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.

'Speaking up for safety': A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis.

BACKGROUND: The international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement. STUDY AIMS: To elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement. DESIGN: The study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks. SETTING: School of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia. PARTICIPANTS: Of the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data. METHODS: An evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach. RESULTS: Five major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning. CONCLUSIONS: Findings indicate that teaching assertiveness skills and establishing a preparatory framework for 'speaking up for safety' early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.

Development and Effects of Assertiveness Training applying Dongsasub Training for Nursing Students in Clinical Practice

PURPOSE: This study was conducted to develop assertiveness training applying Dongsasub training for junior nursing students, and to verify effectiveness of the training on assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. METHODS: The study design was a non-equivalent control group non-synchronized design. Participants were 63 nursing students in clinical training (31 students in the experimental group and 32 students in the control group). The assertiveness training applying Dongsasub training consisted of four sessions. Outcome variables included assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. Data were analyzed using Chi-square, Fisher's exact test and independent samples t-test with SPSS/WIN 21.0. RESULTS: Scores of assertiveness behavior (t=-2.49, p=.015), self-esteem (t=-4.80, p<.001) and clinical competence (t=-2.33, p=.023) were significantly higher and clinical practice stress (t=4.22, p<.001) was significantly lower in the experimental group compared to the control group. CONCLUSION: Results indicate that the assertiveness training applying Dongsasub training can be used as a nursing intervention to lower clinical practice stress and improve the clinical competence of nursing students.

Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with intellectual disabilities.

BACKGROUND: Outwardly-directed aggressive behaviour is a significant part of problem behaviours presented by people with intellectual disabilities. Prevalence rates of up to 50% have been reported in the literature, depending on the population sampled. Such behaviours often run a long-term course and are a major cause of social exclusion. This is an update of a previously published systematic review (see Hassiotis 2004; Hassiotis 2008). OBJECTIVES: To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly-directed aggressive behaviour in people with intellectual disabilities when compared to standard intervention or wait-list controls. SEARCH METHODS: In April 2014 we searched CENTRAL, Ovid MEDLINE, Embase, and eight other databases. We also searched two trials registers, checked reference lists, and handsearched relevant journals to identify any additional trials. SELECTION CRITERIA: We included studies if more than four participants (children or adults) were allocated by random or quasi-random methods to either intervention, standard treatment, or wait-list control groups. DATA COLLECTION AND ANALYSIS: Two review authors independently identified studies and extracted and assessed the quality of the data. MAIN RESULTS: We deemed six studies (309 participants), based on adult populations with intellectual disabilities, suitable for inclusion in the current version of this review. These studies examined a range of cognitive-behavioural therapy (CBT) approaches: anger management (three studies (n = 235); one individual therapy and two group-based); relaxation (one study; n = 12), mindfulness based on meditation (one study; n = 34), problem solving and assertiveness training (one study; n = 28). We were unable to include any studies using behavioural interventions. There were no studies of children.Only one study reported moderate quality of evidence for outcomes of interest as assessed by the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We judged the evidence for the remaining studies to be of very low to low quality. Most studies were at risk of bias in two or more domains: one study did not randomly allocate participants and in two studies the process of randomisation was unclear; in one study there was no allocation concealment and in three studies this was unclear; blinding of assessors did not occur in three studies; incomplete outcome data were presented in one study and unclear in two studies; there was selective reporting in one study; and other biases were present in one study and unclear in four studies.Three of the six studies showed some benefit of the intervention on improving anger ratings. We did not conduct a meta-analysis, as we considered the studies too heterogeneous to combine (e.g. due to differences in the types of participants, sample size interventions, and outcome measures).Follow-up data for anger ratings for both the treatment and control groups were available for two studies. Only one of these studies (n = 161) had adequate long-term data (10 months), which found some benefit of treatment at follow-up (continued improvement in anger coping skills as rated by key workers; moderate-quality evidence).Two studies (n = 192) reported some evidence that the intervention reduces the number of incidents of aggression and one study (n = 28) reported evidence that the intervention improved mental health symptoms.One study investigated the effects of the intervention on quality of life and cost of health and social care utilisation. This study provided moderate-quality evidence, which suggests that compared to no treatment, behavioural or cognitive-behavioural interventions do not improve quality of life at 16 weeks (n = 129) or at 10 months follow-up (n = 140), or reduce the cost of health service utilisation (n = 133).Only one study (n = 28) assessed adaptive functioning. It reported evidence that assertiveness and problem-solving training improved adaptive behaviour.No studies reported data on adverse events. AUTHORS' CONCLUSIONS: The existing evidence on the effectiveness of behavioural and cognitive-behavioural interventions on outwardly-directed aggression in children and adults with intellectual disabilities is limited. There is a paucity of methodologically sound clinical trials and a lack of long-term follow-up data. Given the impact of such behaviours on the individual and his or her support workers, effective interventions are essential. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes that include reduction in outward-directed aggressive behaviour, improvement in quality of life, and cost effectiveness.

Interpersonal Communication Competence and Social Anxiety in Nursing Students / 한국간호교육학회지

PURPOSE: This study aimed to identify a relationship between the communication competence and social anxiety in nursing students. METHODS: With a cross-sectional survey, a convenience sampling of 303 nursing students was taken from P-university in Y-city. The instrument for the study was a questionnaire that is consisted of the general characteristics, an Interaction Anxiousness Scale (IAS) and a Global Interpersonal Communication Competence Scale (GICC). Data was analyzed using descriptive statistics, t-test, one-way ANOVA, Kruskal-Wallis, Pearson's correlation coefficients and stepwise multiple regression with SPSS version 21.0. RESULTS: The mean score of the IAS was 41.89+/-8.74 and the GICC was 3.51+/-0.34. Communication competence significantly differed by the satisfaction of major (F=10.86, p<.001). In addition, the satisfaction of interpersonal relationships was significantly different in both communication competence (F=17.52, p<.001) and social anxiety (F=23.85, p<.001). Social anxiety had a negative correlation with communication competence (r=-.48, p<.001). Social anxiety accounted for 55.3% of the variance-social relaxation (beta=-.62), assertiveness (beta=-.18), interaction management (beta =.14) and efficiency (beta=-.13)- of communication competence's subcategories. CONCLUSION: It was found that communication competence has an influence on social anxiety. Therefore, education programs are needed to promote communication competence for a decline of social anxiety in nursing students.

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.

An approach to using noncognitive variables in dental school admissions.

Dental school admissions committees continue to grapple with challenges associated with recruiting, admitting, and enrolling students who best meet the mission of the particular institution. For many students, particularly underrepresented minority students and those from non-traditional backgrounds, standardized tests such as the Dental Admission Test (DAT) are poor predictors of their potential for success. Noncognitive assessment methods can be used in conjunction with traditional cognitive measures in making admissions decisions. These methods have been employed by hundreds of higher education institutions, foundations, and scholarship programs, but are relatively new in dental education. This article describes a prevalent assessment model and discusses one dental school's implementation of the model, with the outcome of enrolling students from diverse backgrounds whose career goals parallel the mission of the school.

Feminist self-defense and resistance training for college students: a critical review and recommendations for the future.

There remains resistance to feminist self-defense and resistance training programming for women, despite (a) documented effectiveness of rape resistance strategies in avoiding rape, (b) consistently high rates of sexual victimization on college campuses, and (c) limited evidence of lasting change in sexual assault perpetration reduction within existing men's prevention programs. The current article seeks to discuss (1) the rationale for feminist self-defense and resistance training for women, (2) key components of feminist self-defense and resistance training, (3) barriers to its implementation, (4) outcomes of self-defense and resistance training programming, and (5) recommendations for future work. Such suggestions include increasing funding for large-scale self-defense and rape resistance outcome research to examine program effectiveness. Specifically, outcome research that examines the role of contextual factors (e.g., alcohol use) and women's victimization histories is needed. Finally, self-defense training and resistance training should be combined with bystander intervention and men's programs with the goal of providing synergistic effects on rape reduction.

Sintomas de ansiedade, depressão, nível de estresse, uso de álcool e outras drogas e repertório de habilidades sociais como fatores relacionados ao comportamento sexual de risco em pessoas infectadas pelo HIV em tratamento na cidade de São Paulo / Symptoms of anxiety, depression, stress level, use of alcohol and other drugs and range of social skills as factors related to sexual risk behavior in HIV-positive individuals being treated in the city of São Paulo

Objetivo: Avaliar a influência de sintomas de ansiedade e depressão, nível de estresse, consumo de álcool e drogas e repertório de habilidades sociais na prática de sexo sem preservativo em uma amostra representativa de indivíduos com HIV/AIDS em tratamento ambulatorial na cidade de São Paulo. Métodos: Participaram da pesquisa 667 pacientes, 383 (57,4%) homens e 284 (42,6%) mulheres, portadores do vírus HIV em tratamento na Casa da AIDS, Emílio Ribas, CRT Santa Cruz, SAE DST/AIDS Campos Elíseos, SAE DST/AIDS Cidade Líder II, CR DST/AIDS Nossa Senhora do Ó, AE Vila Prudente e CR DST/AIDS Santo Amaro. Para a coleta de dados foram utilizados os seguintes instrumentos: Mini Exame do Estado Mental, questionário sociodemográfico, Escalas de Avaliação de Ansiedade e Depressão de Beck, Inventário de Sintomas de Estresse, Escala de assertividade de Rathus, questionário sobre uso de álcool, tabaco e outras drogas, AUDIT, Questionário sobre Comportamento Sexual na Vida e a Escala de Avaliação de Comportamento Sexual de Risco - SERBAS. Os pacientes foram entrevistados nos locais onde faziam seu tratamento. Resultados: A análise múltipla mostrou que ter algum parceiro soropositivo e ter feito uso de maconha antes do sexo foram associados negativamente ao uso do preservativo. Ter dois ou mais parceiros sexuais nos últimos três meses foi associado a ter trabalho regular, ter feito sexo em grupo, contaminação anterior por alguma outra doença sexualmente transmissível, parceiro soropositivo, não residir com o parceiro, sexo em troca de álcool, droga, abrigo/comida alguma vez na vida, orientação homossexual, prática de sexo anal, CD4 acima de 350 cels/mm3 e uso de cocaína antes do sexo. Sintomas de ansiedade e depressão, nível de estresse e falta de habilidades sociais afetaram significativamente a vida sexual dessa população diminuindo as chances de fazer sexo nos três meses anteriores à entrevista, mas não mostraram associação com o uso de preservativo e múltiplos parceiros...

Introduction: The AIDS epidemic is a major public health problem. It is estimated that, even after becoming aware of their serostatus, one in three people with HIV continues to have sex without a condom, regardless of the partner's serostatus. Purpose: To evaluated the influence of symptoms of anxiety and depression, stress level, alcohol and drug use and the range of social skills on having sex without a condom in a representative sample of individuals living with HIV/AIDS and receiving outpatient treatment in the city of São Paulo. Methods: 667 patients - 383 (57.4%) men and 284 (42.6%) women - with HIV and being treated at Casa da AIDS, Emílio Ribas, CRT Santa Cruz, SAE DST/AIDS Campos Elíseos, SAE DST/AIDS Cidade Líder II, CR DST/AIDS Nossa Senhora do Ó, AE Vila Prudente and CR DST/AIDS Santo Amaro participated in the study. The following tools were used to collect data: Mini-Mental State Examination, social and demographic survey, Beck Anxiety and Depression Inventories, Stress Symptom Inventory, Rathus Assertiveness Schedule, alcohol, tobacco and other drugs use survey, Alcohol Use Disorders Identification Test (AUDIT), Sexual Behavior Survey, and Sexual Risk Behavior Assessment (SERBAS). Patients were interviewed at the places where they were being treated. Results: The multiple analysis has shown that having an HIV-positive partner and using marijuana before sex were negatively associated with condom use. Having two or more partners over the past three months was been associated with having regular job, have done group sex, previous infection with other sexually transmitted infections, an HIV-positive partner, not living with the partner, sex in exchange for alcohol, drug, shelter/food at least once in their lives, homosexuality, engagement in anal sex, CD4 cells/mm3 count above 350, and use of cocaine before sex. Anxiety and depression symptoms, stress level and lack of social skills significantly affected the sexual lives of...

Effects of anger awareness and expression training versus relaxation training on headaches: a randomized trial.

BACKGROUND AND PURPOSE: Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. METHODS: Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. RESULTS: On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. CONCLUSIONS: Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from an emotional expression or emotional reduction approach to chronic pain.

An examination of personality characteristics related to acquiescence.

Acquiescence, the tendency to agree with statements regardless of content, is often a concern when administering self-report instruments. While there is evidence to support acquiescence as a response style, this reporting tendency may be related to personality factors of individuals. Using a sample of 757 adults, we investigated the Rosenberg Self-Esteem Scale for acquiescence response tendencies by applying the Rasch partial credit model. Results suggested that favorable (i.e., Agree or Strongly Agree) responses were more frequent for the positively worded items than for negatively worded items. Second, the relationship between acquiescence and seven additional personality measures was examined overall and by sex. Among females, acquiescence was correlated with personality measures measuring perceptions by others, whereas acquiescence among males was related to exhibition types of behaviors.

Effects of a single-session assertiveness music therapy role playing protocol for psychiatric inpatients.

The purpose of this study was to implement and measure the effectiveness of a single-session assertiveness music therapy role playing protocol for psychiatric inpatients. Participants (N=133) were randomly assigned by group to one of three conditions: (a) Assertiveness Music Therapy, (b) No Music Assertiveness, or (c) Music No Assertiveness. Participants in both assertiveness conditions role played a number of different commonly occurring scenarios at an inpatient psychiatric facility and in the community. There were no significant between-group differences in posttest quality of life, locus of control, or other subscales. However, participants in both assertiveness conditions tended to have slightly higher internal locus of control and overall quality of life scores than participants in the music no assertiveness condition. Additionally, the assertiveness music therapy condition had higher attendance rates than the other conditions. A higher percentage of participants from both the assertiveness music therapy and music no assertiveness conditions indicated they thought their session was the most helpful/therapeutic group therapy session in which they had participated; this was not the case for the assertiveness no music condition. Future research is warranted to measure the effects of protocols that can help psychiatric patients generalize skills learned in treatment.

[Alexithymia and specific relationship patterns in a clinical sample]. / Alexithymie und spezifische Beziehungsmuster in einer klinischen Stichprobe.

OBJECTIVES: Alexithymia is characterized by deficits in perceiving, differentiating and regulating affects, both one's own affects and those of others. It is often related to interpersonal problems which are a major reason for seeking psychotherapy. This study assesses the relationship between alexithymia, specific relationship patterns and interpersonal problems in a clinical inpatient sample. METHODS: We evaluated alexithymia (Toronto-Alexithymia-Scale-26: TAS-26), relationship patterns (Relationship Patterns Questionnaire-II; RPQ-II) and interpersonal problems (Inventory of Interpersonal Problems: IIP) in 152 patients with various mental disorders upon admission to an inpatient clinic for psychosomatic medicine and psychotherapy. RESULTS: Alexithymia (TAS-20) was significantly negatively associated with self-assertion (RPQII) and significantly positively associated with overall interpersonal problems (IIP-total score). Specifically, the interpersonal style associated with alexithymia was characterized by cold, socially avoidant, nonassertive and exploitable behavior (IIP-subscales). CONCLUSIONS: Alexithymia in patients with mental disorders is linked to specific relationship patterns and interpersonal problems at the beginning of an inpatient psychotherapy. Because interpersonal problems, and especially the therapeutic alliance, are strong predictors of outcome in individual psychotherapy, specific attention should be paid to this relationship in the treatment of alexithymic patients.

Assessing women's responses to sexual threat: validity of a virtual role-play procedure.

This study evaluated the validity of a role-play procedure that uses virtual reality technology to assess women's responses to sexual threat. Forty-eight female undergraduate students were randomly assigned to either a standard, face-to-face role-play (RP) or a virtual role-play (VRP) of a sexually coercive situation. A multimethod assessment strategy was used to evaluate the efficacy of the role-play procedure in creating a realistic and immersive situation. Consistent with our hypotheses, women in the VRP condition exhibited greater negative affect and immersion than women in the RP condition. In addition, the level of assertive refusal in the VRP, but not the RP, condition differentiated between women with and without a prior history of sexual victimization. These findings provide evidence of the validity of a virtual role-play procedure for assessing women's responses in sexually threatening situations.

Empowerment in the midwifery context--a concept analysis.

OBJECTIVE: The concept empowerment is difficult to understand, define and translate into different contexts. Therefore, the purpose of this paper was to analyze the empowerment concept in the midwifery context, focused on the childbearing period, aimed at clarifying its meaning in order to enable comprehension and use in clinical practice, education and research. DESIGN: Semi structured interviews and written text. SETTING: Prenatal clinics, delivery and maternity wards in western Sweden. PARTICIPANTS: Nine midwives and 12 couples. MEASUREMENTS AND FINDINGS: A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically elucidated in the fieldwork phase. The final step was to describe criteria and attributes, illustrative cases, antecedents and consequences of the concept. The following tentative criteria and attributes of empowerment in the midwifery context are described: developing a trustful relationship; starting an awareness process, making it possible to reflect on the changing situation; acting based on the parents' situation on their own terms, getting them involved and able to make informed choices; confirming the personal significance of becoming parents. Finally, empowerment in the midwifery context was redefined. KEY CONCLUSION: Midwives use empowerment in education and research as well as strategies on both the micro and macro levels in practice. IMPLICATIONS FOR PRACTICE: Empirical findings from the concept analysis confirm the concept's relevance in the midwifery context.

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.

Telling our stories: the importance of women's narratives of resistance.

While more research is emerging on women's capacity for successful resistance and the benefits of self-defense training for women, "resistance" to the idea of women's resistance remains high. In this note, I describe the importance of bringing true accounts of successful resistance to both academic and lay communities, and the benefits to women of recounting their own experiences of successful resistance to violence and harassment. Such accounts provide new scripts for women's options in responding to violence, mark attempted but thwarted rape as a visible event, and remind women of their own agency in the face of assault.