https://doi.org/10.33698/NRF0239-Rajesh Kumar, Sushil Kumar Maheswari
Introduction: Personality is a deeply ingrained pattern of behaviour and continues to change throughout life in response to age related needs and demands. Developing assertiveness in one’s personality will help to maintain balance between goals and relationship in life. Objective: To ascertain assertiveness, psychological well-being and traits of personality among nursing students. Material & methods: A cross-sectional descriptive survey was carried by enrolling 105 baccalaureate nursing students at All India Institute of Medical Sciences, Bhubaneswar, Odisha. Rathus Assertiveness Schedule, Ryff’s Psychological Well-being Scale and Eysenck Personality Questionnaire Revised-Short Form (EPQR-S) was used to ascertained assertiveness, psychological well-being and type of personality among nursing students. Appropriate descriptive and inferential statistics was applied to compute the results. Results: Findings revealed that all of nursing students are non-assertive in communication. However, there is a signicant difference (p=0.032) in assertiveness between third year and fourth year nursing students. Similarly, there is signicant difference (p=0.013) in psychological well-being in both the group of nursing students. Further, ndings depicted that assertiveness among nursing students found signicant association with class (p=0.032), family income (p=.040), education of father (p=0.034) and occupation of mother (p=0.037). Conclusion & recommendations: There was a signicant association of class and family income with assertiveness in nursing students. We recommend a longitudinal study to observe the pattern and consistency of these variables among nursing students.
Keywords: Personality, assertiveness, psychological well-being, nursing students
Correspondence at:
Dr. Rajesh Kumar
Assistant Professor College of Nursing AIIMS
Rishikesh Uttarakhand-249203 Mobile-70559-11523
Email id: rajeshrak61@gmail.com
Introduction
Assertiveness is a social skill has number of different dimensions, including ability to express honestly, meeting the needs of others, respecting feeling of others and meeting the needs, desire and want without violating the rights of others1. It is one of the m o s t e s s e n t i a l a n d f u n d a m e n t a l c o m m u n i c a t i o n s k i l l c o n s i s t i n g interpersonal and behavioural skills2. N u r s i n g s t u d e n t s m a y e n c o u n t e r economical, educational, sexual, academic and many unidentied adaption crisis. Assertiveness enables the nursing students to convey their suggestion in a direct and comfortable way and helps to handle the n e g a t i v e c r i t i c i s m . A s s e r t i v e communication is a key to attribute for nursing students in pursuing quality nursing education and maintain professional r e l a t i o n s h i p a n d e m p o w e r m e n t 3 . Traditionally, nurses been taught to remain submissive and follow the orders of physician blindly.
Assertiveness is a core feature of an individual’s personality. Assertiveness is not in born characteristics of personality but sometimes exception could be seen. It can be practice and improvised by daily use of certain techniques to make the behaviour assertive. The evidence of impact of personality on assertiveness behaviour is very few and rare4. Indeed, ndings related to impact of personality t raits on assertiveness behaviour is ambiguous and mixed. Meta-analysis report that presence of few personality factors had signicant relationship with assertive behaviour5. On the other hand, study presents no relationship between self-efcacy and assertive behaviour6. However, self-report m e a s u r e s o f a s s e r t i v e n e s s a n d communication skill show positive relationship. Research on identication and relationship of different personality traits to academic performance, job and academic communication is growing7.
Subjective well-being is dened as a state of happiness, pleasant emotion, life satisfaction and a relative absence of unpleasant mood and emotions8. Assertive behaviour said to improve self-esteem, s a t i s f a c t o r y i n t e r p e r s o n a l a n d communication and constructive conict management9. Lack of assertiveness and condence in nursing students can be easily noticed by the patient and may hinder the trusting relationship between nurse and patent 1 0 . Assertiveness should be differentiating to aggressiveness which involves inappropriate and socially acceptable behaviour.
Assertiveness and effective communication skills should be started in beginning of nursing education studies to encourage students to express opinions and their personal rights. It will also become a maxim to ll the gap between theory and practice. Therefore, investigators planned and executed descriptive survey to overview types of personality traits and assertiveness and psychological well-being among nursing students.
Objective: To ascertain assertiveness, psychological well-being and traits of personality among nursing students.
Material and methods
A descriptive cross-sectional study was conducted among the Nursing students of All India Institute of Medical Sciences, Bhubaneswar, Odisha. A sample of 106 BSc Nursing third year (n=52) and fourth year nursing students (n=53) was drawn by using total enumeration sampling technique. Data was collected through a socio-demographic data sheet, Rathus A s s e r t i v e n e s s S c h e d u l e , Ry f f ‘ s Psychological Wellbeing Scale and Eysenck Personality Questionnaire-Short form (EPQR-S), which was distributed among nursing students.
Socio-demographic profile sheet: It consisted of personal information of students i.e. age, gender, class of study, parent’s education & occupation status, type of family, family monthly income, and distance from home to institute etc. Profession related variables: It consisted additional information on variables related to profession and its nature i.e. frequency of surng net in a day, choice of nursing as a carrier profession and history of attending counselling in nursing students etc.
Rathus Assertiveness Schedule11: It is standardised 30 items 6-point rating scale ranging from 3=very much like me;2= rather like me;1= slightly like me; – 1=slightly unlike me;-2=rather unlike me;- 1=very much unlike me. RAS total score ranging from -90 to 0 to +90 in subjects. The schedule measures social boldness by asking readers to rate themselves on various personal inclinations. There is no cut score for scale and getting higher score indicate better assertiveness in subjects and vice- versa. Test-retest reliability of the scale was 0.78 and split half was 0.77. The experts in the eld of nursing, psychology and psychiatry conrmed the validity. The permission was obtained to use the scale from concerned authority.
Ryff’ Psychological Well-being Scale12: The scale consisted 42 items on a four-point scale- from strongly agree (SA) =6, to strongly disagree (SD) =1. 42 items are grouped under six domains (7 items for each); 1) autonomy, 2) environmental mastery, 3) personal growth, 4) positive relation, 5) purpose in life and 6) self- acceptance. Each domain score range from 7-42. Scale is on continuous scale and does not have category or cut point for total scale score. Getting higher score indicates higher psychological well-being in an subject in specic area and scale as well.. The scale test-retest reliability was 0.82. The permission was obtained to use the scale from concerned authority.
Eysenck Personality Questionnaire Revised Short Form (EPQR-Short Form)13: It is self-reported 48 items standardised questionnaire. 48 items are classied under four domains of personality namely; extraversion (12 items), neuroticism (12 items), lie (12 items) and psychoticism (12 items). Each question has binary response, ‘yes’ and ‘no’ with higher score indicate dominant traits of specic personality in the subject. Each dichotomous scored one or zero and each domain had maximum possible score 12 and minimum of zero (score range= 0-12 for each domain). There is no overall score criteria or category for q u e s t i o n n a i r e . T h e r e l i a b i l i t y o f extraversion, neuroticism, psychoticism and lie was found 0.77; 0.77; 0.24, and 0.62, respectively. The permission was sought to use the scale from concerned authority.
Ethical consideration: A brief research proposal was submitted to Institutional Ethical Committee, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha for ethical approval. Ethical permission was obtained after due clarication of related ethical principles i.e. condentiality, consent, and anonymity during and after data collection and dissemination of ndings.
Method of data collection:A formal permission was obtained from concerned authority before proceeding to data collection. The students were called in their respective classrooms at the same time. The data was collected with the help two other faculty members. The students were explained about study objectives and a verbal consent was obtained from all students. All tools were administered at same time to collect information about socio-demographic and profession related variables, personality traits, psychological well-being and assertiveness status among nursing students. It took approximately 20- 25 minutes to collect the data. Data was analyzed using SPSS version 20 and analyzed by using descriptive & inferential statistics.
Results
As per personal characteristics of nursing students, it was evidenced that mean age of students was 20.59 (±0.95) years. Around equal number of students studying in III year (49.5%) and IV year (50.5%) BSc Nursing programme. 77.1% students belong to Hindu religion followed by 18.1% from Christian community. Further, data indicated that 50.5% and 36.2% nursing student’s father and mother respectively had their education up to graduation and above. Around 37.1% student’s father working at govt job and 81% student’ mother were homemaker. About 79% students belong to nuclear family having monthly income more than 5,000 rupees per month (91.5%). Further, in terms of variables related to profession, it was evidenced that 86.7% students surng net more than 5 times in a day and sought counselling services in past (23.8%). In terms of asking about choice of nursing as carer profession, 76.2% students joined the course against their wishes and were compelled by not getting selection in medical examination, nancial problems or wish of their parents.
Assertiveness, psychological well-being and personality traits among nursing students
As per Rathus assertiveness scale, the mean score of assertiveness among nursing students was negative (-22.60±13.10) for all the students indicate non-assertiveness among nursing students. Similarly, 92% students found in score below -90 on RAS scale of the subjects and only 7.69% students of third year had 0 to +90 score. Further, the assertiveness score shows a signicant group difference for third year and fourth year nursing students (p=.032) indicate gradual losing assertiveness skills as the students proceed in to higher class. It reects need of assertiveness skills training or practical sessions for nursing students to face the work place changes, lobbying and advocacy in future for individual and professional level.
Table 1. Frequency distribution on Assertiveness and Personality Traits (n=105)
| Assertiveness and personality traits | III Year (52) | IV Year (53) | ||
| 48((f9,%2.3)1) | 53(f(,1%0)0) | |||
| Assertiveness | 0 to -90 | 3004((577.6.699)) | 28(5020.83) | |
| Bel0owtom+e9d0ian | ||||
|
Personality traits |
Exoticism | Above0-m16edian | 22(42.30) | 25(47.17) |
| Belo1w7-m3e0dian | 38(73.08) | 37(69.81) | ||
| Neuroticism | Abov0e-m17edian | 14(26.92) | 1630.19) | |
| Belo1w8-m3e0dian 0-17 | 29(55.77) | 29(54.72) | ||
| Lie | Abov1e8m-3e0dian | 23(44.23) | 24((45.28) | |
| Below0-m17edian | 28(53.84) | 24(45.28) | ||
| Psychoticism | Abov1e8m-3e0dian | 24(46.15) | 29(54.72) | |
In term of personality traits, ndings revealed that more number (53%) of 3rd year students had exoticism traits as compared to their counterparts (52%). Similarly, these same trends continue for neuroticism, lie and psychoticism personality traits for 3rd among these students could not be ascertained.(Table 1) In terms of psychological well-being among nursing students, ndings revealed a s i g n i c a n t g r o u p d i f f e r e n c e f o r psychological well-being between third year students as compared to 4th year year and fourth nursing student (p=.013) students, although, only few (7.69%) 3rd year nursing students shows assertiveness also, However, reason for assertiveness indicate better level of psychological well- being among senior students as compared to junior students. It point out that student’s shows better psychological well-being as they succeed to higher class or can be said that students develop more autonomy in d e c i s i o n m a k i n g , d e v e l o p m o r e environmental mastery for personal growth and to maintain positive relationship with other students. However, students striving in some of the areas (i.e. personal growth and purpose in life) of psychological well- being. Further, analysis of ndings concluded that assertiveness and psychological well-being running in differing direction and can be understood that lack of assertiveness skills leads to better psychological well-being or vice- versa in nursing students. Further, this could be justied to development of more of introverted personality traits among nursing students as they proceed in to higher class. (Table 2)
Table 2. Level of Psychological Well-being in Nursing Students (n=105)
| BSc Nursing BSc Nursing
Study variables III years IV years p-value Assertiveness (-22.60±13.10) –(1M9e.8a5n±±1S3D.3) -2M5e.3a0n±±1S2D.3 0.032* |
|
| Range score Autonomy (-1273.828±-243.9.918) (-250.1258±-248.7.552) 0.781 | |
| EPenrvsioronnaml gernotwalthmastery 25.652±3.585 25.048±4.003 0.0728
Psychological |
|
| well-being | |
| Pousriptoivseerienlalitfieonship 23.358±4.073 23.086±3.409 0.0873 | |
| STeoltfa-alcceptance 14278.3080±140.8.62 15229.4376±140.8.072 00.0.01835* | |
| ENxeoutrioctic 16.659±2.046 16.68±1.67 0.947626 | |
| traits Lie 2 1 6 257
Personality Psychotic 17.50±2.03 17.92±1.77 0.516 |
|
* significant @ p-value <.05 level
In terms of exploring traits of personality, ndings revealed that personality traits are ingrained pattern and does not change with a small period of lapse in individual. Findings suggested that there is no s ignicant difference in different personality traits between third year and fourth year nursing students. (Table 2)
Association of assertiveness with demographic characteristics of nursing s tudents : One- way ANOVA and independent sample t-test was computed to nd the association of assertiveness as per the socio-demographic and profession related variables of nursing students. Result depicted that junior students were more assertive as compared to senior nursing s t u d e n t s ( – 1 9 . 8 5 ± 1 3 . 3 9 v s – 25.30±12.34;p=0.032) indicate loosing of assertiveness skills progressively towards completion of nursing course. Further, ndings revealed that assertiveness among nursing students found a signicant association with family income (p=0.040), education of father ( p= 0 . 034 ) and occupation of mother (p=0.037). These ndings evidenced that students belong to higher socio-economic class develop better assertiveness as compared to their counterparts. Similarly, students whose mother were private employees and education of father is graduate and above shows better assertiveness as compared to their fellow colleagues. (Table 3)
Table 3. Association of assertiveness with sociodemographic characteristics of nursing students
(n=105)
| Socio demographic characteristics
BSc (N) IVI Year |
f(%)
523(4590.5) |
Mean±SD
-19.850 132.394 |
t/F value
2(1.1(7d2f) |
p-value
0.032* |
|
| -22.12 162.268
± |
0.469 | ||||
| <5000 | 09(8.6) | -23.50±16.25 | 1.786 | 0.040* | |
| Monthly Family
Income (Rs) |
>H5in0d0u0 | 9861(9717.1) | -1292.0647±12.8995
± |
(61) | |
|
Religion |
MSikuhslim0 hristian | 013239(121.89.1)5)
21 29.0 |
-159.670±12.025
± -20.112±091.704 0 1 3 ± |
0(.6818)1
1.6817)6 |
0.667
0.034* |
| Up to 102th class | 4207(2358.2) | -284.003±063.042 | 1.319 | ||
| Education of | th
Self-business |
26(24.8) | ±
-22.27 11.5682 ± |
1.009 | |
| father | GPHGroimvaejtoeb kers
o Emmaployees |
328593(32871).9) | -2149.748±13.476
± -23.36±123.1627 |
(61)
1.641 |
0.481
0.037* |
| mother | ±16.32
± |
||||
*Significant @p-value<0.05; Mean age-20.95 (±0.95) years
Further association between profession related variables and assertiveness was computed to see the impacts of these variables on assertiveness among nursing students. However, it was evident that there is no signicant association between p r o f e s s i o n r e l a t e d v a r i a b l e s a n d assertiveness among nursing students. (Table 4)
Table 4. Association of assertiveness with profession related variables of nursing students
(n=105)
| Attended Counselling No 80(76.2) -22.38±14.25 -0.428 0.670 |
| Yes 25(23.8) -22.75±13.386 (01.80731)
Choice of Nursing No 80(76.2) -20.87± 0.679 |
| < 5 times 14(13.3) -22.96±13.367 0(.69)8 0.893
Internet surfing/day >5 times 91(86.7) -22.61± |
| ±13.47 (61) |
*Significant @p-value<0.05
Discussion
Assertiveness is an important aspect of interpersonal relationship. Nursing is female dominant profession and female are submissive by nature and taught to value sacrice and service to the others. They also expect to be a part of health team but lacks of strong assertiveness communication stop them to be a part of health team. Similarly, nursing students reported high level of s t ress and anxiety and described pressurized due to long hours of training, assignment and theoretical hours (Watkins S et al, 2011)14. Cumulative impacts of high stress, anxiety, non-assertiveness may have negative impacts on development of personality and psychological well-being in nursing students.
Therefore, the present study was conducted to assess personality traits, assertiveness and psychological well- being among nursing student studying at All India Institute of Medical Sciences, AIIMS Bhubaneswar, India. Result revealed that nursing students are non-assertive in communication and interpersonal relationships while studying in initial academic stage and develop assertiveness in the subsequent class of nursing course. These study ndings are in line with many previous study conducted on nursing students which depicted that assertiveness among nursing students is low as compared to other academic and professional grade students (Amicone et al, 2015)15. Further, similar ndings reported in a study conducted by Ibrahim SA (2010)16 on nursing students revealed that half of students were in the category of non- assertiveness score and need empowerment to develop assertiveness skills. A close similar ndings reported in a study conducted by Rezayat F et al (2014)17 depicted that 55.6% students indicate average and low level of assertiveness.
In the present study, psychological well- being was higher in fourth year nursing students as compared to their counter parts and shows a signicant group difference. Similar consistent ndings reported in a study conducted on nursing students that 38.7% students face depression and reported poor psychological well-being (Rezayat F et al, 2014)17. Further. Other researcher reported 30.8%, 17.7% and 6.3% of nursing students suffer mild, m o d e r a t e a n d s e v e r e d e p r e s s i o n respectively indicating poor psychological well-being in nursing students (Azizi M et al, 2013)18. Similarly, a study conducted by consistent with previous study conducted on nursing students depicted that high income leads to develop more assertiveness among nursing students as compared to their counterparts (Ibrahim SA, 2011)16. Further, there was no signicant association between assertiveness and age, sex, type of family, choice of nursing as a career profession and frequency of surng net/day. These results are consistent with those of another study (Rezayat F et al, 201417; Shrestha R et al, 2016)20. In another study, a signicant relationship was observed b e t w e e n c h o i c e o f n u r s i n g a n d assertiveness among nursing students (Taghavi T et al, 2010)21. However, this work was different in terms of subjects, setting and subject selection or sampling process.
The present study should be observed preliminary in this led and generalisation of the ndings might consider low as the data was collected though purposive R a m a d a n F H e t a l ( 2 0 1 7 ) 1 9 o n sampling technique and one time cross- psychological well- being reported consistent nding for poor psychological well-being among third year nursing students. However, the statistics regarding level of assertiveness among different class of nursing students are not available.
Further, association of assertiveness with socio-demographic characteristics of nursing students reported a signicant association with class of students, father education, occupation of mother and family income of the students. The ndings are sectional survey may also impede the generalisation. The selection of sample might not be representative and association of ndings also not allowed to nd out the relationship between study variables. However, study ndings recommend exposing the nursing s tudents to assertiveness training programme and raised a question to nurse educator to teach and practice assertiveness skills to nursing students to overcome undue stress, anxiety and poor psychological well-being during the course and future.
References
- Ellis HJ, Hartley C. Managing and coordinating nursing care, 4th edi. Philadelphia, PA: Lippincott, William and Wilkins; 2000
- Gist M, Stevens CK, Bavetta AG. Effects of self-efcacy and post- t r a i n i n g i n t e r v e n t i o n o n t h e acquisition and maintenance of complex interpersonal Personal psychology 1991;44:837-61
- Clark Assertiveness issue for nursing administration and mangers. Journal of nursing administration 2010;20-24
- Kuntze A, Henk T Yander Molena, Borna Big ve personality traits and assertiveness do not affect mastery of communication skills. Health professions education 2016;33-43
- Feingold Gender differences in personality: a meta-analysis. Psychol Bull 1994 ; 116 (3) : 429-56
- Hommes Self- instruction communication skill training for distance education. Effects on skills, self-efcacy, motivation and transfer. Ridderkerk. The Netherlands: Ridder print off-Setdukkeij; 2006
- Burke LA, Witt Personality and h i g h – m a i n t e n a n c e e m p l o y e e b e h a v i o u r . J B u s P s y c h o l 2004;18(3):349-63
- Diner Ed, Diener RB. New directions in subjective well-being research: The cutting edge. Indian journal of clinical psychology 2000;27(1):21-33
- Weiten W & Lioyd MA. Psychology applied to modern life: Adjustment in 21st century. Singapore: Thompson learning; 2004
- O’mara A. Communicating with other health professionals, In: Boggs, (Ed.), Interpersonal relationship: professional communication skills for nurses, 2 nd ed. Philadelphia: Saunders;1995
- McCormick IA. A simple version of the Rathus Assertiveness Schedule. Behavioural assessment 1984;7:95- 99
- Ryff C, Keyes C. The structure of psychological well-being Journal of personality and social psychology. Current directions in psychological sciences 1995;69:719- 27
- Tiwari T, Singh AL, Singh A short form revised Eysenck personality questionnaire: A Hindi Edition (EPQRS-H). Industry psychiatry journal 2009;18(1):1-5
- Watkins K, Roos V, Walt An exploration of personal, relational and collective well-being in nursing students during their training at a tertiary educational institution. Journal of interdisciplinary health Sciences 2011;16:(1):1-10
- Amicone, Kaitlin F, Miller Assertiveness in nursing students. Honours research projects 2015. Paper 8
- Ibrahim Factors affecting assertiveness among students nurses. Nurses Educ Today 2011;31(4):356- 60
- Rezayat F, Nayeri ND. The level of depression and assertiveness among nursing International journal of community based nursing and midwifery 2014;2(3):177-184
- Azizim , Khamseh F, rahimi A, Barati
- The relationship between self- esteem and depression in nursing s t udents of selected medical university in Tehran. Iranian journal of psychiatric nursing 2013;1:28-34
- R a m a d a n F H , Ya k o u t R A . Psychological well- being and communication s tyles among Medical-surgical nursing IOSR journal of nursing and health sciences 2017;6(1):75-85
- Shrestha R, Adhikari T, Joshi Assertiveness of professional nurses in Kathmandu, Nepal. Indian journal for advanced nursing 2016;2(1):1-15
Taghavi T, Shari N, Aghajani m, M e h r a n A . R e l a t i o n b e t w e e n assertiveness and anxiety in nursing and midwifery students. Journal of Hayat 2010;15:61-71