Empowering Nurses to Lead Every Nurse in Every Setting North
Dakota Action Coalition Leadership Program Copyright ND Center for
Nursing 2014
Slide 2
The North Dakota Action Coalition is a member of the Campaign
for Action that was established in response to Institute of
Medicine Future of Nursing Recommendations. Website:
www.campaignforaction.org
Slide 3
High-quality, patient-centered health care for all will require
a transformation of the health care delivery system Institute of
Medicine Report 3
Slide 4
Campaign for Action Areas of Focus Leadership Practice &
Care Education Interprofessional Collaboration Diversity 4
Slide 5
The North Dakota Action Coalition is focused on the leadership
development area of focus from the National Campaign. We have been
working in groups over the last two years to develop leadership
training customized to the needs of North Dakota nurses.
www.ndcenterfornursing.org/nd-action-coalition/
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Every Nurse in Every Setting
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Nationally, it has been shown that when nurses are positioned
to influence system practice and policies it leads to improvements
in quality of care, wellness, and reduced medical errors. Nurse-led
initiatives have: Reduced falls with harm Reduced code blue calls
Reduced 30-day re-admissions Improved care transitions. 7
Slide 8
What Can You Do as a Nurse Leader? Volunteer Speak up at
workplace Pursue lifelong learning Serve on boards and enter policy
debates Mentor Seek out committees Share the Institute of Medicine
report Support academic progression Teach the next generation Join
the North Dakota Action Coalition 8
Slide 9
The North Dakota Action Coalition is co-lead by: the ND Action
Coalition North Dakota Center for Nursing Patricia Moulton, PhD
Executive Director Established in 2011 501c3 non-profit
organization Vision: A unified voice for nursing excellence
Mission: Guide the ongoing development of a well-prepared and
diverse nursing workforce to meet the needs of the citizens of
North Dakota through research, education, recruitment and
retention, advocacy and public policy. www.ndcenterfornursing.org
University of Mary Harold Schaefer Emerging Leaders Academy Cheryl
Kalberer, MED, Coordinator, Emerging Leaders Academy Coordinator at
the University of Mary Established in 1998 Experiential leadership
development program for select students Mission: To identify and
develop servant leaders of moral courage Guided by an external
advisory board of representatives from across the health care
profession http://www.umary.edu/academics/e
mergingleadersacademy/ela_tab1.p hp
http://www.umary.edu/academics/e mergingleadersacademy/ela_tab1.p
hp
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Leadership Is. Everybodys business Relational Learned
Self-development An ongoing process Is not. A title A right A job
In your genetic makeup A means for power
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Leaders and Managers : Change Agents LEADER: Innovates Develops
Investigates reality Focuses on people Challenges status quo Asks
what and why Does the right thing MANAGER: Administers Maintains
Accepts reality Focuses on system and structure Accepts status quo
Asks how and when Does things right
Slide 12
The North Dakota Action Coalition Leadership Program is divided
into 4 modules. 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.
14 The learning module begins with the next slide.
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EC HO ECHO Essential Communication Hearing Ourselves Presented
by the North Dakota Action Coalition Communication Group 15
Slide 16
The purpose for this learning activity is to introduce the 5
factor model for becoming a skilled communicator and to provide
reflective practice tools that grow your communication skills.
Objectives 1.Define communication. 2.Review the 5 factor model for
becoming a skilled communicator. 3.Review the use of
self-reflection. 4.Review frameworks/ standards/ codes that inform
the practice of self- reflection in nursing. 5.Use self-reflection
to develop expertise for becoming a skilled communicator. 6.Develop
your personal action plan to become a skilled communicator 16
Slide 17
To successfully complete this learning activity and be awarded
contact hours: The learner must Complete the module and the
additional 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. Complete
course and self evaluations. To earn a certificate of Achievement
in Leadership Development you will need to complete the additional
project as described at the end of this learning activity. 17
Slide 18
Opportunities for further learning are presented through-out
this learning activity. You are urged to take time to engage in
these extra learning activities. 18
Slide 19
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.
19
Slide 20
Becoming a skilled communicator requires 5 factors: 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-and-
You.html 20
Slide 21
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
express and listen truthfully also known as being candid. 21
Slide 22
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. communication
listenmeaninghearspeak 22
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Meaning making requires we reflect on the way we process and
store the stories of our experiencesdepending on ones world view
and adult development level shared experiences may end up being a
different story to another person. 23
Slide 24
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 and eventually wisdom. 24
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We need to HEAR what we say to others. We need to HEAR what
others say to us. 25
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Most people talk so they wont hear May Sarton, Belgian American
writer 26
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Communication is often filtered, we need to inspect, clean and
sometimes replace our filters. 27
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There are a number of strategies and tools to help you practice
reflection 28
Slide 29
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. Bulman, C., & Schutz, S. (2013). Reflective Practice in
Nursing, 5 th ed. Hoboken, NJ: Wiley-Black. 29
Slide 30
What is the benefit of reflective practice in nursing? Helps
you learn from experiences Opens up your practice for others to
examine - requires open- mindedness and courage. Requires you to
take on and act on criticism. Is intermingled with feelings and
emotions. These feelings and emotions lead to deeper reflection.
Fuels motivation to improve ones practice. Bulman, C., &
Schutz, S. (2013). Reflective Practice in Nursing, 5 th ed.
Hoboken, NJ: Wiley-Black. 30
Slide 31
What specific skills are involved in reflection? Self-awareness
Aware of character, beliefs, values, qualities, strengths, and
limitations Description Ability to state characteristics or
appearance WITHOUT expressing judgment 31
Slide 32
Skills involved in reflection (cont.) Critical analysis
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 32
Slide 33
Skills involved in reflection (cont.) 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 33
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Reflective thinking is a process that grows knowledge, skills,
attitudes, and judgment 34
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Reflection is meant to grow and challenge our thinking..
35
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Frameworks are maps to help guide us in reflection. 36
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Frameworks ask a common set of questions that can guide our
thinking. Gibbs Reflective Cycle 37
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There are many frameworks to choose from or you can create your
own. 38
Slide 39
One framework used in nursing is Tanners Clinical Judgment
Model 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), 513-
516. Consider how it compares to the Nursing Process Assessment
Diagnosis Outcomes identification Planning Implementation
Evaluation ANAs Nursing Scope and Standards, 2 nd Edition, 2010
39
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The Nursing Process & Tanners 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) 40
Slide 41
The Nursing Process & Tanners 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) 41
Slide 42
The Nursing Process & Tanners 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 42
Slide 43
You are strongly encouraged to utilize these frameworks for
self care in becoming a skilled communicator. 43
Slide 44
For the reflective process to be effective, we must reflect on
how we see ourselves in any situation. What self-deceptions do we
hold? Have you examined your role and perceptions about
miscommunications that have occurred? 44
Slide 45
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? Do I assume responsibility for attaining and
maintaining my work environment? What is my definition of my work
environment? Is my definition complete? How would others describe
the workplace? Is that description how all members feel? If there
is collective unhappiness what is my responsibility in perpetuating
the perceived shortcomings? Am I open and trustworthy? Do I
acknowledge and change routines and behaviors that have hindered
communication? Commit at least 10 minutes to each question, write
your reflections in your journal. 45 Reflective Exercise
Slide 46
Authentic Are you the real deal? 46
Slide 47
Over the next several slides Nursings Standards of Professional
Performance are briefly reviewed. These standards describe a
competent level of behavior in the professional role. 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 47
Slide 48
Standard 7. Ethics Practices ethically Review the ANA Code of
Ethics for Nurses
http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/E
thicsStandards/CodeofEthics.aspx Review the International Code of
Ethics for Nurses
http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ Standard 8.
Education Attains knowledge and competencies that reflect current
nursing practice 48
Slide 49
Standard 9. Evidence-Based Practice and Research Integrates
evidence and research findings into practice Standard 10. Quality
of Practice Contributes to quality nursing practice 49
Slide 50
Standard 11. Communication Communicates effectively in all
areas of practice Standard 12. Leadership Demonstrates leadership
in the professional practice setting and the profession 50
Slide 51
Standard 13. Collaboration Collaborates with the healthcare
consumer, family, and others in the conduct of nursing practice
Standard 14. Professional Practice Evaluation Evaluates her or his
own nursing practice in relation to professional practice standards
and guidelines, relevant statutes, rules, and regulations 51
Slide 52
Standard 15. Resource Utilization Utilizes appropriate
resources to plan and provide nursing services that are safe,
effective, and financially responsible Standard 16. Environmental
Health Practices in an environmentally safe and healthy manner
52
Slide 53
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? 53 Reflective Exercise
Slide 54
Authentic Leadership Acknowledge your strengths and weaknesses
List both your strengths and your weaknesses Consider your
weaknesses your initial 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 you behave when you receive
feedback? Commit one hour to writing your responses in your
reflective journal. Bulman, C., & Schutz, S. (2013). Reflective
Practice in Nursing, 5 th ed. Hoboken, NJ: Wiley-Black. 54
Reflective Exercise
Slide 55
Brief side track on the topic 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/emotionalintell.
htm
http://psychology.about.com/od/personalitydevelopment/a/emotionalintell.
htm http://www.mindtools.com/pages/article/newLDR_45.htm
http://www.ei-nurses.com/2e.php 55
Slide 56
Becoming Mindful... Paying attention in a non-judgmental
manner... 56
Slide 57
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
Http://www.mayoclinic.org/mindfulness-exercises/ART-20046356
57
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The art of reflection instead of reaction PBR 3 Pause (stop
your negative thinking, your habitual response) Breath (slow deep
breathes, to trigger your parasympathetic nervous system) Relax
(comes with breathing) Reflect (instead of reacting) Re-write your
story (dont jump to conclusions, instead strive to cleanse
deceptions, what is the real story?)
www.americannursetoday.com/.../11a8ce23-ea5c-4cff-b7ea-9a4fb5ca17
58
Slide 59
Each person brings their own unique ways of speaking and
listening to communication. Practice suspending judgment while
listening to others. Be fully present. 59
Slide 60
Becoming 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. 60
Slide 61
An approach for becoming candid... Carefronting ends the blame
game. Stop and ask yourself: What is the respectful thing to do
now? (Respect for both yourself and others) 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? 61 Reflective Exercise
Slide 62
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/ANAPeriodic
als/OJIN/TableofContents/Volume112006/No2May06/tpc30_316075.html
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.
http://www.emergingrnleader.com/carefronting/ 62
Slide 63
Bringing the Five Factors together your action plan, first a
reminder... 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. 63
Slide 64
Skilled communicator action plan Based on your responses to the
reflective exercises, develop a personal action plan to increase
communication skills. Enlist trusted others to help you meet your
goals. Consider the 5 factors when developing your plan. Becoming
aware of self-deception Becoming reflective Becoming authentic
Becoming mindful Becoming candid Implement your plan and evaluate
the outcome. 64
Slide 65
Leadership Development
Slide 66
To earn your certificate of achievement in leadership
development you will need to submit the following: Evidence of
completion of Communication Module Document one additional instance
of applying the 5 factor model for skilled communication in your
practice. Document one instance of using Carefronting and the
outcome of using this technique. While the 5 factor model will no
doubt be helpful in all aspects of you life, we ask your examples
be from interactions as a nurse. You may compile all the additional
requirements in a portfolio and submit all the project requirements
at the end of Module 4.
Slide 67
Additional Recommended Reading Bulman, C., & Schutz, S.
(2013). Reflective Practice in Nursing, 5 th ed. Hoboken, NJ:
Wiley-Black. Prather, H. (2000). The little book of letting go.
Berkeley, CA: Conari Press. 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. Vital Smarts
(Crucial Conversations) http://www.vitalsmarts.com/resource-center/
http://www.vitalsmarts.com/resource-center/ 67