Interprofessional Communication

Question 1

Why is inter-professional communication important?

Answer 1

• Helps with con’t of care

- Helps individuals understand the roles and scope of practice from other professions

Question 2

What happens when we experience unresolved conflict?

Answer 2

• Diminished morale
• Diminished care and care standards
• Increased sick time and attrition

Question 3

What are the different types of conflict resolution styles?

Answer 3

• Avoidance (can have both positive or negative outcomes
• Accommodation (giving someone else their way, usually best when relationship is worth more than the conflict or when you are wrong; goal is to eliminate conflict ASAP)
• Competition (power is used to stop conflict, can be either negative or positive)
• Compromise (temporary solution, everyone needs to give something up)
• Collaboration (more timely, but everyone’s needs are on the table and everyone wins, involving some type of compromise)

Question 4

What are some common causes of conflict in healthcare?

Answer 4

• Inadequate communication ***
• Incorrect facts
• Lack of trust
• Unclear position descriptions
• Misunderstand of roles and responsibilities (e.g. doctors not understanding nurse barriers in practice)
• Unclear or conflicted goals and objectives
• Inadequate action plans
• Direction
• Unstable leadership
• Inability to accept change
• Lack of resources or competition for resources
• Power issues

Question 5

What are factors influencing health care relationships?

Answer 5

• Different focus of work: social/caring vs. cure/clinical
• Intimate work (nursing intimacy vs. clinical nature of medicine)
• Professional socialization
• Cultural/media stereotypes (nurses perceived by public as more cooperative and caring, but less intelligent and realistic)
• Power asymmetry
• Different role and gender expectations
• Differing goals needs, responsibilities and perceptions of care
• Resources

Question 6

What are antecedents?

Answer 6

• Events or incidents that must occur prior to the occurrence of the concepts
• Individual characteristics
• Interpersonal factors
• Organizational factors

Question 7

Describe how conflict may proceed:

Answer 7

Antecedents > Perceived conflict > Consequences

Question 8

What is horizontal violence?

Answer 8

• A form of bullying that occurs between individuals on the same level within an organization
• Manifests as behaviors that control, diminish or devalue another
• Can be overt or covert in nature

Question 9

What are some theories of possible causes of horizontal violence?

Answer 9

• Group oppression (people feel oppressed, nurses may feel oppressed and undervalued)
• Disenfranchising work practices (nurse under pressure to complete work may miss breaks to accomplish tasks, may become target for HV)
• Low self-esteem (Women more likely to undervalue their work and themselves, more likely to lash out)
• Easy targets (unsure of actions new nurses are easy targets for HV)
• Socialization (primary female profession has been socialized to internalize feelings of aggression)
• General and hierarchical abuse (maintaining the status quo; “eating the young”)

Question 10

What are covert behavior examples?

Answer 10

• Cannot be observed by anyone other than the person performing the behavior
• Unfair assignments
• Sarcasm
• Eye-rolling
• Ignoring
• Refusing to help
• Refusing to work with someone
• Sighing

Question 11

What are overt behavior examples?

Answer 11

• That which can be seen and measured
• Name calling
• Arguing/ yelling
• Backstabbing
• Intimidation
• Gossiping
• Criticizing of work
• Blaming
• Fault finding

Question 12

What is the impact of conflict and horizontal violence on the care environment?

Answer 12

• Diminished confidence/self-esteem
• Absences from work or intent to leave the profession
• Reduced team collaboration
• Impaired information transfer/ communication
• DIMINISHED QUALITY OF PATIENT CARE!

Question 13

What are the recommendations made by the joint commission on quality and patient safety?

Answer 13

• Recognition and awareness – Assess the frequency and impact of these behaviours
• Cultural commitment/ Leadership/Champions – All must have a responsibility to create a positive professional workplace
• Policies and Procedures – acceptable and not acceptable behaviours must be clearly defined with processes for dealing with unacceptable behaviours
• Incident reporting – standardized reporting process including documentation of follow-up
• Structure and process – Methods for addressing the issues
• Initiating factors – understanding the underlying issues that cause these behaviours
• Education and training – to raise awareness, discuss barriers to resolution
• Communication tools – Message and message delivery, SBAR
• Discussion forums – Encouraging staff interaction
• Intervention strategies – debriefings, action plans for assistance

Question 14

What does CRNBC recommend for this conflict?

Answer 14

• Confirm the problem
• Communicate the problem
• Document the problem

Question 15

What are some organizational strategies for HV?

Answer 15

• Establish Senior Leadership commitment
• Create infrastructure to support managers and staff
• Policy Development- zero tolerance
• Education- staff (assertiveness training); management (conflict management training)
• Culture of Safety (be supportive; role model; do not participate in unit gossip)
• Clear reporting system/structure

Question 16

What are individual strategies for HV?

Answer 16

• Recognize aggressor is at fault not you
• Know institutional policies
• Develop and implement an action plan (with help from employer)
• Confront aggressor
• Make a formal written complaint
• Seek legal action (last resort)
• Don’t wait –confront sooner rather than later
• Always speak to the person in private
• Take a few deep breathes, center, begin conversation
• Ensure proper positioning for conversation
• Remember the goal: speak your truth
• Try to get through anger/fear (loud, aggressive, mean) to the primary emotion-hurt
• When you don’t know what to do paraphrase…..Let me get this straight, you are saying…..

Question 17

What are some statements we can use for interventions?

Answer 17

• I see from your expression there is something…….
• I learn most from people who communicate directly..
• When things are different from what I learned…..
• It is my understanding that there was more information…….
• I don’t feel right talking about this….
• I don’t feel right talking about him/her….

Question 18

What does CUS stand for?

Answer 18

• I feel CONCERNED
• I am UNCOMFORTABLE
• I am worried about patient SAFETY