Professional Interpersonal Skills for Nurses Professional Interpersonal Skills for Nurses Carolyn Kagan Lecturer at Manchester Metropolitan University, UK, and works with North Western Training and Development Team, UK Josie Evans Huddersfield University, UK and South Manchester Health Authority, UK SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. First published in 1986 as A Manual of Interpersonal Skills for Nurses. An experiential approach. This edition 1995 © 1995 Carolyn Kagan and Josie Evans Originally published by Chapman & Hall in 1995 This edition not for sale in North America and Australia; orders from these regions should be referred to Singular Publishing Group, Inc., 4284 41st Street, San Diego, CA92105, USA Typeset in 10/12pt Palatino by Best-set Typesetter Ltd, Hong Kong ISBN 978-0-412-44100-4 ISBN 978-1-4899-4463-4 (eBook) DOI 10.1007/978-1-4899-4463-4 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library (Ç9 Printed on permanent acid-free text paper, manufactured in accordance with ANSI/NISO Z39.48-1992 and ANSI/NISO Z39.48-1984 (Permanence of Paper) For Mark Contents Preface x 1 Introduction 1 A model of interpersonal skill 4 2 Self and self-awareness 6 Personal identity 7 Internal events 9 External events 15 Sense of self as 'agent' 19 The process of becoming self-aware 22 Summary 23 Self-development exercises 24 3 Social behaviour 26 Non-verbal behaviour 26 Speech 30 Summary 40 Self-development exercises 41 4 Social perception 43 Labelling 45 Stereotypes 46 Implicit personality theories 47 Consistency 48 Personal relevance 49 Constructive and reconstructive social perception 49 Summary 50 Self-development exercises 52 5 Social problem solving (1) 55 The social problem-solving process 55 Attitudes 58 Persuasion 64 Summary 67 Self-development exercises 68 V111 Contents 6 Social routines 71 Social roles 71 Norms and social rules 76 Social ritual 77 Functions of social routines 83 Transactional analysis 83 Summary 87 Self-development exercises 88 7 Facilitation and the development of rapport 90 Rapport 90 The recognition and expression of emotion 91 Recognition and expression of interpersonal attitudes 95 The communication of understanding 98 Self-disclosure 101 Summary 103 Self-development exercises 104 8 Influence and assertion 106 Control and social interaction 106 Questions and interpersonal control 107 Reassurance, information and explanation 116 Assertiveness 119 Negotiation and compromise 125 Summary 126 Self-development exercises 127 9 Counselling 129 The counselling approach 129 The counselling process 131 Summary 144 Self-development exercises 146 10 Conflict, aggression and violence 149 Handling conflict 149 Aggression and violence 154 Summary 158 Self-development exercises 159 11 Social problem solving (2) 162 Breaking bad news 162 Managing change 167 Summary 170 Self-development exercises 172 Contents ix 12 Working with groups 175 The nature of groups 175 Communication in and between groups 176 Roles 179 Leadership 180 Power 181 Team development 184 Multidisciplinary teamwork 185 Summary 187 Self-development exercises 188 13 Supervision and appraisal 190 The nature of supervision 191 Developmental approach to supervision 191 Styles of supervision 192 Proactive approach to supervision 195 Enhancing motivation and feedback 197 Personal objectives for change 201 Appraisal and performance review 203 Summary 204 Self-development exercises 206 14 Handling pressure 207 The nature of stress 207 Interpersonal skills and stress 210 Stressors in nursing 210 Summary 220 Self-development exercises 222 15 Constraints on using effective interpersonal skills 224 Personal constraints 224 Social constraints 228 Roles 228 Environmental constraints 232 Cultural constraints 236 Summary 241 Self-development exercises 243 References 245 Further reading 260 Index 262 Preface This book is a sequel to an earlier book A Manual of Interpersonal Skills for Nurses: An Experiential Approach written by Carolyn Kagan, Josie Evans and Betty Kay in 1986. At that time interpersonal skills was relatively new to nursing curricula, and all nurse basic and post-basic training syllabi contained some aspects of interpersonal skills. Teachers were also new to the area and many were anxious about how they were to introduce experientially based interpersonal skills learning into their courses. Since that time, nurse education has changed. Project 2000 has been introduced and post-basic training courses have been integrated with higher education. Schools of nursing have combined to form colleges of health in partnership with, or with courses accredited by, institutions of higher education. There has been a shift from experiential exploration of interpersonal skills to the need for an academic understanding of material underpinning interpersonal skill in nursing. The Health Service, too, has changed. Steadily and unrelentingly throughout the 1980s, health service management and organization has changed. The roles of patients and other consumers of health care have been evolving. Purchaser/provider splits have permeated acute and long-term sectors in hospital, and community and primary care. Trusts have emerged, nurses have been regraded and it is highly unlikely that any nurse is doing the same job, in the same kind of health service, as slhe was doing in 1986. Indeed, in 1994 there is a far greater range of employers of nurses than there was in 1986, with the rapid growth of the independent health care sector. All of these changes mean that there are new demands being made on nurses in their use of interpersonal skills, and we have incorporated discussion of many of these into this book. So, there are totally new sections on handling pressure, working with groups, managing change, handling conflict, aggression and violence, and supervision, appraisal and performance review. Some sections remain much as they were in the earlier book, as we remain convinced that they form the basis of professional interpersonal skills in nursing. Familiar sections making a reappearance are those fOCUSing on self-awareness; fundamental inter personal processes (speech, non-verbal behaviour, social perception); Preface xi rapport and facilitation; counselling; social problem solving; and con straints on the effective use of interpersonal skills. Throughout, reference to the parent disciplines of social psychology and to the nursing literature have been incorporated. Details of experi ential exercises and their management in the classroom have been omitted - these are still to be found in the 1986 book. Each chapter has some self-development exercises. We think we have made these up; however it is in the nature of interpersonal skills development exercises that sometimes people think particular exercises should have been attributed to them. We apologize if we have omitted to acknowledge anyone's work or ideas. Two features have been retained but appear in different forms. Illustrations from real nursing situations are clearly marked in boxes. These include illustrations from a far wider range of nursing situations, including community (district nursing, learning disability and psy chiatric nursing, school nursing and practice nursing) and hospital episodes. All the examples we have used have been witnessed directly or indirectly: none of them are fiction. We have also drawn attention to areas of controversy, dealt with inadequately by the literature, but central to nursing practice. Thus, questions are raised in 'Food for Thought' boxes. We hope the book meets contemporary needs for the continuing development of professional interpersonal skills in nursing. Since writing the earlier book, we too have undergone change. Carolyn is a social worker who works as a lecturer in social psychology at what is now the Manchester Metropolitan University. Since 1987 she has been seconded to work part-time with the North Western Training and Development Team. This is a small multidisciplinary team of two full-time equivalent people, offering consultancy to health and social services for people with learning disabilities in the North Western Region (19 health districts, 11 social service authorities and an increas ing number of health trusts and GP fundholders). She works at the interface of interpersonal and profeSSional development, organizational change and user empowerment. Josie has moved to a joint post with Huddersfield University and South Manchester Health Authority, run ning a satellite Diploma in Nursing course in the Authority, as part of the professional nursing development programme. She is currently researching the contribution continuing professional development makes to the quality of nursing care, and patients' perceptions of 'comfort'. Betty Kay, who contributed to the earlier book, has been unable to write this one. Her commitments have meant that she has, regrettably, been unable to continue beyond the initial stages. However, we remain indebted to her for her continued interest, support and sense of humour.