Assertiveness in nursing-increasing the level of confidence among nursing professionals: A review

Assertiveness refers to an optimistic Attribute of an individual where he/she knows what needs to be spoken or discussed without nagging or denigrate the other person. This article stresses on the need of assertion among nursing competent. It further justifies the techniques and factors influencing the assertiveness. It also Clear up the difference between passive behavior, aggressive assertive behavior that would allow the nurses to control the situations politely. Assertiveness is considered also to be an essential interpersonal skill, especially for nurses. Becoming more assertive can lead to increased respect and recognition as a person and as a nurse. As nurses work in different situations they have to be assertive in order to meet the confrontation and to win the collaboration from others


Introduction
Assertiveness is a very essential skill required for our daily lives.Individuals can get things done if they are assertive.Of course, they must ensure that they are not aggressive.Whatever has to be said has to state in clear and matter-of-fact terms and not in an abusive manner 1 .
Assertiveness is the way of expressing one's feelings, opinions, beliefs, and needs openly and honestly, without violating the rights of others.Assertive staff nurses are able to suggest their views clearly and accepts and takes criticism positively, respects the rights and responsibilities in a nursing situation and act accordingly.Lack of assertiveness results in ineffective communication thus compromising quality patient care.If suppose, the patients identify the lack of assertiveness in nurses, they do not develop trusting relationship with them.Assertive nurses empower their patients and build confidence in whatever the care provided 2, 3 Assertiveness is essential to nursing profession in many ways.Nursing profession is the respectful profession which demands and shows respect for others.Assertive ways of communicating and putting one's own concerns, ideas in front of others which help to the clients care as well as for nursing profession itself.Assertive nurse defends client in every aspect.It enhances honesty and dedication in the nursing profession 4

Definition
Assertiveness is defined as the ability to express one's feelings, opinions, beliefs, and needs directly, openly and honestly, while not violating the personal rights of others 5 (Ellis & Hartley, 2005).
Assertiveness is described as the ability to be comfortably strong willed about one's thoughts, feelings, and actions; and neither inhibited nor aggressive in actions for the betterment of oneself in the surrounding environment 5 .

Assertive Body Language
Body language is a powerful way of communicating to people how has on others.When you are trying to use the following assertiveness techniques, try to also use assertive we would like to be treated.Sometimes, we are unaware of our body language and the impact it body language.
Assertive body language includes the following:

Basic Assertion
Basic assertion is when we make a statement that expresses clearly our needs, wants, beliefs, opinions or feelings.This type of assertion can be used every day to make our needs known.Typically basic assertion uses "I" statements.

Saying "No"
Many people have great difficulty saying "No" to others.Even people who are quite assertive in other situations may find themselves saying "Yes" to things that they really don't want to do.Now saying "Yes" to something you don't really want to do can be inappropriate in some situations.

Broken Record
Be persistent and keep saying what you want over and over again without getting angry, irritated, or loud.Stick to your point.

Free Information
Learn to listen to the other person and follow-up on free information people offer about themselves.This free information gives you something to talk about.

Self-Disclosure
Assertively disclose information about yourself -how you think, feel, and react to the other person's information.This gives the other person information about you.

Fogging
An assertive coping skill is dealing with criticism.Do not deny any criticism and do not counterattack with criticism of your own.

Agree with the truth
Find a statement in the criticism that is truthful and agree with that statement.9. Agree with the odds: Agree with any possible truth in the critical statement.

Agree in principle
Agree with the general truth in a logical statement such as, "That makes sense."

Negative Assertion
Assertively accepting those things that are negative about yourself and Coping with your errors.

Workable Compromise
When your self-respect is not in question offer a workable compromise.

Accepting Compliments
Some people find it extremely difficult to accept compliments.Understandably there are times when it may feel uncomfortable; however, being able to accept other people's positive comments about our appearance, our work or some other aspect of ourselves is an important assertiveness and social skill 7 .

Factors influencing assertiveness in nursing
Assertiveness is considered as an important responsibility of the nurses.And it is a learned skill that has to be developed.There are different factors which influence the development and practice of assertive behavior in a person.Two main factors that influence our decision to "speak up" or be assertive are

Our perception of the reaction of others to the situation
Generally, in a group setting, if we see something wrong, we first look at how others are reacting before we speak up.
When we look at the reaction of others, we are checking to see if they appear concerned with the situation.If we find that others do not appear concerned then we will probably be reluctant to speak up.

Perceived obedience to authority
We may also not "speak up" because we believe we are just following orders or that speaking up would represent questioning authority.This type of obedience towards authority and the personal feeling of powerlessness inhibit the assertiveness.Team leaders can reduce these barriers by ensuring that team members understand that assertive behaviour is demanded of all personnel.Junior members must be confident that senior leadership has empowered them to speak up, without fear of reprisal 8 .The factors influencing the assertiveness of a person can be broadly classified as

Why assertiveness is essential for nurses?
In all spheres of our professional lives, we have to be assertive.It is a competitive world today.One faces many challenges in one's work arena.Also, one has to deal with all kinds of people.Some may be helpful and cooperative and others may not be so helpful.It may not be very easy to convince some people.At times your views may not be acceptable to the other person.Only the person who is assertive can get his way or else everybody will trample upon him or her.One has to be firm about things and not give easily to everything that another person wants him or her to do.
Assertiveness is an important requisite for today's professional nurse.As nurses move away from traditional subservient roles and perceived stereotypes it is increasingly being recognized that a nurse needs to be assertive.It mitigates against personal powerlessness and results in personal empowerment.Nursing has determined that assertive behavior among its practitioners is an invaluable component for successful professional practice.It enables us to express ideas while respecting the ideas of others, overcome burnout and to reduce distress, to solve problems diplomatically and tactfully, to negotiate healthily to tackle verbal abuse and violence in work environment Nursing is centred on the nurse-patient relationship.Nursing is a profession whose "object" is the human being and thus the success of the work is partly determined by the effective cooperation with patients and other health care professionals.Assertiveness is necessary for effective nurse/patient communication, and it is suggested that its development may also aid the confidence of the profession as it develops.It is considered as one of the essential life skills that has to be developed by everyone 8

Conclusion
Nurses communicate with patients, colleagues and other health care team members on a daily basis; such an interaction is improved when nurses have speechifying skills.The potential benefits of assertive behavior to nurses are immeasurable where it enhanced self-awareness, improved staff performance, improved patient care and interdisciplinary collaboration and cohesiveness.Consequently assertiveness is a key attribute for nurses without which true autonomy, professional status or empowerment cannot be achieved.

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PASSIVE Violates one`s own rights by failing to express honest feelings, thought and beliefs and consequently permitting others to violate oneself or the expressing of one`s own thoughts and feelings in such an apologetic, meek manner that others can easily disregard them.The basic message of an aggressive communicator: "This is what I think -you are stupid for believing differently.This is what I want -what you want is not important.This is what I feel -your feelings don`t count".oThegoal of aggressive communication is domination, and winning, forcing the other person to loose.Winning is ensured by humiliating, degrading, or overpowering other people so that they become weaker or less able to express and defend their needs and rights.
o Body language : invasive / angry staring -eye contact , loud voice , invasion of personal body space , use of aggressive gestures ( pointing finger ) , stiff , posturing , towering cloths .ASSERTIVEStands up for personal rights and expresses thoughts, feelings, and beliefs in direct and appropriate ways that do not violate another person`s rights .oThebasicmessage of an assertive communicator: "This is what I think.This is what I feel .This is how I see the situation".The goal of assertive communication is to get and give respect, to ask for fair play , and to leave room for compromise when the rights and needs of two people conflict .oBody language : Direct but non threatening eye contact , calm voice , respectful of personal body space , use of illustrative gestures , and an erect , but relaxed posture62.2.Techniques of assertive behaviour