By: Mae G.

Marcojos, RN

 Define verbal communication and non verbal communication List down the components of communication process using a diagram direction Discuss the ten basics for good communication Use an assertive style of communication using the nurses Bill of Rights as identified by Hermann and differentiate between aggressive and passive style of communication List down common blocks to communication and discuss on how to improve them Use through examples the common patterns of communication networks.

What is Communication?
Communication by definition is the transfer of information and understanding from one person to another.

Elements of Communication

Sender Message receiver

The Message

What you are trying to convey through verbal or non-verbal Words mean different things to different people.

Nonverbal behavior

The Message
1. 2. 3.

Verbal WHAT Non -verbal HOW Communication climate

Positive-enhances the message Negative-detracts from understanding the message.

Components

Encoding Transmission. Decoding The response, or feedback The nurse leader or manager uses communication skills in all aspects of organizational life. Appropriate manner of communication process is essential.

Basics for Good Communication

1.

2.

Clarify your ideas and analyze your thoughts. Provide an opportunity for questions and answers Consider the setting, both physical and psychological

Climate Behavioral Characteristics

Listening Supportive Empathy Climate Acceptance Shared problem solving attitude Openness Evaluating Defensive Advice giving Climate Superiority

Positive Climate

The value of a positive communication climate is that it fosters behaviors among the leader and followers that lead to trustful and cooperative working relationships. It is a kind of climate that will foster innovations in the work place, making change a possibility.

Basics for Good Communication cont

3. Consult with others when necessary to be exact and objective. 4. Be mindful of the overtones as well as the message itself. 5. Take the opportunity to convey something to help, value, or praise to the receiver. 6. Follow up your communication

Basics for Good Communication cont.

7.

8.

9.

10.

Be sure your actions support your communication. "What I say. I do". Be an active listener. Practice what you preach. Give credit for the contributions of others when genuinely deserved. Be assertive when expressing your view.

Nurse's Bill of Rights by Herman

The right to be treated with respect The right to be listened to The right to have and to express thoughts, feelings, and opinions The right to ask questions and to challenge The right to understand job expectations as well as have them written The right to say "no" and not feel guilty The right to be treated as an equal member of the health team The right to change one's mind

Nurse's Bill of Rights by Herman cont.

The right to ask for change in the system The right to have a reasonable workload The right to make a mistake The right to make decisions regarding health and nursing care The right to initiate health teaching The right to be a patient advocate or to help a patient speak for himself or herself

Assertive VS Aggressive

direct and clear Listen to others objective words direct eye contact spontaneous verbal expressions well-modulated voice based on selfrespect and consideration for other people.

concerned with the rights of one position loud, inappropriate, confronting, or hostile. Subjective Confronting, sarcastic, Verbal approach with an air of superiority and rudeness Belittles others The rights of others not considered.

Passive

Not consider any rights Uninvolved or unable to share thoughts withdrawn and shy or purposefully withholding

Things to remember:

Communication is an essential hallmark of health care. Leader and followers have a basic right to give and to receive information in a professional manner. Communication skills grow and develop over time and are the means by which leadership is exercised. Communication does not necessarily mean agreement or harmony over every issue but is

Blocks to Communication

prevent the message from being delivered or understood. Some common reasons for blocks to communication are:
poor listening habits Psychological blocks, Environmental distractions Semantic barriers (Davis).

Blocks to communication are the reason why people leave meetings with half messages and incomplete or inaccurate information.

Listening Skills

Active listening begins as you give full attention to the person speaking. This means that you listen carefully with your mind as well with your gestures and facial expressions. Active listening will enhance the understanding of messages

Psychological Blocks

When an individual hears something that produces a profound emotional reaction. An intense response to communicated message very likely will produce a block to the rest of the message. Emotions are powerful forces that may interfere with reason and must be recognized and respected before constructive communication may continue.

Environmental Distractions

Considered to be a block to communication when it interferes with the communication process.

Semantic Barriers

Since words are symbolic, their meaning is subject to multiple interpretations. The leader should try to be aware of the choice of words or phrases Using messages in the proper context will reduce misinterpretation.

Communication Networks

MANAGEMENT CONFLICTS

By: Mae G. Marcojos, RN

Objectives:

Identify aspects of your professional role that predisposes to conflict with nurse administrators or physicians Analyze an ongoing conflict in your organization and identify the manifest conflict, the felt conflict, antecedent conditions and internal and external factors influencing the conflict. Differentiate the three common methods of conflict resolution Elaborate the different ways of conflict management and identify the most preferred of conflict management

Conflict Resolution

Conflict is inevitable In health care organizations the potential for conflict is HEIGHTENED. WHY?

What is Conflict?

Expressed struggle between at least two interdependent parties, who perceive incompatible goals, scarce rewards, and interference from the other party in achieving their goals. They are in a position of opposition in conjunction with cooperation.

It produces a

feeling of tension,

5 characteristics of a conflict situation

1.

2.

3.

4.

5.

at least two parties are involved in some form of interaction difference in goals and/or values either exists or is perceived to exist by the parties involved the interaction involves behavior that will defeat, reduce, or suppress the opponent, or gain a victory the parties come together with opposing actions and counteractions each party attempts to create in imbalance, or favored power position (Filley, 1975).

Inter-group conflicts

occur between two small groups, two large groups, or between a large group and a small group. Has certain predictable consequences. Cohesiveness increases, but members become more task oriented and less concerned with the needs of individual members. Autocratic group leader Highly structured

Inter-group conflicts

Increased cohesion increase production Stereotyping and hostile behaviors destructive

Conflict management strategies

should therefore be used to ensure that the conflict will have a HEALTHY OUTCOME.

Personal-Group Conflicts

Conflicts between an individual and a small group or between an individual and a large group are In this type of conflict an

Intrapersonal Conflicts

Disagreement within him-or herself. May result from having to make a choice between two things of generally equal value Management of intrapersonal conflict MUST COME from the individual involved.

Conflict Resolution Theory

Filley 1975 argues that the conflict resolution process moves 6 steps: (1) antecedent conditions (2) perceived conflict (3) felt conflict (4) manifest behavior (5) conflict resolution or suppression (6) resolution aftermath

Antecedent Conditions

certain conditions exist which can lead to conflict, though they do not always do so. Conflict may develop from a number of antecedent sources, including:
Incompatible goals Distribution of scarce resources when individuals have high expectations of rewards Regulations, when an individuals need for autonomy conflicts with anothers need for regulating mechanisms Personality traits, attitudes, and behaviors

Antecedent Conditions con

Interest

in outcomes

Values
Roles,

when two individuals have equal responsibilities but actual boundaries are unclear, or when they are required to simultaneously fill two or more roles that present inconsistent or contradictory expectations. Tasks, when outputs of one individual or group become inputs for another individual or group, or outputs are shared by several individuals or groups.

Perceived Conflict

Two or more individuals logically and objectively recognize that their aims are incompatible.

Felt Conflict

Individuals experience feelings of threat, hostility, fear or mistrust.

Manifest Behavior
OVERT action or behavior takes place - oppression, competition, debate, or problem solving. 2 kinds of behaviors in response to perceived and felt conflict:

(1) Conflictive behaviors (Negative) (2) Problem solving behaviors (Positive)

Conflict Resolution or Suppression

the conflict is resolved or suppressed either by all parties' agreement or else by the defeat of one party.

Behavior directed toward the resolution of conflict can be characterized by 3 different communication strategies:
Win- Lose Common (2) Lose- Lose Avoid (3) Win -Win. Suppressing but not sacrificing needs
(1)

Resolution Aftermath

Individuals experience or live with the consequences of the Resolution During this phase, participants experience feelings directly related to the outcomes of the resolution process. If the conflict is resolved in a positive or negative fashion

Conflict Process

Conflict Management /Styles of Approaching Conflict/

Do individuals have different ways of handling conflict? In addition, how do the styles employed by individuals affect the outcomes of the conflicts?

Interpersonal Conflict 5 styles by Kilmann and Thomas (1976)

(1) Avoidance (2) Competition (3) Accommodation unassertive but cooperative (4) Compromise not ignore neither struggle (5) Collaboration assertive and cooperative
Effective

communication

Compromising Innovative solutions are sacrificed in favor of quick solutions.

STAFF DEVELOPME

What is Staff Development ?

PROCESS directed towards the personal and professional growth of nurses and other personnel while they are employed by a health care agency. Refers to all training and education provided by an employee to improve the occupational and personal knowledge, skills and attitudes of vested employees.

Staff Development

A process consisting of orientation, in-service education and continuing education for the people of promoting the development of personnel within any employment setting, consistent with the goals and responsibilities of the employment.( ANA)

Why do we need Staff Development?

Social change and scientific advancement Advancement in the field of science like medical science and technology. To provide the opportunity for nurses to continually acquire and implement the knowledge, skills, attitudes, ideals and valued essentials for the maintenance of high quality of nursing care:
As

part of an individual's long-term career growth. To add or improve skills needed in the short term

Why do we need Staff Development? Cont.

Being

necessary to fill gap in the past performance To change or correct long-held attitudes of employee Need to increase the productivity and quality of the work. To motivate employees and to promote employee loyalty Fast growing organizations.

Goals
Assist each employee (nurse) to improve performance in his/her position. Assist each employee (nurse) to acquire personal and professional abilities that maximize the possibility of career advancement.

Objectives
To increase employee productivity. To ensure safe and effective patient care by nurses. To ensure satisfactory job performance by personnel.

Objectives cont.
To orient the personnel to care objectives, job duties, personnel policies, and agency regulations. To help employees cope with new practice role. To help nurses to close the gap between present abilities and the scientific basis for nursing practice that is broadening through research.

Steps of staff development program

Assess the educational needs of all staff members Set priority Develop general objectives for the staff development program Determine the resources needed to reach the desired objectives Develop a master calendar for an entire year Develop and maintain staff development record system Establish files on major educational topics

Resources:

Public libraries, Audiovisual program in addition to many books and computers, research activities and speakers to community groups. Schools and universities Association Health and inter service agency Other nursing homes Ones own staff

Types of Staff Development

Induction training

Job orientation

In-service education

Continuing education

Training for special function

Induction Training

It is a brief, standardised indoctrination to an agencys philosophy, purpose, policies and regulations given to each worker during her or his first 2 or 3 days of employment in order to ensure his or her identification with agencys philosophy, goals and norms.

Why do we need Induction Training? Increased retention of newly hire employees, Improved employee morale and Increased productivity.

Steps of Induction:
2. Introduction to the other employees, superiors and subordinates.
5.

1. Tour of facilities
4. Departmental visit

3.

Descripti on of organizational functions.

Orientation to philosophy goals and objectives

6. Administratio n policies and procedures

Job Orientation

Individualised training programme

intended to ACQUAINT a newly hired employee with job responsibilities work place, clients and co-workers.

The process of creating awareness with an individual of his/her roles, responsibilities and relationships in the new work situation.

Components
A new employee to his or her job setting to aware her job responsibility and expectation. Present employee to the job responsibilities of his/ her expanded and enriched role. The old employees to the policy changes.

Types of Orientation

General orientation Specific orientation

Importance of orientation programme

Provides essential, relevant and necessary information Helps employee to gain confidence, Lessen the time for the employee to learn about new situations related to his/her job setting. Helps the new employee to develop a sense of belonging

Eliminates:

Learning by trial and error Passing of incorrect information by old employees and peers. Reduces misinterpretation Mistakes and confusion Apprehension Help new employee in solving initial problems and adjust the new situation/environment, Acquaints her with personnel services readily with in the institution/community

Content of Orientation Program

The organisation and its environment Policies, rules and regulation

Personnel
Functions to be undertaken

Service

In-Service Education

Planned learning experience provided by the employing agency for employees. planned educational experience provided in the job setting and closely identified with services in order to help person perform more effectively as a person and as a worker.

Concept of in-service education

Closely identified with services Help a persons to improve performance effectively Planned education activities Provided in a job setting

Why do we need In-Service Education?

Social changes and scientific advancement Changes and advancement in the field of service Increased the demand of nursing services. Consumer demand quality care

Why do we need In-Service Education? Cont.

Rapid changes in medical and nursing practice create a need for in service education As health care delivery system become more complex, the need for continues skill training also increased.

Aims
Improvement of client through upgrading the services rendered with scientific principles. To keep in face in changing society to their needs. Acquisition of new knowledge Improvement of performance To develop specific skills required for practice.

Aims cont.

To develop right concept of client care. To maintain high standards of nursing To observe and bring change in staff members chances for promotion It reduces turnover, absenteeism. To discover potentialities, to alert personnel in working environment.

Types of In-Service Training

Centralized in-service training one department will held responsibility for improvement of knowledge, skills, practice of their nursing staff. They will devote full time for in-service activities.

Types of In-Service Training

Decentralized in-service education Planned for staff members who work together, giving care for clients with similar conditions and share similar goals.

Types of In-Service Training

Combined in-service approach higher nursing authorities and all staff development occurs in proposed programme of education. They plan, conduct and evaluate the programme and further plan their programme basing on the need arises.

Steps in in-service education:

Assessment: Pinpoint needs, prioritize needs, set training objectives, and develop criteria Implementation: Climatic check, actual conduction of training with ongoing monitoring

Steps in in-service education cont.

Evaluation: Establishment of criteria, pre test to the participants, post test following completion of the training or program. Observation on transfer of learning to the job, follow up studies for assessment of extent of retention of learning.

Continuing Education:
Continuing education is all the learning activities that occur after an individual has completed his/her basic education. (COOPER) The education which builds on previous education. (SHANON)

Why do we need Continuing Education? To ensure safe and effective nursing care as nurses need to keep abreast with interest, knowledge and technical advances. To meet the needs of population. To develop the nurses by updating their knowledge and

Why do we need Continuing Education? Cont.

For career advancement. With the advancement of technology, new role change takes place and to play those roles, education is required. To acquire special skills. Due to shortage of nurses (because their movement to abroad, more hospital and training college), more knowledgeable person is required.

Functions of Continuing Education: To meet the health needs and public expectations. To develop the practicing abilities of the nurse. To recognize gaps in knowledge. To test abilities of participants to do formal academic study.

Functions of Continuing Education cont.

To improve the communication between the participants, faculty, community and health sector. To shape or support university educational policies and practices. To ensure the quality of education. To grant the budget for extension studies. To maintain the academic standards. To provide opportunities for educational growth.

Functions of Continuing Education cont.

To maintain the roles as bed side nurses and to assume more supervisor, administrative, to specialize and to generalize the practice. To provide and prepare faculty who see continuing nursing education as a personal responsibility. To provide a variety of continuing nursing education opportunities of high quality to nurses in both education and service

Training for Specific Function

developing expert technical or manual skills, communication and helps the personnel to perform their functions effectively.

Objectives:
To help the nursing personnel to perform correct methods and procedures with understanding. Establishing standards and quality of nursing services. Procedure to skill nurses to skilled nurses.

Types of Skills:
Psychomotor skill

Cognitive skill
Teaching skills Affective skill Communication skill Supervisory skills

Why do we need Skill Training?

Individual nurse needed to have greater freedom to choose the specific field of nursing in which she would work. Good work to be recognized and reward. A venues of advancement and promotion need to be better development Fear of making mistakes

Standards of staff development programme (ANA)

Standard 1 Organization and Administration

The nursing service department and the nursing staff development unit philosophy, purpose and goals address the staff development needs of nursing personnel.

Standard II Human Resources

Qualified administrative, educational and support personnel are provided to meet the learning and developmental needs by nursing services personnel.

Standards III Learner

Nursing staff development educators assist nursing personnel in identifying their learning needs and planning learning activities to meet those needs.

Standard IV Program Planning

Provides the unit systematically, plans and evaluate the overall nursing staff development program in response to health care needs.

Standard V Educational Design

Educational offering and learning experience are designed through the use of educational process and incorporate adult education and learning principles.

Standard VI Material Resources And Facilities

Material sources and facilities are adequate to achieve the goals and implement the functions of the overall nursing staff development unit.

Standard VII Records And Reports

The nursing staff development unit establishes and maintains a record keeping and report system

Standard VIII Evaluation

Evaluation is an integral ongoing and systematic process, which includes measuring the impact on the learning

Standard IX Consultation

Nursing staff development educators use the consultation process to facilitate and enhance achievement of individual, departmental and organizational goals.

Standard X Climate

Nursing staff development educators foster a climate which promotes open communication, learning and professional growth.

Standard XI Systematic Enquiring

Nursing staff development educators encourage systematic inquiry and applications of the results into nursing practice.

Potential difficulties in staff development & training activities:

Lack of time Inadequate resources at disposal Under-funded training budgets Conflicting priorities Lack of Clarity about what should be done

Potential difficulties in staff development & training activities cont.

Failure to identify, or accept the need. Shortfall in training skill or experience Fear that trained employee will leave the organization or will be poached by competitor. Cynical attitude to Staff developmentNot directly measurable. Treated as Cost not investment.

Methods of delivering staff development programme:

Induction

Physical tour of the faculities

Group discussion

Seminar

Hand book and pamphlet

Job orientation
Orientation Seminar

Discussion
Hand out or book and pamphlets

In-service education
Orientation Skill training Continuing education Leadership training

Continuing education

Lecture

Journal club

Seminar

Demonstration

Book review

Correspondence course

Formal course

Clinical research

Training for skill

Demonstration

Discussion

Role-play method.

DECISION MAKING

Decision Making
Objectives: Describe the types of decisions Explain the mechanisms of decision-making Discuss the steps of logical decision-making Identify the factors responsible for decisionmaking Discuss the importance of decision making for nurse managers? Recognize the decision-making tools Explain the barriers for decision-making and mechanisms of overcoming it

What is Decision Making?

a choice made between two or more alternatives It is choosing the best alternative to reach the predetermined objective. Thus decision making is a process of identifying and selecting a course of action to solve specific problem

Types of Decisions

Decisions made in the nursing service can be categorized depending upon the following criteria: How much time the manager spends in making decision What proportion of the organization must be involved in making decision The organization function/ the nursing/midwifery functions on which they focus

3 Classifications
On the basis of these there are three classifications: 1. Ends -Means 2. Administrative-Operational 3. Programmed-Nonprogrammed

1. Ends-Means

Ends: deals with the determination of

desired individual or organizational results to be achieved

Means: decisions deal with strategic or

operational programmes, activities that will accomplish desired results. These usually occur during managerial planning processes, strategy and objective formulation processes

2. Administrative-Operational

Administrative: made by senior

management, which have significant impact throughout the organization. Usually this type of decision is concerned with policy, resource allocation and utilization.

Operational: are generally made by

mid level and first line managers and address day to day operational activities of a particular organizational

3. Programmed-Non programmed

Programmed-these are repetitive

and routine in nature. Since they can be programmed, procedures, rules and often manuals are formulated to cover those situations None programmed: unique and non- routine

Conditions that initiate decision making 1. Opportunity/threat 2. Crisis 3. Deviation 4. Improvement

Ways of Decision Making

1. Relying on tradition: taking the same decisions that had been undertaken when similar problem arouse in the past 2. May appeal to authority and make decisions based on suggestions from an expert/a higher level management 3. Priority reasoning: based on assumption 4. Logical decision making: is a rational, intelligent and systematic approach to ndecision making

Steps of logical Decision Making

1. Investigating the situation

Define the problem

Identify the problem objective Diagnose the cause

2. Develop alternatives 3. Evaluate alternatives 4. Implement and follow up

Factors Influencing Decision Making

1. Decision makers attribute

Knowledge, experience, and judgment Perception and personality Values and philosophy

Factors Influencing Decision Making cont. 2. The Situation

Urgency of solution and time pressures Magnitude and importance Structure and uncertainty and risk Cost benefit

3. Environmental Constraints
External

Internal

Encouraging creativity
Convergent thinking-the problem is divided into smaller and smaller pieces to find a more manageable perspective. Divergent thinking: One's view of the problem is expanded. The problem is considered in different ways Brain storming: under favorable circumstances a group working together can identify more ideas than an individual or the group of individuals working separately. It is a technique managers can use to create a

Decision Making Tools

1. Probability theory - is the likelihood that an event or outcome will actually occur and allow decision makers to calculate an expected value for each alternative. Expected Value (EV) = Income it would produce (I) x its probability of making that income (P).

2. Decision tree - are graphic decision making tools used to evaluate decisions containing a series of . steps

Deciding to decide
1. Is the problem easy to deal with Tip: avoid being bogged down in trivial details. Effective managers reserve decision making techniques for problems that require them. 2. Might the problem resolve itself Tip: prioritize and rank problems in order of importance

Deciding to decide cont.

3. Is it my decision Tip: the closer to the origin of the problem the decision is the better. Before deciding ask the following questions: Does the issue affect other departments? Will it have a major impact on the superior's area of responsibility? Does it need further information from higher level?

3 Is it my decision cont.
Does

it involve serious breach of my departments budget? Is this problem outside my area of responsibility or authority?

If the answer to any of these questions is 'YES' pass it to your superior.

Barriers to Effect DecisionMaking

1. Easy recall: the more easily can

recall the event, the more frequently they believe it occur

2. Easy search: not to put effort to

seek information from the appropriate sources

3. Misconception of chance:
Most people do not understand the nature of random solution based on past

Barriers to Effect DecisionMaking cont.

4. Confirmation gap 5. Relaxed avoidance: the manager decides not to decide or act after noting that the consequences of inaction will not be serious

Barriers to Effect DecisionMaking cont.

6. Defensive avoidance: Faced with a problem and unable to find a good manager seeks a way out. He/she may let someone else make decisions. This resigned posture may prevent consideration of more viable alternative 7. Panic: the manager feels pressurized not only by the problem but also time

Overcoming barriers to individual problem solving 1. Setting priority 2. Acquiring relevant information 3. Proceeding methodically and carefully

THANK YOU FOR LISTENING!