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

Assertiveness in physicians' interpersonal professional encounters: A scoping review

PURPOSE

Good relationships between physicians, patients, families and the healthcare team are essential for high-quality care. Medical encounters are sometimes challenging. They may include conflicts, requiring physicians to be assertive: that is to share and protect their needs, rights and values while preserving those of others. Whereas assertiveness has been studied in patients and nursing staff (those with less power in healthcare), physicians' assertiveness, which must be mindful of these power differences, lacks a comprehensive review. Thus, this scoping review focuses on assertive communication in physicians' encounters.

METHODS

A literature search of four online databases: MEDLINE, Embase, PsycINFO and WoS, seeking articles on physicians' assertiveness as a communication style published until February 2022. The Joanna Briggs Institute approach and the Preferred Reporting Items for Systematic Reviews checklist underpinned the review protocol.

RESULTS

We identified 1513 articles relating to assertiveness, reviewed 153 full-text articles and selected 22 for full review, 68% from the last decade. The articles focused mainly on assertive communication and relationships with medical staff, with 54% focusing on bottom-up power relations. In 40% of the articles, no clear definition of assertiveness was included. Definitions included had varied focus: on self, on the other or both. Overall, assertiveness measures varied widely, precluding a methodical comparison.

CONCLUSIONS

Despite the growing interest in physicians' assertiveness, a clearer definition and in-depth exploration of assertiveness are needed alongside development of valid measures of assertiveness appropriate to physicians. Based on the review, we offer a relational definition of assertiveness as the capacity to communicate one's views, concerns, rights and needs while respecting others and preserving therapeutic, collegial and educational professional alliances. This definition may serve to expand research in the field while offering a professional alternative to problematic communication styles-passive and self-denying or paternalistic and aggressive -that obfuscate and thus undermine physician-patient relationships.

Attitudes toward Patient-Centred Care, Empathy, and Assertiveness among Students in Rehabilitation Areas: A Longitudinal Study

This study assessed attitudes toward patient-centred care, empathy, assertiveness, and subjective perception of communication skills and technical knowledge among Portuguese undergraduate students in healthcare. These students may develop rehabilitation activities with patients in their person-oriented or technique-oriented professions. Portuguese nursing and allied health students from two public higher education schools completed questionnaires in the first and third academic years: Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy, Scale for Interpersonal Behaviour, and a subjective perception of technical knowledge and communication skills. A total of 183 students completed the surveys. In the first year, students showed moderate to high scores on patient-centredness attitudes, empathy, and assertiveness and perceived themselves as having good communication skills. Students from person-oriented programmes significantly improved their Total and shared patient-centred attitudes in the third year compared with students attending technique-oriented professions. Significant differences in empathy were found between groups in the third year. Distress associated with assertive behaviours increased significantly across time in students from technique-oriented programmes compared with their peers in person-oriented programmes. The results suggest that the health profession's orientation and the programmes' specific curriculum might have a role in how some dimensions evolved in the two groups of students. The increasing assertiveness-related discomfort highlighted the importance of assessing and monitoring students' emotional wellbeing during their initial interactions with patients.

Assertive communication training for nurses to speak up in cases of medical errors: A systematic review and meta-analysis

BACKGROUND

Several authors have previously assessed the effects of assertive communication training for nurses to speak up in cases of medical errors. Inconsistent results regarding the nurses' attitudes, behaviors, and confidence levels were noticed.

OBJECTIVE

To identify the effectiveness of assertive communication training on nurses' behaviors, attitudes, and confidence levels for speaking up in cases of medical errors and to identify vital components for success.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, ERIC, Embase, Scopus, and CINAHL were searched up for studies published from the inception of the database to December 16, 2022.

METHODS

Two researchers independently performed a primary screening of titles and abstracts for relevant studies, followed by a review of full texts if the references met inclusion criteria and quality assessment. Data were retrieved for nurses and nursing students who received medical error-related assertive communication training for speaking up, and learning outcomes for attitudes, behaviors, and confidence levels were reported based on pooled data. Pooled estimates were calculated using a random-effects model.

RESULTS

A total of eleven studies with 1299 participants were included in systematic review, and among them nine studies with 804 participants were analyzed in meta-analysis. From the pooled results, the intervention group, which received assertive communication training, exhibited substantially improved speaking-up behaviors compared with the control group (SMD = 0.58; 95 % CI, 0.14-1.03). Considerable differences were noted in the nurses' times of speaking up in cases of medical errors between pretest (38 %; 95 % CI, 0.14-0.68) and posttest (78 %; 95 %CI, 0.70-0.85) based on the pooled data. The nurses' attitudes and confidence levels for speaking up varied markedly between pretest and posttest.

CONCLUSION

Structured assertive communication training may improve nurses' speaking-up behaviors in cases of medical errors. To conduct effective assertive communication training, nursing educators should incorporate multiple teaching approaches into structured training and ensure an adequate training duration.

Technology-based interactive communication simulation for Korean nurses: A randomized controlled repeated-measures design

BACKGROUND

Effective and standardized technology-based communication simulations addressing diverse clinical situations for novice nurses are limited.

OBJECTIVES

This study evaluated the efficacy of the Technology-based Interactive Communication Simulation for Nurses on communication competency (knowledge, self-efficacy, skills, and clarity), compassion, and assertiveness among novice nurses.

DESIGN

We used a randomized controlled repeated-measures design. Participants were randomly assigned to either the intervention (Technology-based Interactive Communication Simulation for Nurses) or attention control group and completed the assigned program, the questionnaire thrice (i.e., before, immediately after, and four weeks after the program), and the e-simulation twice (i.e., immediately after and four weeks after the program).

SETTINGS AND PARTICIPANTS

Korean nurses with six months to two years of experience recruited from five secondary and tertiary hospitals participated in the study at a private, quiet place of their choice.

METHODS

The intervention comprises two simulation cases across different formats: (1) an interactive communication simulation for various clinical situations followed by a tailored debriefing; and (2) a video showing a conflict between a nurse and caregiver and between nurses, followed by a self-reflection activity. Communication skills and clarity were also evaluated by raters. Data analyses included descriptive analyses, t-tests, chi-square tests, and a generalized estimating equation model.

RESULTS

In total, 142 nurses (73 in the intervention and 69 in the attention control groups) participated in the programs, and 128 participated through the four-week follow-up. Technology-based Interactive Communication Simulation for Nurses significantly improved communication knowledge and self-efficacy and compassion among novice nurses compared to the attention control program, and its effects were maintained for four weeks. The group difference in communication skills and clarity evaluated by the raters was also significant.

CONCLUSION

Technology-based Interactive Communication Simulation for Nurses is effective in enhancing the communication competence of novice nurses. Future studies should analyze assertiveness in Korean healthcare settings.

Relationship between Self-Esteem and Stress Coping Strategies among Internship Nursing Students

BACKGROUND: Self-esteem is an essential personality trait in nursing professionals and nursing students need to have a high self-esteem and effective coping strategies to be successful in their future career. AIM: This study aimed to assess the relationship between the level of self-esteem and the stress coping strategies, used by internship nursing students (intern-nurses), at the completion of their internship training. METHODS: A descriptive correlational cross-sectional design was used to measure self-esteem and identify the stress coping strategies of intern-nurses at Alexandria University. Data were collected with a self-administered questionnaire, including the Rosenberg self-esteem scale and the Brief Coping Orientation to Problems Experienced (Brief COPE). The questionnaire was distributed to all intern-nurses (273 intern-nurses) during their last rotation in the internship training. In total, 150 completed the survey, resulting in 54.9% response rate. SPSS software was used for the analysis. RESULTS: In total, 150 intern-nurses participated in the study. The majority of the sample had a moderate to high self-esteem, and the mean total self-esteem was 29.21/40 ± 4.44. The most frequently used coping strategy was problem-solving, followed by social support, positive thinking, and lastly an avoidance coping strategy. There was a positive correlation between self-esteem with both the problem-solving and social support coping strategies. However, there was a negative correlation between the self-esteem score and the avoidance coping strategy. CONCLUSION: The majority of the sample had a moderate to high self-esteem and they use problem-solving and social support coping strategies to manage stress. Intern-nurses with a high self-esteem cope positively and effectively with stress. Conversely, intern-nurses with a low self-esteem cope negatively with stress. Counseling and stress intervention programs are essential to promote nursing students self-esteem and assist them to develop positive and active stress coping strategies.

Using Toolkits to Improve Students' Skills in Advocacy

BACKGROUND

Advocacy is widely recognized as a nursing responsibility. Speaking up, a form of advocacy, is known to benefit patient safety and quality of care yet research shows that nurses are hesitant to speak up and face multiple barriers when deciding to do so.

METHOD

A toolkit that included web-based learning modules and simulation experience with a standardized patient was developed to enhance advocacy skills in baccalaureate nursing students. Student perceptions of the efficacy of this approach were used to revise and improve toolkit materials.

RESULTS

There were 131 participants over four semesters. Students reported the toolkit helped them understand how to use advocacy skills (87%), allowed them to use critical thinking (97%), and practice advocacy (94%).

CONCLUSION

Educational experiences like this promote development of students' advocacy skills in a safe environment and can be used to bridge the gap between expectation and practice. [J Nurs Educ. 2022;61(X):XXX-XXX.].

Psychometric evaluation of the Arabic version of the Irish Assertiveness Scale among Saudi undergraduate nursing students and interns

Background

Irish Assertiveness Scale is commonly used to examine the individual’ level of assertiveness. There is no adequately validated Arabic instrument that examines the level of assertiveness among Arabic-speaking undergraduate nursing students.

Objectives

The purpose of this study was to translate, then evaluate the psychometric properties of the Arabic version of the Irish Assertiveness Scale among Saudi undergraduate nursing students and interns.

Design

Cross-sectional survey.

Settings

Three nursing colleges from three provinces in Saudi Arabia: Riyadh, Eastern and Makkah provinces.

Participants

283 questionnaires were completed by 3^rd and 4^th year undergraduate nursing students, and nursing interns.

Methods

A standard procedure including forward-backward translation, cultural adaptation and pilot testing was adopted to translate the Irish Assertiveness Scale into Arabic language. Content validity was measured using content validity index. Scale reliability was measured using cronbach’s alpha coefficient and mean inter-item correlation. The sample was randomly split, and exploratory and confirmatory factor analysis was then conducted on each sample to examine the construct validity of the proposed scale. A subsequent convergent validity and discriminant validity were also tested.

Results

The item-level content validity index ranged from 0.9 to 1.0, and the overall content validity index was 0.93. The exploratory factor analysis resulted in 23-items, four-factor solution explaining 49.4% of the total variance. The mean inter-item correlation for each factor ranged between 0.22 and 0.4. Cronbach’s alpha coefficients for the overall scale was 0.80. The confirmatory factor analysis showed that the proposed four-factor solution had the best model fit. Whilst discriminant validity was supported in the new model, convergent validity was partially met.

Conclusions

This study contributed toward establishing the Arabic version of the Irish Assertiveness Scale. Considering the limitations of the convergent validity demonstrated in the new instrument, a modified version of the Irish Assertiveness Scale might be needed to ascertain the most feasible model which best captures the level of assertiveness in Arabic cultural context.

Investigation the correlation between psychological empowerment and assertiveness in nursing and midwifery students in Iran

BACKGROUND

Assertiveness is a key skill for nurses and midwives, and should be considered in the students' education. In this regard, variables such as psychological empowerment, which may have a significant correlation with assertiveness, should be identified and studied.

OBJECTIVES

The aim of this study was to investigate the correlation between psychological empowerment and assertiveness in nursing and midwifery students.

DESIGN

A cross-sectional and correlational study.

SETTINGS

/Participants: This study was carried out on 200 Iranian nursing and midwifery students.

METHODS

The students were randomly selected for the study. The study tools were The Rathus' Assertiveness Schedule and Spreitzer's Psychological Empowerment Scale. Data were analyzed by descriptive and inferential statistics.

FINDINGS

There was a positive and significant correlation between psychological empowerment and assertiveness. The components of meaning and self-determination had a positive and significant correlation with the assertiveness.

CONCLUSIONS

Since psychological empowerment and assertiveness in decision-making and interaction with colleagues and patients are considered as essential skills for nurses and midwives, we recommend that, required measures should be taken to promote these skills in nursing and midwifery students.

What a difference a year makes: the impact of the district nursing specialist practice programme

District nursing has a long history as a service that provides care for patients in their home environment. Demographic changes and a need to optimise out of hospital care has impacted on the acuity of patients supported and the complexity of caseload management. District nurses, in order to effectively manage such increased demands on their busy service, need to possess excellent, assertive case management skills. This study explores and evaluates the impact of the Specialist Practice Qualification in district nursing on the assertiveness and leadership skills of students. A mixed methods approach was adopted, utilising a quantitative assertiveness questionnaire at three points during the programme across the 12 participating higher education institutions, alongside qualitative semi-structured interviews. Statistical analysis of assertiveness scores demonstrated a statistically significant increase in scores across the duration of the programmes, with no difference related to the academic level of programme studied. Qualitative analysis demonstrated wide ranging positive impacts of the programme, including the acquisition of knowledge of underpinning theory, enhanced leadership skills and the development of a voice to truly advocate for the patient. The Specialist Practice Qualification has a dramatic impact on the professional performance of students selected to undertake the programme. The programme is frequently at risk as a result of cuts in post-registration funding. This study effectively demonstrates the substantial impact of the programme; a programme that should remain an option for future district nurses.

Promoting emotional intelligence and resilience in undergraduate nursing students: An integrative review

OBJECTIVE

To synthesize the evidence that explored resilience and emotional intelligence in undergraduate nursing students.

BACKGROUND

Nursing is a demanding profession that offers unique challenges. Emotional intelligence and resilience are traits that can allow nursing students to effectively respond to challenges in professional placements and future practice.

DESIGN

An integrative review incorporating both quantitative and qualitative research designs.

DATA SOURCE

Studies in the English language were identified through a systematic search in electronic databases: CINAHL, PubMed, ERIC, Scopus and PsycINFO. No restriction dates were used and the search was up until November 1, 2017.

REVIEW METHODS

Methodological quality was assessed using the Critical Appraisal Skills Programme checklist for qualitative research and the Newcastle-Ottawa Quality Assessment Scale for quantitative research. Data analysis was conducted based on the integrative review method.

RESULTS

Fourteen articles were included. A positive relationship was found between resilience and performance in undergraduate studies including professional experience placements. While some studies observed an important role for emotional intelligence for nursing students, there is currently insufficient evidence to conclude that emotional intelligence improves nursing students' communication, academic success and retention.

CONCLUSION

Developing skills, such as resilience, as part of nursing programs allows students to be better prepared to deal with the unique challenges in nursing practice.

Nursing curriculum and bullying: An integrative literature review

OBJECTIVES

The purpose of this integrative review was to identify and synthesize key concepts that inform curriculum which increase nursing students' competence, skills and strategies when addressing bullying. Specifically, the authors sought to examine the concepts informing educational interventions, skills, and strategies, which addressed the bullying of nursing students.

DESIGN

Integrative literature review.

DATA SOURCES

A search of the electronic databases CINAHL, MEDLINE, ERIC, PsycINFO, Proquest, and PubMed was conducted in January 2016 using search terms such as 'bully' 'nursing student' 'education' and 'curriculum'.

REVIEW METHODS

Articles were screened for relevance and eligibility and extracted onto a table. Critical appraisal was conducted using multiple tools. Papers were analysed using constant comparison and concept mapping.

RESULTS

61 articles were included in the synthesis. Concepts identified included: empowerment, socialization, support, self-awareness, awareness about bullying, collaboration, communication, and self-efficacy. All concepts linked to empowerment. Social Cognitive Theory was used by many studies. Active teaching methods which gave students opportunities to practice skills were the most effective.

CONCLUSIONS

Empowered nursing students have the potential to address bullying more effectively and competently. Empowerment of nursing students is a powerful concept that educators must consider when developing curriculum and educational interventions to address bullying.

Is modified brief assertiveness training for nurses effective? A single-group study with long-term follow-up

AIM

To evaluate the long-term effectiveness of modified brief assertiveness training (with cognitive techniques) for nurses.

BACKGROUND

Most assertiveness training takes a long time to conduct; thus, briefer training is required for universal on-the-job training in the workplace.

METHODS

In this single-group study, nurses received two 90-min training sessions with a 1-month interval between sessions. The degree of assertiveness was assessed by using the Rathus Assertiveness Schedule as the primary outcome, at four time points: pre- and post-training, 3-month follow-up and 6-month follow-up.

RESULTS

A total of 33 nurses received the training, and the mean Rathus Assertiveness Schedule score improved from -14.2 (SD = 16.5) pre-training to -10.5 (SD = 18.0) post-training (p < .05). These improvements were maintained until the 6-month follow-up. The pre-post effect size of 0.22 (indicating small effect) was larger than the effect sizes ranging from -0.56 to 0.17 (no effect) reported in previous studies that used brief training.

CONCLUSIONS

Modified brief assertiveness training seems feasible and may achieve long-term favourable outcomes in improving assertiveness among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The ease of implementation of assertiveness training is important because creating an open environment for communication leads to improved job satisfaction, improved nursing care and increased patient safety.

The Relationship Between Cultural Sensitivity and Assertiveness in Nursing Students from Turkey

Background: As foreigners live in and visit Turkey for various reasons, it is essential to provide culturally appropriate health care. Purpose: This study was conducted to determine the relationship between cultural sensitivity and assertiveness in university nursing students. Method: This descriptive, cross-sectional study was conducted at two universities in the cities of Kilis and Elazığ, Turkey. The study sample consisted of 444 nursing students. Data collection tools included a questionnaire about participant sociodemographic characteristics, Chen and Starosta’s Intercultural Sensitivity Scale, and the Rathus Assertiveness Scale. Results: The mean age of participants was 21.09 years. Most students (71.6%) were female and 34.7% of the students stayed at the hostel. Of the students, 44.4%, 27.5%, and 28.2% attended were the second-, third-, and fourth-year students, respectively. Participants were asked about problems related to caring for patients who speak different languages. The mean score for the Intercultural Sensitivity Scale was 89.42 ± 13.55 and the total score for all students for the Assertiveness Scale was 112.64 ± 15.61. We identified a positive relationship between total scores for the Intercultural Sensitivity Scale and the Assertiveness Scale ( p < .001). There was relationship between cultural sensitivity and gender and want to work overseas; assertiveness and year of nursing education and want to work overseas. Conclusions: Nursing students at both schools had a moderate level of cultural sensitivity and assertiveness. It has been determined that as assertiveness level of the students increased, intercultural sensitivity of them also increased. Implications for Practice: Consequently, it is concluded that training as assertive and self-confident individuals during the nursing education of students has a contribution to making patient-specific and culture-sensitive care.

Emotional intelligence and affective events in nurse education: A narrative review

OBJECTIVE

To investigate the current state of knowledge about emotional intelligence and affective events that arise during nursing students' clinical placement experiences.

DESIGN

Narrative literature review.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Scopus, Web of Science, ERIC and APAIS-Health databases published in English between 1990 and 2016.

REVIEW METHODS

Data extraction from and constant comparative analysis of ten (10) research articles.

RESULTS

We found four main themes: (1) emotional intelligence buffers stress; (2) emotional intelligence reduces anxiety associated with end of life care; (3) emotional intelligence promotes effective communication; and (4) emotional intelligence improves nursing performance.

CONCLUSIONS

The articles we analysed adopted a variety of emotional intelligence models. Using the Ashkanasy and Daus "three-stream" taxonomy (Stream 1: ability models; 2: self-report; 3: mixed models), we found that Stream 2 self-report measures were the most popular followed by Stream 3 mixed model measures. None of the studies we surveyed used the Stream 1 approach. Findings nonetheless indicated that emotional intelligence was important in maintaining physical and psychological well-being. We concluded that developing emotional intelligence should be a useful adjunct to improve academic and clinical performance and to reduce the risk of emotional distress during clinical placement experiences. We call for more consistency in the use of emotional intelligence tests as a means to create an empirical evidence base in the field of nurse education.

Lateral hostilities among nurses employed in intensive care units, emergency departments, operating rooms, and emergency medical services. A national survey in Italy

BACKGROUND

Lateral hostilities (LHs) are "nasty, unkind, aggressive behavior between colleagues working at comparable organizational levels." When LHs occur "at least once a week for a period of not less than 6 months," they become "bullying." The frequency of lateral violence in health care literature varies from 5.7% to 65%.

OBJECTIVES

The aim of this study was to explore the extent of LH and the effects on the quality of lives of Italian nurses working in prehospital emergency medical system, emergency department, intensive care unit, and operating rooms.

METHODS

A descriptive study was conducted through an online survey in the Web site of the National Italian Association of Critical Care Nurses (ANIARTI).

RESULTS

A total of 1504 nurses filled up the questionnaire, with 1202 valid data entries (79.9%). Of this group, 739 (61.5%) were women and 951 (79.1%) had experienced some form of LH at least once in the last 12 months, whereas 269 (22.4%) felt to be victims of bullying. The number of transfers to other departments/services due to LH was 43 cases (3.6%), and 829 (69%) experienced psychophysical disorders attributed to LH experienced in the span of the year.

DISCUSSION

Lateral hostility is a frequent occurrence that calls for implementation of management policies to achieving an overall improvement of the work environment climate.

Enhancing assertiveness in district nurse specialist practice

District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.

The effect of nurse education on the self-esteem and assertiveness of nursing students: A four-year longitudinal study

BACKGROUND

The nurse education program affects many aspects of personal development. Nursing students gain skills in critical thinking and analysis and also develop communication and management skills. The four-year program may also have an effect on students' assertiveness and self-esteem.

OBJECTIVES

This study was conducted to determine the impact of the four-year higher nursing school educational program on students' self-esteem and assertiveness.

DESIGN

Descriptive longitudinal design.

SETTING

The study took place at a Foundation University in Istanbul, Turkey over the period 2006-2010. The students' levels of self-esteem and assertiveness were assessed at the beginning and end of the first, second, third and fourth years of the program.

Assertiveness and problem solving in midwives

BACKGROUND

Midwifery profession is required to bring solutions to problems and a midwife is expected to be an assertive person and to develop midwifery care. This study was planned to examine the relationship between assertiveness and problem-solving skills of midwives.

MATERIALS AND METHODS

This cross-sectional study was conducted with 201 midwives between July 2008 and February 2009 in the city center of Sivas. The Rathus Assertiveness Schedule (RAS) and Problem Solving Inventory (PSI) were used to determine the level of assertiveness and problem-solving skills of midwives. Statistical methods were used as mean, standard deviation, percentage, Student's T, ANOVA and Tukey HSD, Kruskal Wallis, Fisher Exact, Pearson Correlation and Chi-square tests and P < 0.05.

RESULTS

The RAS mean scores and the PSI mean scores showed statistically significant differences in terms of a midwife's considering herself as a member of the health team, expressing herself within the health care team, being able to say "no" when necessary, cooperating with her colleagues, taking part in problem-solving skills training. A statistically significant negative correlation was found between the RAS and PSI scores. The RAS scores decreased while the problem-solving scores increased (r: -0451, P < 0.01).

CONCLUSIONS

There were significant statistical differences between assertiveness levels and problem solving skills of midwives, and midwives who were assertive solved their problems better than did others. Assertiveness and problem-solving skills training will contribute to the success of the midwifery profession. Midwives able to solve problems, and display assertive behaviors will contribute to the development of midwifery profession.

The Effect of Assertiveness Training on the Mobbing That Nurses Experience

This research was designed to determine the impact of assertiveness training on the mobbing experience of nurses. This study was conducted in two phases. In the first phase, 218 nurses completed the mobbing scale; the education group consisted of 38 nurses who received a score at or above 204 points. A total of 180 nurses were excluded from the education group because they received less than 204 points. The study was conducted with 30 nurses because 8 nurses did not agree to participate in the study. The 30 nurses received the assertiveness training program. Six months after training, the nurses completed the mobbing scale and Rathus Assertiveness Inventory (RAI) again. The assertiveness training positively affected the assertiveness and mobbing scores ( p = .000). After the training, the assertiveness scores increased and the mobbing condition score decreased ( p < .01). Assertiveness training is an effective method for decreasing mobbing. In line with these results, training programs, which support nurses’ personal development by providing counseling and support to nurse victims of mobbing, are recommended.

Assertiveness training for undergraduate midwifery students

Assertiveness can be defined as an interpersonal behaviour that promotes the fact all people in a relationship are equally important. All health professionals including midwives must work with and care for people. At times this will include facilitating interactions that require skilful negotiation and assertiveness. Yet embedding assertiveness education into undergraduate midwifery curricula has not been widely adopted. This paper explores one method of delivering assertiveness training in an undergraduate midwifery course and provides comment on the effectiveness of this strategy in developing assertiveness skills in a cohort of undergraduate midwifery students. We used an assertiveness survey which was administered immediately before and 3-4 months after an assertiveness training workshop. All students (n = 55) attending the training day were invited to participate. Of these 41 (77% response) chose to participate in the pre intervention survey and 32 participated (9 students lost to follow-up) in the follow up survey. There was an overall improvement in self-perceived assertiveness scores following the assertiveness training workshop. These findings provide encouraging evidence that educational institutions that offer specific and targeted assertiveness education will be rewarded with more assertive graduates.

Self-confidence, gender and academic achievement of undergraduate nursing students

The aim of this study was to determine the self-confidence levels of nursing students and the factors related to such self-confidence. Data were obtained via a questionnaire for socio-demographic characteristics and a 'Self-Confidence Scale' prepared by the researchers. High self-confidence levels were noted in 78.6% of female students and 92.3% of male students. While 84.5% of second-year students had high self-confidence levels, this rate was 76% in fourth-year students. Female nursing students were significantly less self-confident than male students. Self-confidence should be nurtured in a caring nursing curriculum; however, there is a lack of clarity as to what confidence means, how it is perceived by students and what educators can do to instil self-confidence in nursing students.

Factors affecting assertiveness among student nurses

This study aimed to investigate the factors affecting assertiveness among student nurses. The study was carried out at Faculty of Nursing, Port-Said University, on 207 student nurses from four different grades. Rathus Assertiveness Schedule, consisted of 30 items, was used to measure the students' assertiveness level and a 12-item scale developed by Spreitzer was used to measure students' psychological empowerment. The study results showed that 60.4% of the students were assertive, while about half of the students were empowered. A positive relation between student assertiveness and psychological empowerment was detected. Moreover, positive relations regarding family income and students' assertiveness and psychological empowerment were determined. The study recommended introduction of specific courses aiming at enhancing the acquisition of assertiveness skills, in addition, nurse educators must motivate their students to express their opinion and personal rights and also they must pay attention for students' empowerment and enhance students' autonomy.

Relation of assertiveness and anxiety among Iranian University students

ACCESSIBLE SUMMARY

• The findings from the present study revealed that less than 30% of nursing and midwifery students have high assertiveness and only half of them have low anxiety. • Assertiveness and anxiety have negative correlations in nursing and midwifery students and affect the mental health and educational and occupational performance of the students. • Many factors such as years of education and working while studying influence the level of assertiveness in the students. • The anxiety in students had a significant relation with the father's level of education, family income, etc.

ABSTRACT

The simultaneous existence of low assertiveness and high anxiety in nursing and midwifery students leads to the disruption of study performance. There exists little information concerning their assertiveness. The purpose of this study was to determine the relation of assertiveness and anxiety in nursing and midwifery students. In this correlational, cross-sectional study, 173 nursing students (68 males and 105 females) and 77 midwifery students were recruited from the Tehran University of Medical Sciences in Iran. Data were collected using a questionnaire including personal-social factors, the Spielberger Trait Anxiety Inventory and the Assertion Inventory of Gambrill and Richey. More than half of the nursing and midwifery students (59.5% and 59.7%, respectively) had moderate assertiveness. Also, 43.3% and 36.4% of them had moderate and high levels of anxiety. Pearson correlation test revealed that assertiveness and anxiety had negative correlations in nursing (r=-0.51, P < 0.001) and midwifery (r=-0.449, P < 0.001) students. Some demographic variables had significant correlations with assertiveness and anxiety among the students. Considering the relation of assertiveness and anxiety and its effects on mental health and educational and occupational performance, students should be informed of the required skills for positive interaction with others and to increase assertiveness and decrease anxiety.

Empathic anger in junior nursing students

The ideal clinical experience fosters development of psychomotor, cognitive, and affective skills while affording initial socialization into the profession. It is expected that during these experiences, nursing students will encounter illustrative exemplars of caring and professional values. The primary stressors during initial clinical experiences arise from issues related to performance and socialization. Nursing students view a good relationship with the RNs at the clinical site as the most crucial influence on their professional growth and development. Even more distressing to students than being treated poorly themselves is watching patients receive uncaring treatment. Students' sadness and anger provoked by perceived uncaring treatment blends to form empathic distress. A content analysis of an assigned narrative from junior nursing students explores empathic anger experienced by the students during their initial clinical rotations.

A longitudinal study of stress and self-esteem in student nurses

INTRODUCTION

It is well recognised that nurse education/training can be a stressful experience and that self-esteem is an important predictor of stress. BACKGROUND/LITERATURE: While there are a significant number of studies showing levels and contributors to stress among students. There is little evidence of how these levels change over time. The aim of the study was to investigate nursing students' experiences of stress and levels of self-esteem during three years of their undergraduate nursing programme.

METHODS

Participants completed the stress in nurse education questionnaire and the culture free self-esteem inventory at various time points in the study, and a demographic questionnaire at baseline. The students who took part in the study commenced their nurse training in September 2002.

DATA/RESULTS

This study has demonstrated that levels of self reported stress and "general" self-esteem are significantly different at different stages the nurse training process. Self reported stress were at the highest at the beginning of the third year and these were significantly higher when compared to stress reported at any other time point. Self-esteem levels were lowest at the end of training.

CONCLUSIONS

Trying to obtain data only at single time point during nurse education/training is inadequate as this research has shown that there is indeed variation in student psychological well being across the academic year.

Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments

The primary purpose of this study was to validate the perceptions of frequency and patterns of bullying behavior experienced by registered nurses (RNs) across the United States. This study was completed to develop relevant and sensitive tailored interventions for the future. A 30-item anonymous electronic survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying. Findings from the overall population of 303 RN respondents (mean age of 49 years) indicated that 70% of the bullying was reported by a predominant group of staff RNs (n = 212), and it is this group that is the focus of this report. Of this group, bullying occurred (a) most frequently in medical-surgical (23%), critical care (18%), emergency (12%), operating room/Post Anesthesia Care Unit (9%), and obstetrical (7%) areas of care and (b) within the 5 years or less of employment on a unit (57%). Perpetrators included senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%) who publicly humiliated, isolated, excluded, or excessively criticized the staff nurses. Subsequent stress levels were reported as moderate or severe, with support found primarily with family, colleagues, and friends and not with an available workplace infrastructure of solution. Many left the workplace completely with or without jobs awaiting them. Bullying among U.S. nurses is a hidden problem with significant patient-directed quality performance and workforce implications. It is critical that innovative strategies be developed and implemented to address the root cause of this problem.

Undergraduate nursing students' level of assertiveness in Greece: a questionnaire survey

BACKGROUND

A number of studies of nursing and midwifery have found stress and bullying to be frequent problems. Those suffering from bullying and stress need to have high levels of assertiveness to resist and to cope successfully. Hence, it was considered vital to assess the assertiveness level of nursing students throughout their training curriculum.

METHODS

The study population was composed of nursing students in different semesters at one school in Central Greece (n=298) who agreed to complete a questionnaire on assertiveness level assessment, which had been translated into Greek and adapted to this population. All students present in class completed the questionnaire, representing 80% of the total population of active students. Mean assertiveness scores between semesters were compared by ANOVA and comparisons between the responses of the first semester students and responses of advanced semester students were done by Pearson's chi square.

RESULTS

The main finding of this study was that the assertiveness levels displayed by students increase slightly in advanced semesters by comparison to those displayed by first-semester students.

CONCLUSIONS

Assertive behavior should be encouraged through learning methods. Nurses should preferably obtain this training throughout their studies. Instructors have an essential role in the improvement and achievement of assertiveness training curriculums for undergraduate nursing students.

A review of nursing and midwifery education research in the Republic of Ireland

This literature review aims to (a) provide a summary of the research conducted in the Irish nurse/midwifery education field, (b) identify key recommendations from the research reviewed and (c) examine the policy, theory and methodological implications of the research conducted. The electronic databases of CINAHL (EBSCO host 1982-2006) and PubMed (1950-2006) were searched for the relevant literature. Sixty-one studies satisfied the criteria for inclusion which were based on; quality of research design, sampling, data analysis, scientific merit, and authorship (registered nurse/midwife who conducted research in the Republic of Ireland). Findings demonstrated diversity in relation to aims, methods and results highlighting a need to formulate a collaborative research agenda in nurse and midwifery education.

Sexual bullying: addressing the gap between bullying and dating violence

Millions of youth in the United States are involved in some aspects of bullying behavior. Increasing rates of youth violence, including horrific violent school events, have brought national attention upon the phenomenon. Bullying is a broad construct that covers a wide variety of behaviors from name calling to physical abuse, and it is associated with serious negative health outcomes. Sexual bullying appears to be antecedent to more severe forms of relationship violence, and it is proposed as a conceptual link between bullying and more advanced forms of sexualized violence, such as teen dating violence and adult forms of intimate partner violence.