Assertiveness for a Successful Nursing Profession
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What is Assertiveness? Every individual possesses a unique style of communication-based on the manner in which they get involved in interactions and share information with others. According to Alvernia University (2018), people demonstrate four communication styles, including passive, assertive, aggressive and passive-aggressive. Individuals with the passive style may not show any resistance when accepting events or behaviour of other people. Nevertheless, society, in general, considers the passive style as weak and vulnerable, and negatively evaluate those who demonstrate this communication style as fearful and futile (Maloney & Moore, 2019). On the other hand, the style of being aggressive, "pursuing one's aims and interests forcefully, sometimes unduly," is seen as powerful, dynamic, spirited, courageous, or innovative. However, the assertive communication style is recognized as the most effective type (Taghavi et al., 2014). Assertiveness is a vital interpersonal skill that facilitates the imbalance of power among individuals (Alberti & Emmons, 2008) and is identified as the capacity possessed by the individuals to recognize and respect their own beliefs and those of others. It can also be defined as the ability possessed by individuals to fulfill their desires, defend one's rights, and express one's beliefs, feelings, and thoughts while concurrently recognizing and respecting the rights of others (Roya et al., 2014). Assertiveness is also considered to denote individual's capability of rejection by saying no, expressing requirements and negative/positive feelings, and starting, continuing and finishing a conversation (Lazarus, 1973). Factors Affecting Assertiveness Assertive behaviour is developed with the influence of numerous factors (Binuja & Nagarajaiah, 2020). The general classification of factors that influence the assertiveness of an individual is two-fold, namely intrinsic factors or attributes that are within the person. These include intrinsic factors such as gender, inheritance, disposition, sense of self-respect and self-assurance, level of knowledge and skill in practice, defiance, psychological factors such as anxiety and style of coping. On the other hand, extrinsic factors that remain- ing external to an individual such as his/her country, culture, religion, type of family to which he/she belongs, socio-economic status, educational status, profession, exposure to mass media, the child-rearing pattern of the parents, nature of parent-child interaction during his/her childhood, determined to keep up-to-date, peer group, and role models may also have an impact on the assertive behaviour of a person (Binuja & Nagarajaiah, 2020). Importance of Assertiveness in the Nursing Profession Individuals who demonstrate behaviours associated with assertiveness have higher feelings of self-esteem and tend to achieve success in their lives efficiently (Ibrahim, 2011; Karagözoğlu et al., 2007). In addition, assertiveness has the potential to help individuals to demonstrate constructive social behaviours and suitable social interactions with others and improve their problem-solving ability and self-awareness (Hadavi & Nejad, 2018). When people demonstrate behaviours that demarcate positive assertiveness, it helps them in building close relationships. Furthermore, it facilitates the maintenance of healthy human relationships with no harm being caused to others (Taghavi et al., 2014). Assertiveness is considered a valuable nursing skill since it brings numerous benefits for nurses (Roya et al., 2014). For instance, in healthcare settings, it has been noted that assertiveness strengthens inter-professional relationships, prevents workplace violence (Karakaş & Okanli, 2015), reduce occupational stress, minimizes negligence, and improves nurses' leadership ability, sense of job satisfaction, professional autonomy, and professional efficacy. In addition, assertiveness is also directly correlated with nurses' caring skills (Montini et al., 2008). Apart from this, it enhances nurses' professional dignity, enabling them to solve their professional problems and preventing them from making inaccurate judgments (Yin, 2011). More importantly, assertiveness permits nurses to develop influential team relationships. It has been identified that partnership with other team members needs both a high level of assertiveness and a high level of cooperation (Boone et al., 2008). Moreover, nurses' assertiveness facilitates them when they are unsure or concerned about medical procedures, patient treatment, or patients' symptoms, which, in turn, contributes to reducing risk and pre-venting significant medical errors (McVanel & Morris, 2010). Improving Assertiveness among Nurses Improving assertiveness skills among nurses and nursing students is an excellent investment for the future, which can be done through both pre-registration and post-registration education programmes (Timmins & McCabe, 2005). However, improving interpersonal skills like assertiveness is challenging, and several methods in teaching that are highly creative and are supported by empirical evidence need to be used in making the learning experience productive (McCabe and Timmins, 2003). For example, the teaching-learning strategy of role-play could be used during particular teaching sessions to ensure that evocative, practically applicable learning occurs (McCabe & Timmins, 2003). Further, previous research conducted on assertiveness training programmes has shown significant impacts on improving assertiveness among nurses and nursing students worldwide (Eslami et al., 2016; Fensterheim & Baer, 1975; Karakaş & Okanli, 2015). However, the necessity for more detailed research in the form of extensive controlled studies on the process of evaluating the efficacy of assertiveness training of nurses, namely performance of the analysis of subgroup, focusing on nurses working in high-risk situations and comprehensive follow-up observations (Yoshinaga et al., 2018). Conclusions and Recommendations Assertiveness is a crucial skill in the nursing profession. Therefore, it is recommended to inculcate well-designed assertiveness training programmes be incorporated into nursing education programmes implemented in Sri Lanka and to improve assertiveness skills in pre-registration and post-registration nurses. Further, it is necessary to conduct extensive research on interventions to develop assertiveness among nurses in this context.
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