Leadership and Management Nursing 1

Communication

Supervisor: S. Haeriyanto, SKM., Mkep.

Member of Group
Harry Suryani Intan Yuanita Nurliza Permata Sari Siti Robiah

Effective communication consists of transmitting an accurate message to the proper recipient at the appropriate time in manner that conserves the senders and receivers energy, followed by checking to ensure that the intended message was received.

David Berlo (1960)

David Berlo proposed a linear model of communication act contains the following elements: Source Message Channel receiver

Linear model of communication act contains the following elements: Source

Message

Channel

Receiver

Source
The source or initiator characteristics that influence effectiveness are: Communication skill Knowledge Attitudes Cultural background

Message
The message effectiveness are: Structure Content Code Treatment characteristics that determine

Channel
Of the following channels, one may be more effective than another for a particular communication: Sight Hearing Touch Taste Smell

Receiver
Receiver characteristics that influence effectiveness are: Communication skills Knowledge Attitudes Cultural background

Drucker (1974)
Drucker argued that the receiver is the most important element in the foregoing four step communication requires a sharing of experience between message sender and receiver.

Shannon and Weaver (1949)

Circular model of the communication process that included the four elements, plus three additional ones: signal, noise, and feedback. Feedback

Sender

noise

Message

noise

Receive

Feedback

Fritz et al. (1984)

Communication climate may facilitate or inhibit communication. Climate variables that influence message transmission are trust between sender and receiver, message ambiguity, senders and receivers valuing of each other, emotional separation between sender and receiver, senders empathy for receivers perceptions, threat perceived by sender or receiver, and fixed views of sender and receiver

Dance (1967)
The key principles for effective communication of work related information: 1. Communication is a process, rather than a single event. 2. The communication process is frequently impaired by noise (unintended additions, distortions, or deletions of message content), a problem that can be eliminated by feedback, which clarifies the receivers perceptions of transmitted symbols. 3. Communication is intrapersonal as well as interpersonal. 4. Communication is nonverbal as well as verbal. Nonverbal communication gesture, posture, facial expression, bodily movement, position relative to other, clothing, grooming, accoutrements.

Levson and Guy (1989)

Social psychological factors impair message transmission, even between willing and wellmeaning communications. Among them: 1. Homophyly 2. Chain of command 3. Frame of reference 4. Self preservation 5. Crisis

Tuckman (1965)
The group communication process as consisting of four stages: 1. Forming 2. Storming 3. Norming 4. Performing

Forming Stage
In the forming stage, members communicate to decide who is to lead the group and what tasks the group is to accomplish.

Storming Stage
In the storming stage, conflict develops, as members discuss what work rule will govern them and which member will be responsible for each task.

Norming Stage
In the norming stage, members achieve cohesion and relief at overcoming their earlier conflict.

Performing Stage
In the performing stage, members carry out their assigned tasks while communicating commitment to group goals and to one another.

Communication Principles

The following principles are useful in determining the content and media of the managers written and spoken communications with care givers: Workers tend to see and hear messages that are compatible with their expectations and predispositions. Workers who read about a topic are more inclined to listen to a message on the same topic. The effectiveness of different media varies with the workers education level. The higher the education, the greather the reliance on print. The lower the education, the greater the reliance on aural and pictorial media.

 The more trustworthy or prestigous the communicators, the less manipulative he is considered to be by message receivers Majority opinion is more effective in changing worker attitudes than expert opinion Communication of facts is usually innefective in changing opinios against a workers strong disposition Workers with low self-esteem are more likely to be influenced by persuasive communication than those with high self-esteem

THEORY OF TRANSACTIONAL ANALYSIS

Techniques of transactional analysis have been used to categorize, understand, predict, and alter behaviour of sick and well persons. As a therapeutic intervention, transactional analysis investigates ways in which people structure time so as to obtain recognition from other. Unlike psychoanalysis, transactional analysis assumes that a person can analyze his or her own problems and can learn to express feelings honestly ina group situation. We focus here on interpersonal interaction patterns.

INTERPERSONAL TRANSACTIONS
According to berne, each person enganges in transactions with others to obtain strokes. A transaction consist of some sort of stimulus by one person, followed by some sort response by another. A stroke is a positive or negative unit of recognition between people: a word, phase, gesture, or facial expression. The following are positive stroke: a smile, pleasant greeting, compliment, pat on the back, letter of comendation, or pay raise. Some examples of negative strokes are: a frown, insul, reprimand, shove, or disciplinary letter.

TYPES OF INTRAPERSONAL TRANSACTIONS

Persons engange in the following types of transactions to satisfy stroke hunger and structure time: withdrawal, rituals, activities, pastimes, games, and intimacy. Through with drawal the individual removes himself from transactions with others. When withdraw is temporary, as in daydreaming, the effect is harmless. When profound psychological pain causes a person to withdraw permanently from other. Psychological health is impaired.

 A ritual is a socially programmed performance by several persons in whic each regulates his or her involvement with the group. Some common rituals are church services, cocktail parties, club meetings, birthday celebrations, and perfunctory sexual performaces.

Life Positions
According to harris, each person relates to others from one of four life positions (harris 1969) 1. I'm Not OK, you're OK This position results from the inferior position of the child relative to his parents and negative, feelings experienced during the parent's effort to civilize him or her. A person who retains this inferior position through out life engages in game playing to obtain strokes and maintain security. 2. I'm Not OK, you're Not OK This position results when the not ok child is abandoned by a cold and uncaring parent during the second year of life. The lack of stroking that produce this life position interferes with development of the adult state, so the person's hold on reality is tenuous.

3. I'm OK, you are not OK This life position develops in the child who is brutalized by his or her parents and survives. The person believes that he can be OK if his or her parents will only of him or her alone. This position has an internal parent who permits him or her to treat others cruelly, that is has psychopathic tendencies. 4. I'm OK, you're OK An uncaring or a brutal parent converts the child to the second or third life position respectively. Once a child has selected a life position, he or she operates from that position throughout life, unless he or she consciously adopts the fourth life position. Transactional analysis enables a person to identify the ego state from which he to adopt and motivates him or her to adopt the I'm OK you're OK position.

Management application for transactional analysis

Transactional analysis can help a nurse manager to lead and control subordinates. Thee origin of all child and parent responses is the not OK position on which each person begins life. Therefore, when stress exacerbates feelings of helplessness in either manager or subordinate and the person is faced with equally undesirable alternatives. When feeling of inadequacy develop in an area where the person has stored unexamined parental admonitions and rules, the critical parent is activated. Traditional methods of nursing education predispose of transactional problems. Some professional programs overemphasize a need for efficiency to the point that adult state is overdeveloped. Other programs so overemphasize the protective function of nursing that the parent state becomes overdeveloped. Few professional programs encourage the student nurse attend to her or his own needs and feelings, so that the student 's child state is neglected. Nurse managers often develop transactional problems with subordinates, because the hierarchical structure typical of many health agencies encourages supervisors to assume an authorization role and staff nurses to assume a subservient role.

 Nurses often experience transactional problems with physicians. In American society physicians have higher social status and greater personal authority than nurses. Consequently there is a tendency for physicians to address nurses in a controlling or critical manner and nurses to respond in a petulant. To maintain complementary transactions at this point, a nurse should shift from the nurturing parent to adult state interactions with the patient. Knowledge transactional analyses enables a manager to modify coworkers behavior to improve communication and increase productivity. A manager also needs an understanding of ego states to interpret and modify her or his own responses to patients and coworkers. In formation from the critical parent produces the compulsions and quirks that are responsible for each manager.

 One function of the adult state is to check the suitability of the old parent and child state data for the person's current life situation. A nurse manager may be unsuccessful because he or she follows a negative life script like ''sisyphus''. A manager may be successful, because he or she follows a positive life script like Florence . Thus transactional analysis can strengthen a person's adult ego state, thereby improving reality testing, outcome prediction, and decision effectiveness.

Communication levels
Klatt (1978) differentiates among four levels of communication in an organization. Top level a broadcast system distributes the same message in non personal fashion to all agency employees. The media used in the formal information system include video scream and computer print out messages, printed reports , telephone messages, graphs, and some conversational interchange. At third level of organizational communications that provide amplification, classification and feedback for the broadcast and formal information system. To enhance effectiveness of any level of organizational communication, managers must strengthen both in formational and relational aspects of the process.

Organization Double Bind

Wishbow (1987), theorizes that some communication difficulties in a complex organization arise from circumstances akin to the double-bind phenomenon. Bateson (1972), claimed that schizophrenia develops when a child is subjected to a double bind by receiving paradoxical messages from the mother, one meaning at the verbal level, a different meaning at the psychological level .

Three mall-scale change efforts may minimize the frequency or severity of the double-bind phenomenon in a nursing organization. 1.Defuse negative feelings by training employees in metacommunication skills or means of talking about the nature of double bind. 2.Decrease role ambiguity by training managers to construct explicit statements of role expectations for new employees. 3.Schedule frequent recreational and social events to provide opportunities for employees to express their emotional, irrational side.

Documentation of Care
Nurses documentation of care is often incomplete or inaccurate and is likely to be undervalued by nurses and other health professionals (Steckel 1976: Walker and Semanoff, 1964) Documentation of nursing actions and conclusions are probably nurses most important written communication. All health agencies establish formal policies governing time, content, nature, terminology, and form for nurses recorded observations diagnoses, interventions, and evaluations

Management Information Systems

In agencies with computerized MISs, Nurse managers receive monthly, weekly, or daily computerized report of patient admission and discharge, patient census, personnel hired, separated, and on payroll, personal work and absence hours, supply use, diet orders, ordered x-rays, patient infections, budget-account summaries and the like.

Managers find much of the information in these computerized reports irrelevant and distracting, because it relates to matter over which they have no control

Summary
The nurse managers principal activity is to communicate information, ideas, opinion, attitudes, and feelings to others to facilitate work, increase motivation, effect change, optimize care, increase satisfaction, and facilitate cooperation. Effective communication requires accurate perception and clear transmission of intended messages. A manager needs high-level listening, speaking, and writing skills. Techniques of message capping, transactional analysis and script analysis are helpful in clarifying covert messages transmitted by coworkers