title: Assertion Practices and Beliefs Among Nurses and Physicians on an Inpatient Pediatric Medical Unit.
abstract: BACKGROUND
  Teamwork and communication are critical elements of safe and effective patient care. Standardized communication tools have been implemented in many health care organizations, but little is known about attitudes and perceptions of assertion, the willingness to "speak up," by nurses and physicians at an academic pediatric institution.
  
  
  METHODS
  We conducted 6 focus groups with nurses, residents, and attending physicians using a standardized semistructured focus group guide to promote discussion. Focus groups were recorded and transcribed, and results were analyzed by 2 independent reviewers to identify thematic content.
  
  
  RESULTS
  Three themes emerged: (1) interpersonal factors, (2) organizational factors, and (3) complexity of care environment. Subthemes were the roles of hierarchy, relationships, and communication and personality style; the value of using standardized communication tools such as SBAR (Situation, Background, Assessment, Recommendation), direct face-to-face communication, and geographic and technology factors; and the need for coordinated communication and agreement across care team members about the care plans. Nurses reported reliance on peers for decision-making, on when and how to assert on behalf of patient care. Nurses and residents experienced barriers to assertion from concerns of relationships and their position within professional hierarchies. Attending physicians were supportive of being asserted to by any care team provider.
  
  
  CONCLUSIONS
  Interpersonal relationships, power dynamics, and organizational factors impact care team providers' willingness to assert in the inpatient setting. Standardized communication tools are effective. Further development and implementation of communication models that support experience, peer reliance, and direct face-to-face communication are warranted to improve assertion communication in the inpatient setting
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reese
authors.forename: Ryan
authors.initials: R
authors.lastname: Simmons
authors.forename: Juliana
authors.initials: J
authors.lastname: Barnard
mesh_terms: D001242:Assertiveness; D001291:Attitude of Health Personnel; D002648:Child; D000066491:Clinical Decision-Making; D003142:Communication; D017144:Focus Groups; D006757:Hospital Units / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007398:Interpersonal Relations; D008505:Medical Staff, Hospital / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010348:Patient Care Team; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014481:United States