The Future of Nursing LEADING CHANGE , ADVANCING HEALTH

1. The Future of NursingLEADING CHANGE, ADVANCING HEALTH The report from the Future of Nursing can be found at the following link. http://www.thefutureofnursing.org/IOM-Report

2. Transforming leadership • Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions. • FROM: Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine

3. What is needed is a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. • The new style of leadership that is needed flows in all directions at all levels. Everyone from the bedside to the boardroommust engage colleagues, subordinates, and executives so that together they can identify and achieve common goals (Bradford and Cohen, 1998). • FROM: Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine

4. Empowering Nurses to LeadEvery Nurse in Every Setting North Dakota Action Coalition Leadership Program Communication

5. North Dakota Action Coalition The North Dakota Action Coalition (NDAC)  is focused on the development of statewide leadership programming for “Every nurse, in every setting”  This includes nursing students, front-line nurses, community nurses, advanced practice nurses, chief nursing officers and nurse researchers. The ND Action Coalition is co-led by the ND Center for Nursing and the University of Mary Harold Schafer Emerging Leaders Academy and is part of the National Campaign for Action. To learn more click on the links below: http://www.thefutureofnursing.org/content/action-coalitions http://www.thefutureofnursing.org/

6. Leadership Program is divided into 4 main areas. Communication is foundational for learning about and understanding first yourself and then systems. Knowledge of how systems function is necessary to institute change. The ability to accept and engage in change is necessary to be an advocate for health policy.All nurses are expected to lead!

7. Evaluation of learning: Applying the IOM Core Competencies in Nursing Education During this learning activity you will be asked to evaluate if and how you meet the learning objectives. Take a few minutes now to review the evaluation form found at the end of this module. Part of learning the art of reflection is to be able to compare yourself against set standards and/or objectives. To better facilitate the reflective process you are strongly encouraged to read and understand the expected outcomes so you can measure your progress while you are learning. One standardized set of capabilities is the IOM Core Competencies in Nursing Education. We provide a review on the next slide.

8. Providing patient-centered care: I will be able to Identify, respect, and care about patients' differences, values, preferences, and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health. • Working in interdisciplinary teams: I will be able to Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable. • Employing evidence based practice: I will be able to Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. • Applying quality improvement: I will be able to Identify errors and hazardsin care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality. • Utilizing informatics: I will be able to Communicate, manage knowledge, mitigate error, and support decision making using information technology. --From Health Professions Education: A Bridge to Quality. Institute of Medicine, 2003

9. In addition to evaluating whether or not you have met the learning activity objectives, you will be asked to evaluate whether or not this learning activity has helped you to meet the IOM’s core competencies.You will also be asked to respond to the following 3 questions. They are provided here to help you reflect on your learning experience while you proceed with this learning activity. • Tell us what you have learned about communication. • Describe one scenario where you have used the material learned in this continuing nursing education activity. • How do you predict you will use this material in the future?

10. ECHOEssential CommunicationHearing Ourselves Presented by the North Dakota Action Coalition Communication Group

11. The purpose for this learning activity is to introduce the 5 factor model for becoming a skilled communicator and to provide reflective practice tools that grow your communication skills. Objectives • Define communication. • Review the 5 factor model for becoming a skilled communicator. • Review the use of self-reflection. • Review frameworks/ standards/ codes that inform the practice of self-reflection in nursing. • Use self-reflection to develop expertise for becoming a skilled communicator. • Develop your personal action plan to become a skilled communicator

12. Communication is far more than speaking …. It is about HEARING not only what others say to us but HEARING what we say to others. To become a skilled communicator we must learn to hear ourselves.

13. Becoming a skilled communicator requires 5 factors: • Becoming aware of self-deception • Becoming reflective • Becoming authentic • Becoming mindful • Becoming candid The foundation for this learning activity is based on the Five Factor Model of Becoming a Skilled Communicator (Kupperschmidt, Kientz, Ward, and Reinholz, 2010). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/A-Healthy-Work-Environment-and-You.html

14. Becoming reflective exposes self-deception, which leads to discovering your authentic self. • The act of reflection leads to heightened awareness / alertness to verbal and nonverbal communication (emotional intelligence) which is being mindful. • These states of becoming prepare one to speak purposefully, to express and listen truthfully also known as being candid.

15. To successfully complete this learning activity and be awarded contact hours: • The learner must • Complete the reading assignments. • Complete the learning activities. • You will need to write in a journal during this learning activity, you may do so either on paper or by using your computer. Save your work so you can access it and re-read your thoughts. • Complete course and self evaluations.

16. Opportunities for further learning are presented through-out this learning activity. You are urged to take time to engage in these extra learning activities.

17. When we speak we count on others to listen and hear our meaning… When we listen others count on us to hear their meaning… Communication is about meaning making.

18. Meaning making requires we reflect on the way we process and store the stories of our experiences…depending on one’s world view and adult development level shared experiences may end up being a different story to another person.

19. As we process the bits of data we constantly receive during the act of communicating, we translate those bits into streams of information, it is in reflecting/ thinking that we turn all those bits into knowledge. Leadership requires we process those bits of data in a way that fosters development of wisdom.

20. We need to HEAR what we say to others….We need to HEAR what others say to us.

21. “Most people talk so they won’t hear”May Sarton, Belgian American writer

22. Communication is often filtered, we need to inspect, clean and sometimes replace our filters. Reflection is a way to inspect, clean and if necessary replace our filters…

23. As nurses we need to elevate our communication to a level that fosters professionalism.We have a standard of professional performance to meet.

24. There are a number of strategies and tools to help you practice reflection

25. Becoming reflective is. . . • The process of pondering, carefully and persistently, the MEANING of an experience. • Creating meaning from past or current events that guide future behavior. • Self-questioning so situations become more clear and coherent. • Systematically examining the past and the present to inform the future.

26. What is the benefit of reflective practice in nursing? • Learn from experiences • Opening up one’s practice for others to examine requires open-mindedness and courage. • Requires one to take on and act on criticism. • Is intermingled with feelings and emotions. • Fuels motivation to improve one’s practice. Bulman, C., & Schutz, S. (2013). Reflective Practice in Nursing, 5th ed. Hoboken, NJ: Wiley-Black.

27. What specific skills are involved in reflection? • Self-awareness • Aware of character, beliefs, values, qualities, strengths, and limitations • Description • Ability to state characteristics or appearance WITHOUT expressing judgment

28. Skills involved in reflection (cont.) • Critical analysis • Separation of the whole into its component parts • Undertake a detailed examination of structure, elements, or parts. • Understand the nature of, how parts relate to, and influence other parts. • Include the manner ways of knowing (empirical, aesthetic, personal, ethical) • Challenge assumptions • Synthesis (opposite of analysis) • The process of result of building up separate elements, ideas, into a connected and coherent whole • Evaluation • Make a judgment about the value of something • Use of predefined criteria or standards

29. Reflective thinking is a process that grows knowledge, skills, attitudes, and judgment

30. Reflection is meant to grow and challenge our thinking….. We have all heard the saying…”think outside the box”…. Do we mean we wish others would think more like what is in our box? Or are we ready to examine our own thinking, behavior, worldview, values, and respect where others are in this process as well?

31. Frameworks are maps to help guide us in reflection.

32. Frameworks ask a common set of questions that can guide our thinking. Gibbs Reflective Cycle

33. Modified Gibbs Reflection Cycle

34. There are many frameworks to choose from or you can create your own.

35. One framework used in nursing is Tanner’s Clinical Judgment Model • Introduction • Background • Noticing • Interpreting • Responding • Reflection-in-action • Reflection-on-Action Nielsen, A., Stragnell, S., & Jester, P. (2007). Guide for reflecting using the clinical judgment model. Journal of Nursing Education, 4(11), 513-516. Consider how it compares to the Nursing Process • Assessment • Diagnosis • Outcomes identification • Planning • Implementation • Evaluation ANA’s Nursing Scope and Standards, 2nd Edition, 2010

36. The Nursing Process & Tanner’s Clinical Judgment Model Introduction (Assessment) Your view of the situation (Be aware of your viewpoint) Background (Assessment) Relationship, experiences, formal knowledge (Be aware of the factors that create your background) Noticing (Assessment) Initial and later (Be aware of your patterns for sensing situations)

37. The Nursing Process & Tanner’s Clinical Judgment Model Interpreting (Diagnosis) Cause, patterns, similarities, differences, observations, data (Be aware of your viewpoint, how does it impact your meaning making) Responding (Outcome planning, Implementation) Actions, stressors, feelings (Be aware of your patterns)

38. The Nursing Process & Tanner’s Clinical Judgment Model Reflection-in-Action (Evaluation) Think about practice while doing it (This takes practice) Reflection-on-Action (Evaluation) Thinking back on what we have done to discover how we may have contributed to the outcome or unexpected outcome. (Consider working with someone you trust to help clarify your point of view) http://simulation.laerdal.com/forum/forums/storage/14/4049/thinkinglikeanurse.pdf

39. You are strongly encouraged to utilize these frameworks for self care in becoming a skilled communicator.

40. For the reflective process to be effective, we must reflect on how we see ourselves in any situation. What self-deceptions do we hold? Have you examined your role and perceptions about miscommunications that have occurred?

41. Reflective exercise to become aware of self-deception • Do I fully appreciate the work of nursing and the environment in which that work takes place? • Do I base my practice on the Code of Ethics for Nurses? (See next slide for link to review Code of Ethics for Nurses) • Do I assume responsibility for attaining and maintaining my work environment? • What is my definition of my work environment? • Is my definition complete? • How would others describe the workplace? • Is that description how all members feel? • If there is collective unhappiness what is my responsibility in perpetuating the perceived shortcomings? • Am I open and trustworthy? • Do I acknowledge and change routines and behaviors that have hindered communication? • Commit at least 10 minutes to each question, write your reflections in your journal.

42. Authentic – Are you the real deal?

43. Over the next several slides Nursing’s Standards of Professional Performance are briefly reviewed. These standards describe a competent level of behavior in the professional role. • Standard 7. Ethics • Standard 8. Education • Standard 9. Evidence-Based Practice and Research • Standard 10. Quality of Practice • Standard 11. Communication • Standard 12. Leadership • Standard 13. Collaboration • Standard 14. Professional Practice Evaluation • Standard 15. Resource Utilization • Standard 16. Environmental Health

44. Standard 7. Ethics • Practices ethically Review the ANA Code of Ethics for Nurses http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics.aspx Review the International Code of Ethics for Nurses http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ • Standard 8. Education • Attains knowledge and competencies that reflect current nursing practice

45. Standard 9. Evidence-Based Practice and Research • Integrates evidence and research findings into practice • Standard 10. Quality of Practice • Contributes to quality nursing practice

46. Standard 11. Communication • Communicates effectively in all areas of practice • Standard 12. Leadership • Demonstrates leadership in the professional practice setting and the profession

47. Standard 13. Collaboration • Collaborates with the healthcare consumer, family, and others in the conduct of nursing practice • Standard 14. Professional Practice Evaluation • Evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations

48. Standard 15. Resource Utilization • Utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible • Standard 16. Environmental Health • Practices in an environmentally safe and healthy manner

49. Reflective exercise: Your performance as a nurse? • Do you practice ethically? • Do you attain knowledge and competencies that reflect current nursing practice? • Do you integrate evidence and research findings into practice? • Do you contribute to quality nursing practice? • Do you communicate effectively in all areas of practice? • Do you demonstrate leadership? • Do you collaborate with the health care team, patient, family, and others in conducting your practice? • Do you evaluate your practice in relation to professional standards? • Do you use appropriate resources and provide safe, effective, and financially responsible nursing service? • Do you practice in an environment that is safe and healthy?

50. Reflective exercise: Authentic leadership • Acknowledge your strengths and weaknesses • List both your strengths and your weaknesses • Consider your weaknesses your guide for self-development • What is your purpose? • Do you hold and practice professional values? • Do you role model professional behaviors? • Do you practice through your heart as well as your mind? • Do you have enduring relationships? • Do you treat others with respect? • Do you practice self discipline? • Do you seek out and act on feedback? • How do you behave when you receive feedback? • Commit one hour to writing your responses in your reflective journal.