NU 349 Transition to Professional Practice: Communication

Communication process

the active part of communication with 6 elements

6 Elements of Communication

Sender

Encoding

Message

Channel

Receiver

Feedback

Sender

initates content delivery

Encoding

process of selecting the words, gestures, tone of voice, signs and symbols used to transmit the message

Message

words, gestures, letter

Receiver

intreprets the message

Feedback

verbal, nonverbal, or both

Interpersonal Variables of Communication

factors that influence communication, such as visual, auditory, or kinesthetic components

Barriers to Communication

Unclear expectations

Confusion

Anger

Desire for power

Negative reputation

Manipulation/control

Insecurity

Prejudice or bias

Mistrust

Inattention or preoccupation

Fear, anxiety, or stress

Interruptions

Benefits of Communication

Clear directions/expectations

Understanding and knowledge

Forgiveness

Recognized leadership

Respect

Independence

Realistic self-image

Acceptance

Trusting relationships

Self-control

Comfort and security

Motivation and concentration

Communication Styles

Non-assertive (passive)

Aggressive

Passive aggressive

Manipulative

Assertive

Assertive Communication

communication that utilizes "I" statements, objectively describes behavior and issues, strives for compromise, and speaks clearly and positively

Assertive Communication Suggestions

Maintain eye contact

Convey empathy

Good posture

Speak clearly

Be direct & descriptive

Listen! Watch!

Utilize non-verbal gestures & expressions

Appropriate location & timing

Focus on behaviors & issues; do not attack person

When should you be assertive?

Patient advocacy

Accepting criticism/feedback/compliments

Saying no

Communicating expectations

Critiquing others

Asking for help

Communication with the Healthcare Team

Lateral flow

Trust and respect

Respectful delegacy

Be clear and precise

Ask for feedback/repeat back and keep eachother informed

Tips for Communication: With Nurses

Give complete handoffs

Share observations, not assumptions

Be supportive - offer help

Tips for Communication: With Providers

Be prepared with vitals, labs, meds, and assessment

Be concise and state main concern first

Offer a recommendation

Tips for Communication: With Interdisciplinary Team Members

Respect their expertise

Clarify shared goals

Share relevant updates from your nursing perspective

Tips for Communication: Student Nurse

Introduce yourself

Ask questions respectfully

Take initiative within your scope of practice

Accept feedback

Communication is in the top _______ root causes for what?

three; sentinel events

STEPPS Model

Strategies and

Tools to

Enhance

Performance and

Patient

Safety

Team STEPPS Goals

Reduce clinical errors and improve outcomes

Improve patient and staff satisfaction

Reduce malpractice claims

Team Structure

identification of the components of a multi-team system that must work together to ensure patient safety

Communication

structured process by which information is clearly/accurately exchanged among team members

Leadership

ability to maximize the activities of team members by ensuring that team actions are understood, changes in info are shared, and team members have the necessary resources

Situation Monitoring

process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team

Mutual support

ability to anticipate and support team members need through accurate knowledge of their responsibilities and workload

Communication Tools

Call out

Check-back

CUS(S)

Call out

conveys critical info and informs all team members at once

Check-back

Closed-loop communication that ensures the receiver understood the message as the sender intended

CUS(S)

"I am concerned"

"I am uncomfortable"

"This is a safety issue"

"Stop"

Two Challenges Rule

Voice concern at least two times

Other team member must acknowledge the concern was heard

Handoff

transfer of information, authority, and responsibility during transition in care

SBAR

communications critical information about a patient that requires immediate attention or action

IPASS

Illness Severity

Patient Summary

Action List

Situation Awareness and Contingency Planning

Synthesis by Receiver

Shift report

ideally done at the bedside and should include:

Patient identifiers

Diagnoses

Physician

PMH

Current condition

Resuscitation status

Nutritional status

Pending or critical issues/tests

Goals/discharge plan

Team Building

Deliberate process of unifying a group of individuals, working toward a common goal and accomplishing more together than individually

Group Process

Forming

Storming

Norming

Performing

Adjourning

Enhancing group communication

Come to meetings prepared

Listen and be open

Keep on track

Present your ideas and ask for other's

State disagreements and back them up

Clarify when needed

Communication Framework for group projects

I statement

DESC Script (Describe, express, specify, consequences)

SBAR

Conflict

A struggle between two opposing forces; should be brought out in the open to avoid conflicts later

Constructive conflict

productive outcomes achieved

Destructive conflict

poor communication, dissatisfaction

What causes conflict?

Emotions

Diversity

Ineffective communication

Lack of resolution skills

Role ambiguity

Misaligned goals

Common Areas of Conflict in Nursing

Quality of care

Parental care

Treatment decisions

Family involvement

Staff inconsistency

Conflict Resolution Styles

Collaboration

Avoidance

Compromise

Accomodation

Competition

Collaboration

"Win-win" situation that aims to solve problems via assertiveness, cooperation, and evaluating differing views; often leads to creativity and new ideas

Avoidance

"Lose-lose"

an escapist conflict style with withdrawal from the situation and tries to remain neutral, delaying response to conflict

Competition

"Win-lose"

a conflict style based on power and is aggressive, uncooperative; can be appropriate in short-term needs

Compromise

"no lose-no win"

conflict style in which the person takes a middle of the road approach and there is give/take by both parties, often never confronting conflict

Accomodation

"Lose-win"

conflict style that suppresses and smooths over differences, dreads conflict, and maintains harmony

Guidelines to Conflict Resolution

Aim fo a win-win

Be honest, willing to negotiate, and compromise

Do not make it personal and do not confront while angry

"I statements" to express your feelings

Allow the other person to talk

Take responsibility for yourself

Focus on the present and weigh consequences

Identify resolution options

The Persecutor

a dictator or bully with an attitude of superiority and belittles/intimadates others with loud speech/threats; may have a group of followers and often compensating for low-self esteem

Dealing with a Persecutor

Self-awareness and self-control

Identify their behavior calmly and assertively

Get their attention without making them defensive/lowering self-esteem

Avoid reacting emotionally

Allow to vent

Sneak

manipulator and gaslighter that engages in mind games/emotional abuse and have a destructive influence on how a person views themselves/reality; studies their target and uses desires, values, and beliefs against them

- Silent treatment

- Deceives/lies

- Friendly to your face, avoids confrontation

- Insecure/low self-esteem

Dealing with a Sneak

Directly call out their actions/behavior and rally peer support

Avoid being rude or aggressive

Remain open-minded

Convince them that their behavior must change

Whiner

chronic complainer, pessimistic, and narcissistic in a continual state of disappointment with themselves/circumstances and sees themself as a victim of injustice; complains to feel more dominate/mature, often creating a toxic work environment

What is being a whiner a result of?

not having lived up to the expectations of their younger self

Dealing with a Whiner

Listen actively/sincerely and acknowledge their difficulty

Offer practica lsolution

Positive outlook redirection

Increase self-awarneess

Encourage empathy

Help them see the impact of their behavior on others