communication conflict interdisciplinary_team

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


◦ 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


◦ 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


◦ 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


◦ 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


◦ 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


◦ 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


◦ 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


◦ 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


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


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

https://www.ncsbn.org/2930.htm

Social Media

https://www.ncsbn.org/2930.htm

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

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