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NURS 4520: Final Material > Class 7 > Flashcards

Class 7 Flashcards

1
Q

what key concepts are found in Brindley’s article on improving verbal communication in critical care medicine? (4)

A
  • verbal dexterity is critical in the clinical setting
  • horizontal authority
  • horizontal communication
  • strategies to enhance medical communication
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2
Q

according to Brindley, what is horizontal authority

A
  • the concept that senior members are as important as junior members of the healthcare team
  • may refer to IP power imbalances as well –> ex. physician vs nurse
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3
Q

according to Brindley, what is horizontal communication

A
  • an enviro where subordinates are empowered to speak up, and senior members listen
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4
Q

according to Brindley, what are strategies to enhance medical communication (10)

A
  • graded assertiveness
  • resuscitate by voice
  • avoid mitigating speech
  • 5 step advocacy
  • SBAR
  • call out method
  • below 10 000 feet method
  • 3 C’s of communication
  • closed loop method
  • repeat method
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5
Q

according to Brindley, _________ are the most common human error contributing to adverse healthcare outcomes

A
  • communication errors
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6
Q

according to Brindley, what is mitigating speech

A
  • sugar coating language to be polite
  • deferential (i.e. “maybe we should do this”, “would you mind doing this”)
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7
Q

according to Brindley, mitigating speech is linked to? when should it never be used?

A
  • inadequate crisis mngmt
  • never be used in CPR situation or an emergency situation
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8
Q

according to Brindley, when can mitigating speech be used?

A
  • in non-crisis situation to team build –> asking politely for help will strengthen your relationship vs demanding it
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9
Q

according to Brindley, what is graded assertiveness

A
  • approach using up to 6 strategies from least to most direct
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10
Q

according to Brindley, what are the 6 strategies included in graded assertiveness

A
  • hint
  • preference
  • query
  • shared suggestion
  • statement
  • command
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11
Q

according to Brindley, what is an example of a “hint” in graded assertiveness?

A

“should things look like this?”

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12
Q

according to Brindley, what is an example of a “preference” in graded assertiveness?

A

“i think it would be wise to do the following…”

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13
Q

according to Brindley, what is an example of a “query” in graded assertiveness?

A

“what do you think we should do?”

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14
Q

according to Brindley, what is an example of a “shared suggestion” in graded assertiveness?

A

“you and I should do the following”

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15
Q

according to Brindley, what is an example of a “statement” in graded assertiveness?

A

“I think we need to do the following”

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16
Q

according to Brindley, what is an example of a “command” in graded assertiveness?

A

“do this now”

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17
Q

according to Brindley, what is resuscitate by voice?

A
  • HCP taught to deliberately speak up, announce intentions
    ex. “I am going to give epi”
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18
Q

according to Brindley, what is the benefit of resuscitate by voice

A
  • announcing intentions allows other team members to double check an action
    ex. if someone is being given an antibiotic they are allergic to
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19
Q

according to Brindley, what is included in 5 step advocacy

A

1: address the individual
2: state your concern (use clear language and include your own worry)
3: state the problem as you see it
4: state a solution
5: obtain agreement

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20
Q

according to Brindley, when should SBAR be used (3)

A
  • when transferring care
  • obtaining opinions
  • summarizaing complex pts
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21
Q

when should SBAR not be used

A
  • in critical situations
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22
Q

according to Brindley, when should the call-out method be used (3)

A
  • speaking up to other team members while completing a task
  • following an important change in pt condition
  • when something appears to be wrong
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23
Q

according to Brindley, the call-out method involves…

A
  • verbally forcing a time out to reflect/reassess
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24
Q

according to Brindley, the call-out method involves…

A
  • verbally forcing a time out to reflect/reassess
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25
Q

according to Brindley, what is the “below ten thousand feet” method

A
  • concept that people can be in extremely delicate situation which require focus –> in these situations ensure we are communicating only necessary info, and that we ask before diving in
  • gauge the moment & timing of convo, communicate based on context
    ex. dont interrupt a nurse during med prep
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26
Q

according to Brindley, what are the 3 Cs of communication

A

Clear instructions
Citing names
Closing the loop

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27
Q

according to Brindley, what is closed loop communication

A
  • confirming task completion by demanding feedback
    ex. “pls tell me when this task is done”, “pls insert a large bore IV for immediate blood transfusion and let me know when its done”
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28
Q

what is read-back method

A
  • reading back a verbal/phone order to confirm it before processing
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29
Q

according to Brindley, what is the repeat-back method

A
  • repeating to confirm mutual understanding
    ex. “the order was for 15, one-five, of morphine IV stat correct?”
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30
Q

what key concepts are found in Drinka? (2)

A
  • communication among HCP include narratives, words and their meaning, business jargon, and unspoken influences on team communication
  • goal is to understand how the influence of language can impact the team in a positive way
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31
Q

according to Drinka, what is multivocality

A
  • each HC discipline focuses on different aspects of the pt’s health history/presenting concern
  • each will tell the pt narrative differently and each narrative builds on the others to create a complete picture of the pt’s needs, creates holistic picture
  • involves the “layering” of each provider’s unique version of the story
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32
Q

according to Drinka, multivocality/narratives contributes to…

A
  • a narrative community of practice
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33
Q

according to Drinka, what are interpretative gaps? how can they be reduced?

A
  • gaps caused by the limits of each profession’s expertise
  • can be reduced by joining all provider narratives
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34
Q

according to Drinka, constructing a holistic picture of the patient requires the _______(3) of provider narratives?

A
  • reinterpretation
  • reconfiguration
  • reintegration
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35
Q

according to Drinka, what is included under “words and their meanings”

A
  • medical jargon, which is unique to each discipline
  • use of common phrases, acronyms, language
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36
Q

what is an important aspect of words and their meaning

A
  • must be comfortable questioning each other’s words/line of reasoning
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37
Q

according to Drinka, what is meant by “business jargon” in healthcare team communication?

A
  • business terms centered around quality improvement terminology which HCP often adopt
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38
Q

according to Drinka, what are examples of business jargon in healthcare? (4)

A
  • actionable
  • best practices
  • buy-in
  • core competency
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39
Q

according to Drinka, who often brings in business jargon to healthcare teams?

A
  • managers –> as best practice is based off statistics and statistical terms are often business terms
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40
Q

according to Drinka, how can unspoken influences on team communication influence an individual’s communication

A
  • previous history w team work influences how a person communicates in team settings
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41
Q

according to Drinka, how can unspoken influences on team communication influence an individual’s communication (2)

A
  • previous history w teamwork influences how a person communicates in team settings
  • lays groundwork for how HCP view themselves in relation to a team and how quick they assimilate into the team
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42
Q

according to Drinka, what 3 concepts are included in the unspoken influences on team communication

A
  • myths
  • metaphors
  • mental image
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43
Q

according to Drinka, what are myths

A
  • narratives that arise in the course of a teams development that unmask the worldview of the teams members
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44
Q

according to Drinka, myths can be used to…

A
  • develop and sustain team culture
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45
Q

according to Drinka, what is an example of a positive myth r/t team communication

A
  • a team being very good at dealing w a particular type of pt (ex. pts w dementia) –> can bolster morale
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46
Q

according to Drinka, what are metaphors r/t team communication

A
  • figurative language based on life experiences
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47
Q

according to Drinka, what influences metaphors (2)

A
  • team experiences growing up influence our metaphor of what a team is (most common are sports, ex. comparing to a hockey team)
  • metaphors continue change based on experience
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48
Q

according to Drinka, sports metaphors are more likely to…

A
  • be misinterpreted in the healthcare setting than other team metaphors
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49
Q

according to Drinka, metaphors can be a valuable tool in….

A
  • diagnosing the state of the team
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50
Q

according to Drinka, what are unidimensional metaphors

A
  • overly simple metaphors
  • indicates something is not working
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51
Q

according to Drinka, what do negative unidimensional metaphors indicate?

A
  • there is unresolved team conflict
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52
Q

according to Drinka, members of an IPC team should explicity discuss…

A
  • the metaphors they use to describe team functioning, as well as how the team would like to see these metaphors change over time
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53
Q

according to Drinka, what are mental images r/t team communication

A
  • the mental image a person has of their team
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54
Q

according to Drinka, asking team members to ________ r/t mental images can allow us to understand team dynamics

A
  • draw a picture of their team
    ex. do people appear close, friendly, etc.
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55
Q

according to Drinka, mental images allow team members to reveal and review…

A
  • their interactional patterns
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56
Q

what key concepts are found in overton’s article on conflict mngmt? (2)
* according to the study guide, know the main points from this article*

A
  • conflict competence
  • common responses to conflict
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57
Q

according to Overton, what is conflict competence

A
  • the ability to develop and use cognitive, emotional, and behavioral skills that enhance productive outcomes of conflcit which reducing the likelihood of escalating or harm
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58
Q

what are Thomas-Kilmann’s conflict modes

A
  • 5 conflict modes that vary in assertiveness and cooperativeness
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59
Q

according to Thomas-Kilmann’s conflict modes, what is assertiveness

A
  • focus on my needs, desired outcomes, and agenda
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60
Q

according to Thomas-Kilmann’s conflict modes, what is cooperativeness

A
  • focus on others’ needs and mutual relationships
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61
Q

according to Overton, what are common responses to conflict (5)

A
  • avoiding
  • accommodating
  • competing
  • compromising
  • collaborating
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62
Q

describe the assertiveness and cooperativeness of competing

A
  • high assertiveness
  • uncooperative
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63
Q

describe the assertiveness and cooperativeness of avoiding

A
  • unassertive
  • uncooperative
64
Q

describe the assertiveness and cooperativeness of compromising

A
  • moderate assertiveness and cooperativeness
65
Q

describe the assertiveness and cooperativeness of collaborating

A
  • high assertiveness
  • high cooperativeness, both
66
Q

describe the assertiveness and cooperativeness of accomodating

A
  • unassertive
  • high cooperativeness
67
Q

according to Overton, conflict is associated w….

A
  • high rates of employee turnover
68
Q

according to Overton, pt safety is negatively impacted by…

A
  • poor conflict mngmt
69
Q

according to Overton, what are crucial conversations

A
  • a discussion between two or more people where
    1. the stakes are high
    2. opinions vary
    3. emotions run strong
70
Q

according to Overton, what are confrontations

A
  • face-to-face conversations in which someone is held accountable
71
Q

according to Overton, how many levels of intensity of conflict are there?

A

5

72
Q

according to Overton, what is lvl 1 of intensity of conflict

A
  • differences
  • people have diff perspectives but understand each other’s viewpoints and are comfortable w the difference
  • thoughtfully consider different perspectives on the situation
73
Q

according to Overton, what is lvl 2 of intensity of conflict

A
  • misunderstandings –> two people understand a situation differently
74
Q

according to Overton, what is lvl 3 of intensity of conflict

A
  • disagreements –> people have diff viewpoints, understand each other’s views, but are uncomfortable w the difference
75
Q

according to Overton, what is lvl 4 of intensity of conflict

A
  • discord –> relationship issues between people involved even after a specific conflict is resolved
    ex. like a grudge
76
Q

according to Overton, what is lvl 5 of intensity of conflict

A
  • polarization –> situations of intense negative feelings and behaviors, resolution is hard
    ex. COVID debates
77
Q

according to Overton, what are 3 types of trust

A
  • trust formed by confidence in the intention of others
  • communication trust or trust of disclosures
  • capabaility trust
78
Q

according to Overton, what is communication trust or trust of disclosures

A
  • everyone is comfortable that people will share info, be honest, and keep private info confidential
79
Q

according to Overton, what is capability trust

A
  • confidence in other’s abilities to deliver on promises
80
Q

according to Overton, responses to conflict requires?

A
  • self awareness regarding physical and emotional reaction to conflict situation
81
Q

according to Overton, what is an avoidance response to conflict

A
  • recognizing and actively deciding not to engage
82
Q

according to Overton, when is the avoidance response to conflict useful? (2)

A
  • when issue is minor or temporary
  • when emotions are high
83
Q

according to Overton, what is the competing response to conflict

A
  • forcing, being uncooperative, and assertive
84
Q

according to Overton, when is the competing response to conflict useful? (2)

A
  • in emergency situations
  • or when an unpopular action NEEDs to be taken
85
Q

according to Overton, what is the accommodating response to conflict

A
  • yielding
  • deferring to other’s needs, not having your needs met
86
Q

according to Overton, when is the accommodating response to conflict useful? (3)

A
  • when you are wrong
  • if issue is more critical to others
  • if harmony is values
87
Q

according to Overton, what is a downside to the accomodating response to conflict

A
  • conflict will repeat itself as residual resentment remains
88
Q

according to Overton, what is the compromising response to conflict (2)

A
  • balance of assertiveness and cooperativeness
  • a negotiation between two parties w equivalent power, focused on fixing the problem w a set amt of resources
89
Q

according to Overton, what is the collaboration response to conflict (3)

A
  • balance of assertiveness and cooperativeness
  • focuses on finding a solutions where all parties are satisfied
  • allows for a broader view on problem solving
90
Q

according to Overton, both compromising and collaboration are a ___________ response

A
  • problem solving response
91
Q

according to Overton, a safe enviro for conflict resolution involve… (2)

A
  • mutual respect
  • mutual purpose
92
Q

according to Overton, conflict resolution should start w …. (4)

A
  • open-ended questions
  • focusing initially on points of agreement
  • use “I” statements
  • be aware of body language
93
Q

according to Overton, an enviro for conflict resolution should be… (4)

A
  • private
  • neutral
  • time protected
  • should start w establishing the gap between expected and observed behavior
94
Q

according to Overton, what mistakes should be avoided w conflict resolution (4)

A
  • softening the message by using compliments (will perceive manipulation)
  • inappropriate humor
    -non-verbal hints
  • subtle comments instead of direct verbal confrontation
95
Q

according to Overton, what are the key elements to conducting a convo for conflict resolution (4)

A
  • scoping
  • defining the problem
  • ensuring that everyone understands their role and tasks
  • reflecting on how to avoid similar conflicts in the future
96
Q

according to Overton, what is scoping

A
  • involves understanding what is happening, each person’s perspective, what is important to each person, establishing ways each person can work toward a solution
97
Q

according to Overton, scoping involves

A
  • stating opinions and perspectives
  • set ground rules
  • ask clarifying questions
  • use empathy
98
Q

what is the purpose of AMPP

A
  • describes the 4 main listening skills to use when facing an issue
99
Q

according to Overton, what does AMPP stand for

A

Ask
Mirror
Paraphrase
Prime

100
Q

according to Overton, what is included in the “ask” of AMPP

A
  • ask what the situation is
  • start the convo and allow for the other person to discuss their feelings
101
Q

according to Overton, what is included in the “mirror” of AMPP

A
  • encourage the speaker to continue or offer more info when they seem reluctant
  • make statements about what you are observing
    ex. “you seem down”
102
Q

according to Overton, what is included in the “paraphrase” of AMPP

A
  • restating the individual’s responses
  • acknowledge the story
103
Q

according to Overton, what does paraphrasing demonstrate? (2)

A
  • active listening
  • shared understanding
104
Q

according to Overton, what is included in the “prime” of AMPP

A
  • making a guess out loud about what the person might be thinking or feeling
  • prime when getting nowhere
105
Q

according to Overton, what does priming allow?

A
  • primes them to correct you, agree, clarify, and feel comfortable speaking
106
Q

according to the WRHA, IP conflict resolution occurs when…

A
  • HCP/students work as a team that actively engages in addressing disagreements and responds effectively to all types of conflict
107
Q

according to the WRHA, IP conflict resolution requires us to… (2)

A
  • acknowledge that different perspectives can contribute to role ambiguity, role overload, and goal differences
  • be self accountable and respect responsibility for own ability to address conflict in a healthy, respectful way
108
Q

according to the WRHA, to support IP conflict resolution, HCP must (4)

A
  • create a safe enviro where differing opinions are welcome
  • validate and acknowledge differing perspectives
  • communicate positively and constructively
  • see conflict with the potential for positive outcome
109
Q

according to the WRHA, the outcome of IP conflict resolution is…

A
  • conflict positive perspective = differences are part of healthy, constructive interactions
110
Q

what is the significance of difficult convos to an IP team’s collaboration and functioning (5)

A
  • professionalism
  • diversity
  • pt safety and care
  • personal growth
  • consequences of “sweeping under the carpet”
111
Q

how do some people face difficult conversations? (3)

A
  • avoid them
  • face them and handle them poorly
  • we face them and handle them well
112
Q

handling conflict well involves… (8)

A
  • empathy
  • thinking before speaking
  • try not to be confrontational
  • active listening
  • patience
  • no distractions
  • validation
  • listen where person it at
113
Q

silence in the conversation can be due to… (3)

A
  • masking
  • avoiding
  • withdrawing
114
Q

violence in the conversation can involve (3)

A
  • controlling
  • attacking
  • labelling
115
Q

what is verbal dexterity

A
  • means using speech best suited to the situation at hand
116
Q

what is verbal dexterity

A
  • means using speech best suited to the situation at hand
117
Q

what are examples of unspoken influences on team communication (6)

A
  • past memories of team performance and membership
  • myths, metaphors
  • timing of communication
  • context of situation
  • enviro
  • consider proximity of pts and public when communicating and discussing sensitive info
118
Q

what are 3 parts to the difficult convo

A
  • “what happened” convo
  • the “feelings” convo
  • the “identity” convo
119
Q

what is included in the “what happened” convo

A
  • discourse about what actually happened (facts), which leads to what should have happened
120
Q

attributes of ______ can twist and tangle up participants in the “what happened” convo… therefore, it is important to focus on _________ in teams

A

-blame
- focus on culture of safety

121
Q

what is involved in the “feelings” convo (3)

A
  • critical aspect of any convo
  • feeling vulnerable
  • imp, like “staging an opera without music”, get the plot but miss the point
122
Q

what is included in the “identity” convo (3)

A
  • what does the convo mean to us, reflect on the team and self?
  • how are the roles and responsibilities of team members impacted?
  • professional identity may be shaken (ex. if someone says “nurses are crappy”)
123
Q

what 2 acronyms are used to describe aspects of effective communication

A
  • STATE
  • AMPP
124
Q

what does STATE stand for

A

Share your facts
Tell your story
Ask for others path
Talk tentatively
Encourage testing

125
Q

what are some techniques to dealing w difficult convos (80

A
  • prepare, may rehearse
  • focus on the issue/problem, not the person
  • validate the person’s feelings
  • clarify your scope, limits, boundaries, and assumptions of others
  • problem solve w the person-present options, strategies for moving forward
  • have an exit strategy (time limit, another apt.)
  • document
  • debrief
126
Q

what can be done w emotions to help address difficult convos

A
  • untangle your emotions from the need to have a difficult convo
  • separate your emotion from doing it, from the things that you actually need to talk about and the outcome you want to accomplish
127
Q

what are 5 steps to handling difficult convos

A
  1. acknowledge your responsibility and be accountable for ur part in the situation
  2. define the outcome (objective of convo) that you wanted in the first place –> always go back to the objective
  3. listen and validate the person, hear where they are at
  4. restate the outcome, keep talking until you hit the outcome
  5. bonus: rehearse w a friend first
128
Q

define: conflict

A
  • conflict is serious disagreement and argument about something important
  • involves desires that are incompatible
129
Q

what are 3 types of conflict

A
  • relational
  • task
  • process
130
Q

what is relational related conflict

A
  • strain between group members
131
Q

what is task related conflict

A
  • conflict about the type of task or if the task needs to be performed
132
Q

what is process related conflict

A
  • conflict about how to performa task
133
Q

what is a mechanism of resistance

A
  • avoidance
134
Q

what are some ways people display avoidance (5)

A
  • humour
  • being negative
  • “we dont have a problem” statements
  • social media
  • denial
135
Q

describe Thomas-Kilmann’s conflict modes

A
  • involves 5 types of conflict modes that vary in assertiveness and cooperativeness
136
Q

“I’ll meet you halfway” is an example of which conflict mode?

A
  • compromise
137
Q

“forget about it. let’s not make a big deal out of it” is an example of which conflict mode?

A
  • avoidance
138
Q

“we’ll do it my way. let’s just get the job done” is an example of which conflict mode?

A
  • competing
139
Q

“whatever you want is fine with me” is an example of which conflict mode?

A
  • accomodating
140
Q

“id like to do it this way, what would you like? lets find a way for both of us to get what we want” is an example of which conflict mode?

A
  • collaborating
141
Q

what are examples of sources of conflict in an IP team (9)

A
  • intra-team issues
  • not realizing what you don’t know
  • professional autonomy and fear of making mistakes
  • role blurring
  • different outlook on goals, cultural background
  • issues w communication/communication breakdown
  • absence of role modelling
  • horizontal hostility
  • inability to effectively deal w incompatibilities
142
Q

what are benefits of conflict in teamwork (3)

A
  • can improve decision making and performance
  • may make members more demanding of their own work and more demanding of their team members
  • keeps team’s purpose in focus
143
Q

how might team member’s express conflict

A
  • verbal –> direct and indirect
  • nonverbal –> direct and indirect
144
Q

what are examples of verbal, direct expression (3)

A
  • blame others
  • deny own actions
  • strongly defend a single position
145
Q

what are examples of verbal & indirect communication (3)

A
  • raise unrelated points
  • raise/lower voice
  • change opinions when pressured
146
Q

what are examples of nonverbal & direct communication (2)

A
  • exclude essential disciplines
  • withhold important info
147
Q

what are examples of nonverbal and indirect communication (5)

A
  • avoid eye contact
  • glare
  • remain silent
  • sigh
  • conceal emotions
148
Q

what are power currencies

A
  • tangible or intangible attributes or qualities that are admired by people
149
Q

what are examples of power currencies (10)

A
  • respect
  • trust
  • morality
  • integrity
  • warmth
  • skills
  • enthusiasm
  • friendliness
  • helpfulness, flexibility
  • assertiveness
150
Q

how might power currencies be used? (3)

A
  • to get our attention
  • helpful ways
  • destructive ways (ex. fire that warms can also burn)
151
Q

team conflict analysis involves considering… (4)

A
  • what are the factors contributing to the conflict?
  • what are the interests of both/all parties?
  • what conflict styles are being used?
  • what conflict styles might be more appropriate?
152
Q

with conflict, it is ALWAYS important for a team leader to suggest specific strategies to address and resolve conflict. why or why not?

A
  • depends on the situation ex. crisis vs discharge
153
Q

when managing conflict in IP teams, it is important to ask…(2)

A
  • “what might be preventing us from working together effectively?”
  • “before we return to our task, does anyone have any further ideas or suggestions how to proceed (based on what we have been talking about)?”
154
Q

conflict in IP teams can be managed by … (7)

A
  • valuing the potential positive nature of conflict
  • recognizing the potential for conflict to occur and taking constructive steps to address it
  • identify common situations that can lead to conflict
  • know and understand strategies to deal w conflict
  • effectively work to address and resolve disagreements
  • establish a safe enviro where people can express diverse opinions
  • describe what is happening, shift focus
155
Q

according to Drinka, what are 3 approaches to integrating conflict into collaborative teamwork (3)

A
  • make interpersonal risk-taking safe
  • view conflict as a source of learning and innovation
  • democratize power hierarchies
156
Q

rules for conflict mngmt should be established during which stage of team developemnt?

A
  • forming stage w team charters

NURS 4520: Final Material (5 decks)

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