Reframing tension and conflict to maximize learning

The Foundation Years, 2009

Trainers in healthcare frequently find themselves managing situations of conflict or discomfort. For example, in groups one participant might dominate discussion and constantly challenge the trainer; or the group might be passive and want 'expert knowledge' from the trainer, whereas the trainer would prefer the group to be more proactive. These situations can challenge trainers and pose barriers to learning. This article invites trainers to examine how they perceive the causes of tension and conflict, and how this might influence the ways they react in group-work, multi-professional teams and one-to-one relationships. Tensions exist in all groups and tutorials and come from a variety of sources. Many trainers feel uncomfortable when tension or conflict is evident and focus their entire energy, often unconsciously, on suppressing differences and avoiding discomfort. By adopting this attitude, trainers may be missing a transformational learning opportunity 1 ; for example, radically influencing attitudes to patient care or working partnership with other professionals. In the model proposed by Tuckman, 2 a critical time in the development of any group is the storming phase. Storming, coming after the initial forming, is a necessary stage when challenging questions are asked and personal viewpoints become more apparent. The trainer might feel threatened or experience a desire to assert their authority. How trainers respond to this phase influences the patterns which are established in the group. Storming does not happen just once in groups, but we see it recurring as a positive feature which can often change the nature of groups. Trainers' feelings and interpretations Writers on facilitation skills increasingly encourage trainers to be aware of their own emotions and reactions, and not to see themselves as neutral, objective health professionals. 3-6 Writing about communication skills in medicine, Kurtz et al. recognize the perceptual skills of healthcare professionals-that is, what

BMJ Quality & Safety

Critical Care Nurse, 2018

BACKGROUND Cultivating a healthy work environment and upholding patient safety are important priorities in health care. Challenges in workplace communication are common and affect staff well-being and patient outcomes. Previous interventions have focused on organizational issues and work-life balance. OBJECTIVE To assess the feasibility of monthly interdisciplinary educational rounds that support clinicians' ability to navigate workplace clinical and communication challenges while promoting interprofessional teamwork and self-care. METHODS The Program to Enhance Relational and Communication Skills rounds are an educational initiative within a large pediatric tertiary care hospital. Participation is voluntary and offered to interprofessional clinicians from 4 critical care units, cardiac catheterization unit, and intermediate care unit. Topics of monthly hour-long sessions are developed collaboratively. Feasibility is assessed by ongoing documentation of attendance. Postintervention questionnaires are used to evaluate the program's value. RESULTS Between April 2010 and December 2016, a total of 1156 clinicians participated (median, 18 per seminar): 653 nurses (56%), 103 social workers (9%), 102 child life specialists (9%), 32 psychologists (3%), 40 chaplains (3%), 18 physicians (2%), 18 ethicists (2%), and 190 others (16%), including medical interpreters, nursing students, and administrative staff. Ninety-two percent of participants rated their participation as "quite valuable" or "very valuable." Programs of highest interest included child assent, bereavement, social media, and workplace bullying. Evolution into actual clinical practice change remains a challenge for the future. CONCLUSION Our approach to communication and workplace challenges is relevant, user-friendly, and feasible. Diffi cult topics are addressed in real time, with clinicians learning interprofessionally. (Critical Care Nurse. 2018;38[6]:15-22) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Describe the key philosophy of the Program to Enhance Relational and Communication Skills (PERCS) rounds and Workshops 2. Identify the importance of PERCS champions to the promotion and development of PERCS rounds 3. Identify 3 important characteristics of the PERCS rounds that may aide in developing a similar educational initiative To complete evaluation for CE contact hour(s) for activity C1861, visit www.ccnonline.org and click the "CE Articles" button. No CE fee for AACN members. This activity expires on December 1, 2021. The American Association of Critical-Care Nurses is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Registered Nursing of California (#01036) and Louisiana (#LSBN12).

Academic Medicine, 2002

Purpose. Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices. Method. Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each researcher and coded for emergent themes in the grounded theory tradition. Coding consensus was achieved via regular discussion. Findings were returned to insider ''experts'' for their assessment of authenticity and adequacy.

Pediatric Critical Care Medicine, 2009

Background: Communication skills and relational abilities are essential core competencies that are associated with improved health outcomes, better patient adherence, fewer malpractice claims, and enhanced satisfaction with care. Yet, corresponding educational opportunities are sorely underrepresented and undervalued.

Mediterr J Pharm Pharm Sci, 2021

Apart from our hard skills, every professional must develop soft skills to consolidate their complex skills to attain professional development. Hard skills are those that specific to one's profession. These skills can be measured, quantified and easier to learn. Both verbal and written communication are essential components of professionalism. These skills help interact with colleagues, allied health workers and patients who seek counselling. Some of the practical communication skills involve face-to-face, online video calls or email. One of the main attributes of vocal communication is being an active listener and listening to the patient

2015

The Joint Commission, 2012). Significant reduction of medical errors is constrained by a lack of understanding for the causes of communication failure; the bulk of knowledge about communication failure is known after such failures result in medical errors. The problem addressed in this dissertation is the lack of tools to study provider-provider communication in progress. The study included here aims to demonstrate one means by which provider-provider communication can be successfully characterized. Few studies of provider-provider communication during care delivery have been conducted. Some understanding of information exchanges has been provided from studies by communication and listening scholars in health care and in other fields where precise communication is essential. However researchers lack the ability to recognize the specific components in an information exchange between two or more providers that indicate communication has succeeded or failed. These conditions leave new studies without testable theories and offer no reasonable basis for hypotheses about communication failure. This study employed an exploratory inquiry strategy and leveraged verbal listening behaviors in closed loop communication (CLC) to identify characteristics of communciation. Observations were conducted of medical (MD) and nursing (RN) student teams managing Emergency iii Medicine (EM) simulations. Observers accessed the videotaped EM encounters at the Center for Advancing Professional Excellenec (CAPE) at the University of Colorado Denver's Anschutz Medical Campus (UC/AMC). Students' verbal listening behaviors were used to characterize their exchanges of information; CLC provided a framework to identify and position the listening behaviors in exchanges of information. This study had three goals, which were revised based on learning gained from the study. 1. To identify specific steps in provider-provider exchanges of information where communication succeeds and fails-is revised to-To characterize the exchanges of information among the MD and RN student teams during simulated care delivery 2. To describe the characteristics of communication sufficiently to assess outcomes of communication loops not being closed-is deleted as data gathered did not support this goal and the goal was determined to exceed the scope of the study. 3. To recommend hypotheses to study to inform providers' communication curriculum, professional development, and subsequent research-The exploration and data supported this goal and it was retained. Hypotheses for future studies are detailed. Competencies and decision-making: Hypothesis One. There is a negative correlation between students' demonstration of specific communication competencies and specific clinical decisionmaking competencies in the same simulation of care delivery. Researchers should consider study participants' level of communication education and/or practice experience when deciding the type and number of competencies to be evaluated in the study. Level of communication skill and competencies: Hypothesis Two. There is no relationship between IP teams whose members are closely matched with respect to their level of acquired communication skill and their ability to demonstrate communication competencies. The data iv suggests that researchers should minimize disparities among study participants' education and/or practice experience. Nonverbal behaviors: Hypothesis Three. There is no relationship between nonverbal behaviors and the ability to more thoroughly identify the contributing factors for successful and unsuccessful communication. This study and the literature make a case for nonverbal behaviors to supplement, expand, and give clues to underlying issues in the associated verbal behaviors. Hypothesis Four. There is no relationship between increasing acuity of the care delivery encounter and the number of information exchanges that end in closed loops. Provider-provider observational studies demonstrate as acuity of the condition being treated increases participants' listening behaviors increase and, in some cases, communication competency declines. Educators and providers need precise understandings of communication failure to confidently advise changes to curriculum and practice and produce the health professions work force to deliver that care. v ACKNOWLEDGEMENTS The support, inspiration, expertise, and unyielding commitment to excellence in scholarship from my committee was decisive in my successful dissertation. Travis Maynard was my first committee member and I am all the better for his steady, high expectations for scholarship. Gene Gloeckner filled an unexpected vacancy on the committee and named the study's inquiry strategy that stood up to the necessary challenge from other committee members. Gwyn Barley inspired the entire dissertation, from introducing me to patient safety issues in 2005 and to interprofessional education (IPE) in 2011 and for opening the way to the CAPE as my research site. I sometimes "blamed her" as well when sleep deprivation and momentary lapses in clarity stalled my work! My advisor, Carole Makela, orchestrated the entire process: she guided, cajoled, affirmed, informed, and somehow knew exactly when to contribute and when to leave me to make my own discoveries. Carole provided an irresistible standard for thinking, researching, and writing that is the reason I have arrived at completion. Friends, at Regis University and in my personal life, supported me and warmly, humorously urged me along; my family tolerated my absences from or short stays at gatherings. My observers, Shimaa Basha and Malia Crouse, deserve a special thanks for attention to our work every bit as committed and vigilant as mine. The "support group" of Ph.D. candidates at CSU regularly supported, critiqued, and inspired my work. I hope you all know how very deeply I appreciate your support and many contributions. vi DEDICATION Two people held unique, inspiring roles through the entire Ph.D. process, my father, Ralph Rosser and my wife, Mary Cook, and to them I dedicate this work. My father gave me curiosity and the intellectual strength to pursue and complete the Ph.D. Dad would have drawn genuine pleasure from my rambling verbal explorations of new concepts, vexing questions, and occasional dead ends; he would have happily given it right back, with his own propensity for the same behaviors. I regularly stopped to imagine how he would have aided my progress, from his powerful intellect, enthusiasm for learning, and his faith. I missed him terribly, then and now. Mary made innumerable sacrifices so I had time for the work. Her gifts were a steady outlook, endless patience with the Ph.D. process and how I experienced it, and unconditional love and support for me. She listened to me, comforted me, made me accountable for my words and actions, and, when the time was right, would just leave me alone. Mary now gets as much of the time I will have from completing the Ph.D. as I can possibly give her. vii TABLE OF CONTENTS

Take on Using and Teaching Basic Communication Skills for Health Care Professionals, 2020

This project proposes that immediately teaching health care professionals basic communication skills in a Solution Focused way will provide therapeutic benefits for both client and care provider. Firstly, this article focuses on the development of a small set of core principles for Solution Focused work, easily explained to any audience. Secondly, it addresses the question “how can basic communication skills be applied immediately in a Solution Focused way?”

AMERICAN JOURNAL OF BIOETHICS, 2006