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Leadership and Management
Nursing 1
Communication
Supervisor: S. Haeriyanto, SKM., Mkep.
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Member of Group
Harry Suryani
Intan Yuanita
Nurliza Permata Sari Siti Robiah
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Effective communication consists of transmitting anaccurate 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.
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David Berlo (1960)
David Berlo proposed a linear model of communication
act contains the following elements:
Source
Message Channel
receiver
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Linear model of communication act contains the
following elements:
Source
Message
Channel
Receiver
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Source
The source or initiator characteristics that influence
effectiveness are:
Communication skill
Knowledge
Attitudes
Cultural background
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Message
The message characteristics that determine
effectiveness are:
Structure
Content Code
Treatment
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Channel
Of the following channels, one may be more effective
than another for a particular communication:
Sight
Hearing Touch
Taste
Smell
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Receiver
Receiver characteristics that influence effectiveness are:
Communication skills
Knowledge
Attitudes
Cultural background
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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.
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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
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Fritz et al. (1984)
Communication climate may facilitate or inhibit
communication.
Climate variables that influence message transmission
are trust between sender and receiver, messageambiguity, 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
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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 byfeedback, 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.
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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
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Tuckman (1965)
The group communication process as consisting of four
stages:
1. Forming
2. Storming
3. Norming
4. Performing
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Forming Stage
In the forming stage, members communicate to decide
who is to lead the group and what tasks the group is to
accomplish.
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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.
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Norming Stage
In the norming stage, members achieve cohesion and
relief at overcoming their earlier conflict.
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Performing Stage
In the performing stage, members carry out their
assigned tasks while communicating commitment to
group goals and to one another.
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Communication Principles
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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.
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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 inchanging opinios against a workers strong
disposition
Workers with low self-esteem are more likely to be
influenced by persuasive communication than thosewith high self-esteem
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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 oninterpersonal interaction patterns.
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INTERPERSONAL TRANSACTIONS
According to berne, each person enganges in transactions with
others to obtain strokes. A transaction consist of some sort ofstimulus 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.
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TYPES OF INTRAPERSONAL TRANSACTIONS
Persons engange in the following types of transactions to satisfystroke 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.
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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.
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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.
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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 orher 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.
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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.
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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 andnurses 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 modifycoworkers 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. Information from the critical parent produces the compulsions and quirks
that are responsible for each manager.
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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.
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Communication levels
Klatt (1978) differentiates among four levels of communication in anorganization.
Top level a broadcast system distributes the same message in nonpersonal fashion to all agency employees.
The media used in the formal information system include video screamand computer print out messages, printed reports , telephonemessages, graphs, and some conversational interchange.
At third level of organizational communications that provideamplification, classification and feedback for the broadcast and formalinformation system.
To enhance effectiveness of any level of organizational communication,managers must strengthen both in formational and relational aspects ofthe process.
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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 .
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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.
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Documentation of Care
Nurses documentation of care is often incomplete or inaccurateand is likely to be undervalued by nurses and other health
professionals (Steckel 1976: Walker and Semanoff, 1964)
Documentation of nursing actions and conclusions are probablynurses 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
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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
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Summary
The nurse managers principal activity is to communicateinformation, 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
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