace.

AIM: This paper reports a study describing the assertive behaviour of a group of professional nurses and midwives and exploring potential barriers and facilitators to the use of assertiveness skills in the workplace. BACKGROUND: As nurses and midwives move away from traditional roles, it is increasingly being recognized that they need to behave in an assertive manner. Much literature supports the use of assertive behaviour in clinical practice. Although specific individual assertive behaviours and skills have been examined in many settings, little empirical evidence exists about the frequency and use of assertiveness skills by nurses and midwives in the workplace. While there is evidence on barriers to the use of assertive skills, there is little information about factors that may facilitate their use. METHOD: A survey design was adopted, using a 44-item questionnaire to collect data from a 2.5% random sample of nurses/midwives registered with the National Nursing Board of Ireland. The data were collected in 2003. RESULTS: While respondents frequently complimented their colleagues and often allowed them to express opinions, they were less accomplished at expressing their own opinions or making requests. Assertive behaviours were used more frequently with nursing/midwifery colleagues than with management/medical colleagues. Most used assertiveness skills with other grades of staff in their own profession. Responsibility to patients/clients emerged as a supporting factor for using assertive behaviour. Managers, the work atmosphere and fear were viewed as obstacles. CONCLUSION: Nurses and midwives needs to learn how to behave assertively, and this should be included in both pre- and post-registration education programmes. As use of assertiveness skills was reported to be least frequent with nurse/midwife managers, local policies and guidelines may be needed to encourage clinical practitioners to act autonomously and as client advocates.

Adult↗
PubMed1985

Evaluations and consequences of assertive behavior.

Male and female high assertive and low assertive subjects observed videotaped scenes of actors exhibiting assertive, empathic-assertive, and nonassertive behavior in response to unreasonable requests made by acquaintances. Subjects provided evaluative ratings of actors in the different scenes and rated the likelihood of various consequences that might follow from the actors' behaviors. Generally, empathic-assertive behavior was more positively received than assertive behavior. Empathic assertion received high ratings on dimensions of competence and likeability and was associated with expectations of positive consequences of a social (i.e. requestor's reactions to the actor's behavior) or personal (i.e. the actor's own feelings) nature. In contrast, both empathic-assertion and assertion were believed to result in more negative long-term consequences (i.e. the effect the actor's responses will have on the relationship in the long run) than nonassertive behavior. These effects were modified by the sex of the requestor and the sex and assertiveness of the subject, but unaffected by the sex of the actor. Implications of these findings for research and training of assertive behavior are discussed.

Assertiveness↗
PubMed1989

Dimensions of assertiveness: differential relationships to substance use in early adolescence.

We tested a multidimensional formulation of assertiveness and substance (tobacco, alcohol, and marijuana) use in 3 metropolitan-area school samples of adolescents aged 12-14 years. Three studies (N = 675, N = 1,430, and N = 5,545) included inner-city and surburban settings and included White, Black, and Hispanic students. Factor analysis of versions of the Gambrill-Richey Assertion Inventory indicated five independent dimensions of assertive behavior. Multiple regression analysis indicated that a dimension of Substance-specific Assertiveness was inversely associated with substance use, whereas dimensions of Social Assertiveness and Dating Assertiveness were positively associated with substance use. A dimension of General Assertiveness was unrelated to substance use. Interaction effects indicated that relations were stronger for girls for Substance and Social Assertiveness and for boys for Dating Assertiveness. Implications of the findings for models of assertive behavior and for design of primary prevention programs are discussed.

Adolescent↗
PubMed1999

Assertiveness predicts threat and challenge reactions to potential stress among women.

In this study assertiveness as a moderator of stress reactions among women was examined. Specifically, the experimenters examined how high and low assertive women cognitively appraised, affectively and physiologically responded to, and behaviorally coped with the stress of giving an impromptu speech. High assertive women appraised the speech stressor as challenging, whereas low assertive women appraised the stressor as threatening. High assertive women also had a challenge pattern of autonomic response during the task, compared with the threat response of low assertive women. Afterward, the high assertive women reported experiencing less stress and negative emotion and greater positive emotion than did the low assertive women. Overall, the high assertive women's stress-related reactions indicated challenge, whereas the low assertive women's reactions indicated threat (see J. Tomaka, J. Blascovich, R. M. Kelsey, & C. L. Leitten, 1993).

Analysis of Variance↗
PubMed1989

An investigation into the assertive behaviour of trained nurses in general hospital settings.

Nurses are often considered to be lacking in assertive skills. This exploratory study compares the assertive behaviour of trained nurses at work and in general life situations. Questionnaire and interview techniques are used to investigate the behaviour of a small sample of sisters, staff nurses and enrolled nurses in general hospital settings. Trained nurses are found to be less assertive at work than in general life situations. In the work situation sisters are more assertive than staff nurses. The enrolled nurses are the least assertive of the trained nurses. The complex nature of assertive behaviour becomes apparent. Factors which promote assertiveness at work include knowledge, confidence, experience and the wearing of uniform. Factors which inhibit this behaviour are tradition, training and the hierarchical structure within the hospital. The use of assertiveness tends to be situation specific. Assertiveness is viewed as a positive behaviour and is of value to nurses, but there are mixed feelings about the usefulness of assertiveness training.

Adult↗
PubMed2004

Assertiveness and caring: are they compatible?

BACKGROUND: Findings from numerous assertion studies suggest that nurses are generally non-assertive. This study examines the role of caring as an important determinant of adaptive assertive behaviour. AIM AND OBJECTIVES: The aim of the investigation was to explore the relationship between assertion and caring skills. Two study objectives sought to determine whether both positive and negative assertive behaviours were related to caring skills. DESIGN: Correlational and cross-sectional study. METHOD: The Caring Assessment Instrument (Care Q - Questionnaire Version) and the assertion inventory were used to collect self-report data from a convenience sample of 94 subjects. Behavioural data were obtained by directly sampling 50 nurses' responses within role-play situations. RESULTS: One significant result between the various assertion measurements and caring skill scores was noted, highlighting a relationship between negative assertion and the caring 'accessible' subscale. CONCLUSION: Overall the findings of the study suggest that positive and negative assertive behaviours are not related to caring skills. RELEVANCE TO CLINICAL PRACTICE: The current findings suggest that the presence of caring attributes cannot be offered as a possible reason for non-assertion in nurses.

Assertiveness↗
PubMed1984

The effectiveness of assertive training with elderly psychiatric outpatients.

The usefulness of assertive training for elderly psychiatric outpatients was assessed through a quasi-experimental evaluation of a program at a community geriatric facility. Elderly clients are frequently labeled as "untreatable" and are therefore often denied therapeutic treatment. This study is an example of the potential effectiveness of applying treatment techniques which have been developed with younger populations to a geriatric population. Nineteen clients, aged 50-75, participated in the study, either as participants in the assertion training or as members of a no-treatment control group. The assertion training consisted of 14 semi-weekly sessions, with coaching and feedback provided by the therapists. Assertive behaviors were assessed through self-report, role play and staff ratings of adaptive behaviors of clients. Pre-intervention comparisons between the groups along these dimensions were nonsignificant. However, post-test assessment indicated a significant between group difference in self-reported assertiveness-(t(17) = 2.69; p less than .05). Dependent t-tests indicated that the experimental group became more assertive (t(9) = 2.59; p less than .05), but the control group did not. Changes as assessed by role play and staff rating did not reach statistical significance. Results which indicate the potential effectiveness of assertive training with this population are discussed in terms of a specificity conceptualization of assertiveness and implications for assertive training with this population.

Aged↗
PubMed1982

Assertiveness training in fourth- and fifth-grade children.

An assertiveness training program for 343 fourth- and fifth-grade children was designed and evaluated. All children in 10 classrooms were randomly assigned by classroom to one of three conditions: (a) assertiveness training, (b) a control intervention, or (c) a no-treatment control. The intervention procedures were administered for 2 hours a week for 12 weeks in groups of 6 pupils each. Assertiveness was higher among classes receiving assertion training on the quality of alternatives generated on the Interpersonal Problem-solving Test, an Assertion Quiz and a Group Decision Task. Teachers reported better comportment and higher achievement and higher popularity among the assertion classes. Grade point averages increased for the pupils in the assertiveness group 1 year following the intervention. Observations indicated a greater number of student-initiated contacts with the teacher and fewer questions answered by the pupils receiving assertiveness training. The usefulness of assertiveness training as a primary prevention intervention is discussed.

Assertiveness↗
PubMed2004

Assertiveness with physicians: does it predict mammography use?.

In a prior study we found that women's self-reported assertiveness with their healthcare providers was associated with their use of mammography in a population-based cross-sectional sample of women. Women who reported being more assertive, by repeating information if they felt their doctor didn't hear them, asking their doctor to explain information they didn't understand, or reminding their doctor about screening tests, were more likely to have received a mammogram recently than those who reported being less assertive. Here we examined how women's self-reports of assertiveness predicted their use of mammography three years later. We examined this using a population-based sample of 781 women living in rural Washington State who were participating in a trial of mammography promotion. We found that assertive women were younger on average than less assertive women, but that even after controlling for age, education, income, and marital status, women who reported being assertive with their doctor in 1994 were more likely to receive regular mammograms in the next three years than those who did not (OR 2.1; CI 1.5, 2.9). If future studies also suggest that assertiveness predicts use of mammography or other preventive healthcare services, it would be valuable to examine the promotion of assertiveness as a means of improving public health.

Aged↗