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Chapter: Psychiatric Mental Health Nursing : Therapeutic Communication

Assertive Communication

Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way.



Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way (Hopkins, 2008). It recognizes the rights of both parties, and is useful in a variety of situations, such as resolving conflicts, solving problems, and expressing feel-ings or thoughts that are difficult for some people to express. Assertive communication can help a person deal with issues with coworkers, family, or friends. It is particu-larly helpful for people who have difficulty refusing anoth-er’s request, expressing emotions of anger or frustration, or dealing with persons of authority.


Nurses can assist clients to learn and practice assertive communication skills, as well as using assertive communi-cation to communicate with other nurses and members of the health-care team. It can be used in both personal and professional situations.


Assertive communication works best when the speaker is calm; makes specific, factual statements; and focuses on “I” statements. For example, one of the nurses on your unit is always a few minutes late to work, arriving in a rush and disrupting change-of-shift report. There are four types of responses that coworkers can have to this situation:


·    Aggressive: After saying nothing for several days, one nurse jumps up and yells, “You’re always late! That is so rude! Why can’t you be on time like everyone else?” Then the nurse stomps out of the room, leaving every-one uncomfortable.


·    Passive-aggressive: A coworker says to another nurse, “So nice of her to join us! Aren’t we lucky.” Everyone sits in uncomfortable silence.


·    Passive: One nurse doesn’t say anything at the time, but later tells coworkers, “She’s always late. I had to tell her what she missed. I have so much work of my own to do.” But this nurse doesn’t say anything to the nurse who was late.


·    Assertive: After report, one nurse says, “When you are late, report is disrupted, and I don’t like having to re-peat information that was already discussed.” This nurse has communicated feelings about the specific situation in a calm manner with no accusations or in-flammatory comments.


Using assertive communication does not guarantee that the situation will change, but it does allow the speaker to express honest feelings in and open and direct way that is still respectful of the other person. This lets the speaker feel good about expressing the feelings, and may lead to a discussion about how to resolve this problem.

Sometimes people have difficulty “saying no” or refus-ing requests from others. Later, the person may regret say-ing yes, and feel overburdened or even resentful. Using assertive communication can help the person say no politely, but firmly, even when the person making the request is persistent in the request.


Nurse 1: “Can you work for me next Saturday?”

Nurse 2: “No, I can’t work for you nextSaturday.”

Nurse 1: “Oh please, can’t you help me? I have tickets for a concert that I really want to see?”

Nurse 2: “I can’t work for you next Saturday.”

Nurse 1: “Why not? I heard you say you weren’t doing anything special this weekend. Please, I’ll never ask again. Please? I’ll do something special for you.”

Nurse 2: “I can’t work for you next Saturday.”

This is called the “broken record technique.” Instead of responding to additional information, such as concert tickets, not having plans, or emotional pleas, the speaker simply repeats the response without justifying or explain-ing the response. In time, the person can become quite comfortable refusing a request without feeling guilty or compelled to explain the refusal. In time, this can allow the person to avoid stress from being overcommitted or resentful from agreeing to a request that is later resented.


Assertive communication takes practice. It is often helpful to “rehearse” statements or responses in advance, especially if expressing feelings or discussing conflict is difficult. Using assertive communication doesn’t always produce a positive result, and others may not like the assertive communication style, especially if it is a change from a previous style. But the speaker can feel confident that he or she communicated thoughts and feelings openly and honestly while respecting the rights of both parties.


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