The Joint Commission cites communication among team members as the #1 factor in sentinel events (2008).
6 minute video
Effective communication is a message that is easily understood and accepted. With all communication there is the actual message being sent, the receiver’s belief or interpretation of that message, and the reaction to the message. There is often much to communicate in a very limited period of time and often times a very high-stressed situation. Personal goals or hidden agendas can influence the way a message is delivered or received. What can influence messages being sent? being distracted, in a hurry, wanting something in return, being tired, overworked, stressed, upset, hungry, multiple interruptions. With unclear and ineffective communication, employees feel isolated and dissatisfied.
Communication is multimodal-more than one piece of information is interpreted to convey meaning. Verbal communication only one aspect. Verbal communication includes tone of voice, speed of information relayed, volume.Nonverbal-misunderstandings can be clarified when people involved comment…..The context of the communication and the environment are strong influences with communication as well. Precipitating events and preconceived ideas, opinions, or thoughts that the receiver has developed before the encounter can also influence the interpretation of the message.
Personal space-Includes comfortable and uncomfortable space between peopleEye contact-Includes glancing, gazing, staring, or not looking at another person.Position- Includes sitting, standing behind, facing, being in front of, or standing oppositePosture-Includes slouching, stiffening, slumping, twisting , cringing, towering, crouching, angling, tilting the pelvis down and forward, or titling the buttocks to the rearParalanguage includes vocal inflectionFacial Expressions-includes using the face to express being pensive, amused, sad, barely tolerant, cautious, angry, pouting, anxious, startled, confused, sleepy, or intoxicatedGestures-Include clenching the fist, shaking a finger, pointing, biting finger nails, tugging at your hair squirming folding arms, raising eye browsTouch-include gentle, firm, hurrying, coercive, overly friendly and respectful touchesLocomotion- includes styles of movingPacing refers to how action is takenLatency of response-refers to time it takes to react to questions or interact in a conversationContext-refers to the amount and source of light, color of lighting. Size of room, color of walls and furniture.Physiological response-refers to signs of emotion
Behavioral capacity-the knowledge and skills to perform a certain behavior. Master learning through skills training.Expectations-The values that the person places on a given outcome, incentives; Present outcomes of change that have functional meaning. Anticipate and model positive outcomes of a behavior and success is more likely.Observational Learning-Behavioral acquisition that occurs by watching the actions and outcomes of others’ behavior; Include credible role models of the targeted behavior. Watch people’s behavior and observe reinforcementsSelf-efficacy-The person’s confidence in performing a particular behavior; Approach behavioral change in small steps to ensure success. The more confident people are in performing a particular behavior the more successfulExpectancies-The values that the person places on a given outcome, incentives; Present outcomes of change that have functional meaning. The greater value a person pts on a given outcome the more likely the outcome will occur.If you were the nurse leader how would you use social cognitive theory with your staff.
How would the nurse manager begin to share her vision with staff in an exciting and motivating way?BMHCC will be the provider of choice for quality, patient-focused, health care in collaboration with the physicians and the communities we serve.
1. “Thank you for your critique. I’m going to think hard about what you said.”4. “I can handle this. I’m already handling it.”5. “I can stay calm so I can listen and help this person” or “I refuse to let this person upset me.”6. “I appreciate your viewpoint; let’s see if we can come to a consensus on this.”7. “I heard you say________; is that what you mean?”
“We were in a difficult situation; we got through it and I’m positive we can learn from it.”“ I’m wondering if you feel angry about the changes. Are you?”4. “Let’s hear some opposing viewpoints; we need to get everyone’s ideas.”
Chapter 18Learning Outcomes Communicate effectively with diverse intergenerational and inter-professional team members. Apply positive communication techniques in diverse situations Recognize negative communication techniques. Evaluate conflicting verbal and nonverbal communication cues. Examine constructive methods of communicating in conflict situationsActivity Complete conflict questionnaire and bring to class
open purposeful passionate connect the dots succinct Use compelling evidence deliver a clear message put themselves in the others’ situations listen carefully (pick up cues) while they are communicating with their audiences(Disch, 2009, QSEN module by AACN)
Aggressive communication: limits the focus on or understanding of the opinions, values, or beliefs of others. Assertive communication: enables a person to act in his or her own best interest without denying or infringing on the rights of others. Passive (or non-assertive): timid or reserved manner, resulting in limited concern for one’s own rights regardless of the situation. Fails to say what is meant.
Effective communication Unclear and ineffective communication
Multimodal (Baber & Mellor, 2001) ◦ More than one piece of information is interpreted to convey meaning Verbal communication Nonverbal communication ◦ Major message ◦ People respond more ◦ Comment and observe on nonverbal communication
Personal space Touch Eye contact Locomotion Position Pacing Posture Latency of Paralanguage Response Facial Expressions Context Gestures Physiological response
Social Cognitive Theory (Bandura, 2001) ◦ Cognitive ◦ Emotional ◦ Behavioral Explains how people acquire and maintain certain behavioral patterns which includes communication.
Listens attentively to others’ ideas and concerns Invites contact and is approachable Treats employees with respect Develops collaborative relationships within the organization Builds and sustains positive relations in the organization Shares information readily with staff Recognizes and uses the staff’s ideas Articulates ideas effectively both verbally and in writing Succinctly communicates viewpoints Involves staff in building consensus on issues Models healthy communication and promotes cooperative behaviors Nursing Leadership Institute (2002)
Perceive and identify emotions in others’ face, tone of voice and body language and the ability to name one’s own feelings, discuss emotions, and communicate clearly and directly. Analyze, reason, solve problems, make decisions, and guide what is important to think about Understand how emotions, thoughts, and behavior affect each other and how feelings can lead behavior Take responsibility for one’s own emotions and happiness, to turn negative emotions into positive learning and growing opportunities, and to help others identify and benefit from their emotions Adapted from Steve Hein, (2005). Emotional intelligence. Retrieved April 15, 2007, from http://eqi.org
Listen and thanks others for positive criticism: it is a vote of confidence that can lead to success Carry around a picture of an inspiring person and use it to handle a particular situation Trust your feelings and behavior Use constructive inner dialogue as a guide. Learn to manage fear and anger by saying or thinking positive coping messages Appreciate different viewpoints Avoid mind reading Keep things in perspective; don’t overplay the significance of one bad encounter
Remember that emotions are contagious, so use positive messages. Tune into the emotional context within which words occur, and read between the lines. Always phrase findings as hunches, not verified facts. Remember past emotional experiences, and use them to be empathic with others. Invite disagreement; it will lead to learning on both sides.
◦ Related to culture, gender, background, and personal experiences◦ Influential arguments based on flawed logic◦ Barriers to meaningful communication◦ Understanding logical fallacies will help the nurse to recognize the difference between legitimate and faulty reasoning and to promote effective communication
◦ Ad hominem abusive Attack the person instead of the issue The speaker hopes to discredit the other person by calling attention to some irrelevant fact about that person◦ Appeal to common practice Something is okay because most people do it Could lead to significant professional and legal problems
◦ Appeal to emotion—Attempt to manipulate other people’s emotions in order to avoid the real issue◦ Appeal to tradition—Doing things a certain way is best because it has always been done that way◦ Confusing cause and effect—Assumes that one event must cause another just because two events often occur together◦ Hasty generalization—Coming to a conclusion on the basis of a very small number of examples◦ Straw man—A person’s position on a topic is misrepresented
◦ Red herring—Introduction of an irrelevant topic in order to divert attention away from the real issue◦ Slippery slope—Belief that an event will inevitably follow another without any real support for that belief
◦ Framing an answer while the other person is still talking◦ Environmental disturbances that provide significant disruption◦ Preexisting concerns or worries that block absorption of conversation◦ Attempts to continue work in progress that leads to inattention◦ Ineffective engagement or peculiar mannerisms
◦ Give undivided attention to the sender Move to a quieter area Stop the speaker and clarify points not understood◦ Provide feedback in terms of perceived meaning of the message rephrased in the receiver’s own words
◦ Give attention to positioning, so that sender and receiver are facing each other and are able to make eye contact◦ Note nonverbal messages such as body language◦ Finish listening before you begin speaking◦ Active listening will dramatically improve the likelihood that the correct message will be received
◦ Written documents should be descriptive◦ Information should be quantified whenever possible◦ Descriptive categories for physical conditions Measurement, color, position Location, drainage, or condition◦ Descriptive categories to document meetings, conferences, evaluations, or other interchanges Time, setting, people present Issues or goals discussed Direct quotes
◦ Provide complete information to help avoid communication breakdown◦ Anticipate and answer relevant questions before they are asked
◦ State the necessary information clearly and briefly◦ Determine what facts are pertinent to enable the reader to understand the true message◦ When in doubt and when appropriate, ask another party to read the message and provide feedback◦ Confidentiality and privacy must be observed◦ Be as judicious in handling written material as in handling any other form of communication
◦ Email, attachments, chat rooms◦ Lacks nonverbal cues to aid in communication◦ Beware: Communication via computer can often be retrieved even after it has been deleted◦ Clarification—important to ensure that the correct message is received
◦ A plethora of observations indicate that men and women solve problems, make decisions, and communicate from different perspectives
◦ Women Generally work toward compromise Preserving relationships is of paramount importance Seek to communicate with sensitivity toward how the information is being received Value the process of communication itself as a significant part of relationships◦ Men Generally work toward winning Focus on goals and move aggressively toward accomplishment Communicate with a purpose in order to achieve an identified goal Typically use communication as a tool to deliver information
◦ Traditionalists or Veteran, born 1925-1945 Great Depression and World War II were critical events Place a high premium on formality and the top-down chain of command Respect from others, including the use of formal titles, is preferred Comfortable making decisions based on what worked favorably in the past
◦ Baby Boomers, born 1946-1962 Experienced the reshaping of corporate culture Considered to be highly competitive people willing to sacrifice to achieve success Strive for recognition Desire a personable style of communication Desire a top-down organizational approach Place value on earning respect
◦ Generation X, born 1963-1979 Associated with a high divorce rate among their parents, working mothers, and the latch-key phenomenon Characterized as skeptics who value a balance in work and personal life Value efficiency and may agree to working extra hours if the reason is deemed beneficial Expectations are immediate Chosen communication pattern is characterized by brevity and directness
◦ Millennial, born 1980-2000 Newest members of the workforce Highly collaborative and optimistic Strive for a balance between work and home life Need a voice in organizational decision making Prefer communication that is framed in a positive manner
◦ Sensitivity to cultural differences is an integral part of the nurse’s responsibility◦ Obvious difficulty is a potential language barrier Preponderance of slang terms and colloquialisms can confound a literal translation Stress associated with illness and/or hospitalization adds to the potential for misunderstanding
◦ Many communication components do not carry the same meaning in various cultures Direct eye contact Touch Gestures
◦ Variety of disciplines approaching health care from the unique perspective of the theories and therapies of the varied professions◦ Listening is an essential tool for identifying the intended message of other disciplines◦ Frequent clarification and a sense of “safety” are paramount◦ Remember, the fundamental goal of all health care professionals is to provide quality patient care
◦ Breach of confidentiality and privacy through careless gossip has ethical and legal ramifications◦ Communication about confidential or personal patient issues must be controlled in all areas: nurses’ station, utility rooms, etc...
◦ Conflicts stemming from differences in goals or desires are not good or bad◦ Fundamental bases for conflict are information and perception One person has information that another doesn’t have, or two individuals have different sets of information People see things on the basis of their unique belief systems
◦ Maintaining an environment supportive of professional communication enables conflict to be handled appropriately with positive outcomes
Disagreement where the parties involved perceive a threat to their needs, interests, or concerns. Usually complex set of issues to address. Satisfactory resolution is challenging and time consuming.
Perceive a Threat Respond on the basis of their perceptions Conflicts contain substantive, procedural, and psychological dimensions Predictable and expectable situations that naturally arise Creative problem-solving strategies are essential
What are some key sources of conflict? When do they tend to occur? How do people respond to these conflicts? When we solve the problem do we do so long- term?
Culture of shame and blame ◦ IOM Reports ◦ Systems and Processes Research says overtime is dangerous Good physician-nurse relationships produce better patient outcomes
Hostile and aggressive behavior by an individual or group towards others. Endemic in the workplace culture Unacceptable Destructive overt or covert behavior
Belittling gestures Verbal abuse Gossiping Sarcastic comments Fault finding Ignoring or minimizing another’s concern Slur and jokes Comments that devalue Disinterest and discouragement
Stage 1 ◦ Reduced self esteem ◦ Sleeping disorders ◦ Free floating anxiety Stage 2 ◦ Difficulty with emotional control ◦ Difficulty with motivation Stage 3 ◦ A relative intolerance ◦ A loss of ability ◦ Changed response patterns
Name the problem Raise issue-break the silence Ask about process Engage in reflective practice Ensure self caring behaviors Be willing to speak up
Frustration ◦ Perceive goals blocked ◦ Angry Conceptualization ◦ Own picture Action ◦ Non-action ◦ Administrative orbiting ◦ Secrecy ◦ Law and Order ◦ Appropriate actions
Outcomes ◦ Degree which goals achieved ◦ Nature of subsequent relationships
Come together voluntarily Work cooperatively on the issues Many times we need a third person to help negotiate
“I value the point being made more than our relationship.” “Its them or me.” “Ive got to win this one!” “Im sure they will see it my way if they just think about it.” “I know Im right.” This is the “I win, you lose” position. A person whose actions are expressed this way is sometimes symbolized as a shark.
- “I will be quiet and listen.” “Its not that big a deal.” “Id rather just forget it.” “Its not worth the trouble.” “What difference could I make anyway?” “I lose, you lose.” A turtle.
“I value our relationship more than this point.” “Lets just get this over with so we can get on to other things.” “This tension is very uncomfortable. Ill just do what they want.” “Fine I give in, have it your way.” “I lose, you win.” A teddy bear.
- “Im sure if we work together we can come up with a better answer than either of us individually.” “Im not giving in yet, but I am willing to hear your opinion, and give you mine.” “I win, you win.” An owl.
- “This isnt important enough to fight over.” “I dont want to be unreasonable.” “If I give her this, maybe shell give me that.” “We could both live with that.” A fox.
New standard began January 1, 2009 Survey of 4,530 healthcare employees ◦ 77% witnessed disruptive behavior from physicians ◦ 65% witnessed disruptive behavior from nurses ◦ 67% linked disruptive behavior to adverse outcomes
Education of healthcare workers ◦ Courtesy during Telephone interactions Business etiquette General people skills Recommend organizations have a Code of Conduct
Employ positive communication techniques Provide a “safe” environment in which patients and co- workers can ask questions and learn Focus energy toward solving conflict Maintain clear, open, sensitive communication
6 Tips for Nurses Using Social Media Social networks and the Internet provide unparalleled opportunities for rapid knowledge exchange and dissemination among many people, but this exchange does not come without risk. Nurses and nursing students have an obligation to understand the nature, benefits, and consequences of participating in social networking of all types. Online content and behavior has the potential to enhance or undermine not only the individual nurse’s career, but also the nursing profession.
ANA’s Principles for Social Networking 1. Nurses must not transmit or place online individually identifiable patient information. 2. Nurses must observe ethically prescribed professional patient — nurse boundaries. 3. Nurses should understand that patients, colleagues, institutions, and employers may view postings. 4. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. 5. Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities. 6. Nurses should participate in developing institutional policies governing online conduct.
6 Tips to Avoid Problems 1. Remember that standards of professionalism are the same online as in any other circumstance. 2. Do not share or post information or photos gained through the nurse-patient relationship. 3. Maintain professional boundaries in the use of electronic media. Online contact with patients blurs this boundary. 4. Do not make disparaging remarks about patients, employers or co-workers, even if they are not identified. 5. Do not take photos or videos of patients on personal devices, including cell phones. 6. Promptly report a breach of confidentiality or privacy.
References:American Nurses Association.(2011, September). Principles for socialnetworking and the nurse. SilverSpring, MD: Author.National Council of State Boards ofNursing. (2011, August). White Paper:A nurses guide to the use of socialmedia. Chicago, IL: Author.www.NursingWorld.orgSeptember 2011