Building Teams Through Communication and Partnerships

This chapter explains major concepts and presents tools with which to create and maintain a smoothly functioning team. Life requires that we work together in a smooth and efficient manner, communicate effectively, and develop relationships that produce partnerships. Many important team efforts occur in the work setting. Research has demonstrated that teams are critical to patient safety because they encourage frequent and ongoing communication and create a safety net for staff, a system in which safeguards and support are a part of the routine functioning of each team member. Such teams often include members with various backgrounds and educational preparation (e.g., physicians, nurses, administrators, allied health professionals, and support staff such as housekeeping and dietary staff members). Each team member has something valuable to contribute and deserves to be treated honorably and with respect. When teams are not working effectively, all team members must change how they communicate and interact within the team.

Objectives

• Evaluate the differences between a group and a team.

• Value four key concepts of teams.

• Demonstrate an effective communication interaction.

• Identify at least five communication pitfalls.

• Apply the guidelines for acknowledgment to a situation in your clinical setting.

• Compare a setting that uses the “rules of the game” with your current clinical setting.

• Develop an example of a team that functions synergistically, including the results such a team would produce.

• Discuss the importance of team to patient safety and quality.

effective communication

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synergy

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The Challenge

Diane Gallagher RN, MS Director, Women’s and Children’s Services, Rush-Presbyterian–St. Luke’s Medical Center, Chicago, Illinois

An extensive “team” of people works together to care for the neonate in a neonatal intensive care unit (NICU). They include physicians, registered nurses, respiratory therapists, physical therapists, social workers, neonatal nurse practitioners, and ancillary staff. Occasionally, specialists are consulted for specific cardiac, neurologic, or gastrointestinal problems. These are intermittent “team” members who play a crucial role in the baby’s care.

Recently, a new group of specialists joined our team. They were identified as a top-notch group who would, by virtue of their expertise and reputation, increase the census and revenues for the hospital. Our team was excited to have this opportunity to grow in an area in which we had infrequent experience. However, integration of these new team members did not go smoothly. There were clinical disagreements, communication breakdowns, and interpersonal conflicts. The experience evolved into mutual distrust and control issues.

As disagreements, insults, and complaints escalated on both sides, the situation came to a defining moment when the director of the specialty group said, “I’m never bringing any of our patients here. I’m sending them to the PICU.” The response from the NICU team was, “Fine with us; we don’t need you, your patients, or the hassle.” It seemed reasonable to not work together because, in fact, functionally we were already not working together. This response was in direct conflict with our belief that we could provide a valuable service and make a difference for both the patients and their families. This posed a dilemma for the staff, but everyone felt the situation was hopeless.

No one believed we could function as a team, and therefore further efforts to work together were futile. We had tried and failed. Let’s just cut our losses and move on. How does one create a team when no one believes it is possible and some believe it is not even necessary?

What do you think you would do if you were this nurse?

Introduction

As we experience changes such as cost-cutting and quality and safety issues in health care, teamwork becomes critical. The adage “If we do not all hang together we will all hang separately” was never more true than now as we move through an era in which nursing is accountable for patient outcomes that affect reimbursement for care and the institutional financial bottom line. To create finely tuned teams, communication skills must improve. Each team member must focus on improving his or her own skills, as well as supporting other team members, to grow in effective communication. These skills will be increasingly important as teams negotiate an evolving healthcare system that includes accountable care organizations—an outcome of the 2010 Health Care Reform legislation.

In our society, in which so much emphasis is placed on the individual and individual achievement, teamwork is the quintessential contradiction. In other words, with all the focus on individuals, we still need individuals to work together in groups to accomplish goals and keep patients safe. Everybody knows and understands this, particularly individuals who spend their Sundays watching football or basketball. These team sports are premier models of cooperation and competition. They are the model for teamwork for business today, and they represent a group following their respective leader or “coach” (Parcells, 2000).

Groups and Teams

The definition of group is a number of individuals assembled together or having some unifying relationship. Groups could be all the parents in an elementary school, all the members of a specific church, or all the students in a school of nursing, because the members of these various groups are related in some way to one another by definition of their involvement in a certain endeavor. A team, on the other hand, is a number of persons associated together in specific work or activity. Not every group is a team, and not every team is effective.

A group of people does not constitute a team. From Davis and Sharon’s perspective (2002), a team is a group of people with a high degree of interdependence geared toward the achievement of a goal or a task. Often, we can recognize intuitively when the so-called team is not functioning effectively. We say things such as, “We need to be more like a team” or “I’d like to see more team players around here.” Consequently, in the process of defining team, effective versus ineffective teams should be considered. Teams are groups that have defined objectives, ongoing positive relationships, and a supportive environment and that are focused on accomplishing a specific task. Teams are essential in providing cost-effective, high-quality health care. As resources are expended more prudently, patient care teams must develop clearly defined goals, use creative problem solving, and demonstrate mutual respect and support. Facilities with ineffective teams will find themselves out of business.

Exercise 18-1

Think of the last team or group of which you were a part. Think about what went on in that team or group. Specifically think about what worked for you and what did not work. Use the “Team Assessment Exercise” in Table 18-1 to assess aspects of your team more specifically. Address each of the identified areas and discover how well your team or group functioned. Think about roles, activities, relationships, and general environment. Consider examples of shared decision making, shared leadership, shared accountability, and shared problem solving. These are the concepts that can be used to evaluate the functioning of almost any team of which you are a member.

TABLE 18-1

TEAM ASSESSMENT EXERCISE

ARE WE A TEAM?

Directions: Select a team with which you work. Place a checkmark beside each item that is true of your team. If the statement is not true, place no mark beside the item.

1. The language we use focuses on “we” rather than “you” or “I.”

2. When one of us is busy, others try to help.

3. I know I can ask for help from others.

4. Most of us on the team could say what we are trying to accomplish.

5. What we are trying to accomplish on any given work day relates to the mission and vision of nursing and the organization.

6. We treat each other fairly, not necessarily the same.

7. We capitalize on people’s strengths to meet the goals of our work.

8. The process for changing policies, procedures, equipment is clear.

9. Meetings are focused on the goals we are focused on.

10. Our outcomes reflect our attention to goals and efforts.

11. Acknowledgment is individual and goal-oriented.

12. Innovation is supported by the team and management.

13. The group makes commitments to each other to ensure goal attainment.

14. Promises are kept.

15. Kindness in communication is evident, especially when bad news is delivered.

16. Individuals can describe their role in the overall work of the group.

17. Other members of the team are seen as trustworthy and valued.

18. The group is cost-effective and time-effective in attaining goals.

19. No member is excluded from the process of decision making.

20. Individuals can speak highly of their team members.

Tally the number of checkmarks and multiply that number by 5. The resultant number is an assessment of how well your team is functioning. The higher the score, the better the functioning.

©The Wise Group, 2007, Lubbock, Texas.

When a team functions effectively, a significant difference is evident in the entire work atmosphere, the way in which discussions progress, the level of understanding of the team-specific goals and tasks, the willingness of members to listen, the manner in which disagreements are handled, the use of consensus, and the way in which feedback is given and received. The original work done by McGregor (1960) sheds light on some of these significant differences, which are summarized in Table 18-2.

TABLE 18-2

ATTRIBUTES OF EFFECTIVE AND INEFFECTIVE TEAMS

ATTRIBUTE	EFFECTIVE TEAM	INEFFECTIVE TEAM
Working environment	Informal, comfortable, relaxed	Indifferent, bored, tense, stiff
Discussion	Focused Shared by almost everyone	Frequently unfocused Dominated by a few
Objectives	Well understood and accepted	Unclear, or many personal agendas
Listening	Respectful—encourages participation	Judgmental—much interruption and “grandstanding”
Ability to handle conflict	Comfortable with disagreement Open discussion of conflicts	Uncomfortable with disagreement Disagreement usually suppressed, or one group aggressively dominates
Decision making	Usually reached by consensus Formal voting kept to a minimum General agreement is necessary for action; dissenters are free to voice	Often occurs prematurely Formal voting occurs frequently Simple majority is sufficient for action; minority is expected to go along with opinion
Criticism	Frequent, frank, relatively comfortable, constructive Directed toward removing obstacle	Embarrassing and tension-producing; destructive Directed personally at others
Leadership	Shared; shifts from time to time	Autocratic; remains clearly with committee chairperson
Assignments	Clearly stated Accepted by all despite disagreements	Unclear Resented by dissenting members
Feelings	Freely expressed; open for discussion	Hidden; considered “explosive” and inappropriate for discussion
Self-regulation	Frequent and ongoing; focused on solutions	Infrequent, or occurs outside meetings

Adapted from McGregor, D. (1960). The human side of enterprise. New York: McGraw-Hill.

Ineffective teams are often dominated by a few members, leaving others bored, resentful, or uninvolved. Leadership tends to be autocratic and rigid, and the team’s communication style may be overly stiff and formal. Members tend to be uncomfortable with conflict or disagreement, avoiding and suppressing it rather than using it as a catalyst for change. When criticism is offered, it may be destructive, personal, and hurtful rather than constructive and problem-centered. Team members may begin to hide their feelings of resentment or disagreement, sensing that they are “dangerous.” This creates the potential for later eruptions and discord. Similarly, the team avoids examining its own inner workings, or members may wait until after meetings to voice their thoughts and feelings about what went wrong and why.

In contrast, the effective team is characterized by its clarity of purpose, informality and congeniality, commitment, and high level of participation. The members’ ability to listen respectfully to each other and communicate openly helps them handle disagreements in a civilized manner and work through them rather than suppress them. Through ample discussion of issues, they reach decisions by consensus. Roles and work assignments are clear, and members share the leadership role, recognizing that each person brings his or her own unique strengths to the group effort. This diversity of styles helps the team adapt to changes and challenges, as does the team’s ability and willingness to assess its own strengths and weaknesses and respond to them appropriately.

The challenges encountered in today’s healthcare systems are prodigious. Patient safety issues are at the forefront. Ongoing rounds of downsizing, budget cuts, declining patient days, reduced payments, and staff layoffs abound. Effective teams participate in effective problem solving, increased creativity, and improved health care. The effects of smoothly functioning teams on patient safety and the creation of a just culture are critically important, and one tool set to address these issues, including communication, can be found in the Literature Perspective on p. 349.

Literature Perspective

Resource: Kouzes, J. M., & Posner, B. Z. (2007). The leadership challenge (4th ed.). San Francisco: Jossey-Bass, John Wiley & Sons.

This model focuses on how leaders in all walks of life and all aspects of the workplace mobilize people to get extraordinary things done. Ordinary people such as novice nurses can guide others along pioneering journeys to phenomenal accomplishments. The research and work that Kouzes and Posner have done establish relationships as the core of leading any change or initiative. Five key aspects of establishing and maintaining relationships constitute the heart of this leadership model:

• Model the Way—Credibility is the foundation of leadership. It is established by consistently Doing What You Say You Will Do or by Setting the Example for the other team members.

• Inspire a Shared Vision—Imagine exciting and ennobling possibilities, and enlist others in these dreams through positive attitude, excitement, and hard work.

• Challenge the Process—Seek innovative ways to change, grow, and improve—experiment and take risks.

• Enable Others to Act—Foster collaboration by promoting cooperation and building trust. Create a sense of reciprocity or give and take. Establish a sense of “We’re all in this together.”

• Encourage the Heart—Novice leaders encourage their constituents to carry on. They keep hope and determination alive, recognize contributions, and celebrate victories.

Implications for Practice

When nurses use this model to approach leadership, they can strengthen their skills. Each of the examples above provides a way for new, emerging, and established leaders to remain committed to the team with which they work.

Generational Differences

It is not unusual today to have team members from four different generations of workers: Veterans, Baby Boomers, Generation X, and Generation Y. Because the workforce is aging, there may be a preponderance of Baby Boomers and Generation Xers in a work setting. Each generation, traditionally interpreted as a span of 20 years, grew up in a different era and was influenced by different historical events and cultural developments (Weingarten, 2009). For example, Veterans live by the rules and do not question authority. Boomers lived through the Cold War and were influenced by the assassinations of President Kennedy, Senator Robert Kennedy, and Martin Luther King, Jr.; the Civil Rights movement; and the Women’s Rights movement. Generation X nurses were often the “latch-key kids” because both parents worked outside the home. Divorce was common, and job stability was no longer guaranteed. Generation Y nurses are the future of the profession and have grown up with massive amounts of information and technology. They have experienced terrorism and natural disasters. They are culturally diverse and view education as the key to success. Efforts to understand and bridge these differences can be the difference between a dysfunctional and an effective team. Chapter 3 provides more detail about these differences.

Communicating Effectively

Communication in the work environment is not only important to good working conditions that retain nurses but also critical to reduction of medical errors (American Association of Critical-Care Nurses [AACN] & VitalSmarts, 2005; Arford, 2005). Because of such issues, new graduates go through a facility orientation, which emphasizes communication skills. Many nurses view this as a waste of time that could be used to further technical skills; however, at evaluation time, communication skills are often seen as a significant area for improvement (Buckman, Korsch, Baile, & Jason, 2000; Weiner, Barnet, Cheng, & Daaleman, 2005). The only thing human beings do more often than communicate is breathe. Communication is the most important component of daily activities. It is essential to clinical practice, to building teams, and to leadership. A person cannot not communicate. Because communication consists of both verbal and nonverbal signals, humans are continuously communicating not just thoughts, ideas, and opinions but also feelings and emotions (Morreale, Spitzberg, & Barge, 2001). Once the message is sent, it cannot be retracted; it can be amended, but the first impression of the communication usually is lasting. However, as important as this initial impression is, it is often an unconscious response or reaction.

How we communicate is also a reflection of self-worth: Once a human being has arrived on this earth, communication is the largest single factor determining what kinds of relationships she or he makes with others and what happens to each in the world (Satir, 1988). Self-worth is a major influence in all communication. Stress results whenever self-worth is threatened.

Communication is learned from watching others. A host of poor examples can be seen in movies and television. Poor communication leads to relationship breakdowns, misunderstandings, high levels of emotion, judgment, and an excess of drama. Nursing programs teach therapeutic communications with patients and their families. However, little focus is placed on effective communication in the workplace, although communication is essential to building and maintaining smoothly functioning teams.

A basic model of communication patterns between the sender and the receiver is found in Figure 18-1. Effective communication develops a rhythm in which messages are sent and received in a productive, respectful, and supportive manner (Nemeth, 2008). Communication begins to break down as the rhythm is disrupted. The sender-receiver pattern disintegrates into a non-rhythmic event, as described in Figure 18-1. When non-rhythmic patterns develop, the participants may feel disrespected, upset, and even fearful.

FIGURE 18-1 Potential communication rhythms.

Stress

In her classic work, Satir (1988) identified the connection between stress and self-worth that can evolve as a result of a breakdown in communication. She defined stress as a threat to positive self-worth. Human beings tend to feel stress or anxiety whenever there is an unconscious linking of feelings, behaviors, or comments from others to a lowering of self-esteem or an attack on self-worth. A conscious effort ought to be made to relieve stress through activities such as ensuring specific/scheduled quiet time, requesting peer support, keeping a journal, treating yourself to something special, or going for a walk (Weiss, 2001).

Stress Response Model

When this threat is identified, the receiver often reacts using one of the five communication patterns: attribution of blame, placation, constrained cool-headedness, immaterial irrelevance, or congruence (Bradley & Edinberg, 1990; Satir, 1988). Each pattern interaction and the source of the interaction are described with examples of each pattern in Table 18-3. The pattern that produces effective communication, the one to strive for, is congruence. Congruent communication occurs when both the verbal and nonverbal actions fit the inner feelings of the sender and are appropriate to the context of the message. This communication pattern creates the kind of connection between the sender and the receiver that fosters respect, support, and the creation of relationship.

TABLE 18-3

COMMUNICATION PATTERNS

PATTERN	INTERACTION	SOURCE	EXAMPLE
Attribution of blame	Sender blames receiver	Fault-finder dictator acts superior as camouflage for fear and low self-esteem	Mostly “you” messages; for example, “You really blew it!”
Placation	Sender placates receiver	Sender’s low self-worth: puts herself/himself down	“I was wrong. I’m sorry. It’s all my fault.”
Constrained cool-headedness	Sender is correct and very reasonable without feeling or emotion	Feelings of vulnerability covered by cool analytical thinking	“Studies have shown that in 75% of cases, the patient is correct. I decided to use research data in coming to a solution.”
Irrelevant	Sender is avoiding the issue, ignoring own feelings and feelings of the receiver	Fear, loneliness, and purposelessness	“Wait a minute. Let me tell you about …” (changes the subject)
Congruence	Sender’s words and actions are congruent; inner feelings match the message	Any tension is decreased, and self-worth is at a high level	“For now, I feel concerned about the anger and hostility exhibited by Dr. X. I’m wondering what approach would de-escalate him.”

Adapted from Satir, V. (1988). The new peoplemaking. Mountain View, CA: Science & Behavior Books; and Bradley, J., & Edinberg, M. (1990). Communication in the nursing context (3rd ed.). Norwalk, CT: Appleton & Lange.

Communication Barriers

In today’s busy world, many interruptions and interferences to clear, focused, effective communication create breakdowns. According to Olen (1993), to be aware of these potential problems allows both sender and receiver to be prepared to minimize such barriers.

• Distractions: Distractions most commonly come through sensory perceptions, such as poor lighting or background noise, including music, talking, ringing phones, and interruptions by others. Papers, reports, and heavy workloads can also be distracting.

• Inadequate knowledge: The sender and receiver may be at different levels of knowledge, particularly in this time of highly specialized and technical knowledge bases. For multiple reasons, one person may not seek clarity from the other.

• Poor planning: The process of organizing, planning, and clearly thinking through what needs to be communicated is very helpful. If the interaction is more spontaneous, it can more easily fall into a non-rhythmic pattern.

• Differences in perception: Both the sender and the receiver have their individual mental filters—the way in which they see the world. Because of this individuality, no two filters are the same. Thus the same message is interpreted differently. Add to this, for example, sociocultural, ethnic, and educational differences, and it is easy to see how these differences can occur.

• Emotions and personality: Someone who is experiencing distress may not be able to receive another message or may have difficulty keeping his or her emotions out of an unrelated message. Most humans, at some point, bring distress or problems from home to the workplace. If these remain unconscious, they can influence the work setting in a negative or nonproductive way.

Communication Pitfalls

Effective communication suggests that the interaction is a rhythmic pattern that is respectful and clear, promotes trust, and encourages the expression of feelings and viewpoints. On the other hand, pitfalls in communication comprise actions, behaviors, and words that create distrust, are dishonoring, and decrease the feelings of self-worth in the receiver. Box 18-1 lists the major pitfalls of communication. These pitfalls lead to communication breakdowns that affect not only the team but also the quality of care to patients (Jason, 2000).

BOX 18-1 Communication Pitfalls

1 Giving Advice

It is so tempting to give advice when a co-worker comes with an issue or problem. Don’t! Most often what the person wants is to work through the issue by talking out loud. Just listen.

2 Making Others Wrong

When telling others “our” story of distress, the adversary is always “wrong.” The telling of the story to a third party only reinforces how right “I” am and how wrong, bad, or terrible the other person is. If you have an issue or problem, take the problem to the person with whom you are upset. “Take the mail to the correct address.” Don’t gossip!

3 Being Defensive

Defensiveness occurs when you do not listen, are hostile or aggressive, or respond as if attacked when there was no attack. Look for a physiologic signal in your body so that you can identify your own distress. Stop. Breathe. Acknowledge that the message did not come out the way you intended, and begin again.

Also, defensiveness can occur when met with hostile, aggressive behavior from another. Rather than choose an emotional response or react to the attack, know that the other person’s behavior has nothing to do with you personally but is the response chosen by that person in a moment of stress. Any one of a dozen other responses could have been chosen. Understand that the person is motivated by fear or hurt.

4 Judging the Other Person

Evaluating another person as “good” or “bad,” as someone you like or do not like, or judging their actions or behavior as “stupid” or “crazy” or “inappropriate” is a reflection of how you judge yourself. Who is the hardest person on you? Of course, you are. Know that you can have feelings about situations or behaviors without judging the other person in a negative way. Rather, you can feel compassion for his or her stress and fear, which often drives behavior. This is true particularly when a supervisor or physician is reprimanding you.

5 Patronizing

Speaking to others as though they are less than human or in need of custodial care fails to honor them as human beings. You do not have to be condescending or seek to humiliate in an overly sweet voice. These are merely other versions of judging or making the person wrong. Another approach is to question what is at issue for them in the moment.

6 Giving False Reassurance

One of the great temptations of nurses is to “fix” things and make them better, to rescue the situation or the person involved. To accomplish this goal, sometimes we reassure inappropriately. Know that you do not have to fix every situation. You can support people to work through situations themselves.

7 Asking “Why” Questions

When working in the team, refrain from asking “why” questions. These tend to create a defensive response in the other person. Instead, ask “What makes you think …”

8 Blaming Others

Saying things such as “You make me so angry” is blaming the other person for your feelings, which you choose at any given time. In nearly every situation, the responsibility for communication breakdown is a joint responsibility. You can always choose your response, even if that response is to say, “I can’t discuss this with you now. I would like to talk about this later when I am calmer.”

Communication Guidelines

Effective guidelines can be used when communicating. Such tools as SBAR are often used when conveying clinical information from one caregiver to another (Box 18-2). Most of these tools are used to facilitate a positive outcome and to create an environment in which the communicator can achieve the desired outcome. Unconscious use of any of the pitfalls will most likely result in thwarting the desired outcome. Box 18-3 lists effective guidelines for communication.

BOX 18-2

SBAR Communication

Miscommunication is the most commonly occurring cause of sentinel events and “near misses” in patient care. One of the most popular structured communication systems, created by professionals in the Colorado Kaiser Permanente System, focuses on a method to provide information that honors the system in which practitioners and medical providers learn to glean information and apply it to decision-making trees. SBAR is the system that honors the structured transfer of information.

Situation. The professional identifies the patient, the physician, the diagnosis, and the location of the patient. The nurse describes the patient situation that has instituted this SBAR communication.

Background. Next the nurse provides background information, which could include information relevant to the current situation, mental status, current vital signs (all of them), chief complaint, pain level, and physical assessment of the patient.

Assessment. The nurse offers an assessment of the chief problem and describes the seriousness of the situation. Any specific changes in the patient’s condition should be described.

Recommendation. The nurse can make a request of the physician or suggest specific action such as a medication, laboratory work, or an x-ray examination. The nurse could also request that the physician come and evaluate the patient.

Modified from www.medleague.com/Articles/Newsletters/newsletter31.pdf. (Retrieved July 15, 2009.)

BOX 18-3

Guidelines for Communication

• Approach each interaction as though the other person has no knowledge of effective communication. Assume responsibility for creating the sender-receiver rhythm.

• Share your thoughts and feelings. Be self-revealing.

• Use casual conversation or “small talk”; it can be important to relationships, particularly when it is light and humorous. It balances the deep, meaningful talk.

• Acknowledge, praise, and encourage the other person; doing so is supportive and brings life and energy to the relationship.

• Present messages in a way that the other person can receive them.

• Take responsibility for any problem or issue you have with another, and speak about it as your problem or issue also.

• Use language of equality even when position titles are not of the same level.

Adapted from Olen, D. (1993). Communicating: Speaking and listening to end misunderstanding and promote friendship. Germantown, WI: JODA Communications.

Exercise 18-2

In pairs or small groups, compare the effective guidelines for communication with the communication pitfalls. Give examples of each from your own recent personal experience. Hypothesize how you could have changed the pitfalls into a positive interaction.

Key Concepts of Teams

In rare instances, a team may produce teamwork spontaneously, like kids in a schoolyard at recess. However, most management teams learn about teamwork because they need and want to work together. This kind of working together requires that they observe how they are together in a group and that they unlearn ingrained self-limiting assumptions about the glory of individual effort and authority that are contrary to cooperation and teamwork. Keys to the concept of team include the following:

• Conflict resolution

• Singleness of mission

• Willingness to cooperate

• Commitment

Conflict Resolution

When thinking about conflict, it is helpful to realize that conflict is fundamental to the human experience and is an integral part of all human interaction (Porter-O’Grady & Malloch, 2007)). Therefore the challenge is to recognize the breakdown in the communication process and to deal appropriately with it (Porter-O’Grady & Malloch, 2007). Conflicts are usually based on attempts to protect a person’s self-esteem or to alter perceived inequities in power, because most human beings believe that other people have greater power, and thus these human beings are unlikely to achieve their objectives (Sportsman, 2005). For example, when a nurse recognizes upset and reaction between two nursing assistants with whom he or she is working, the following steps can be helpful (Sportsman, 2005):

• Identify the triggering event.

• Discover the historical context for each person.

• Assess how interdependent they are on each other.

• Identify the issues, goals, and resources involved in the situation.

• Uncover any previously considered solutions.

Assessing the level of working relationship between the conflicted parties is essential, particularly if they work together on a regular basis.

The word team is usually reserved for a special type of working together. This working together requires communication in which the members understand how to conduct interpersonal relationships with their peers in thoughtful, supportive, and meaningful ways. It requires that team members be able to resolve conflicts among themselves and to do so in ways that enhance rather than inhibit their working together. In addition, team members must be able to trust that they will receive what they need while being able to count on one another to complete tasks related to team functioning and outcomes. To communicate effectively, people must be willing to confront issues and to express openly their ideas and feelings—to use interactive skills to accomplish tasks. In nursing, constructive confrontation has not been a well-used skill. Consequently, if communication patterns are to improve, the onus is on each of us as individuals to change communication patterns. In essence, for things to change, each of us must change.

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