UNIT 4: Professional Responsibility Flashcards
What are some problems with communication?
If it is: Ineffective, unaware of bias
What is incivility?
- Behaviors consistent with bullying and lateral/vertical exists, “nurse eat their young”
Conflict usually is a result of
- Lack of training
- Lack of practice
- Lack of motivation
- Uncomfortable with resolving conflict
What makes change difficult?
It is constant, rapid, unready, choatic
What is the ANAs take on communication, conflict, civility, change?
States that nurses are required to “create an ethical environement and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect.” similary, nureses must be afforded the same level of respect of dignity as others. Thus, the nursing profession will no longer tolerate violence of any kind from any source…
Confidentiality & privacy includes the?
- Patient
- Caregiver
- Other team members
Keep in mind- praise in public, correct in private
Maintain conversations in a a professional tone and manner to improve environment
What are issues affecting converyed information from the sender?
- Unclear speech
- Intricate/confused message
- Poor sentance structure
- Inappropriate uses of terms or jargon
- Knowledge deficit regarding topic
What are issues affecting conveyed information from teh reciever
- Lack of attention
- Prejudice and bias
- Preoccupation with another problem
- Physical factor
What is and what should we know about assertive communicaiton
- Honest, direct and accurately expresses the person’s feelings, beliefs and ideas, and opinions
- Respect for self and others constitutes both the basis for and the result of assertive communication. Disagreement and discussion are considered to be healthy part of the communcation process andnegotiation is the postive mechanism for problem solving, learning and personal growth
What should we know about passive or nonassertive communication?
- Also referred to as submissive communication
- When people display submissive behavior or use submissive communication style, they allow their rights to be decided by others. I lose you win
What should we know about agressive communication?
- It is used to humiliate, dominate, control or embarass the other person or lower that person’s self esteem- Creates an I win you lose situation
- Agressive communication may be in the form of screaming, sarcasm, rudeness, belittling jokes, and even direct personal insults.
Assertive communication allows communcaiton that is…
- Direct
- Honest
- Nonthreating
- Acknowledges & deals with conflict
- Fine line between assertive & agressive communication
Passive communication allows communication that may
- Allows rights to be violated
- May be a protective mechanism
- Dismisses own feeling as being unimportant
- May be a means of manipulation by way of passive-agressive behavior
Agressive communication allows communication that
- Asserts the speakers rights, ideas, and opinions with little respect for others
- May be used to humilate, dominate, control or embarrass others
Therapeutic communication involves the….
Patient & family. Promotes openess, honest, direct, frequent and ongoing communicaiton
Therapeutic communicaiton is NOT
- Giving premature advice
- Minimizing feelings
- Falsely reassuring
- Making value judgments
- Asking “why” questions
- Asking excessive questions
- Giving approval
- Disapproving
- Changing the subject
What does our acryonm STOP stand for when talking about strategies for difficult conversations?
S:Sate the situation/problem
T:Tell the person what you want
O: Offer an oppurtunity to respond
P: Provide closure
What are different communication stratagies we can use in nursing?
- SBAR
- call-out
- check-back
- Handoff
What is conflict?
- Arises from a preception of incompatibility or difference in beliefs, attitudes, values, goals, priorties, or decsions
Conflict has an impact on….
- Job satisfaction
- Individuals
- collaborative efforts
- organizational costs
- negative impact on patients
What are general causes of conflict?
- Personality differences
- Value differences
- Blurred job boundaries
- Battle for limited resources
- Constraints on decsion-making process
- Communication
- Departmental competition
- Unmet expectation for co-workers
- Complexity of organization
What are postive outcomes of conflict?
- Increased group performance
- Improved quality of decsions
- Stimulation of creativity
- Innovation
What are negative outcomes of conflict?
- Discontent/burnout
- Gossip
- Disrupted communication
- Reduced group cohesiveness/effectiveness
- Fighting amoung group members
What is the cost of mismangaed conflict?
- Management time
- Presenteeism (coming to work despite illness,injury, anxiety, etc., often resulting in reduced productivity)
- Absenteeism
- Turnover
- Litgation
Reasons why nurses are uncomfortable with conflict?
- 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
What accommodating in team conflict managment?
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”
Whatis avoiding in team conflict managment?
The party is aware of the conflict but wants to withdrawal from it. They are unassertive and uncooperative, postpone dealing with the issue
What is collaborating in team conflict managment?
- Setting aside original goals to work toward a common goal
What is competing in team conflict managment?
- Pursuing a desired solution at the expense of others. Stand up for rights and defent important principles
What is compromising in team conflict managment?
- Each person gives up something; the solution provides incomplete satisfaction of both parties. Assertive and cooperative. Work creatively and opely to find the solution tha tmost fully satisfies all important goals and concerns to be achieved.
Conflict resolution is aimed at…
- Prevent disruptive behavior
- Usually ongoing, escalates over time, cumulative
- Significant negative effects on individuals, patient care and safety, and organization - Preserve postive culture/operations
- Promote postive relationships.
What are the results of unresolved conflict?
- Resentment
- Backbiting
- Bullying
- Other dysfunctional behaviors
What are some conflict resolution techniques?
- Negotiation
- Process where two or more people come to an agreement
- Conciliation
- A 3rd person attempts to diffuse the negative emotions that are often involved in conflict
- Mediation or arbitration
- When the sides are unable to reach a resolution
What is conciliation?
A 3rd person attempts to diffuse the negative emotions that are often involved in the conflict
How should we react to conflict behaviors?
- 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 “With I”
- Focus on the postive
- Be willing to negotiate/compromise
- Be direct/honest
- Focus on behaviors/issues
- Do not interrupt
- Don’t attack the person
What should we know about the acronyn DESC?
It is a constructive approach for managing and resolving conflict:
D: Describe the specific situation
E: express your concerns about the action
S: Suggest other alternatives
C: Consequences should be states
The DESC script can be used to communicate effectvely during all types of conflictand is most effective in resolving interpersonal conflict. The descp script can be used in situations involving greater conflict, such as when hostile or harassing behaviors are going and safe patient care is suffering.
What is civility?
- Having good manners & being polite
- Respecting others
- Recognizing that all human beings are important
- Protecting others from discrimination
What is incivility?
- Lack of civility
- Any type of speech or behavior that disrupts the harmony of home work, or educational environment
- Other names in health care
- “Nurses eating their young”
- Aggressive communicaiton
What are the effects of workplace incivility?
A hostile healthcare work environment may lead to nurse to
1. Fail to clarify an unreadable order because of fear
2. Lift or ambulate heavy or debilitated clients without assistance rather than asking for help
3. Use an unfamiliar piece of equipment without asking for instructions first
4. Carry out orders that the nurse did not belive were correct
What is bullying?
- Repeated, unwanted, harmful actions intended to humilate, offend and cause distress such as a hostile remarks, verbal attacks, threats, intimidation and witholding support.
- Incivility that is one step beyond impoliteness. Can occur anywhere. Repeated actions intended to Coerce, intimidate, offent, cause distress to a person.
What is one on one bullyin from peers is called
Peer abuse or lateral (horizontal) violence
What should we know about lateral violence?
- It is not a new phenomenon for nurses
- A part of the health care culture almost form the beginning.
- Nurses sometimes use horizontal violene to attack one another as a means of venting their frustration and aner against a supervisor or instituation they feel helpless to change
What is the bullying viscous cycle?
- Those bullied may bully when they move into supervisory positions
- prepetuates a culture of vertical violence
- Common in health care
- I went through it, not its your turn to pay your dues
- Eating your young phenomenon
How can we break the 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
- Peer support
- good nutrition and exercise
- Time-outs
- speak up about horizontal violence
Civility best practice includes?
- 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
What are some bullying prevention strats?
- Know hospital policy
- code word
- practice strategy
- address
- report
- document
- consider confrontation
- support peers
- Be selft aware
What is team structure?
Facilitates teamwork by idenfifying the individual amount which information must be communicated, a leader must be clearly designated and mutual support must occur
What is situation monitoring?
- A way for team members to be aware of whats goin gon around them
- Is moderated by communcation
- Is enhanced by team leadership
- Allows for mutal support by anticipating other team members needs
What is situational awareness?
- The state of knowing the current conditions affectings ones work?
- Includes knowing
- Status of the patient
- status of the other team member
- Environmental conditions
- Current progress towards goal
The awareness is achieved by constantly monitoring the ever-changing situation.
Mutural support is…
- giving task assistance
- Sharing feedback
- Speaking up
- Moderated by communciaton
- Modeled by team leaders
- Depends on information gathered through situation monitoring
ask elizabeth about sllide 42
What should we know about change?
- Change in inevitable in health care
- The pace of change is accelerating
- Change is complex
- Nurse always adapting to change
What is the change therory?
- Developed by Kurt Lewin.
- He theorized a 3 stage model of change known as unfreezing-change-refreeze model that requires prior learning to be rejected and replaced
What are the 3 main concepts of the change theroy?
- Driving forces
- Restraining forces
- Equalibrium
What are the driving force in the change therory?
1.Are those that push in a direction that causes change to occur. They facilitate change becaus ethey push the patient in a desired irection. They cause a shift in the equalibrium towards chane
What are the restraining forces in the change therories?
- The 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
What is the equilibrium in the change therories?
- 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 and retraining forces
What is the unfreezing phase of the nursing change therory?
- 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 and group conformity
What are the 3 methods that can lead to the achievement of unfreezing?
- Increase driving forces that direct behavior aware from existing situation
- Decrease restraining forces that negatively affect the change movement
- A combination of the the 1st two methods
what is the change stage in the nursing theory?
- Involves a process of change in thoughts, feelings, behavior or all 3, that is more liberating or more productive
What is the refreezing stage of the nursing change theroy?
- Establishing change as new habit, so it becomes standard operating procedure “without this final stage, it can be so easy for person/organization to go back to old habits)
Resistance to change…
- Is to be expected
- May be rooted in anxiety or fear
- Not all resistance is bad, it may be a warning that something needs readjusting or clarity
- Vewing the nurse or resister as the soulution rather than the problem helps reframe the issue
What are some emotional responses to change?
- Fear
- Sadness
- Outrage
- stress
- disorientation
- eroded loyality
- lack of comitment
- low risk taking
What can we do to help support staff in periods of change?
- active listening
- Promoting action steps & solutions
- Keep staff informed of desicions
- Solciting input & encouraging participation
- Reframing difficult messages
Leaders as change agents
- Articulate a clear need for change. Start a plan
- Get reliable informtion to implementers
- Do not promise things that cannot be delivered
- Get group partcipation by leaving the details to the people who must implement the change. Revise the plan PRN
- Motivate through rewards and benifts
