Communicating with clients and their families occupies a major portion of the nurse’s day.
Nurses teach clients and their families about medications and the client’s condition, clarify the physician’s treatment plan, and explain procedures. To do this effectively nurses need to use communication skills and recognize the barriers to communication.
Today’s healthcare environment requires nurses to be creative and effective when com- municating with clients and their families. The healthcare consumer, often confronted by the bureaucracy of the managed care environment, may enter the setting in a highly charged emo- tional state. Nurses need to recognize the signs of the anxious or angry client and promptly intervene to defuse the situation before it esca- lates. Practicing good listening skills and show- ing interest in the client often help.
Early morning admissions on the day of surgery and short-term stays make client teaching a challenge. The nurse must complete the admission requirements, surgical check- lists, and preoperative teaching within a short period of time. Time for postoperative teach- ing is also shortened. It is important for the nurse to communicate clearly and concisely what will be done and what is expected of the client. Allow time for questions and clarifica- tions. For many clients, a written preoperative and/or postoperative teaching guide helps to clarify the instructions.
CONCLUSION
The responsibility for delivering and coordi- nating client care is an important part of the role of the professional nurse. To accomplish this, nurses need good communication skills.
Being assertive without being aggressive and conducting interactions in a professional manner enhance the relationships nurses develop with colleagues, physicians, and other members of the interdisciplinary team.
Perhaps if Inez and her colleague had known more about communication, especial- ly how to ask for help, their day would not have been so difficult. Staying calm and good communication skills demonstrate profession- alism and an ability to work with others.
26 ❖ Essentials of Nursing Leadership and Management
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S T U D Y Q U E S T I O N S
1. Role-play a situation between a client and a nurse. Have a third student make a list of the different attending skills you used with the client during the inter- action. (Some examples for role-play: Client compliance with medication regi- men; teaching a client how to self-administer insulin; a client who says to the nurse, “I hate it here.”)
2. This is your first position as an RN, and you are working with an LPN who has been on the unit for 20 years. Your first day on the job she says to you,
“The only difference between you and me is the size of the paycheck.”
Demonstrate how you would respond to this statement using assertive commu- nication techniques.
3. A physician orders, “Vit K 10 mg. IVP.” You realize that this is a dangerous order. How would you approach the physician?
4. A client is admitted to the same-day surgical center for a breast biopsy. She is accompanied by her significant other, who has just had an altercation with an admissions secretary about the managed care criteria for payment. The client is required to wait for 30 minutes after her designated arrival time. The nurse comes out to call the client back to the holding area and the significant other turns and says loudly, “What is wrong with you people? Can’t you ever get anything straight? If you can’t get the insurance right and you can’t get the time right, how can we expect you to get the surgery right?” As the nurse, how would you diffuse the situation?
C R I T I C A L T H I N K I N G E X E R C I S E
Eric worked the evening shift. Every day when he got the report from Yvonne, he heard how difficult the day had been, what a “pain” certain patients were, and excuses as to why so many things had been left for him to do. Eric quietly listened to this and continued to pick up after Yvonne. He did not discuss the sit- uation with anyone but felt very anxious because he was always behind before he could begin. One afternoon Eric became annoyed and yelled, “What is your problem? Everything is left for me to do, and all you give me are excuses.
Besides complaining, what do you do all day?”
1. What type of communicator is Eric?
2. Identify the behavior Eric exhibited that enabled Yvonne to continue her behavior.
3. How could Eric have handled this situation with Yvonne in a more con- structive manner?
4. If you were the team leader, how would you handle this situation?
R E F E R E N C E S
American Nurses Association (ANA). (1985). Code for Nurses. Washington, DC: ANA.
Arnold, E., & Boggs, K. (1995). Interpersonal Relationships(ed. 2). Philadelphia: W.B. Saunders.
Arnold, J., & Pearson, G. (eds.). (1992). Computer Applications in Nursing Education and Practice.New York: National League for Nursing.
Barter, M., & Furmidge, M. (1994). Unlicensed assistive personnel. J Nurs Adm, 24(4), 36–40.
Berlo, D.K. (1960). The Process of Communication.San Francisco: Reinhart Press.
Chevernet, M. (1988). STAT: Special Techniques in Assertiveness Training for Women in Health Professions(ed. 2). St. Louis: C.V. Mosby.
Fontaine, K.L., & Fletcher, J.S. (1995). Essentials of Mental Health Nursing(ed. 3). Redwood City, Calif.:
Addison-Wesley.
28 ❖ Essentials of Nursing Leadership and Management Maslow, A. (1954). Motivation and Personality. New
York: Harper.
Tappen, R.M. (1995). Nursing Leadership and Management: Concepts and Practice (ed. 3).
Philadelphia: F.A. Davis.
Tappen, R.M., Weiss, S.A., & Whitehead, D.K. (1998).
Essentials of Nursing Leadership and Management.
Philadelphia: F.A. Davis.
Vacarolis, E.M. (1994). Foundations of Psychiatric- Mental Health Nursing.Philadelphia: W.B. Saunders.
29
Giving and Receiving Feedback
O U T L I N E Feedback Is Essential
Guidelines for Providing Feedback Provide Both Positive and Negative Feedback Give Immediate Feedback
Provide Frequent Feedback Give Negative Feedback Privately Be Objective
Base Feedback on Observable Behavior Accept Feedback in Return
Include Suggestions for Change
Communicate in a Nonthreatening Manner
Seeking Evaluative Feedback When Is Evaluative Feedback Needed?
Responding to Evaluative Feedback Performance Appraisal Procedure
Standards for Evaluation Peer Review
Fundamentals of Peer Review A Comprehensive Peer Review System Conclusion
O B J E C T I V E S
After reading this chapter, the student should be able to:
• Provide positive and negative feedback in a constructive manner.
• Respond to feedback in a constructive manner.
• Evaluate the conduct of performance appraisals.
• Participate in formal peer review.
C H A P T E R 3
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In good weather, Herbert usually played basket- ball with his kids after dinner. Yesterday, howev- er, he told them he was too tired. This evening, he said the same thing. When they urged him to play anyway, he snapped at them and told them to leave him alone.
“Herbert!’’ his wife exclaimed, “Why did you do that?’’
“I don’t know,” he responded. “I’m just so uptight these days. My annual review was sup- posed to be today, but my nurse manager was out sick. I have no idea what she is going to say.
I can’t think about anything else.’’
If Herbert’s nurse manager had been providing informal feedback to staff on a regular basis, Herbert would have known where he stood. He would have had a good idea about what his strengths and weaknesses were and would not be afraid of an unpleasant surprise during the review. He would also be looking forward to the opportunity to review his accomplishments and make plans for further developing his skills with his manager. He still would have been disap- pointed that she was unavailable, but he would not have been so distressed by it.
The process of giving and receiving evaluative feedback is an essential leadership responsibility.
Done well, it is very helpful. Done poorly, as in Herbert’s case, it can be stressful, even injurious.
In this chapter, we consider the do’s and don’ts of giving and receiving feedback, how to share constructive positive and negative evaluative comments with your coworkers, and how to respond constructively when you are on the receiving end of such comments.