1. Assertiveness Training
Chapter 14
Assertiveness
Training

2. Assertive Communication
Assertiveness is behavior that enables individuals to:
Act in their own bests interests
Stand up for themselves without undue anxiety
Express their honest feelings comfortably
Exercise their own rights without denying the rights of others

3. Assertive Communication (cont.)
Honesty is basic to assertive behavior and is expressed in a manner that promotes self-respect and respect for others.

4. Basic Human Rights The right to be treated with respect
The right to express feelings, opinions, and beliefs
The right to say “no” without feeling guilty
The right to make mistakes and accept the responsibility for them
The right to be listened to and taken seriously

5. Basic Human Rights (cont.)
The right to change your mind
The right to ask for what you want
The right to put yourself first, sometimes
The right to set your own priorities
The right to refuse justification for your feelings or behavior

6. Basic Human Rights (cont.)
If one is to accept these rights, he or she must also accept the responsibilities that accompany them.

7. Response Patterns
Individuals develop patterns of responding to others. These include:
Watching other people (role-modeling)
Being positively reinforced or punished for a certain response
Inventing a response
Not thinking of a better way to respond
Not developing the proper skills for a better response
Consciously choosing a response style

8. Four Common Response Patterns
Nonassertive Behavior Sometimes called passive behavior. These individuals seek to please others at the expense of denying their own basic human rights.
Assertive Behavior These individuals stand up for their own rights while protecting the rights of others. Feelings are expressed openly and honestly. Self-respect and respect for others are maintained.

9. Four Common Response Patterns (cont.)
Aggressive Behavior These individuals defend their own basic rights by violating the basic rights of others. Aggressive behavior hinders interpersonal relationships.
Passive-Aggressive Behavior These individuals defend their own rights by expressing resistance to social and occupational demands. Sometimes called indirect aggression, the behavior takes the form of passive, nonconfrontative action. These individuals use actions instead of words to convey their message, and the actions express covert aggression.

10. Four Common Response Patterns (cont.)
Two clients disagree on what movie to watch during free activity time. One client says to the other, “I would like to watch the comedy instead of the murder mystery.” The nurse recognizes this as which form of communication response pattern?
A. Nonassertive
B. Assertive
C. Aggressive
D. Passive-Aggressive

11. Four Common Response Patterns (cont.)
Correct answer: B
Assertive individuals express feelings openly and honestly. Individuals using this communication pattern use “I” statements and communicate tactfully. The example presented in the question demonstrates the use of an assertive communication pattern.

12. Behavioral Components of Assertive Behavior
Intermittent Eye Contact. This conveys the message that one is interested in what is being said.
Body Posture. Sitting and leaning slightly toward the other person in a conversation.
Distance/Physical Contact. Appropriate physical distance is culturally determined. Invasion of personal space may be interpreted by some individuals as aggressive.

13. Behavioral Components of Assertive Behavior (cont.)
Gestures. These may also be culturally related. Gestures can add meaning to the spoken word.
Facial Expression. Various facial expressions convey different messages.
Voice. The voice conveys a message by its loudness, softness, amount and placement of emphasis, and evidence of emotional tone.

14. Behavioral Components of Assertive Behavior (cont.)
Fluency. Being able to discuss a subject with ease and with obvious knowledge conveys assertiveness and self-confidence.
Timing. Assertive responses are most effective when they are spontaneous and immediate.
Listening. Assertive listening means giving the other individual your full attention.

15. Behavioral Components of Assertive Behavior (cont.)
Thoughts. One’s attitudes about the appropriateness of assertive behavior influences one’s response.
Content. Many times what is being said is not as important as how it is said.
Persistence. An assertive person persists in his/her pursuits.

16. Behavioral Components of Assertive Behavior (cont.)
A nurse is conducting an assertiveness training class. Which of the following characteristics of assertive behavior should the nurse include?
A. Eye contact should be steady and continuous.
B. Invasion of intimate space can be interpreted as assertive behavior.
C. While interacting, individuals should turn slightly away from the other person.
D. The facial expression is congruent with the verbal message.

17. Behavioral Components of Assertive Behavior (cont.)
Correct answer: D
Various facial expressions convey different messages. In assertive communication, the facial expression is congruent with the verbal message.

18. Techniques that Promote Assertive Behavior
Standing up for one’s basic human rights
Assuming responsibility for own statements
Responding as a “broken record” – persistently repeating in a calm voice what is wanted
Agreeing assertively–assertively accepting negative aspects about oneself; admitting where an error has been made
Inquiring assertively–seeking additional information about critical statements

19. Techniques that Promote Assertive Behavior (cont.)
Shifting from content to process–changing the focus of the communication from discussing the topic at hand to analyzing what is actually going on in the interaction
Clouding/fogging–concurring with the critic’s argument without becoming defensive and without agreeing to change
Defusing–putting off further discussion with an angry individual until he or she is calmer

20. Techniques that Promote Assertive Behavior (cont.)
Delaying assertively–putting off further discussion with another individual until one is calmer
Responding assertively with irony
Using “I” statements–taking ownership of one’s feelings rather than saying they are caused by another person

21. Thought-Stopping Techniques
A technique that was developed to eliminate intrusive, unwanted thoughts
The individual practices interrupting negative thought processes with the word “stop,” and shifting his or her thoughts to ones that are considered pleasant and desirable

22. Role of the Nurse
Nurses must understand and use assertive skills to effect change that will improve the status of nursing and the system of health-care provision.
Nurses who understand and use assertiveness skills can assist clients who wish to effect behavioral change in an effort to increase self-esteem and improve interpersonal relationships.

23. Role of the Nurse (cont.)
Nurses can teach clients assertiveness skills on a one-to-one basis or in a group situation.
Information should include examples of various behavioral responses (assertive, nonassertive, aggressive, and passive-aggressive), as well as techniques that can be used to promote assertive behavior.

24. Role of the Nurse (cont.)
Clients should be given the opportunity to practice their newly learned skills through role-play to facilitate the behavior when the actual situation arises.