leadership and management nursing 1

8/3/2019 Leadership and Management Nursing 1

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Leadership and Management

Nursing 1

Communication

Supervisor: S. Haeriyanto, SKM., Mkep.


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Member of Group

Harry Suryani

Intan Yuanita

Nurliza Permata Sari Siti Robiah


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Effective communication consists of transmitting anaccurate message to the proper recipient at the

appropriate time in manner that conserves the

senders and receivers energy, followed by checking

to ensure that the intended message was received.


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David Berlo (1960)

David Berlo proposed a linear model of communication

act contains the following elements:

Source

Message Channel

receiver


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Linear model of communication act contains the

following elements:

Source

Message

Channel

Receiver


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Source

The source or initiator characteristics that influence

effectiveness are:

Communication skill

Knowledge

Attitudes

Cultural background


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Message

The message characteristics that determine

effectiveness are:

Structure

Content Code

Treatment


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Channel

Of the following channels, one may be more effective

than another for a particular communication:

Sight

Hearing Touch

Taste

Smell


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Receiver

Receiver characteristics that influence effectiveness are:

Communication skills

Knowledge

Attitudes

Cultural background


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Drucker (1974)

Drucker argued that the receiver is the most important

element in the foregoing four step communication

requires a sharing of experience between message

sender and receiver.


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Shannon and Weaver (1949)

Circular model of the communication process that included the

four elements, plus three additional ones: signal, noise, and

feedback.

Feedback

Sender noise Message noise Receive

Feedback


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Fritz et al. (1984)

Communication climate may facilitate or inhibit

communication.

Climate variables that influence message transmission

are trust between sender and receiver, messageambiguity, senders and receivers valuing of each other,

emotional separation between sender and receiver,

senders empathy for receivers perceptions, threat

perceived by sender or receiver, and fixed views of

sender and receiver


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Dance (1967)

The key principles for effective communication of work

related information:

1. Communication is a process, rather than a single event.

2. The communication process is frequently impaired by

noise (unintended additions, distortions, or deletions of

message content), a problem that can be eliminated byfeedback, which clarifies the receivers perceptions of

transmitted symbols.

3. Communication is intrapersonal as well as interpersonal.

4. Communication is nonverbal as well as verbal.Nonverbal communication gesture, posture,

facial expression, bodily movement, position relative to

other, clothing, grooming, accoutrements.


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Levson and Guy (1989)

Social psychological factors impair message

transmission, even between willing and wellmeaning

communications. Among them:

1. Homophyly

2. Chain of command

3. Frame of reference

4. Self preservation

5. Crisis


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Tuckman (1965)

The group communication process as consisting of four

stages:

1. Forming

2. Storming

3. Norming

4. Performing


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Forming Stage

In the forming stage, members communicate to decide

who is to lead the group and what tasks the group is to

accomplish.


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Storming Stage

In the storming stage, conflict develops, as members

discuss what work rule will govern them and which

member will be responsible for each task.


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Norming Stage

In the norming stage, members achieve cohesion and

relief at overcoming their earlier conflict.


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Performing Stage

In the performing stage, members carry out their

assigned tasks while communicating commitment to

group goals and to one another.


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Communication Principles


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The following principles are useful in determining the content

and media of the managers written and spoken

communications with care givers:

Workers tend to see and hear messages that are compatible with

their expectations and predispositions.

Workers who read about a topic are more inclined to listen to a

message on the same topic.

The effectiveness of different media varies with the workers

education level. The higher the education, the greather the

reliance on print. The lower the education, the greater the

reliance on aural and pictorial media.


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The more trustworthy or prestigous the

communicators, the less manipulative he is considered

to be by message receivers

Majority opinion is more effective in changing worker

attitudes than expert opinion

Communication of facts is usually innefective inchanging opinios against a workers strong

disposition

Workers with low self-esteem are more likely to be

influenced by persuasive communication than thosewith high self-esteem


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THEORY OF TRANSACTIONAL ANALYSIS

Techniques of transactional analysis have been used to categorize,

understand, predict, and alter behaviour of sick and well persons.

As a therapeutic intervention, transactional analysis investigates

ways in which people structure time so as to obtain recognition

from other.

Unlike psychoanalysis, transactional analysis assumes that a person

can analyze his or her own problems and can learn to express

feelings honestly ina group situation. We focus here oninterpersonal interaction patterns.


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INTERPERSONAL TRANSACTIONS

According to berne, each person enganges in transactions with

others to obtain strokes. A transaction consist of some sort ofstimulus by one person, followed by some sort response by

another.

A stroke is a positive or negative unit of recognition between people: a word, phase, gesture, or facial expression. The

following are positive stroke: a smile, pleasant greeting,

compliment, pat on the back, letter of comendation, or pay raise.

Some examples of negative strokes are: a frown, insul,

reprimand, shove, or disciplinary letter.


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TYPES OF INTRAPERSONAL TRANSACTIONS

Persons engange in the following types of transactions to satisfystroke hunger and structure time: withdrawal, rituals, activities,

pastimes, games, and intimacy. Through with drawal the individual

removes himself from transactions with others.

When withdraw is temporary, as in daydreaming, the effect is

harmless. When profound psychological pain causes a person to

withdraw permanently from other. Psychological health is impaired.


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A ritual is a socially programmed performance by several

persons in whic each regulates his or her involvement with the

group. Some common rituals are church services, cocktail

parties, club meetings, birthday celebrations, and perfunctory

sexual performaces.


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Life Positions

According to harris, each person relates to others from one of four life

positions (harris 1969)

1. I'm Not OK, you're OK

This position results from the inferior position of the child relative to his

parents and negative, feelings experienced during the parent's effort to

civilize him or her. A person who retains this inferior position through out life

engages in game playing to obtain strokes and maintain security.

2. I'm Not OK, you're Not OK

This position results when the not ok child is abandoned by a cold and

uncaring parent during the second year of life. The lack of stroking that

produce this life position interferes with development of the adult state, so

the person's hold on reality is tenuous.


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3. I'm OK, you are not OK

This life position develops in the child who is brutalized by his or her

parents and survives. The person believes that he can be OK if his orher parents will only of him or her alone. This position has an internal

parent who permits him or her to treat others cruelly, that is has

psychopathic tendencies.

4. I'm OK, you're OK

An uncaring or a brutal parent converts the child to the second or third

life position respectively. Once a child has selected a life position, he or

she operates from that position throughout life, unless he or she

consciously adopts the fourth life position. Transactional analysis

enables a person to identify the ego state from which he to adopt and

motivates him or her to adopt the I'm OK you're OK position.


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Management application for transactional analysis

Transactional analysis can help a nurse manager to lead and control subordinates.

Thee origin of all child and parent responses is the not OK position on which each

person begins life. Therefore, when stress exacerbates feelings of helplessness in

either manager or subordinate and the person is faced with equally undesirable

alternatives. When feeling of inadequacy develop in an area where the person has

stored unexamined parental admonitions and rules, the critical parent is activated.

Traditional methods of nursing education predispose of transactional problems.

Some professional programs overemphasize a need for efficiency to the point that

adult state is overdeveloped. Other programs so overemphasize the protective

function of nursing that the parent state becomes overdeveloped.

Few professional programs encourage the student nurse attend to her or his own

needs and feelings, so that the student 's child state is neglected. Nurse managers

often develop transactional problems with subordinates, because the hierarchical

structure typical of many health agencies encourages supervisors to assume an

authorization role and staff nurses to assume a subservient role.


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Nurses often experience transactional problems with physicians. In

American society physicians have higher social status and greater

personal authority than nurses. Consequently there is a tendency for

physicians to address nurses in a controlling or critical manner andnurses to respond in a petulant. To maintain complementary

transactions at this point, a nurse should shift from the nurturing parent

to adult state interactions with the patient.

Knowledge transactional analyses enables a manager to modifycoworkers behavior to improve communication and increase

productivity.

A manager also needs an understanding of ego states to interpret and

modify her or his own responses to patients and coworkers. Information from the critical parent produces the compulsions and quirks

that are responsible for each manager.


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One function of the adult state is to check the suitability of

the old parent and child state data for the person's current

life situation.

A nurse manager may be unsuccessful because he or

she follows a negative life script like ''sisyphus''. A

manager may be successful, because he or she follows a

positive life script like Florence .

Thus transactional analysis can strengthen a person's

adult ego state, thereby improving reality testing, outcome

prediction, and decision effectiveness.


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Communication levels

Klatt (1978) differentiates among four levels of communication in anorganization.

Top level a broadcast system distributes the same message in nonpersonal fashion to all agency employees.

The media used in the formal information system include video screamand computer print out messages, printed reports , telephonemessages, graphs, and some conversational interchange.

At third level of organizational communications that provideamplification, classification and feedback for the broadcast and formalinformation system.

To enhance effectiveness of any level of organizational communication,managers must strengthen both in formational and relational aspects ofthe process.


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Organization Double Bind

Wishbow (1987), theorizes that some communication

difficulties in a complex organization arise from

circumstances akin to the double-bind phenomenon.

Bateson (1972), claimed that schizophrenia develops

when a child is subjected to a double bind by receiving

paradoxical messages from the mother, one meaning at

the verbal level, a different meaning at the psychological

level .


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Three mall-scale change efforts may minimize the frequency or

severity of the double-bind phenomenon in a nursing organization.

1.Defuse negative feelings by training employees in

metacommunication skills or means of talking about the nature of

double bind.

2.Decrease role ambiguity by training managers to construct

explicit statements of role expectations for new employees.

3.Schedule frequent recreational and social events to provide

opportunities for employees to express their emotional, irrational

side.


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Documentation of Care

Nurses documentation of care is often incomplete or inaccurateand is likely to be undervalued by nurses and other health

professionals (Steckel 1976: Walker and Semanoff, 1964)

Documentation of nursing actions and conclusions are probablynurses most important written communication. All health

agencies establish formal policies governing time, content,

nature, terminology, and form for nurses recorded observations

diagnoses, interventions, and evaluations


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Management Information Systems

In agencies with computerized MISs, Nurse managers receive

monthly, weekly, or daily computerized report of patient admission

and discharge, patient census, personnel hired, separated, and on

payroll, personal work and absence hours, supply use, diet orders,

ordered x-rays, patient infections, budget-account summaries and the

like.

Managers find much of the information in these computerized reports

irrelevant and distracting, because it relates to matter over which they

have no control


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Summary

The nurse managers principal activity is to communicateinformation, ideas, opinion, attitudes, and feelings to others to

facilitate work, increase motivation, effect change, optimize care,

increase satisfaction, and facilitate cooperation.

Effective communication requires accurate perception and clear

transmission of intended messages.

A manager needs high-level listening, speaking, and writing skills.

Techniques of message capping, transactional analysis and script

analysis are helpful in clarifying covert messages transmitted by

coworkers

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