ASSERTIVENESS

INTRODUCTION
Assertiveness is the key to successful relationships for the client, the family, the language
and behavior.

Assertiveness is frequently misunderstood. Some people believe you have to be confident to be

assertive. But being assertive is less about being confident and more about valuing yourself and
your profession. Becoming more assertive can lead to increased respect and recognition as a
person and as a nurse. It can get you more of what you want. Becoming more assertive is a
process. It's not something that happens overnight. You can, however, make some small changes
now to start moving in the right direction. Assertiveness is an antidote to fear, shyness, passivity,
and even anger. As nurses work in different situations nurse, and other colleagues. It is the
ability to express your thoughts, your ideas, and your feelings without undue anxiety and without
expense to others. Assertiveness means being clear about what you need and respectful in your
way have to be assertive in order to meet the challenges and to win the cooperation from others.

The assertive nurse appears confident and comfortable. Assertive behavior is not compared
with nonassertive or passive behavior, in which individuals disregard their own needs thoughts
and aggressive behavior in which individuals disregard the needs and rights of others. The
assertive is positive, caring, clear,nonjudgmental, clear and direct without threatening or attacking.

A nurse leader or manager must be assertive to facilitate problem identification, problem

solving, and decision making

DEFINITION OF ASSERTIVESS
Assertiveness is the ability to express yourself and your rights without violating the
rights of other.

Assertiveness is the ability to express ones positive and negative feelings and rights in
a socially accepted manner and recognizing other’s rights and feelings.

Assertiveness means being clear about what you need and respectful in your language and
behavior. It means that we have respect both for ourselves and for others. We are consciously
working toward a "win-win" solution to problems. A win-win solution means that we are trying
to make sure that both parties end up with their needs met to the degree possible. An assertive
person effectively influences, listens, and negotiates so that others choose.
PRINCIPLES OF ASSERTIVENESS
1. RESPECT YOUR SELF AND OTHER PERSON EQUALLY

This is your overarching goal. When you evaluate how you dial afterwards, these are the
questions to ask yourself

o Did I maintain my self respect?

o Did I respect other person?

Here are some criteria to evaluate your performance.

RESPECT YOURSELF:

Becoming less passive –the do’s of assertiveness.

Express your feeling

 Ask for what you need

 State your performance

 Assert your right

RESPECT OTHER PERSONS:-

Becoming less aggressive – the don’ts of assertiveness.

× Do not yell

× Do not hit nor other wise physically dominate or intimate the person

× Do not call the person names or otherwise use words to attack them personally

× Do not say things simply to hurt the person

× Do not loss control of your anger.

2. DEFINE YOUR GOAL.

Before you carry out an assertiveness exercise, think it through. What are you trying to
accomplish? Be clear within yourself about your goals.

3. CHOOSE AN APPROPRIATE SETTING.

If possible, choose a time and place that gives you privacy, quiet, peace -- whatever setting will
most help you achieve your assertiveness goals.
4. IF POSSIBLE, PICK A TIME WHEN THE OTHER PERSON IS CALM.

Try your best to pick a time when the other person is maximally receptive to what you have to
say.

5. STAY CALM.

Do not lose control of your anger. If you feel you are going to lose control, leave the situation
until you have regained control and can handle the situation calmly.

6. USE ASSERTIVE BODY LANGUAGE.

Stand or sit up straight, look the other person in the eye, and speak in a clear and audible voice.

7. BE AS BRIEF AND AS CLEAR AS POSSIBLE.

The more brief and clear you are, the more powerful your message will be.

8. TALK ABOUT YOUR PERSONAL FEELINGS, NOT ABOUT OBJECTIVE

"RIGHTNESS".

Don't preach to the other person about right and wrong. Rather, speak in a personal way. Use "I
feel" statements. Say things like: "I feel angry that you .... I feel uncomfortable when you .... I
don't like it when you ...."

8. DO NOT GET DEFENSIVE.

Do not over-justify your feelings. Do not start listing all the reasons that explain why you are
speaking. Your feelings are enough justification. You do not need to speak of any others.

8. REQUEST SPECIFIC BEHAVIOR CHANGE.

Tell the person exactly what you want them to do to correct the situation. Be specific and
concrete. Criticize the behavior, not the person. Say: "I don't like it when you throw your clothes
on the floor;" not, "You are a slob." Say, "Please start putting them in the hamper or putting them
away;" not, "Stop being such a slob."

9. WHEN YOU WANT TO SAY SOMETHING NEGATIVE, START AND END WITH
POSITIVES.

This is the "sandwich technique,” so called because you sandwich a negative between two
positives. Don't make up the positives: use positives that are true.

10. IF THE OTHER PERSON PROTESTS, SIMPLY KEEP RESTATING YOUR

POSITION.
This principle helps you stay on track and stay true to your goal. Don't get lost in arguments the
other person raises. Don't go off on tangents. Don't retreat because you have trouble tolerating
the other person's anger. No matter what the other person says, just calmly and succinctly keep
repeating your point.

CHARACTERISTICS OF ASSERTIVE PEOPLE

1. They feel free to express their feelings, thoughts and desires.
2. They know their own rights and rights of others.
3. They have control over their anger.
4. They have good understanding of feelings of the person.

BENEFITS OF ASSERTIVESS IN NURSING

1. Healthy and meaningful relationship.
2. Less friction and conflict among employees.
3. Increased self esteem, self respect and respect from others.
4. Increased productivity at work and the home.
5. Less stress and an overall sense of well-being.
6. Emotional and physical health improves.

TYPES OF ASSERTION
1. Basic assertion: this is a simple, straightforward expressions of your beliefs, feelings, or
opinions .It stands up for your rights or rights of the others, for example “I want to.....” “I
don’t want you to......” “Would you....”? I have different opinion.
2. Empathic assertion: this conveys some sensitivity to the other persons. it usually
contains two parts –a recognitions of the persons situation or feelings ,followed by a
statement in which you stand up for your rights. Example; “I know the unit is short
staffed, but I have a pressing personal commitment and cannot work for a second shift”.
3. Escalating assertion: this occurs when the other person fails to respond to your basic
assertion and continues to violate your rights .you gradually escalate the assertion and
become increasingly firm. It may even include the mention of some type of resulting
action on your part, made only after several basic assertive statements. For ex; “ I told
you that as a nurse I cannot have a social relationship with you .I must insist that you
refrain from asking me personal questions”.
4. I –language assertion: this is especially useful for expressing negative feelings.
AIMS OF ASSERTIVENESS
 The aim of assertiveness is to find the best possible solution for all the people.
 It is about finding win- win solutions.
 Assertiveness sees everyone as equal with equal rights and responsibility.
 Assertiveness increases the chances of our needs being met.
 Assertiveness allows us to remain in control
 Assertiveness brings greater self-confidence.
 Assertiveness lets us have greater confidence on others.
 Assertiveness people have more friends.
 Reduced stress.

RESPONSE PATTERNS

 Nonassertive
 Assertive
 Aggressive
 Passive- aggressive
Non-assertive behavior - Individual who are nonassertive seek to please others at the expense of
denying their own basic human rights. They seldom let their true feelings show and often feel
hurt and anxious because they allow others to choose for them. They seldom achieve their own
desired goals. They uses actions instead of words and hope someone will guess what they want.
Their voice are hesitant, weak and expressed in a monotone. Their eyes are usually downcast.
They feel uncomfortable in inter-personal interaction. All they want is to please and to be liked
by others. Their behavior helps them avoid unpleasant situations and harbor confrontations with
others. However they often harbor anger and resentment.

Assertive behavior -Assertive individuals stand up for their own rights while protecting the
rights of others. Feelings are expressed openly and honestly. They assume responsibility for their
own choices and allow others to choose themselves. They maintain self-respect and respect for
others by treating everyone equally and with human dignity.

Their voices are warm and expressive and eye contact is intermittent but direct. These
individuals desire to communicate effectively with, and be respected by others. They are self-
confident and pleasurable relationship with others.

Assertive Messages

 “Yes, that was my mistake.”

 “As I understand your point…”
 “Let me explain why I disagree with that point.”
 “Let’s define the issue and then explore some options to help resolve it.”
  “Please hear me out and then work with me to resolve my concern.”
Aggressive behavior-Individual who are aggressive defend their own rights by violating the
basic rights of others. Feelings are often expressed dishonestly and inappropriately.They say
what is on their mind, often at the expense of others.

They express an air of superiority and their voices are loud, demanding, anger or cold,
without emotion. They want to increase their feeling of power by dominating or humiliating
others. Aggressive behavior hinders interpersonal relationship.

Aggressive Messages

 “You must…”
 “Because I said so.”
 “You idiot!” “You always…”
 “You never…”
 “Who screwed this up?”
Passive-aggressive behavior - Individuals defend their own rights by expressing resistance to
social and occupational. These individual are manipulative and they undermine others with
behavior that expresses the opposite of what they are feeling. They allow others to make choices
for them, they resist by using passive behavior such as stubbornness, forgetfulness. They use
action instead of words to convey the message. They become irritable, argumentative when
asked to do something. They do not want to do. This behavior offers a feeling of control and
power, individual actually feel resentment and that they are being taken advantage of. They
possess extremely low self-confidence.

Passive-aggressive messages

 I am not ok,you are not ok

 “I knew that wouldn’t work.”
 “If that’s the way you want it…”
 “How could you even think that?”
 “When was the last time you helped me?”
 Non-assertive behavior I am not ok,you are ok
 Assertive behavior I am ok,you are ok
 Aggressive behavior I am ok,you are not ok
 Passive aggressive behaviorAm not ok, you are not ok
Assertiveness model

A-SE-R-T model

 A-Ask for god’s help: pray to god to guide you through scripture and his spirit.
 S- State the problem: think over and state the facts of the problem.
  E- Express yourself: state your feeling. Do not judge.
 R- Request change and feedback: specify one behavior change. Then listen to other
person’sthoughts and opinions.
 T- Talk it out: paraphrase their ideas. Discuss the consequences, consideration and
options.

BEHAVIORAL COMPONENT OF ASSERTIVE BEHAVIOR

Eye contact: Eye contact is considered appropriate when it is intermittent. Individual feel
uncomfortable when someone stares at them continuously. Intermittent eye contact conveys that
massage that one is interested in what is being said.

Body posturesitting and leaning slightly towards the other person in a conversation suggests an
active interest in what is being said. Emphasis on an assertive stance can be achieved by standing
with an erect posture, squarely facing the other person. A slumped posture always conveys
passivity and non-assertiveness

Distance/ physical contact:The distance between two persons in an interaction has a strong
cultural influence. We are very careful about whom we allow to enter this intimate space.
Invasion of this space may be interpreted by someone as very aggressive.

Gesture:Nonverbal gesture may be culturally related. Gesturing can add emphasis, warmth,
depth, or power to the spoken words.

Facial expression: Various facial expressions convey different messages. Eg. Smile, surprise,
anger, fear. It is difficult to fake these messages. It should be congruent to the facial expression.

Voice: It conveys a message by its loudness, softness, degree and placement of emphasis and
evidence of emotional tone.

Fluency:Being able to discuss a subject with easy and with obvious knowledge conveys
assertiveness and self-confidence.

Timing: Assertive responses are most effective when they are spontaneous and immediate. It is
never too late to be assertive, it is correct and worthwhile to seek out the individual at a later time
and express the assertive response.

Listening: Assertive listening means giving the other individual full attention, by making eye
contact, nodding to indicate acceptance of what is being said, and taking time to understand what
is being said before giving a response

Thoughts:Cognitive processes affect one’s assertive behavior. Two such process is:An
individual’s attitudes about the appropriateness of assertive behavior in general.The
appropriateness of assertive behavior for himself or herself specifically
Content: Many times individuals do not respond to an unpleasant situation because “I just don’t
know what to say”. Emotions are expressed when they are experienced. It is also important to
accept the ownership of those emotions and not devalue the worth of another individual to assert
oneself.

STRATEGIES OF IMPROVING ASSERTION AT WORK

 Ask
 Bring energy to the job
 Get your emotions under control
 Find a good place to talk if possible
 Effective assertion requires a listener
 If an ideal time and place is not possible for effective communication, decide whether to
speak up at that time, or to wait until a more conducive moment..
 Ideal time and place to communicate

TECHNIQUES FOR BEING ASSERTIVE

 Identify your personal rights, wants and needs.
 Identify how you feel about a particular situation.
 Be direct and clear:- deliver your message to the person for whom it is intended.. If you
want to tell Sheila something, tell Sheila; do not tell everyone except Sheila.
 Own your message:- in describing your feeling use “I” messages. Use “I” statements to
express your feeling instead of evaluating and blaming others. Be as specific and clear as
possible about what you want, think, and feel. The following statements project this
preciseness: "I want to..."
"I don't want you to...”
"I like it when you did that."
"I have a different opinion, I think that...”
 Avoid assumptions about others thinking or feeling about what their motives are, or about
how they may react.
 Avoid statement that beings with “why” “you”. This may put the other person on
defensive that protect from attack. .
 Ask for feedback: ‘Am I being clear?’ Asking for feedback can encourage others to
correct any misperceptions you may have as well as help others realize that you are
expressing an opinion, feeling. Or desire rather than a demand. Encourage others to be
clear, direct, and specific in their feedback about you.
 Stop apologizing all the time:many of us say “ I am sorry” on regular basis without even
thinking about it. All though we say it in an effort to be polite, it sounds like you are
taking a blame for everything that happens. Don’t say “I am sorry” unless you done
something, you truly need to apologize for.
 Learn to take a complements:- when complimented on a job well done, many of us could
have responded: oh I didn’t do anything, it was nothing or don’t mention it. It was the
 team that did all the work. A more appropriate response would be to say “ thank you”. I
had a great team to work with us.
 Act confident even if you don’t feel confident. Force yourself to make good eye contact
with people and use a steady, audible voice when speaking. Stand or sit erect with your
head upright and straight on your shoulders, not tilted to the side or bent forward. Act like
you have a right to be there, even if you don't feel that way. If someone attempts to
interrupt you while you're talking, keep talking until you are done and raise the volume of
your voice if necessary to be heard. If you stop talking midstream in an effort to of a right
to speak than you do.
 Feel free to say NO, I don’t know, I don’t understand etc.
 Evaluate your expectation. Are they reasonable? Be willing to compromise.

THOUGHT- STOPPING TECHNIQUE

Assertive thinking is sometimes inhibited by repetitive, negative thoughts of which the
mind refuses to let go. Individual with low self worth may be obsessed with thoughts such as “ I
know he’d never want to go out with me.” “ I am so ugly”. This type of thinking foster the belief
that once individual rights do not deserve the same consideration as those of other, and reflects
non assertive communication and behavior response pattern. This technique were developed by
Joseph Wolpe (1990) and are intended to eliminate intrusive, unwanted thoughts.

METHOD

In a practice setting, with eye closed, the individual concentrate on unwanted recurring
thoughts. Once the thought is clearly established in the mind, he or she shouts aloud “STOP”.
This action will interrupt the thought, and it is actually removed from ones awareness. The
individual then immediately shifts his or her thoughts to one that is considered pleasant and
desirable.

AN ASSERTIVE NURSE
 Appears self confident and composed
 Maintains eye contact
 Uses clear ,concise speech
 Speaks firmly and positively
 Speaks genuinely, without sarcasm
 Is no apologetic
 Takes initiative to guide situations
 Gives same message verbally and non verbally
ASSERTIVE RIGHTS
1. To be treated with respect
2. To express feelings ,opinions and beliefs
3. To say no
4. To make mistakes and be responsible for them
5. To an equitable wage
6. To give and receive information as a professional
7. To ask for what you want
8. To refuse without making excuses or feeling guilty
9. To be human
10. To determine your own priorities

ASSERTIVE RESPONSIBILITIES
1. To treat others in a way that recognizes their human dignity.
2. To accept ownership of our feelings and show respect for those that differ from our own.
3. Others also have the rights to say no.
4. To accept responsibility for own mistakes and to try to correct them.
5. To listen to others.
6. To accept the possible consequences that the change may incur; to accept the same
flexibility in others.
7. To accept others right to refuse your request.
8. To put others first sometimes.
9. To consider one’s limitations as well as strengths in directing independent activities.
10. To accept others without requiring justification.

REASONS FOR LACK OF ASSERTIVENESS

1. Timmins and Catherine reported that nurses behave in a passive way, conforming to
the image of a nice nurse. Nurses were less adept at disagreeing with others opinions
and providing constructive criticism.
2. Many of us thought that we should please defer to others.
 3. That if someone says or does something that if we don’t like, we should just be quiet
and try to stay away from that person in the future.
4. Traditional assumptions learned in the childhood.
5. Grew up doubting themselves and looking to others for validations and guidance.
6. From childhood females are taught to be passive rather than assertive.
7. Lack of respect and trust for self and others.
8. Lack of clarity about task.
9. Inability to say sorry in spite of being wrong.

HOW TO BE EFFECTIVELY ASSERTIVE

1.Use assertive body language; Face the other person, stand or sit straight, don’t use dismissive
gestures, be sure you have a pleasant, but serious facial expression, keep your voice calm and
soft, not whiney or abrasive.

2. Use ‘I’statements;Keep the focus on the problem you are having, not on accusing or blaming
the other person;ex; I’d like to be able to tell my stories without interruption. Instead of you’re
always interrupting my stories.

3. Use facts, not judgments; ex; your punctuation needs work and your formatting is
inconsistent instead of he makes me angry.

4. Make clear, direct, requests;Don’t invite the person to say no.ex; will you please instead of
would you mind or why don’t you

5. Express ownership of your thoughts, feelings, and opinions; ex; I get angry when he breaks
his promises. Instead of he makes me angry.

STRATEGIES TO PROMOTE ASSERTIVE COLLABORATION

* Say "thank you" to each other and to health professionals who demonstrate respect and
collaboration.

* Establish a facility-wide decision-making committee comprising key health care professionals

and a representative group of nurses in staff and management positions. Keep attendance of
meetings dynamic so that anyone may participate. This committee would establish policies in
handling complaints of aggressive behaviors.

* Inform others of the outcomes and costs of threatening or provocative communications, citing
financial and patient care impact.
* Ask for what you want and need.

* Use the "no" word and don't feel guilty when turning down what you believe to be an
unreasonable request.

* Plan in-service and staff development programs to help nurses deal assertively with conflict
resolution and continuous change.

* Say what you mean.

* Preface important comments with "I" words. For example, I disagree, I think, I want, I know, I
believe, Ifeel ... ("You" words are perceived as aggressive). Compare these two remarks: "I believe this
assignment is unreasonable and I need you to re-look at the uneven distribution of patient loads;"
versus "You are insane if you think I'm going to take all those patients!"

* Support nurses' rights. Listen respectfully to others and clarify anything you don't understand.

* Take responsibility for your own actions, feelings, and beliefs. Remember, no one can "make"
you angry or guilty without your permission.

THE BILL OF ASSERTIVE RIGHTS

1. You have the rights to be treated with respect and dignity.
2. You have the right to have and express your own feelings and opinions.
3. You have the right to be listened to and taken seriously.
4. You have the right to judge your own behavior, thoughts and emotions, and to undertake
the responsibility for their initiation, and consequences upon yourself.
5. You have the right to make mistakes and be responsible for them.
6. You have the right to say; “I don’t know”.
7. You have the right to say; “I don’t understand”.
8. You have the right to ask for information [including from professionals]
9. You have the right to change your mind.
10. You have the right to be independent to the good will of others before coping with them.
11. You have the right to get what you pay for.
12. You have the right to choose your profession.
13. You have the right to practice your own religion.
14. You have the right to ask for what you want [realizing that the other person has the right
to saying]
 15. You have the right to acquire knowledge.
16. You have the right to say ‘no’ without feeling guilty.
17. You have the right to do anything so long as it does not violate the rights of others.

ROLE OF NURSE
It is important for nurses to become aware of and recognize their own behavior response. Are
they mostly non assertive? Assertive? Passive assertive?

Aggressive? Do they consider their behavior responses effective?. Do they wish to change? .
Remember all individuals have the right to choose whether or not want they want to be assertive.

The ability to respond assertively is especially important to nurse who are committed to further
development of the profession assertive skill facilitated the implementation of change that is
required if the image of nursing is to be upgraded to the level of professionalism that most nurses
desire.

Nurses who understand and use assertiveness skills them selves can in turn assist client who wish
to effect behavioral changes in an effort to increase self esteem and improve IPR. The nursing
process is use full tools for nurses who are involved in helping clients increase their
assertiveness.

ASSESSMENT
Nurses can help clients become more aware of their behavioral responses. Many tools for
assessing the level of assertiveness have been attempted over the year. None have been very
effective. Perhaps this is because it is so difficult to generalize when attempting to measure
assertive behavior.

DIAGNOSIS
Possible diagnosis for individual needing assistance with assertiveness include

 Coping, defensive

 Coping, ineffective

 Decisional, conflict

 Denial, ineffective

 Personal, identity

 Powerlessness
  Rape-trauma syndrome

OUTCOME IDENTIFICATION/IMPLEMENTATION
The ultimate goal of a nurse who assisting with the needing assistance is to help them to develop
more satisfying inters personal relation ship.

Out come criteria would be derived from specific nursing diagnosis. Some example might
include

1. The client verbalize and accepts responsibility for his/her own behavior

2. The client is able to express opinion and disagree with the options of others in a
socially acceptable manner and with out feeling guilty.

3. The client is able to verbalize positive aspect about self.

4. The client verbalizes choice made in a plan to maintain control over his/her life
situation.

5. The client approaches others in an appropriate manner for one-one interaction.

In clinical settings nurses can teach client the technique to use to increase their assertive
responses. This can be done on a one to one basis or in a group situation. Ones these techniques
have been discussed, nurses can assist client to practice them through role playing.

An important part of this type of intervention is to ensure that clients are aware of the differences
among, assertive, non assertive, aggressive and passive aggressive behavior in the same
situation.

EVALUATION
Evaluation requires that the nurse and client asses whether or not these techniques are achieving
the desired out comes. Reassessment might include the following questions.

 Is the client is able to accept criticism with out becoming defensive?

 Can the client express true feeling to when his or her basic human rights are violated?

 Is the client able to decline a request with out feeling guilty?

 Can the client verbalize positive qualities about himself or herself?

 Does the client verbalize improvement in interpersonal relation ship?

Assertive training serves to extend and creates more flexibility in an individuals communication
style so that he or she has a greater choice of responses in various situations.
CONCLUSION
Assertive behavior helps individual feel better about them selves by encouraging them to stand
up for their own basic human rights. These rights have equal representation for all individuals.
Along with rights come an equal number of responsibilities. Part of being assertive includes
living up to these responsibilities.
 REFERENCES
BOOKS:

1. Basheer,P.Shebeer.Khan,S.Yaseen.(2013).A concise textbook of advanced nursing

practice.1st Edition.Emmess Medical Publisher.Bangalore.Pg no-649:651
JOURNAL:
1. Okuyama A, Wagner C, Bijnen B (2014) How we can Enhance Nurses’ Assertiveness: A
Literature Review. J Nurs Care 3:194. doi:10.4172/2167-1168.1000194l
2. Tenant,Charles.(1982) "Assertiveness Training — A Practical Approach", Journal of
European Industrial Training, Vol. 6 Issue: 6, pp.3-6, https://doi.org/10.1108/eb002396
WEBSITE:
1. https://en.wikipedia.org/wiki/Assertiveness
2. www.rfppl.co.in/subscription/upload_pdf/pramila%20r_1345.pdf
 MAR BASELIOS COLLEGE OF NURSING,BHOPAL

SUBJECT: MENTAL HEALTH NURSING

SEMINAR ON
“SELF-ESTEEM”

SUBMITTED TO: SUBMITTED BY:

Mrs.Sini Shaji Mrs.Shashi Prabha

Professor M.Sc.Nursing I Year

Date:27.1.20