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By: Mae G. Marcojos, RN


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Define verbal communication and non verbalcommunication

List down the components of communicationprocess 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 byHermann 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.


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What is Communication?

Communication by definition is the transfer of

information and understanding from one person

to another.


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Elements of Communication

Sender

Message

receiver


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The Message

What you are trying to convey through verbal

or non-verbal Words mean different things to different

people.

Nonverbal behavior


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The Message

1. Verbal WHAT

2. Non -verbal HOW

3. Communication climate Positive-enhances the message

Negative-detracts from understanding the

message.


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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.


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Basics for Good

Communication

1. Clarify your ideas and analyze your

thoughts. Provide an opportunity for

questions and answers

2. Consider the setting, both physical andpsychological


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Climate Behavioral Characteristics

Listening

Empathy

Acceptance

Shared problem solving attitude

Openness

Evaluating

Advice giving

Superiority

Supportive

Climate

Defensive

Climate


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Positive Climate

The value of a positive communication climate

is that it fosters behaviors among the leader

and followers that lead totrustful and

cooperative working relationships.It isa kind of climate that will foster innovationsin the work place, making change apossibility.


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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 GoodCommunication cont


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7. Be sure your actions support your

communication. "What I say. I do".

8. Be an active listener. Practice what you

preach.

9. Give credit for the contributions of others

when genuinely deserved.

10. Be assertive when expressing your view.

Basics for GoodCommunication cont.


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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 wellas have them written

The right to say "no" and not feel guilty

The right to be treated as an equal member of thehealth team

The right to change one's mind


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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 apatient speak for himself or herself


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Assertive VS Aggressive

direct and clear

Listen to others

objective words

direct eye contact spontaneous verbal

expressions

well-modulated

voice based on self-

respect andconsideration for

other people.

concerned with the

rights of one position

loud, inappropriate,

confronting, or hostile.

Subjective

Confronting,

sarcastic,

Verbal approach with

an air of superiorityand rudeness

Belittles others

The rights of others

not considered.


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Passive

Not consider any rights

Uninvolved or unable to share

thoughts

withdrawn and shy orpurposefully withholding


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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 timeand are the means by which leadership is

exercised.

Communication does not necessarily mean

agreement or harmony over every issue but is


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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).


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Blocks to communication are the reason why

people leave meetings with half messages

and incomplete or inaccurate information.


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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 facialexpressions.

Active listening will enhance the

understanding of messages


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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 tothe rest of the message.

Emotions are powerful forces that may

interfere with reason and must be recognizedand respected before constructive

communication may continue.


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Environmental Distractions

Considered to be a block to communication

when it interferes with the communication

process.


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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.


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Communication Networks


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CONFLICTS

By: Mae G. Marcojos, RN


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Objectives:

Identify aspects of your professional role thatpredisposes to conflict with nurse administratorsor physicians

Analyze an ongoing conflict in your organizationand identify the manifest conflict, the felt conflict,antecedent conditions and internal and externalfactors influencing the conflict.

Differentiate the three common methods of

conflict resolution

Elaborate the different ways of conflictmanagement and identify the most preferred ofconflict management


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Conflict Resolution

Conflict is inevitable

In health care organizations the potential for

conflict is HEIGHTENED. WHY?


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What is Conflict?

Expressed struggle between at least

two interdependent parties, who

perceive incompatible goals, scarce

rewards, and interference from the otherparty in achieving their goals.

They are in a position of opposition in

conjunction with cooperation.

It produces afeeling of tension,

h i i f fli


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5 characteristics of a conflict

situation

1. at least two parties are involved in some form ofinteraction

2. difference in goals and/or values either exists oris perceived to exist by the parties involved

3. the interaction involves behavior that will defeat,reduce, or suppress the opponent, or gain avictory

4. the parties come together with opposing actionsand counteractions

5. each party attempts to create in imbalance, orfavored power position (Filley, 1975).


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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 needsof individualmembers.

Autocratic group leader

Highly structured


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Inter-group conflicts

Increased cohesion increase production

Stereotyping and hostile behaviors

destructive

Conflict management strategiesshould therefore be used to ensure that the

conflict will have a HEALTHY OUTCOME.


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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


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Intrapersonal Conflicts

Disagreement withinhim-or herself.

May result from

having to make achoice between twothings of generallyequal value

Management ofintrapersonal conflictMUST COME fromthe individual

involved.


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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


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Antecedent Conditions

certain conditions exist which can lead toconflict, though they do not always do so.

Conflict may develop from a number of

antecedent sources, including: Incompatible goals

Distribution of scarce resources when individualshave high expectations of rewards

Regulations, when an individuals need forautonomy conflicts with anothers need forregulating mechanisms

Personality traits, attitudes, and behaviors


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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 groupbecome inputs for another individual or group, or

outputs are shared by several individuals or

groups.


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Perceived Conflict

Two or more individuals logically

and objectively recognize that

their aims are incompatible.


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Felt Conflict

Individuals experience feelings of

threat, hostility, fear or mistrust.


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Manifest Behavior

OVERT action or behavior takes place

- oppression, competition, debate, or problem

solving.

2 kinds of behaviors in response to perceivedand felt conflict:

(1) Conflictive behaviors (Negative)

(2) Problem solving behaviors (Positive)

Conflict Resolution or


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Conflict Resolution or

Suppression

the conflict is resolved or suppressed either byall parties' agreement or else by the defeat ofone party.

Behavior directed toward the resolution ofconflict can be characterized by 3 differentcommunication strategies:

(1) Win- LoseCommon (2) Lose- LoseAvoid

(3) Win -Win. Suppressing but not sacrificingneeds


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Resolution Aftermath

Individuals experience or live with the

consequences of the Resolution

During this phase, participants experience

feelings directly related to the outcomes of theresolution process.

If the conflict is resolved in a positive or

negative fashion


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Conflict

Process

Conflict Management /Styles of


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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 theconflicts?

I t l C fli t 5 t l b


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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 andcooperative

Effective communication


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Compromising

Innovative solutions are

sacrificed in favor of quick

solutions.


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STAFF DEVELOPM

Wh t i St ff D l t ?


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What is Staff Development ?

PROCESS directed towards the personal andprofessional growth of nurses and otherpersonnel while they are employed by a health

care agency.

Refers to all training and education providedby an employee to improve the occupational

and personal knowledge, skills and attitudes of

vested employees.


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Staff Development

A process consisting of orientation,in-service education and continuingeducation for the people of

promoting the development ofpersonnel within any employmentsetting, consistent with the goals and

responsibilities of the employment.(ANA)

Why do we need Staff


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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 qualityof nursing care:

As part of an individual's long-term career growth.

To add or improve skills needed in the short term



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Why do we need StaffDevelopment? Cont.

Being necessary to fill gap in the past

performance

To change or correct long-held attitudes of

employeeNeed to increase the productivity and quality of

the work.

To motivate employees and to promote employee

loyalty

Fast growing organizations.

Goals


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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.

Goals


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Objectives

To increase employee

productivity.To ensure safe and effective

patient care by nurses.

To ensure satisfactory job

performance by personnel.


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Objectives cont.

To orient the personnel to careobjectives, job duties, personnel

policies, and agency regulations.

To help employees cope with newpractice role.

To help nurses to close the gap

between present abilities and thescientific basis for nursing practice that

is broadening through research.

Steps of staff development


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Steps of staff development

program

Assess the educational needs of all staffmembers

Set priority

Develop general objectives for the staffdevelopment program

Determine the resources needed to reach thedesired objectives

Develop a master calendarfor an entire year Develop and maintain staff development

record system

Establish files on major educational topics

Resources:


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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


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Types of Staff Development

Induction

training

Job

orientation

In-service

education

Continuing

education

Training for

specialfunction


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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


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Why do we need Induction

Training?

Increased retention of newly hire

employees,

Improved employee morale andIncreased productivity.

St f I d ti


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Steps of Induction:

1. Tour of

facilities

2. Introductionto the other

employees,superiors andsubordinates.

3. Description of

organizationalfunctions.

4.Departmentalvisit

5. Orientation

to philosophygoals andobjectives

6. Administration policies andprocedures

J b O i t ti


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Job Orientation

Individualised training programme

intended to ACQUAINT a newly hiredemployee with job responsibilities work

place, clients and co-workers.

The process ofcreating awarenesswith an individual of his/her roles,

responsibilities and relationships in the

new work situation.

C t


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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 expandedand enriched role.

The old employees to the policy

changes.

T f O i t ti


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Types of Orientation

Generalorientation

Specificorientation

Importance of orientation


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Importance of orientation

programme

Provides essential, relevant andnecessary 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

Eli i t


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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 problemsand adjust the new situation/environment,

Acquaints her with personnel services readily

with in the institution/community

C t t f O i t ti P


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Content of Orientation Program

The

organisation

and its

environment

Policies,

rules and

regulation

Personnel

ServiceFunctions to

be

undertaken

I S i Ed ti


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In-Service Education

Planned learning experience

provided by the employing agency for

employees.

planned educational experience

provided in the job setting and closelyidentified with services in order to

help person perform more effectively

as a person and as a worker. C t f i i d ti


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Concept of in-service education

Closely identified with services

Help a persons to improve

performance effectivelyPlanned education activities

Provided in a job setting

Why do we need In-Service


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y do e eed Se ce

Education?

Social changes and scientific

advancement

Changes and advancement in thefield of service

Increased the demand of nursing

services.Consumer demand quality care

Why do we need In-Service


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y

Education? Cont.

Rapid changes in medical and

nursing practice create a need for in

service educationAs health care delivery system

become more complex, the need for

continues skill training also increased.

Aims


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Aims

Improvement of client through upgrading

the services rendered with scientific

principles.

To keep in face in changing society to theirneeds.

Acquisition of new knowledge

Improvement of performance

To develop specific skills required for

practice.

Aims cont


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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.

T f I S i T i i


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Types of In-Service Training

Centralized in-service training

one department will held

responsibility for improvement ofknowledge, skills, practice of their

nursing staff. They will devote full

time for in-service activities.

Types of In Service Training


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Decentralized in-service education

Planned for staff members who work

together, giving care for clients withsimilar conditions and share similar

goals.

Types of In Service Training


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Combined in-service approach

higher nursing authorities and all

staff development occurs in proposedprogramme of education. They plan,

conduct and evaluate the programme

and further plan their programmebasing on the need arises.

Steps in in service education:


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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


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p

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:


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Continuing Education:

Continuing education is all the

learning activities that occur after

an individual has completedhis/her basic education.

(COOPER)

The education which builds onprevious education. (SHANON)

Why do we need Continuing


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y g

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


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y g

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 andtraining college), more knowledgeable person

is required.

Functions of Continuing


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g

Education:

To meet the health needs andpublic expectations.

To develop the practicing abilitiesof the nurse.

To recognize gaps in knowledge.

To test abilities of participants todo formal academic study.



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Education cont.

To improve the communication betweenthe participants, faculty, community and

health sector.

To shape or support university educationalpolicies 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.



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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


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Training for Specific Function

developing expert technical or manualskills, communication and helps the

personnel to perform their functions

effectively.

Objectives:


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Objectives:

To help the nursing personnel toperform correct methods and

procedures with understanding.Establishing standards and quality

of nursing services.

Procedure to skill nurses to skillednurses.

T f Skill


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Types of Skills:Psychomotor skill

Cognitive skill

Teaching skills

Affective skill

Communication skill

Supervisory skills

Why do we need Skill


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Training?

Individual nurse needed to have greaterfreedom 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


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Standards ofstaff

developmentprogramme

(ANA)

Standard 1 Organization and


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Standard 1 Organization and

Administration

The nursing service department

and the nursing staff developmentunit philosophy, purpose and

goals address the staff

development needs of nursingpersonnel.

Standard II Human Resources


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Standard II Human Resources

Qualified administrative,educational and support

personnel are provided to meetthe learning and developmental

needs by nursing services

personnel.

Standards III Learner


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Standards III Learner

Nursing staff development

educators assist nursing

personnel in identifying theirlearning needs and planning

learning activities to meet those

needs.

Standard IV Program Planning


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Standard IV Program Planning

Provides the unit systematically,

plans and evaluate the overall

nursing staff developmentprogram in response to health

care needs.

Standard V Educational Design


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Standard V Educational Design

Educational offering and learningexperience are designed through

the use of educational processand incorporate adult education

and learning principles.

Standard VI Material Resources


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Standard VI Material Resources

And Facilities

Material sources and facilities are

adequate to achieve the goalsand implement the functions of

the overall nursing staff

development unit.

Standard VII Records And


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Standard VII Records And

Reports

The nursing staff development

unit establishes and maintains arecord keeping and report system

Standard VIII Evaluation


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Standard VIII Evaluation

Evaluation is an integralongoing and systematic

process, which includesmeasuring the impact on the

learning

Standard IX Consultation


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Standard IX Consultation

Nursing staff developmenteducators use the consultation

process to facilitate and enhanceachievement of individual,

departmental and organizational

goals.

Standard X Climate


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Standard X Climate

Nursing staff developmenteducators foster a climate which

promotes open communication,learning and professional growth.

Standard XI Systematic


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Standard XI Systematic

Enquiring

Nursing staff development

educators encouragesystematic inquiry and

applications of the results into

nursing practice.

Potential difficulties in staffdevelopment & training


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development & training

activities:

Lack of time

Inadequate resources at disposal

Under-funded training budgetsConflicting priorities

Lack of Clarity about what should be

done

Potential difficulties in staffdevelopment & training activities


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development & training activities

cont.Failure to identify, or accept the need.

Shortfall in training skill or experience

Fear that trained employee will leavethe organization or will be poached by

competitor.

Cynical attitude to Staff development-Not directly measurable. Treated as

Cost not investment.

Methods of delivering staffdevelopment programme:


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development programme:

InductionPhysical

tour of thefaculities

Groupdiscussion

SeminarHand book

andpamphlet


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Job orientation

Orientation

Seminar

Discussion

Hand out or book and pamphlets

I i d ti


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Leadership training

Continuing education

Skill training

Orientation

In-service education

Continuingeducation

Lecture


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education

DemonstrationSeminarJournal club

Book reviewCorrespondence

courseFormal course

Clinical research


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Training

for skillDemonstration Discussion

Role-play

method.


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DECISIONMAKING

Decision Making


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g

Objectives: Describe the types of decisions

Explain the mechanisms of decision-making

Discuss the steps of logical decision-making

Identify the factors responsible for decision-making

Discuss the importance of decision making for

nurse managers? Recognize the decision-making tools

Explain the barriers for decision-making andmechanisms of overcoming it

What is Decision Making?


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g

a choice made between two or morealternatives

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


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yp

Decisions made in the nursing servicecan be categorized depending upon the

following criteria:

How much time the manager spends inmaking decision

What proportion of the organization must

be involved in making decisionThe organization function/ the

nursing/midwifery functions on which

they focus

3 Classifications


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On the basis of these there arethree classifications:

1. Ends -Means2. Administrative-Operational

3. Programmed-Non-

programmed


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2. Administrative-Operational


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p

Administrative: made by seniormanagement, which have significantimpact throughout the organization.

Usually this type of decision is concernedwith policy, resource allocation andutilization.

Operational: are generally made bymid level and first line managers andaddress day to day operational activitiesof a particular organizational

3. Programmed-Non -

programmed


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programmed

Programmed-these are repetitiveand routine in nature. Since they can

be programmed, procedures, rules

and often manuals are formulated to

cover those situations

None programmed: unique andnon- routine

Conditions that initiate decision

making


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making

1. Opportunity/threat

2. Crisis

3. Deviation4. Improvement

Ways of Decision Making


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y g

1. Relying on tradition: taking the samedecisions that had been undertaken whensimilar problem arouse in the past

2. May appeal to authority and make decisions

based on suggestions from an expert/ahigher level management

3. Priority reasoning: based on assumption

4. Logical decision making: is a rational,intelligent and systematic approach tondecision making


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Factors Influencing Decision

Making


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Making

1. Decision makers attribute Knowledge, experience, and

judgmentPerception and personality

Values and philosophy

Factors Influencing DecisionMaking


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g

cont.2. The Situation Urgency of solution and time pressures

Magnitude and importance

Structure and uncertainty and risk

Cost benefit

3. Environmental ConstraintsExternal Internal

Encouraging creativity


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Convergent thinking-the problem is dividedinto smaller and smaller pieces to find a

more manageable perspective.

Divergent thinking: One's view of theproblem 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


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1. Probability theory - is the likelihood that anevent or outcome will actually occur andallow decision makers to calculate anexpected value for each alternative.

Expected Value (EV) = Income it wouldproduce (I) x its probability of making thatincome (P).

2. Decision tree - are graphic decision makingtools used to evaluate decisions containing aseries of . steps

Deciding to decide


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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 itselfTip: prioritize and rank problems in

order of importance

Deciding to decide cont.


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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 thesuperior's area of responsibility?

Does it need further information from

higher level?

3 Is it my decision cont.


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Does it involve serious breach ofmy departments budget?

Is this problem outside my area of

responsibility or authority?

If the answer to any of thesequestions is 'YES' pass it to your

superior.

Barriers to Effect Decision-Making


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Making

1. Easy recall: the more easily canrecall the event, the more frequently they

believe it occur

2. Easy search: not to put effort toseek information from the appropriate

sources

3. Misconception of chance:Most people do not understand the nature

of random solution based on past


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Barriers to Effect Decision-Making cont


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Making cont.

6. Defensive avoidance: Faced with aproblem and unable to find a good

manager seeks a way out. He/she may

let someone else make decisions. Thisresigned posture may prevent

consideration of more viable alternative

7. Panic: the manager feels pressurized

not only by the problem but also time

vercom ng arr ers oindividual problem solving


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1. Setting priority

2. Acquiring relevant information

3. Proceeding methodically andcarefully


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THANK YOU FORLISTENING!