الفهرس 
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Abstract
SUMMARY
Communication is a basic function of human beings, of vital importance to developing interpersonal relationships, and for groups, organizations, and society to function well. Assertiveness is an essential skill for nurses to build effective team relationships and to provide quality nursing care(Nazari et al., 2018). Meanwhile, self-esteem influences how nurses think, feel, and motivate themselves and act so that nurses with high self-esteem are confident, and demonstrate respect and concern for patients and colleagues. Accordingly, it was deemed important to assess the ability of training in communication skills to enhance nurses’ self-esteem and assertiveness (Hyatt et al., 2018).
This study aims to assess the effect of a communication skills training program on head nurses’ assertiveness and self-esteem. The research hypothesis was that a communication skills training program will improve head nurses’ assertiveness and self-esteem.
The study was conducted at Nasser Institute Hospital for Research and Treatment using a one-group quasi-experimental study design with pre-post assessment. All 50 head nurses working in different departments were included. Data were collected using a self-administered questionnaire that included a knowledge questionnaire to assess head nurse’s knowledge about basic communication skills components; Sorensen Self-esteem Scale to assess the level of self-esteem among head nurses with 25 statements categorized into positive personality, negative personality, and social personality; in addition to an Assertiveness Assessment Scale with 47 items categorized into verbal and non-verbal, active guidance/orientation, work habits, control of fear, assertiveness relating to colleagues, and system negotiation domains.
The main study findings are as following.
Head nurses’ age range from 22 to 53 years, mostly with bachelor degree (60.0%), and married (66.0%). The medians of their total and current experience were 16.0 and 5.0 years respectively; 48.0% had previously attended training courses in communication.
46% of the head nurses had satisfactory total knowledge of communication at the pre-intervention phase. This improved to 100% at the post-intervention phase, and slightly declined to 94% at the follow-up phase (p<0.001).
Most (70%) head nurses had high assertiveness at the pretest, and this improved at post- and follow-up phases reaching 94% (p=0.002).
34% of the head nurses had high self-esteem at the pretest; it improved to 78% at the posttest, and slightly decreased to 76% at follow-up (p<0.001).
Significantly more head nurses with pretest satisfactory knowledge were among those having a bachelor degree.
Significantly more head nurses with pretest high assertiveness were among those aged 40 years or older.
A significant positive relation was revealed between head nurses’ pretest total knowledge and total self-esteem (p=0.002).
A significant positive relation was shown between head nurses’ pretest total assertiveness and self-esteem (p=0.008).
Significant moderate positive correlations were found between head nurses’ scores of self-esteem and their knowledge and assertiveness scores.
A significant weak positive correlation was revealed between head nurses’ knowledge and assertiveness scores (r=0.326).
Weak positive correlations were found between head nurses’ qualification and their knowledge, self-esteem, and assertiveness scores.
In multivariate analysis:
o The study intervention was the main positive predictor of the knowledge score, along with the nursing qualification.
o Head nurses’ age and knowledge score positive predictors of their assertiveness score.
o Head nurses’ knowledge and assertiveness scores were positive predictors of their self-esteem score.
Conclusion
In conclusion, the training program in communication is effective in improving head nurses’ knowledge, self-esteem, and assertiveness, and this is lasting for at least three months.
Recommendations
The study recommends application of the developed program to all head nurses in the study settings and in similar ones, adopting the adult learning approaches, with related workshops and seminars to be regularly conducted. Preparatory programs for newly appointed head nurses should be organized as a pre-requisite for promotion to such job positions. The undergraduate nursing curricula should give more emphasis to the issues of assertiveness and self-esteem. The same study should be replicated using a randomized controlled design to provide stronger evidence. Further studies are proposed to evaluate the effect of improving head nurses’ assertiveness and self-esteem on their burnout and job satisfaction.