PC III-Session 2

PC III- Session 2 – Interpersonal Chapter 23 & 24 Standards for a Healthy Work Environment (Pg. 444) • Collaborative culture with respectful communication and behavior • Communication-rich culture that emphasizes trust and respect • Clearly defined role expectations with accountability • Adequate workforce • Competent leadership • Shared decision making • Employee development • Recognition of workers' contributions Six Standards characteristic of a healthy workplace (Pg. 444) 1. Nurses must be as efficient in communication skills as they are in clinical skills 2. Nurses must be relentless in pursuing and fostering true collaboration. 3. Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations. 4. Staffing must ensure the effective match between patient needs and nurse competencies. 5. Nurses must be recognized and recognize others for the value each brings to the work of the organization. 6. Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement. Code of Behavior (Pg. 444) Disruptive Behavior (Pg. 446) • Incivility is common in large organizations, especially hospitals. • Although less than 3% of physicians and less than 3% of nurses exhibit disruptive behaviors, this is enough to effect client outcomes (Rosenstein & O'Daniel, 2005). • A number of authors have found that nurse-to- nurse destructive, disruptive behaviors occur more frequently than such physician-nurse interactions (Woelfle, 2007). • the term disruptive behavior uses the original definition from Leymann in Sweden: at least two negative acts per week, occurring over more than 6 months in duration (Johnson, 2009).

PC III- Session 2 – Interpersonal Chapter 23 & 24 Physician-Nurse Conflict Resolution (Pg. 451) Remarkable increases in safety in airline and space programs were achieved by creating a climate in which junior team members were free to question decisions of more senior, powerful team members. Health care is adopting a similar philosophy. The American Medical Association (American Medical Association [AMA], 2008) has specifically stated that codes of conduct define appropriate behavior as including a right to appropriately express a concern you have about patient care and safety. While this is being set forth as a medical code of conduct for physicians, should it also apply to nurses? Nurses influence physician-patient communication. Nurses assess what physicians tell patients, encouraging them to seek clarification, and support our patient’s right to ask questions. This is an important aspect of our belief that the patient is a valued member of our health team. Do you think it is ever appropriate for a nurse to criticize a physician’s actions to a patient? A common underlying factor in at least 25% of all malpractice suits is an inadvertent or deliberate critical comment by another health care professional concerning a colleague’s actions. Research has demonstrated that better collaboration and better communication are associated with safer care and better patient care outcomes, including reduced drug errors, reduced mortality, improved patient satisfaction, and somewhat with shorter hospital stays. There will be occasions when you have collaboration difficulties. Methods to improve safe communication are discussed in Chapter 2. Make a Commitment to Open Dialogue. Listening should constitute at least half of a communication interaction. Foster a feeling of collegiality. Use strategies to defuse anger. During your negotiation, discussion should begin with a statement of either the commonalities of purpose or the points of agreement about the issue (e.g., “I thoroughly agree Mr. Smith will do much better at home. However, we need to contact social services and make a home care referral before we actually discharge him; otherwise, he will be right back in the hospital again.”). Points of disagreement should always follow rather than precede points of agreement. Empathy and a genuine desire

PC III- Session 2 – Interpersonal Chapter 23 & 24 Constructive Criticism (Pg. 455) Resolving Interpersonal Conflict (Pg. 451) Use peer negotiation • As students, you will encounter situations in which the behavior of a colleague causes a variety of unexpressed differences or disagreement because the colleague's interpretation of a situation or meaning of behavior is so different from yours. • The conflict behaviors can occur as a result of age differences, differences in values, philosophical approaches to life, ways of handling problems, lifestyles, definitions of a problem, goals, or strategies to resolve a problem. • These differences cause friction and turn relationships from collaborative to competitive. • Generally, conflict increases anxiety. • When interaction with a certain peer or peer group stimulates anxious or angry feelings, the presence of conflict should be considered. • Once it is determined that conflict is present, look for the basis of the conflict and label it as personal or professional. • If it is personal in nature, it may not be appropriate to seek peer negotiation. • Sharing feelings about a conflict with others helps to reduce its intensity. • It is confusing, for example, when nursing students first enter a nursing program or clinical rotation, but this confusion does not get discussed, and students commonly believe they should not feel confused or uncertain. • As a nursing student, you face complex interpersonal situations. • These situations may lead you to experience loneliness or self-doubt about your nursing skills compared with those of your peers. • These feelings are universal at the beginning of any new experience . • By sharing them with one or two peers, you usually find that others have had parallel experiences.

PC III- Session 2 – Interpersonal Chapter 23 & 24 Examples of Unclear Communication Process (Pg. 452) Continuity of Care Concept (Pg. 61) Continuity of care describes a multidimensional longitudinal construct in health care, which emphasizes seamless provision and coordination of client-centered quality care across clinical settings. COC operates across three dimensions: Relational continuity as “a therapeutic relationship with a practitioner that spans more than one episode of care and leads, in the practitioner, to a sense of clinical responsibility and an accumulated knowledge of the patient’s personal and medical circumstances” (p. 118). Frequent team communication about all aspects of care

PC III- Session 2 – Interpersonal Chapter 23 & 24 • Team meetings serve the distinct purpose of concentrated discussion about targeted client and family needs, and meeting related treatment goals. Informational continuity • Informational COC allows for an uninterrupted flow of data and clinical impressions between health care providers and agencies, with clients and their families, over time and space. • Gaps in informational continuity can occur as a result of misplaced clinical records, inadequate discharge planning or referral data, deficient or delayed authorization for treatment, and lack of understanding by the client of their illness or treatment, or self-management guidelines. • Lack of information at time of transfer can result in treatment delays, and can increase the client and/or family's anxiety unnecessarily. • When clients get full information and a consistent message from their health care providers, regardless of where they are in the health care system, they become more relaxed and open to treatment recommendations. • Informational continuity requires sharing health and treatment information and changes with clients and families that are consistent, complete, accurate, value neutral, and delivered in an easily understandable and supportive manner. • Notifying the family of changes in the client's condition or treatment recommendations is an essential part of ensuring informational continuity, particularly if the family is not in close contact with the client. Management continuity • refers to a consistent, coherent care management approach, which can be flexibly adjusted, as client needs change. Care coordination and case management have emerged as significant methodologies associated with management continuity. • Continuity of care exemplifies the shift in emphasis from acute care to long-term self- management of chronic illness in the community. The COC process is concerned with the safety and quality of care as well as a seamless coordination of services. • The overarching goal of COC is to ensure reliable coordinated transition of clients from one health care setting to another, such that care in each setting continues to provide a secure health safety net for individuals and families that they can rely on for support and information. Review of the Principles of COC COC contributes to the development of: • Increased accessibility to coordinated health care services with a smoother flow of care from one service area to another • Personalization of care to meet a client’s changing needs across delivery systems • Informational data sharing of various elements of personal and medical data electronically over time and place, which contribute to appropriate care delivery • Health services provided in an organized, logical, and timely manner, using a shared management plan. • COC decreases the potential for service duplication, conflicting assessments, gaps in service, and reduces the use of preventable acute care services. • Improved continuity: lessens medication and treatment errors, provides timely follow-up, and can ease transitions between care settings. • For chronically ill and elderly clients, COC means that they are more likely to have health care providers familiar with their overall history, who can notice subtle changes in health status To communicate with the inter- professional team to ensure the continuity of care. Effective Communication • Start with introducing yourself to other members of the team. • Identify your professional role on the team and issues/plans with respect to the target client situation. • Seek specific feedback from other team members. • The focus of team group meetings is always on the immediate care issues of the client. • Each team member, including the client, is personally accountable for sharing relevant client information, listening to the comments of others, and actively participating in focused problem solving and decision discussions. • In team group meetings, it is important to respect the diversity, professional values, and ideas of each team member even when you do not agree with them. • It is important to respect and consider the input of other team members who may approach the same situation from a very different perspective.   Tips to enhance communication in team and task groups (Pg. 468) Listen before you speak . Attentive listening is one of the strongest collaborative communication skills. When you take a measured listening stance, you show respect for the speaker. As you hear the other person’s words, visually attend to the attitudes and nonverbal behaviors of the speaker and other team members. These are important

PC III- Session 2 – Interpersonal Chapter 23 & 24 information-transmitting factors, which can influence understanding, so that you can respond appropriately. Know what you are talking about . When you share clinical observations and professional opinions in team meetings, be as informed, authentic, specific, and descriptive as possible. Honest feedback and genuine sharing builds trust and strengthens professional relationships, even when ideas are being challenged. Evidence-based data provide an underpinning for interdisciplinary discussions. Nurses can communicate a critical appraisal of a patient’s presenting issues, health needs, preferences, values, and personal responses. This is your forte. Nurses spend the most time with patients and have the most “talking and observing” sustained contact with them. Use your voice wisely . Nurses’ active participation in formal team meetings is essential. You do not have to comment on everything, but your input is unique and critical to the discussion. Information about the patient as a person and human responses to illness and treatment represents data nurses are best positioned to share. • Be open to different ideas. A strong advantage of team communication is that it allows more than one viewpoint to bear on a health situation. Exploration of different ideas and perspectives enriches the problem-solving approaches needed to develop a coordinated consistent and workable approach to difficult patient issues. Have knowledge of the differences in role responsibilities and common values of other disciplines so you can better frame messages and can understand their perspective. Recognize your limitations, as well as your strengths, and how you might be able to incorporate the expertise of other disciplines in total patient care. Ask for feedback . Encourage other team members with whom you interact to provide relevant feedback, for example, “I’d like to hear what you think about this.” Analyze the information you receive, and ask relevant open-ended questions. Brainstorming and problem-solving processes are indispensable to developing the most workable solutions. Interdisciplinary team decisions should be negotiated, not dictated, with all members being mindful of working though their individual differences in a respectful manner. Consensus solutions work best and are more easily implemented. Work within the system . Although patients are the core focus of care, health care centers are part of much larger health care management systems, which influence team functions and outcomes (Ginter, Duncan, & Swayne, 2013). System factors beyond the control of the patient and the direct care team will influence what is and is not possible in a given health care situation. Valuable time is saved when team members are knowledgeable about the constraints and opportunities available within their delivery system.