Empowering Nurses to Lead
Every Nurse in Every Setting
North Dakota Action Coalition
Leadership Program
Communication
North Dakota Action Coalition
The North Dakota Action Coalition (NDAC) is focused on the development of
statewide leadership programming for “Every nurse, in every setting” This
includes nursing students, front-line nurses, community nurses, advanced
practice nurses, chief nursing officers and nurse researchers.
The ND Action Coalition is co-led by the ND Center for Nursing and the
University of Mary Harold Schafer Emerging Leaders Academy and is part of
the National Campaign for Action.
http://www.thefutureofnursing.org/content/action-coalitions
http://www.thefutureofnursing.org/
Leadership Program is divided
into 4 main areas.
Communication is foundational
for learning and understanding
about systems. Knowledge of
how systems function is
necessary to institute change.
The ability to accept and engage
in change is necessary to be an
advocate for health policy.
All nurses are expected to lead!
ECHO
Essential Communication
Hearing Ourselves
Presented by the North Dakota Action Coalition
Communication Group
The purpose for this learning activity is to provide reflective practice tools
to grow your skills for becoming a skilled communicator.
Objectives
1. Define self-reflection.
2. Review frameworks/ standards/ codes that inform the practice of selfreflection in nursing.
3. Use self-reflection to develop expertise for becoming a skilled
communicator.
4. *Demonstrate skilled communication by sharing one example of how you
used the factor of becoming candid.
*You must meet all the objectives to receive contact hours for this learning activity.
Communication is
far more than speaking ….
It is about HEARING not only
what others say to us but
HEARING what we say to
others.
To become a skilled
communicator we must learn
to hear ourselves.
Becoming a skilled communicator requires
 Becoming aware of self-deception
 Becoming reflective
 Becoming authentic
 Becoming mindful
 Becoming candid
The foundation for this learning activity is based on the Five Factor Model of Becoming
a Skilled Communicator (Kupperschmidt, Kientz, Ward, and Reinholz, 2010).
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
OJIN/TableofContents/Vol152010/No1Jan2010/A-Healthy-Work-Environment-andYou.html
Becoming reflective exposes
self-deception, which leads to
discovering your authentic self.
The act of reflection leads to
heightened awareness /
alertness to verbal and
nonverbal communication
(emotional intelligence) which
is being mindful.
These states of becoming
prepare one to speak
purposefully, to speak and
listen truthfully also known as
being candid.
To successfully complete this learning activity
and be awarded contact hours:
• The learner must
• Complete the reading assignments.
• Complete the learning activities.
• You will need to write in a journal during this learning activity, you may do so either on
paper or by using your computer. Save your work so you can access it and re-read your
thoughts.
• Contribute to any online discussions as assigned during the learning activity.
• Complete objective #4 and submit per instructions one example of using the
becoming candid factor.
• Complete course and self evaluations.
Opportunities for further
learning are presented
through-out this learning
activity.
You are urged to take time
to engage in these extra
learning activities.
When we speak we count
on others to listen and
hear our meaning… When
we listen others count on
us to hear their meaning…
Communication is
about meaning making.
listen
speak
communication
hear
meaning
Meaning making requires we reflect on the way we process
and store the stories of our experiences…depending on one’s
world view and adult development level shared experiences
may end up being a different story to another person.
As we process the bits of data we
constantly receive during the act
of communicating, we translate
those bits into streams of
information, it is in reflecting/
thinking that we turn all those
bits into knowledge.
It is what we do with that
knowledge that leads to wisdom.
We need to HEAR what we say to others….
We need to HEAR what others say to us.
Communication is often filtered,
we need to inspect, clean and
sometimes replace our filters.
Reflection is a way to inspect,
clean and if necessary replace our
filters…
As nurses we need to
elevate our
communication to a
level that fosters
professionalism.
We have a standard of
professional
performance to meet.
There are a number of strategies and
tools to help you practice reflection
Becoming reflective. . .
• Is the process of pondering, carefully and persistently, the MEANING
of an experience.
• Creating meaning from past or current events that guide future
behavior.
• Self-questioning so situations become more clear and coherent.
• Systematically examining the past and the present to inform the
future.
Reflective practice in nursing
• Learn from experiences
• Opening up one’s practice for others to examine requires openmindedness and courage.
• Requires one to take on and act on criticism.
• Is intermingled with feelings and emotions.
• Fuels motivation to improve one’s practice.
Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed. Hoboken, NJ: Wiley-Black.
Skills involved in reflection
• Self-awareness
• Aware of character, beliefs, values, qualities, strengths, and limitations
• Description
• Ability to state characteristics or appearance WITHOUT expressing judgment
Skills involved in reflection
• Critical analysis
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Separation of the whole into its component parts
Undertake a detailed examination of structure, elements, or parts.
Understand the nature of, how parts relate to, and influence other parts.
Include the manner ways of knowing (empirical, aesthetic, personal, ethical)
Challenge assumptions
• Synthesis (opposite of analysis)
• The process of result of building up separate elements, ideas, into a connected and
coherent whole
• Evaluation
• Make a judgment about the value of something
• Use of predefined criteria or standards
Reflective
thinking is a
process that
grows
knowledge,
skills,
attitudes, and
judgment
Reflection is meant to grow and challenge our thinking…..
We have all heard the
saying…”think outside the
box”…. Do we mean we wish
others would think more like
what is in our box?
Or are we ready to examine our
own thinking, behavior,
worldview, values, and respect
where others are in this process
as well?
Having a map to help
guide us in reflection is
always helpful.
Frameworks ask
a common set of
questions that
can guide our
thinking.
There are many
frameworks to choose
from or you can create
your own.
One framework used in
nursing is Tanner’s Clinical
Judgment Model
Consider how it compares
to the Nursing Process
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Introduction
Background
Noticing
Interpreting
Responding
Reflection-in-action
Reflection-on-Action
Nielsen, A., Stragnell, S., & Jester, P. (2007).
Guide for reflecting using the clinical judgment
model. Journal of Nursing Education, 4(11), 513516.
Assessment
Diagnosis
Outcomes identification
Planning
Implementation
Evaluation
ANA’s Nursing Scope and Standards, 2nd
Edition, 2010
The Nursing Process & Tanner’s Clinical Judgment Model
Introduction (Assessment)
Your view of the situation
(Be aware of your viewpoint)
Background (Assessment)
Relationship, experiences, formal knowledge
(Be aware of the factors that create your background)
Noticing (Assessment)
Initial and later
(Be aware of your patterns for sensing situations)
Using Tanner’s Clinical Judgment Model
Interpreting (Diagnosis)
Cause, patterns, similarities, differences, observations, data
(Be aware of your viewpoint, how does it impact your meaning making)
Responding (Outcome planning, Implementation)
Actions, stressors, feelings
(Be aware of your patterns)
Using Tanner’s Clinical Judgment Model
Reflection-in-Action (Evaluation)
Think about practice while doing it
(This takes practice)
Reflection-on-Action (Evaluation)
Thinking back on what we have done to discover how we may have
contributed to the outcome or unexpected outcome.
(Consider working with someone you trust to help clarify your point of view)
http://simulation.laerdal.com/forum/forums/storage/14/4049/thinkinglikea
nurse.pdf
You can utilize these frameworks not only for
patient care but for self care in becoming a
skilled communicator.
Case Study Exercise: Use Tanner’s Clinical
Judgment Model as a framework to reflect on
a situation where you felt communication
between yourself and another could have
gone better.
????Access the discussion site to interact with
your online classmates. ????
How can we turn this into a group learning
How are we going to do this – when
activity?
nursing want the CE in a predetermined
timeframe? And sometimes one seating.
Reflective exercise to
become aware of self-deception
Do I fully appreciate the work of nursing and the environment in which that work
takes place?
 Do I base my practice on the Code of Ethics for Nurses? (See next slide for link to review Code
of Ethics for Nurses)
Do I assume responsibility for attaining and maintaining my work environment?
 What have I defined my work environment as?
 Is my definition complete?
Am I open and trustworthy?
Do I acknowledge and change routines and behaviors that have hindered
communication?
Commit 15 minutes to each question, write your reflections in your journal.
Code of Ethics for Nurses
Review the ANA Code of Ethics for Nurses
http://nursingworld.org/MainMenuCategories/ThePracticeofProfession
alNursing/EthicsStandards/CodeofEthics.aspx
Review the International Code of Ethics for Nurses
http://www.icn.ch/about-icn/code-of-ethics-for-nurses/
Authentic – Are you the real deal?
Over the next several slides Nursing’s Standards of Professional
Performance are briefly reviewed.
Standard 7. Ethics
Standard 8. Education
Standard 9. Evidence-Based Practice and Research
Standard 10. Quality of Practice
Standard 11. Communication
Standard 12. Leadership
Standard 13. Collaboration
Standard 14. Professional Practice Evaluation
Standard 15. Resource Utilization
Standard 16. Environmental Health
Standard 7. Ethics
Standard 8. Education
• The registered nurse…
• Practices ethically
• Attains knowledge and competencies that reflect current nursing practice
Standard 9. Evidence-Based Practice and Research
Standard 10. Quality of Practice
• The registered nurse…
• Integrates evidence and research findings into practice
• Contributes to quality nursing practice
Standard 11. Communication
Standard 12. Leadership
• The registered nurse…
• Communicates effectively in all areas of practice
• Demonstrates leadership in the professional practice setting and the
profession
Standard 13. Collaboration
Standard 14. Professional Practice Evaluation
• The registered nurse…
• Collaborates with the healthcare consumer, family, and others in the conduct
of nursing practice
• Evaluates her or his own nursing practice in relation to professional practice
standards and guidelines, relevant statutes, rules, and regulations
Standard 15. Resource Utilization
Standard 16. Environmental Health
• The registered nurse…
• Utilizes appropriate resources to plan and provide nursing services that are
safe, effective, and financially responsible
• Practices in an environmentally safe and healthy manner
Reflective exercise: Your performance as a nurse?
• Do you practice ethically?
• Do you attain knowledge and competencies that reflect current nursing
practice?
• Do you integrate evidence and research findings into practice?
• Do you contribute to quality nursing practice?
• Do you communicate effectively in all areas of practice?
• Do you demonstrate leadership?
• Do you collaborate with the health care team, patient, family, and others in
conducting your practice?
• Do you evaluate your practice in relation to professional standards?
• Do you use appropriate resources and provide safe, effective, and
financially responsible nursing service?
• Do you practice in an environment that is safe and healthy?
Reflective exercise: Authentic leadership
• Acknowledge your strengths and weaknesses
• List both your strengths and your weaknesses
• Consider your weaknesses your guide for self-development
• What is your purpose?
• Do you hold and practice professional values?
• Do you role model professional behaviors?
• Do you practice through your heart as well as your mind?
• Do you have enduring relationships?
• Do you treat others with respect?
• Do you practice self discipline?
• Do you seek out and act on feedback?
• How do behave when you receive feedback?
• Commit one hour to writing your responses in your reflective journal.
Brief overview of emotional intelligence
Emotional intelligence (EI) refers to the ability to perceive, control and
evaluate emotions.
The subset of social intelligence that involves the ability to monitor
one's own and others' feelings and emotions, to discriminate among
them and to use this information to guide one's thinking and actions.
(Peter Salovey and John D. Mayer, 1990)
To read more
http://psychology.about.com/od/personalitydevelopment/a/emotional
intell.htm
Becoming Mindful
Paying attention in a
non-judgmental manner
Exercise for becoming mindful
• What is mindfulness?
Mindfulness is the act of being intensely aware of what you're sensing
and feeling at every moment — without interpretation or judgment.
Spending too much time planning, problem-solving, daydreaming, or
thinking negative or random thoughts can be draining. It can also
make you more likely to experience stress, anxiety and symptoms of
depression. Practicing mindfulness exercises, on the other hand, can
help you direct your attention away from this kind of thinking and
engage with the world around you.
Http://www.mayoclinic.org/mindfulness-exercises/ART-20046356
The art of reflection instead of reaction…
• PBR3
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Pause
Breath
Relax
Reflect
Re-write your story
• http://www.americannursetoday.com/article.aspx?id=5048
• In a nutshell: when you feel your fear/ anger button being
pushed…mentally and physically stop what you are doing, take slow
deep breaths until you feel relaxed. Reflect on what just happened,
then record an authentic story in your brain.
Candid
The ability to speak frankly, free from bias, a willingness to risk
speaking/ hearing the truth.
Happens in environments where there is sufficient trust.
Must be willing to suspend judgment while listening to others.
Must be willing to hear what you are thinking and quiet your mind.
It is ok if we hold diverse points of views. It does not necessarily mean
we disagree. We have simply chosen a different meaning.
Each person brings their own unique
ways of speaking and listening to
communication.
Practice suspending
judgment while
listening to others.
Be fully present.
An approach for becoming candid
Carefronting ends the blame game.
Below are reflective questions for this approach for becoming candid.
What is the respectful thing to do now?
Where do we go from here?
When do we begin to discuss the conflict- if not now, when?
Who will end the blame and help work toward the professional practice
environment we all deserve?
For more on Carefronting follow the link below.
http://www.emergingrnleader.com/carefronting/
Dr. Betty Kupperschmidt an Associate Professor of Nursing at the University of
Oklahoma, has been a pioneer in bringing the concept of carefronting to nursing
practice.
More resources for Carefronting
• Carefronting: An innovative approach to managing conflict
• October 2012 Vol. 7 No. 10
Author: Rose O. Sherman, EdD, RN, NEA-BC, FAAN
http://www.americannursetoday.com/article.aspx?id=9584&fid=9534
Addressing Multigenerational Conflict: Mutual Respect and
Carefronting as Strategy (Kupperschimidt, 2006)
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/
ANAPeriodicals/OJIN/TableofContents/Volume112006/No2May06/tpc3
0_316075.html
Bringing the Five Factors together – your
action plan, first a reminder. . .
Becoming reflective exposes selfdeception, which leads to discovering
your authentic self.
The act of reflection leads to
heightened awareness / alertness to
verbal and nonverbal communication
(emotional intelligence) which is
being mindful.
These states of becoming prepare
one to speak purposefully, to speak
and listen truthfully also known as
being candid.
Final exercise
• Demonstrate skilled communication by sharing one example of how
you used the factor of becoming candid.
• Need instructions for how this will occur..
Recommended Reading
Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed.
Hoboken, NJ: Wiley-Black.
Senge, P., Scharmer, C.O., Jaworski, J., & Flowers, B.S. (2004). Presence:
Human purpose and the field of the future. New York: Crown Publishing
Group.