Archive for category: Nursing

APRNs should not only recognize but also make it part of their practice to develop strategies to reduce or eliminate health disparities. Review information from Healthy People 2020 and the CDC Office of Minority Health and Health Disparities websites.
What health disparities can you find that are relevant to your community (heart disease and stroke)?
How can you better advocate for minority groups who have poorer health outcomes?
What specific objectives in Healthy People 2020 can help this effort?

Healthy People 2020 website:
www.healthypeople.gov/2020/default.aspx.

Review the following for integration into your writing/responses:

**References should be scholarly articles no later than 5 years old.

Read Chapter 7 in your text Murray, E. (2017). Nursing leadership and management for patient safety and quality care. Philadelphia, PA.: F.A. Davis Company.
The following Web sites offer many resources Institute for Healthcare Improvement (IHI) Tools
http://www.ihi.org/resources/Pages/Tools/default.aspx
Society for Quality http://www.asq.org/learn-about-quality/quality-tools.html
Over the past 6 months, patients in the intensive care unit have experienced an increase in central line infections. The nurse leader and manager suspects that the increase is related to more central lines being inserted in the emergency department. A quality improvement (QI) team is being formed to identify the root causes of central line infections.
• Who should be on the QI team?
• What leadership theories and models would you use with this team?
• Outline the steps in the QI process to use in this situation.
• How would the QI team implement an activity to improve the infection rate, and how will the team know the activity worked?
• What Quality Improvement Tool would you use to visually display the outcomes over time to your team?

TO READ CHAPTER 7:
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Writer please note: I don’t like quality of this paper so I want you to addressed all the below comment.

Please don’t make reference to the US, use UK reference only

Change the reference list too

Please read the below comments and addressed all

Why do patients not adhere to treatments? Discuss in relation to sociological explanations, and apply concepts to a particular disease/condition.

• Introduce the content of the essay: the topics you will discuss, with theories/authors/concepts you will use; how you will apply notions as part of your analysis. (Can you start the introduction with “ In this essay I will addressed…………..and then you write what you will talk about in the essay)

Analysis:

• Critically engage with the theories and evidence: Start with key definitions, and key sociological theories in relation to your chosen question.
• Apply concepts and theories to a specific disease, condition (Diabetes, high blood pressure, breast cancer) and/or healthcare contexts (NHS, patients/service users, services)
• Include medications ( Why we take or don’t take medications for the disease, condition).
• Argue about the topic from different perspective (what other authors think).
• Include relevant statistical/demographic research data
• The essay should include intext references of 5 original academic sources: you will write this as: eg ‘as defined by Goffman 1969, the concept of stigma refers to….’
• You can include direct quotations by saying: ‘as defined by Goffman 1969, open quote [quotation you want to use] end quote’

• Present key theory/concepts: 3 perspectives to understand doctor-patient relationship (consensus, conflict, negotiation) (Gabe, Bury, Elston, 2013) Concepts: adherence, non-adherence and concordance [Horne et al ,2005]
• Develop non-adherence and concordance further: Explain intentional and unintentional non-adherence to medication-taking. Explain the challenges in achieving concordance.
  • Provide an example of a particular disease where adherence to medication is not good (use journal articles). Present some data/stats. [E.g. non-adherence with diabetes medication is 50%]. Identify factors for non-adherence for your chosen disease, and reflect on the concepts presented before (section b): which factors are intentional/non-intentional?; to which extent is concordance achievable?

 

Conclusion: answer the question in relation to your chosen disease: summarise key aspects analysed. You can also refer to implications for  policies/ interventions, or need for more research/or services.

 

Learning for professional development Summative Assessment

• Identify 2 primary articles- It should be research papers. It can be qualitative or quantitative or a mixed methodology.
• These two articles should link to your area of improvement- giving you answers to your area of improvement. It best to choose 2 different articles with different view points
• CRITICAL REFLECTION- needs to be in first person,
• All reference should feature citation.
• Link to revalidation and NMC code 2018.

Introduction

• What the assignment is going to discuss.
• Introduce the topic.
• Mention the reflection method you will be using, which is ROLF, however don’t describe the model.

CRITICAL REFLECTION (400WORDS)

• IDENTIFY gap in the area of improvement this is I NEED TO IMPROVE MY ABILITY TO IDENTIFY THE EARLY SIGNS OF SEPSIS IN ORDER TO ESCALATE A DETERIORATING. PATIENT IN A TIMELY MANNER.
• Every statement should be supported with evidence (literature)

CRITICAL ANALYSIS (1800WORDS)

• Step one- critiquing article 1- talk about the methodology, sampling eg- purposive sampling etc supporting with evidence, where the study was conducted, purpose of the study, strengths of the study, talk about the ethical approval, informed consent and implication of it, limitations of the study.
• Repeat the same for article 2
• STEP 2- Compare and contrast both articles, findings- what are both articles saying similary and differently. Integrate both articles to make it a critically analysed discussion. Link it with up to date research. Is there a theme in theme of the findings?? Then compare this with other evidence from other source out there.

 

CRITICAL REFLECTION (400 WORDS)

• Write about revalidation and how life long education is required in the nursing profession.

 

Title of Assessment:

Identify ONE area of interest which you feel you need to develop within your nursing practice. This area of improvement must relate to your clinical practice.  It must be appropriate for a  student nurse. Critically analyse at least 2 up to date research studies that relate to your specific area of development, ensuring you also use many other sources of evidence to support your critical analysis.  Critically reflect on what you have learnt from the evidence in relation to your nursing practice. Critically reflect on how you will improve your practice as a student nurse in relation to the evidence you have critically analysed.

 

Note: The area of improvement should NOT be based on the following topics:  Assertiveness, Delegation, Decision making and prioritizing, Leadership, managing difficult conversations, communication, professional identity, SBAR or dealing with the hierarchical structure within an organisation. This is because these topics are being covered in depth in  Year 3 modules.

 

Assessment Type: 3000 words essay

Assessment Requirements:

Submit using the summative template which is found under the assessment portal on the module site.

Introduction (approx. 200 words)

To be written in the 3^rd person

State what your essay is going to include (so the aim of the essay). The introduction needs to highlight your area of improvement. You also need to write one sentence where you identify which reflective model you have used to help you critically reflect for this essay. (Please remember in this essay you DO NOT use a reflective model as a format for the essay. So you DO NOT structure it around a reflective model by writing a What section, So what section, Now what section but you follow the set framework highlighted here in the guidelines so Introduction, identify specific learning need, critical analysis, critical reflection).

Identify ONE area of interest which you feel you need to develop your nursing practice. (approx. 400 words)

To be written in the 1^st person

Please critically reflect on how you identified a gap in your knowledge /practice and found a specific area of improvement. Please then critically reflect how your ONE specific learning need has limited your practice as a student nurse. This specific area of improvement can be the same as your formative assignment or you can change it.

It is essential that your area of interest is appropriate for a msc student nurse (so it should be challenging you rather than an improvement which you met in the first year and are just repeating). Please write this section in the first person as you are writing about yourself.

It is expected that you would use relevant, up to date evidence to support each statement you make.

Critically analyse at least 2 up to date research studies that relate to your learning need. Critically analyse other evidence that enhances your knowledge about your specific learning need. (approx. 1800)

To be written in the 3rd person

Critical analysis contains two steps.

Step One (400 words suggested – 200 words per article)

You need to briefly identify the key findings of each specific study, which should generally not take more than a few sentences each. You then need to concisely analyse an aspect of the study to identify it was valid, reliable, trustworthy or ethically robust.

N.B: You should be selecting 2 primary studies to critique.

Step Two (1400 words suggested)

You then need to compare and contrast the findings of the 2 selected studies with a range of other studies and explore the topic, discuss the relevance of the findings and the available literature to clinical practice. You should look at policies and other evidence including literature reviews and critically analyse why there is agreement or disagreement between the evidence you have found.

The most important aspect is that you have the most relevant and most up to date evidence. If you have been found to use old evidence and we can find much more up to date evidence then your essay is out of date and is not evidence based.

Critically reflect how you will attempt to change or improve your practice as a result of this learning. (approx. 400)

To be written in the 1st person

From the extensive reading you have undertaken (up to date policies, CQC reports, research studies, Acts, educational articles) please critically reflect on the specific findings of the evidence and critically reflect how you might embed this practice in your future practice. Please critically reflect on how you feel this will enhance your practice and evidence base and the care you give as a student nurse.

Critical reflection involves demonstrating self-awareness in relation to your need and the evidence you have read. You need to demonstrate understanding of how the evidence supports or challenges how you have previously been nursing.

It is expected that you would use relevant, up to date evidence to support each statement you make.

Conclusion (approx. 200 words)

To be written in the 3rd person

Please write a clear conclusion identifying the key points you have made about changes to your practice as a nurse in relation to your specific learning need. It is expected that you would use relevant, up to date evidence to support each statement you make.

Assessment Weighting: 100%

Maximum Word Count: 3000 +/- 10%

Your work must be submitted in the electronic format via Canvas.

Your work must be submitted in the following file: doc / .docx (It is your responsibility to submit your work in the correct file.

Marking Criteria and Feedback Form – Level 7 Written Coursework.

Learning for professional Development 3      Module Code:

Learning Outcomes – Knowledge and understanding:   Successful students will typically be able to: • Critically analyse and reflect upon their own professional development needs, and those of others involved in nursing care.   • Analyse and interpret the use of research and evidence to inform their nursing practice.

Learning Outcomes – Skills and attributes:   Successful students will typically be able to: • Demonstrate the ability to engage in advancing their Continuing Personal and Professional Development (CPPD), using a structured and reflective approaches.   • Demonstrate how knowledge of learning and leadership can help foster supportive practice learning environments.   • Employ a range of strategies designed to apply the findings of research and evidence into nursing practice.

 

        Markers: Select criteria appropriate to the assignment and omit irrelevant ones. Use yellow highlight to indicate which feedback statements are relevant to this student.

 

Indicative classification	1st Class Honours / Distinction	1stClass Honours / Distinction	1st Class Honours / Distinction	Upper 2nd Class Honours / Commendation	Lower 2nd Class Honours / Pass	3rd Class Honours / Pass	N/A	N/A	N/A
Descriptor	Outstanding 90-100	Excellent 80–89	Very Good 70-79	Good 60-69	Clear Pass 50-59	Marginal Pass 40-49	Marginal Fail 30-39	Clear Fail 20-29	Little or nothing of merit  0-19
Structure and organisation 5%	The structure, organisation and presentation of the work is exemplary throughout.	The work is structured, organised and presented in a highly effective way.	The work is logically structured, and the organisation and presentation of information is very effective.	The work is logically structured, and the organisation and presentation of information is effective.	The work is logically presented, and the organisation and presentation of information is mostly good.	The work is illogically structured in places and some of the information is presented poorly or in a disorganised way.	The structure of the work is inconsistent or illogical. Information is often presented poorly or in a disorganised way.	There is insufficient structure and logic in the work and information is either poorly presented or absent.	There is little or nothing of merit to award marks for.
Writing clarity, fluency and accuracy 5%	Highly articulate and fluent writing style with no errors in grammar, punctuation or spelling.	Highly articulate and fluent writing style with very few (minor) errors in grammar, punctuation or spelling.	Articulate and fluent writing style. A few minor errors in grammar, punctuation and/or spelling.	Ideas are mostly expressed clearly but errors in grammar, punctuation and/or spelling impair meaning in a few places.	Ideas expressed clearly in most places but errors in grammar, punctuation and/or spelling impair meaning in some places.	Ideas expressed reasonably clearly but errors in grammar, punctuation and/or spelling impair meaning in several places.	Ideas not always clear.   Various errors in grammar, punctuation and/or spelling make it unclear / difficult to understand in a number of places.	Ideas poorly expressed. Numerous inaccuracies in grammar, punctuation and spelling make it unclear/ difficult to understand in many parts.	There is little or nothing of merit.
Demonstration of knowledge and understanding    20%	Outstanding knowledge and understanding of topic area demonstrated. All relevant points and issues covered plus some novel or unusual aspects which add to the overall quality of the work.	Excellent knowledge and understanding demonstrated. All relevant points and issues covered.	Very good level of knowledge and understanding demonstrated. Covers most relevant points and issues.	Good knowledge and understanding demonstrated. A few minor errors and/or omissions noted.	A satisfactory level of knowledge and understanding demonstrated. Some minor errors and/or omissions noted but none significant.	Sufficient knowledge and understanding demonstrated. Some errors and/or omissions noted.	Insufficient knowledge and understanding demonstrated. Some content irrelevant, inaccurate or absent.	Inadequate knowledge and understanding demonstrated. Key content inaccurate or absent.	Little or nothing of merit.
Use of evidence / research to support work 15%	Content is drawn from a wide range of relevant primary and secondary sources and integrated into the work in a highly effective way.	Content is drawn from a wide range of relevant primary and secondary sources and integrated into the work very effectively.	Content is drawn from a wide range of primary and secondary sources and integrated into the work in an effective manner.	Content is drawn from a good range of primary and secondary sources and integrated into the work well.	Content is drawn from a satisfactory range of primary and secondary sources and is mostly well-integrated.	Content is drawn from a narrow range of sources and integration is patchy or incomplete resulting in a superficial exploration of the topic.	Content is not drawn from a sufficiently wide range of sources, and integration into the work is limited and/or ineffective.	Insufficient and/or irrelevant literature used. Limited or no integration into work.	Little or nothing of merit.
Ability to think critically and analytically   30%   Analysis   Critical analysis	Highly accomplished piece of work with significant evidence of ability to think critically and analytically.	Accomplished work with substantial evidence of ability to think critically and analytically.	Consistently demonstrates critical and analytical approaches to thinking.	Critical and analytical thinking evident throughout majority of the work.	Clear evidence of ability to think critically and analytically although some missed opportunities to develop and/or expand on ideas more thoroughly.	Ability to think critically and analytically evident but many ideas could be expanded on or developed further.	Some critical thinking evident but inconsistent and under-developed. Mainly descriptive.	Limited or no evidence of critical thinking.	Little or nothing of merit.
Ability to reflect   20%   Reflection	Extremely accomplished and insightful reflection showing highly developed understanding of own learning journey.	Excellent reflection showing very well-developed insight and understanding of own learning journey.	Very good reflection showing well-developed and thoughtful understanding of own learning journey.	Good reflection showing a considered and thoughtful understanding of own learning journey.	Clearly thought through reflection showing a satisfactory understanding of own learning journey.	Reasonably well thought through reflection showing an emergent understanding of own learning journey.	Reflection needs further development to show sufficient evidence of understanding own learning journey.	Limited evidence of reflective thinking and understanding of own learning journey.	Little or nothing of merit.
Use of referencing system   5%   Referencing	Recommended referencing system used with no inaccuracies or inconsistencies of presentation noted.	Recommended referencing system used with very few (minor) inaccuracies and/or inconsistencies.	Recommended referencing system used with few inaccuracies and/or inconsistencies.	Recommended referencing system used with several  inaccuracies and/or inconsistencies.	Recommended referencing system used with some inaccuracies and/or inconsistencies.	Recommended referencing system used but multiple inaccuracies and/or inconsistencies noted.	Attempt to use recommended referencing system but numerous errors noted.	Recommended referencing system not used.	No recognised reference system attempted.

Provisional weighted/overall mark (before application of penalties):

First Submission: For each day for up to five days after the published deadline, coursework submitted late will have the numeric grade reduced by 10 grade points until the numeric grade reaches the pass grade, i.e. 40 (UG) or 50 (PG); this includes deferred coursework.

Second Submission (referral): The resubmitted element, if successful, will be capped at a bare pass, i.e. 40 (UG) or 50 (PG). The full mark of any previously passed elements will be retained. Coursework submitted late, i.e. at any point after the published deadline date and time, will be awarded a zero.

Re-enrolment: Grades awarded for modules on re-enrolment will not be capped for classification purposes.

Provisional Marks: All marks are provisional until ratified by the relevant Board of Examiners.

Marking and Moderation:  All marking and moderation procedures are governed and guided by the current University’s Policies and Regulations.

Reflection on Learning

Please consider the learning you have achieved while working on this assignment and how you have applied the feedback you have been given. For example:

• What previous feedback have you been given and how have you used it to inform and improve this assessment?
• What have you learned in this assessment that you intend to apply to your practice and how will you demonstrate this?

Keep your feedback and reflection in a file/portfolio as evidence of your professional development. 

EXAMPLE OF WORK

This assignment aims to highlight the author’s learning need (assertiveness in challenging poor clinical practice) based on a reflection on clinical practice experience. Moreover, there will be a critically analyse of two literature in relation to the interventions to addressing the author’s learning need. The critical analysis will focus on the validity of the first literature and the reliability of the second literature. The findings from the two literature will be compared and contrasted with the findings from other studies that explored the topic. The relevance of the findings to the author’s clinical practice will be discussed.  It should be noted that the studies to be used in the above are non-United Kingdom’s (UK’s) studies. This is due to non-existence of UK’s studies that addressed the interventions to the author’s learning need, as observed through a systematic search. Furthermore, using the Rolfe et al.’s (2011) reflective model, the author will critically reflect on their learning from the above findings. The reflection will aim to improve the author’s clinical practice through continuing personal and professional development (CPPD). And to foster the leadership to support the learning needs of other healthcare professionals (HCPs) involved in patients’ care.

My lack of assertiveness to challenge poor clinical practice (Law & Chan, 2015) became obvious, during one of my clinical experiences in the second year of the nursing programme. This became apparent during the night, in which, l was assigned to work with a senior nurse. I observed during the shift that the senior nurse was attempting to drag-lift an elderly patient with the support of a healthcare assistance. I did, however, suggest to them that there was a sliding sheet below the bed, which would have made the task easier (MacGregor, 2016). Yet, my suggestion was ignored, and they proceeded with drag-lifting the patient. I could hear the patient making a discomforting sound during the drag-lift, which suggested to me that she was experiencing pain. Reflecting on the situation, I realised that my lack of assertiveness when challenging the poor clinical practice has negatively impacted on my nursing responsibility of promoting patients’ safety (Fagan et al., 2016; Francis, 2013; Nursing and Midwifery Council (NMC), 2018). Hence, moving forward, l will explore an evidence-based approach and critically reflect on such evidence, in other to improve my assertiveness when challenging poor clinical practice.

Moving on to critical analysis, firstly, Gultekin et al. (2018) implemented assertiveness- training (lectures; group and individual discussions with trainers, and simulations) through a randomised control trial (RCT) that involved 70 nursing students. Gultekin et al. (2018) observed that compared with the (n=40) control-group, assertiveness-training improved assertiveness amongst 30 students in the intervention-group, with a probability (p)-value of 0.05. RCT is a research methodology that randomly allocates participants to the intervention or the control-group (Creswell, 2013). And p-value statistically measures the relationship between interventions and results (Heale & Twycross, 2015), with a p-value less than 0.05 indicating a one in 20% chance that findings/results are unrelated to interventions (Polit & Beck, 2013). Using RCT makes the findings from Gultekin et al.’s (2018) study valid (Aveyard, 2014) because RCT prevents participants’ selection bias (Gerrish & Lathlean, 2015). However, the sample size (n=70) suggests that the findings are ungeneralizable (LoBiondo-Wood & Haber, 2013). Haslam and McGarty (2018) proposed a minimum sample size of 150 to generalise a research’s findings.

Secondly, Nakamura et al.’s (2017) quasi-experiment (non-randomisation experiment) (McCusker & Gunaydin, 2014) used the Rathus assertiveness scale (RAS) to measure the pre and post-training assertiveness of 22 nurses. RAS is a 30-item assertiveness measurement tool, with a high score indicating a high level of assertiveness and vice-versa for a low score (Mersin et al., 2015). Nakamura et al. (2017) found that their assertiveness-training (cognitive behaviour therapy (CBT); video presentation; discussions and simulations) improved participants’ mean assertiveness score from -12.9 pre-intervention to -8.6 post-intervention. However, Nakamura et al. (2017) gave no rationale behind their utilisation of a quasi-experiment which is often subjected to a selection bias, due to its non-randomisation approach (Barratt et al., 2014). The use of a quasi-experiment instead of a less bias methodology such as RCT (Holloway & Galvin, 2016) suggests a potential flaw, with regards to the reliability of the findings (Green et al., 2013). Although, the baseline data (Punch, 2013) of the participants, that is, their demographics and pre-intervention assertiveness levels were equal; therefore, making the findings reliable (Morse, 2015).

Yet, the above findings are from non-UK’s studies; thus, suggesting their inapplicability to the author, due to a variance in educational culture and orientation to the UK (Raymond et al., 2017). However, the findings indicate the potential impact of assertiveness-training in addressing the author’s learning need.

The findings from Gultekin et al. (2018) and Nakamura et al.’s (2017) studies correlate with the observation made by Nashina and Tanigaki (2013). Nashina and Tanigaki (2013) used RCT to assess the impact of their assertiveness-training (lectures, CBT, group discussions and simulation), with 10 nursing students in the intervention-group and 56 in the control-group. Compared with the control-group, Nashina and Tanigaki (2013) observed from the RAS that the mean assertiveness score improved from -15.5 to -7.0 amongst the intervention group, with p=0.04, and no changes were observed in the control-group.

Also, Soni and Srinivasa (2017) used a quasi-experiment to implement assertiveness-training (lectures, group discussions, brain-storming, role-play and feedbacks) for 32 nursing students. The assertiveness assessment tool (25-items Likert scale on assessment of assertiveness) (Sreedevi et al., 2018) used in the study indicated that the mean assertiveness score increased from 63.43 pre-training to 88.43 post-training. The finding from Soni and Srinivasa’s (2017) study is strengthened by their utilisation of the Likert scale because of the strong reliability of the tool (Nacioglu, 2016).

Nonetheless, a cohort study of 33 nurses by Yoshinaga et al. (2017) used the RAS to assess the effectiveness of assertiveness-training (lectures; CBT, video presentation; discussions and role-play). The study found that after a six-month follow-up, the cohort’s assertiveness levels have improved, with a mean score of -14.2 pre-training to -10.5 post-training. The six-month follow-up makes the findings significant (O’ Connor et al., 2013; Kraemer & Blasely, 2015). Raemer et al. (2016) emphasised that the long-term efficacy of assertiveness-training is often observed after three to six-months follow-up.

Regardless, the similarities in the findings from the previously mentioned studies further highlight the effectiveness of assertiveness-training towards addressing the author’s learning. Nevertheless, Hinde (2018) attributes the similarities in the above findings to the multicomponent approach to the assertiveness-training. In other words, the used of lectures, group discussions; video presentations and simulation or role-play improves the effectiveness of assertiveness-training (Warland et al., 2014). In support of this assertion, a systematic review by Omura et al. (2017) also found that multicomponent assertiveness-trainings implemented for different HCPs improved their assertiveness levels. This implies that the author’s learning need will be best addressed by assertiveness-training that applied multicomponent approach as aforementioned.

However, the effectiveness of assertiveness-training has also been observed in studies that used a single component in their training. For example, Abed et al.’s (2015) quasi-experiment used the assertive behaviour inventory tool (ABIT) to measure the impact of lecture-based assertiveness-training on the assertiveness levels of 30 nurses. ABIT is a 25-item self-reporting tool developed by Clark and Shea (1990). Abed et al. (2015) found that the participants’ assertiveness levels significantly improved post-assertiveness-training with p< 0.029. However, there was no control-group in their study. Brannen (2017) and Hartas (2015) indicated that having a control-group in a quasi-experiment helps to ascertain that findings are related to intervention/s-but not extraneous variables. This, thus, implies a limitation to Abed et al.’s (2015) findings. Although, the ABIT used by Abed et al. (2015) is a valid tool for measuring assertiveness level (Speed et al., 2017).

Nevertheless, RCT by Sayr et al. (2014) involving nurses (n=58 intervention-group and n= 58 control-group) and using the RAS also found that assertiveness-training (simulation) correlates with improved assertiveness level within the intervention group, with p=0.01. The findings from Sayr et al.’s (2014) study were significant because assertiveness levels remain high (96%) among the participants in the intervention-group after a six-month follow-up.

The above evidence, thus, suggests that regardless of its components, assertiveness-training will be effective towards improving individual assertiveness level. However, Lin et al. (2014) emphasised that the length of assertiveness training similarly impacts the effectiveness of assertiveness training. In other words, a brief assertiveness-training is less effective compared with assertiveness training implemented over an extended period (Yoshinaga et al., 2017). In fact, the similarities in the findings from the aforementioned studies can equally be attributed to the duration of their assertiveness-trainings. The observations made from the individual study indicate that assertiveness training was implemented weekly for three to four-week durations. Apart from the previously mentioned studies, other studies have also observed the effectiveness of assertiveness training implemented over an extended period, regardless of their components. For instance, Asi-Karakes and Okanl’s (2015) quasi-experimental implemented a weekly assertiveness-training for 30 nurses, over a month duration. The RAS used in their study indicated an improved assertiveness mean score from -20.4 pre-training to -8.9 post-training.

A similar observation was also made in Kaur et al.’s (2018) RCT. Kaur et al. (2018) found that compared with 16 nurses in the control-group, the assertiveness-training implemented over two-week improved the assertiveness of 15 nurses in the intervention-group. The RAS score showed an increment from 18.9% pre-intervention to 49.8% post-intervention amongst the intervention-group, with no changes in the control-group.

However, the NMC (2018), likewise, the Royal College of Nursing (RCN) do not currently recommend assertiveness-training for nurses and students. This might be due to the reason highlighted in the introductory paragraph. Although, the NMC (2018) highlighted the importance of assertiveness amongst HCPs in their code of conduct. Yet, Ion et al. (2017) suggest that mentorship, as emphasised by the NMC can be instrumental in improving assertiveness amongst students, for example. Andrew and Mansour’s (2013) survey of 186 UK’s nursing students found that having assertive mentors helped some students to be assertive during their clinical placements. However, Jack et al. (2018) observed that some mentors often lack assertiveness skills, as reported by some nursing students who participated in the study. In fact, Andrew and Mansour (2013), and Jack et al. (2018) recommended assertiveness-training to improve students and mentors’ assertiveness. The National Health Service (NHS) Safeguarding Policy (2017) and Francis’s (2013) report also recommended assertiveness training to improve assertiveness among HCPs. This recommendation and the findings from the literature further ascertain the significance of assertiveness-training to the author’s learning need

Interestingly, however, the effectiveness of assertiveness-training has not been observed by a study such as Lilah et al. (2016). Lilah et al.’s (2016) longitudinal study (a study that observes participants over a long period of time) (Fraley & Hudson, 2014) involving 60 student nurses found that assertiveness-training incorporated into four-year nursing curriculum had no impact on the students’ assertiveness levels. The RAS indicated that participants’ assertiveness level decreased from 81.2% during the first year to 72.9% during the final year of the nursing program. The finding from this study is particularly important because of the duration of the study (Bryman, 2016). In fact, the finding is in contrast with Lin et al. (2014) and Yoshinaga et al.’s (2017) assertions which underscored that the duration of assertiveness-training improves its effectiveness.

Lilah et al.’s (2016) finding is supported by a quasi-experiment carried-out by Doherty et al. (2015). Doherty et al. (2015) found that their assertiveness-training did not improve the assertiveness levels of the 61 student nurses who participated in their study. The RAS showed that assertiveness level decreased by 3% among the participants post-training.

A similar observation was made by two RCTs (Honjo & Komoda, 2013; Yamamoto et al., 2015). Honjo and Komoda (2015) implemented assertiveness-training that involved 22 nurses in the intervention-group and 25 nurses in the control-group. The study found that assertiveness-training based on lectures, role-play and group discussions had no impact in the intervention-group, with p= 0.079. Although, Honjo and Komoda’s (2015) assertiveness-training was brief (90mins), which might suggest the reason for its ineffectiveness (Lin et al., 2014). Nevertheless, Yamamoto et al.’s (2015) study involving 28 student nurses (10 in intervention-group and 18 in control-group) also found that assertiveness-training (lectures and role-play) had no impact in the intervention-group, with p=0.06. These findings, thus, indicate a limitation to assertiveness-training in addressing the author’s learning need.

However, Obiagel (2015) suggests that the ineffectiveness of assertiveness-training can be attributed to intrinsic factor such as self-esteem. This implies that assertiveness-training that does not include an approach to improving individual self-esteem might be ineffective (Taraneh et al., 2017). However, the participants in the studies (Doherty et al., 2016; Honjo & Komoda, 2013; Lilah et al., 2016; Yamamoto et al., 2015) that observed the ineffectiveness of assertiveness-trainings had no problems with their self-esteem. Lilah et al. (2016), in particular, observed a high level of self-esteem amongst the nursing students in their study. This implies a disassociation between self-esteem and assertiveness.

Nevertheless, Valizadeh et al.’s (2016) study observed the ineffectiveness of assertiveness-trainings that did not address low self-esteem amongst some nursing students. Whilst Nashina and Tanigaki (2013), Nakamura et al. (2017) and Yoshinaga et al. (2017) observed that the inclusion of CBT that improves self-esteem translated to improve assertive amongst their studies’ participants. Yet, other studies, for instance, Abed et al. (2015) and Gultekin et al. (2018) that did not include psych-education (Ghezelbash et al., 2015) such as CBT in their assertiveness- training still observed the positive effect of their training, as previously highlighted.

The above evidence implies that self-esteem might not be the only barrier to the effectiveness of assertiveness-training. In fact, confidence was also highlighted by Tajabadi et al. (2018) as another intrinsic barrier to the effectiveness of assertiveness-training. Kim (2016) explained that a lack of confidence can inhibit the practical effectiveness of assertiveness-training. This assertion supports the observation made by Eraydin and Karagozoglu (2017). Eraydin and Karagozoglu (2017) observed that the lack of confidence amongst some students affects the effectiveness of assertiveness-training implemented in their nursing programme. Although, this observation was mainly amongst first-year students in Eraydin and Karagozoglu’s (2017) study. Regardless, a study by Kukulu et al. (2013) found a correlation between a lack of confidence and the ineffectiveness of assertiveness-training amongst some final-year nursing students.

Reflecting on the above findings, I have realised that, although, my self-esteem and confidence will not inhibit the efficacy of assertiveness-training in addressing my learning need; however, another personal barrier such as culture may affect its effectiveness (Ibrahim, 2014; Okuyama et al., 2016). Mansbach et al. (2014) noted that Individual cultural orientation often affects the practical implementation or the effectiveness of assertiveness-training. This reflects on me because my cultural upbringing dissuades the questioning and a challenge to the bad practice of those with authority or in a senior position. Correspondingly, Kilic and Sevinc (2017) observed that some student nurses avoided challenging the poor practice of clinicians, due to their cultural orientations which dissuade a challenge to the elderly and individuals with authority. Nacioglu (2016), however, emphasised that an individual might still be assertive without a challenge to culture. Implying that, assertiveness is about expressing one’s opinion through a calm approach without disrespecting others (Fagan et al., 2014; Schwappach & Gehring, 2014). Larijani et al. (2017) observed that some student nurses were assertive in questioning senior clinicians’ decisions, whilst maintaining a culture of respect towards such clinicians. This, therefore, suggests a need to take this into consideration in addressing my learning need

Nevertheless, the ‘fear of retribution’ (Rainer, 2015) might similarly play a role in nurses and student nurses’ abilities to be assertive, regardless of training (Ion et al., 2017). Kent et al. (2015) observed that some student nurses often have the abilities to be assertive. However, they avoid challenging their mentors’ bad practices, due to the fear of being ostracized or failed during their clinical experience (Bickhoff et al., 2016; Kent et al., 2015). This assertion supports my feelings during the previously discussed clinical episode, in which, l realised my learning need. Raymond et al. (2017), however, suggest that the implementation of assertiveness training that applies a psychological approach to addressing fear and improving confidence can nullify the above. The effectiveness of this was observed in Nakamura et al.’s (2017) study as previously explained. Although, Rees et al. (2015) proposed that this should be coupled with organisational support that encourages assertiveness to challenge poor clinical practice and good mentoring that promotes assertive behaviours. Lukewich et al. (2015) found that having a supportive environment and assertive mentors promoted assertive behaviours amongst some nursing students during their clinical placements.

Regardless, Pool et al. (2015) emphasised that assertive behaviours should support CPPD. CPPD is a part of the NMC (2018) revalidation process which encourages life-long learning (Bishop, 2017). Consequently, ensuring an up-to-date evidence-based practice that assures patients’ safety (Coventry et al., 2015). Welp et al. (2018) explained that CPPD often culminates in autonomous leadership, in which, nurses, for example, make autonomous decisions and delegate a task to others. Hence, a need for assertive behaviour to support autonomous leadership (Endacott et al., 2014). Gonnelli and Raffagnino (2018) noted the correlation between assertiveness skills and strong leadership ability amongst some nurses in their integrated review. This means that effectively addressing my leaning need will equally be beneficial to my future leadership role through CPPD, as mandated by the NMC (2018).

Nonetheless, Garcia et al. (2014) highlight that assertive leadership should support the developmental needs of other HCPs involved in patients’ care. Implying that, an assertive leader should contribute toward improving the assertiveness of other less assertive HCPs (Bengtsson & Carlson, 2015). McMillan et al. (2014) suggest mentoring and preceptorship as leadership approaches to supporting others’ assertiveness. The evidence from Andrew and Mansour’s (2013) study as aforementioned suggests the effectiveness of these leadership approaches toward improving others’ assertiveness.

Regardless, however, Jack et al. (2018) proposed a regular assertiveness-training as a part of CPPD to maintain assertive behaviour. Sayr et al. (2014) noted that intrinsic and extrinsic factors like those mentioned can have a sudden impact on individual assertiveness. This assertion supports the observation made in Maheshwari and Gill’s (2015) study, in which, some nurses attributed their non-assertive behaviours to anxiety, stress, and loss of confidence. Nashina and Tanigaki (2013) and Yoshinaga et al. (2017), in fact, proposed that assertiveness-training should be updated at three to six-month interval to maintain its effectiveness.

Moving forward as a student and a future nurse, l will participate in multicomponent assertiveness-training to improve on my learning need. Whilst also exploring approaches that nullify the influence of culture and the fear of retribution on the ability to address my learning need. Also, my assertiveness will be utilised to support my future autonomous leadership through CPPD. Whilst using my leadership role to improve others’ assertive behaviours. As a part of CPPD, l will partake in regular assertiveness-training to improve on my assertive skills and behaviours.

In summary, the assignment has highlighted the author’s learning need through a reflection on clinical experience. Also, two studies based on the utilisation of assertiveness-training in addressing the author’s learning need were critically analysed. The findings from the two critically analysed studies have been compared and contrasted with other studies that explored the effectiveness of assertiveness- training in meeting the author’s learning need. The similarities and differences in the findings were also highlighted by the author through critical analysis. The author also reflected on the findings and explore some personal barriers that might inhibit the effectiveness of assertiveness-training in addressing their learning need. The importance of the author’s assertiveness to their CPPD was highlighted, with the importance of their assertiveness in supporting others’ learning needs explored. Finally, the need for a regular assertiveness-training to support the author’s CPPD was similarly emphasised.