Factors Affecting Assertive Behaviour among Head nurses

Introduction

Head nurses in Current healthcare environments need become to be more aware of how use assertiveness effectively in their workplaces to manage the challenges their face when dealing with human resources. Head nurses are traditionally regarded as being in subservient roles and as having to live up to public expectations .The pressure of these expectations is thought to reduce a their capacity to behave in an assertive manner⁽¹⁾.They require the competence of clinical grasp and clinical forethought for providing patient appropriate care. Furthermore, head nurses are expected to show clinical leadership at the patient bedside to provide direction and support to patients and health care team for integrating the care they provide to achieve positive patient outcomes. So that they assert their opinions to other team members for changing the care plan for their patients ⁽²⁾.

Assertiveness is referred to as an ability to convey feelings, beliefs, and thoughts without anxiety and to express personal rights without denying the rights of others. It contributes to accept the responsibility of behavior, helping in increase self-esteem and self-confidence⁽³⁾.Furthermore assertiveness is usually used to describe both behaviors and    individuals. such as a highly assertive person refer to someone who was seen by others as habitually acting in a highly assertive way and it was described as expressing thoughts and feelings without denying the rights of others^{( 4, 5)}.

  Assertive behaviors is the ability to stand up for the rights and expresses the personal needs, values, concerns and ideas in direct and appropriate ways, assertive people meeting their needs, without violating the needs of others or trespass on other personal space. They communicate with others by using direct sentences, maintain eye contact, and use appropriate distance, head nods and lean forward to listen attentively to the speaker. So that assertiveness is a key attribute for head nurses without it true autonomy and personal empowerment cannot be achieved thus  it is considered to be an essential skill for them^{(6, 7)}.

Lack of assertiveness can lead to depression from anger turned inward, resentment, frustration, anxiety, which leads to avoidance, poor relationships of all kinds, non-assertive people are often unable to express emotions of any kind, and always isolated⁽⁸⁾. Nonassertive head nurse often attempts to avoid problem by remaining silent, when she is angry, she can’t face problems and become defensive without taking proper decision, moreover, she try to hide her deficiencies and weakness that reflect a risk factors for critical situations which need strong decision and proper action at proper time⁽⁹⁾.

Significance of the study:

     Assertive  is consider to be healthy and desirable behavior for all people who interact in group situation, head nurses in multidisciplinary care show that they are rarely asked for their opinions during health team meeting and conversations. These conversations demonstrate a degree of lack of assertiveness. One study reported that in general individuals are not highly skilled in expressing their own needs which is at the core of assertive behaviour ⁽¹⁰⁾. Other study stated that head nurses and nurse managers frequently did not express their opinions or provides constructive criticism and suggestions in nursing practice ⁽¹¹⁾. So that head nurse needs to be assertive in the clinical field and confident in professionally relationships and skills, also assertiveness increases self-worth and decrease helplessness and hopelessness ⁽¹²⁾. Thus this study will describe factors affecting assertive behaviour   among  head nurses in their work .

Aim of the study

Identifying the factors affecting assertive behaviour among head nurses at Minia University Hospitals.

Research Question

What are the factors affecting assertive behaviour among head nurses at Minia University Hospitals?

Subjects and Methods

 Research design:

 Descriptive design was utilized in current study to achieve the aim of the study.

Research Setting:

    The study was conducted at Minia University Hospitals, which include four different hospitals, (Minia university hospital, Obstetric & Gynecology and Pediatric hospital, Renal urology hospital, and Cardiothoracic hospital) in Minia Governorate.

Sample

 Convenient sample of all available head nurses in Minia University Hospitals were included in this study, with total number (n= 50).

Tools of data collection:

Data for this study was collected by using one tool. Self-administrated questionnaire sheet (Factors Assertive Behaviour). Which classified into two parts:-

• Part I: Socio-demographic data sheet, to get information about head nurses working at Minia University Hospitals includes (name, age, gender, marital status, qualification and years of experience)
• Part (II): (Factors Assertive Behaviour questionnaire). This tool aimed to identify factors affecting assertive behaviour among head nurses. It was developed by Rasetsoke, (2012) ^(1), modified and translated into arabic by the researcher. It consisted of 56 questions, which were grouped under four factors as follows: Communication skills factor (16 questions), Personal / Professional rights and responsibilities factor (12 questions), Conflict factor (14 questions) and Self –confidence factor (14 questions).

Scoring system: 

The questionnaire containing 56 questions with a 5–point likert scale. This questions were scored 1, 2, 3, 4 and 5 for the responses Never, Rarely, Neutral, Often, and Always, respectively. For each factor, the scores of items were summed-up and the total divided by number of the items giving a mean score for factor. These scores were converted into a percent score. Head nurses considered high assertive if the percent score was  60 % or  more, and head nurses considered low assertive if the percent score Less than 60% .

• 60% and more   ----------- High assertive.
• Less than60% ------------ Low assertive

Validity

   Study tool was reviewed by three experts, two of them are assistant professors of nursing administration in Faculty of Nursing, Assuit University, one assistant professor of nursing administration in  Faculty of Nursing, Minia University. Based on experts comments and recommendations of thesis supervisors minor changes had been made in the questionnaire .

Reliability

The tool was designed in it is final format and tested for reliability by using, cronbach’s alpha coefficient test (0.82). the tool proved to be reliable.

Pilot study

A pilot study was carried out on approximately (10 % ) of the study sample in a selecting  setting to evaluate  the applicability & clarity and feasibility of the study tool and to estimate the time needed for filling the tool  that ranged between 15 to 30 minute . As well as, identifying problems that may be encountered during actual data collection. Result of the pilot study illustrated that no modification needed so that the pilot sample study was included in the main study sample.

Study procedure

An official letter of the study approved was obtained from Dean of Faculty of Nursing –Minia University  to  the manager of  the hospitals. This letter was including a brief explanation of the objective of the study. After receiving the initial acceptance from the ethical committee at the Faculty of Nursing, Minia University, the researcher initially introduced herself to all participants to explain the aim of the study and to obtain their permission. They were assured that the collected data would be absolutely confidential. Data were collected in the period from February 2016 until June 2016. The researcher collected the data during the morning at two days/week from 10 AM to 12 PM.

Ethical consideration:

A written initial approval obtained from the research ethical committee in the Faculty of Nursing, Dean of Nursing Faculty and agreement from Egypt academic for research center and technology. participants in this study were voluntary and informed about the purpose, procedure of the study and the right to withdraw from the study at any time without any rational. Written consent were obtained from the subjects after reading all details. Confidentiality  and anonymity of each subjects were ensured through coding of all data and protecting the obtained data .

Statistical design

Data entry and statistical analysis were done using a Statistical  Sackage for Social Science (SPSS), version (16).Data were presented using descriptive statistics in the form of frequencies and percentages, mean and standard deviations. Cronbach alpha coefficient was calculated to assess the reliability of the developed tool through their internal consistency. Probability (p-value) is the degree of significance, if it less than 0.05 was considered significance, the more significance is the result (*) , less than 0.001 was considered highly significance (**) and correlation coefficient was done by using Spearman rank correlation. 

Results

Table (1): Socio-demographic characteristics of head nurses in the study sample (n=50).

Table (1): Revealed that two thirds of study sample their age were more than thirty one  years. majority of the study sample were femalse (92% ), more than three quarters of head nurses were married (82%) ,and the majority of head nurses were have bachelor degree (98%) .Finally regarding to years of experience nearly to half of head nurses (48% ) had experience between 5 to less than 10 years.

  Fig. (1) Distribution of level of high assertiveness among head nurses (n=50)

Figure (1): Illustrated that two thirds of head nurses have high assertiveness regards communication (66%),but have low assertiveness in personal/ professional rights and responsibility, conflict ,and self – confidence (58% ,58% , 44% respectively ).

Fig. (2) Distribution of assertiveness level among head nurses  ( n=50)

Figure (2) : Illustrated that more than half of study sample (54%) have low level of assertiveness compared with less than half of them (46%)  have high level of assertiveness ,which  indicated that there was low assertiveness level in all study sample.

Table (2): Relations between head nurses total assertiveness and their socio-demographic characteristics (n=50)

NS…. Not Significant

 Table (2): Found that there were no statistical significance differences between  head nurses’  total assertiveness and their socio demographic in which p- value > 0.05. 

 Table (3) Best fitting multiple linear regression model for total assertiveness score.

r-square=0.06                        Model ANOVA: F=4.26, p=0.045

Variables entered and excluded: age, marital status, qualification, job position, experience

Table (3): showed that there was statistical significance difference between  total assertiveness and female gender in which p – value < .045.