Chapter 18

Chapter 18
Effective Communication and
Conflict Resolution
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Communication: Complex Process
That Can Easily Lead to
Misunderstandings
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 Who relays the message
 What is the message
 In what way is the message relayed
 To whom is the message relayed
 With what effect is the message relayed
Five Elements of Communication

 Sender
 Receiver
 Message
 Dynamic, cyclic process whereby the receiver
becomes the sender on responding to the
message; this is followed by repeated alternating
of roles
Three Primary Components

 Interpretation of information
 Influences
• Context and environment
• Precipitating event
• Preconceived ideas
• Style of transmission
• Experiences
• Personal perceptions
Subcomponents of Communication

 Sender’s message may mean to the receiver
something that was entirely unplanned or
unexpected by the sender
(cont'd)

 Filtration
 The most concise delivery of information is subject to
some amount of filtration by the receiver
 It is possible to filter out some part of intended
communication that is essential to correct
understanding
(cont'd)
7

 Feedback
 Response from the receiver
 Dynamic process—receiver interprets and responds
to the original message, then sender begins the same
process of feedback to the receiver
 Both communicants constantly assess nonverbal
communication
 Based on interpretation and filtration
(cont'd)
8

1. A charge nurse has asked for the upcoming
holiday off. The nurse manager calls her into the
office and states, “The unit must be covered. Do
you have any suggestions on how to cover it?”
The charge nurse assumes her boss is upset with
her for asking for the day off because she never
asks her opinion on staffing. Which of the
following elements most likely influenced the
communication process?
A.Interpretation
B.Filtration
C.Closed communication
D.Blocking

Verbal and Nonverbal
Communication

 The spoken word
 Factors influence meaning of speech
 Same words can have several meanings
 Tone or inflection affects meaning
 True meaning of a statement may be contained in the
emphasis placed on a specific word
Verbal Communication

 Attitude
 Involves a predisposition or tendency to respond in
one way or another
 Attitude that accompanies a verbal interaction is more
meaningful than the actual words spoken
Verbal Communication (cont'd)

 Many factors confirm/deny the spoken word
 Facial expression
 Presence or absence of eye contact, posture, and
body movement
 Indirect nonverbal messages influence
communication
• Dressing style
• Lifestyle
• Material possessions
Nonverbal Communication

 Preconceived ideas and expectations interpret
input from all sources
 When verbal and nonverbal messages do not
agree, receiver is more likely to believe the
nonverbal message
 Importance of nonverbal clues explains the
advantage of face-to-face communication
Nonverbal Communication (cont'd)

Positive Communication
Techniques

 Openness
 Empathy
 Supportiveness
 Positiveness
 Equality
Characteristics of Positive
Communication

 Essential to effective communication between
patient and nurse
 Development of trust is enhanced by:
 Openness on the part of the nurse
 Honesty, integrity, and dependability
Developing Trust

 Achieved by:
 Communicating clearly in language that laypersons
can understand
 Keeping promises
 Protecting confidentiality
 Avoiding negative communication techniques such as
blocking and false reassurance
 Being available to the individual
 Nursing and interdisciplinary team members
should share the essential element of trust
Developing Trust (cont'd)

 Fundamental component in accessible
communication
 Comments that start with “You” put the
receiver’s defenses on alert
 “I” messages sound much less accusatory
 Allow the receiver to respond to the true
message rather than start to mount a defense
Using “I” Messages

 Demonstrates undivided attention to the patient
 Important in communication with coworkers and
interdisciplinary team members
 Avoidance can be interpreted a number of ways:
shy, scared, insecure, preoccupied, unprepared,
dishonest (and so on)
 Use of direct eye contact is a Western value
 In some cultures, avoidance of eye contact is a
more appropriate social behavior
Establishing Eye Contact

 Making and then breaking promises destroy
trust in any interpersonal relationship
 Once a commitment is made, every effort must
be expended to fulfill the expectation
 If the request is impossible to supply, explain the
situation or circumstances
Keeping Promises

 Ability to mentally place oneself in another
person’s situation to better understand the
individual
 Understanding the experiences of the other
person
 Enhances nurse’s ability to help patient through
a true understanding of what the individual is
feeling and needs
Expressing Empathy

 Open-ended questions or statements that
require more information than yes or no
 Questions or statements that are phrased to
require only one- or two-word responses may
miss the mark entirely
Using Open Communication

 Sender should ask for feedback to be certain the
receiver is correctly interpreting what is being
said
 Receiver should stop the sender any time the
message becomes unclear and provide
feedback regularly
 “What I hear you saying is...”
 “I understand you to mean…”
Clarifying Information

 Other techniques to clarify communication
 Use easily understood language
 Give examples
 Draw a picture
 Make a list
Clarifying Information (cont'd)

 Body positioning and movement send loud
messages to others
 Communication is enriched through:
 An open stance such as holding arms at the side or
out toward the patient rather than crossed
 Leaning toward the patient as if to hear more clearly,
rather than away from the patient
Being Aware of Body Language

 Individuals generally have a well-defined sense
of personal space
 Nurse should be sensitive to each patient’s
preferences in terms of touch
 A gentle touch for some can demonstrate
genuine interest and concern
Using Touch

Negative Communication
Techniques

 Asking yes/no questions
 Making inquiries or statements that require
single-word answers and limit the response
 Crossing arms, hands on the hips
 Avoiding eye contact
 Turning away or moving away from the
individual
Closed Communication Styles

 Occurs when the nurse responds with
noncommittal and/or generalized answers
 A nurse who is uncomfortable with certain topics
may consciously or unconsciously block
communication through generalizations or
closed responses
Blocking

 Answers such as “Don’t worry” or “It’ll be okay”
in response to serious questions or concerns
 May be interpreted by the patient as placating or
showing a lack of concern or a lack of
knowledge
False Assurances

 Verbal and nonverbal messages that do not
agree
Conflicting Messages

Logical Fallacies

 Related to culture, gender, background, and
personal experiences
 Influential arguments based on flawed logic
 Barriers to meaningful communication
 Understanding logical fallacies help the nurse to
recognize the difference between legitimate and
faulty reasoning and promote effective
communication
Overview

 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
Types of Logical Fallacies

 Appeal to emotion: attempt to manipulate other
people’s emotions 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
Types of Logical Fallacies (cont'd)

 Straw man: person’s position on a topic
misrepresented
 Red herring: introduction of an irrelevant topic 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
Types of Logical Fallacies (cont'd)

Listening

 Framing an answer while 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, peculiar mannerisms
Distractions to Good Listening

 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
Good Listening Habits

 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 greatly improves the likelihood
that the correct message will be received
Good Listening Habits (cont'd)

Written Communication

 Absolute accuracy is paramount when one is
recording in the legal document (medical record)
 Every effort should be made to report concisely
and truthfully
Accuracy

 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
Attention to Detail

 Provide complete information to help avoid
communication breakdown
 Anticipate and answer relevant questions before
they are asked
Thoroughness

 State necessary information clearly and briefly
 Determine what facts are pertinent to enable
reader to understand the true message
 When in doubt and if appropriate, ask another
party to read 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
Conciseness

Electronic Communication

 Email, text messages, 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
Computer-Based Communication

Communication Styles

 Pronounces basic rights without violating the rights of
others
 States wants, needs, desires, and feelings using
objective, direct comments
 Connotes style of positive declaration and confidence
 Preferred communication style for professional nurses
 To speak assertively:
 Be sure of the facts
 Carefully consider the options
 Exude confidence while making the observation, request, or
point
Assertive

 Claim basic rights in ways that violate the well-
being of others
 Commanding, dominant, superior attitude
 Make accusations that blame or put down others
 Conveys dominance and implies an inclination
to start quarrels or fights
Aggressive

 Influenced or acted upon without acting in return
 Uses apologetic words with hidden meanings
 Seems disconnected and fails to say what is
meant
Passive Communication

 Avoid direct confrontation
 Manipulate others to achieve their personal
goals
 Appear to be honest but undermine others
through gossip, playing the victim, etc.
 Win in situations by making others look bad
Passive-Aggressive
Communication

2. While making patient rounds, the charge nurse is
told that a staff nurse sat in the room with the
family and watched television, causing the
patient’s medications to be late. When
communicating with the staff nurse, the charge
nurse states, “I will not tolerate lazy disorganized
nurses on my unit. Either join my team or leave,
and I don’t want to hear any of your excuses.”
Which type of communication did the manager
use?
A. Straw man
B. Aggressive
C. Assertive
D. Passive

Special Influences on
Communication

 A plethora of observations indicate that men and
women solve problems, make decisions, and
communicate from different perspectives
Communication and Gender
Differences

 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 to achieve an identified goal
 Typically use communication as a tool to deliver information
Communication and Gender
Differences (cont'd)

 Traditionalists
 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
Communication and Generational
Differences
58

 Baby-boomers
 Experienced the reshaping of corporate culture
 Highly competitive and 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 Xers
 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
 Communication is brief and direct

 Millennials
 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 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
Cultural Diversity

 Many communication components do not carry
the same meaning in various cultures
 Direct eye contact
 Touch
 Gestures
Cultural Diversity (cont'd)

 Variety of disciplines approaching health care
from the unique perspective of the theories and
therapies of the varied professions
 Listening essential for identifying the intended
message of other disciplines
 Frequent clarification and a sense of “safety” are
paramount
 Fundamental goal of all health care
professionals: provide quality patient care
Interprofessional Team
Communication

 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.
Confidentiality and Privacy

Social Media:
Warning! Warning! Warning!

 Health care–related sites, chatrooms, blogs,
forums, and video sites provide an unparalleled
opportunity to network, share, and problem-
solve health care issues
 Patient retains right to confidentiality and privacy
in every medium – nurses must be very careful
in not using a patient’s name or any other type
of identifying information!
Social Media

 Potential board of nursing actions for
inappropriate use of social media:
 Unprofessional conduct
 Unethical conduct
 Moral turpitude
 Mismanagement of patient records
 Revealing a privileged communication
 Breach of confidentiality
Social Media

 According to The Joint Commission (2012), this
practice is not acceptable
 Receiving individual is not able to verify unequivocally
the identity of the person sending the text
 No way to make a copy of the original message to
place in the permanent record
 Anything sent electronically has the potential to be
inadvertently misdirected and/or intercepted
Texting Patient Information

Understanding and Managing
Conflict

 Conflicts stemming from differences in goals or
desires are not good or bad
 Fundamental to 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
The Nature of Conflict

 Beneficial consequences of conflict
 Recognizes talents and innovative abilities
 Identifies an outlet for expression of aggressive urges
 Introduces innovation and change
 Diagnoses problems or areas of concern
 Establishes unity
The Nature of Conflict (cont'd)

 Harmful consequences of conflict
 Negative effect on emotional and physical well-being
 Emphasis on personal welfare over that of the group
 Diversion of time and energy from important goals
 Financial and emotional costs
 Personal fatigue

 Maintaining an environment supportive of
professional communication enables conflict to
be handled appropriately with positive outcomes

 Empathy
 Feeling what the other person is feeling and seeing
the situation as he/she sees it
 Believing that the other person’s feelings are valid,
legitimate, and justified
 Equality
 All participants in the process are equal
 Respect for individual differences is apparent
 People are comfortable expressing themselves freely
and openly
Characteristics That Support
Professional Communication

 Openness
 Feelings and thoughts stated directly and honestly
 No attempt to disguise real object of disagreement
 Positiveness
 Using agreement as a basis for approaching
disagreements and impasses
 Conflict is viewed as positive
(cont'd)

 Supportiveness
 Feelings expressed with spontaneity rather than
strategy
 Requires flexibility and a willingness to change
personal opinions/positions
(cont'd)

 Conflict is seldom created intentionally
 May occur because of lack of awareness of how
our own behavior contributes to interpersonal
problems
 Important first step is to recognize one’s own
conflict resolution style
Conflict Resolution

 Common conflict resolution styles
 Avoidance: one person uses passive behaviors and
withdraws from the conflict; neither person is able to
pursue goals
 Accommodation: one person puts aside his/her goals
in order to satisfy the other person’s desires
 Force: one person achieves his/her own goals at the
expense of the other person
 Compromise: both people give up something to
experience partial goal attainment
 Collaboration: both people actively try to find solutions
that will satisfy them both
Conflict Resolution (cont'd)

 Second step is to engage in active listening
 Reduces the emotional charge from the situation
 Active listening techniques
I. Paraphrasing
II. Reflecting
III. Open questioning
IV. Acknowledging
V. Summarizing
VI. Framing
VII.Reframing
80

 Third step is that all people involved must view
their conflict as a problem to be solved mutually

 When conversation is escalating, try to move to private location
 Speak in a normal tone of voice
 Use “I” messages
 Maintain eye contact throughout
 Maintain an open body stance with your hands at your side or open
toward the individual (but not invading the other person’s space)
 Do not physically back away unless you perceive you are actually in
physical danger
 Offer explanations, but do not make excuses
 If you say you will take care of something, or report something, or
change something, do it
Professional Responses to
Verbal Conflict

 Use positive communication techniques
 Provide a “safe” environment in which patients
and coworkers can ask questions and learn
 Focus energy toward solving conflict
 Maintain clear, open, sensitive communication
Promoting a Professional
Nursing Image

Chapter 18

Recommended

Recommended

More Related Content

What's hot

What's hot (18)

Viewers also liked

Viewers also liked (14)

Similar to Chapter 18

Similar to Chapter 18 (20)

More from stanbridge

More from stanbridge (20)

Chapter 18

Editor's Notes