Praise for Critical Conversations “This book is chock-full of ideas that will help any nurse in any setting. Clancy provides hints, tips, and tidbits of communication advice, using real-life clinical scenarios and experiences from her nursing practice. The use of acronyms throughout the book helps readers remember information. The most basic is CAR (C=consider, A=act, and R=ROI), a tidy process that can benefit nurses in a variety of settings. The author returns again and again to the CAR model as a means to process new information. Complete chapters on body language, emo- tional intelligence, and organizational culture are another plus, as are the ‘scripts’ that walk the reader through situations that can be a communication nightmare: asking someone to stop gossiping, checking in on perceptions, and giving difficult news.” –Cheryl Dellasega, PhD, CRNP Professor, Penn State College of Medicine Author, When Nurses Hurt Nurses and the award-winning Toxic Nursing “Critical Conversations is a treasure trove of pragmatic, action-oriented communication tools for all levels of healthcare providers, from novice to expert. Leaders, mentors, coaches, and educators can easily use the numerous mnemonic acronyms, such as CAR, to inspire and engage every member of a healthcare team.” –Victoria L. Rich, PhD, RN, FAAN Associate Professor, Nurse Administration, University of Pennsylvania ANCC Magnet Consultant “Critical Conversations offers valuable information and tips on how to engage in dialogue. The book is helpful and easy to read; it should be included in your reading list for self- improvement and lifelong learning. The author’s presentation makes the material simple to comprehend. I recommend that you read this book and share it with others.” –Linda Burnes Bolton, DrPH, RN, FAAN Vice President and Chief Nursing Officer Cedars-Sinai Medical Center critical conversations Scripts & Techniques for Effective Interprofessional & Patient Communication Cheri Clancy, MSN, MS, RN, NE-BC Copyright © 2014 by Sigma Theta Tau International All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retriev- al system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Any trademarks, service marks, design rights, or similar rights that are mentioned, used, or cited in this book are the property of their respective owners. Their use here does not imply that you may use them for similar or any other purpose. The Honor Society of Nursing, Sigma Theta Tau International (STTI) is a nonprofit organization whose mission is to support the learning, knowledge, and professional development of nurses committed to making a difference in health worldwide. Founded in 1922, members include practicing nurses, instructors, researchers, policymakers, entrepreneurs, and others. STTI’s 494 chapters are located at 676 institutions of higher education throughout Australia, Botswana, Brazil, Canada, Colombia, Ghana, Hong Kong, Japan, Kenya, Malawi, Mexico, the Netherlands, Pakistan, Portugal, Singapore, South Africa, South Korea, Swaziland, Sweden, Taiwan, Tanzania, United Kingdom, United States, and Wales. More information about STTI can be found online at www.nursingsociety.org. Sigma Theta Tau International 550 West North Street Indianapolis, IN, USA 46202 To order additional books, buy in bulk, or order for corporate use, contact Nursing Knowledge Internation- al at 888.NKI.4YOU (888.654.4968/US and Canada) or +1.317.634.8171 (outside US and Canada). To request a review copy for course adoption, email [email protected] or call 888.NKI.4YOU (888.654.4968/US and Canada) or +1.317.634.8171 (outside US and Canada). To request author information, or for speaker or other media requests, contact Marketing, the Honor Soci- ety of Nursing, Sigma Theta Tau International at 888.634.7575 (US and Canada) or +1.317.634.8171 (outside US and Canada). ISBN: 9781938835469 EPUB ISBN: 9781938835476 PDF ISBN: 9781938835483 MOBI ISBN: 9781938835490 ____________________________________________________________________________________ Library of Congress Cataloging-in-Publication Data Clancy, Cheri, 1972- author. Critical conversations : scripts & techniques for effective interprofessional & patient communication / Cheri Clancy. p. ; cm. Includes bibliographical references. ISBN 978-1-938835-46-9 (alk. paper) -- ISBN 978-1-938835-47-6 (EPUB) -- ISBN 978-1-938835-48-3 (PDF) -- ISBN 978-1-938835-49-0 (MOBI) I. Title. [DNLM: 1. Communication. 2. Nurse-Patient Relations. 3. Interprofessional Relations. WY 88] RT82 610.7306’9--dc23 2014012899 ____________________________________________________________________________________ First Printing, 2014 Publisher: Renee Wilmeth Principal Book Editor: Carla Hall Acquisitions Editor: Emily Hatch Development and Project Editor: Jennifer Lynn Editorial Coordinator: Paula Jeffers Copy Editor: Charlotte Kughen Cover Designer: Rebecca Batchelor Proofreader: Barbara Bennett Interior Design/Page Layout: Rebecca Batchelor Indexer: Joy Dean Lee Illustrator: Amy Parker Hassos Dedication This book is dedicated to: My three beautiful children, Paige (13), Shane (10), and Colin (9). “I love you right up to the moon—and back.” –Sam McBratney My entire family, especially my Mom and Dad, for all your unconditional love, support, and laughter. My friends for supporting me on this endeavor. My colleagues and fellow nurses for sharing in our life-long journey of caring for others. Acknowledgments A special thank-you to Mary Ann Scott and Emily Hatch of Sigma Theta Tau International and Jennifer Lynn for making it happen! Thank-you to Dr. Shelley Johnson for your contributions to Chapter 8 and your genuine friendship and mentorship over the years. Thank-you to Dr. Marie O’Toole and my colleagues at Rutgers University, Stratford, NJ. Thank-you to Nancy Edwards and colleagues with Mead Johnson Nutritionals. Thank-you to the American Organization of Nurse Executives (AONE), Ad- vance Nursing, and ASHRM for publishing my articles. Thank-you to the leaders of Kennedy Health System for believing in my passion to improve the patient experience and welcoming me into the Kennedy Health System family. About the Author Cheri Clancy, MSN, MS, RN, NE-BC Cheri Clancy is a seasoned leadership speaker and trainer, nurse educator, and board-certified ANCC nurse executive with more than 15 years of healthcare leadership experience. She holds a Bachelor of Science in Nursing (BSN), a Master of Science (MS) in Health Administration and Wellness Promotion, and a Master of Science in Nursing (MSN) in Organizational Leadership. Clancy has been a keynote leadership speaker at numerous events and health- care seminars across the United States. She is a member of many professional organizations, including the National Honor Society of Nursing, Sigma Theta Tau International; American Nurses Association (ANA); American Organiza- tion of Nurse Executives (AONE); American Association of Ambulatory Nurses (AAAN); The Beryl Institute; National Nursing Staff Development Organization (NNSDO); and the American College of Healthcare Executives (ACHE). Clancy has received various honors and awards, including recognition from the March of Dimes in Nursing Leadership Excellence. She has also published numerous articles on various nursing leadership topics. Clancy began her career as a clinical neonatal and pediatric nurse. Her passion for listening to the voice of the patient and family was the genesis for her pro- gressive healthcare leadership experience. Currently, Clancy is the assistant vice president of The Patient Experience at Kennedy Health System, a faculty member at Rutgers University’s School of Nursing, and a national speaker on nursing leadership and healthcare service excellence. Some of her prevalent presentation topics include transformational nursing leadership, conflict resolution, managing and leading change, above- the-line leadership, rounding to improve the patient experience, and coaching for success. About the Contributing Author—Chapter 8 Shelley A. Johnson, RN, EdD Shelley A. Johnson received her baccalaureate degree from The University of Pennsylvania, School of Nursing in 1997. She received a scholarship from the National Black Nurses Association to attend The Pennsylvania State University in 1999, where she received a Master’s of Science in Community Health Nursing. She completed her doctoral education at the University of Phoenix with a focus on educational leadership. Dr. Johnson has taught in undergraduate and graduate programs for more than 15 years. She has taught for The Pennsylvania State University, Raritan Valley Community College, Rutgers University, LaSalle University, and University of Medicine and Dentistry of New Jersey. She is currently the founding director and chair of Nursing and Health Science in the College of Sciences and Technology at The Lincoln University in Pennsyl- vania. Her specialties are in education, leadership, mental health, and communi- ty health. She is certified as a staff developer, a nurse executive, a nurse educator, and as a comprehensive systematic reviewer. She has conducted presentations and workshops, published articles, and partici- pated in research related to a variety of topics. These topics include perceptions of student bullying, health disparities, cultural diversity, advocacy, leadership, and nursing education. Research interests include nursing and educational practices, the academic environment, and leadership development. Table of Contents About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii About the Contributing Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi 1 On Finding Common Sense . . . . . . . . . . . . . . . . . . . . . . . 1 The Driver’s Seat: Finding Common Sense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Your Road Map: Guiding Principles for Effective Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 The Drive Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2 Body Language Exposed . . . . . . . . . . . . . . . . . . . . . . . . . 31 In the Driver’s Seat: Understanding and Interpreting Body Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Your Road Map: Improving Body Language Messaging and Interpretations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Pulling It All Together With the CAR Framework . . . . . . . . . . . . . . . . . . . . . . . 61 Getting the Results You Want . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 The Drive Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 3 The Emotionally Intelligent and Emotionally Competent Nurse . . . . . . . . . . . . . . . . . . . . 67 The Driver’s Seat: Understanding Your Emotions and Your Intelligence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Your Road Map: Improving Your Emotional Intelligence and Emotional Competence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 The Drive Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 4 Impromptu Scripting Techniques . . . . . . . . . . . . . . . . 111 The Driver’s Seat: Using Impromptu Scripts and Acronyms for Recollection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Your Road Map: Scripting Techniques for Acronyms, Body Language, and Emotional Intelligence . . . . . . . . . . . . . . . . . . . . . . . . . . 115 The Drive Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137