2 types of communication:

1) facilitative- gives a pos outcome in which you use words in terms of getting
meaning across
2) obstructive-makes it more difficult for people to communicate effectively

****LOOK AT EX OF FACILITATIVE ON PP135-136 AND

OBSTRUCTIVE ON PP137-139***

Components of communication:
1) communication in writing s/a w/ nurse's notes
2) speaking effectively
3) listening skills
4) nonverbal communication
5) telephone
6) technology

What are some things to remember when communicating with a doctor on the
telephone:
1) say your name
2) don't apologize for calling
3) state your needs briefly but completely
4) if doctor is coming ask when to expect them
5) chart attempts to talk w/ doctor, doctor's name and content if you talked to
doctor
6) if a doctor is rude, tell them
7) if you can't get a doctor or get what you need, tell your nurse manager
8) if you get cut off, call back

Feedback - needs to be heeded in order to evaluate communication effectiveness?

Why is listening to the pt so important when trying to communicate information to

them?
You need to determine if what you said was understood

What are some basic principles of effective communication:

1) communication process involves 2 people
2) sender must make message clear
3) use simplest most precise words possible
4) encourage feedback
5) non-verbal is comm.
6) be respectful of surroundings in home
7) rep and credibility makes it easier to communicate during a difficult situation
8) must have sound relationship
9) be there, don't daydream or plan ahead what to say next
10) communicate directly with the person you want to receive the message
11) be aware of personal values and biases

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true/false: just the giving of info is communication
false. There must be an opportunity for a response to be given

What is an example of a way to clarify with a patient if communication was

understood in a situation such as discharge teaching about signs and symptoms of
infection?
Could you please repeat at least 3 signs and symptoms of infection for which you
would call your doctor

Why is it so important to communicate w/ your supervisor?

To state needs clearly, explain rationales for needs, and suggest how needs can
benefit the whole unit

What are some things to remember when talking with your supervisor?
1) keep them informed but make appointments
2) write down needs to show importance of what you have to say and it shows a
sense of responsibility
3) use care w/ words that may blame or over exaggerate a situation and don't talk
with a supervisor when angry
4) except feedback b/c there may be a good reason for granting or not granting
requests
5) use correct channels- NEVER GO ABOVE OR AROUND YOUR SUPERVISOR,
GO TO THEM 1ST

How can you communicate effectively with other nursing personnel?

Promote a sense of trust and respect, don't get the I'm more important than you
attitude consider yourself as equals, and be confident in yourself

How can you communicate effectively with nursing assistants?

Treat them with respect, provide them with simple step by step instructions, ensure
you have their full attention when giving them directions, then follow up to ensure
they understood what was asked of them and they followed thru with the tasks

Where is the place to start projecting a positive image?

With the 1st impression your appearance creates

How can one's personal image be used in the communication process?

1) making sure you know what you're talking about
2) your credibility can enhance communication because people listen more to
people they respect
3) flexibility and adaptivity in behaviors allows you to relate more comfortably and
effectively to others
4) being enthusiastic relates to others you work hard and care about your work

What are some ways men and women differ in their communication?

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1) men are more logical, sequential, focused perspective, but ask fewer questions,
and uses a more dominant communication style that is direct, confident, and
assertive
2) women see the big picture, seek solutions based on what makes others more
comfortable, ask more questions, and use a more supportive and soft tone

What are some examples of times when you would have to be flexible in
communication by adapting to other styles:
1) in cultural differences such as Spanish speaking patients
2) patients w/ communication barriers s/a hearing deficits or confusion
3) codes
4) pediatric patients

How can a good nurse manager use the grapevine gossip or rumors to be able to
communicate with staff?
1) can provide factual information
2) can talk about it face to face w/ staff
3) address significant issues

What are some barriers to communication:

1) image 5) noise
2) knowledge 6) system overload
3) attitude 7) social/psychological barriers
4) physical barriers 8) semantic barriers

Active listening - involves paraphrasing, clarifying, questions, and commitment. It

involves concentrating all your energy on understanding and interpreting the
message with the meaning the sender intended. Of the 4 means of
communication, it requires most of your communication time.

Nonverbal communication - uses movements, gestures, body position, and voice

tone to transmit messages. Involves making eye contact, standing up straight w/
shoulders back, toes pointed slightly outward and slightly apart, standing about 4 ft
away from the receiver, using a forceful voice w/out pauses, and avoiding negative
behaviors s/a nodding constantly or yawning.

Passive or avoidant - type of behavior which means one lets others push them
around, they don't stand up for themselves, they do what they're told regardless of
how they feel about it, they're unable to share feelings or needs with others, they
have difficulty asking for help, and feel hurt and angry at others for how they're
treated by them.

Aggressive - type of behavior which means one puts their own needs 1st, they
communicate in an angry, dominating way, they attempt to put others down, they

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convey a superior attitude, they control and manipulate, and seen as threatening or
demanding by others.

Assertive - type of behavior which means a person stands up for themselves in a

way that doesn't violate the rights of others, they express their true feelings in an
honest and direct way, they don't let others take advantage of them, they show
respect for others, they take responsibility for actions, they can accept compliments
or criticism, and they act in a way that enhances self respect. Have a greater
chance of getting needs met.

Cultural diversity - deals w/ a pattern of values and beliefs that is reflected in the
behaviors we demonstrate. We need to 1st understand our own and become
aware of stereotypes that may interfere w/ our ability to see them as individuals.

Filters - communication goes thru these when one interacts with someone
perceived as different. May be related to culture, sex, education level, age, and
experience. When a message goes thru one, the actual message may be
interpreted according to the receiver's cultural values and beliefs leading to
misinterpretation.

What is a big thing health care workers do to patients, when communicating info to
them, which can cause misinterpretation of the message?
Use jargons or anacronyms or give long explanations to info

In terms of effectively communicating in writing, what does the anacronym KISS

mean?
Keep It Short and Simple

Team - a small number of people w/ complimentary skills and are trying to work
toward the same goal.

Groups - can be obscure and minimally cohesive, such as in name or attributes.

They can also be highly organized and issue oriented w/ a high degree of personal
or professional interaction such as the ANA.

Informal - type of group which evolve spontaneously thru social interactions and
aren't organized or structured. Example - is his friends who all have to decide what
they want to major in in college.

Formal - type of group which is an aggregate of unique individuals who chose to

join an organized, structured learning environment.

Real group - group which is task oriented and organized by its relationship to the
organization. Example of this type of group is your clinical groups in nursing
school.

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Task group - group joined outside of the real group which meets together to gain
knowledge from each other.

Committees and task forces - nurse advocate groups, thru these, work to
address issues and support services in various areas of the nursing profession.

Team building - seen as a deliberate process of unifying a group of individuals into

a functional working unit, accomplishing specific goals.

There must be 3 attributes in 3 categories that help build a highly complementary

and functional team:
1) interpersonal skills
2) problem solving and decision making skills
3) technical or functional expertise

What are the concepts of team building?

1) communication
2) singleness of mission (same goal)
3) commitment

What are some questions you should ask yourself when preparing to work with a
team?
1) will I be in the "in" or "out" group
2) do I have any power and control
3) will I be appreciated for my skills and contributions to the group and have "say
so"

Collaboration - teams are a formal way to actualize it. It's at the heart of
successful decision making. Among team members, it leverages skills, time, and
resources for their own benefit and that of the organization.

What are something that all team members should acknowledge in order to be
effective:
1) specific goal
2) personally knowing someone helps you to get along better
3) sincerity is shown by saying what you mean and meaning what you say
4) be timely
5) people love to be praised in public

Synergy - ability of a group to work together by having a clear purpose, listen

actively, are compassionate, tell the truth, are flexible, and commit to resolving
conflicts.

What is the key strategy to team building?

Managing emotions

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Positive psychological bond - one of the most important ingredients to the team
nursing approach which can bring the individuals of a team together. Without it
there will always be limits to the overall quality and function of the team.

What is a very important issue for nurses in relation to "self"?

Self recognition w/ positive forms of recognition from each other

What are some important principles in making an effective presentation?

Develop a positive attitude and practicing to make a good presentation

Why is communication by the nurse in a team so important?

One can influence the quality of care given to the patients

What is the key to an effective team meeting?

Planning and organization that occurs before the meeting is held

Conflict - disagreement among 2 or more people, groups, or organizations.

Inevitable where there are people w/ different views. As a process, it's neutral.

Ex of the different types of conflict b/t coworkers:

1)role- 11p-7a nurse doesn't know who does pre-op enemas, him or 7a-3p nurse
2) communication - failed to tell patient they're NPO after midnight for a procedure
in the am and the patient eats breakfast that am
3) goal- placing personal achievement and advancement above everyone else's
4) personality- aggressive nurse working w/ passive nurse
5) ethical or values- nurse taking care of a pt who reminds them of a family
member who just died recently
6) sexual harassment- 1st let person know it's unacceptable then go from there if
that doesn't work

What are some examples of different types of conflict between nurses and patients
or family:
1) quality of care - Nancy is concerned about her baby having to be stuck everyday
which a is necessary part of treatment
2) treatment decisions – Mrs. H doesn't want her 96 y/o mother to get a g tube
because she has lost 15 lbs r/t anorexia
3) family involvement t- family needing to be constantly informed of pt's condition
4) quality of parental care- mom staying w/ 1m/o won't wake up to feed or change
the baby
5) staff inconsistency - all staff aren't reminding a pt not to smoke in his room

What is the key to successfully managing conflict?

Tailoring response to fit each situation instead of just relying on 1 technique

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Competition - a win-lose type of conflict resolution. the use of force to exert more
power than the others. It sets up a type of competition that is usually used in a
situation such as your head nurse denying your request to be off Christmas day
because there are other staff members who have seniority over you. It's rep by the
shark, "the player", who forces the issue.

Avoidance - a lose-lose type of conflict resolution involving one who is unassertive

and uncooperative. In this type of conflict resolution, both parties involved feel
frustrated and angry. At times it can be appropriate s/a when 2 nurses are
beginning to raise their voices at one another and one nurse walks away. It's rep
by the turtle, "the escapist", who w/draws from situation, tries to remain neutral, and
delays responding to conflict.

Accommodation - a lose-win type of conflict resolution involving one who

accommodates at their own expense and often ends up angry and resentful. Ex of
this is where a nurse asks for time off; the head nurse may put herself aside and let
them have their way even if it called for making a place for them to be off. It's rep
by the bear, "the smoother", who smoothes differences over; dreads conflict, and
maintains harmony.

Compromise - a modified win-lose type of conflict resolution involving one who

compromises or bargains to resolve a situation and maintain a relationship b/t 2
people. Requires moderate assertiveness and cooperativeness. Ex of this is a
head nurse allowing a nurse to have 1 day of a holiday off but not an entire week
but the staff on that 1 day will be short. It's rep by the fox "the negotiator" who
takes a middle of road position, asks give and take from both parties, and seldom
confronts conflict.

Collaborator - a win-win type of conflict resolution involving a high level of concern

for the problem, outcome, and relationship of parties involved. It deals w/ problem
solving and confrontation. The needs, feelings, and desires of both parties is
considered. Ex of this is you agree to work the 1st part of the holiday wk and see
that inventory is done for the head nurse who agreed to work the last half of the wk
for you. It's rep by the owl, "the problem solver" who is assertive and cooperative,
objective in evaluating diff views, and uses creativity to form new ideas.

****LOOK AT REEVE'S HANDOUT ON WHEN TO USE TYPES OF

CONFLICT RESOLUTION****

How to deal w/ anger management?

1) change the image- stop, look, and change
2) move
3) focus
4) breathe
5) consider how you can learn from situation

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Time management - the use of tools and techniques/strategies that are used to
control wasted time and to ensure that the time invested in activities leads to
achieving desired, high priority goal. Its prim purpose is to allow one the
opportunity to achieve personal and professional goals.

What is involved in time management?

1) self discipline-keep track of how time is used
2) planning- carry out plans
3) appropriate delegation
4) assessment of current time use patterns
5) setting priorities- you have certain tasks that must be done
6) evaluation- determine if change is needed to manage time

What are the overall concepts of time management?

You must balance job and life, follow the time style that works for you, and id your
brain side time style

What are some characteristics of someone who is right brained:

Creative, flexible, spontaneous, fun, "let's wing it", relax

What are some characteristics of someone who is left brained:

Structured, organized, sees rules as good, make time limits, set goals, know
priorities

Think about what some of YOUR time wasters are?

Mine are watching tv, even if it's reruns, interruptions by the phone or my family,
spend too much time typing questions for info that "clutters the mind" as the
teachers put it, saying no even if I have 100 things to do, etc

When is the best time to schedule difficult tasks?

When you are at your highest energy times

To increase energy in order to be able to effectively tackle difficult tasks, what are
some things you can do?
Get plenty of rest, alternate mental and physical tasks, and spend an hr relaxing
after a long day of working on your tasks

What is included in your time management checklist:

1) goal setting
2) planning- writing down
3) setting priorities- after goal established and may change
4) organization
5) time tools- checklists, timelines
6) dealing w/ info- determine priorities
7) establishing deadlines for finishing tasks
8) control what you do- design your own schedule

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9) appropriate delegation even at home
10) evaluate and revise accordingly

What are some specific things you can do to manage your patient care:
1) be ready for report before report begins
2) organize shift activities looking at pts w/ highest acuity
3) note environment in patient room s/a iv’s, drainage receptacles,
4) id busiest times on the unit and plan care accordingly- you wouldn't plan to chart
when pt coming back from or
5) be on time for report
6) be flexible, look at new ways of doing things, leave time for emergencies or
unforseen things, and observe those nurses who seem to get everything done

What are the payoffs of time managemen?

Increase productivity, job satisfaction, improved professional relationship, decrease
time anxiety and tension, and better health system

System used when items can't be handled at once b/c of time commitments.
abc system- a- do it now; b- necessary but do later; c- when I get to it

What is something you can do for charting to help make it easier?

Do it as you go rather than waiting till the end of shift

How can you deal w/ procrastination:

Consider consequences, the earlier you start the earlier you finish, break projects
into chunks, reward yourself when finished, and don't expect perfection

Priority - something that is more important than anything else at any given time.
Nurse must be able to use this for 1 patient or a group of patients. Involves
reexamination throughout the day according to assessed needs and unscheduled
interruption.

What is the principle of prioritizing established by the ANA standards of practice?

Doing no harm and protecting the health and safety of the patient

Maslow's Hierarchy of Needs:

• Self actualization- g&d, health, autonomy
• Self esteem- sense of self worth, self respect, dignity
• Love and belonging- affiliation, affection, intimacy, support
• Safety and security- physiologic and psychologic safety, protection, stability
• Physiological- o2, food, elimination, temp, sex, activity, rest, comfort

What is considered a high priority situation?

1) life threatening events -those effecting the airway s/a inability to clear airway, r/f
aspiration, and gas exchange and those effecting the cv sys s/a hemorrhage,
alteration in cop, altered tissue perfusion, fvd/fve, or shift in fluid volume

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2) unstable pts- those w/ a change in their condition that could be life threatening
s/a altered mental status, r/f violence, change in VS, new admit that is unstable, pt
transferred from ICU, ER, or

What is considered a medium priority situation?

Nonemergent problems that could r/i unhealthy consequences s/a physical or
emotional impairment but unlikely to threaten one's life s/a anxiety, education,
scheduled events s/a med administration, confusion, acute urinary elimination,
pain, r/f injury, r/f infection, incontinent pt immobilized in the bed

What is considered a low priority situation?

Those that are resolved easily w/ minimal interventions and have little potential to
cause significant dysfunction s/a self care deficit, altered family coping, and
powerlessness

What are the Gordon's functional health patterns and which is priority:
1) health perception or health mgmt- r/f injury, alt health maintenance, ineffective
therapeutic regimen
2) nutrition or metabolic- fvd/fve, brstfdg, nutrition: less than/more than body
requirements, skin integrity
3) elimination - constipation/diarrhea, incontinence, alt urinary elimination,
hypo/hyperthermia, ftt adult
4) activity or exercise- ineffective airway clearance, r/f aspiration, decrease cop,
ineffective breathing pattern, activity intolerance, self care deficit ***PRIORITY
B/C AIRWAY***
5) sleep or rest- sleep pattern disturbance
6) cognitive-perceptual- confusion, knowledge deficit, memory impaired, alt
thought process, pain
7) self perception or self concept-anxiety, body image disturbance, disturbed self
esteem, hopelessness, fear
8) role or relationship- alt family processes, r/f violence, caregiver role strain,
impaired verbal communication
9) sexuality or reproductive- rape/trauma syndrome, sexual dysfunction, alt
sexuality pattern
10) coping or stress tolerance- ineffective community/family/individual coping, r/f
violence, r/f suicide
11 )value or belief- r/f spiritual distress

What is involved in priority setting:

1) multitasking
2) monitor for changes
3) select sickest pt in a group of patients
4) select priority nursing action

How do you prioritize?

1) Obtain all the necessary data from such resources as nurses note, pt history,

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labs, and knowing their disease process
2) sort and organize the info obtained
3) id priorities and follow do no harm principle

Delegation - transferring to a competent individual the authority to perform a

selected nursing task in a selected situation for which the nurse retains
accountability for. It enable you to accomplish all that is expected of you, allows
outcomes to be achieved in a timely, cost effective manner, contributes to the
employee's personal and professional growth, and drive is based on patient
outcomes.

What do you base your decision to delegate a task on?

Basis of your assessment of the desired outcomes set forth for your patient and
competency of the individual

3 parts to delegation:
Delegation itself, supervision, and accountability

What do you need to delegate a task?

1) delegator - person who does the delegating
2) delegate - person who accepts task
3) activity, task, or job to be delegated
4) transfer responsibility or authority to the delegate

Once a task is delegated, what must you as the nurse do?

Supervise to ensure delegate knows how to perform the task and follow up to
ensure it was done

What dictates what you can delegate?

1) Your state's nurse practice law which is THE LAW (nothing can override it!!!)
2) the agency's policy and procedure
3) your job description and the job description of the delegate

Supervision - 1st component is provision of guidance of direction, then evaluation,

and f/u by the licensed nurse for accomplishment of a nursing task delegated to
unlicensed assistive personnel. Can be done directly by actually watching the
person do the task or indirectly by having knowledge of seeing them previously
perform the task.

Personal accountability - one of biggest questions concerning teamwork and

delegation. It's being answerable for actions and standing behind it?

What are you accountable for as the delegator:?

1) making decision to delegate task
2) assess patient's needs

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3) plan desired outcomes
4) assess competency of delegate by observing 1st, know job description
5) give clear directions and obtain acceptance of the task
6) follow up on completion of tasks and provide feedback to delegate

What can you not delegate?

1) assessment that id's needs and problems and dx human responses
2) any aspect of planning including the development of comprehensive
approaches to the total care plan
3) any provision of health counseling, teaching, or referrals to other health care
providers
4) therapeutic nursing techniques and comprehensive care planning

What are some important nursing responsibilities in terms of delegating the RIGHT
TASK:
1) determining what's needed and if it's a task that can be delegated to someone
else
2) be familiar w/ nurse practice act
3) know job description, skills lists, and competency of delegate
4) consider what can and can't be delegated s/a assessment, planning, nursing
diagnosis, and teaching
5) be sure to match the right person w/ the right task

What are some important nursing responsibilities in terms of delegating to the

RIGHT PERSON:
Focus on outcomes and strengths and weaknesses of team members and once
again match right task to right person

What are some important nursing responsibilities in terms of delegating w/ the

RIGHT COMMUNICATION:
1) clearly comm pt outcomes and expectations which determines success of the
delegated task and teams performnce
2) achievement of pt outcome is dependent upon the direction you give and how
it's given
3) don't assume others know what you need (they're not mind readers)

What are some important nursing responsibilities in terms of providing the RIGHT
FEEDBACK to delegate:
1) ask for their input 1st
2) give them credit for their effort
3) agree on future plan and revisit it
4) share perceptions with one another
5) explore different viewpoints, focusing on outcomes
6) ask for other's input to determine steps to ensure you attain desired outcome

true/false: the RN is fully responsible and accountable for the tasks delegated to

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someone?
False. The RN IS accountable but the delegate is accountable for accepting the
task and not following through w/ it

What are the 4 c's of clinical delegation?

Clear (do they understand),
Concise (too much info=confusion),
Correct (according to policy),
Complete (all info)

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