Effective Communication and Conflict Resolution



Effective Communication and Conflict Resolution


Anna Marie Sallee, PhD, MSN, RN




Learning Outcomes


After studying this chapter, the reader will be able to:


1. Outline factors that can influence the communication process.


2. Communicate effectively with diverse intergenerational and interdisciplinary team members.


3. Apply positive communication techniques in diverse situations.


4. Recognize negative communication techniques.


5. Evaluate conflicting verbal and nonverbal communication cues.


6. Examine constructive methods of communicating in conflict situations.


7. Respond to inappropriate use of logical fallacies in communication.


8. Develop professional social media interaction behaviors.



Key Terms



Active communication


A participatory form of communication that promotes change.


Active listening


The process of hearing what others are saying with a sense of seriousness and discrimination.


Aggressive communication


A manner of communicating that limits the focus on or understanding of the opinions, values, or beliefs of others.


Assertive communication


A form of communication that enables a person to act in his or her own best interest without denying or infringing upon the rights of others.


Blocking


Obstructing communication through noncommittal answers, generalization, or other techniques that hamper continued interaction.


Communication


A process of relaying information between or among people by the use of words, letters, symbols, or body language.


Conflict


An experience in which there is simultaneous arousal of two or more incompatible motives.


Decode


A process whereby the receiver takes the message and interprets its meaning.


Empathy


An attempt to experience another person’s point of view without losing one’s own identity.


Encode


A process of translating an idea already conceived into a message suitable for transmission.


Equality


An attitude that relays acceptance and approval of another person.


Feedback


Response from the receiver, which can be verbal or nonverbal.


Filtration


Unconscious exclusion of extraneous stimuli.


Information


The data that is meaningful and alters the receiver’s understanding.


Interpretation


Receiver’s understanding of the meaning of the communication.


Negative communication techniques


Behaviors that block or impair effective communication.


Nonassertive communication


Communicating in a timid and reserved manner resulting in limited concern for one’s own rights regardless of the situation.


Nonverbal communication


Unspoken cues (intentional or unintentional) from the communicant, such as body positioning, facial expression, or lack of attention.


Openness


An attitude of willingness to self-disclose, react honestly to the messages of others, and own one’s feelings and thoughts.


Passive communication


A form of communication in which the individual fails to say what is meant.


Perception


The manner in which one sees reality.


Positive communication techniques


Behaviors that enhance effective communication.


Receiver


The destination for or receptor of a message.


Sender


Anyone who wishes to convey an idea or concept to others, to seek information, or to express a thought or emotion.


Supportiveness


The concern that is fostered by being descriptive rather than evaluative and provisional rather than certain.



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Additional resources are available online at:


http://evolve.elsevier.com/Cherry/


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How is your message being received?


Vignette


Stacy Shannon, RN, the charge nurse on 4-East, receives a telephone call from the secretary in the emergency department (ED) to inform Stacy that a patient is ready for transfer. Stacy was expecting this patient, but had not anticipated the transfer would occur so soon and had not yet informed the nurse who would be assigned to the patient. The ED secretary explains that there are many patients waiting to be seen in the ED and it is becoming increasingly chaotic. Stacy replies that she will locate the nurse who will be assigned to the patient and facilitate the transfer as soon as possible. As Stacy goes down the hallway to locate this particular nurse, she learns that the nurse has left the unit on a short break and is expected back within 10 minutes.


Stacy calls the ED secretary to arrange for the transfer to occur in 20 minutes. To her surprise, she finds out that the patient has left the department and is being brought to 4-East immediately. Within a few moments, the patient and ED nurse arrive. The ED nurse states that he wants to give report on this patient quickly because he needs to return to the ED right away. Stacy assists him in transferring the patient to a bed and making the patient as comfortable as possible.


As Stacy completes this process, the nurse who was on break returns to the unit, learns that she has a new patient she did not expect, and immediately has to receive report from the ED nurse. Stacy notes through both body language and tone of voice that the interaction between the two nurses is less than cordial.


Within 10 minutes Stacy receives a telephone call from the ED charge nurse wanting to discuss this incident. Negative comments are made about the 4-E nurse who left the unit “unannounced” and that “there is a concern for patient safety.” How can Stacy best facilitate a positive outcome in this situation?




Chapter Overview


Effective communication is a foundational component of professional nursing practice. The development of effective communication skills can only enhance each nurse’s professional image while building strong relationships with both patients and colleagues. Understanding communication processes and principles is required for nurses to interact professionally with patients, families and significant others, nursing peers, managers, student nurses, physicians, other members of the interdisciplinary team, and the public. Nurses communicate through a variety of media including the spoken and written word, demonstration, role modeling, and on occasion, public appearances. The exchange of ideas and feelings is hardly limited to verbal communication. There are many types of nonverbal communication that are often as meaningful as, and in many instances more meaningful than, audible expression. Because communication is such a complex process, there are infinite opportunities for sending or receiving incorrect messages. All too frequently communication is faulty, resulting in misperceptions and misunderstandings.


This chapter reviews the communication process and components, communication styles, and principles of effective communication in professional nursing including special communication issues related to documentation, cultural diversity, gender and generational differences, interdisciplinary teams, and the use of social media. A major focus of the chapter is describing effective, positive communication techniques that can prevent or reduce conflict. The chapter also provides techniques that can be used to effectively manage conflict situations when they do occur.




The Communication Process


Communication is a process requiring certain components. There must be a sender, a receiver, and a message. Effective communication is a dynamic process: with a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes (Figure 18-1). The method of delivery influences the effectiveness of communication. In addition, communication is affected by many subcomponents, both environmental and in the mind of the communicators (Figure 18-2). When communication with another person occurs, verbally or nonverbally, a typical pattern develops that includes the actual message being sent, the receiver’s belief or interpretation of that message, and the reaction to the message.


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FIGURE 18-1 The Communication Process.

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FIGURE 18-2 Factors Influencing Interpretation of Messages.

Think about the communication activities that occur in the health care setting. There is often much to communicate in a limited period of time and sometimes during very high stress situations. In addition to the actual message, personal goals or hidden agendas can influence the way a message is delivered and/or received. Because of this, it is very important to understand the many elements that influence the communication process.



Interpretation


Interpretation of information can be influenced by such factors as context, environment, precipitating event, preconceived ideas, personal perceptions, style of transmission, and past experiences. Because of the interaction of these factors, the sender’s message may mean to the receiver something that was entirely unplanned or unexpected by the sender (see Fig. 18-2).







Past Experiences


Each person comes to any type of communication, whether it is friendly conversation, informational lecture, staff meeting, performance evaluation, or any other possible scenario, with baggage in terms of past experiences. Because past experiences are a variety of positive, neutral, and negative events, the influence that the experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experiences cannot be overstated. An astute sender will begin to investigate such a possibility if the receiver reacts in an unexpected or inappropriate manner to information that was not expected to produce such a response, which may range from nonresponse to overly vehement response.






Verbal Versus Nonverbal Communication






Verbal Communication


Verbal communication is the most common form of interpersonal communication and involves talking and listening. An important clue to verbal communication is the tone or inflection with which the words are spoken and the general attitude used when speaking. Suzette Haden Elgin refers to the “tune the words are set to” (1993, p. 186). The key to the true meaning of a statement may be contained in the emphasis placed on a specific word. Consider how differently the following phrase could be perceived based on the inflection or the emphasis on the wording:



With an emphasis on bed, the first phrase most likely will be perceived as an inquiry. The second phrase might imply that you are going to bed, but no one else is. The last phrase, an imperative (or command), gives the impression of increased emotion, such as anger or frustration.


Another element central to verbal interaction is the concept of attitude. Being aware of and learning to understand the concept of attitude is key to effective communication. Attitude involves a predisposition or tendency to respond in one way or another. Often the attitude that accompanies a verbal interaction, which can be positive or negative, is much more meaningful than the actual words spoken. Although we may hear “attitude” in a person’s tone of voice, it is most often communicated loud and clear through nonverbal communication.



Nonverbal Communication




Nonverbal communication involves many factors that either confirm or deny the spoken word. Facial expression, the presence or absence of eye contact, posture, and body movement all project a direct message. Indirect nonverbal messages might include dressing style, lifestyle, or material possessions. Never presume that external trappings and physical presentation do not influence the quality of communication. Preconceived ideas and expectations interpret input from all such sources, often on an almost subconscious level.


Consider the following scenario: Rhonda, a young wife and mother, was admitted to the ED with significant abdominal pain. As the nurse inquires about her symptoms, Rhonda repeatedly glances at her husband, Tommy, before she answers. Although she denies any pain at this time, you observe that she guards her stomach, has a “clenched” jaw line, and does not make eye contact with you. As you assess and question Rhonda, Tommy often interrupts with comments such as, “She’s just fine. It was only a stomach ache, and it’s gone this morning, isn’t it, dear?” Which message seems more likely to be true—the verbal or the nonverbal? How will you address the nonverbal cues? As you read the remainder of this chapter, consider strategies that you can use to enhance communication between this husband and wife.


The inability to make eye contact may be construed to mean that the speaker is shy, scared, or not telling the truth. The judgment of which condition is the correct one is based on all the factors that feed into the receiver’s interpretation—perception, preconceptions, precipitating event, context, past experiences, environment, and transmission. Faced with the many opportunities for incorrect interpretation, is it any wonder that misunderstandings occur?


An important concept to remember is that when the verbal message and the nonverbal message do not agree, the receiver is more likely to believe the nonverbal message. In 1971, Albert Mehrabian (1981) conducted a seminal study on nonverbal communication in which he found that most communication is 55% nonverbal, 38% vocal signals (such as tone, pitch, or pace), and only 7% the actual words we say. Mehrabian’s study has significantly influenced our understanding of the “silent messages” we send. In fact, body language is often the most trusted indicator for conveying feelings, attitudes, and emotions (Borg, 2011) because it so often comes from our subconscious—which is much less likely to deceive! Nonverbal language includes such things as dress, posture, facial expression, eye contact, body movements, body tension, spatial distance, touch, and voice.


Kim Holland (2012) states eloquently: “Patients see our hearts through our eyes. It takes an incredible amount of professionalism to appear relaxed, make eye contact and help our patient know—for that brief moment—we are with them.” Body positioning toward the patient, a relaxed stance, a gentle touch, and an open face will signal your total presence.


An understanding of the importance prescribed to body language and other nonverbal clues to the intent of the message explains the advantage of face-to-face communication whenever possible. Although a telephone conversation supplies verbal messages, intonation, and feedback, other signals are missing such as facial expression, body position, and environmental clues. The perils inherent in written and electronic communication will be discussed later in this chapter.



Positive Communication Techniques


Effective communication involves a positive exchange of ideas between or among individuals. The successful communicator will strive to demonstrate openness, availability, and acceptance both verbally and nonverbally. The following are some of the many techniques that will help achieve positive communication style.




Using “I Messages”


The use of “I messages” is a fundamental component in acceptable communication. Consider the following exchange.



When a comment starts with “you,” most commonly the receiver’s defenses will promptly go on alert. The use of “you” in such a context sounds—and most probably is meant to be—accusatory. Notice how the emotions quickly escalate to anger. Also notice that although the receiver initially tries to sound conciliatory, he soon begins to respond in a similar accusatory form. Instead of using accusatory and defensive language, the sender should frame the comment in terms of how it makes her or him feel. Consider this alternative:



The difference is obvious. When “I messages” are used, they become less likely to sound accusatory. By using such an opening, the sender allows the receiver to respond to the true message rather than start to mount a defense. It allows for more effective communication because the receiver is more likely to offer an explanation such as the following:



In this instance, the “I message” enhances communication by giving Donald the opportunity to address the real concern. In addition, if Laura is truly astute, she has a wonderful opportunity to support her colleague by voicing appreciation for the working circumstances of his shift. Most people respond gratefully to recognition and commiseration. The exchange could build collegiality between the two coworkers and perhaps between the two shifts.



Establishing Eye Contact


As mentioned previously, the avoidance of eye contact can be interpreted in a number of different ways. A person who does not make eye contact may be thought to be shy, scared, insecure, preoccupied, unprepared, or dishonest—the list could go on and on. None of these qualities is likely to be appreciated in a primary caregiver. By making direct eye contact, the nurse gives undivided attention to the patient, and the patient is likely to feel valued and understood by the nurse. Eye contact in essence says, “I am wholly available to you. What you are saying is important to me.”


Eye contact is equally important in communication with coworkers and other members of the interprofessional team. This quality is lost in telephone conversations or written communications.


Keep in mind, however, that the use of direct eye contact is a Western value. In some cultures, avoidance of eye contact is considered more appropriate social behavior. By careful observation, the nurse quickly will recognize whether direct eye contact is interpreted as inappropriate or disrespectful. Nurses must make every effort to be sensitive to the cultural values of the client and their coworkers to enhance effective communication.



Keeping Promises


Little else can destroy the fragile trust developing in any interpersonal relationship as quickly as making and then breaking promises. Inherent in the concept of promise keeping are the qualities of honesty and integrity. Once a commitment is made, every effort must be expended to fulfill the expectation. Sometimes the request is impossible to satisfy. If this happens, the nurse must explain the situation or circumstances. The fact that the patient understands the nurse has made an effort to meet his or her needs or desires often is more important than whether the goal is accomplished. If the nurse responds, “I’ll check on that,” and then finds the request impossible to fulfill, but never returns with an explanation, the lack of dependability perceived by the patient (or colleague) will surely drive a wedge into the relationship.




Using Open Communication


Certain styles of phrasing questions and statements lend themselves to obtaining more information. For example, suppose Chris asks Mr. Barrow, “Do you know where you are?” and Mr. Barrow responds, “Yes.” Can Chris assume that Mr. Barrow knows he is in the hospital? Not necessarily. Chris may be surprised to hear a completely unexpected response if he rephrases the inquiry:



Using open-ended questions or statements that require more information than “yes” or “no” can help gather enough facts to build a more complete picture of the circumstances. Questions or statements that are phrased to require only one- or two-word responses may miss the mark entirely.






Negative Communication Techniques


Several negative communication techniques have been alluded to in the previous discussion. Closed communication styles, such as asking “yes” or “no” questions or making inquiries or statements that require other single-word answers, potentially limit the response of the person and may prevent the discovery of pertinent facts. Closed body language can also hinder effective communication. Crossed arms, hands on the hips, avoidance of eye contact, turning away from the person, and moving away from the person all impose a sense of distance in the relationship. Three other techniques that are detrimental to good communication are termed blocking, false assurances, and conflicting messages.



Blocking


Blocking occurs when the nurse responds with noncommittal or generalized answers. For example:



Does Mr. Clayton feel reassured? Not likely. Will he be inclined to broach the subject with Makayla again? Probably not. Makayla has incorporated some important aspects of positive communication into her response—cheerfulness and touch—but she has not truly communicated. She has effectively blocked Mr. Clayton’s attempt to get the reassurance he wanted from her. He may be too intimidated to ask anyone else, assuming that his fear is invalid.


By generalizing in this way, Makayla has trivialized Mr. Clayton’s concerns. He is not “many people.” He needs to be validated as an individual experiencing a legitimate feeling. Makayla can validate his fear and put it into perspective at the same time with a different approach.



Makayla: “What makes you think you might not wake up, Mr. Clayton?”


Mr. Clayton: “Well, my wife’s cousin’s husband had surgery about 25 years ago, and he never woke up.”


Makayla: “What kind of surgery did he have?”


Mr. Clayton: “Uh, it was some kind of heart surgery, and he had another heart attack on the table and died right there.”


Makayla: “It sounds like his condition was critical going into surgery.”


Mr. Clayton: “Yes, ma’am. He’d been sick for a long time.”


Makayla: “It’s not uncommon to feel afraid of having anesthesia, especially if you have never had surgery before. There are rare cases in which complications do occur during surgery. That’s why we put the disclosures on the consent form, so that you will know just what the risks are. Thankfully, though, most surgeries are without such drastic problems. Although your gallbladder certainly has made you uncomfortable, you are otherwise in good health. The tests that were done before surgery, like the chest radiograph and the laboratory work, show that you are healthy and should do well with the anesthesia. That drastically decreases the chance for complications in your case. I will be glad to answer any other questions you have or to ask the anesthetist to come and talk with you some more.”


Makayla has validated Mr. Clayton’s feeling as legitimate, provided an explanation with reasonable reassurances, and offered to explore the issue with him further or to have someone else talk with him.


Some things are difficult to talk about with another person. The dying patient may want to talk about how he or she feels, ask questions, or perform a life review. A nurse who is uncomfortable with such topics may consciously or unconsciously block communication through generalizations or closed responses. Avoidance of the blocking technique requires a good understanding of oneself. If unable to provide the open communication the patient obviously needs, the nurse should access other personnel who are more comfortable in the situation.


Related posts:

  1. Nursing Research and Evidence-Based Practice
  2. Ethical and Bioethical Issues in Nursing and Health Care
  3. Workforce Advocacy and the Nursing Shortage
  4. Budgeting Basics for Nurses

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Nov 6, 2016 | Posted by in NURSING | Comments Off on Effective Communication and Conflict Resolution

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