Unit 6 - Subject Area: Enhancing communication skills
Focus: Assertiveness, non-verbal cues
The focus of Unit 6 is on assertiveness.
Learning Objective: By the end of this unit, you will be able to describe assertive behaviour and apply it in managing challenging interactions with patients.
Assertiveness is a particular type of behaviour. It’s often associated with people who are confident and direct when dealing with others. Sometimes assertiveness is misunderstood and confused with aggression.
Assertive behaviour means clearly expressing your wants and needs while also respecting the rights, needs and feelings of others. Aggressive behaviour is focusing only on your own interests, without caring about the rights, needs or feelings of others.
While assertiveness may come naturally to some, it is also a skill that can be developed through practice, self-awareness and sometimes guidance.
People who are more passive or aggressive in their communication styles may need to work on becoming more assertive by learning to express their thoughts, feelings and boundaries in a clear and respectful way.
Pause for Thought
Have you ever found yourself in a situation where you had to choose between being passive, assertive or aggressive? What was the outcome? What could you have done differently to handle the situation with more assertiveness?
„Nursing belongs to the group of professions in which empathy, personality, reliability, and assertiveness are very important in social contacts. The last of the mentioned elements, assertiveness, demonstrates itself as inter alia resoluteness without violence, gentleness towards others, strength, and decisiveness. An element that is important for a person considering the possibility for assertive behaviour is the feeling that “what I want to do is appropriate”, “I’ve got the right to this particular behaviour, to such a reaction to the situation”. This moment of internal consent is the basis for the decision to behave assertively.”1
1. Empathic Assertion
How it works: Begin by acknowledging the patient’s feelings or perspective, then clearly state your own needs or limits.
Why it helps: Patients feel heard and respected, reducing defensiveness.
Example:
Patient: “I need this medication right now — I can’t wait.”
Clinician: “I can see this situation feels urgent for you, and I want to help. At the same time, I need to make sure the treatment is safe for you, so I’ll need to complete an assessment first.”
2. The “I” Statement Technique
How it works: Express your feelings and boundaries using “I” rather than “you,” which avoids blame.
Why it helps: Keeps communication respectful while clarifying your stance.
Example:
Instead of: “You’re being unreasonable.”
Say: “I feel concerned when requests come in this way, because I want to ensure I provide safe and effective care.”
3. Positive Framing / Redirection
How it works: Shift the focus from what cannot be done to what can be offered.
Why it helps: Patients are less likely to feel dismissed.
Example: “I’m not able to prescribe that medication, but what I can do is explore alternatives that may work just as well for your symptoms.”
4. Boundary Setting with Compassion
How it works: Clearly state limits, but do so with warmth and understanding.
Why it helps: Maintains trust while protecting professional integrity.
Example: “I understand you’re frustrated, and I want to support you. I can’t continue the conversation if shouting continues, but I’ll be glad to talk when we can do so calmly.”
5. Collaborative Problem-Solving
How it works: Invite the patient into the process of finding a solution.
Why it helps: Patients feel empowered rather than controlled.
Example: “It sounds like pain relief is your top concern. Let’s look together at the safe options available to manage that.”
✅ Why these are more human-centered:
- They rely on empathy, clarity, and collaboration.
- They protect boundaries without escalating conflict.
- They keep the therapeutic relationship intact, even in difficult moments.
| Challenging Situation | Human-Centered Response | Method Applied |
|---|---|---|
| Patient makes repeated demands for medication/tests | “I hear how important this is to you. I need to ensure what we choose is safe and appropriate, so let’s review your options together.” | Empathic Assertion |
| Patient is upset or blaming staff | “I feel concerned when conversations become heated, because I want to give you my full attention. Let’s take a moment so we can talk calmly.” | “I” Statement + Boundary Setting |
| Patient insists on something not clinically appropriate | “I’m not able to provide that treatment, but what I can do is discuss safe alternatives that may help with your symptoms.” | Positive Framing / Redirection |
| Patient raises their voice or uses disrespectful language | “I understand this is frustrating. I want to help, but I can only continue the conversation if we speak respectfully.” | Compassionate Boundary Setting |
| Patient resists advice or plan | “It sounds like you’re not sure about this option. What’s most important to you in your care? Let’s see if we can find an approach that works for both of us.” | Collaborative Problem-Solving |
| Patient feels unheard or dismissed | “I can see this matters a lot to you. Could you share more about your concerns so I understand fully before we decide next steps?” | Empathic Listening |
– Assertiveness involves clearly expressing your needs and opinions while respecting the rights and feelings of others.
– Techniques like “I” statements, active listening and positive reframing, are helpful tools in healthcare settings to manage difficult patient interactions and maintain control of conversations.
- Do the exercises.
- Watch illustrative video accompanying Simulation 6.
- Participate in Role-play Simulation 6.
- Share reflections and key takeaways during debrief.
- Kadłubowska M. et al. „Analysis of selected sociodemographic factors affecting assertive behaviours among nurses and students of nursing”, Nursing Problems / Problemy Pielęgniarstwa, Journal of the Polish Nurses Association, 1/2019 vol.27