AN EXAMINATION OF ASSERTIVE SKILL DEVELOPMENT AS A PREREQUISITE FOR EFFECTIVE COMMUNICATION IN NURSING PRACTICE IN THE NIGERIA HEALTHCARE SECTOR

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Effective communication in nursing practice is crucial for guaranteeing high-quality patient care, enhancing teamwork, and encouraging positive health outcomes (Jiu et. al., 2018). In the Nigerian healthcare sector, characterised by resource constraints, high patient loads, and diverse cultural contexts (Seun et al., 2018), the significance of assertive communication skills is paramount. Assertiveness in nursing encompasses the confident and respectful expression of oneself, the advocacy for patients, and the navigation of intricate interactions within the healthcare setting (Jason et al., 2020). Nurses engage regularly with patients and collaborate with healthcare team members as necessitated by their professional duties. Clear and impactful communication significantly improves the overall efficacy of the nursing field. Nurses ought to demonstrate assertiveness in their communication practices (Kelleci et al., 2021).

Exhibiting assertiveness in a professional environment entails maintaining a self-assured and respectful attitude, which facilitates effective communication with colleagues. Engaging in constructive and affirmative exchanges in the workplace can foster strong team dynamics, enhance leadership capabilities, and promote collaborative efforts. Assertiveness refers to an individual's capacity to convey their opinions in a sincere and transparent way, while also articulating their emotions and thoughts, and respecting the rights of others (Lambertz & Blight, 2017). Individuals who demonstrate confidence in articulating their thoughts and possess the capacity for empathy, show respect for others, and are capable of declining requests (Uzuntarla et al., 2017; Eliusuk, Gunes, Arslan; 2018). Assertiveness serves as a vital mode of communication for nurses, patients, and individuals alike. Effective communication with individual patients is essential in nursing, making it imperative for students to develop strong communication skills prior to embarking on their professional journey (Uluoglu et al., 2017). Research indicates that the development of assertive skills has a beneficial impact on the aggressive behaviour exhibited by nurses (Kutlu, 2019). Boket et al. (2019) demonstrated that the assertiveness training provided to nursing students significantly enhances their communication skills (Booker et al., 2019).

The notion of assertiveness, characterised by its role in balancing relationships, enhancing satisfaction, and promoting understanding, emerges as a crucial skill in response to the rise of communication-related issues within nursing services (Omura et al., 2019). This circumstance renders assertiveness an essential requirement in the professional lives of nurses (Markid et al., 2019). The impact of low-level assertiveness on a nurse's communication is detrimental, potentially resulting in decreased quality of care and diminished job satisfaction, as highlighted in the review of studies concerning nurses' assertiveness levels (Losa-Iglesias et al., 2017; McCartan, 2018). As assertiveness levels rise, individuals experience positive effects on their treatment and recovery processes, enhanced communication skills, a reduction in conflicts, and increased job satisfaction (Rezayat, 2018). Assertiveness may be regarded as a manifestation of self-esteem (Christopher et al., 2019). Research indicates a correlation between the self-esteem of nurses and their assertiveness levels (Dehghan et al., 2018). Furthermore, nurses who perceive themselves as competent tend to exhibit greater sociability compared to those who lack this self-perception (Efe, 2017). This situation has been associated with the pursuit of safety in life, the attainment of success and happiness, the ability to overcome disappointments, and the capacity for transformation through elevated self-esteem levels.

The cultivation of assertive skills in nursing necessitates a combination of structured learning and hands-on practice. Programs and workshops centred on assertiveness can equip nurses with essential tools to improve their communication skills (Ose et al., 2019). Research indicates that assertiveness training can enhance self-confidence, foster better patient relationships, and promote more effective teamwork (Nash & Murray, 2019). Within the framework of nursing education and practice in Nigeria, the incorporation of assertiveness training into curricula and professional development initiatives can effectively tackle the unique communication challenges encountered by nurses in this environment. Furthermore, assertiveness is not a fixed ability; it necessitates continuous practice and enhancement (Ikedieze et al., 2022). The elements of mentorship, peer support, and reflective practice play a crucial role in the advancement of skills. In Nigeria, fostering environments that enable nurses to engage in assertive communication, obtain constructive feedback, and gain insights from seasoned practitioners can greatly enhance these essential skills (Ojo et al., 2022).

Although assertive communication holds significant value, there is a scarcity of research regarding assertiveness training within the context of nursing education and practice in Nigeria. Many nursing programs prioritise the development of clinical skills, yet they frequently neglect to incorporate communication training that encompasses assertiveness techniques. Research carried out within comparable healthcare frameworks indicates that incorporating assertive skill development into nursing curricula can markedly enhance nurses' confidence and professional interactions, which in turn may result in improved patient care outcomes (Shin et al., 2019). Nonetheless, a notable deficiency persists within Nigeria's healthcare education framework concerning the structured cultivation of assertiveness among nurses, highlighting an urgent necessity to rectify this shortcoming. Thus, the necessity for this investigation arises.

1.2 Statement of the Problem

Effective communication serves as a fundamental element of exemplary nursing practice, crucial for safeguarding patient well-being, promoting teamwork across disciplines, and improving the overall delivery of healthcare services. In the Nigerian healthcare sector, marked by its intricate challenges, the importance of assertive communication skills cannot be overstated. The ability to be assertive in nursing empowers practitioners to advocate effectively for patients, engage in the negotiation of care plans, and adeptly manage interpersonal relationships with both colleagues and patients. Nevertheless, in light of the acknowledged significance of these skills, a considerable disparity exists in their cultivation and implementation within the Nigerian healthcare landscape.

The healthcare system in Nigeria faces a multitude of challenges that hinder effective communication among nurses, patients, and other healthcare professionals. Challenges like insufficient infrastructure, constrained resources, and an elevated patient-to-nurse ratio foster a high-stress atmosphere that can hinder effective communication (World Health Organisation, 2020). For example, due to ongoing shortages of medical supplies and personnel, nurses frequently encounter obstacles in championing patient needs and delivering optimal care. This highlights the importance of effective communication skills to confront and alleviate these challenges (Oni et al., 2021). Furthermore, the structured framework of the Nigerian healthcare system frequently positions nurses in a lesser role compared to physicians and other senior healthcare practitioners (Bode et al., 2021). This hierarchy may impede nurses from voicing concerns, providing suggestions, or advocating for patients in a meaningful manner (Afolabi et al., 2020). In this context, effective communication is essential for nurses to maneuver through power dynamics, engage in decision-making processes, and guarantee that patient needs are addressed despite systemic limitations.

Although the advantages of assertive communication are evident, there exists a notable deficiency in the cultivation and implementation of these competencies among nurses in Nigeria. Contemporary nursing education and professional development initiatives frequently prioritise technical competencies and clinical expertise, while placing insufficient emphasis on communication and assertiveness (Nash & Murray, 2019). Consequently, nurses might experience a deficiency in both confidence and competence necessary for assertive communication, which can adversely affect their capacity to advocate for patients and work collaboratively with fellow healthcare professionals. The absence of assertiveness training in the nursing curricula and professional development programs in Nigeria highlights a more significant concern within the healthcare sector. In the absence of organised initiatives to incorporate assertive skill development within nursing education and practice, the advantages of proficient communication are likely to be inadequately leveraged. This disparity affects not just patient care but also the overall efficiency and effectiveness of the healthcare system. This study aims to explore the development of assertive skills as a fundamental requirement for effective communication within nursing practice in the Nigerian healthcare sector.

1.3 Objectives of the study

The primary objective of this study is to critically examine assertive skill development as a prerequisite for effective communication in nursing practice in the Nigeria healthcare sector. Specific objectives of this study are to:

1. To find out whether there is a relationship between assertive skill development and effective communication in nursing practice in the Nigeria healthcare sector

2. To explore the role of assertive skill development in enhancing effective communication in nursing practice within the Nigerian healthcare sector

3. To identify challenges to assertive skill development in Nigerian nursing education and practice

4. To examine the impact of assertive skill development on nurse communication skills within the Nigerian healthcare sector.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. Is there a relationship between assertive skill development and effective communication in nursing practice in the Nigeria healthcare sector?

      2. What is the role of assertive skill development in enhancing effective communication in nursing practice within the Nigerian healthcare sector?

      3. What are the challenges to assertive skill development in Nigerian nursing education and practice?

      4. What is the impact of assertive skill development on nurse communication skills within the Nigerian healthcare sector?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Assertive skill development has no significant role in enhancing effective communication in nursing practice within the Nigerian healthcare sector.

Ha: Assertive skill development has significant role in enhancing effective communication in nursing practice within the Nigerian healthcare sector.

1.6 Significance of the study

This research carries considerable importance for multiple parties involved in the Nigerian healthcare landscape. Comprehending the influence of assertiveness on effective communication can result in enhancements across various dimensions of healthcare delivery, ultimately benefiting patients, nurses, healthcare institutions, and more.

For patients, the importance of effective communication cannot be overstated, as it is essential for obtaining high-quality care and realising favourable health outcomes. Effective communication empowers nurses to articulate concerns, champion patient needs, and guarantee that patients' perspectives are acknowledged within the healthcare framework. The development of assertiveness skills in nursing practice can significantly enhance patient satisfaction, foster a clearer comprehension of care plans, and promote heightened safety measures. Consequently, individuals will encounter care that is more tailored and attentive, significantly influencing their overall health and wellness.

This study will provide substantial benefits to nurses themselves. Enhancing assertive communication skills can significantly elevate one's confidence, strengthen the capacity to advocate for oneself and others, and refine interactions with peers. Assertiveness training will empower nurses to tackle challenges with greater efficacy, engage in decision-making processes, and adeptly maneuver through the hierarchical and cultural intricacies of the Nigerian healthcare system. Consequently, nurses will attain enhanced professional fulfilment, diminished stress levels, and elevated job performance.

Healthcare institutions can benefit from the findings of this study by achieving greater operational efficiency and providing better patient care. Organizations that promote assertiveness training for their nursing personnel are likely to observe enhanced collaboration, improved communication among team members, and a more favorable workplace atmosphere. Clear and purposeful communication within the institution fosters efficiency in processes, minimizes conflicts, and enhances the management of resources. The execution of assertiveness training initiatives can further elevate the institution's standing in delivering exceptional, patient-focused care.

Educational institutions and training providers engaged in nursing education will discover the study to be beneficial for the advancement of curriculum and program improvement. The findings from this study can inform the incorporation of assertiveness training into nursing education curricula, thereby ensuring that emerging nurses possess vital communication skills from the beginning of their training. Training providers may leverage the study's findings to craft specialized professional development programs that tackle particular communication challenges encountered by nurses within the Nigerian healthcare landscape.

The findings of this study will serve as a valuable resource for those involved in the healthcare sector, aiding in the formulation of policies and guidelines that enhance effective communication practices. Understanding the significance of assertiveness in nursing can contribute to the development of policies that advocate for the integration of communication skills training within nursing education and ongoing professional growth. Moreover, recommendations grounded in evidence can assist in tackling systemic challenges associated with communication and collaboration within the healthcare system.

Interdisciplinary teams will experience positive outcomes from the improved communication dynamics that stem from the development of assertiveness skills in nurses. The exchange of information among nurses and other healthcare professionals’ fosters enhanced collaboration, promotes coordinated care, and ultimately contributes to improved patient outcomes. As nursing professionals cultivate their assertiveness abilities, collaborative teams will benefit from improved synergy, resulting in more effective and holistic care provision.

The study's importance is amplified by the inclusion of viewpoints from both researchers and students, reaching far beyond mere practical applications. This enhances the discourse surrounding nursing communication, providing a solid basis for subsequent research and the development of educational curricula. By examining these essential aspects, the research will contribute to a more comprehensive and effective strategy for enhancing communication skills in nursing, ultimately benefiting all parties involved.

1.7 Scope of the study

Broadly, this study focus is to critically examine assertive skill development as a prerequisite for effective communication in nursing practice in the Nigeria healthcare sector. Empirically, the study will explore whether there is a relationship between assertive skill development and effective communication in nursing practice in the Nigeria healthcare sector, the role of assertive skill development in enhancing effective communication in nursing practice within the Nigerian healthcare sector, challenges to assertive skill development in Nigerian nursing education and practice and the impact of assertive skill development on nurse communication skills within the Nigerian healthcare sector.

Geographically, the study will be carried out in Lagos University Teaching Hospital, Lagos state.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding an examination of assertive skill development as a prerequisite for effective communication in nursing practice in the Nigerian healthcare sector. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around Lagos University Teaching Hospital, Lagos state. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Assertive communication: Assertive communication is specified as the ability to speak and interact in a manner that considers and respects the rights and opinions of others while also standing up for your rights, needs, and personal boundaries.

Effective Communication: Effective communication is the process of exchanging ideas, thoughts, opinions, knowledge, and data so that the message is received and understood with clarity and purpose. When we communicate effectively, both the sender and receiver feel satisfied.

Communication skills: Communication skills are the abilities you use when giving and receiving different kinds of information. Some examples include communicating new ideas, feelings or even an update on your project. Communication skills involve listening, speaking, observing and empathizing.

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