Asertiveness Skills
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Transcript of Asertiveness Skills
7/23/2019 Asertiveness Skills
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PROFESSIONAL DEVELOPMENT
Interactions with colleagues occur in many different
situations: managing or being part of a team, imple-
menting or being required to implement change,del-
egating and receiving delegated tasks.Any of these situa-
tions may give rise to tensions. In this article, we aim to
highlight certain difficulties with colleagues that can ar ise
through an inability to assert ourselves in an appropriate
and effective manner.We will also look at ways in which
we can change our behaviour.
The outcome of an exchange with a colleague can
leave us feeling dissatisfied, abused, impotent or even
guilty. Feelings of impotence can result through the frus-
tration of having acquiesced to an undesirable outcome.
Guilt can be the result of being overly forceful or inap-
propriately aggressive to achieve a desired outcome.
In short, if we have achieved our goal, it may have cost
a deterioration in our relationship. But what causes this
type of problem and how can we change? In hindsight weoften think we could have handled a given situation bet-
ter.However, hindsight would be better replaced by fore-
sight. Assertiveness can be the key to change. We need
to develop an ability to say ‘yes’ and ‘no’, or agree and
disagree in an appropriate manner.
AssertivenessAssertiveness enables you to express yourself with confi-
dence,without the inappropriate use of aggressive, passive
or manipulative behaviours (Bishop, 2000).
At the core of assertiveness is the recognition that both
you and the person you are communicating with have
basic rights (Bishop, 2000).
AggressionWhen aggression is used as a form of communication, we
are ignoring the rights of the other person. This is the
key difference between aggressive and assertive behav-
iour.Aggressiveness might develop as a strategy because it
has worked in the past.Alternatively, it may be something
that we have witnessed in others when trying to assert
their authority. However, as noted by Paterson (2000), it
is a short-lived strategy.
PassivenessIn contrast to an aggressive communication style, when
an individual adopts a passive approach, they are ignoring
their own rights. For example, this may be someone who
finds it difficult to say ‘no’ to colleagues because they feel
that they ought to agree to the requests of others.
Passive aggressionThis is a combination of aggressive and passive styles of
communication.Paterson (2000) notes that this strategy is
used when aggression is disguised. Classic examples
would be of someone grudgingly agreeing to a request or
sighing and muttering inaudibly before walking away.
The importance of verbaland non-verbal skillsIn order to conduct ourselves in an appropriately
assertive manner we must develop effective verbal and
non-verbal communication skills.Taken in isolation, the
content of what we say is not enough.The words need to
be conveyed with appropriate use of tone and volume.Attimes, certain words or phrases may need to be stressed.
In face-to-face encounters, body language is a vital com-
ponent of effective communication. Not only do we
need to sound confident, but our body language must
match the content of our delivery to achieve an ‘air of
confidence’.We must also listen and be sensitive to the
views or points made by the individual or individuals
concerned. Furthermore, we need to acknowledge the
constraints imposed on others when we are pushing to
reach a desired outcome.
Developing assertiveness skillsHaving defined assertiveness and the difference between
assertiveness, aggressiveness, passiveness and passive-
British Journal of Community Nursing Vol 10, No 6 281
Assertiveness: making yourself
heard in district nursingSally Lawton, Fiona Stewart
Sally Lawton is Senior Lecturer in Nursing - Palliative Care,Roxburghe House, NHS Grampian, and Fiona Stewart isManager, Simulated Patient Programme, Medical School, University of Aberdeen Email: [email protected]
ABSTRACTBeing assertive is not the same as being aggressive. Assertiveness is a tool
for expressing ourselves confidently, and a way of saying ‘yes’ and ‘no’ in
an appropriate way. This article explores issues concerned with
assertiveness in district nurse settings. It outlines helpful techniques to
develop assertiveness, such as the broken record, fogging, negative
assertion and negative inquiry.
KEY WORDSAssertiveness Communication District nursing
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PROFESSIONAL DEVELOPMENT
agg ressiveness, we
want to highlight
some techniques that
can be used to
improve our assertive-
ness skills.
Firstly, we need to
examine why we are
reluctant to be
assertive. It might be
that we do not under-
stand the concept fully
and associate it with
aggressiveness, selfish-
ness or not appearing
to be ‘nice’. Timmins
and McCabe (2005)
report that a lack of
assertiveness may be
associated with a per-
ception that to be
assertive demonstrates
uncaring behaviour. But, as we show in this article,
assertiveness is being able to say what you feel, while
respecting the other person’s point of view. We suggest
that assertiveness is caring behaviour.
For example, you may find that your colleagues contact
you about a patient on a day off or when you are on hol-
iday. Because you do not want to be thought of as uncar-
ing, you do not voice your frustration or feelings of
anger. Instead, you agree to discuss the patient.However,by saying nothing, are you inviting future intrusions into
your well-earned time off?
Saying no in an assertive way –the broken record techniqueHow can we say no in a way that allows us to remain
respectful of the other person?
It is often when we want to say ‘no’ that we find it most
difficult to be assertive.The first technique to try is the
use of repetition which is also known as the ‘broken
record’ technique (Smith, 1975). It is particularly useful
when dealing with people who are unable to take no for
an answer.A new district nurse may be vulnerable to such
approaches. When using this technique, you quietly
repeat a phrase back to the person, as shown in Box 1.
With each repetition, the goal is to stay very calm,keep
your tone of voice the same and avoid g iving in to the
pressure. The broken record technique is an effective
assertiveness skill because you maintain your stance while
still showing respect for the other person.
FoggingAnother aspect of assertiveness is coping with criticism
from colleagues.
Smith (1975) suggests the use of fogging.This involves
listening closely to what the person is saying and
acknowledging that there may be some truth in it.
An example of fogging:
Lisa: You were really late for the meeting with
the new manager, that’s really unacceptable.
Susan: You are right, Lisa, it was unacceptable
that I was late.
When you are using the fogging technique, you are
agreeing with the possibility that the person may be
right.
Negative assertionThe third technique is negative assertion (Smith, 1975).
This is when you accept that you may have made a mis-
take and agree with the criticism. Here is an example of
negative assertion.Norma is a newly qualified district nurse and has found
the assessment of a new patient very difficult.She is being
challenged by a colleague and feels rather defensive about
her lack of confidence.
Kate: Your assessment and care plan is reallyvague and useless, Norma.
Norma: (defensive) Well, I think it is alright.
OR
(negative assertion) You are probably right, Kate,I have found this really challenging and don’t
think I have done my best work.
Negative inquiry You may follow this with a fourth technique of negative
inquiry (Smith, 1975). This is when you follow up the
perceived criticism with a specific prompt to find out
more about the criticism.
For example:
What is it about the assessment that you thinkis particularly vague, Kate?
If the criticism has been just, the individual will be able
to give examples of the problem which may be of help to
you. However, if the criticism is unjust, it is unlikely that
they will be able to generate any specific examples.
282 British Journal of Community Nursing Vol 10, No 6
‘It is often when we want to say ‘no’ that we find it most difficult to be assertive. The
first technique to try is the use of repetition, which is also known as the ‘broken record’
technique. It is particularly useful when dealing with
people who are unable to take no for an answer. A new
district nurse may be vulnerable to such
approaches. When using this technique, you quietly repeat a phrase back to the person.’
Box 1. Example of the broken record technique
Sally: Fiona, will you take the student for me next week?
Fiona: No, I already have a student to take out with me.
Sally: But, another student will not really make much ofa difference…
Fiona: I already have a student to take out with me.
Sally: But you are so good with students, it would reallyhelp me out.
Fiona: I already have a student to take out with me.
Sally: Ok, then, I will ask Katy.
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Putting assertiveness skillsinto practiceMaking requestsConsider yourself in the following encounter between a
district nurse and the duty GP in Box 2. Could the use of
assertiveness skills help in this situation? This examplehighlights the use of two techniques described above.
This type of situation can be particularly difficult if you
perceive that the individual carries more influence than
you. Not only is it essential to prepare for this meeting by
having all the relevant details about the patient, but also,
be ready to assert yourself when challenged.
Giving feedbackWhen giving feedback in an assertive manner, one useful
technique is the 3-step ‘I’ message. Look again at the
example about being late for a meeting. If Susan is fre-
quently late for meetings, Lisa might feel that she needs
to discuss the issue. However, the example illustratesa rather aggressive approach when Lisa says ‘Susan,
you are late’.
The three step ‘I’message is a way of giving Susan feed-
back in a more useful and assertive way.
Lisa might rephrase the feedback as follows:
‘Susan, I feel angry when you are late for themeetings with the manager because it means wecannot use her limited time to discuss all thestaffing issues.’
Here, your own feelings are expressed about the issue
and its effect in a particular situation.This is very differ-
ent to the aggressive ‘you make me so angry when you
are late’.
ConclusionConsider the types of encounters when you feel least
assertive. For example, you may feel that the person has
more influence than yourself.As a result you consider that
you have no right to disagree. This could be a situation
similar to that of Jenny and Dr Calder in Box 2. In thistype of scenario, it will help to plan ahead by working
through possible responses beforehand.
The rehearsal of assertiveness skills will also help in
spontaneous encounters when there is no time for plan-
ning.Whether the situation is pre-planned or spontaneous,
you can always learn to assert yourself. BJCN
Bishop S (2000) Develop Your Asser tiveness.. 2nd edn. Kogan Page, London
Deering C (1996) Learning to say no. Am J Nurs 96(4): 62–4
Paterson R (2000) The Assertiveness Workbook: How to express your ideas and
stand up for yourself at work and in relationships. New Harbinger, Oakland
Smith M (1975) When I Say No, I Feel Guilty. Bantam, New York
Timmins F, McCabe C (2005) How Assertive are nurses in the workplace?
A preliminary pilot study. J Nur s Mana ge 13(1): 61–7
British Journal of Community Nursing Vol 10, No 6 283
PROFESSIONAL DEVELOPMENT
Box 2. Use of two assertiveness techniques
You have been to visit Mr Roberts who has lung cancer. You feel that his mood is very low and you are concernedabout him. You would like a GP to assess his mental state. However, you have always found today’s duty doctor to bedismissive of your opinions and you anticipate that today will be no different. You have also been taken off-guard or
had insufficient information or time to respond with confidence. The usual outcome of previous encounters is that youeither give in or do not pursue your requests.
Jenny: Dr Calder, I have been to see Mr. Roberts today and I am concerned about his mood. I wonder if he may be depressed.
Dr Calder: He was fine last time I saw him – have you become an expert in mental health now?
Jenny:You are right, I am not an expert in mental health (negative assertion) but I am very concerned about Mr. Robert’s mood (broken record).
Dr Calder: He was fine when I saw him last week.
Jenny: I saw him this morning and I think things might have changed. I am concerned that his mood is very low (broken record).Also, he says that he is not sleeping well, has lost his appetite and has lost
interest in everything. He even said that he feels his life is rather pointless.Dr Calder:You know, Jenny, that does sound different to when I saw him last week. Maybe I should
pay him a visit.
Jenny:Thanks, I would appreciate that.
KEY POINTSAssertiveness is a way of communicating with
another person while respecting both your and their
point of view, without having to resort to aggressive
or passive behaviour.
Thinking about situations when you feel least
assertive is the first step to becoming more assertive.
Practising techniques such as fogging, negative
assertion and negative inquiry will help to develop
your skills.
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