Assertiveness training to prevent verbal abuse in the OR - Home Study Program

AORN Journal,  Jan, 2004  by Debra Buback

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Self-assertion is presented in the module as a method of learning about one's own limitations and strengths. Assertion develops power and control. Increasing personal security helps individuals deal with anger. One researcher notes seven steps to becoming self-assertive. The individual should

* acknowledge that the situation made him or her angry; (14)

* identify his or her feelings about the situation, which reduces the power that the feelings have over the him or her;

* develop a stronger sense of personal identity, which provides greater control of the situation;

* learn to forgive and forget to keep the doors to relationships open;

* practice physical cues that confirm confidence and help regain control of the situation, such as

* ensuring that facial expressions correspond with their message,

* learning to ignore distractions,

* listening effectively to the other person and understanding the other person's message before answering,

* standing straight,

* using good eye contact,

* using relaxed and natural gestures,

* using a level, well-modulated voice and speaking clearly;

* avoid reciprocating with aggressive behavior because it is ineffective; and

* handle situations diplomatically using active listening skills.

Careful, attentive listening is critical because communication is the key for success. The assertive person stays calm, listens to both sides of a situation, and focuses attention on problem solving. Willingness to negotiate and compromise, when appropriate, helps regain control of an explosive situation.

An assertive person informs the abuser of his or her feelings, letting the abuser know that the abuse will not be tolerated. Individuals should learn to say "no" and use "I" statements, such as, "I did not appreciate the language you used today. Please do not use it again." (15)

Numerous case studies are presented in the module. Staff members read the case studies and answer a series of questions about the problems and successes presented in the case study. Two case studies are presented and an example of discussion sessions between the team members and the project moderator follow.

CASE STUDY ONE

Nurse Friendly is assigned as the circulating nurse in room two for Dr Rude. Dr Rude has five surgical cases, the first one scheduled to start at noon. New requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandate that the surgeon sign the informed consent and confirm the surgical site before the patient can be taken to the OR. The OR has been prepared for the first case, the patient is in the preoperative holding area, has been assessed by the anesthesia care provider, and is ready for surgery before Dr Rude arrives.

Nurse Shy is caring for the patient in the preoperative holding area. Nurse Friendly assesses the patient in the holding area, confirms the surgical site with the patient, and notes that the informed consent is correct but that the surgeon has not signed or verified the consent with the patient. Nurse Friendly and the surgical team members then await Dr Rude's arrival.