Difficult communications-presentation-qsen-website
- 1. Gerry Altmiller, EdD, APRN, ACNS-BC
- 2. Learner will beableto identify typesof difficult communications. Learner will beableto describemanifestationsand consequencesof difficult communications Learner will beableto describestrategiesto use during difficult communicationsto improvepatient safety.
- 3. Writeabout asituation/conversation wheretherewas conflict that impacted patient safety-tell thestory.
- 4. Hierarchical relationships Oppressivecommunication patterns ◦ Communication istheroot causeof 66% of Sentinal Events 1995-2005 The Jo int Commissio n Complexity of care/Sophisticated technologies Heavy workloads-fatigue Timepressured schedules Stereotyping High stakes/high stressenvironment Organization’sfailureto enforcecodeof conduct Concealment dueto isolation
- 5. Interdisciplinary Interactions ◦ Hierarchial relationships ◦ Presenceof an authority gradiant ◦ Negativeor disruptivebehaviors
- 6. Nurse-patient/patient-Nurse interactions ◦ Angry patients ◦ Angry nurses
- 7. Nurse-NurseInteractions ◦ Lateral Violence: an aggressive& destructivebehavior of nursesagainst each other. Woelfle& McCaffrey 2007 ◦ Resultsin injuring thedignity of another ◦ Reducesone’sconfidenceand self esteem
- 8. Oppressed population concept Cyclical Exclusion from thepower structure Seen as“Right of Passage” “Thisishow peoplewereto mewhen I was learning” New-to-practiceRNsand new-to-practice- areaareat greatest risk
- 9. Talking behind one’sback Discouragement; humiliation Blocking chancefor promotion Scapegoating; innuendo Belittling or criticizing acolleaguein front of others Isolating or freezing acolleagueout of group activities; exclusion Sabotage; withholding pertinent information In-fighting Failureto respect confidencesand privacy Eyebrow raising, snideremarks, turning away, making faces
- 10. Cyclical repetition Physical symptoms Useof sick days Extremecasessuicide Nursesleavetheprofession (1 in 3 internationally) 30% leave1st new grad position within 1 year (Bowles& Candela, 2005) Nursesaren’t at their best so patient caresuffers
- 11. Lateral violenceviolates The Co de o f Ethics fo r Nurses with Interpretive Statements (ANA, 2001) http://www.nursingworld.org/codeofethics Barriersimpedeknowledge& skill acquisition To improveprofessional practicelife To stressfor new to practicenurses To improveconflict resolution skills To attrition To stop new generationsof nursesfrom being socialized into negativepractices TheJoint Commission mandateschangefor patient safety in Sentinel Alert 40
- 12. Accept one’sfair shareof the workload. Respect theprivacy of others. Becooperativewith regard to the shared physical working conditions(noise, temp). Bewilling to help when requested. Keep confidences. Work cooperatively despite feelingsof dislike. Don’t denigrateto superiors (speak negatively about, haveapet namefor) Do addressco-workersby their first name, ask for help and advicewhen necessary. Makeeyecontact with co-workerswhen speaking. Don’t beoverly inquisitiveabout each other’slives. Repay debts, favors, compliments. Don’t converseabout aco-worker with another co-worker. Stand up for the“absent member” in a conversation when he/sheisnot present. Don’t criticizepublicly. Griffin, 2004
- 13. Cognition: obtaining, organizing & using intellectual knowledge Self reflection both personal and professional Liberatetheoppressed by not letting it continue
- 14. Rehearsed direct responses ◦ I seefrom your expression thereissomething……. ◦ I learn most from peoplewho communicatedirectly.. ◦ When thingsaredifferent from what I learned….. ◦ It ismy understanding that therewasmoreinformation……. ◦ I don’t feel right talking about this…. ◦ I don’t feel right talking about him/her…. Griffin, 2004
- 15. ◦ Stopstheautomatic processof theevent ◦ Consciously not responding or not reacting ◦ Allowing timeto processinformation previously taught The event is no t a perso nal affro nt ◦ Allowsindividual to respond differently to harmful inferenceof lateral violence ◦ Liberatestheoppressed by not letting it continue
- 16. Reframing conversation using safety strategies ◦ Debriefing Feedback whether positiveor negativeshould alwaysbean unbiased reflection of eventsand open thedoor to discussion of evidence-based practice ◦ Two Challenge Rule ◦ CUS Concerned, uncomfortable, safety ◦ Check back ◦ Time-o ut ◦ CriticalLanguage “I need someclarification.”
- 17. Effective Communication SBAR for Safe Patient Hand-offs ◦ Situation ◦ Background ◦ Assessment ◦ Recommendation
- 18. De-escalation techniquesfor aggressivebehaviors Takethefocusoff thepower struggle Refocusdiscussion back to thepatient needs Enlist thesupport of thosemoresenior Identify thosereceptiveto questions Listen to concernsof others End conversationswhereco-workersarebeing discussed Reflection Challengeyourself to remain civil in thefaceof incivility Ask yourself what went well? What went poorly? What could I havedonedifferently?
- 19. Clear Timely
- 20. Familiarizestudentswith TheJoint Commission expectation: Sentinel Event Alert 40: Behaviorsthat UndermineaCultureof Safety Sentinel Event | Joint Commission
- 21. Reframesituation/conversation using: ◦ CognitiveRehearsal ◦ Safety Strategies ◦ De-escalation
- 22. Difficult Communication patternsareapatient safety threat Createsfear of ridiculefor asking questions Strategy: Alwaysbring focusback to thepatient Education hasapositiveeffect ◦ Empowersnursesto know that it isnot personal ◦ Breaksthecycle; it can bestopped ◦ Contributesto making team membersaccountableto each other ◦ Encouragesaprofessional dialogue
- 23. Woelfle, C. & McCaffrey, R. (2007). Nurseon nurse. Nursing Fo rum, 42(3), 123-31. Griffin, M. (2004). Teaching cognitiverehearsal asashield for lateral violence: An intervention for newly licensed nurses. The Jo urnalo f Co ntinuing Educatio n in Nursing, 35(6), 257- 263. BowlesC. & Candela, L. (2005). First job experiencesof recent graduates: Improving thework environment. Nevada Nurses Asso ciation ISSN: 0273-4117