Importance of Assertiveness and Self Esteem among Nursing Students

When we talk about being assertive, we mean having the confidence to stand up for yourself and your rights without violating the rights of others. The ability to articulate one's thoughts, feelings, and values in a manner that is at once confident and considerate. To be assertive is to express one's desires, demands, opinions, and rights without violating the rights of others. A forthright demeanour is beneficial to one's social standing, sense of autonomy, and self-confidence. Developing your self-assurance and reclaiming your life by learning to be more aggressive is a terrific goal (Barbara, 2004). If you work on becoming more aggressive, you might be able to get over your anxiety, shyness, passivity, and even anger. To overcome challenges and win the support of their colleagues, nurses need to learn to be more aggressive in the many different environments in which they work. A good example of assertiveness is knowing when and how to say "yes" or "no." We're looking for a solution that works for everyone. When trying to reach a mutually beneficial agreement, it's essential that each party's needs be met. When customers pay a visit to corporate, it's because they've been influenced, heard, and negotiated with by a forceful individual. The capacity to speak assertively is an important skill for nurses to have while working in collaboration with other health care professionals. Inadequate or insufficient communication has also been identified as a crucial factor in medical errors. Nurses' ability to speak out when they observe potential dangers in the delivery of care are vital for a number of reasons, including the safety of their patients, the quality of their care, and the prevention of medical errors (Begley, 2004). Due to the urgent nature of hospital patients and the velocity with which their situations might change, poor assertiveness skills may pose a substantial risk to patient safety. In fact, Warland and coworkers documented a case of a tragic neonatal mortality in Australia, and a later study related the reason to many flaws, one of which was a lack of assertiveness by the health care providers involved (Jayne, 2015).

The effectiveness means producing an intended result. In this study its refers to the extent of improvement in assertive behavior and self esteem among the GNM students through assertiveness training and is assessed by Rathus Self assertive Schedule scale and Rosenberg Self-Esteem scale (Kimberley, 2012). Assertive Behaviour To be assertive is to act in one's own best interest, to speak out for oneself without undue fear, to admit one's own emotions without fear of repercussions, or Self Esteem In this study it refers to overall evaluation of self worth, self respect and independence which is measured by using Rosenberg Self-Esteem scale. Importance of Assertiveness in Nursing Being assertive is a crucial trait for a modern nurse to have. A more forceful demeanour is expected of nurses as the profession breaks free of stereotypically servile duties. The ability to communicate effectively with patients requires nurses to be assertive, and it has been argued that nurturing this quality might also boost morale in the field. Being able to properly voice one's ideas and concerns on patient care to other health professionals, particularly those in charge, is an essential skill for any health worker. Interacting successfully in healthcare's complex and ever-changing settings with patients, family members, coworkers, and members of the multidisciplinary team is essential. Assertiveness is a quality that promotes and enables effective inter-professional communication and cooperation in healthcare settings, with a particular emphasis on the clinicians' capacity to express their perspectives and concerns in their role as patient advocates. Possessing the ability to be assertive is crucial in today's health care setting, as it helps foster harmonious and effective interactions between employees (Robbins, 2007). An assertive person is one that is not afraid to stand up for what they believe in, is secure in their own skin, and is not afraid to speak out for themselves when the time is right. Assertive behaviour is associated with elevated mood, a greater sense of mastery over one's life, and more fulfilling relationships. To achieve these goals, this module on assertiveness training aims to:

• To instruct future nurses on how to respond positively to hostile patients.

• To help the nursing students become more self-aware in terms of their emotional reactions to the actions of others and their strategies for dealing with so-called "difficult" patients.

• To improve one's communication skills and empathy for others.

The ability "to cope with oppressive atmospheres, interact well to patients, and face oppression concerns" can be enhanced by teaching students of nursing to be more aggressive. Newly licensed nurses believe that being able to behave assertively is crucial to their smooth transition from student to licensed nurse. To guarantee that their interactions promote and preserve patient safety, health professionals need highly developed communication skills (Shimizu, patients, families, and coworkers in the medical field, students in these fields must have strong verbal and nonverbal communication skills. nursing students in Greece, and found that those with low levels of assertiveness and self-esteem were more likely to engage in risky professional behaviours once they graduated. The researchers concluded that training in assertiveness skills should begin early on in nursing school. Despite the fact that many studies highlight the significance of assertiveness and its connections to improvements in assertiveness in general, there is a lack of critical reviews that appraise and synthesize the evidence to determine the efficacy of assertive communication training programs, particularly for health professionals and students. A nurse's capacity to speak out when she has concerns about a procedure, the care she is receiving, or a patient's symptoms is crucial in minimizing harm and avoiding serious mistakes. Many professional nurses and nurse managers working in nursing units retain a submissive role and do not assert themselves sufficiently despite some changes having occurred in recent years as a result of the feminist movement and demands for female equality, as well as employment legislation that has allowed most nurses to pursue clinical, education, or management career pathways. Nurses who are self-assured and apply their assertive abilities in the workplace can improve their interactions with patients, coworkers, and other members of the healthcare team. The goal of nursing is to promote health and well-being among patients and the general public by facilitating two-way communication between healthcare providers and the people they serve. As a result, one of the primary goals of nursing education is to instill in students the confidence and assertiveness they'll need to succeed in the profession (Suzuki, 2009). Problem-solving, active participation in decision-making, clear and eloquent communication, and aggressive behaviour are all skills that RNs may bring to the table to help the profession advance. The goal of this study was to highlight the significance of assertiveness and problem-solving abilities among midwives and to investigate the connection between the two concepts. In nursing, being assertive is valued because of the many benefits it brings to the profession, including better leadership, more fulfilling work, less problems at work, and more adaptability to change. The capacity to take charge and deal well with emergencies is a lifesaving talent. Nurse managers in today's health care systems need to learn how to employ assertiveness in the workplace to better handle the obstacles they have while interacting with other members of the health team. Managers in the nursing profession have always been viewed as All people have equal rights regardless of their socioeconomic status, and it is not only desirable but necessary to cultivate a sense of self-worth along with the assertive style of behaviour, according to the original assertive training designed not for clinical practice of psychological treatment of nerve disorders but for activation of human potential. While they both acknowledged that assertiveness isn't a magic bullet for avoiding problems and setbacks, they did agree that by stepping up to obstacles with a sense of assurance, issues might be handled in the most effective and efficient way possible. This study provided conclusive proof that group learning and behaviour change are more successful than individual efforts. Assertiveness training is a crucial component of behavioural therapy since it is predicated on the idea that people's internal states will reflect their external displays of emotion. The core tenet of assertiveness education is that each individual possesses the inherent right to make known to others their own perspectives, emotions, and demands. Without the freedom to vent our emotions, we run the risk of feeling stifled emotionally, which may lead to feelings of depression, anxiety, and anger, as well as a diminished sense of self-worth (Uzaina, 2015). When we aren't confident in ourselves to express what we want, it might produce tension in our relationships with other people. Assertiveness is contextual, meaning that it varies depending on when, where, and how it is being used. What one person considers to be an adequate level of assertiveness in a given setting may strike another as either overly quiet or too aggressive. The benefits of assertiveness training for nurses have been extensively studied, and shown to include increased assertiveness, less job-related stress, elevated mood and self-esteem, and averting burnout. Some academic works have even argued for include assertiveness instruction in the formal education of nurses at all levels. The majority of research, however, has been conducted on training that takes more than 10 hours in total (e.g., 1.5 hr 10 sessions), making it challenging to implement as universal on-the-job training. As a result, there is an immediate need to create more condensed training programs. Numerous analyses of nurses' roles in interdisciplinary care have found that nurses are seldom asked for their input during health team meetings or in casual interactions between colleagues. Furthermore, the level of assertiveness deficit needs to be clarified. Nurses require greater training in assertiveness, and the way through which they are educated and taught in this area needs more explanation. These are some of the aspects of assertiveness and confidence in which the researcher is particularly interested. These concerns all play a part in how nursing is put into practice and assessed. Research on the factors that influence assertive behaviour in nurses might lead to more effective training methods. Evaluation of Self esteem Having low self-esteem might make it harder to learn new skills and grow in ways that are beneficial to one's life and career. Feelings of weakness, helplessness, hopelessness, fear, fragility, incompletion, worthlessness, and inadequacy are also common among those with low self-esteem. They are plagued with self-doubt, fail to see their own potential, react poorly to praise, are reluctant to take on new duties, and have trouble establishing their own opinions. If you struggle with feelings of insecurity in social or professional settings, assertiveness training might help. You may retrain yourself to be more confident by detaching from old habits and replacing them with new, more forceful ones. A person's sense of self-worth plays a crucial role in shaping who they become. Multiple studies have found that confident individuals tend to be aggressive. High levels of assertiveness are indicators of healthy self-esteem in people. Studies examining the effect of assertiveness training on self-esteem have shown contradictory results. One study found that participants who took an assertiveness course had a significantly higher mean self-esteem than those who did not (Wesley, 2008). Multiple studies have reported these results. While many people found their self-esteem improved following assertiveness training, some saw no difference. Clearly, further research is required to resolve this seeming conflict. The goal of any excellent assertiveness training (AT) program is to help its participants feel better about themselves, build up their self-esteem, and express their feelings and thoughts correctly, all of which will lead to better communication and relationships with others. There has been a growing awareness that nurses and midwives, given their newfound autonomy, ought to adopt a more forceful demeanour. There is much research behind the use of aggressive techniques in the medical setting. Although research on nurses' and midwives' assertiveness has focused on particular assertive behaviours and abilities, there is a dearth of data on how often and how often these professionals really utilize them on the job. A person's self-esteem (SE) may be thought of as an appraisal and a stance toward oneself along a positive-negative axis. It's a silent reflection of the person's confidence in his own resilience and right to joy in the face of adversity. A person with high SE thinks well of themselves and believes they deserve positive emotions and praise. The hallmark of someone with low SE is a pervasive feeling that they are unable to do anything worthwhile in life and are hence unworthy of receiving affection and respect from others. A low self-esteem person is one who struggles with feelings of inadequacy and lack of confidence. There are two ways that emotions like this might show themselves. When an individual has strong sentiments that he is not competent enough to perform well, he may avoid taking on many jobs that demand his attention completely, or he may try to overcome these feelings by acting arrogant or on par with everyone else. A person's self-evaluation and sense of self-worth are influenced by the thoughts and feelings of others around them. One's sense of self-worth can be boosted by anything that makes one feel good emotionally. Raising one's sense of self-worth means becoming more certain that one has what it takes to succeed in life and deserves to be happy. This, in turn, makes one more likely to approach challenges head-on with the kind of confidence, generosity, and optimism that ultimately leads to success and satisfaction. Individuals with higher levels of self-esteem are more likely to have lofty goals for themselves, and not simply in terms of their professional lives. Your self-esteem is an aggregate measure of how you value yourself, both positively and negatively, based on your unique set of experiences and observations. Having low self-esteem might make it harder to learn new skills and grow in ways that are beneficial to one's life and career. Feelings of weakness, helplessness, hopelessness, fear, fragility, incompletion, worthlessness, and inadequacy are also common among those with low self-esteem. They are plagued with self-doubt, fail to see their own potential, react poorly to praise, are reluctant to take on new duties, and have trouble establishing their own opinions. If you struggle with feelings of insecurity in social or professional settings, assertiveness training might help. You may retrain yourself to be more confident by detaching from old habits and replacing them with new, more forceful ones.

The primary goal of assertiveness training is to assist the trainee develop a more positive self-image, increase their assertiveness, develop more effective methods of expressing their feelings and ideas, and solidify their sense of self-worth. Learn how to handle challenging conversations with the help of this course. According to the vast majority of academics, there are three basic kinds of responses to every given situation: rejection, request, and expression. Both behavioural and cognitive strategies are used in training for assertiveness. Instruction, demonstration, feedback, role acting, training, augmentation, homework, panel discussion, relaxation, and self-study educational resources are all common forms of training. The members of the group may practice aggressive conduct inside the group, which is why it is thought that group training is more useful than individual training. When people in a group know why one person is acting assertively, they are more likely to accept that member's actions. Furthermore, there are more chances to foster and improve assertiveness in a group setting. Furthermore, an effective group contains between 5 and 12 members and is homogenous in terms of member attributes. It has been determined that 6-12 weeks of twice-weekly group meetings are optimal (Yen-Ru, 2004). their feelings and thoughts correctly, all of which will lead to better communication and relationships with others. There has been a growing awareness that nurses and midwives, given their newfound autonomy, ought to adopt a more forceful demeanour. There is much research behind the use of aggressive techniques in the medical setting. Although research on nurses' and midwives' assertiveness has focused on particular assertive behaviours and abilities, there is a dearth of data on how often and how often these professionals really utilize them on the job.

LITERATURE SURVEY

Akbari,et.al. (2012), assessed the impact of assertiveness training on Iranian college women's confidence and ability to succeed in life. The study hypotheses were tested using a pre- and post-test experimental group design and a multivariate analysis of covariance (Moncova) including three groups of 20 participants (two experimental and one control). The results of the study demonstrated that assertiveness training had a positive impact on self-confidence and general self-efficacy, as well as on the following outcomes: decreased disability and confusion, improved conflict resolution, and

Makhija & Singh (2010), conducted a study to determine the efficacy of assertiveness training for teenagers in Indian contexts. Eighty boys and eighty girls in the 10th and 11th grades at a public school in Chhattisgarh participated in a study that found pupils in the experimental group who received training in assertiveness had greater gains in self-esteem than those in the control group who had no such training. Research participants were also told that assertiveness training programs did not improve their grades. A.Rezan et.al.(2009), analyzed the impact of an assertiveness training program on the confidence and self-esteem of young adults. Criteria including "Rathus Assertiveness Schedule (RAS)" scores, willingness to participate, instructors' opinions, and parents' consent were taken into account while choosing pupils for the experimental and control groups. "Rathus Assertiveness Schedule" was used to compile the data. The school counsellor spent 50-70 minutes each week with the experimental group for 12 weeks, implementing a program designed to improve assertiveness as the independent variable. The non-treatment group went through this phase. Results from an ANCOVA study of the program's influence on teenagers' assertiveness indicate that the program is successful.

Being assertive is a quality that helps one in all aspect of life. It helps one develop an emotionally stable identity free of baggage like guilt and remorse. The inability to be content with one's circumstances makes life tough for the non-assertive individual and those around them. College life is full with scenarios when students encounter roadblocks due to a lack of or an abundance of this talent. Because of the widespread belief that early adulthood is optimal for the development of vision, perseverance, self-reliance, and initiative—all qualities that are objective prerequisites for assertiveness—nursing students at an early stage of their careers have received a great deal of attention for cultivating these traits. Each student should acquire an aggressive personality trait so they may excel in school and in their future careers with confidence and courage, since students are the backbone of every nation and make significant contributions to its social development. There is a connections with other people. Children who learn to be assertive grow up to be confident and content with their social skills. Therefore, a thorough examination of the relationship between these two topics can shed insight on how to best equip future generations with a wide range of social skills.

1. Barbara Schoen John. (2004). Psychiatric Mental Health Nursing.(4th ED.). Philadelphia: Lippincott. 2. Barke. (2003). Psychiatric and mental health nursing.(1st ED.). London: EDward Arnold publishers. 3. Begley, C.M., Glacken, M., 2004. Irish nursing students‘ changing levels of assertiveness during their pre-registration programme. Nurse Education Today 24 (7), 501–510 4. Dr. Bimla Kapoor (2010), ―Text book of psychiatric nursing‖ (2nd edition) published by Kumar publishing house, New Delhi. 5. Jayne E.Stake, Cathy J.DeVille,Christine L.Pennell: The effects of assertive training on the performance self –esteem of adolescent girls; Journal of Youth and Adolescence. 2015; 12 (5): 435-42. 6. Kimberley A. Moore, Erin E.hudson, and Brandon F.smith: The relationship between assertiveness and social anxiety in college students; Research journal for the Human Science.2012; Vol.14 (1), 77-79. 7. Parray, W. M., & Kumar, S. (2016). Assertiveness among undergraduate students of the University. The International Journal of Indian Psychology, 4 (1), 283-291. 8. Pipas, D.M. & jaradat, M. (2010). Assertive communication skill. Annals universitatis Apulensis Series economica, 12(2).Psychological Thought, 6(1), 3–26. 9. Polit and denise F (2004), ―Nursing research, principles and methods,‖ philadelphia, lippincott publications. 10. R. Sreevani, (2010) A guide to Mental Health and psychiatric nursing, New Delhi, Jaypee brothers, 3rd edition 11. Robbins P. & Philip Honaker L.,(2007). An experimental investigation of assertiveness training group setting. Journal of Educational psychology.3, 81-86. 12. S.Mohebi,et.al: The effect of assertiveness training on students academic anxiety; Journal of Pakistan Medical Association. 2012; Vol.62 (37), 1067-1071. 13. Shebeer.P.Basheer, S.Yaseen Khan.(2013).A concise text book of Avanced nursing practice. (1st ED). Bangalore: EMMESS medical publishers. 14. Shimizu, T., Kubota, S., Mishima, N. and Nagata, S. (2004). Relationship between self esteem and assertiveness training among Maruyama, A., Azuma, T., & Sato, C. (2009). Relationship between assertiveness and burnout among nurse managers. Japan Journal of Nursing Science, 6(2), 71-81. 16. Uzaina & Parveen A. (2015). Study of Relationship between mental health and assertiveness among Adolescents. The international journal of Indian psychology. 3. (1), 2349-3429. 17. Wesley, Mark & Mattaini, (2008).Reflected appraisal, academic Assertiveness in performance during adolescence. Journal of Educational psychology, 97(4), 673-686. 18. Yen-Ru Lin,et,al: Evaluation of an assertiveness training program on nursing and medical students assertiveness, self esteem, and interpersonal communication satisfaction; Nurse education today.2004;Vol.24 (8) 656-665.

Research Scholar, Shri Venkateshwara University, Uttar Pradesh