Ch. 7: Communication Leadership

An example of an external variable that may affect communication is: a. circumstance. b. personality. c. thoughts. d. feelings

ANS: A Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us.

A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: a. interpersonal communication. b. clarity. c. image. d. intention.

ANS: A If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's non-verbal behavior may suggest that she is not interested in interacting with the family.

A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model

ANS: A The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015).

Organizational tones are based mostly on: a. unspoken cultural norms. b. commitment to success. c. communication behavior. d. leadership styles.

ANS: A The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole.

Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes e. Safety culture

ANS: A, C, D Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process.

Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy

ANS: A, C, D Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.

E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing

ANS: A, D, E Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that there are four times you should never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed.

The process in which information, perception, and understanding are transmitted from person to person is: a. articulation. b. communication. c. evaluation. d. pronunciation.

ANS: B Communication is the process in which information, perception, and understanding are transmitted from person to person.

_____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing

ANS: B Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.

The transformational leader engages staff by: a. punishing errors. b. sharing vision and decision making c. taking a top-down approach to leadership. d. making unilateral decisions for the team.

ANS: B Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism.

Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity.

ANS: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.

The number one cause of preventable medical errors is: a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency.

ANS: B The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program

Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing)

ANS: B To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient's diagnosis e. Discharge summary given to patient's spouse

ANS: B, C Fax transmissions sent to the incorrect physician's office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.

A client's wife is concerned about her husband's declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed "no breathing machine" for long-standing care, but she is unsure of his wishes if he were to need a "breathing machine" for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client's physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client's concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action

ANS: B, C Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.

NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness

ANS: B, C, D NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding.

Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious

ANS: B, C, D, E Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients' health care decisions and preferences.

Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task.

ANS: B, C, E At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing.

Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety.

ANS: B, D, E Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy

Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues

ANS: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.

Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication

ANS: C Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.

A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. advisement. b. consultation. c. persuasion. d. suggestion

ANS: C Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.

A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS.

ANS: D Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events.

Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA).

ANS: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality.

Interpersonal communication is defined as: a. the conscious intent by one individual to modify the thoughts or behaviors of others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face interaction.

ANS: D Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.