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
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
3
Q
according to Brindley, what is horizontal communication
A
- an enviro where subordinates are empowered to speak up, and senior members listen
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
5
Q
according to Brindley, _________ are the most common human error contributing to adverse healthcare outcomes
A
- communication errors
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”)
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
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
9
Q
according to Brindley, what is graded assertiveness
A
- approach using up to 6 strategies from least to most direct
10
Q
according to Brindley, what are the 6 strategies included in graded assertiveness
A
- hint
- preference
- query
- shared suggestion
- statement
- command
11
Q
according to Brindley, what is an example of a “hint” in graded assertiveness?
A
“should things look like this?”
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…”
13
Q
according to Brindley, what is an example of a “query” in graded assertiveness?
A
“what do you think we should do?”
14
Q
according to Brindley, what is an example of a “shared suggestion” in graded assertiveness?
A
“you and I should do the following”
15
Q
according to Brindley, what is an example of a “statement” in graded assertiveness?
A
“I think we need to do the following”
16
Q
according to Brindley, what is an example of a “command” in graded assertiveness?
A
“do this now”
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”
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
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
20
Q
according to Brindley, when should SBAR be used (3)
A
- when transferring care
- obtaining opinions
- summarizaing complex pts
21
Q
when should SBAR not be used
A
- in critical situations
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
23
Q
according to Brindley, the call-out method involves…
A
- verbally forcing a time out to reflect/reassess
24
Q
according to Brindley, the call-out method involves…
A
- verbally forcing a time out to reflect/reassess
25
according to Brindley, what is the "below ten thousand feet" method
- 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
26
according to Brindley, what are the 3 Cs of communication
Clear instructions
Citing names
Closing the loop
27
according to Brindley, what is closed loop communication
- 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"
28
what is read-back method
- reading back a verbal/phone order to confirm it before processing
29
according to Brindley, what is the repeat-back method
- repeating to confirm mutual understanding
ex. "the order was for 15, one-five, of morphine IV stat correct?"
30
what key concepts are found in Drinka? (2)
- 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
31
according to Drinka, what is multivocality
- 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
32
according to Drinka, multivocality/narratives contributes to...
- a narrative community of practice
33
according to Drinka, what are interpretative gaps? how can they be reduced?
- gaps caused by the limits of each profession's expertise
- can be reduced by joining all provider narratives
34
according to Drinka, constructing a holistic picture of the patient requires the _______(3) of provider narratives?
- reinterpretation
- reconfiguration
- reintegration
35
according to Drinka, what is included under "words and their meanings"
- medical jargon, which is unique to each discipline
- use of common phrases, acronyms, language
36
what is an important aspect of words and their meaning
- must be comfortable questioning each other's words/line of reasoning
37
according to Drinka, what is meant by "business jargon" in healthcare team communication?
- business terms centered around quality improvement terminology which HCP often adopt
38
according to Drinka, what are examples of business jargon in healthcare? (4)
- actionable
- best practices
- buy-in
- core competency
39
according to Drinka, who often brings in business jargon to healthcare teams?
- managers --> as best practice is based off statistics and statistical terms are often business terms
40
according to Drinka, how can unspoken influences on team communication influence an individual's communication
- previous history w team work influences how a person communicates in team settings
41
according to Drinka, how can unspoken influences on team communication influence an individual's communication (2)
- 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
42
according to Drinka, what 3 concepts are included in the unspoken influences on team communication
- myths
- metaphors
- mental image
43
according to Drinka, what are myths
- narratives that arise in the course of a teams development that unmask the worldview of the teams members
44
according to Drinka, myths can be used to...
- develop and sustain team culture
45
according to Drinka, what is an example of a positive myth r/t team communication
- a team being very good at dealing w a particular type of pt (ex. pts w dementia) --> can bolster morale
46
according to Drinka, what are metaphors r/t team communication
- figurative language based on life experiences
47
according to Drinka, what influences metaphors (2)
- 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
48
according to Drinka, sports metaphors are more likely to...
- be misinterpreted in the healthcare setting than other team metaphors
49
according to Drinka, metaphors can be a valuable tool in....
- diagnosing the state of the team
50
according to Drinka, what are unidimensional metaphors
- overly simple metaphors
- indicates something is not working
51
according to Drinka, what do negative unidimensional metaphors indicate?
- there is unresolved team conflict
52
according to Drinka, members of an IPC team should explicity discuss...
- the metaphors they use to describe team functioning, as well as how the team would like to see these metaphors change over time
53
according to Drinka, what are mental images r/t team communication
- the mental image a person has of their team
54
according to Drinka, asking team members to ________ r/t mental images can allow us to understand team dynamics
- draw a picture of their team
ex. do people appear close, friendly, etc.
55
according to Drinka, mental images allow team members to reveal and review...
- their interactional patterns
56
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***
- conflict competence
- common responses to conflict
57
according to Overton, what is conflict competence
- 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
58
what are Thomas-Kilmann's conflict modes
- 5 conflict modes that vary in assertiveness and cooperativeness
59
according to Thomas-Kilmann's conflict modes, what is assertiveness
- focus on my needs, desired outcomes, and agenda
60
according to Thomas-Kilmann's conflict modes, what is cooperativeness
- focus on others' needs and mutual relationships
61
according to Overton, what are common responses to conflict (5)
- avoiding
- accommodating
- competing
- compromising
- collaborating
62
describe the assertiveness and cooperativeness of competing
- high assertiveness
- uncooperative
63
describe the assertiveness and cooperativeness of avoiding
- unassertive
- uncooperative
64
describe the assertiveness and cooperativeness of compromising
- moderate assertiveness and cooperativeness
65
describe the assertiveness and cooperativeness of collaborating
- high assertiveness
- high cooperativeness, both
66
describe the assertiveness and cooperativeness of accomodating
- unassertive
- high cooperativeness
67
according to Overton, conflict is associated w....
- high rates of employee turnover
68
according to Overton, pt safety is negatively impacted by...
- poor conflict mngmt
69
according to Overton, what are crucial conversations
- a discussion between two or more people where
1. the stakes are high
2. opinions vary
3. emotions run strong
70
according to Overton, what are confrontations
- face-to-face conversations in which someone is held accountable
71
according to Overton, how many levels of intensity of conflict are there?
5
72
according to Overton, what is lvl 1 of intensity of conflict
- 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
according to Overton, what is lvl 2 of intensity of conflict
- misunderstandings --> two people understand a situation differently
74
according to Overton, what is lvl 3 of intensity of conflict
- disagreements --> people have diff viewpoints, understand each other's views, but are uncomfortable w the difference
75
according to Overton, what is lvl 4 of intensity of conflict
- discord --> relationship issues between people involved even after a specific conflict is resolved
ex. like a grudge
76
according to Overton, what is lvl 5 of intensity of conflict
- polarization --> situations of intense negative feelings and behaviors, resolution is hard
ex. COVID debates
77
according to Overton, what are 3 types of trust
- trust formed by confidence in the intention of others
- communication trust or trust of disclosures
- capabaility trust
78
according to Overton, what is communication trust or trust of disclosures
- everyone is comfortable that people will share info, be honest, and keep private info confidential
79
according to Overton, what is capability trust
- confidence in other's abilities to deliver on promises
80
according to Overton, responses to conflict requires?
- self awareness regarding physical and emotional reaction to conflict situation
81
according to Overton, what is an avoidance response to conflict
- recognizing and actively deciding not to engage
82
according to Overton, when is the avoidance response to conflict useful? (2)
- when issue is minor or temporary
- when emotions are high
83
according to Overton, what is the competing response to conflict
- forcing, being uncooperative, and assertive
84
according to Overton, when is the competing response to conflict useful? (2)
- in emergency situations
- or when an unpopular action NEEDs to be taken
85
according to Overton, what is the accommodating response to conflict
- yielding
- deferring to other's needs, not having your needs met
86
according to Overton, when is the accommodating response to conflict useful? (3)
- when you are wrong
- if issue is more critical to others
- if harmony is values
87
according to Overton, what is a downside to the accomodating response to conflict
- conflict will repeat itself as residual resentment remains
88
according to Overton, what is the compromising response to conflict (2)
- 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
according to Overton, what is the collaboration response to conflict (3)
- balance of assertiveness and cooperativeness
- focuses on finding a solutions where all parties are satisfied
- allows for a broader view on problem solving
90
according to Overton, both compromising and collaboration are a ___________ response
- problem solving response
91
according to Overton, a safe enviro for conflict resolution involve... (2)
- mutual respect
- mutual purpose
92
according to Overton, conflict resolution should start w .... (4)
- open-ended questions
- focusing initially on points of agreement
- use "I" statements
- be aware of body language
93
according to Overton, an enviro for conflict resolution should be... (4)
- private
- neutral
- time protected
- should start w establishing the gap between expected and observed behavior
94
according to Overton, what mistakes should be avoided w conflict resolution (4)
- softening the message by using compliments (will perceive manipulation)
- inappropriate humor
-non-verbal hints
- subtle comments instead of direct verbal confrontation
95
according to Overton, what are the key elements to conducting a convo for conflict resolution (4)
- scoping
- defining the problem
- ensuring that everyone understands their role and tasks
- reflecting on how to avoid similar conflicts in the future
96
according to Overton, what is scoping
- 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
according to Overton, scoping involves
- stating opinions and perspectives
- set ground rules
- ask clarifying questions
- use empathy
98
what is the purpose of AMPP
- describes the 4 main listening skills to use when facing an issue
99
according to Overton, what does AMPP stand for
Ask
Mirror
Paraphrase
Prime
100
according to Overton, what is included in the "ask" of AMPP
- ask what the situation is
- start the convo and allow for the other person to discuss their feelings
101
according to Overton, what is included in the "mirror" of AMPP
- 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
according to Overton, what is included in the "paraphrase" of AMPP
- restating the individual's responses
- acknowledge the story
103
according to Overton, what does paraphrasing demonstrate? (2)
- active listening
- shared understanding
104
according to Overton, what is included in the "prime" of AMPP
- making a guess out loud about what the person might be thinking or feeling
- prime when getting nowhere
105
according to Overton, what does priming allow?
- primes them to correct you, agree, clarify, and feel comfortable speaking
106
according to the WRHA, IP conflict resolution occurs when...
- HCP/students work as a team that actively engages in addressing disagreements and responds effectively to all types of conflict
107
according to the WRHA, IP conflict resolution requires us to... (2)
- 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
according to the WRHA, to support IP conflict resolution, HCP must (4)
- 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
according to the WRHA, the outcome of IP conflict resolution is...
- conflict positive perspective = differences are part of healthy, constructive interactions
110
what is the significance of difficult convos to an IP team's collaboration and functioning (5)
- professionalism
- diversity
- pt safety and care
- personal growth
- consequences of "sweeping under the carpet"
111
how do some people face difficult conversations? (3)
- avoid them
- face them and handle them poorly
- we face them and handle them well
112
handling conflict well involves... (8)
- empathy
- thinking before speaking
- try not to be confrontational
- active listening
- patience
- no distractions
- validation
- listen where person it at
113
silence in the conversation can be due to... (3)
- masking
- avoiding
- withdrawing
114
violence in the conversation can involve (3)
- controlling
- attacking
- labelling
115
what is verbal dexterity
- means using speech best suited to the situation at hand
116
what is verbal dexterity
- means using speech best suited to the situation at hand
117
what are examples of unspoken influences on team communication (6)
- 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
what are 3 parts to the difficult convo
- "what happened" convo
- the "feelings" convo
- the "identity" convo
119
what is included in the "what happened" convo
- discourse about what actually happened (facts), which leads to what should have happened
120
attributes of ______ can twist and tangle up participants in the "what happened" convo... therefore, it is important to focus on _________ in teams
-blame
- focus on culture of safety
121
what is involved in the "feelings" convo (3)
- critical aspect of any convo
- feeling vulnerable
- imp, like "staging an opera without music", get the plot but miss the point
122
what is included in the "identity" convo (3)
- 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
what 2 acronyms are used to describe aspects of effective communication
- STATE
- AMPP
124
what does STATE stand for
Share your facts
Tell your story
Ask for others path
Talk tentatively
Encourage testing
125
what are some techniques to dealing w difficult convos (80
- 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
what can be done w emotions to help address difficult convos
- 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
what are 5 steps to handling difficult convos
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
define: conflict
- conflict is serious disagreement and argument about something important
- involves desires that are incompatible
129
what are 3 types of conflict
- relational
- task
- process
130
what is relational related conflict
- strain between group members
131
what is task related conflict
- conflict about the type of task or if the task needs to be performed
132
what is process related conflict
- conflict about how to performa task
133
what is a mechanism of resistance
- avoidance
134
what are some ways people display avoidance (5)
- humour
- being negative
- "we dont have a problem" statements
- social media
- denial
135
describe Thomas-Kilmann's conflict modes
- involves 5 types of conflict modes that vary in assertiveness and cooperativeness
136
"I'll meet you halfway" is an example of which conflict mode?
- compromise
137
"forget about it. let's not make a big deal out of it" is an example of which conflict mode?
- avoidance
138
"we'll do it my way. let's just get the job done" is an example of which conflict mode?
- competing
139
"whatever you want is fine with me" is an example of which conflict mode?
- accomodating
140
"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?
- collaborating
141
what are examples of sources of conflict in an IP team (9)
- 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
what are benefits of conflict in teamwork (3)
- 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
how might team member's express conflict
- verbal --> direct and indirect
- nonverbal --> direct and indirect
144
what are examples of verbal, direct expression (3)
- blame others
- deny own actions
- strongly defend a single position
145
what are examples of verbal & indirect communication (3)
- raise unrelated points
- raise/lower voice
- change opinions when pressured
146
what are examples of nonverbal & direct communication (2)
- exclude essential disciplines
- withhold important info
147
what are examples of nonverbal and indirect communication (5)
- avoid eye contact
- glare
- remain silent
- sigh
- conceal emotions
148
what are power currencies
- tangible or intangible attributes or qualities that are admired by people
149
what are examples of power currencies (10)
- respect
- trust
- morality
- integrity
- warmth
- skills
- enthusiasm
- friendliness
- helpfulness, flexibility
- assertiveness
150
how might power currencies be used? (3)
- to get our attention
- helpful ways
- destructive ways (ex. fire that warms can also burn)
151
team conflict analysis involves considering... (4)
- 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
with conflict, it is ALWAYS important for a team leader to suggest specific strategies to address and resolve conflict. why or why not?
- depends on the situation ex. crisis vs discharge
153
when managing conflict in IP teams, it is important to ask...(2)
- "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
conflict in IP teams can be managed by ... (7)
- 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
according to Drinka, what are 3 approaches to integrating conflict into collaborative teamwork (3)
- make interpersonal risk-taking safe
- view conflict as a source of learning and innovation
- democratize power hierarchies
156
rules for conflict mngmt should be established during which stage of team developemnt?
- forming stage w team charters
NURS 4520: Final Material
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