Group Dynamics - 1

Course Overview and Evaluation

• Course Focus: Developing an understanding of verbal, non-verbal, and written communication skills; understanding group dynamics; introduction to medical terminology and report writing; appropriate patient and bystander interactions; teamwork development; leadership dynamics; and conflict resolution.

• Evaluation Breakdown:     - Attendance: $5\%$     - Unit Quizzes (Total $35\%$):         - Group Dynamics: $15\%$         - Medical Terminology: $10\%$         - Documentation: $10\%$     - Assignments (Total $20\%$):         - Types of Leaders: $10\%$         - Incident Histories: $10\%$     - Final Exam: $40\%$

Introduction to EMS Communication

• The Evolving EMS Scope: Emergency Medical Services is ever-changing; the scope of practice is constantly developing and expanding.

• Impact of Proper Communication:     - Maximizes patient care quality.     - Builds trust and confidence between the patient and the paramedic.     - Displays professionalism when interacting with allied agencies.

• Significance: Communication is the most internal component in all collaborative efforts, personal relationships, and groups.

Defining Communication

• Formal Definition: The act of exchanging information through a shared system of signs, including words, gestures, and behaviors.

• The Process: Information is received, processed, and transmitted.

• The Gap: Interpretations may vary drastically between the sender and receiver (Interpretation vs. Intention).

• Outcomes:     - Good Communication: Contributes to efficient and effective outcomes; fosters a sense of well-being.     - Poor Communication: Leads to clinical errors, poor morale, and unsatisfactory patient care.

Dyadic Communication

• Definition: "One-to-one" communication involving a dyad (a pair or two individuals).

• Application: Integral part of the patient-paramedic interaction and the interaction between paramedic partners.

• The 8 Messages Involved:     1. What you mean to say.     2. What you actually say.     3. What the other person hears.     4. What the other person thinks they hear.     5. What the other person says.     6. What the other person thinks they say.     7. What you hear.     8. What you think the other person says.

• Challenges: Feelings, attitudes, inflections, and emotions make clear conversation challenging.

Paramedic Communication Responsibilities

• Active Listening: Required to obtain a pertinent and accurate patient history.

• Information Delivery: Provide relevant, truthful, and clear information to patients, bystanders, and nursing staff.

• Gauging Non-Verbal Cues: Observe signs of aggression, agitation, pain, fear, and clinical signs/symptoms.

• Documentation: Write thorough and precise ambulance call reports and incident reports; these are considered legally binding documents.

• Professionalism: Utilize proper medical terminology and maintain respectful, stereotype-free conversation.

• Ensuring Comprehension: Adapt language to the target audience and use good judgment regarding pacing and timing.

• Multimodal Interaction: Effectively interact verbally and non-verbally (in person, over the phone, or via radio) with patients, bystanders, nurses, doctors, dispatchers, and other responders.

Active Listening and Communication Breakdowns

• The Source of Problems: The majority of problems result from misunderstandings, often caused by poor focus and poor communication.

• Processing Speed: The human mind processes information faster than words are spoken.

• Mindset and Mood: The current mood or mindset of an individual may alter the meaning of the message delivered.

• The Response Trap: Planning a response before receiving the entire message leads to listening to ourselves rather than the sender.

• Consequences of Poor Listening:     - Tunnel vision.     - Close-mindedness.     - Missing vital information.

• Clinical Breakdowns occur when:     - Questions are redundant.     - Fears are minimized.     - Personal or religious preferences are disrespected.     - Critical family members or caregivers are neglected/ignored.     - Patients are excluded from the care plan.     - Partners have conflicting impressions and fail to communicate with each other.

Synergy and Collaboration

• Concept of Synergy: The whole is more than the sum of its parts.

• Synergy in Care:     - Joint goal setting.     - Shared decision making.     - Group participation.     - Plans supported by all participants.

• Types of Collaboration:     - Intraprofessional: Within the same profession (e.g., paramedic to paramedic).     - Interprofessional: Across different professions (e.g., paramedic to police, fire, or hospital staff).

• Process Requirements: Decision-making must allow every perspective to influence outcomes; new perspectives should be welcomed. This requires flexibility, respectful conflict resolution, and active listening to improve outcomes and prevent errors.

Interpersonal Skills and Trust

• Attitude: Shapes behavior; participants must be aware of their personal attitude toward teamwork.

• Trust Building: Built on the ability to share vulnerabilities and strengths (knowing what you do not know).

• Emergency Context: Trust usually takes time to build, which is a luxury not often available in emergencies. Strong group dynamics increase productivity and outcomes in these high-stakes situations.

• Core Requirements: Show respect, establish rapport, demonstrate commitment, and cooperate.

Group Dynamics: Roles and Norms

• Groups: Can be formed for various reasons (e.g., town council, class projects, Search and Rescue). Small groups may require one individual to take on multiple roles.

• Role Definition: The function assumed or the part played by a person in a situation; also known as position, responsibility, or duty (e.g., student, parent, employee).

• Culture and Norms:     - Culture: The way of life of people in a given group, country, or society.     - Norms: Written or unwritten "rules" for how something is "supposed to go." Used as guidelines for judging role fulfillment (e.g., "good student").     - Societal Norms: Laws of the land.     - Organizational Norms: Policies and procedures.     - Family Norms: House rules.

• Values: Principles or standards of behavior judged as important. Includes ethical, moral, social, ideological, doctrinal (religious), and intrinsic (welfare of others) values.

• Principles: Standards by which a course of action is evaluated; logical, factual, and practical.

The Five Basic Moral Principles

1. Goodness: Do for others and do not harm them.

2. Equality: Treat all members as equals and with respect.

3. Justice: Fair and just dealings among all members.

4. Truth: Personal integrity and trustworthiness.

5. Freedom: Respect the choices of others, even if we disagree.

Developing Group Norms

• Maintain consistency between all members.

• Allow participation from all members so all viewpoints are heard.

• Reach a consensus or unanimous agreement.

• Commit to the group rules.

Group Development and Hindering Behaviours

• Functionality: Groups contain both functional and dysfunctional members.

• Dysfunction: Occurs when a member acts to serve personal needs, even if they believe they are working for the group.

• The 5 Group-Hindering Behaviours:     1. Blocking: Arguing, resisting, or disagreeing in a way that interferes with progress (versus constructive disagreement).     2. Out of Field: Withdrawing, daydreaming, whispering to others, or using a cell phone during discussion.     3. Intimidating: Expressing disapproval, joking aggressively, or threatening behavior.     4. Digressing: Getting off-subject or making long, rambling speeches.     5. Recognition Seeking: Bragging, appealing for sympathy, or using dismissive nonverbal cues.

Conflict and Conflict Management

• Nature of Conflict: Can be energizing/constructive (leading to solutions) or divisive/destructive (if personal or chronic).

• Trigger: Occurs when values or beliefs are threatened.

• Three Stages of Conflict:     1. Work to preserve relationships and core values while accomplishing the task.     2. Disconnect from relationships while still preserving core values and the task.     3. Self-preservation takes over; the task is abandoned.

• Conflict-Handling Styles:     - Competing: Goal is to win ($High\,Assertiveness, Low\,Cooperation$).     - Avoiding: Goal is to delay ($Low\,Assertiveness, Low\,Cooperation$).     - Accommodating: Goal is to yield ($Low\,Assertiveness, High\,Cooperation$).     - Compromising: Goal is to find middle ground ($Mid\,Assertiveness, Mid\,Cooperation$).     - Collaborating: Goal is to find a win-win solution ($High\,Assertiveness, High\,Cooperation$).

Functional Group Roles

• Two Basic Group Goals:     1. Task Goal: Getting the job done.     2. Social Goal: Building relationships (Cohesion).

• The 12 Functional Roles:     - Task Actions (6):         1. Share Ideas: Multiple ideas increase success.         2. Seek Ideas: Listen to differing thoughts.         3. Suggest Directions: Streamline ideas.         4. Summarize Progress: Reflect to reduce confusion.         5. Check Comprehension: Provide regular feedback.         6. Motivate: Encourage focus.     - Social Actions (6):         1. Encourage: Ensure all participate.         2. Support: Words of affirmation.         3. Facilitate Communication: Foster relationships.         4. Observe Process: Defuse conflict early and recognize stress.         5. Stress Reliever: Provide "comic relief."         6. Conflict Mediator: Manage interpersonal conflict via tactful discussion.

Dysfunctional Roles

• Free Rider: Non-contributor who expects to benefit; seen as lazy.

• Dominator: Takes on excessive workload; monopolizes roles; makes unwelcome executive decisions; seen as a "control freak."

• Rescuer: Similar to dominators; genuinely interested in success but views themselves as more competent than others.

• Distractor: Talks excessively about irrelevancies; uses excessive humor; slows productivity.

• Cynic: Lacks trust; has a negative outlook; causes strain on task and social development.

• Aggressor: Intimidates others; makes negative judgments; causes group division.

Leadership Roles and Styles

• Leadership vs. Management: Leadership is demonstrated by one with a vision who gets others to believe in it. "People work for managers; people follow leaders."

• Leadership Characteristics: Shows initiative, judgment, sensitivity, and timing. Understands participatory decision-making.

• Power Types:     - Charismatic Power: Chosen for personal qualities.     - Legitimate Power: Designated to lead (formal).

• Leadership Style Comparison:     - Classic Leadership: Established by hierarchy; provides answers; formal communication; may retain information to establish power/control.     - Shared Leadership: Quality of interaction; work together for common goals; based on teachable attributes (curiosity, empathy); informal communication; information is shared freely; relies on democratic process.

• Categories of Leaders:     - The Autocrat (Dictator): Exclusively task-oriented; effective with low maturity/responsibility groups; may be considered offensive.     - The Democrat: Places trust in members; consensus-based; higher group happiness; can be time-consuming.     - The Laissez-Faire: Group self-directs; leader sits back; effective with high maturity/responsibility groups; typically considered the most effective style when members are highly knowledgeable.