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Correlation of Assertive Behavior with CommunicationSatisfaction among NursesMaheshwari S K1 and Gill Kanwaljit Kaur21, Corresponding Author & Assistant Professor, University College of Nursing, BFUHS, Faridkot (Pb), India2, Professor and Principal, SKSS College of Nursing, Sarabha, Ludhiana (Pb), IndiaAbstractBackground: Assertive nurses are likely to impart effective patient care as they can stand up for their rights andrefuse unreasonable requests but nurses show non-assertive and submissive behaviour which result in lack ofcommunication satisfaction, stress and low self esteem. Objective: The aim of the present study was to examinethe relationship of assertive behaviour and interpersonal communication satisfaction among nurses. Methods: In adescriptive, co-relational, cross sectional survey, 220 eligible nurses working in selected hospitals of Punjab wereidentified conveniently and data were gathered using Socio demographic Data Sheet, Rathus AssertivenessSchedule (RAS) and Interpersonal Communication Satisfaction Inventory (Com-Sat). Data were analyzed usingdescriptive statistics and Independent t-test, ANOVA and Pearson’s correlation. Results: Assertive behavior haslarge positive correlation with interpersonal communication satisfaction at 0.01 level of significance (r= 0.505**).Older nurses who are on regular job, studied from Govt. nursing institutions and working in Govt. hospitals weremore assertive. Nurses those are older (p<.002), studied from Govt. nursing colleges (p<.03) and with designationof nursing sister/ward in-charges had more score on communication satisfaction score as compared to staff nurses(p<.049). Conclusion: Study concluded that assertive behaviour of nurses results in high interpersonalcommunication satisfaction. Nurses should use assertive behaviour as it directly affects the interpersonalcommunication satisfaction ultimately results in high patient care. Policy makers can plan and organizeassertiveness training or other intervention for non assertive nurses so that they can be trained for assertivebehaviour and communication.Keywords: Assertive behaviour, Interpersonal communication satisfaction, Nurse.INTRODUCTIONNursing in hospitals involves negotiating complex interpersonal relationships and working in overcome a socialand political context within constraints of resources, while balancing a multiplicity of tasks and roles. Nurses areproviding care and comfort to those suffering from illness and injury. Nurses communicate with each other, withpatients and with members of the health team during delivery of health care, both verbally and nonverbally andtransmit their thoughts, feelings and massages (Geldard & Geldard, 2009). Nursing research literatures call thenurses to become more assertive (Gaddis 2004, Madden P 1996). Assertiveness has great importance in nursingpractice, but that it is complex and requires time and practice to make it effective (McCabe C & Timmins F,2003).Assertiveness is the ability to be honest, direct and appropriate expression of opinions, feelings,attitudes and rights, without undue anxiety, in a way that doesn’t infringe on the rights of others (Albert &Emmons, 1986). Assertiveness is a one style of communication which reflects nurse’s expression of theirgenuine feelings, standing up for their legitimate rights, and refusing unreasonable requests (Maheshwari, 2008).Assertive nurses resist undue social influences, disregard arbitrary authority figures, and refuse to conform toarbitrary group standards. Assertive nurses value what they think and feel personal empowered, have self esteemand self respect (Townsend 2003). They recognize their own strengths and limitations. In addition, beingassertive means taking responsibility for his life and his choices (Rees S & Graham, 1991).Assertive behavior develops respect towards self and other nurses, promotes self-disclosure, selfcontrol, increase confidence, satisfactory communication (McCabe C & Timmins F, 2010) and positiveappreciation of self-worth. It is the most effective way of solving interpersonal problems and conflicts. Assertivenurses become happier, less manipulative, feel better about them and reach their goals more easily. Nurses whodisplay assertive behaviour are more likely to maintain rigorous patient care practices while also assistingpatients in expressing their own needs. Assertive nurses are also better skilled at communicating effectively withother members of the health care team than unassertive nurses (Hodgetts, 2011).Factors which promote assertive behavior among nurses at work include age, sex, high education,seniority in job, knowledge, confidence, experience and wearing of uniform (Jaime et al 1998). Senior staffnurses are more assertive than junior staff nurses. Older age nurses are less assertive than young age. Diplomaholder nurses are less assertive than baccalaureate nurses (Kilkus SP 1993).Although studies have found assertive behaviour in nurses to be an invaluable component of successfulcommunication practice, nursing has been described as an oppressed discipline that remains the underdog in themedicine profession (Kilkus SP 1993). Chan D (2002) suggested that the culture of nursing has encouragedJournal of Health, Medicine and Nursing www.iiste.orgISSN 2422-8419 An International Peer-reviewed JournalVol.14, 201569passivity rather than assertiveness. As a result of this, there is a high probability that professional nurses may notconduct themselves with sufficient assertiveness both in the work place and in advancing their careers.Professional nurses frequently did not express their opinions or provide constructive criticism andsuggestions in nursing practice (Gholamhossein 2009). Timmins and McCabe (2005) reported that the nursesbehave in a passive, nice way and was 'less adept at disagreeing with others' opinions and providing constructivecriticism' (Jaime et al 1998, Kilkus SP 1993).Lack of assertiveness result in frequent emotional trauma because nurses have poor communicationskills and are unable to express their feelings about their needs and worries. Nurses who are unable to discussimportant issues with others develop self-destructive beliefs which are emotionally damaging for them. It resultin unsatisfactory communication. Nurses may also develop maladaptive behaviors in order to cope with theseemotions (Geldard & Geldard, 2009). Non-assertive behavior among nurses results in high stress (Lee &Crockett 1994, Yamagishi et al 2007), low self esteem (Maheshwari & Gill 2015), frustration, anxiety andmental fatigue (Karagozoglu, 2008). Nurses have burden of other people’s work due to inability in saying “no”.Areti Klisiari & Alexia Gaki (2012) reported that communication is the most important variable in thisnurse patient relationship. A good communication contributes to the smooth conduct of any examination andprocedure and has a positive impact on health outcomes, and provides satisfaction to the health care professionalwho influences and is influenced by his relationship with the patient. Siamian Hasan et al (2014) evaluated theinterpersonal communication skills among the health care centers staff and indicated that public relation skill,listening, reward and punishment in good scope and other skills were in the average scope. Ross Linda et al
(2014) did a study to identify paramedic students’ perceptions of their interpersonal communication competence
and suggested that student paramedics self-report their interpersonal communication skills highly apart from
areas related to assertiveness and listening skills.
Abdollah et al (2012) reported that interpersonal communication skills training program increased the
job satisfaction among the working nurses. Yen-Ru Lin et al (2004) studied the effect of an assertiveness training
program on nursing and medical student’s assertiveness, self-esteem, and interpersonal communication
satisfaction and found that assertiveness and self-esteem of the experimental group were significantly improved
in nursing and medical students after assertiveness training.
The existence of the above problems raised the awareness of the researcher that most of the professional
nurses in hospitals were lacking assertive behaviour and only few were situational assertive. In paucity of
evidence over the subject in India, the present study is aimed to assess the relationship of assertive behavior with
interpersonal communication satisfaction among nurses in selected hospitals of Punjab. Study will also measure
the association of assertive behaviour and interpersonal communication satisfaction with selected sociodemographic
and professional characteristics of nurses. Moreover, the findings of this study will have
significance in the field of assertiveness training. The findings will help the future nurse practitioner and
researcher to develop effective guidelines concerning the scheduling and formatting of assertiveness training
from the results of the study. Also, specific recommendations for further research in assertiveness training will be
drawn from the results of this study.
MATERIAL AND METHODS
A descriptive, co-relational cross sectional survey was done to assess the relationship of assertive behavior and
interpersonal communication satisfaction with each other and with other demographic variables among nurses.
The present study was conducted in the November-December 2013 at fourteen conveniently selected hospitals
located in four districts of Punjab. The hospitals were selected on the basis of expected availability of nurses,
giving permission to conduct the study and convenience in terms of distance. The population under study is
nurses working in the selected hospitals of Punjab. Sample consisted of staff nurses of various hospitals, those
meeting the inclusion criteria were selected by the researcher for the study. The group included only those staff
nurses
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