Nursing leadership having difficult conversations
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Nursing Leadership:  Having Difficult Conversations. . Karren Kowalski, PhD, RN, NEA-BC, FAAN Grant, Project Director Colorado Center for Nursing Excellence Public Health Nursing Webinar July 29,2010 . Objectives:.

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Nursing Leadership:  Having Difficult Conversations.

Karren Kowalski, PhD, RN, NEA-BC, FAAN

Grant, Project Director

Colorado Center for Nursing Excellence

Public Health Nursing Webinar

July 29,2010


Objectives:

Describe communication and why poor communication can be problematic in the workplace.

Explain three types of communication filters.

Define human reactions seen during a conflict or difficult situation.

List communication tools used in working with peers and staff to provide constructive feedback.


Communication

  • Words 7%

  • Tonality 35%

  • Facial & Body Language 58%


Humans Communicate:

  • Thoughts

  • Ideas

  • Opinions

  • Feelings

  • Emotions


Poor Communication Leads to:

  • Relationship Breakdown

  • Misunderstandings

  • High levels of emotion

  • Judgement

  • High Drama

  • Incivility


In the workplace:

  • Very little focus

    placed on communication

  • Yet it is essential

    for smoothly

    functioning teams


Goleman’s Framework for Emotional Competencies


Communication Filters

1. MENTAL STATE

  • Frame of Mind

    • Optimism vs. Pessimism

      • Affects information processing

      • Affects ability to focus on “present moment”

    • Assumptions

    • Intentions and Hidden Agenda

    • Judgments of Self & Others

    • Belief systems


2. Emotional States

  • Negative feelings about job, co-workers etc.

    • Insecurity

    • Threats

    • Stress

    • FEAR

    • Ego Needs (for approval, perfection, need to be right)

    • Unhealed Wounds


Emotional States (cont)

  • Positive feelings: (tend to be more resourceful, easy going, open to change)

    • Joy

    • Delight

    • Hope

    • Humor/laughter


3. Current State of the Relationship

  • Positive relationships are the foundation of Human Enterprise

  • Quality of relationships effects

    productiveness of the team

  • Unresolved conflicts destroy teams


Definitions:

  • Relationship - the state of being related or connected or bonded together

  • Conflict - competitive or opposing

    action of incompatibles: antagonistic state or action, opposing needs, drives, wishes or demands

  • Confront - to face especially in challenge; meet or bring face to face


Awareness Model

  • Difficult person

  • Difficult situation

  • Conflict Empowerment:

    • Being bigger than the situation in which you find yourself

    • It’s a Choice


Stimuli for upset or reaction:

OUTSIDE Trigger: an action by another person or by yourself

The responding Feeling is Inside

“You Make me Feel so …..


Automatic Reactions

Stress or Fear (buttons are pushed)

Unconscious – fight or flight

Create list of responses/reactions

  • Panic, Defensive, Frustrated, Resentment,

  • Defensive, Victimized, Sabotaged, Threatened

  • Anger, Negative, Self-righteous, Attack, Annoyed

  • Blamed, Sarcastic, Freeze, Clam up, Withdraw,

  • Counterattack, Walk, Denial


Patterns or Cow trails

Raised adrenalin Leads to:

  • Assumptions – we act on them

  • Examples:

    • Fused in my car

      (other drivers)


We can go through life reacting to:

External World

vs.

Responding Creatively


IN REACTION

  • FEEL BLAME “You make me Feel ……. “

  • THINK JUDGMENT “I think You’re a Jerk”

  • WANT DEMAND “Why don’t you

    get a life?”


Awareness Model


Awareness Model (continued)


Communication Practice Session

identify feelings or sensations

I’m feeling

refer to your perspective of the situation, check assumptions

I think

identify what you want from the relationship or situation

I want

How I’d like to work together is


When correction is needed: ARC STATEMENT

A = Action the person has taken

R = Reaction from the administrator/leader

C = Consequences or impact on other team members

Can you see how this negatively impacts the team?


ARC STATEMENT


references

American Association of Critical-Care Nurses (AACN) & VitalSmarts. (2005). Silence kills: The seven crucial conversations for healthcare. San Francisco: The American Association of Critical-Care Nurses.

Druskat, V., & Wolff, S. (2001). Building the emotional intelligence of groups. Harvard Business Review,79(3), 81-91.

Jason, H. (2000). Communication skills are vital in all we do as educators and clinicians. Education for Health,13(2), 157-161.


Morreale, S., Spitzberg, B., & Barge, K. (2001). Human communication: Motivation, knowledge, & skills. Belmont, CA: Wadsworth.

Nemeth, C.P. (2008). Improving Healthcare Team Communication: Building on Lessons from Aviation and Aerospace. Aldershot, UK. Ashgate Publishing.  Ltd.

Patterson, K., Grenny, J., McMillian, R.; & Switzler, A. (2002). Crucial Conversations: Tools for Talking When Stakes are High. New York, NY; McGraw-Hill.


  • Patterson, K., Grenny, J., McMillian, R.; & Switzler, A. (2004). Crucial Confrontations: Tools for talking about broken promises, violated expectations and bad behavior. New York, NY: McGraw-Hill.

  • Porter-O’Grady, T. (2004a). Constructing a conflict resolution program for health care. Health Care Management Review,29(4), 278-283.

  • Porter-O’Grady, T. (2004b). Embracing conflict: Building a healthy community. Health Care Management Review, 29(3), 181-187.


QUESTIONS and ANSWERS

Karren Kowalski, PhD, RN, NEA-BC, FAAN

Contact via email:

[email protected]

Nursing Continuing Education credits are available for

30 days following the live presentation. In order to

receive your evaluation form and nursing contact hour

certificate please email your: name, state, email

address to: Patti White, MAPHN at

[email protected]


Acknowledgements

  • New England Alliance for Public Health Workforce Development

  • Boston University School of

    Public Health

  • Massachusetts Association of Public Health Nurses (MAPHN)


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