Respectful Conversations- BRIDGES

Respectful

Conversations

Let's go!

by digitalpoppins

Objectives

• Identify how we "tick" emotionally
• Master calling a provider
• Use tools to have a challenging conversation
• Maintain respect and decrease emotional response

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The Behavior Model

• Emotions fight or flight response
• Our body responds in that crucial moment and causes us to react poorly (blood flow literally shifts from our brain in a fight or flight response)
• We tend to fight or roll over and play dead due to our own triggers

• Common chain of events
• Past experiences, stereotyping, & misunderstandings shape our "story"
• Our "story" creates emotion
• Emotions create our behavior

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When to call provider

2 yo with URI and croupy cough. Provider orders 60mg ketorolac IV

• I am Concerned
• I’m concerned that is the incorrect order.
• I am Uncomfortable
• I’m uncomfortable with that dose. Do you mind checking it?
• This is a Safety issue
• This is a safety issue. Please review the order.

I am Concerned

I am Uncomfortable

There is a Safety issue

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Activity: Small group discussion

• How do you prepare to call the provider?

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Calling Provider

• Stop, take a deep breath, & relax
• Get most recent information gathered:
• Get new VS and do an assessment
• Ask the patient if they need anything else from provider
• Check chart to see if request is already addressed in chart
• Review orders/labs/diagnostics
• Plan your call with SBAR

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Problem

Practice

Patient situation: You are working day shift and it is late in the afternoon. Your 68-year-old patient, Jane Fisher, was admitted last night for N/V/D. You have infused 800 mL of NS and the IV is running at 80 mL/hr. The patient has had about 400 mL of clear liquids during your shift. This morning's VS were T 98.5, P 76, RR 14, BP 128/78, sats 97% RA. In your morning assessment, you had WNL findings except for slight abdominal cramping. She has only voided 100 mL so far today.

• Plan your call to the provider

• In pairs, practice the call
• Rotate roles & practice

• Provide feedback- was it enough information, too much information, clear message, etc

• VS: T 100.9, P 98, RR 20, VP 102/60, sats 97%
• No further urine output
• Vomited x6= 1600 mL
• Diarrhea x3= 325 mL
• Pt c/o dizzy, nausea, and slight urgency to void. Abd firm and tender over RLQ. C/O RLQ pain 4/10 and cramping. No other changes to your assessment.
• No diagnostics have been done

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Problem

Practice

Patient situation: You are working night shift and it is about 2 am. Your 76-year-old patient, Joe Dodge, was admitted at noon yesterday for a Rt THA. You infused 350 mL of NS and then locked the IV because the patient tol reg diet after surgery. Your initial VS were T 98.8, P 81, RR 16, BP 132/70, sats 99% 1 LPM NC. In your evening assessment, you had WNL findings except for pain to Rt hip 4/10. You administered hydrocodone 1 tab. It is 0100 and he is awake and C/O pain 8/10. You gave hydrocodone 2 tabs. It has been 45 min. He now rates pain at 7/10 and just threw up. He continues to feel nauseated.

• Plan your call to the provider

• In pairs, practice the call
• Rotate roles & practice

• Provide feedback- was it enough information, too much information, clear message, etc

• Orders include: Ibuprofen 600 mg q 6 hr prn mild pain, Hydrocodone 7.5/325 mg x2 tab q 4 hr prn moderate pain, DAT, VS q 4 hours, WBAT, O2 to keep sats >94%.
• CBC, CMP, and coags were WNL pre-op
• 0150: VS T 98.5, P 96, RR 20, BP 158/86, sats 98% RA and no changes to assessment info

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What do you consider a "difficult" conversation?

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70% of us avoid difficult conversations related to fears or past negative experiences

- ANA

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What is the most important element for a difficult conversation to have a good outcome?

If it doesn't feel safe, the conversation will derail

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Encouraging Safety

• Build an emotional bank EVERY DAY

• Plan and practice

• Attitude of Qs

• Avoid accusing or being authoritative
• Location matters

• Be aware of your body language

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Powerful Questions

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Avoid saying

• "you always..."
• "you never..."
• "clearly..."
• "obviously..."

• "have you thought of..."
• "you might consider..."
• "it's not personal..."

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ACTIVITY

Conversation Prompts

• Here are several conversation prompts:
• I find it difficult to speak up in meetings.
• I struggle with balancing work and personal life.
• I’m not sure my contributions are valued by the team.
• I avoid giving feedback because I don’t want to hurt anyone’s feelings.
• I feel overwhelmed by constant change.
• I’m not confident leading people who have more experience than I do.
• I often say yes to things I don’t have time for.
• I’m frustrated when people don’t follow through on commitments.
• I’m not sure how to address underperformance on my team.
• I feel like I’m always in reactive mode.

• Each person in the breakout will pick a statement prompt.
• Each person take turns sharing their prompt and how it relates to them personally.
• The rest of the members should actively listen and ask “what” and “how” to gain a deeper understanding of their colleague’s perspectives.

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Ask Questions at Every Stage

Attitude of questions = safety, no derailment

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CONVERSATION TWISTS

Safe ways to handle conversation twists and derailments

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Conversation Tool

1. Diagnose and reflect (BEFORE)
2. Introduce the conversation
3. Seek and Share information
4. Find shared meaning/goals
5. Commitments and close
6. Reflect on the conversation (AFTER)

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Top Tips

Don’t have the conversation unprepared or in a hurry. Give yourself plenty of time in your schedule

CONSIDER, PLAN, & PRACTICE your difficult conversation before you approach it.

Example: “I want to give this plenty of time. Can we talk about this at noon?”

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Activity: Practice

• Think of a difficult conversation you need to hold
• Fill out the Conversation Tool (Plan)
• In pairs, practice the difficult conversation
• Rotate roles, allowing your partner to practice their difficult conversation
• Provide feedback on how you felt during the conversation

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Afterwords...

• make an effort to reduce ongoing tension by resuming normal interactions

• Keep the conversation confidential unless a leader needs to know about it

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Thank you!

Material from Caring Conversations by Gary Westbroek, Intermountain Health

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