The impact of coercive and assertive communication styles on children's perception of chores: an experimental investigation.

Introduction: This article presents the findings of an experimental study aimed at investigating the impact of coercive and assertive communication on children's emotional responses and behavioral tendencies within parent-child interactions. Methods: The study tested four hypotheses related to children's feelings, personalization bias, the need to express their point of view, and the desire to retreat to their room alone. Short audio stimuli recorded by a female assistant, representing a mother addressing her child, were utilized to create five different communication situations. The experimental procedure involved participants listening to the audio stimuli and answering related questions. The study included 123 participants between the ages of 9 and 13, with an equal gender distribution. Results: The results of One-Way ANOVA tests indicated significant differences among the four types of communication in terms of unpleasant feelings, personalization bias, listening to a personal point of view, and retreating into a personal room. The findings suggest that coercive communication elicited more negative emotional responses and stronger tendencies toward personalization bias, expressing personal opinions, and seeking solitude compared to assertive communication. Discussion: The implications of these findings highlight the importance of promoting positive and respectful communication strategies in parent-child relationships to foster children's emotional well-being and healthy behavioral development.

Comunicación asertiva, estado nutricional y desarrollo físico en adultos mayores / Assertive Communication; Nutritional Status and Physical Development in Aged Adults

Introducción: La asertividad es una herramienta comunicacional que puede contribuir de manera positiva en que los adultos mayores interpreten correctamente la necesidad e importancia de realizar acciones que permitan mantener un adecuado desarrollo físico y estado nutricional durante la tercera edad. Objetivo: Describir cómo la implementación de la comunicación asertiva puede ayudar a la incorporación de los adultos mayores al programa de actividades físicas del adulto mayor. Métodos: Se realizó una investigación básica, no experimental y descriptiva en una población de 157 adultos mayores, de los cuales 113 formaron parte de la muestra de investigación. Se aplicó la comunicación asertiva para lograr la incorporación de estos al programa de actividades físicas del adulto mayor. Resultados: El miedo al contagio con COVID-19 fue la principal causa referida para no participar en las actividades (17,70 por ciento). Predominaron los adultos mayores con nivel de conocimiento bajo sobre la importancia de las actividades físicas en los adultos mayores. Después de aplicar la comunicación asertiva se logró que el 64,60 por ciento de los ancianos se incorporaran al programa. Conclusiones: La asertividad, con sus técnicas y acciones, facilitó la incorporación de adultos mayores al programa de actividades físicas. Su aplicación se basó en la preparación y la capacidad de negociación con las personas de la tercera edad para poder lograr su incorporación a las actividades físicas del programa del adulto mayor(AU)

Introduction: Assertiveness is a communicational tool that can contribute positively to aged adults' correct interpretation of the need and importance of performing actions that allow them to maintain adequate physical development and nutritional status during older age. Objective: To describe how the implementation of assertive communication can help the incorporation of aged adults to the physical activity program for the elderly. Methods: A basic, nonexperimental and descriptive research was conducted with a population of 157 aged adults, of which 113 were part of the research sample. Assertive communication was applied to achieve their incorporation into the physical activity program for the elderly. Results: Fear of infection with COVID-19 was the main reported cause for not participating in the activities (17.70 percent). Aged adults with a low level of knowledge about the importance of physical activities for the elderly predominated. After applying assertive communication, 64.60 percent of the older adults could become part of the program. Conclusions: Assertiveness, with its techniques and actions, facilitated the incorporation of aged adults to the physical activities program. Its application was based on the preparation and the ability to negotiate with older adults in order to achieve their incorporation to the physical activities of the program for the elderly(AU)

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.

Exploration of students' reaction in medical error events and the impact of personalized training on the speaking-up behavior in medical error events.

BACKGROUND: The ability of medical students to speak up before a medical error occurs is a timely and necessary interaction to prevent potential patient harm. As it may be crucial to improve patient safety, we explored how medical students react to a medical error and provided them appropriate training regarding speaking up about medical issues. METHODS: A quasi-experimental study was conducted in Taiwan involving 153 medical students who participated in a speaking-up simulation course. They were divided into two groups. The first group participated in a non-life-threatening scenario before the intervention, followed by a personalized debriefing session, then a life-threatening scenario after the intervention. The second group participated in a life-threatening scenario before the intervention, followed by a personalized debriefing session, then a non-life-threatening scenario after the intervention. Students also completed patient safety attitude survey. RESULTS: During the preintervention scenario, the overall medical students' speaking-up rate to medical error was 45.1%. The speaking-up rate of medical students in life-threatening scenario was significantly higher than the rate in non-life-threatening scenario before the intervention (64.6% vs 24.3%, p < 0.001). After personalized debriefing, the speaking-up rate to medical errors was significantly improved both in life-threatening scenarios (95.9%, p < 0.001) and in non-life-threatening scenarios (100%, p < 0.001). Male medical students had significantly higher speaking-up rates than female students in life-threatening scenario (76.2% vs 51.4%, p = 0.02). On post-intervention surveys, students provided several reasons for their likelihood of speaking up or remaining silent during a medical error event. CONCLUSIONS: Medical students' rate of speaking-up to medical error was higher in a simulated life-threatening scenario than in a simulated non-life-threatening scenario. Faculty-led personalized debriefing can facilitate medical students' adoption of communication strategies to speak up more in medical error events. Educators should also consider gender differences when they design effective assertive communication courses.[Box: see text].

Students' experience of the challenges of using assertive communication.

Assertive communication is a skill that many nurses, particularly nursing students, find challenging. This article describes the findings of phenomenological study that set out to explore third-year student nurses' experiences of using assertive communication in the clinical setting. A narrative enquiry approach reviewed six reflective written accounts of their experiences. In addition, seven students took part in an in-depth semi-structured group discussion of their clinical experiences. Data were analysed using a hybrid interpretive phenomenological analysis and discourse analysis framework. Three key themes emerged: a sense of responsibility/duty and a sense of failure when this is not upheld, the importance of mentors in promoting self-confidence and self-esteem, and a sense of belonging on placement. The students responded well to positive role models and were able to identify negative role models. Accurate, constructive feedback and support was important to help students reflect appropriately.

The assertiveness of final year student radiographers during their clinical practice: A study in Ghana.

INTRODUCTION: Speaking up by health professionals is essential for patient safety. To ensure that student radiographers are well equipped in professional practice at the time of graduation, their capacity to speak up openly in the clinical setting is very important. This study assessed student radiographers' ability to speak up in the face of patient safety compromises during their clinical rotation and how it impacts their learning. METHODS: Twenty-four (24) final-year radiography students at the University of Ghana, who were then the only final years in the country, were recruited for the study. Questionnaires about assertive communication using a harm index score were given to the students who consented to participate in the study. The data were analysed using Microsoft Excel version 13 and SPSS version 20. RESULTS: The study recorded a response rate of 96% of which the majority (66.7%) were males. The majority (75%) of the participants would not speak up about patient safety issues for reasons. Moreover, 95.8% of the participants got confused when they observed a disparity between clinical practice and lessons taught in the lecture room. CONCLUSION: The ability of students to speak up is dependent on several factors encountered in the clinical area. For students to be able to function well in a clinical team, they need to be competent to speak up to ensure patient safety irrespective of who they work with. This study identified that students preferred to express themselves non-verbally in some situations that deal with patient safety compromises, instead of speaking up. Improving a culture of respect and freedom to speak up in healthcare settings would ensure patient wellbeing.

The appropriateness of abdominal X-ray requests in the acute medical initial admissions unit.

BACKGROUND/AIMS: Abdominal X-rays are frequently requested by clinicians in the Aberdeen Royal Infirmary acute medical initial assessment unit. METHOD: The proportion of indicated abdominal X-rays requested within 24 hours of admission was retrospectively examined. This process was repeated after displaying an educational poster with the Royal College of Radiologists guidelines (cycle 2) and a graded assertive communication poster (cycles 3 and 4); a tool to enable junior doctors to challenge inappropriate requests for abdominal X-rays from seniors. RESULTS: Only 47.2% of abdominal X-ray requests were deemed appropriate in cycle 1. A 1.54% reduction in abdominal X-ray requests and an 11.5% increase in indicated abdominal X-rays were noted after cycle 2. Cycle 3 led to a statistically significant improvement with 2.6% fewer patients undergoing an abdominal X-ray and a 24.6% increase in indicated abdominal X-rays. This improvement was sustained in cycle 4. CONCLUSIONS: Promoting graded assertive communication is an effective means of helping junior doctors to challenge seniors requesting non-indicated abdominal X-rays.

Comunicación asertiva en directivos de la Escuela de Iniciación Deportiva Provincial / Comunicação assertiva nos gestores da Escola Provincial de Iniciação ao Esporte / Assertive communication in managers of the Provincial School of Sport Initiation

RESUMEN La asertividad es una habilidad social clave para la promoción del desarrollo humano y la prevención de problemas psicosociales en los diversos ámbitos del desarrollo humano. El objetivo de este trabajo es determinar las características que asume la comunicación asertiva en directivos de la Escuela de Iniciación Deportiva Escolar "Ormani Arenado Llonch" de Pinar del Río. Se realizó un estudio observacional, descriptivo, transversal en el periodo comprendido entre abril y junio de 2018. Para ello, se utilizó un muestreo no probabilístico por conveniencia, quedando conformada la muestra por 12 directivos. Como métodos empíricos de obtención de información, se utilizaron: la observación, la Escala de Asertividad de Rathus y la entrevista semiestructurada. En la investigación, se mostró predominio de directivos que se encontraban entre los 50 y 60 años de edad (33 %) y que pertenecían al género masculino (67 %). Los cargos ocupados fueron fundamentalmente Subdirector en Formación Integral, Jefe de Grado y Jefe de Departamento (25 %). La totalidad de la muestra recibió cursos de superación de postgrado (100 %). Primaron los participantes que tenían entre 21 y 30 años de experiencia laboral. Prevaleció el estilo comunicativo asertivo confrontativo (42 %). El desarrollo económico y social en la Cuba de hoy necesita de directivos que actúen alejados de posturas agresivas y egoístas; pero también que dejen atrás posturas acríticas y pasivas, necesita de hombres y mujeres asertivos.

RESUMO A assertividade é uma habilidade social chave para a promoção do desenvolvimento do homem e a prevenção de problemas psicossociais em diferentes áreas da evolução humana. O objetivo deste trabalho é determinar as características que a comunicação assertiva assume nos dirigentes da Escola de Iniciação ao Esporte "Ormani Arenado Llonch" de Pinar del Río. Um estudo observacional, descritivo e transversal foi realizado entre abril e junho de 2018. Para este fim, foi utilizada uma amostragem de conveniência não-probabilística, e a amostra consistiu de 12 diretores. Os métodos empíricos utilizados para obter informações foram: a observação, a Escala de Assertividade de Rathus e a entrevista semiestruturada. A pesquisa mostrou uma predominância de gerentes entre 50 e 60 anos de idade (33 %) e pertencentes ao sexo masculino (67 %). Os cargos ocupados foram principalmente o de Chefe Adjunto de Treinamento Integral, Chefe de Grau e Chefe de Departamento (25 %). A amostra inteira recebeu treinamento de pós-graduação (100 %). Os participantes com entre 21 e 30 anos de experiência de trabalho foram predominantes. Prevaleceu o estilo de comunicação assertiva e confrontacional (42 %). O desenvolvimento econômico e social na Cuba de hoje precisa de gestores que estejam longe de posturas agressivas e egoístas; mas também que deixem para trás posturas acríticas e passivas; precisa de homens e mulheres assertivos.

ABSTRACT Assertiveness is a key social skill for the promotion of human development and the prevention of psychosocial problems in the various areas of human development. The aim of this paper is to determine the characteristics that assertive communication assumes in managers of the Sports Initiation School "Ormani Arenado Llonch" of Pinar del Río. An observational, descriptive, cross sectional study was conducted in the period between April and June 2018. For this purpose, a non-probabilistic convenience sampling was used, and the sample consisted of 12 managers. The empirical methods used to obtain information were: observation, the Rathus Assertiveness Scale and the semi-structured interview. It was shown a prevalence of managers between 50 and 60 years of age (33 %) and belonging to the male gender (67 %). The positions held were mainly Assistant Director in Integral Formation, Head of Grade and Head of Department (25 %). The totality of the sample received postgraduate courses (100 %). Participants with between 21 and 30 years of work experience prevailed. The assertive confrontational communicative style prevailed (42 %). Economic and social development in today's Cuba needs managers who act away from aggressive and selfish postures; but also who leave behind uncritical and passive postures; rather it is needed assertive men and women.

Factors Influencing Nurses' Willingness to Speak Up Regarding Patient Safety in East Asia: A Systematic Review.

Speaking up for patient safety among health care professionals is important because it can contribute to the prevention of adverse patient events, such as medication errors, infections, wrong-site surgical procedures, and other sentinel events. This systematic review identified factors that facilitate or inhibit nurses' willingness to speak up regarding patient safety in East Asian hospitals. Following the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases, including PubMed, CINAHL, PsycInfo, and Web of Science, were searched. Nine studies were analyzed in this review, including five qualitative and four quantitative studies published between 2014 and 2019. Quality of included studies were evaluated using the Mixed-Method Appraisal Tool. Data synthesis was based upon qualitative-led synthesis adopting two existing multilevel frameworks on safety voice and employee voice signals. Four studies were conducted in Japan, three in South Korea, one in Hong Kong, and one in Taiwan. We organized factors influencing East Asian nurses' willingness to speak up regarding patient safety according to the following four contexts: individual (motivation toward patient safety, organizational commitment, perceived effectiveness and importance of speaking up, and assertive personality), team (positive relationship and team trust, team culture, and mentoring), organizational (hospital administrative support and organizational culture) and sociocultural (hierarchy and power differential and collectivistic culture). However, due to the limited number of studies conducted in East Asian hospitals, further studies with larger cohort samples of nurses in various East Asian countries should be conducted to deepen our understanding of nurses' willingness to voice their concerns for patient safety.

Design and evaluation of an assertiveness communication training programme for nursing students.

AIMS: The aims of this paper are to (a) outline the design and implementation of an evidence-based assertiveness communication workshop for Japanese nursing students; and (b) report on the evaluation of nursing students' satisfaction with the workshop using the Satisfaction with Assertiveness Communication Training Program Survey. BACKGROUND: A body of research attests to the relationship between assertive communication and patient safety. This paper reports the design and evaluation of an assertiveness communication training programme designed to enhance students' ability to communicate safety in clinical practice. DESIGN: A culturally appropriate and evidence-based assertiveness communication workshop, informed by Gagne's instructional design principles, was implemented for third-year nursing students in two Japanese higher educational institutions in December 2017. A descriptive study design was used to evaluate the workshop. METHODS: Students' perceptions of the workshop were evaluated using the Satisfaction with Assertiveness Communication Training Program Survey, which includes ten items that are rated using a 5-point Likert scale from strongly disagree [1] to strongly agree [5]. Data were analysed using descriptive statistics. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used in the reporting of this study. RESULTS: A total of 111 students from a population of 150 participated in the study giving a response rate of 74%. The overall mean satisfaction score was 4.12 indicating a high level of agreement with each of the survey items. With the exception of two items, the mean scores were above 4.0. "Confidence in using assertiveness communication skills" and "Utilising role-plays to practice learnt skills" received mean scores of 3.71 and 3.90, respectively. CONCLUSION: Given the compelling research about the importance of assertive communication in health care, the results from this study support continuing investment in assertiveness communication training programmes for nursing students. RELEVANCE TO CLINICAL PRACTICE: Assertive communication is an essential communication skill for safe nursing practice. Culturally appropriate assertiveness communication training programmes are of particular relevance in hierarchical healthcare contexts.

Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power.

Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.

Cultural factors influencing Japanese nurses' assertive communication. Part 1: Collectivism.

Culture influences the way health-care professionals communicate with each other and their ability to relate to colleagues in an assertive manner. Cultural barriers can also make it difficult for nurses to speak up even when they have concerns about patient safety. An understanding of the potential impact of cultural factors is therefore needed when developing assertiveness communication training programs. This paper presents the findings from a study that explored Japanese nurses' perceptions of how culture and values impact assertive communication in health care. Semistructured interviews with 23 registered nurses were undertaken, and data were analyzed using directed content analysis. Two major themes were identified: collectivism and hierarchy/power. In the present study, we discuss the cultural values related to collectivism that included four categories of "wa" (harmony), "uchi to soto" (inside and outside), implicit communication/ambiguity, and "nemawashi" (groundwork). The findings highlight the impact of culture on nurses' assertive communication behaviors and can be used to inform the design of culturally-appropriate assertiveness communication training programs for Japanese nurses working both within their own country or internationally.

Age ascription as a resource and a source of resistance - An interactional study of health professionals' castings of patients into the category 'old'.

This case study aims to give an understanding of what actions health professionals' castings of patients into the category 'old' perform on a medical and social level as well as what actions patients' interactional management of these castings perform. Particularly, this study aims to bring to the fore the negotiability of health professionals' perspectivating age ascriptions. This is done with the conversation analytic method (CA) according to which altercasting is a mutual construction performed turn by turn and shaped by the reactions of the interlocutor who can approve, resist, or modify the identity in question. The data are drawn from two Swedish television documentaries on health encounters. Three major findings are presented. Firstly, the castings of the patients into the category 'old' are in several cases embedded in metaphors that either position the patient's body in the role of a victim of old age or in the role of a machine to routinely check. Secondly, the castings with a fateful approach to old age are ambivalent; whereas they serve as resources for the health professionals' normalizing of medical projects and perspectives, they can constitute sources of problems for the patients' doctorability and/or agency. Thirdly, the health professionals' perspectivating age ascriptions are negotiable; their design facilitates resistance to them, and the patients accept, modify, interrupt or reverse them.

Do As I Say: Using Communication Role-Plays to Assess Sexual Assertiveness Following an Intervention.

Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET's efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one's sexual partner as an assertive communication behavior within sexual health contexts.

Trabajando a gusto en Enfermería / Working with pleasure in Nursing

Introducción: la atención a personas hospitalizadas, amerita de parte de sus cuidadores contar además de sus conocimientos con la estabilidad emocional y calidad en las relaciones humanas; lo cual puede ser fortalecido a través del desarrollo de aptitudes personales. Objetivo: describir los resultados de la intervención educativa "Trabajando a gusto" dirigida al personal de enfermería de un hospital de tercer nivel, orientada al fortalecimiento de la dimensión personal. Metodología: estudio descriptivo resultado de un proyecto de extensión desarrollado en el Hospital Universitario de Santander (HUS). Se utilizaron tres instrumentos: Comunicación asertiva, Control de emociones, Prevención y manejo del estrés, los cuales se aplicaron antes y después de la intervención. Resultados: en el Eje temático de Comunicación Asertiva las personas aumentaron el nivel de asertividad pasando de un 39,17% en el pretest a un 45,48% en el postest. En el eje de Control de Emociones, la claridad definida como la buena comprensión pasó de un 25,37% antes de la intervención a un 32,14% en el nivel clasificado como excelente; en la reparación definida como la capacidad de regular los estados emocionales correctamente, los participantes pasaron en el nivel excelente de un 26,47% a un 38%. En la prevención y manejo del estrés no se evidenciaron cambios. Conclusiones: la intervención fue positiva en algunos aspectos de la comunicación y el control de emociones. Si bien las actitudes son aprendidas y posibles de ser modificadas, se requieren procesos formativos a largo plazo para mayores y mejores resultados, con un acompañamiento posterior y nuevas mediciones. Salud UIS 2012; 44 (1): 29-38.

Introduction: the care provided to patients who are hospitalized, requires from the caregivers not only their knowledge, also their emotional stability and interpersonal skills, which can be strenghtened trought the development of their personality. Objective: to describe the results of the educational initiative "Working with pleasure" directed towards the nursing staff in a third level hospital, targeted at strengthening the staff’s personality traits. Methodology: descriptive study result of an extension research project performed at the HUS (University Hospital of Santander, by their acronym in Spanish). Three tools were used: Assertive Communication, Emotion Control, and Stress Prevention and Management. They were all used before and after the intervention. Results: the participants of the assertive Communication thematic axis showed an increased assertiveness level from 39,17% prior to the test to 45,48% after the test. Regarding Emotion Control, clarity (defined as good comprehension) went from 25,37% prior to the intervention to 32,14%, a level classified as excellent. For Reparation (defined as the capacity to correctly regulate emotional states the subjects) improved from 26,47% to 38%. For Stress Prevention And Management no variation was evident in the study. Conclussions: the intervention was effective regarding communication and emotion control. While attitudes are learnt and modifiable, they require long-term learning processes to achieve more significant and better results as well as follow ups and further measurements. Salud UIS 2012; 44 (1): 29-38.