Comfort Conversations in Complex Continuing Care Assessing Patients and Families

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As a nurse leader, you encounter one common denominator every day: people. Networking with people and building relationships are the foundations of everything you do. And although the work is rewarding, it can also be emotionally draining at the same time. Not all conversations are the same or have the same significance. Some conversations are impactful, charged with emotion or with the potential to evoke strong feelings.¹ When these types of conversations evolve, they can become difficult to navigate and manage. Complex conversations require skill and a consistent approach to garner positive outcomes; promote healthy relationships; and support cohesive, highly functional teams.^1,2

According to the American Organization for Nursing Leadership, nurse leaders must hone the skills of effective communication and relationship building to be successful leaders within an organization.³ As with any skill set, dedicated practice and training are required to develop proficiency and competency.⁴ This article shares practical tips and strategies for the successful management of complex, often difficult, conversations.

Do this first

Most leaders dread engaging in difficult conversations with team members. This can lead to not addressing problems in a timely manner or a lack of proper preparation for complex discussions. Before beginning a difficult conversation, it's important to focus on the expected outcome(s) of the interaction in advance. Keep expectations for the conversation realistic. A team member's unhealthy behaviors won't magically disappear because of a single conversation—it takes work to accept that there's a problem and then develop an agreed-upon solution. Sometimes, a problem requires several conversations over time to achieve expected outcomes. Planning your strategy before the conversation adds value to the interaction and increases your potential for success. If you're looking to change behavior, focus on creating healthy conversations that catapult you toward that goal.

When preparing for the conversation, it's important to understand contributing factors that may predispose the situation to conflict or angst. Antecedent conditions are those conditions or influences that serve to propel situations toward conflict; they may or may not be the cause but serve to influence the environment or relationship. Antecedent conditions can affect the outcome of a difficult conversation if you aren't prepared to address them. In nursing, antecedent conditions may be incompatible goals, differences in values and beliefs, task interdependencies (especially asymmetric dependencies, in which one party is dependent on the other but not vice versa), unclear or ambiguous roles, competition for scarce resources, differentiation or distancing mechanisms, and unifying mechanisms.⁵

Giving thought to each of these possibilities allows us to be more prepared before engaging in a difficult conversation. Identifying and addressing potential conditions decreases the challenges in the conversation and creates an environment for a more successful outcome. For example, if there's a situation of unclear or ambiguous roles, this needs to be addressed before you can move forward toward resolution.

Design the interaction

Preparing the environment for the conversation is important. Right time, right place, and right people are all significant when setting the appointment. Have ample time set aside for the conversation so the meeting isn't rushed but make a time limit. Select a private area because often the matters discussed are confidential. Lastly, the right people should be at the table. Depending on the issue to be discussed, additional personnel may need to be present, such as a representative from the human resources department.

Framing the conversation from the beginning allows all participants to understand the ground rules and goals. Set the agenda and provide boundaries and expectations for every participant. Setting expectations for tone of voice and respect may also be valuable for participants to hold each other accountable, paving the way for a healthy dialogue to occur.

Be prepared to keep the dialogue on track and proceeding in a healthy manner. Consider these five points for damage control during a difficult conversation: gain and maintain control, be objective/neutral, maintain calm, word criticisms carefully, and adhere to policies and procedures.⁶ You should be mentally prepared for confrontation and aware of possible misunderstanding of intentions and motives.⁷ Don't oversimplify the issue; be disrespectful of participants; allow lashing out, shutting-down behaviors, or silencing of participants; allow preconceived notions to interfere or feelings and emotions to rule the conversation; or lose focus on or commitment to the goal.⁷ And remember that everyone must own their contribution to the problem.⁷

Steer the dialogue exchange

There are several techniques for navigating difficult conversations, including storytelling, the talking stick, the broken record, the Situation-Behavior-Impact (SBI) model, listen to collaborate, and confrontation. You may decide to slightly change one or combine two or more to create what you think will work best for your impending conversation.

Storytelling . This technique is best used when two people don't agree on the details of the shared experience. It allows for participants to share, with equal time, their perception of what occurred in the conflict. Once the first individual has shared what happened, including how it made him or her feel, the second individual must repeat back what he or she heard. Next, the two individuals change roles and repeat the process. This negates the opportunity for either person to agree or disagree with what the other has stated because it's his or her "story." You then facilitate by leading the conversation through steps to resolution and how to move forward to reconciliation.^8,9

Talking stick . The talking stick technique is valuable when you have individuals who attempt to monopolize the conversation. It has fewer boundaries than storytelling and can be used with individuals who are more seasoned. Each person has the opportunity to discuss how he or she feels but can only talk if holding the stick. You're responsible for holding them accountable and monitoring talk time so that both participants are equally participatory. Once you sense the discussion is completed, the conversation then navigates toward resolution.¹⁰

Broken record . This technique is about redirecting and refocusing the conversation to focus on the reason for the meeting. It's most often used between a leader and team member. In this situation, you would use a phrase such as, "I understand you're aware of a coworker who's been tardy; however, today we're here to discuss your attendance issues." Each time the team member brings up the other employee, consistently refocus the discussion back to him or her, repeating the same phrase.^11,12

SBI . This technique can be used when you anticipate a conversation that may be particularly challenging regarding feedback. Focused on the behavior rather than the individual, SBI was developed as a framework to provide organization and structure for any feedback situation.¹³ The three steps of situation, behavior, and feedback are used to build the conversation pieces. The intent is to design your conversation around the unhealthy behavior, not the team member. The conversation should address the situation using specific details so the individual has a clear understanding of what behavior needs to be addressed. Lastly, you marry the behavior with what resulted in the situation. SBI may be the best choice when you need to address the behaviors of individuals who have no insight into their own actions. You frame the conversation in such a way to facilitate self-reflection. The goal is for the individual to realize how his or her behaviors impact the team.

Listen to collaborate . People listen in different ways in different situations. You can be listening for information, such as when you ask for directions or listen for a solution when you have a broken piece of equipment. However, it's particularly important to listen when you need to collaborate in a difficult situation. Monitor your emotions so you can obtain all the information you need to have a successful, healthy conversation. Consider these seven steps to collaboration: start with empathy and insight listening, use your eyes, listen for feelings, don't be fooled by anger, acknowledge, normalize the feelings, and uncover inferences and assumptions.¹² The main idea with this technique is to discover triggers that cause emotional highs and attempt to remove those obstacles. Be calm and work with individuals to promote resolution. Once emotional highs enter the conversation, you're no longer operating with rational thought but rather responding to those emotional triggers.

Confrontation . Although confrontation has a negative connotation, it's an effective tool for resolving conflict when used appropriately.^5,14 The five steps are identify the problem, explain how the problem is affecting you personally, explain what you want to happen, ask if the other person is willing to do what you've asked, and decide on the follow-up timeline and plan.^4,11,13,14 These steps may involve some negotiation and/or revisiting until there's agreement. It's important to always use "I" statements when interacting in a confrontation-style conversation. Avoid using "you did" statements because this automatically places blame and creates a defensive response. Once the conversation turns adversarial, you've lost the opportunity for resolution and a productive outcome.

Define the solution

It's difficult, if not impossible, to avoid a certain amount of anxiety when involved in a difficult conversation; however, if you experience resolution, you've been successful. Depending on the situation, resolution may be a handshake and verbal commitment or a written contract. Every participant should walk away in agreement with the plan to move forward.

Successful navigation

To be successful as a leader, it's imperative to develop trusting relationships and communicate effectively, motivating those around you to maximize their personal potential. Navigating complex or difficult conversations within your work team requires forethought, planning, and practice. We've offered tips and useful strategies to manage these conversations in a fair and consistent manner. As we've mentioned, strong communication skills evolve over time with experience and are refined with continuous growth and development, which requires a reflective intrapersonal understanding of self and a strong interpersonal skill set to be truly effective. There are excellent resources available that focus on leadership assessments, emotional intelligence, and communication styles to help you become a more skilled communicator.

REFERENCES

1. Stone D, Patton B, Heen S. Difficult Conversations: How to Discuss What Matters Most. 2nd ed. New York, NY: Penguin Books; 2010.

• Cited Here

2. Boykins AD. Core communication competencies in patient-centered care. ABNF J. 2014;25(2):40–45.

• Cited Here |
• PubMed

3. American Organization for Nursing Leadership. Nurse executive competencies. 2015. www.aonl.org/system/files/media/file/2019/06/nec.pdf.

• Cited Here

4. Welch TD, Carter M. Deliberate practice and skill acquisition in nursing practice. J Contin Educ Nurs. 2018;49(6):269–273.

5. Sullivan E. Effective Leadership and Management in Nursing. 9th ed. Boston, MA: Pearson; 2018:145–162,198-210.

• Cited Here

6. Bradley GL, Campbell AC. Managing difficult workplace conversations: goals, strategies, and outcomes. Int J Bus Commun. 2016;53(4):443–464.

• Cited Here

7. Turaga R. Managing difficult workplace conversations. IUP J Soft Skills. 2015;9(1):15–34.

• Cited Here

8. Landrum ER, Brakke K, McCarthy MA. The pedagogical power of storytelling. Scholarsh Teach Learn Psychol. 2019;5(3):247–253.

• Cited Here

9. Herzog RJ, Counts McClain K. Assessing stories managers tell. Adm Theory Praxis. 2017;39(3):222–237.

• Cited Here

10. Covey S. The Seven Habits of Highly Effective People. New York, NY: Free Press; 2004:95–144.

• Cited Here

11. Cheng A, LaDonna K, Cristancho S, Ng S. Navigating difficult conversations: the role of self-monitoring and reflection-in-action. Med Educ. 2017;51(12):1220–1231.

12. Kay B. Tough talks: how to find success with difficult conversations and move forward productively. J Financ Plan. 2019;32(3):24–26.

• Cited Here

13. Doucette J. Confronting a coworker's difficult behavior. Nurs Manag. 2017;48(5):56.

14. Sullivan E. Becoming Influential: A Guide for Nurses. New York, NY: Pearson; 2013.

• Cited Here

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