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Effective Communication

Preventing School Failure

 Citation Format: MLA (Modern Language Assoc.):

Works Cited

Price, Joseph P. “Effective Communication.” Preventing School Failure, vol. 35, no. 4, Summer 1991, p. 25. EBSCOhost, doi:10.1080/1045988X.1991.9944255.

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EFFECTIVE COMMUNICATION 

A Key to Successful ColIaboration

Although school reform may be designed with the best interest of students in mind, the path to its achievement is pitted with potential for personal stress. One reason for this stress among educators is the limited training they have received in the process of communication (Jellinek, 1990)--the skills that are needed to help formulate and implement new relationships, programs, and policies that accompany reform efforts, including site-based decision making, peer coaching, and mentoring. To reduce the professional stress that may accompany such efforts and to raise the level of school comfort and efficiency, educators need to further develop their abilities in the art of communication by acquiring greater knowledge, skills, and experience in the total process, with an emphasis in the area of listening.

Face-to-Face Communication

The basic components of face-to-face communication are defined in Figure 1 and consist of a speaker, Listener, statement, mode of expression, and response (Adler, 1983). In practice, these elements take on a dynamic quality that emerges through the interactive process between the speaker and listener. However, this process is often influenced by a wide range of factors that exist prior to the start of verbal communication. Some of the most common attributes of speakers and listeners that affect their communication are values, attitudes, culture, social class, education, experience, and knowledge. A speaker and listener should try to identify some of the factors they have in common that can serve as the basis for establishing a comfortable relationship and facilitating their communication. For example, consider two teachers from different buildings, preparing to discuss the most appropriate classroom placement for a student with disabilities. During their preliminary conversation, the teachers learn that they attended the same college and are members of the same sorority. These common features in their backgrounds may allow them to establish a quick sense of trust and serve to expedite an agreement on the placement issue.

Role of the Speaker

In a work setting (as in most other settings), speaking skills are highly valued, and individuals who demonstrate mastery of them enjoy significant power and prestige (Adler, 1983). By speaking articulately, professionals convey information, clarify critical issues, expand and elaborate on important points of view, refute opposing positions, and even reduce tension. Truly, these skills are worthy of development.

Although speaking skills are fundamental for effectively communicating, a series of specific steps also can be essential in executing the speaker role. The following suggestions may be useful, especially when the speaker is preparing for a structured meeting:

  1. Determine the purpose of the gathering (e.g., Why are we meeting? What are we expected to discuss? What is the desired outcome?).
  2. Determine the steps that should be taken to adequately prepare for the meeting (e.g., What do I need to know? What things do I need to take?).
  3. Decide who should be informed of this meeting and how much advance notice should be given.
  4. Consider the potential cost of the meeting in terms of time, energy, and money relative to the benefits to be derived. Remember that every activity has a cost attached to it that must be paid by you and the school that employs you. Plan early and participate in the meeting so that the benefits will justify the cost.
  5. Consider how to present the information (e.g., Should this interaction be formal, informal, general, detailed, highly related to prior experiences or relationships?).
  6. At the time of presentation, identify the task and check for clarity so that everyone knows what is to be done. Share relevant information and allow time for the listener to consider your statements and to raise questions if needed. If the listener seems uncertain, encourage and even suggest questions (e.g., "What concerns do you have?", "Would it be helpful if I restated or explained. . . ?"). Also, identify areas of common difficulty (e.g., "Many people have trouble with . . ." or "I find this area to be rather difficult; would you like for me to review it again?").

During the entire process, the speaker should be monitoring the listener to determine if that person's interest is waning. This would be evident if one sees the person doodling, day dreaming, or struggling to stay awake; it suggests the need for the speaker to make a quick adjustment in communication style. This adjustment may only require a change in such things as speech volume, rate, rhythm, or vocabulary.

Role of the Listener

In our culture, the role of listening is rarely assigned the level of importance it deserves in the communication process. People tend to think of listening as an inactive process and equate it with hearing, which it is not. Hearing is a natural process in which auditory stimuli are received, whereas listening is a learned skill that involves concentration, analysis, and evaluation through extensive practice. Yet people are not given many opportunities to acquire the requisite skills during their formative years. Recently, a team of investigators surveyed a group of industrial managers regarding their use of and their training in basic communication skills (Burley, 1982) and discovered the following:

Time Spent                 Training Received

Reading      10%                  60%
Writing      15%                  30%
Talking      30%                  10%
Listening    45%                  00%

In view of the vast discrepancy between the amount of time spent listening and the training received, it is not surprising that leaders in industry, business, and education seek to improve their ability to communicate, especially in the art of "active listening" (Bryant, 1987).

Active Listening

Active listening is most valuable when used to develop the mutual understanding that is necessary to solve important problems. It involves a knowledge of the words being used, the various meanings that words may have for other people, and the feelings and behaviors that are generated by the use of words (Burley, 1982). As a process, active listening requires that the following occur:

  1. Be clear about the purpose for listening. Like the speaker, the listener has an obligation to understand the purpose of a meeting. Is it intended to allow the speaker an opportunity to ventilate frustrations? Is it scheduled to share critical information? Or is the listener expected to help solve a problem? Each of these objectives requires a substantially different emphasis while listening in order to produce the most beneficial response.
  2. Recognize the appropriateness of the context. If the listener is to be effective in his/her role, the situation must be appropriate. To determine this, several questions should be answered.
  3. Is this the right setting for a discussion, or are there too many distractions or not enough privacy?
  4. Is this the right time to meet, or, for example, is it too close to the lunch break to begin an important or lengthy conversation?
  5. Is it so late in the day that participants may lack the energy and patience needed to be effective?
  6. Are other events in progress that could affect the current discussion? If so, should this meeting/ discussion be postponed?
  7. Avoid making assumptions. During a meeting or conversation, the listener should resist the temptation to make assumptions about the meaning of a statement. If the speaker says, "Before long I'll make a permanent change in that student's schedule," the listener may assume that the change will be made within a week or two, whereas the speaker may be planning to make the change next semester. Too often a listener makes assumptions about a statement and then acts on them as if they are true, even though they are not checked with the speaker.
  8. Delay judgments. The effects of premature judgments can severely impeded communication, because the listener is likely to respond on the basis of limited information rather than receiving the full statement and assessing particular issues in context of the "big picture."
  9. Focus on the speaker. While listening, concentrate on what the speaker is saying and how it is being said. Look for cues of conviction, sincerity, anger, confusion, happiness, and so on. Nonverbal signals from the speaker including gestures, facial expression, and posture contribute to the meaning of the message, often as much as the speaker's words. These signals are considered further later in this discussion.
  10. Wait before responding. The use of a pause can be very helpful during an interaction, even though it is seldom used on a conscious level. It gives both parties a chance to reflect on what has been said and to prepare an appropriate response. This response could be in the form of a question or an extension of the original statement.
  11. Rephrase the important concepts. As information is shared by the speaker, the listener can enhance communication by restating and rephrasing specific ideas. This process, called paraphrasing, will help to clarify and give emphasis to areas of uncertainty.
  12. Make good sense of the time differential. A little-known fact about communication is that the rate of speech for most people is approximately 125 words per minute, whereas the average rate of thought is approximately 425 words per minute. In practical terms, this means that a listener can process information at a much faster rate than a speaker can articulate it. This differential or lag time leaves the listener with opportunities to assess the process and the content of the communication and thereby contribute to the outcome in a more creative way. It should purposely be used to thus enhance communication.

Verbal and Nonverbal Responses From the Listener

Verbal statements are the type of responses most people think of when they consider professional interactions. A listener's verbal reactions to incomplete, inconsistent, or ambiguous statements convey the enormous desire and need for clear and comfortable communication. At other times, a conversation can be accurate and appropriate, even though complete verbal statements are not employed. Words of acknowledgment such as yes, hmmm, okay, or I see may suffice on some occasions. However, the quality of these responses is important for the interaction. A person should use strong, confidant responses and be ready to contribute full statements or questions as the circumstances warrant.

In contrast to verbal responses, nonverbal responses are seldom acknowledged on a level consistent with their importance. Approximately 70% of our communication is nonverbal, and it is highly influential in creating and maintaining our impression of a person, especially in the areas of trust and respect. When a speaker's words and nonverbal cues do not match, the listener tends to rely on the implied meaning of the nonverbal cues. Unfortunately, most speakers have limited awareness of their nonverbal cues and therefore are less able to modify them or make them congruent with their verbal statements. The presence of incongruence is one reason a listener should continuously monitor the speaker and raise questions in pursuit of clarity.

Sometimes referred to as "body language," nonverbal cues are gathered from all parts of one's face and body and convey fairly consistent meaning. Consider the examples and their possible meanings as shown in Figure 2.

It is worth noting that eye contact, smiles, and nodding of the head are among the most common and welcomed nonverbal cues.

Summary of Guidelines for Improving Listening Skills

When combined, the information on successful listening suggests that doing the following will enhance your skills as a listener:

  1. Be sure that you are clear on the purpose of the meeting or the main topic to be discussed.
  2. Raise questions with an awareness of their value to the flow of information. For example, open-ended questions such as "What do you mean by . . . ?" and "How would you describe . . . ?" tend to produce elaborated information. In contrast, closed types of questions such as "Did you . . . ," "Would you . . . ," and "When did it . . . " usually generate highly specific but limited information.
  3. Use clear body language that is congruent with your understanding and feelings. Try to convey a positive demeanor and a high level of attention (e.g., smile, sustain eye contact, nod).
  4. Offer restatements by paraphrasing, echoing, or repeating a segment of the speaker's point while using his or her own words or describing the speaker's emotions, for example, "I sense that you feel...."
  5. Selectively use silence to provide time to summarize the statement, check for accuracy, analyze the content, and prepare an appropriate response. Although no specific period of silence is always the "right" amount, 8 to 10 seconds is typically a comfortable amount for most people.
  6. Take notes to improve the quality of listening. This compels the listener to concentrate on and remember what was said for a longer period of time. The retention rate for most listeners after the first 48 hours is only 25% of what they have heard. In view of this limited rate of retention, the added labor of note taking may be worth the potential benefits of prolonged recall, especially if the note-taking process is not disruptive to the speaker.

As school professionals become more conscious of the skills they should use to effectively carry out the roles of speaker and listener, they can more systematically work to enhance their communication. When speaking they can convey information with less ambiguity, and as listeners they can more directly check their comprehension of the message. Given the explicit and implicit requirements in many of the school reform initiatives for school professionals to work together closely, the need for improving all school professionals' communication skills cannot be overstressed.

FIGURE 1. Elements of face-to-face communication.

Speaker             The person who makes a statement

Listener            The person who receives the statement

Statement           A message sent from the speaker to the listener

Mode of Expression  The means by which the statement is
                    communicated (It is generally oral using
                    the spoken word, but body language is
                    also an important component.)

Response            A statement made by the listener


FIGURE 2. Possible Interpretations of nonverbal cues.

           Facial Cues

Rolling eyes: disbelief
Raised or elevated eyebrow: suspicion
Broad smile happiness, satisfaction, approval

          Arm Position

Crossed: tension, anger, impatience
At side: relaxed

          Position of Hands

Tightly laced fingers: tension, anger
Hands supporting chin: tired, bored
Tight fist: tension, anger

REFERENCES

Adler, M. J. (1983). How to speak: flow to listen. New York: Macmillan.

Bryant, B. (1987). Quality circles: New management strategies |or schools. Ann Arbor, MI: Prakken.

Burley, A. M. (1982). Listening: the forgotten skit New York: Wiley and Sons.

Jellinek, M. S. (1990). School consultation: Evolving issues. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 311-314.

~~~~~~~~

By JOSEPH P. PRICE

 

Joseph P. Price is an associate professor in the School of Education at Grand Valley State University in Allendale, Michigan.


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Effective Interpersonal Communication

Citation Format: MLA (Modern Language Assoc.):

Works Cited

Vertino, Kathleen A. “Effective Interpersonal Communication: A Practical Guide to Improve Your Life.” Online Journal of Issues in Nursing, vol. 19, no. 3, Sept. 2014, pp. 1–15. EBSCOhost, doi:10.3912/OJIN.Vol19No03Man01.

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Effective Interpersonal Communication: A Practical Guide to Improve Your Life 

Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow's hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and experiences as a longtime provider of care in the mental health field, the author offers multiple practical strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.

Keywords: Maslow's hierarchy of human needs; communication variables; ineffective communication; Interpersonal communication

Citation:

Vertino, K., (September 30, 2014) "Effective Interpersonal Communication: A Practical Guide to Improve Your Life" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Manuscript 1.

Communication is an integral part of life; without it, we would not survive. Verbal and nonverbal communication begins at birth and ends at death. We need communication not only to transmit information and knowledge to one another, but more importantly, to relate to one another as human beings around the world in the context of relationships, families, organizations, and nations.

The how, what, why, and wherefore of communication can either edify or harm us, as individuals, cultures, religions, and governments of countries, as we attempt to coexist. What we say, how we say it, and what we mean by it are extremely important, and can be life-changing. I recollect two teachers in elementary school. To me, one was a kind, caring person; the other was mean and sarcastic. Students, especially children, are particularly vulnerable during their formative years. Adults, teachers, and other children have the power to either help us blossom as an individuals or to destroy our self-esteem, and thus impact our potential for life. How? A kind (or cruel) word, or facial expression, can mean the world to a child. These two teachers in my past were polar opposites, but both affected me deeply.

In our professional roles as nurses, we are responsible to care for persons who are ill. When ill, patients may be unable to speak or advocate for themselves. Vulnerable patients need our voices to speak for them. Due to our constant exposure to other human beings who are suffering, nurses are perfectly positioned to utilize effective interpersonal communication, and in doing so, support our own emotional, psychological, and spiritual development.

There is a well-established link between team communication, worker morale, and patient safety. Poor team communication has been directly linked to preventable medical errors, high nurse turnover rates, and low morale (Brinkert, 2010; Institute of Medicine, 1999; Vessey, DeMarco, & DeFazio, 2010). Low morale contributes to high levels of stress, burnout, poor job satisfaction, and an overall poor quality of life. Controlling stress and burnout is an essential component of a healthy lifestyle.

Use of effective interpersonal communication strategies by nurses. . . may reduce stress, promote wellness, and therefore, improve overall quality of life. Use of effective interpersonal communication strategies by nurses in both personal and professional settings, may reduce stress, promote wellness, and therefore, improve overall quality of life. This article briefly explores the concept of interpersonal communication as it relates to Maslow's hierarchy of human needs; describes personal variables and the interaction of internal and external variables that can impact communication; and discusses possible causes and consequences of ineffective communication. Drawing on both the literature and my experiences as a longtime provider of care in the mental healthcare field, I offer multiple strategies, with specific examples of possible responses for effective communication. Recommendations in this article are intended for nurses to consider as they seek healthy communication strategies that may be useful in both their personal and professional lives.

Interpersonal Communication and Maslow's Hierarchy of Human Needs

In 1943, Abraham Maslow developed a hierarchy of human needs wherein he described the basis of human behavior in terms of the priorities of survival (Figure 1). Oxygen, food, water, and shelter, our most basic needs, must be met first. Once these basic needs are met we can progress upward in the hierarchy toward fulfillment of needs for safety/security, love/belonging, and esteem. Finally, according to Maslow, the highest human needs revolve around finding one's purpose and realizing one's full potential, which culminate at the pinnacle of the hierarchy in self-actualization.

Maslow's hierachry of human needs can be applied to interpersonal communication. The concept of communication can be most appropriately considered in the context of three levels of the hierarchy: safety, love/belonging, and esteem. Of these, safety has the most intimate involvement with basic, "primitive" needs. For example, it feels very personal when one's safety is threatened by loss of any kind, whether it is a perceived or actual loss. A loss can invoke anger, grief, or fear in response to feeling helpless, powerless, unsafe, and vulnerable. Likewise, effective or ineffective communication may impact our ability to satisfy the needs of love and belonging, and also esteem.

. . . little has addressed how effective interpersonal communication can contribute to a healthy lifestyle in both the personal and professional life of the individual nurse. Many would agree that interpersonal communication is an intimate, human activity that can weigh heavily on our overall psychological health and wellness, and therefore, warrants much discussion and attention. Despite this realization, the literature, especially in nursing, has not addressed this topic adequately. Although much has been written on workplace safety, lateral violence, and bullying to address issues that we face as professionals in the workplace, little has addressed how effective interpersonal communication can contribute to a healthy lifestyle in both the personal and professional life of the individual nurse. As each person seeks to meet his or her human needs, a number of variables, both internal (or personal factors) and external (or behavior of others) can combine to support effective or ineffective interpersonal communication. The next section will offer professional insight that I have gained in my nursing practice related to how multiple variables may impact communication. I offer this not as an exhaustive list of variables, but in the hope that it will provide some context for readers to reflect on their own unique mix of variables as they go on to read and consider the recommendations for effective communication.

Personal Variables: Internal Predisposing Factors

Human beings are complex creatures. We are composed of a plethora of variables that are continuously interacting with one another. Some of these personal variables are internal in nature; they are part of our makeup. Figure 2, developed by the author, is a simple representation of how variables might interact to produce a unique individual. In addition to our genetic makeup and gender, the variables (termed internal predisposing factors) consist of thoughts, feelings, and perceptions that are often learned early in life and shaped by childhood upbringing and experiences. In my clinical experience with patients, I have observed that early experiences can affect persons deeply, and perceptions of these experiences are not easily changed. Indeed, the impact of these experiences can cause a person to be rigid and inflexible. For example, a person who has been abused physically, verbally, or sexually by the opposite sex, and unhealed from this, can become unyielding in any future interactions with persons of that gender regardless of the situation or circumstances. However, all is not lost. In addition to factors that CAN be controlled and factors that CANNOT be controlled, there are factors that may change over time. Consider the variables listed in Figure 2. Which can be changed or controlled? Which cannot? Which are subject to change? These are important distinctions that will become clearer in the discussion of the following sections, as applied to interpersonal communication.

Interaction of Internal and External Variables

Figure 3, developed by the author, represents how internal personal variables demonstrated in Figure 2 and external variables (behavior of others and situations) might interact. Further, consider how the interactions depicted in Figure 3 could influence the outcome and effectiveness of (our) interpersonal communication. Understanding and acceptance that one cannot control others and/or situations can create the psychological freedom necessary to develop insight into one's own behavior. That insight can be the first step toward positive change and improve communication. The next section will consider some causes and consequences of ineffective interpersonal communication, along with strategies and selected examples to support alternatives.

Causes and Consequences of Ineffective Interpersonal Communication

Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Poor team communication has been cited as the number one cause of unnecessary patient deaths related to medical error since the 1990s (Institute of Medicine, 1999). Further, criticism has been directed at healthcare providers, including physicians, for their lack of study of interpersonal communication (Hull, 2007; Shapiro, 2011). Although numerous interpersonal communication theories exist, few have been applied to healthcare communication or utilized in any relevant manner by providers (Bylund, Peterson, & Cameron, 2012). Thus, a knowledge gap exists necessitating a frank discussion and pragmatic strategies for change. This section will offer selected strategies for effective communication for consideration, drawn from both literature and practice experience.

Personal life versus professional role calls us to develop and apply competent skills based on the specific situation, and adopt an appropriate demeanor and response. However, behavior based solely on role expectations may not always be appropriate. Here are some suggestions to begin to think differently. When applying what is discussed in this article to your personal and professional lives, think of yourself holistically. In other words, you cannot compartmentalize basic personality structure, or your personal way of relating to the world; you are who you are. Divorce yourself from antiquated acculturated role expectations of how women or men and nurses are supposed to behave. Strive to develop new ways of relating to support more rewarding interpersonal communication experiences.

One way to do this is to think in terms of the use of "self" versus "skills." Effective interpersonal communication is much more than techniques, skills, or procedures to be mimicked or parroted. Parroting or mimicking is generally viewed as insincere; if one behaves as a robot, most people will sense this. To say one must perform a certain skill or competency, in my opinion, diminishes our ability to have spontaneous human interactions that are meaningful. Techniques and skills can become too automatic and thus may limit your options.

Genuine human rapport requires creativity and flexibility. Genuine human rapport requires creativity and flexibility. Best practice would dictate relating genuinely, human to human, and disregard of communication "scripts." Since new behavior can be risky and frightening, pragmatic strategies aimed at prevention of ineffective interpersonal communication are needed. With this goal in mind, Table 1, developed by the author, provides a brief overview of possible causes, consequences and cures for ineffective interpersonal communication, as well as possible strategies and/or examples for application. The section that follows elaborates on the information in Table 1 and offers additional discussion and/or practical guidance.

Additional Insight about Barriers to Effective Communication: Thoughts from the Trenches

The above table offers many "possibilities" to explain and address some common areas that may contribute to ineffective interpersonal communication. Below is some additional discussion and implications for practice to provide further insight into these concerns.

Cultural and Organizational Taboos/NO TALK Rules

It may be helpful to question "NO TALK" rules and communication taboos, such as the expression, "Children should be seen and not heard." In much of today's society, this may seem an absurd statement, but likely it was an accepted societal norm at some time in the past. But times have changed. In 2014, do not accept statements or situations at face value that do not make sense. You are entitled to an explanation and rationale when it is spoken or inferred that you should "not talk about" something. Find out why. If you are afraid to speak up, ask yourself why. If you are afraid or uncomfortable with conflict, then you must understand that fear of conflict can lead to poor conflict management and poor negotiation/problem solving skills (numbers 2 and 3 in the above table). NO TALK rules are often unspoken; in fact they are generally inferred, creating a more confusing situation. This can add to frustration, helplessness, lack of trust, and avoiding discussion about and problem solving of important issues. The only way around this frustrating barrier is to bring NO TALK issues forward and discuss them openly and honestly.

In the workplace, most nurses know that not reporting (i.e., not talking about) something that they know is wrong or against policy (or could bring harm to a patient) because "you don't want to get someone in trouble" is unethical behavior. A striking example of this is failure to report an impaired colleague. How might you talk about this NO TALK issue? Here are some suggestions that I have found helpful. Stick with the facts. Do not make judgments, or offer moralizing and/or solutions for fixing the problem. Go to the person's supervisor and ask if you can speak privately. If you are uncomfortable, say so. You might try saying, "I am not comfortable discussing this, but I feel it is my duty to report that I smelled alcohol on Fred when he gave me report this morning." Keep a record of the date, time, and name of the person with whom you had this conversation. If the behavior is not addressed and occurs again, your next step is to go up the chain of command.

Poor Conflict Management

. . . it is ok to disagree, and not all problems will be or can be solved. If you are not comfortable with conflict, chances are somewhere along the line you may have learned that conflict is "bad." Maybe you witnessed conflict that escalated into inappropriate aggression or violence, or you were not allowed to express negative feelings in order to solve conflict. The term "conflict management" that was coined years ago by the business world suggests that conflict must be managed or kept under control. This is not always true. Conflict often can provide the friction we need to discuss issues, consider alternative strategies and solve problems. Conflict in and of itself is not bad, but necessary. Opinions that differ from our own help us to learn and grow (Peck, 1978). Keep an open mind and discuss solutions respectfully when conflict arises. Remember, too, it is ok to disagree, and not all problems will be or can be solved. You do not have to fix everything.

Poor Negotiation/Problem-Solving Skills

. . . poor negotiation and/or problem-solving skills often happen when people are in a hurry to fix a problem. . . In my experience, poor negotiation and/or problem-solving skills often happen when people are in a hurry to fix a problem, whether at home or in the workplace. A person may not take time to thoroughly think about the problem and possible solutions because we live in what I have heard described as a hurry-up, fix it now, instant mashed potatoes, just put out the fire culture. This "hurry up and fix it/get it away from me" ideology is sometimes due to discomfort with problems. Why? Because problems can evoke negative feelings within us, and we do not want to feel negative feelings. In my opinion, this is a real shame because "problems call forth our courage and wisdom; indeed they create our courage and wisdom" (Peck, 1978, p.16).

It is common knowledge in present day healthcare that the population requiring care is growing and resources are shrinking. A hurry up, problem-avoidance mentality (one that I have often heard described in my years as a provider, especially recently) may deprive people of the opportunity to learn: 1) toleration for unfinished business; 2) creative problem solving; 3) flexible thinking; 4) coping; 5) spontaneity; 6) testing of boundaries; and most importantly 7) to sit with uncomfortable feelings. Emotional maturity is born of the foregoing experiences, and maturity is necessary to become skilled at negotiation and problem solving. Work to both develop negotiation and problem solving skills and also to ensure adequate time to allow for appropriate consideration of the problem at hand.

Lack of Empathy

. . . emotional detachment, a technique adopted by some providers, does not protect one from future or worsening burnout. If you live in a family or work on a team, empathy is a must; however, empathy requires a complex balance of well-developed boundaries, emotional stability, experience, and indeed, effective interpersonal communication. Helping professionals may find themselves on one end or the other of the emotional caring spectrum and err by being overinvested in or, conversely, detached from patients. Unfortunately, emotional detachment, a technique adopted by some providers, does not protect one from future or worsening burnout. For example, physicians have been criticized for their lack of empathy, whereas nurses have been hailed as owning the concept of caring (Spiro, Curren, Peschel, & St. James, 1996). If you lack empathy, you may have become hardened to the world for some reason. Perhaps you have been hurt or are burned out. Compassion fatigue, a term coined in the mid 1990s, describes a phenomenon wherein professionals working with traumatized clients were actually at risk for secondary traumatization due to over identification with their clients' experiences (Sabo, 2006). This phenomenon occurs in all types of healthcare providers. Therefore, to maintain both physical and emotional health, it is important to strive to maintain the delicate balance between over and under caring.

Unresolved Emotional Issues

To support your own health, make the time and effort to get this [professional help] if you need it. While an extensive discussion of this complex topic is beyond the scope of this article, some basic outcomes of unresolved emotional issues are commonly known by all. A disruptive or abusive childhood, adult victimization or trauma of any kind can leave emotional and psychological scars that can be difficult to heal. Survivors of abuse have trouble trusting, and as a result, can misperceive and misinterpret the motives of others. Mistrust of others can create distorted perceptions of the world, distorted communication patterns and general difficulty in personal and professional relationships. If you need professional help to resolve your own emotional issues, you owe it to yourself to do this. To support your own health, make the time and effort to get this help if you need it.

Poor Self-Image/Negative Self-Talk

If you want respect, you must demonstrate this by respecting yourself. A poor self-image, possibly combined with negative self-talk, can set the stage for ineffective interpersonal communication. Never degrade yourself or allow others to denigrate or be disrespectful to you. Never refer to yourself or your personal characteristics in pejorative terms. Make a decision to view these behaviors as unacceptable. If you want respect, you must demonstrate this by respecting yourself.

Sometimes we have to teach people how to treat us. For example, if you are spoken to in a disrespectful or condescending manner, by anyone, especially a co-worker, first know that this is unacceptable. You do not have to take verbal abuse from anyone, especially in the workplace. The expectation is for nurses, physicians, and all members of the healthcare team to behave professionally at all times. Should inappropriate behavior occur, you must make the decision to stand up for yourself. Even if it is hard, try calmly stating words such as, "Excuse me, but I would like to be addressed with courtesy and respect at all times" or "Please refrain from making pejorative remarks and focus on a solution to this problem."

All of us are a mix of positive and not-so-positive characteristics. Learn to appreciate the good qualities in yourself and others. It can be difficult to avoid judging yourself or others. You may find it helpful to pick one quality or character trait you would like to improve. Then, seek the wisdom of a trusted friend, counselor, or sage and ask for support and advice in order to accomplish your goal.

Lack of Boundaries/Inability to Set Limits

Assertiveness, or saying NO and setting limits appropriately is an ART that must be learned. The inability to set limits is generally related to fear of rejection, people pleasing, or emotional insecurity. You may think, "They won't like me." Accept that you will not like everyone, and everyone will not like you, and that is okay. Assertiveness, or saying NO and setting limits appropriately is an ART that must be learned. Setting limits requires one to make simple, short statements in a calm, respectful manner. Focus on the positive and describe the desired behavior, as opposed to one that is undesired. Following this, describe the consequences for continuation of the undesired behavior. Do not argue, threaten, and attempt to intimidate, or show fear. State only the consequences that you have power to enforce, and that you will follow through upon. Do not promise what you cannot deliver. In your role as a nurse, you will deal with upset patients at times; however, you have the right and responsibility to set limits on inappropriate behavior. This is true both in your professional and your personal life. Table 1 provides selected examples of suggested verbal interventions that you might utilize to set limits.

Importance of Self Analysis and Insight

Simply taking the time to engage in self-analysis. . . can support the effective interpersonal communication necessary to maintain your health. Since we do not live in a vacuum or in isolation, understanding yourself and developing insight into YOU is paramount to effective communication. Refer back to the personal variables in Figure 2. Consider how your upbringing may have influenced you. What was your home like? How were you treated and addressed by your parents and teachers? Was your family patriarchal (led by father) or matriarchal (led by mother)? Who delivered the discipline to children in your home? Who were the other significant adults in your life? How has your race, culture, and/or religion possibly influenced you? As an adult, how has your education and real world experience impacted you? Have you travelled to other countries? How have adult relationships such as spouse, children, and significant other influenced you? Have you been ill or lost someone close to you? It is important to understand how these factors have shaped and influenced you, and to what extent. These variables influence how you present, behave, and communicate in the world. Simply taking the time to engage in self-analysis to develop this type of personal insight can support the effective interpersonal communication necessary to maintain your health.

Physical or Mental Illness

Depression, anxiety, and alcoholism appear more likely to be high in professions with high stress, but there remain gaps in the research literature. Ross and Goldner (2009) conducted a review of the literature to examine stigma, negative attitudes and discrimination toward mental illness from a nursing perspective. They determined that although substance abuse among nurses has been studied, no such parallel examining nurses with mental illness could be found. The paucity of literature on the subject of nurses with mental illness is of concern. However, Ross and Goldner (2009) did find that nurses with mental illness are both stigmatized and stigmatizers; they judge themselves and others. In regard to ineffective interpersonal communication, Farrell (2001) reported that nurses who have mental illness often felt as though they were targets of bullying and lateral violence in the workplace.

Research supports that mental illnesses are biochemical brain disorders that are strongly genetically linked (Perese, 2012). Mental illness is not caused by weakness or lack of moral character. Ghaemi (2011) noted that some of the greatest leaders in history suffered from mental illness. Moreover, he purported that it was because of their suffering that these men (e.g., Lincoln, Churchill, Sherman) developed the personal characteristics necessary to become exceptional leaders during times of crisis.

Mental illness can be treated and should not be ignored. There is no shame in seeking the help of a mental health provider. Nurses seeking treatment for mental health disorders not only have the ability to improve their own health, but also by their actions may help to address perceived stigma associated with mental illness.

Hidden Agendas, Politics, Games, and Tests

Over a decade ago Horsfall (1998) addressed several important "personal" variables with respect to effective communication. Two of her foci addressed how power inequalities and personal prejudices affect communication. Even chosen seating in a meeting (i.e., who sits where) can be the subject of interpretation. Unfortunately much of what Horsfall discussed in 1998 has not changed in the present day. Unequal power structures, abuse of power, and feelings of powerlessness (including certain unspoken practices both within nursing, medicine and the world) prohibit equalization of power structures. For example, persistent use of patriarchal (or exclusively male led) systems still exist and contribute to the "inadequacy of mainstream nursing [and other] concepts of communication" (Horsfall, 1998, p. 78). Women, in particular, who communicate in a firm, assertive manner, may be subject to pejorative remarks in a male dominated environment. If there appears to be a gender barrier to effective communication, be firm anyway. Again, table 1 above offers information about how to address communication barriers due to these concerns, using neutral, nonthreatening, wording and actions.

Lack of Clear Plain Speech/Writing

Lack of clarity in speech and/or writing often contributes to ineffective communication. Avoid jargon, any kind of "isms," clichés, slogans and boring overused stories. If you have heard something before, it is likely that others have, too. Use others' work discriminately and give credit as appropriate. Be original. Shorthand, texting, hashtags, and social networking lingo should never be used in professional communication. Say what you mean and mean what you say. Use plain, straight-forward talk that addresses the issue at hand.

. . . if a matter has escalated, make the time to talk in person to clarify concerns. Do not always resort to email to communicate important messages; you can sometimes improve communication by asking for a face to face meeting. Email communication is indeed inappropriate in certain situations. According to a Forbes magazine article, Do You Hide Behind Email?, there are four times you should never use email: when you are mad, criticizing or rebuking; when there is a chance you could be misunderstood; when you are cancelling; or when apologizing (Warrell, 2012). Furthermore, when issues are delicate, sensitive, awkward, or negotiation is needed, they should always be discussed in person. Personal discussions facilitate trust and add to the richness of the experience by facial expression and body language (Warrell, 2012). Confident, mature individuals will speak with you face to face and will not hide behind email to communicate important information. Especially if a matter has escalated, make the time to talk in person to clarify concerns.

Conclusion

Effective interpersonal communication is necessary to negotiate the challenges of everyday living, whether in your personal or professional life. Because human beings are complex and each individual brings his or her own set of internal variables to every situation, the possibilities of interactional outcomes of any given communication can be exponential.

Although much has been written regarding workplace violence (e.g., bullying), practical strategies for addressing the mechanics of effective interpersonal communication are lacking. In order to address this, we need frank, open conversations regarding how our personal internal variables affect our interpretation of the world as we see it. This article has hopefully provided an opening dialogue in that direction with pragmatic discussion of common areas of concern. These recommendations are often ones that we, as nurses, offer to patients every day. Taking the time to consider them as they may apply in our professional and personal lives may go a long way to encourage healthy communication, and thus healthy nurses!

Table 1: Ineffective Interpersonal Communication: 12 Possible Causes, Consequences, Cures, and Examples for Effective Communication

 

Possible Causes Possible Consequences or Interpretations Possible Cures/Strategies Examples of Possible Wording for Effective Communication
1. Social/Familial/Organizational/Cultural Taboos regarding "No Talk" Issues. Frustration Talk openly about the cultural taboos and how they may have contributed to a climate wherein people are reluctant to share or tackle difficult issues. "I am not really comfortable bringing this up, but I feel we need to address it."
Helplessness --
Lack of Trust "I am concerned about a patient safety issue that I want to bring to the attention of the team."
Substantive Issues are ignored --
-- "There is an issue that is bothering me, and I feel we need to discuss it."
2. Poor Conflict Management Skills Inappropriate and misdirected anger Learn how to respectfully disagree. "I can see that you are upset. I would like to discuss this calmly and rationally."
Finger pointing Become comfortable with affect (yours and others). --
Blaming Remain calm and professional in all situations. "Perhaps we can negotiate a compromise, middle ground?"
-- -- "It looks like we may not agree on this, so let's table it for now and discuss again."
3. Poor Negotiation/Problem-Solving Skills Knee jerk responses Learn skills for collaboration. "If you could do what you enjoy most, what would that be?"
Temporary or short-term fixes (sometimes referred to as "Band-Aids") Become comfortable with unfinished (long term) solutions.
Focus is on "putting out fires" rather than vision Discover your strengths and those of others.
-- Assign or negotiate tasks/workgroups/projects based on individual strengths and interests, versus a "we just need a warm body to complete this" approach.
4. Lack of Empathy/Understanding of Others Poor team work/spirit Widen your perceptions and awareness of those around you and the environment. It is very important to make eye contact and give undivided attention while the other person is talking.
Lack of cooperation Endeavor to be a team player. Large organizations, hospital units, work groups and families run best with a cooperative spirit among individuals. --
Wasted time and resources Conversations and regularly scheduled FACE to FACE meetings are a must for development of rapport, negotiating and problem solving. Do not take your phone to meetings unless you are expecting an urgent call.
-- If your group prefers email for all communication, ask for a scheduled face to face, prepare an agenda and send it out in advance. --
-- -- Acknowledge the other person's feelings.
-- -- --
-- -- "I can see how tough this must be for you."
-- -- --
-- -- "Based on looking around this room at all your faces, I can see the angst you are all feeling about this (patient, situation, issue)."
-- -- "I know it has been hard on you to worry about scheduling issues all the time."
5. Unresolved Emotional Issues (e.g., history of physical or emotional abuse) Distorted perceptions of the world Resolve your issues and do not focus on other peoples' issues; to do so takes time from looking at your own issues. "I think there has been a misunderstanding here, I would like to discuss/clarify/clear this up."
Misinterpretation of the motives and messages of others Seek to clarify and resolve the issue, if you feel the other person misinterpreted what you said or meant and as a result there is conflict or bad feelings. --
Distorted responses to communication of others Always own your own words and actions. "I apologize if I was not clear; let me explain what I meant."
6. Poor Self-Image/Self-Esteem Perceived attacks As above, in number 5. "I am feeling like there is quite a bit of emotion in the room right now."
Perceived threats If you feel threatened or attacked, step back, remain calm, and provide feedback to the other person(s). Allow yourself to be honest with your feelings. --
Perceived losses -- "Sounds like this issue gets people fired up."
Fear of others or situations -- --
7. Poor Self-Image/Negative Self-Talk Contributes to low self-image and lack of respect from others. As above, in number 6. When receiving feedback that may be helpful for your development - you can listen first, then respond with, "What I hear you saying is that I can become impatient at times. . . ."
Do not refer to yourself in negative terms, such as, "I'm a mess." --
Listen first, then respond. It may be helpful to ask for a specific example or incident of the behavior to enable you to have a fuller understanding of what may need to be changed. Try, "Can you provide an example of what you are referring to?"
Ask for a specific example. --
8. Lack of Boundaries/Inability to Set Limits Can be caused by history of abuse As above, in number 6. "I have not been trained to perform that task, I would be happy to observe you at this time and learn."
Learn the difference between being a team player and being taken advantage of. --
Do not agree to fulfil obligations, tasks, assignments that you are not fully competent to perform; or clearly qualified to do. "Please walk me through this policy, process, procedure. . . ."
Do not agree to do anything outside your scope of practice or clinical privileges. --
Know that it is ok to say NO. "I will check with my supervisor and inform you what I find out."
Know that it is ok to say YES and ask how to do it. --
-- --
9. Lack of Insight Blindness to your faults and flaws robs you of opportunity for personal growth Be open to input from others. "I have been told I am impatient, do you agree with that observation?"
Ask for honest feedback.
Be willing to take constructive criticism.
Work to develop the insight of a mature adult. Own your mistakes, apologize when you are wrong, and take action to correct any damage that has been done.
Resolve to learn from your mistakes and flaws and not to repeat the same behavior in the future.
Request feedback from trusted individuals.
10. Physical or Mental Illness Pain, depression, or anxiety can affect one's ability to focus, listen, and respond. Take care of your health, no one else will do this or should do this for you. "I am taking a nap/bath/break do not disturb me for one hour."
Request in simple terms the time you need to take care of yourself at work and at home. --
-- "I need to take Friday morning off for a medical appointment."
11. Hidden Agendas, Politics, Games and Tests Disdain and lack of trust for authority figures Do not participate in gossip, rumors or back-stabbing. "It seems we have strayed a bit from the original topic of the meeting. . . . .can we get back to the agenda/problem at hand?"
Secrets create disempowerment and dependency which can lead to increased stress, burnout, lack of creativity and motivation Demonstrate integrity in all that you do. --
-- Be honest. "I believe the item we were discussing was . . . .and . . . the following solution(s) have been offered. . ."
-- Own your own mistakes. --
-- Excuse yourself from or try to redirect the conversation if the discussion has turned from facts/problem solving to gossip or complaining. --
12. Lack of Clear, Plain Speech or Writing (e.g., acronyms, codes, slang, hashtags, accents, culture, apps, jargon) Distancing strategy Speak and present yourself in a professional manner at all times. --
Power move Never use slang or improper English in professional situations.
You can appear uneducated If you lack communication skills for appropriate speech and/or writing, learn them.
-- Use available software and computer technology to review/correct anything submitted in writing.
-- Ask a colleague to proofread for you. Find the person on your team or work unit who enjoys details, and has the skill to find a misplaced semicolon.
-- Do not use acronyms, abbreviations, or other short-hand language unless everyone on the receiving end knows what they mean. If you do not know, ask for an explanation.

 

PHOTO (COLOR): Figure 1:

PHOTO (COLOR): Figure 2: Personal variables: Internal predisposing factors

PHOTO (COLOR): Figure 3: Interaction of Internal and External Variables

References

Brinkert, R. (2010). A literature review of conflict communication causes, costs, benefits and interventions in nursing. Journal of Nursing Management, 18, 145-156. Doi: 10.1111/j.1365-2834.2010.01061.x.

Bylund, C., Peterson, E., & Cameron, K. (2012). A practitioner's guide to interpersonal communication theory: An overview and exploration of selected theories. Patient Education and Counseling, 87(3), 261-267. Doi: 10.1016/j.pec.2011.10.006

Farrell, G. (2001). From tall grass to squashed weeds: Why don't nurses pull together more? Journal of Advanced Nursing, 35(1), 26-33.

Ghaemi, N. (2011). A first-rate madness: Uncovering the links between leadership and mental illness. New York, NY: Penguin Books.

Horsfall, J. (1998). Structural impediments to effective communication. Australian and New Zealand Journal of Mental Health Nursing, 7(2), 74-80.

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Perese, E. F. (2012). Psychiatric advanced practice nursing: A biopsychosocial foundation for practice. Philadelphia, PA: F.A. Davis Company.

Peck, M., & Scott, (1978). The road less travelled. New York, NY: Touchtone Publishers.

Ross, C., & Goldner, E. (2009). Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: A review of the literature. Journal of Psychiatric and Mental Health Nursing, 16(6), 558-567. doi: 10.1111/j.1365-2850.2009.01399.x.

Sabo, B. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 12(3): 136-142.

Shapiro, J. (2011). Does medical education promote professional alexithymia? A call for attendance to the emotions of patients and self in medical training. Academic Medicine, 86(3), 326-332. doi: 10.1097/ACM.0b013e3182088833.

Spiro, H., Curnen, M., Peschel, E., & St. James, D. (Eds.) (1996). Empathy and the practice of medicine: Beyond pills and the scalpel. New Haven, CT: Yale University Press.

Vessey, J. A., DeMarco, R., & DeFazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce. Annual Review of Nursing Research, 28(1), 133-157. doi: 10.1891/0739-6686.28.133.

Warrell, Margie. (2012, August). Hiding behind email? Four times you should never use email. Forbes. Retrieved from: www.forbes.com/sites/margiewarrell/2012/08/27/do-youhide-behind-email/

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By Kathleen A. Vertino, DNP, PMHNP-BC, CARN-AP

 

received her DNP and MS degrees from the University at Buffalo. She holds dual national board certification as a PMHNP and CARN-AP. In addition to her role as a Nurse Practitioner in the Behavioral Health Clinic at the VA Western New York Healthcare System, she is involved in a number of scholarly, academic, and community service activities which include publishing and presenting. Due to her clinical expertise, leadership qualities, compassion for and understanding of patient care, and business acumen she has is sought by peers, colleagues and superiors for participation in numerous diverse task forces, academic and professional development programs, strategic planning initiatives and operations issues both within and outside the Veterans Healthcare Administration (VHA). She is a VHA Certified Mentor at the Fellowship level and has mentored staff with special projects. She is an active voice at the National level for Advanced Practice Nursing.


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