communication conflict interdisciplinary_team
TRANSCRIPT
Communication, Conflict, Interdisciplinary Team
Margaret Strong, MSN, RN, NE-BCCathy Stepter, DNP, RN, ACNS-BC, CNE
Chapter 18
Learning 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
situations
Activity Complete conflict questionnaire and bring to class
Week Two
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)
10 qualities of effective communicators
http://www.youtube.com/watch?v=rRW3Q9iG2js
Transforming Physician-Nurse Communication (Bujak & Bartholomew, 2011)
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.
Key Terms: pg. 381
Effective communication Unclear and ineffective communication
The Importance of 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
Types of Human Communication
Personal space Eye contact Position Posture Paralanguage Facial Expressions Gestures
Touch Locomotion Pacing Latency of
Response Context Physiological
response
Blatner (2002) 13 Categories of Nonverbal Communication
Social Cognitive Theory (Bandura, 2001)◦ Cognitive◦ Emotional◦ Behavioral
Explains how people acquire and maintain certain behavioral patterns which includes communication.
Communication Theories
Behavioral capacity Expectations Observational Learning Self-efficacy Expectancies
Concepts of Social Cognitive Theory
Nursing Leadership Institute (2002)
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
Effective One-on-One Communication
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
Emotional Intelligence
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
Weisinger (1998) Advice to promote Emotional Intelligence
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.
Advice cont.
http://www.youtube.com/watch?v=40uIYiJRc8c&feature=related
Ending Nurse to Nurse Hostility: Raising Awareness (Kathleen Bartholomew)
Positive Communication Techniques
Effective Communication and Conflict Resolution
◦ 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
Cognitive Distortions and Logical Fallacies
Effective Communication and Conflict Resolution
◦ 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
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
Logical Fallacies
Logical Fallacies
◦ 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
Logical Fallacies
◦ 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
Listening
Effective Communication and Conflict Resolution
◦ 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
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 will dramatically improve the
likelihood that the correct message will be received
Good Listening Habits
Written Communication
Effective Communication and Conflict Resolution
◦ 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 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
Conciseness
Electronic Communication
Effective Communication and Conflict Resolution
◦ 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
Computer-Based Communication
Special Influences on Communication
Effective Communication and Conflict Resolution
◦ 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 in order to
achieve an identified goal Typically use communication as a tool to
deliver information
Communication and Gender Differences
◦ 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
Communication and Generational Differences
◦ 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
Communication and Generational Differences
◦ 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
Communication and Generational Differences
◦ 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
Communication and Generational Differences
◦ 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
Cultural Diversity
◦ Many communication components do not carry the same meaning in various cultures Direct eye contact Touch Gestures
Cultural Diversity
◦ 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
Interdisciplinary 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
Understanding and Managing Conflict
Effective Communication and Conflict Resolution
http://www.youtube.com/watch?v=SyFArqgenzU
Of Lions and Lambs: Nurse-Physician communication
◦ 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
The Nature of Conflict
◦ Maintaining an environment supportive of professional communication enables conflict to be handled appropriately with positive outcomes
The Nature of Conflict
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.
Conflict?
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
A Few Gems!
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?
Your Work Environment
Culture of shame and blame◦ IOM Reports◦ Systems and Processes
Research says overtime is dangerous
Good physician-nurse relationships produce better patient outcomes
Examples of Organizational Conflict
Hostile and aggressive behavior by an individual or group towards others.
Endemic in the workplace culture
Unacceptable
Destructive overt or covert behavior
Horizontal Violence or Bullying
Belittling gestures Verbal abuse Gossiping Sarcastic comments Fault finding Ignoring or minimizing another’s concern Slur and jokes Comments that devalue Disinterest and discouragement
Horizontal Violence Includes
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
Effects of Horizontal Violence
Name the problem Raise issue-break the silence Ask about process Engage in reflective practice Ensure self caring behaviors Be willing to speak up
Strategies
http://www.youtube.com/watch?v=rLgEf4wUoos
http://www.youtube.com/watch?v=2sTAolw9VDE&feature=related
Example Horizontal Violence
Conflict Process
Frustration
Frustration◦ Perceive goals blocked◦ Angry
Conceptualization◦ Own picture
Action◦ Non-action◦ Administrative orbiting◦ Secrecy◦ Law and Order◦ Appropriate actions
Process
Outcomes◦ Degree which goals achieved◦ Nature of subsequent relationships
Process
Come together voluntarily
Work cooperatively on the issues
Many times we need a third person to help negotiate
How Do We Resolve Conflict?
“I value the point being made more than our relationship.” “It's them or me.” “I've got to win this one!” “I'm sure they will see it my way if they just think about it.” “I know I'm right.” This is the “I win, you lose” position. A person whose actions are expressed this way is sometimes symbolized as a shark.
Competing
- “I will be quiet and listen.” “It's not that big a deal.” “I'd rather just forget it.” “It's not worth the trouble.” “What difference could I make anyway?” “I lose, you lose.” A turtle.
Avoiding
“I value our relationship more than this point.” “Let's just get this over with so we can get on to other things.” “This tension is very uncomfortable. I'll just do what they want.” “Fine I give in, have it your way.” “I lose, you win.” A teddy bear.
Accommodating
- “I'm sure if we work together we can come up with a better answer than either of us individually.” “I'm not giving in yet, but I am willing to hear your opinion, and give you mine.” “I win, you win.” An owl.
Collaborating
- “This isn't important enough to fight over.” “I don't want to be unreasonable.” “If I give her this, maybe she'll give me that.” “We could both live with that.” A fox.
Compromising
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
JCAHO
JCAHO Recommendations Education of healthcare workers
◦ Courtesy during Telephone interactions Business etiquette General people skills
Recommend organizations have a Code of Conduct
Promoting a Professional Nursing Image
Effective Communication and Conflict Resolution
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
Promoting a Professional Nursing Image
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 Social Media
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.
ANA Principles
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.
ANA Principles
References:American Nurses Association. (2011, September). Principles for social networking and the nurse. Silver Spring, MD: Author.National Council of State Boards of Nursing. (2011, August). White Paper: A nurses' guide to the use of social media. Chicago, IL: Author.www.NursingWorld.orgSeptember 2011