The purpose of this teaching strategy is to equip nurses to manage conflict and resolve situations where difficult communication creates a challenge to achieving safe and effective outcomes. Educators know that there is increasing potential for their nursing students to encounter difficult situations, difficult colleagues, and negative behaviors in the workplace. Hierarchal relationships and oppressive communication patterns can distract from a patient-centered focus, negatively affect outcomes, and place patients at risk. The Joint Commission has identified communication as the root cause of many sentinel events and now requires accredited agencies to uphold an appropriate code of conduct and to address disruptive behaviors. Educators are in a unique position to influence both a healthy work environment and a culture of safety by teaching their students strategies that de-escalate aggression and promote communication and teamwork.
Using this interactive process, students are asked to spend 10 minutes writing about a difficult encounter/situation they were involved in or witnessed, where conflict impacted patient safety. Then the powerpoint presentation is provided where they are taught three communication strategies: (1) Cognitive rehearsal, (2) Reframing communication using safety strategies, and (3) De-escalation techniques for aggressive behaviors. The presentation explains these strategies and how to implement them.
Afterward, students are given 10 minutes to rewrite their stories, reframing them using one of the strategies they were taught. Then they are encouraged to share their stories and reframed stories with peers. Through this process, students recognized that they have the ability to develop communication skills that can positively affect outcomes and address safety concerns. As they transition from student to nurse or move between practice areas, during the interview process, students will be asked not only about what actions they would take in particular patient care situations, but also about what measures they would take in difficult interactions with colleagues. Educators need to see the value in helping students develop behaviors that promote effective communication and teamwork.
This has been adapted to be an effective teaching tool at the pre-licensure level, at the new-to-practice level, and at the graduate education level. It has been implemented in the classroom and as an on-line activity where the powerpoint presentation was provided as narrated slides and students were asked to post their original story along with their reframed story for their peers to review.