Week 4: HealthCare Team Professional Communication

Effective Communication Imperative for Health Professionals

N232 Fundamentals of Nursing

Learning Outcomes

1. Explain why effective communication is imperative among health professionals.

2. Describe the following disruptive behaviors and how they affect the healthcare environment and client safety:

   • Incivility

   • Horizontal Violence

   • Bullying

3. Demonstrate how to communicate effectively as a professional and improve civility when disruptive behaviors and workplace violence occur.

   • Differentiate the major characteristics of assertive and non-assertive communication.

4. Seek ways to enhance communication and foster civility.

What are Disruptive Behaviors?

• Incivility: Rude, disruptive, intimidating, and undesirable behaviors directed at individuals.

• Horizontal Violence: Aggressive behaviors among nurses targeting coworkers, also referred to as lateral violence.

• Bullying: Persistent actions intended to intimidate or degrade others.

How Can We Display Civility?

• Civility:

  • Acting courteous and polite

  • Expressed through respectful communication and actions.

What is Incivility?

• Definition:

  • Refers to rude, disruptive, intimidating, and undesirable behavior directed towards another person.

  • It can cause psychological or physiological distress for those involved.

  • May be subtle or unintentional; ignoring can escalate tensions.

  • Early recognition and intervention are crucial to prevent escalation.

• Potential Impact:

  • Causes psychological distress.

  • May lead to a toxic work environment.

Examples and Impact of Incivility in the Classroom

• Examples:

  • Use of cell phones/computers for unrelated activities, distracting others.

  • Harsh feedback can demoralize and discourage participation.

  • Gossip and undermining behaviors can damage trust.

  • Discrimination and lack of inclusiveness marginalize students.

• Impact:

  • Affects classroom dynamics and engagement.

  • Leads to increased stress and decreased academic performance.

  • Erodes mutual respect and hampers communication.

Negative Behaviors in Healthcare

• Examples of Negative Behavior:

  • Threatening or belittling interactions between nurses.

  • Rude communications among staff.

  • Negative body language or verbal responses.

What is Horizontal Violence?

• Definition:

  • Anger and aggression between nurses; hostility directed at colleagues.

  • Disruptive behaviors are aimed at coworkers of the same organizational level.

• Common Behaviors:

  • Gossiping, verbal abuse, snide remarks.

  • Withholding information; sabotage, ostracism.

  • Scapegoating (placing blame); abrupt responses.

• Impact:

  • Harms team dynamics, morale, and job satisfaction.

  • Recognizing and resolving horizontal violence is crucial for workplace health.

What is Bullying?

• Definition:

  • Persistent intimidation aimed at individuals or groups.

  • Intent to degrade, humiliate, or pose health/safety risks.

• Impact in Healthcare:

  • Creates a hostile work environment.

  • Leads to communication failures and nurse attrition challenges.

  • Contributes to health problems for targets.

Why is Effective Communication Imperative for Health Professionals?

• Patient Safety:

  • Workplace intimidation threatens patient safety.

  • Clear communication reduces medical errors and improves outcomes.

  • Civility fosters a collaborative environment essential for care.

• Vulnerability:

  • Patients need trusting and respectful communication environments.

  • Civility addresses concerns with empathy, reducing anxiety and improving compliance.

  • Vulnerable populations benefit from clear dialogue.

• Nurse Attrition:

  • Poor communication contributes to job dissatisfaction among nurses, leading to burnout.

  • Respectful interactions promote positive culture and retention.

  • Improved teamwork reduces stress and workflow conflicts.

How to Create a Civil Work Environment as an Individual

1. Promote Respect:

   • Encourage respect toward others in all interactions.

2. Raise Awareness:

   • Identify disruptive behaviors in oneself and others.

3. Enhance Communication Skills:

   • Develop skills to intervene in disruptive situations.

4. Foster Positive Change:

   • Use awareness and communication to enhance social environments.

Suggestions to Enhance Communication

• Communication Models and Techniques:

  • SBAR (Situation-Background-Assessment-Recommendation): A communication framework reducing errors and enhancing dialogue.

  • I-SBAR (Identify): Includes introducing oneself and stating issues coherently.

  • I-SBAR-R (Readback): Verifying information to ensure understanding.

  • I-SBAR-Q (Question): Opportunity for questions and clarification.

  • Emotional Intelligence (EQ)

  • DESC: Describe-Express-Specify-Consequence.

  • CUS: Concerned-Uncomfortable-Safety issue.

  • Assertive Communication

  • TeamSTEPPS: A framework for effective teamwork in healthcare.

Utilizing SBAR Communication

• SBAR elements:

  1. Situation: Describing the current state.

  2. Background: Providing relevant clinical context.

  3. Assessment: Expressing thoughts on the problem.

  4. Recommendation: Stating what should be done.

• Applications:

  • Endorsed by TJC, IHI, WHO for improved communication.

DESC Communication Model

• Usage:

  • Provide respectful feedback in various scenarios involving interruptions or mistakes.

  • Help to assert oneself in facing dismissive behaviors from colleagues.

Communication Strategies in Workplace Violence Prevention

• Tips for Managing Potential Violence:

  • Maintain physical awareness: Ensure surroundings are safe and non-conducive to stress.

  • Position strategically: Stay near exits for quick egress if needed.

  • Dress for safety: Avoid items that can be used against you.

  • Obtain training in de-escalation and emergency codes.

• Go-to phrases: Prepare phrases for specific situations to calm and manage conflict effectively.

References

• Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing.

• Taylor, C., Lynn, P., & Bartlett, J. L. (2023). Fundamentals of Nursing: The art and science of person-centered nursing care (10th ed.).

• The Joint Commission. (2018). Physical and verbal violence against health care workers. Sentinel Event Alert.

Additional Resources

• ATI “Nurse’s Touch: Professional Communication” & Civility Mentor.

Assertiveness Spectrum

• General Assertive Behavior:

  • Range of Behaviors: From non-assertive (quiet, withdrawn) to assertive (honesty, straightforwardness) to aggressive (hostile, critical).

  • DESC Structure:

    • Describe: Specific behavior observed.

    • Express: Personal feelings about the situation.

    • Specify: Request for changes.

    • Consequences: Discuss outcomes of actions.

TeamSTEPPS Framework

• Structure: Effective teams involved in patient care include administration, support services, and patient core team members.

• Communication: Clear structured communication is vital in healthcare settings to ensure patient safety and effective team functioning.

• Mutual Support: Team members support each other to deliver safe care and improve performance.

Team Events and Communication Strategies

• Effective Team Leaders: Responsibilities include organizing the team, setting goals, assigning tasks, monitoring performance, and resolving conflicts.

• Team Events:

  • Brief: Initial meeting to share plans.

  • Huddle: Quick check-in to update plans and ensure situational awareness.

  • Debrief: Informal discussions to reinforce learning and improve team dynamics.

Conclusion

Effective communication and recognizing disruptive behaviors are crucial in fostering a positive healthcare environment, ensuring patient safety, and enhancing team dynamics. Developing skills in assertiveness, civility, and using structured communication methods like SBAR, DESC, and CUS can significantly mitigate conflicts and enhance workplace culture.