Professional Responsibilities Flashcards
Communication problems
ineffective
unaware of bias
Conflict problems
lack of training/practice
lack of motivation
uncomfortable resolving
Incivility problems
bullying
lateral/vertical violence
“nurses eat their young”
Change problems
constant
rapid
unready
chaos
ANA Code of Ethics states nurses are required to create what type of environment?
ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect
Confidentiality and Privacy includes
pt
caregiver
other team members
Praise in public, ________ in private
correct
- maintain conversations in a professional tone and manner to improve environment
Issues with the sender of the information
Unclear speech
Intricate/confused message
Poor sentence structure
Inappropriate uses of terms or jargon
Knowledge deficit regarding topic
Issues with the receiver of the information
Lack of attention
Prejudice and bias
Preoccupation with another problem
Physical factors
miscommunications can lead to
med mistakes
bad environment
mistrust
low moral
high turnover
Verbal communication
said
- build up with encouraging words, repeat,
-
Paraverbal communication
tone (silence)
- soft,
speech
volume
diction
- blocks by yelling
Nonverbal communication
body language
- eye contact
- positive facial expressions
- personal space
- open posture
- empathy
Percentages of the 3 types of communication?
Verbal 7%
Paraverbal 38%
Nonverbal 55%
Assertive communication
respects
respects self and others
Assertive communication
honest, direct and accurately expresses the person’s feelings, beliefs, ideas, and opinions
In assertive communication, Disagreement and discussion are considered to be
healthy part of the communication process and negotiation is the positive mechanism for problem solving, learning, and personal growth.
Nonassertive communication is referred to as
submissive
When people display submissive behavior or use submissive communication style, they
allow their rights to be decided by others. I lose you win
Passive communication disrespects
self
Aggressive communication disrespects
others
Aggressive communication is used to
humiliate, dominate, control or embarrass the other person or lower that person’s self esteem – creates an I win you lose situation
Aggressive forms of communication are seen through
screaming, sarcasm, rudeness, belittling jokes, and even direct personal insults
Assertive Communication allows conversations that are
direct
honest
nonthreatening
- Acknowledges & deals with conflict
- everyone is equal
Passive communication traits
Allows rights to be violated by others
May be a protective mechanism
Dismisses own feelings as being unimportant
May be a means of manipulation by way of passive-aggressive behavior
Aggressive Communication
Asserts the speaker’s rights, ideas, and opinion with little respect for others
May be used to humiliate, dominate, control or embarrass others
Therapeutic communication btw
The patient
The family
Openness, honesty, direct, frequent, ongoing
Therapeutic communication is NOT
premature advice
minimize feelings
false reassurances
value judgements
asky “why” statements
excessive questions
approval
disapproving
change subjects
Examples of Effective Communication Tools
TeamSTEPPS
CUS model
- I am concerned
- I am uncomfortable
- This is a safety issue
DESC script - conflict mgmt
“I Pass the Baton”
Crucial conversations
Strategy for Difficult Conversations (STOP)
- State the situation/problem
- Tell the person what you want
- Offer an opportunity to respond
- Provide closure
Communication Strategies by nurses
SBAR
Call-Out
Check-Back
Handoff
Conflict
Arises from a perception of incompatibility or difference in beliefs, attitudes, values, goals, priorities, or decisions
Conflict impacts
job satisfaction, individuals, collaborative efforts, & organizational costs, and most importantly
- negative impact on patients
Intrapersonal
within a person
- THE NURSE TURNS INWARD WHEN HAVING A CONFLICT WITHIN THEMSELVES
- errors in perception
Organizational
with policies and procedures
Interpersonal
btw others
General Causes of Conflict
Personality differences
Value differences
Blurred job boundaries
Battle for limited resources
Constraints on decision-making process
Communication
Departmental competition
Unmet expectations for co-workers
Complexity of organizations
Positive Outcomes of conflict
Increased group performance
Improved quality of decisions
Stimulation of creativity
Innovation
Negative outcomes of conflict
Discontent/Burnout
Gossip
Disrupted communication
Reduced group cohesiveness/effectiveness
Fighting among group members
Cost of mismanaged conflict
Management time
Presenteeism
Absenteeism
Turnover
Litigation
Presenteeism
coming to work despite illness, injury, anxiety, etc., often resulting in reduced productivity
Absenteeism
not showing up due to avoiding others
Why are nurses uncomfortable with conflicts?
- Fear retaliation / ridicule / alienation
- Mistaken belief they are unable to handle the conflict situation
- Feel like they do not have the right to speak up
- Past negative experiences with conflict
- Family background & experiences
- Lack of education/skills on conflict resolution
Team Conflict Mgmt skills you can use
Accommodating
Avoiding
Collaborating
Competing
Compromising
Accommodating
One party seeks to pacify an opponent; that party is willing to be self sacrificing, they obey and serve others but feel resentment “get nothing in return”
Avoiding
The party is aware of the conflict but wants to withdraw from it. They are unassertive and uncooperative, postpone dealing with the issue
Collaborating
Setting aside original goals to work toward a common goal
Competing
Pursuing a desired solution at the expense of others. Stand up for rights and defend important principles
Compromising
Each person gives up something; the solution provides incomplete satisfaction of both parties. Assertive and cooperative. Work creatively and openly to find the solution that most fully satisfies all important goals and concerns to be achieved.
Conflict Resolution
Prevent disruptive behavior
usually ongoing, escalates over time, cumulative
significant negative effects on individuals, patient care and safety, and the organization
Preserve positive culture/operations
Promote positive relationships
Unresolved Conflict Results
Resentment
Backbiting
Bullying
And other dysfunctional behaviors
Negotiation
Process where two or more people come to an agreement
- win win
-calm
- “homework done”
- incentives
- hidden agendas
Conciliation
A 3rd person attempts to diffuse the negative emotions that are often involved in the conflict
Mediation/Arbitration
When the sides are unable to reach a resolution
key element of successful negotiation
Trust on both sides
In negotiation each party gives
up something
Conflict Behaviors for a good outcome
Recognize conflict early
Be proactive
Actively listen
Remain calm
Define the problem
Seek a solution
Listen attentively
Do not spread rumors/let it go
Confront in private when you are not angry
Maintain eye contact/good posture
Start with “I”
Focus on the positive
Be willing to negotiate/compromise
Be direct/honest
Focus on behaviors/issues
Do not interrupt
Don’t attack the person
Conflict Resolution used as a constructive approach for managing and resolving conflict:
DESC
DESC Script
D—Describe the specific situation
E—Express your concerns about the action
S—Suggest other alternatives
C—Consequences should be stated
DESC script can be used to
communicate effectively during all types of conflict and is most effective in resolving interpersonal conflict
DESC script are used in situations involving
greater conflict, such as when hostile or harassing behaviors are ongoing and safe patient care is suffering
DESC script ultimate goal
consensus should be reached
Civility
Having good manners & being polite
Respecting others
Recognizing that all human beings are important
Protecting others from discrimination
Incivility
Lack of civility
Any type of speech or behavior that disrupts the harmony of the home, work, or educational environment
Other names in health care:
“Nurses eating their young”
“Aggressive communication”
A hostile healthcare work environment may lead a nurse to (workplace incivility):
Fail to clarify an unreadable order because of fear
Lift or ambulate heavy or debilitated clients without assistance rather than asking for help
Use an unfamiliar piece of equipment without asking for instructions first
Carry out orders that the nurse did not believe were correct
Bullying
“repeated, unwanted, harmful actions intended to humiliate, offend and cause distress such as a hostile remarks, verbal attacks, threats, intimidation and withholding support.”
- beyond impoliteness
One on one bullying from peers is sometimes called
peer abuse or lateral (horizontal) violence
Repeated actions of bullying intended to:
Coerce, intimidate, humiliate, offend, cause distress to a person
Bullying Viscous Cycle
Those bullied may bully when they move into supervisory positions
Perpetuates a culture of vertical violence
Breaking the cycle of workplace cycle
Name the problem
Raise the issue at staff meetings
Learn from experience – journal
Pursue a path of personal growth
Be a part of the solution not the problem
Set an example of ”civility” by your own behavior
Maintain self-care behaviors
Break the Cycle
Naming the problem:
call it “horizontal violence” to refer to the situation
Raising the issue at staff meetings: bring the light of day to the problem
Asking supervisors about developing a process for dealing with incivility in the workplace
Break the Cycle
Learning from experience:
keeping a journal raises self-awareness about personal values, beliefs, attitudes, and behavior; it is also a good source of documentation
Break the Cycle
Pursuing a path of personal growth:
finding those things that create happiness and satisfaction and developing them goes a long way to counteract incivility
- Ensuring the nurse is part of the solution, not part of the problem
Break the Cycle
Maintaining self-care behaviors:
Peer support
Good nutrition and exercise
Time – outs
Speak up about horizontal violence
Speaking up when “horizontal violence” is witnessed
- by
Develop high-quality preceptor and mentoring programs for students and new nurses.
Educate people on how to recognize and deal with bullying
Recognize bullying behavior early and address it (bullying never stops by itself).
Set an example of “civility” by your own behavior.
Civility Best Practice
Communicate clearly
Be respectful
Consider words & actions
Avoid gossip
Go with the facts
Collaborate
Be polite
Be open
Encourage others
Listen
Offer help
Be responsible for yourself
Do not abuse power
Be direct
Bullying Prevention Strategies
Know hospital policy
Code word
Practice strategy
Address
Report
Document
Consider confrontation
Support peers
Be self aware
TeamSTEPPS Framework
Team Structure
Communication
Leadership
Situation monitoring
Team structure
facilitates teamwork by identifying the individuals among which information must be communicated, a leader must be clearly designated, and mutual support must occur
Communication
which facilitates teamwork by enabling team members to effectively relay relevant information in a manner that is known and understood by all.
Leadership
facilitates teamwork through leaders’ effective communication with their team members to ensure that a plan is conveyed, reviewed, and updated; continuous monitoring of the situation to better anticipate team members’ needs and effectively manage resources; and fostering of an environment of mutual support for role-modeling and reinforcement.
Situation Monitoring
A way for team members to be aware of what is going on around them
Is moderated by communication
Is enhanced by team leadership
Allows for mutual support by anticipating other team members’ needs
Situation Awareness
state of knowing the current conditions affecting one’s work
Situation Awareness includes knowing
Status of the patient
Status of other team members
Environmental conditions
Current progress towardthe goal
awareness is achieved by constantly
monitoring the ever-changing situation
A loss of situation awareness results in
ambiguity, confusion, and a decrease in communication
Mutual Support examples
task assist, share feedback, advocacy and assertion
Monitoring other team members performance to anticipate assistance requests.
Offering or requesting assistance.
Filling in for a member who cannot perform a task.
Cautioning team members about potentially unsafe situations.
Self-correcting and helping others correct their mistakes.
Distributing and assigning work thoughtfully.
Rerouting, delaying work so that the overburdened team member can recover.
Regularly providing feedback to each other.
And providing encouragement.
Mutual support depends on
information gathered through situation monitoring
Mutual support moderated by
communication
Mutual support modeled by
team leaders
Situation Monitoring Barriers
Inconsistency in Team Membership
Lack of Time
Lack of Information Sharing
Hierarchy
Defensiveness
Conventional Thinking
Complacency
Varying Communication Styles
Conflict
Lack of Coordination and Follow-up With Coworkers
Distractions
Fatigue
Workload
Misinterpretation of Cues
Lack of Role Clarity
Situation Monitoring tools
Communication
SBAR
Call-Out
Check-Back
Handoff
Leading Teams
Brief
Huddle
Debrief
Situation Monitoring
STEP
I’M SAFE
Mutual Support
Task Assistance
Feedback
Assertive Statement
Two-Challenge Rule
CUS
DESC Script
Situation Monitoring outcomes
Shared Mental Model
Adaptability
Team Orientation
Mutual Trust
Team Performance
Patient Safety!!
Change
inevitable
accelerating
complex
adapting
Kurt Lewin’s planned change theory
unfreezing-change-refreeze model that requires prior learning to be rejected & replaced
Change Theory has three major concepts:
driving forces, restraining forces, & equilibrium.
Driving forces
those that push in a direction that causes change to occur. They facilitate change because they push the patient in a desired direction. They cause a shift in the equilibrium towards change.
Restraining forces
forces that counter the driving forces. They hinder change because they push the patient in the opposite direction. They cause a shift in the equilibrium that opposes change.
Equilibrium
state of being where driving forces equal restraining forces, & no change occurs. It can be raised or lowered by changes that occur between the driving & restraining forces.
Unfreezing
process of finding a method of making it possible for people to let go of an old pattern that was counterproductive. Must overcome individual resistance & group conformity
3 methods that can lead to the achievement of unfreezing
Increase driving forces that direct behavior away from existing situation
Decrease restraining forces that negatively affect the change movement
A combination of the first two methods
Change stage
involves a process of change in thoughts, feeling, behavior, or all three, that is more liberating or more productive.
Refreezing stage
establishing change as new habit, so it becomes “standard operating procedure.” Without this final stage, it can be easy for person/organization go back to old habits.
Resistance to change
rooted by anxiety/fear
expected as integral to the whole change process
not all bad - warning need to readjust/clarity
resister to the solution help reframe the issue
Resistance
individual rejects proposed new ideas without critically thinking about the proposal. Change requires energy. The change process does not guarantee positive outcomes.
Emotional Response to change
Fear
Sadness
Outrage
Stress
Disorientation
Eroded loyalty
Lack of commitment
Low risk taking
Support in periods of change
active listening
promoting action steps and solutions
staff informed or decisions
soliciting input and encourage participation
reframe difficult messages
Leaders as change agents
Articulate a clear need for change. Start a plan
Get reliable information to the implementers.
Do not promise things that cannot be delivered.
Get group participation by leaving the details to the people who must implement the change. Revise the plan prn.
Motivate through rewards & benefits.
Active listening mnemonic
Sit facing pt
Uncross the arms and legs
Relaxed
Eye contact
Touch if appropriate
Your intuition
Spiritual FICA
F
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C
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