nur 430 unit 3: Professional Communication and Effective Conflict Resolution and Negotiation

Assertive Communication

A way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person's rights. It involves rights and responsibilities for all parties in the communication. Assertive communication is a way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person's rights. A person's position is expressed clearly and firmly by using "I" statements as well as direct eye contact and a calm voice. In addition, assertive communication always requires that verbal and nonverbal messages be congruent. To be successful in the directing phase of management, the leader must have well-developed skills in assertive communication.

Internal and External Climates in Communication

An internal and an external climate also exist in communication. Internal - values and feelings -- the internal climate includes the values, feelings, temperament, and stress levels of the sender and the receiver External - weather, temperature, and timing -- weather conditions, temperature, timing, and the organizational climate itself are parts of the external climate -- the external climate also includes status, power, and authority as barriers to manager-subordinate communication

Passive Communication

Occurs when a person suffers in silence, although he or she may feel strongly about the issue Nonassertive Passive communication occurs when a person suffers in silence, although he or she may feel strongly about the issue. Thus, passive communicators avoid conflict, often at the risk of bottling up feelings that may lead to an eventual explosion.

Leadership Roles Regarding Conflict

Self-awareness - being SELF-AWARE helps in conflict because you can own up to mistakes - be aware of how what you say can be perceived Addresses conflict before it is perceived Seeks a win-win Assists subordinates in identifying alternative conflict resolutions Recognizes and accepts individual differences Good communication skills Role models

Channels of Communication

Because large organizations are so complex, communication channels used by the manager may be upward, downward, horizontal, diagonal, or through the "grapevine." Downward usually from manager to staff traditional primarily directive satisfaction less for subordinate ex. employee handbook, reports, job descriptions ----> In downward communication, the manager relays information to subordinates. This is a traditional form of communication in organizations and helps to coordinate activities in various levels of the hierarchy. the manager relays info down to team members - traditional for organizations in healthcare - ex. from manager ton staff Upward usually from staff to management allows employee input staff satisfaction is thus high supervisor passes up bias and filtering increase as information is passed upward ex. staff meetings, suggestion box ----> In upward communication, the manager is a subordinate to higher management. Needs and wants are communicated upward to the next level in the hierarchy. Those at this higher level make decisions for a greater segment of the organization than do the lower level managers. from staff up to management - ex. employee gives feedback Horizontal - managers interact with others on the same hierarchal level. Diagonal - managers interact with personnel and managers from other departments and different hierarchy and groups such as physicians. - tends to be less formal. ----> In diagonal communication, the manager interacts with personnel and managers of other departments and groups such as physicians, who are not on the same level of the organizational hierarchy. Although these people have no formal authority over the manager, this communication is vital to the organization's functioning. Diagonal communication tends to be less formal than other types of communication. Grapevine - most informal type of communication - this type of communication moves quickly and involves three or four people at a time - the message may be distorted as it speeds along ----> The most informal communication network is often called the grapevine. Grapevine communication flows quickly and haphazardly among people at all hierarchical levels and usually involves three or four people at a time. Senders have little accountability for the message, and often, the message becomes distorted as it speeds along. Given the frequency of grapevine communication in all organizations, all managers must attempt to better understand how the grapevine works in their own organization as well as who is contributing to it.

Conflict: Good or Bad?

Conflict is natural; neither positive nor negative, it just is. Contemporary thinking states that conflict can lead to new ideas. It can produce growth or destruction. Conflict is also created when there are differences in economic and professional values and when there is competition among professionals. Scarce resources, restructuring, and poorly defined role expectations also are frequent sources of conflict in organizations. Openly acknowledging that conflict is a naturally occurring and expected phenomenon in organizations reflects a tremendous shift from how sociologists viewed conflict a century ago. The current sociological view is that organizational conflict should be neither avoided nor encouraged but managed. The leader's role is to create a work environment where conflict may be used as a conduit for growth, innovation, and productivity. When organizational conflict becomes dysfunctional, the manager must recognize it in its early stages and actively intervene so that subordinates' motivation and organizational productivity are not adversely affected. Common causes of organizational conflict: - poor communication - inadequately defined organizational structure - individual behavior (incompatibilities or disagreements based on differences of temperament or attitudes)

Verbal communication.

Face-to-face communication. Oral communication is rapid but may result in fewer people receiving the information than necessary. Managers communicate verbally upward and downward and formally and informally. They also communicate verbally in formal meetings, with people in peer work groups, and when making formal presentations. Telephone communication. A telephone call is rapid and allows the receiver to clarify the message at the time it is given. It does not, however, allow the receipt of nonverbal messages for either the sender or receiver of the message. Accents may be difficult to understand as well in a multicultural workforce. Because managers today use the telephone so much, it has become an important communication tool, but it does have limits as an effective communication device.

GRRRR - tool used in listening

Greeting (offer greeting and establish positive environment) Respectful listening (no interruptions) Review (summarize message to make sure it was heard correctly) Recommend (if necessary) Request more information Reward (offer thanks) Helpful in organizations where disruptive behavior, toxic environments, and power struggles interfere with listening Boynton suggests that using a listening model such as GRRRR is especially helpful in organizations where disruptive behavior, toxic environments, and power struggles interfere with listening. In the Greeting stage, a simple respectful greeting is offered to establish a professional dialogue. Next, participants demonstrate Respectful Listening by giving each other time to think and transmit critical information without interrupting. Review occurs when the speaker summarizes the information he or she has conveyed to make sure that the message was understood correctly. Once the speaker is finished conveying this summary and the other party has validated or clarified it, the listener has enough information to Recommend or Request More Information. The communication exchange ends when both parties Reward each other by recognizing and thanking each other for a collaborative exchange. GRRRR can be used regardless of the relative rank and status of the participants because maintaining structured communication is even more vital when power differences exist used for toxic, power struggle relationships in orgs

ISBAR - verbal communication amongst healthcare professionals

Improving and standardizing professional communication are critical to quality patient care and the reduction of errors. SBAR, ISBAR (adds identification as first step), ANTICipate, and I-PASS are several strategies that have been developed to address this problem. SBAR, first used in the U.S. Navy to standardize important and urgent communication in nuclear submarines and further developed by Kaiser Permanente, is an easy-to-remember tool that provides a structured, orderly approach in providing accurate, relevant information in emergent patient situations as well as routine handoffs Handoffs (verbal exchange of information, which occurs between two or more health-care providers about a patient's condition, treatment plan, care needs, etc.) typically occur both at change of shift and when patients are transferred to different units. Introduction Situation - introduce yourself and the patient and briefly state the issue that you want to discuss (generally the patient's condition). Background - describe the background or context (patient's diagnosis, admission date, medical diagnosis, and treatment to date). Assessment - summarize the patient's condition and state what you think the problem is. Recommendation - identify any new treatments or changes ordered and provide opinions or recommendations for further action. Structured, orderly approach to provide accurate, relevant information, in emergent patient situations as well as routine hand offs.

Verbal and Nonverbal Communication

Incongruences can be a barrier between verbal and nonverbal messages Leaders are sensitive to nonverbal and verbal messages from followers Communication has the greatest likelihood of being accurately interpreted when it's face to face *** According to researchers, body language is thought to account for between 50% and 70% of all communication. Nonverbal communication then must be examined in the context of the verbal content. Generally, if verbal and nonverbal messages are incongruent, the receiver will believe the nonverbal message. Because nonverbal behavior can be and frequently is misinterpreted, receivers must validate perceptions with senders. The incongruence between verbal and nonverbal messages leads to many communication problems. face-to-face is the best way to communicate other elements of non-verbal communications are: - silence - space / proxemics - environment - appearance - eye contact - posture - gesture - facial expression and timing - vocal expression

Impact of Technology on Contemporary Organizational Communication

Internet Hospital information systems and intranets Wireless, local area networking Social media and organizational communication Balancing technology and the human element ----> Technology has dramatically changed how nurses communicate and perform their work. Younger generations of nurses, who grew up using computers, cell phones, and instant messaging, recognize that technology has given us the potential for instant information access and exchange. These nurses approach and accept technology as an adjunct to their nursing cognizance and do not question its presence or use. Nurses are increasingly using the Internet as both a communication tool and an information source. As an information source, the Internet allows nurses to access the latest research and best practice information so that their care can be evidence based. Indeed, the Internet, which is growing faster than any other medium in the world, has enormous potential to improve Americans' health by enhancing communications and improving access to information for care providers, patients, health plan administrators, public health officials, biomedical researchers, and other health professionals The use of hospital information system configurations, such as stand-alone systems, online interactive systems, networked systems, and integrative systems, has also increased. Some organizations have created internal electronic data repositories as a way of cataloging internal reference materials, such as policy and procedure manuals. This increases the likelihood that staff will be able to find such resources when they need them and that they are as up-to-date as possible. In such a system, references are typically converted to the portable document format (PDF) and launched electronically via an intranet (internal networks, not normally accessible from the Internet) that allow workers and departments to share files, use websites, and collaborate Technologies such as social networking, texting, e-mail, and the intranet are increasing the potential for effective and efficient communication throughout the organization, and carefully utilized Web-based platforms can potentially enhance practice, education, and research However, even the most advanced communication technology cannot replace the human judgment needed by leaders and managers to use that technology appropriately. Determining which technological advances can and should be used at each level of the organizational hierarchy to promote efficiency and effectiveness of communication. Assessing the need for and providing workers with adequate training to appropriately and fully utilize the technological communication tools that may become available to them. Balancing cost and benefits Aligning communication technology with the organizational mission Finding a balance between technological communication options and the need for human touch; caring; and one-on-one, face-to-face interaction

Guidelines for Writing Effective Memos

Make main point in the beginning Should be short Only essential information should be included in the memo Written simply Headings should be used in the memo ----> The Purdue Online Writing Lab (1995-2019b) also suggests that business memos should be composed of the following components: Header (includes the to, from, date, and subject lines): - one eighth of the memo Opening, context, and task (includes the purpose of the memo, the context and problem, and the specific assignment or task): - one fourth of the memo - informs you of changes, purpose, etc. Summary and discussion segment (the details that support your ideas or plan): - one half of the memo Closing segment and necessary attachments (the action that you want your reader to take and a notation about what attachments are included): - one eighth of the memo

Types of Alternative Dispute Resolution

Many disputes can be solved informally. Occasionally, however, parties cannot reach agreement through negotiation. In these cases, alternative dispute resolution (ADR) may be indicated to keep some privacy in the dispute and to avoid expensive litigation. Types of ADR include mediation, fact finding, arbitration, due process hearings, and the use of ombudspersons. Mediation - uses a third neutral party - confidential and legally non-binding agreement Arbitration - a binding conflict resolution process Due process hearings - actual court hearings Ombudspersons - these people hold official titles within the organization to investigate grievances

Nonverbal communication.

Nonverbal communication includes facial expression, body movements, and gestures and is commonly referred to as body language. Nonverbal communication is considered more reliable than verbal communication because it conveys the emotional part of the message. There is significant danger, however, in misinterpreting nonverbal messages if they are not assessed in context with the verbal message. Nonverbal communication occurs any time managers are seen. - e.g., messages are transmitted to subordinates every time the manager communicates verbally or just walks down a hallway ex. eye contact, eye rolling, foot tapping

Competing

One party pursues what it wants regardless of the cost to others. Used when a quick, unpopular decision has to be made. The competing approach is used when one party pursues what it wants at the expense of the others (zero sum game). Because only one party typically wins, the competing party seeks to win regardless of the cost to others. These win-lose conflict resolution strategies then typically leave the loser angry, frustrated, and wanting to get even in the future. Managers may use competing when a quick or unpopular decision needs to be made. It is also appropriately used when one party has more information or knowledge about a situation than the other. Competing in the form of resistance is also appropriate when a person needs to resist unsafe patient care policies or procedures, unfair treatment, abuse of power, or ethical concerns.

Accommodating

One party sacrifices his or her beliefs and wants to allow the other party to win. Cooperating is the opposite of competing. In the cooperating approach, one party sacrifices his or her beliefs and allows the other party to win. The actual problem is usually not solved in this win-lose situation. Accommodating is another term that may be used for this strategy. The person cooperating or accommodating often expects some type of payback or an accommodation from the winning party in the future. In addition, employees who use accommodation as a primary conflict management strategy may keep track and develop resentment. Cooperating and accommodating are appropriate political strategies if the item in conflict is not of high value to the person doing the accommodating.

Leader/Manager Communication

Organizational communication is dynamic Excellent interpersonal communication skills Communication in large organizations is complex ----> In addition, the leader is responsible for developing a cohesive team to meet organizational goals. To do this, the leader must articulate issues and concerns so that workers will not become confused about priorities. The ability to communicate effectively often determines success as a leader-manager, and developing expertise in all aspects of communication is critical. interpersonal communication = between 2 or more people intrapersonal communication = within oneself to be an effective leader, you must have great interpersonal communication

Listening

The average person spends 70% of his or her time listening, but only one-third of all messages are retained. Good listening skills are as important as good verbal skills to the manager. Good listening skills take ongoing effort. Research shows that most people hear or retain only a small amount of the information given to them. In fact, communication failure is a common root cause of medical error. It is important that the leader-manager approaches listening as an opportunity to learn. To become better listeners, leaders must first become aware of how their own experiences, values, attitudes, and biases affect how they receive and perceive messages. Second, they must overcome the information and communication overload inherent in the middle-management role. It is easy for overwhelmed managers to stop listening actively to the many subordinates who need and demand their time simultaneously. Finally, the leader must continually work to improve listening skills by giving time and attention to the message sender. The leader's primary purpose is to receive the message being sent rather than forming a response before the transmission of the message is complete. Good listeners are better able to ask great questions—not a multitude of questions—just the ones that matter because they have been paying attention.

Negotiating Strategies

Use factual statements. Listen and keep an open mind. Discuss issues. Start tough.... Handle the unexpected wisely. Deal with the unexpected. Be honest. Be pleasant. Don't give up the ship too early. Try not to use your bottom line. Take a break if necessary. A critical goal in negotiation is that both parties perceive that they have won something that they want. ----> Because negotiation may be a highly charged experience, the negotiator always wants to appear calm, collected, and self-assured. At least part of this self-assurance comes from having adequately prepared for the negotiation. Part of the preparation should have included learning about the people with whom the manager is negotiating. People come with a variety of personality types, and over the course of their careers, managers will encounter most or all personality types in various negotiations. In addition, the negotiator must remember that concerns about status pervade almost every negotiation. Preparation, however, is not enough. In the end, the negotiator must have clarity in his or her communication, assertiveness, good listening skills, the ability to regroup quickly, and flexibility.

1996 Health Insurance Portability and Accountability Act (HIPAA)

called for protection and privacy of medical information, including any information about a patient, whether oral or recorded in any form or medium, that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health clearing house protecting confidentiality and privacy of personal or patient information becomes even more difficult as a result of increased electronic communication because the information available by electronic communication is typically easier to access than traditional information-retrieval methods and because computerized databases are unable to distinguish whether the user has a legitimate right to such information for example, the federal government has mandated computerized patient records, and many health-care organizations have implemented this mandate unfortunately, the discussion and determination of who in the organization should have access to what information are often inadequate before such hardware is put in place, and great potential exists for violations of confidentiality clearly, any nurse-manager working with clinical information systems has a responsibility to see that confidentiality is maintained and that any breaches in confidentiality are dealt with swiftly and appropriately

Communication Process

communication initiation communication sender, receiver, and message. there is a mode or medium communication is written or nonverbal core of management activities ----> Communication can also occur on at least two levels: - verbal ***** and - nonverbal. ***** -> thus, whenever two or more people are aware of each other, communication begins What happens, however, when the thoughts, ideas, and information exchanged do not have the same meaning for both the sender and the receiver of the message? What if the verbal and nonverbal messages are incongruent? Does communication occur if an idea is transmitted but not translated into action? Because communication is so complex, many models exist to explain how organizations and individuals communicate. Basic elements common to most models are listed above. In all communication, there is at least one sender, one receiver, and one message. There is also a mode or medium through which the message is sent—for example, spoken, written, or nonverbal. basically: - a message can be written, verbal, or non-verbal - if verbal and nonverbal messages are incongruent, the message sent can come across as inauthentic, confusing, etc. - messages should match

Variables Affecting Organizational Communication

spatial distance / proxemics different subgroups or subcultures differing authority and work structures organizations in a constant state of flux ----> Formal organizational structure has an impact on communication. People at lower levels of the organizational hierarchy are at risk for inadequate communication from higher levels. This occurs because of the number of levels that communication must filter through in large organizations. As the number of employees increases (particularly more than 1,000 employees), the quantity of communication generally increases; however, employees may perceive it as increasingly closed. In large organizations, it is impossible for individual managers to communicate personally with each person or group involved in organizational decision making. Proxemics = the space in which communication takes place, and how the space affects communication - the amount of space we require depends on what is needed, cultural norms, etc. - in the US, 6-18 inches of space between people is appropriate; most Americans claim a territorial space of 4 feet - from Google = the branch of knowledge that deals with the amount of space that people feel it necessary to set between themselves and others Not only is spatial distance a factor, but the presence of subgroups or subcultures also affects what messages are transmitted and how they are perceived. Gender is also a significant factor in organizational communication, as men and women communicate and use language differently. Women are generally perceived as being more relationship oriented than men, but this is not always the case. Women are also characterized as being more collaborative in their communication, whereas men may be more competitive. Complicating the picture further is the need in the health-care industry for a predominantly male medical profession to closely communicate with a predominantly female nursing profession. In addition, the majority of health-care administrators are male. Therefore, male physicians and administrators may not automatically use the collaborative approach in communication that female nurses may desire. The quality of organizational and unit-level communication then continues to be affected by differences in gender, power, and status.

Upward communication

usually from staff to management allows employee input staff satisfaction is thus high supervisor passes up bias and filtering increase as information is passed upward ex. staff meetings, suggestion box ----> In upward communication, the manager is a subordinate to higher management. Needs and wants are communicated upward to the next level in the hierarchy. Those at this higher level make decisions for a greater segment of the organization than do the lower level managers. from staff up to management - ex. employee gives feedback

Summary

1. Identify the factors that influence communication. 2. Describe how difference in gender, generation, culture, & organization can affect communication. 3. Explain how communication content and medium selection vary according to the context, goals, and relationship of those involved. 4. Explain what principles must be followed for collaborative communication to take place.

Objectives

1. Identify the factors that influence communication. 2. Describe how difference in gender, generation, culture, and organization can affect communication. 3. Explain how communication content and medium selection vary according to the context, goals, and relationship of those involved. 4. Explain what principles must be followed for collaborative communication to take place. 5. Develop a plan to improve your communication skills. 6. Explain how the various types of conflict can be positive or negative. 7. Describe the conflict process. 8. Describe approaches that can be used to manage conflict.

Telephone communication.

A telephone call is rapid and allows the receiver to clarify the message at the time it is given. It does not, however, allow the receipt of nonverbal messages for either the sender or receiver of the message. Accents may be difficult to understand as well in a multicultural workforce. Because managers today use the telephone so much, it has become an important communication tool, but it does have limits as an effective communication device.

Passive-Aggressive Communication

An aggressive message presented in a passive way Limited verbal behavior with incongruent nonverbal behavior Passive-aggressive communication is an aggressive message presented in a passive way. It generally involves limited verbal exchange (often with incongruent nonverbal behavior) by a person who feels strongly about a situation. This person feigns withdrawal to manipulate the situation. For example, the passive-aggressive communication may say yes when they want to say no or be sarcastic or complain about others behind their backs.

Leadership & Management Skills in Managing Conflict

Benefits of conflict Stable work environment Know constructive vs. destructive conflict Use optimal resolution strategies Must have Leadership and Management skills Sensitivity Assertive communication skills ----> There are many benefits to establishing and maintaining an appropriate amount of conflict in the workplace. The manager who creates a stable work environment that minimizes the antecedent conditions for conflict has more time and energy to focus on meeting organizational and human resource needs. When conflict does occur in the unit, managers must be able to discern constructive from destructive conflict. Conflict that is constructive will result in creativity, innovation, and growth for the unit. When conflict is deemed to be destructive, managers must deal appropriately with that conflict or risk an aftermath that may be even more destructive than the original conflict. Consistently using conflict resolution strategies with win-lose or lose-lose outcomes will create disharmony within the unit. Leaders who use optimal conflict resolution strategies with a win-win outcome promote increased employee satisfaction and organizational productivity.

Helpful Tips in Conflict Resolution

Focus on the causes of the disagreement Try to arrive at acceptable solutions Get all the information possible Listen carefully Don't belabor how the conflict occurred Concentrate on understanding and not on agreement ----> Managing conflict effectively requires an understanding of its origin. Some common causes of unit conflict are unclear expectations, poor communication, lack of clear jurisdiction, incompatibilities or disagreements based on differences of temperament or attitudes, individual or group conflicts of interest, and operational or staffing changes. In addition, not only does diversity in gender, age, and culture influence conflict resolution, it may also create conflict itself. Listen, get all information, arrive at solutions that are acceptable, focus on understanding instead of agreement, negotiate and have each party give up something to accommodate for differences

Negotiation Closure and Follow-Up

End on a friendly note. Restate final decision. Hide astonishment at your success. Make the other party feel that they also won. Follow-up.

Aggressive Communication

Expressing oneself in a direct and often hostile manner that infringes on another person's rights Generally oriented to "winning at all costs" Aggressive communication is generally direct, threatening, and condescending. It infringes on another person's rights and intrudes into that person's personal space. This behavior is also oriented toward "winning at all costs" or demonstrating self-excellence.

3 Primary Categories of Conflict NEED TO KNOW ***********

Interpersonal Intrapersonal - internal struggle - ex. new nurse supervisor experiencing imposter syndrome Intergroup

Written Communication

Most often used in large organizations. A manager's written communication reflects greatly on both the manager and the organization. Often works as proof of a conversation. Although communication may take many forms, written communication is used most often in large organizations. The written communication issued by the manager reflects greatly on both the manager and the organization. Thus, the manager must be able to write clearly and professionally and to use understandable language. Many types of written communication are used in organizations. Organizational policy, procedures, events, and change may be announced in writing. Job descriptions, performance appraisals, and letters of reference are also forms of written communication.

communication

_________________ is perhaps the most critical leadership skill, in addition to decision making *************

Arbitration

a binding conflict resolution process There are times, however, when mediators are unable to help conflicted parties come to agreement. When this occurs, formal arbitration may be used. Unlike mediation, which seeks to help conflicted parties come together to reach a decision themselves, arbitration is a binding conflict resolution process in which the facts of the case are heard by an individual who makes a final decision for the parties in conflict.

Telephone Communication

Rapid Allows receiver to clarify message at time it is received Does not, however, allow the receipt of nonverbal messages for either the sender or the receiver Telephone conversations are a good way of sharing information rapidly and allows for further clarification of information. However, does not allow the receipt of nonverbal messages for either the sender or the receiver.

Conflict

The internal or external discord that occurs as a result of differences in ideas, values, or beliefs of two or more people. Conflict is generally defined as the internal or external discord that results from differences in ideas, values, or feelings between two or more people. Because work typically involves interpersonal relationships with people having different values, beliefs, backgrounds, and goals, conflict is an expected outcome.

Conflict Management (1)

Nurse leaders can no longer afford to respond to conflict traditionally. Have to see how well conflict is managed. The optimal goal in conflict is a win-win solution for all involved. This outcome is not possible in every situation, and often, the leader-manager's goal is to manage the conflict in a way that lessens the perceptual differences that exist between the involved parties.

Face-to-face communication.

Oral communication is rapid but may result in fewer people receiving the information than necessary. Managers communicate verbally upward and downward and formally and informally. They also communicate verbally in formal meetings, with people in peer work groups, and when making formal presentations.

Communication Modes

Written communication Verbal communication Nonverbal communication

Written communication.

Written messages (including memos, reports, e-mail, and texting, etc.) allow for documentation. They may, however, be open to various interpretations and generally consume more managerial time. Most managers are required to do a considerable amount of this type of communication and therefore need to be able to write clearly. - takes up a lot of time for managers

Factors Affecting Unit-Level Communication

differences in gender, gender preference, power, and status significantly affect communication. there are clearly differences in the way both men and woman communicate: women communicate more collaboratively, and are perceived to be more relationship-oriented men communicate in a more straightforward way, and are perceived to be more competitive the more the number of people involved in the communication, the greater the chance of distortion

Horizontal communication

managers interact with others on the same hierarchal level.

Nonverbal Communication Clues

space environment outward appearance eye contact body posture gestures facial expression vocal expression Silence can also be used as a means of nonverbal communication. This supports the adage that even silence can be deafening. The following section identifies other nonverbal clues that can occur with or without verbal communication. The study of how space and territory affect communication is called proxemics. All of us have an invisible zone of psychological comfort that acts as a buffer against unwanted touching and attacks. The degree of space we require depends on who we are talking to as well as the situation we are in. It also varies according to cultural norms. Some cultures require greater space between the sender and the receiver than others. In the United States, between 6 and 18 inches of space is typically considered appropriate only for intimate relationships, between 18 inches and 4 feet is appropriate for personal interactions, between 4 and 12 feet is common for social exchanges, and between 12 and 25 feet is a public distance. Most Americans claim a territorial personal space of about 4 feet. Proxemics, then, may contribute to the message being sent. Distance may imply a lack of trust or warmth, whereas inadequate space, as defined by cultural norms, may make people feel threatened or intimidated. Likewise, the manager who sits beside employees during performance appraisals sends a different message than the manager who speaks to the employee from the opposite side of a large and formal desk. In this case, distance increases power and status on the part of the manager; however, the receptivity to distance and the message that it implies varies with the culture of the receive The area where communication takes place is an important part of the communication process. Communication that takes place in a superior's office is generally taken more seriously than that which occurs in the cafeteria. Posture and the way that you control the other parts of your body are also extremely important as part of nonverbal communication. For example, Cherry (2019) suggests that sitting up straight may indicate that a person is focused and paying attention to what's going on. Sitting with the body hunched forward, on the other hand, can imply that the person is bored or indifferent. Crossing arms across one's chest may suggest defensiveness or aggressiveness. Moreover, the weight of a message is increased if the sender faces the receiver; stands or sits appropriately close; and, with head erect, leans toward the receiver. A message accented with appropriate gestures takes on added emphasis. Too much gesturing can, however, be distracting. For example, hand movement can emphasize or detract from the message. Gestures also have a cultural meaning. Some cultures are more tactile than others. Indeed, the use of touch is one gesture that often sends messages that are misinterpreted by receivers from different cultures. Effective communication requires a facial expression that agrees with your message. Staff perceive managers who present a pleasant and open expression as approachable. Likewise, a nurse's facial expression can greatly affect how and what clients are willing to relate. On the other hand, hesitation often diminishes the effect of your statement or implies untruthfulness. Vocal clues such as tone, volume, and inflection add to the message being transmitted. Tentative statements sound more like questions than statements, leading listeners to think that you are unsure of yourself and speaking quickly may be interpreted as being nervous. The goal, then, should always be to convey confidence and clarity.

Smoothing

An individual attempts to reduce the emotional component of the conflict. "smooth things over" Smoothing is used to manage a conflict situation. Smoothing occurs when one party in a conflict attempts to pacify the other party or to focus on agreements rather than differences. In doing so, the emotional component of the conflict is minimized. Managers often use smoothing to get someone to accommodate or cooperate with another party. Although it may be appropriate for minor disagreements, smoothing rarely results in resolution of the actual conflict. trying to pacify rarely results in resolution of conflict = just a Band-Aid

Compromising

Each party gives up something it wants. May result in a lose-lose. In compromising, each party gives up something it wants. Although many see compromise as an optimum conflict resolution strategy, it may result in a lose-lose situation because either or both parties perceive that they have given up more than the other and may therefore feel defeated. For compromising not to result in a lose-lose situation, both parties must be willing to give up something of equal value. Compromising becomes a win-win only when both parties perceive they have won more than the other person. It is important that parties in conflict do not adopt compromise prematurely if collaboration is both possible and feasible. The only way this works is if both parties are willing to give up something of equal value ********

Avoiding

Parties are aware of a conflict but choose not to acknowledge it or attempt to resolve it. The conflict still exists. In the avoiding approach, the parties involved are aware of a conflict but choose not to acknowledge it or attempt to resolve it. Dontigney suggests that those who actively avoid conflict frequently have low esteem or hold a position of low power. Avoidance may be indicated in trivial disagreements, when the cost of dealing with the conflict exceeds the benefits of solving it, when the problem should be solved by people other than you, when one party is more powerful than the other, or when the problem will solve itself. The greatest problem in using avoidance is that the conflict remains, often only to reemerge later in an even more exaggerated fashion.

Negotiation

Resembles compromise when used as a conflict negotiation strategy Emphasis on accommodating Each party must consider trade-offs and their bottom-line Be careful Negotiation in its most creative form is like collaboration and in its most poorly managed form may resemble a competing approach. Negotiation frequently resembles compromise when it is used as a conflict resolution strategy. During negotiation, each party gives up something, and the emphasis is on accommodating differences between the parties. Few people can meet all of their needs or objectives. Most day-to-day conflict is resolved with negotiation. A nurse who says to another nurse "I'll answer that call light if you'll count narcotics" is practicing the art of negotiation.

Mediation

uses a third neutral party confidential and legally non-binding agreement Mediation, which uses a neutral third party, is a confidential, legally nonbinding process designed to help bring the parties together to devise a solution to the conflict. As such, the mediator does not take sides and has no vested interest in the outcome. Instead, the mediator asks questions to clarify the issues at hand (fact finding), listens to both parties, meets with parties privately as necessary, and helps to identify solutions both parties can live with.

Impact of Technology with Comms - The Electronic Health Record (EHR)

A longitudinal electronic record of patient health information produced by encounters in one or more care settings Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports Even health records have changed as a result of technology. The electronic health record (EHR) is a digital record of a patient's health history that may be made up of records from many locations and/or sources, such as hospitals, providers, clinics, and public health agencies. For example, an EHR might include immunization status, allergies, patient demographics, laboratory test and radiology results, advanced directives, current medications taken, and current health-care appointments. The EHR is theoretically available 24 hours a day, 7 days a week, and has built in safeguards to assure patient health information confidentiality and security.

Interpersonal conflict

Also known as horizontal violence (bullying). Two or more people have conflict about goals or values. Hutchinson suggests that the risk of bullying is so great in nursing that most, if not all nurses will be bullied at some point during their working life. Thoughts??? Intrapersonal conflict occurs within the person. It involves an internal struggle to clarify contradictory values or wants. For managers, intrapersonal conflict may result from the multiple areas of responsibility associated with the management role. Managers' responsibilities to the organization, subordinates, consumers, the profession, and themselves sometimes conflict, and that conflict may be internalized. Being self-aware and conscientiously working to resolve intrapersonal conflict as soon as it is first felt is essential to the leader's physical and mental health. This is bullying

Collaborating

An assertive and cooperative means of conflict resolution whereby all parties set aside their original goals and work together to establish a common priority goal. Collaborating is an assertive and cooperative means of conflict resolution that results in a win-win solution. In collaboration, all parties set aside their original goals and work together to establish a supraordinate or priority common goal. In doing so, all parties accept mutual responsibility for reaching the supraordinate goal. Although it is very difficult for people truly to set aside original goals, collaboration cannot occur if this does not happen. For example, a married couple experiencing serious conflict over whether to have a baby may first want to identify whether they share the supraordinate goal of keeping the marriage together. A nurse who is unhappy that he or she did not receive requested days off might meet with his or her supervisor and jointly establish the supraordinate goal that staffing will be adequate to meet patient safety criteria. If the new goal is truly a jointly set goal, each party will perceive that an important goal has been achieved and that the supraordinate goal is most important. In doing so, the focus remains on problem solving and not on defeating the other party. ----> all parties set aside individual goals and decide to work together

Seeking Consensus

Appropriate goal All parties support Greatest challenge in consensus building is time Consensus means that negotiating parties reach an agreement that all parties can support, even if it does not represent everyone's first priorities. Consensus decision making does not provide complete satisfaction for everyone involved in the negotiation as an initially unanimous decision would, but it does indicate willingness by all parties to accept the agreed-on conditions. In committees or groups working on shared goals, consensus is often used to resolve conflicts that may occur within the group. To reach consensus often requires the use of an experienced facilitator and having consensus-building skills is a requirement of good leadership. Building consensus ensures that everyone within the group is heard but that the group will ultimately end up with one agreed-on course of action. Consensual decisions are best used for decisions that relate to a core problem or need a deep level of group support to implement successfully.

Generally, there are 4 types of communication:

Assertive Passive Aggressive Passive-Aggressive

Common Conflict Resolution Strategies

Avoiding Compromising Competing Accommodating Smoothing Collaborating A leader recognizes which conflict management or resolution strategy is most appropriate for each situation. Common conflict management strategies are Avoiding, Compromising, Competing, Accommodating Smoothing and Collaborating. The choice of the most appropriate strategy depends on many variables, such as the situation itself, the urgency of the decision, the power and status of the players, the importance of the issue, and the maturity of the people involved in the conflict.

Communication

Complex Dynamic Participants share in an interaction Verbal/non-verbal Most critical leadership skill ----> Although some functions of management such as planning, organizing, and controlling can be reasonably isolated, communication impacts all management activities and cuts across all phases of the management process. The nurse-leader communicates with clients, colleagues, bosses, and subordinates. In addition, because nursing practice tends to be group oriented, interpersonal communication among team members is necessary for continuity and productivity. One must have excellent interpersonal communication skills, then, to be an effective leader-manager. In fact, communication is perhaps the most critical leadership skill. Organizational communication is even more complex than interpersonal or group communication, as there are more communication channels, more individuals to communicate with, more information to transmit, and new technologies, which both complicate and ease care delivery. Thus, organizational communication is a high-level management function; it must be systematic, have continuity, and be appropriately integrated into the organizational structure, encouraging an exchange of views and ideas. Organizational communication is complex, however, and communication failure often results in a failure to meet organizational goals. In addition, there are confidentiality risks that must be addressed. ----> begins with 2 or more people as they become aware of each other communication is perhaps the most critical leadership skill, in addition to decision making ************* the nurse manager/leader communicates with the charge nurse, nurses communication is complex, verbal, non-verbal

Intergroup Conflict

Occurs between two or more groups of people, departments or organizations. Family/work issues Intergroup conflict occurs between two or more groups of people, departments, and organizations. An example of intergroup conflict might be two political affiliations with widely differing or contradictory beliefs or nurses experiencing intergroup conflict with family and work issues. ex. Democrats vs. Republicans

Conflict Management (2)

goal = lessen the perceptual differences select appropriate resolution strategy appropriate strategy based on: - the situation - urgency of the decision - power/status of members - importance of issue - maturity of Individuals involved The optimal goal in conflict is a win-win solution for all involved. This outcome is not possible in every situation, and often, the leader-manager's goal is to manage the conflict in a way that lessens the perceptual differences that exist between the involved parties. A leader recognizes which conflict management or resolution strategy is most appropriate for each situation. Being open to understanding how other's perceive conflict and adjusting our own perception when new information is received is key to conflict management ***************

Diagonal communication

managers interact with personnel and managers from other departments and different hierarchy and groups such as physicians. tends to be less formal. In diagonal communication, the manager interacts with personnel and managers of other departments and groups such as physicians, who are not on the same level of the organizational hierarchy. Although these people have no formal authority over the manager, this communication is vital to the organization's functioning. Diagonal communication tends to be less formal than other types of communication.

Grapevine communication

most informal type of communication this type of communication moves quickly and involves three or four people at a time the message may be distorted as it speeds along The most informal communication network is often called the grapevine. Grapevine communication flows quickly and haphazardly among people at all hierarchical levels and usually involves three or four people at a time. Senders have little accountability for the message, and often, the message becomes distorted as it speeds along. Given the frequency of grapevine communication in all organizations, all managers must attempt to better understand how the grapevine works in their own organization as well as who is contributing to it.

Ombudspersons

these people hold official titles within the organization to investigate grievances Another option for individuals experiencing conflict may be guidance from ombudspersons. Ombudspersons generally hold an official title as such within an organization. Their function is to investigate grievances filed by one party against another and to ensure that individuals involved in conflicts understand their rights as well as the process that should be used to report and resolve the conflict.

Downward communication

usually from manager to staff traditional primarily directive satisfaction less for subordinate ex. employee handbook, reports, job descriptions ----> In downward communication, the manager relays information to subordinates. This is a traditional form of communication in organizations and helps to coordinate activities in various levels of the hierarchy. the manager relays info down to team members - traditional for organizations in healthcare - ex. from manager ton staff

Organizational Communication Strategies

understand the structure. realize that communication is not a one-way channel. keep communication clear, concise, and simple. sender should seek feedback. use multiple communication methods. don't overwhelm with unnecessary information. ----> Leader-managers must understand the organization's structure and recognize who will be affected by decisions. Both formal and informal communication networks need to be considered. Formal communication networks follow the formal line of authority in the organization's hierarchy. Informal communication networks occur among people at the same or different levels of the organizational hierarchy but do not represent formal lines of authority or responsibility. - for example, an informal communication network might occur between a hospital's chief executive officer (CEO) and her daughter, who is a clerk on a medical wing - although there may be a significant exchange of information about unit or organizational functioning, this communication network would not be apparent on the organization chart ---> it is imperative, then, that managers be very careful about what they say and to whom until they have a good understanding of the formal and informal communication networks Communication is not a one-way channel. If other departments or disciplines will be affected by a message, the leader-manager must consult with those areas for feedback before the communication occurs. Communication must be clear, simple, and precise. This requires the sender to adjust the language as necessary to the target audience. Senders should seek feedback regarding whether their communication was accurately received. One way to do this is to ask the receiver to repeat the communication or instructions. In addition, the sender should continue follow-up communication in an effort to determine if the communication is being acted on. The sender is responsible for ensuring that the message is understood. - ex. teach-back, repeat what you said Multiple communication modes should be used, when possible, if a message is important. Using a variety of communication modes in combination increases the likelihood that everyone in the organization who needs to hear the message actually will hear it. Managers should not overwhelm subordinates with unnecessary information. -> ~~~ Information is formal, impersonal, and unaffected by emotions, values, expectations, and perceptions. ~~~ Communication, on the other hand, involves perception and feeling. It does not depend on information and may represent shared experiences. In contrast to information sharing, superiors must continually communicate with their subordinates.