Proper relation is the main influential factor in the nursing profession [3]. One of important components in human relations is the assertiveness skill [4]. Assertiveness is generally defined as the expression of personal needs, rights and feelings without denying or violating the rights of others [3]. Nowadays, assertiveness is an unavoidable skill and necessity in the nursing profession [12]. Because of the complicated interpersonal relations of a nurse with other treatment team members, patients and their families, and also due to occupational challenges of people with this career, many studies have claimed assertiveness as a fundamental skill [13, 14]. One of ways to gain or improve assertiveness is to train it in a professional way [16]. 
The results of studies have demonstrated that assertiveness training can result in increased assertiveness and assertive interactions in the workplace [16, 18, 19, 21]. The important issue is the difference between two concepts of adaptive assertiveness and aggressive assertiveness. Aggressive assertiveness is a destructive act and can result in numerous negative consequences, while adaptive assertiveness is a positive act that strengthens daily interactions [7]. The present study was performed with aim of studying the effect of assertiveness training on adaptive and aggressive assertiveness in nurses.

This is an interventional study with two experimental and control groups. Study population consists of all nurses working in Alghadir, Emdadi and Omid hospitals in Abhar, Iran. A sample size of 64 was determined according to Motahari et al. [9] and considering Type I error α=0.05 and Type II error β= 0.01. At first, 32 nurses in each group entered the study. At the end, 6 nurses were excluded due to their absence, and 1 nurse in control group refused to continue participation. Both groups filled out the Adaptive and Aggressive Assertiveness Scale developed by Thompson and Berenbaum [11] at baseline. Then, the training program was presented to the nurses in experimental group for 2 days (10 hours). The control group received no intervention but a training package was provided to them at the end of intervention to observe ethical principles. Immediately, 1 and 3 months after intervention, assertiveness was re-evaluated in both groups. The hypotheses were tested at a significance level of less than 0.05 in SPSS v. 24.

The results showed the mean score of adaptive assertiveness was not significantly different at baseline between the two groups (P=0.090), but immediately after intervention, a significant difference was reported (P=0.002). One month after intervention, the mean score of adaptive assertiveness was significantly different between the two groups (P=0.025); but the difference was not significant 3 months after intervention (P=0.136). The mean score of aggressive assertiveness at baseline (P=0.53), immediately after intervention (P=0.16), 1 month after intervention (P=0.44) and 3 months after intervention (P=0.43) showed no significant difference between the two groups (Table 1). 



 

Based on the results, the assertiveness training program improved adaptive assertiveness in nurses, but its effect was not stable such that, after three months, their skill was declined. It can be concluded that the assertiveness training could somehow affect the attitudes of nurses and led to increased adaptive assertiveness in them, but decreased score of adaptive assertiveness and increased score of aggressive assertiveness 3 months after intervention probably was due to the lack of a clear strategy for continuation of training principles. Results of Motahari et al. also reported the effectiveness of assertiveness training in increasing nurses’ assertiveness [9]. 
In previous studies, the results have shown the positive effect of training programs on increasing assertiveness, but their difference with the present study is related to the differentiation of assertiveness types. In other studies, the assertiveness has been reported with an overall score, while in the present study assertiveness was divided into two types of aggressive and adaptive. In our study, assertiveness training could affect aggressive assertiveness, but the mean score showed no significant difference at three time spans in comparison with the control group. In Motahari et al.’s study [9], intra-group differences were reported, similar to our study in terms of aggressive assertiveness, but the score was not reported based on the type of assertiveness.

This study obtained its ethical approval fron the Ethic Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1397.263).

This study was extracted from the master thesis of first author Department of Critical Care Nursing, School of Nursing and Midwifery, Qazvin University of Medical Science.

Conceptualization and initial draft preparation: Gila Shakhpoor and Seyedeh Zahra Hosseinigolafshani; Data collection and writing: Mohammad Hossein Mafi; Data analysis: Maryam Mafi; Intervention and writing: Ali Amiri.

The authors declare no conflict of interest.

The authors would like to appreciate the authorities at the department of nursing, Qazvin University of Medical Sciences. Also, we thanks of all nurses who participated in this study.
 

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