Background: Several authors have previously assessed the effects of assertive communication training for nurses to speak up in cases of medical errors. Inconsistent results regarding the nurses' attitudes, behaviors, and confidence levels were noticed. Objective: To identify the effectiveness of assertive communication training on nurses' behaviors, attitudes, and confidence levels for speaking up in cases of medical errors and to identify vital components for success. Design: Systematic review and meta-analysis. Data sources: PubMed, ERIC, Embase, Scopus, and CINAHL were searched up for studies published from the inception of the database to December 16, 2022. Methods: Two researchers independently performed a primary screening of titles and abstracts for relevant studies, followed by a review of full texts if the references met inclusion criteria and quality assessment. Data were retrieved for nurses and nursing students who received medical error–related assertive communication training for speaking up, and learning outcomes for attitudes, behaviors, and confidence levels were reported based on pooled data. Pooled estimates were calculated using a random-effects model. Results: A total of eleven studies with 1299 participants were included in systematic review, and among them nine studies with 804 participants were analyzed in meta-analysis. From the pooled results, the intervention group, which received assertive communication training, exhibited substantially improved speaking-up behaviors compared with the control group (SMD = 0.58; 95 % CI, 0.14–1.03). Considerable differences were noted in the nurses' times of speaking up in cases of medical errors between pretest (38 %; 95 % CI, 0.14–0.68) and posttest (78 %; 95 %CI, 0.70–0.85) based on the pooled data. The nurses' attitudes and confidence levels for speaking up varied markedly between pretest and posttest. Conclusion: Structured assertive communication training may improve nurses' speaking-up behaviors in cases of medical errors. To conduct effective assertive communication training, nursing educators should incorporate multiple teaching approaches into structured training and ensure an adequate training duration.
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