American Journal of Nursing Research
ISSN (Print): 2378-5594 ISSN (Online): 2378-5586 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Nursing Research. 2018, 6(6), 568-575
DOI: 10.12691/ajnr-6-6-27
Open AccessArticle

Effect of Assertiveness Training Program on Nurse Interns' Self-esteem and Stress at El-Fayoum University Hospitals

Azza Abdeldayem Ata1, and Asmaa Kamal Ahmed2

1Nursing Administration Department, Faculty of Nursing, Zagazig University, Egypt

2Nursing Administration Department, Faculty of Nursing, El-Fayoum University, Egypt

Pub. Date: October 31, 2018

Cite this paper:
Azza Abdeldayem Ata and Asmaa Kamal Ahmed. Effect of Assertiveness Training Program on Nurse Interns' Self-esteem and Stress at El-Fayoum University Hospitals. American Journal of Nursing Research. 2018; 6(6):568-575. doi: 10.12691/ajnr-6-6-27


The internship year is a valuable prospect for new nurses to advance their practice in the real world setting. However, nurse interns are meeting a variety of stressors that could hinder their work outcomes and even their overall wellbeing. Therefore, assertiveness training is required to improve their self-esteem and decrease stress associated with the demanding nature of the nursing profession. The present study aimed to assess the effect of assertiveness training program on nurse interns' self-esteem and stress. A quasi-experimental design was followed to achieve the aim of the present study. It was carried out at El-Fayoum University Hospitals. The study subjects included all the available nurse interns who were enrolled at the academic year 2016-2017. Three tools were used to collect data for this study, the assertive behavior in nurses' questionnaire, the self-esteem scale, and the perceived stress scale. Results revealed that there was a significant improvement in nurse interns' assertiveness mean score after the program implementation (P < 0.05). As well, there was statistically insignificant enhancement in their self-esteem mean score, where P- value > 0.05. Additionally, there was a statistically significant reduction in their total mean score of stress after the program implementation (P < 0.01). Conclusion: The assertiveness training is beneficial in developing nurse interns' self-esteem and decreasing stress. Therefore, it is recommended to provide assertiveness training to the non-assertive nurse interns at the beginning of the internship year to build nurse interns' self-concept and self-esteem and subsequently decrease stress.

assertiveness training self-esteem stress nurse interns

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Haleem, D.M., Manetti, W., Evanina, K., & Gallagher, R. (2011). A senior internship facilitating the transition to nursing practice. Journal of Nurse Educator; 36 (5):208-213.
[2]  Ismail, M., Saber, K., Hegazy, M., Al-amari, N., & Salah, S. (2015). Nursing Internship Program Manual. University of Dammam, College of Nursing, p.5. Retrieved February 15, 2017 from internship program manual.
[3]  Ellis, J.R. & Hartley, C.L. (2012). Nursing in today's world: trends, issues & management. (10thed). Ch.2, Philadelphia: Lippincott Williams & Wilkin. p.122.
[4]  Obied, H., Shabaan, F., Shalaby, H., & Gadiry, S. (2013). Application of designed orientation program for nurse interns based on learning needs assessment. Journal of American Science; 9 (3):80-91.
[5]  Parray, W.M., & Kumar, S. (2017). Impact of assertiveness training on the level of assertiveness, self-esteem, stress, psychological well-being and academic achievement of adolescents. Indian Journal of Health and Well-being; 8 (12): 1476-1480.
[6]  Gibson, D. (2004). The gaps in the gaze in South African hospitals. Social Science and Medicine Journal; 59 (10): 2013-2024.
[7]  Gorgens-Ekermans, G., & Brand, T. (2012). Emotional intelligence as a moderator in the stress–burnout relationship: A questionnaire study on nurses. Journal of Clinical Nursing; 21(15-16): 2275-2285.
[8]  Karimi, L., Leggat, S.G., Donohue, L., Farrell, G., & Couper, G.E. (2013). Emotional rescue: The role of emotional intelligence and emotional labor on well-being and job-stress among community nurses. Journal of Advanced Nursing; 70 (1):176-186.
[9]  Ulric, B., Ashlockch, C.H., Krozek, C., Africa L.M., Early, S., & Carman, M.L. (2010). Improving retention, confidence and competence of new graduate nurses: Results from a 10-years longitudinal database. Nursing Economics Journal; 28 (6): 363-75.
[10]  Katz, H.P. (2013). Telephone medicine triage and training primary care. (6th ed.). London: F.A. Davis Co.
[11]  Abed, G.A. El-Amrosy, S.H. & Atia, M.M. (2015). The effect of assertiveness training program on improving self-esteem of psychiatric nurses. Journal of Nursing Science; 1(1): 1-8.
[12]  Reece, B.L. (2012). Human relations: Principles and practices. (7th ed.). Ch.8., USA: South – Western, Cengage Learning, p. 172.
[13]  Pipas, M.D., & Jaradat, M. (2010). Assertive communication skills. Fundamental Studies of Economic Research Journal; 12 (2): 649-656.
[14]  Begley, C.M., & Glacken, M. (2004): Irish nursing students' changing levels of assertiveness during their pre-registration program. Journal of Nurse Education Today; 24: 501-10.
[15]  Osman, Z.A., Khalil, E.A., Arafa, M.M., & Gaber, N.M. (2012). The effect of reminiscence on self-esteem and depression among elderly people. Journal of American Science; 8(4): 53-61.
[16]  Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, USA: Quinn & Boden Company, pp. 16-20.
[17]  Sorensen, M. (2006). Sorensen self-esteem test. Retrieved May 21, 2016 from http//
[18]  Sheu, S., Lin, H., Hwang, S., Yu, P., Hu, W., & Lou, M. (1997). The development and testing of perceived stress scale of clinical practice. Nursing Research (Republic of China); 5 (4): 341-351.
[19]  Mohamed, N.A., Abd El-Hammed, N.A., & Thabet, R.A. (2016). The effect of assertiveness training program on psychiatric nurses' communication skills and self-esteem. Medical Journal of Cairo University; 84 (1): 663-669.
[20]  Hamoud, A., El Dayem, A., & Ossman, H. (2011). The effect of an assertiveness training program on assertiveness skills and self-esteem of faculty nursing students. Journal of American Science; 7(12): 1085-1096.
[21]  Mahmoud, S., & Hamid, R.A. (2013). Effectiveness of assertiveness training program on self-esteem & academic achievement in adolescents' girls at secondary school at Abha City. Journal of American Science; 9 (8): 262-269.
[22]  Bola, O., & Akin, J. (2014). Effects of mentoring and assertiveness training on adolescents' self-esteem in Lagos State secondary schools. International Journal of Social Science Studies; 2 (3): 78-88.
[23]  Akbari, B., Mohamadi, J., & Sadeghi, S. (2012). Effect of assertiveness training methods on self-esteem and general self-efficacy female students of Islamic Azad University, Anzali Branch. Journal of Basic and Applied Scientific Research; 2 (3): 2265-2269.
[24]  Eslami, A.A., Rabiei, L., Afzali, S.M., Hamidizadeh, S., & Masoudi, R. (2016). The effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students. Iran Red Crescent Med Journal; 18 (1): 1-10.
[25]  Makhija, M., & Singh, P. (2010). Effectiveness of assertiveness training program on self-esteem and academic achievement in adolescents. International Research Journal; I (11): 56-58.
[26]  Maheshwari, S.K., & Gill, K.K. (2015). Relationship of assertive behavior and self-esteem among nurses. International Journal of Health Sciences & Research; 5 (6): 440-449.
[27]  Maheshwari, S.K. & Gill, K.K. (2015). Relationship of assertive behavior and stress among nurses. Delhi Psychiatry Journal; 18 (2): 356-364.
[28]  Moksnes, U.K., Bradley-Eilertsen, M.E., & Lazarewicz, M. (2016). The association between stress, self-esteem and depressive symptoms in adolescents. Scandinavian Journal of Psychology; 57: 22-29.
[29]  Larijani, T.T., Aghajani, M., Zamani, N., & Ghadirian, F. (2017). Assertiveness and the factors affecting it among nursing students of Tehran University of Medical Sciences. International Journal of New Technology and Research; 3(5): 34-38.