Students' experience of the challenges of using assertive communication
Assertive communication is a skill that many nurses, particularly nursing students, find challenging. This article describes the findings of phenomenological study that set out to explore third-year student nurses' experiences of using assertive communication in the clinical setting. A narrative enquiry approach reviewed six reflective written accounts of their experiences. In addition, seven students took part in an in-depth semi-structured group discussion of their clinical experiences. Data were analysed using a hybrid interpretive phenomenological analysis and discourse analysis framework. Three key themes emerged: a sense of responsibility/duty and a sense of failure when this is not upheld, the importance of mentors in promoting self-confidence and self-esteem, and a sense of belonging on placement. The students responded well to positive role models and were able to identify negative role models. Accurate, constructive feedback and support was important to help students reflect appropriately.
Nursing has historically been a submissive profession within health care. Today, changes in healthcare policy, the evolving nursing role and negative healthcare events publicised in the media, have made it essential for contemporary nurses to be leaders within the clinical environment, using assertive communication styles in their exchanges with patients, relatives and other healthcare staff. Individuals in leaderships positions motivate others, set clear goals and make decisions, using listening skills and articulating clearly. The Nursing and Midwifery Council (NMC) (2018a; 2019) standards consider that leadership principles, such as assertiveness, are an integral component in the delivery of high-quality care and there is an expectation that students will engage with this from the start of their education.
The Willis Commission (2012) recognised that nurse educators and qualified nurses are in a unique position to lead nursing as a competent and compassionate workforce. Nursing students must be proficient in recognising, challenging and reporting poor care, working as equal partners alongside other health professionals (NMC, 2018b). This is consistent with Cumming and Bennett's (2012) position that leadership must exist at every level, with each individual viewing themselves as a leader who role models compassion in day-to-day care and who is committed to speaking up when things are wrong.
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