Problem Behaviors and Difficult Group Members

Giving and Receiving Constructive FeedbackGerry Altmiller, EdD, APRN, ACNS-BC

Look at Self FirstMonitor your own behaviorIts difficultBecome a vigilant self monitor

The ChallengeWhen confronted, embarrassed, challenged, rather than act emotionally ask yourself:What do I really want for myself?What do I really want for others?How would I behave if I really wanted these results?

Focus for DialogueMutual purposeRecognize what both parties want, ie: learn the topic; pass the course; graduate nursing school; reach a solution to problemMutual respectChoosing words with caringMaintaining the dignity of the other

What is Constructive Feedback?Based on observations Interactive process of critique to provide insight to correct errors and enhance learningUnbiased, analytical reflection of what occurred Should offer logical connections in order to influence successful learning

Purpose of Constructive FeedbackInfluence future actionsNarrows gap between current performance and desired performanceFundamental to learning

Categories of FeedbackConstructive or CorrectiveConsidered negativeShould be followed with advice for improvementReinforcingConsidered positive

Role of Constructive Feedback in Quality and SafetyEssential for continuous quality improvementIdentifies areas where improvement is possibleNegative consequences if avoidedRecognize value for patient safetyHelps one develop error detection skills

Role of Constructive Feedback in Teamwork and CollaborationEvaluation is part of team processDebriefingEvaluate effectiveness of teamIdentify areas where improvement is possibleTeamSTEPPS Training Video: Labor and Delivery DebriefClick link above, then Click on arrow to view video

Role of Feedback in Delegation ProcessFour steps to DelegationAssess and planCommunicateProvide Surveillance and supervisionEvaluationNurse determines if delegation outcome was successfulNurse needs to lead discussion when expectations are not met

Feedback and Professional DevelopmentEssential for professional GrowthLearned SkillView as opportunity

Focus of Constructive FeedbackAddress faulty interpretationsProvide options for improvementMost effective when focused onTaskProcessSelf-regulation; error detection skillsLeast effective when focused onPerson him/herselfFeedback whether positive or negative should always be an unbiased reflection of events

Delivery is CriticalPerception is everythingShould beTimelyFocused on learningPresented with optimistic viewProviding Constructive Feedback indicates commitments to anothers learning and reinforces importance of what they doReceivers should view as opportunity for improvement rather than review of deficiencies

ChallengesShould not put down anotherMay be ignored if couched in subtle languageConcern over creating conflictsCan be used to shame anotherCorrecting individuals in front of pts or peersIgnoring individualDisplaying contempt for lack of knowledgeTaking over for another implying incapableCauses disconnection from team

Receiving Constructive FeedbackConsider if this is repeating from several sourcesIf perceived as inaccurate, ask for examples and focus on learningUnderstand that constructive criticism initiates self examination; reflection; growth as professional nurse

Why should students learn this skill?Part of professional practiceIncreases knowledgeHelps us develop expertiseAllows us to improve practice

How will Students Use this skill as a Nurse?To support a culture of SafetyCan ask questions without fear of criticismMaintain high quality care; CQIAs part of delegation processDuring peer Review ProcessFor transition to practiceTo increase professional growth & development

TechniqueClear communicationsender; receiver; acknowledgementConcise, precise; no ambiguitiesUse proper terminologyAllow opportunity for clarifications if needConfirm any non-verbal cues (facial expression, eye contact, etc) to ensure patient safety

StrategiesModel appropriate techniques for othersFocus on quality and safety aspectsConnect it to patient outcomesEmphasize as opportunity for learningFeedback with strategies for improvementDebriefings after stressful patient situationsBe direct with colleagues about unacceptable behaviorsIdentify individuals that will answer questionsRole playing until you feel comfortableUse Reflection

Reflection

Challenge yourself to speak with careContinue to speak calmly even if interaction is escalatingAppraise interaction afterwardWhat went well?What went poorly?What could I have done Differently?

Key PointsLearned skillMaintain dignity of otherView as OpportunityRecognize its value in maintaining patient safety

Reference:Altmiller G. (September, 2012). The role of constructive feedback in patient safety and continuous quality improvement. Nursing Clinics of North America, 47(3). 365-74.

Contact: Altmillg@TCNJ.edu

Thank you for listening.