Employment law and ethical considerations. In reviewing the relevant laws discussed from past to present, how would you say American culture is evolving in terms of workplace expectations? Which do you believe evolves more quickly, ethics or the law? What problems might this lead to? Explain your answer with examples.
Submission, APA, 3 paragraphs
In preparation for your development of a community or system's level population health intervention, conduct a search of your local practice community for collaborations and/or community partnerships that have the potential to provide benefit for the population you accessed data about in your week 1 discussion.
Based on your assessment of the collaborations and/or community partnerships you discover in your local practice community, discuss which of those may be of value in addressing the significant health or health-related problem that you identified in the unit 1 discussion.
Please be sure to validate your opinions and ideas with citations and references in APA format.
The post and responses are valued at 100 points. Please review post and response expectations.
Examine the use and impact of technology on adolescents aged 13-18 years.
For this assignment, you will be discussing the impact of technology on human development. You will choose a life stage and address the included topics in your written work. Your report should be 3–5 pages in length and formatted in APA style. No abstract or cover page is necessary, but you must include in-text citations and a corresponding References page.
Your assignment must be typed in 12-point font and double-spaced. You should include no fewer than three (3) sources, with at least one coming from the textbook, an academic article, or another source beyond typical internet materials. If you do use online resources, ensure they are credible. Any information or ideas from primary or secondary sources (including internet content), whether directly quoted or paraphrased, must be properly cited using footnotes or endnotes. Failure to cite your sources constitutes plagiarism, which may result in a failing grade for the assignment, failure of the course, or expulsion from the university.
Assessment 3
Developing and Communicating the Strategic Action Plan
Create an 8-10 slide PowerPoint presentation for an executive audience that outlines an action plan your selected organization will use to achieve its strategic goals and communicate the plan to stakeholders. You will record yourself presenting the slides in an audio or video recording of 5 minutes or less in length.
Note: Each assessment in this course builds upon the work you have completed in previous assessments. Therefore, you must complete the assessments in the order they are presented.
In your previous assessments, you examined how today's health care organizations prepare themselves for the present and the future through strategic management. Specifically, you analyzed how a health care organization's external and internal environments affect its operations.
The next step is to consider an action plan to achieve the organization's strategic objectives and to communicate it to stakeholders.
This assessment provides an opportunity for you to create an executive presentation in the form of PowerPoint slides and an audio or video recording in which you present the information in the slides. In this presentation, you will outline the action plan your selected health care organization will use to achieve its strategic goals, as well as a plan for communicating the strategic goals and action plan to stakeholders.
Reminder: Complete the assessments in this course in the order they are presented. You will complete sections of a strategic management plan for each assessment. In this assessment, you will continue to use the organization and the factor from the AHA’s most recent Environmental Scan report that you chose in the first assessment.
Now you have a solid understanding of the importance of strategic planning, key core concepts and components for the organization you selected, and goals that align with its mission, vision, and values. You have now evaluated where the strengths, weaknesses, opportunities, and threats exist.
The next step in strategic planning is creating an action plan and communicating that plan to its stakeholders. The following two brief videos provide insights into creating a strategic action plan and communicating it to stakeholders.
Watch the brief video in the following reading list for tips on creating an action plan.
Watch the brief video in the following reading list to learn about communicating an action plan.
Create an executive presentation in the form of 8–10 PowerPoint slides and create an audio or video recording (5 minutes or less in length) of yourself making the presentation to your audience. The presentation must describe an action plan to address the identified issues and a communication strategy to share the action plan with the organization's stakeholders.
In the PowerPoint presentation:
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
System Thinking for Good, Part 2
This week, you will return to the business report you began working on in Week 8. As a reminder, you have assumed the role of a consultant who has been asked by the upper management team to evaluate an organizational performance problem within an organization. You will present your findings in the form of a written report with an executive summary presented as a PowerPoint presentation. The organization for this evaluation is one that you selected and with which you are very familiar. You will continue your business report using that selected organization.
As you complete Part 2 of your business report, remember to include specific examples from the organization as well as relevant citations from the Learning Resources, the Walden Library, and/or other appropriate academic sources to support your evaluation.
To prepare for this Assignment:
· Return to the same business report template you utilized in Week 8. With the research and readings from Week 8 and Week 9 in mind, incorporate any feedback, as needed, into your report as you complete Part 2.
Part 2 of your business report, to include the following:
Part 2: Social Responsibility and Ethical Considerations (2–3 pages)
· Identify the major stakeholders of the organization. Illustrate how the organization’s actions do or do not affect positive social change for the stakeholders (explain in detail).
· Through a system thinking lens, apply improvements to the organization to positively affect social change.
· From a systems perspective, evaluate the organization’s performance in terms of diversity and inclusion.
· Assess whether there is a relationship between ethics and inclusion (explain and substantiate your position). Recommend what improvements can be implemented to positively impact both.
Improving Business Performance
Week 9 Learning Resources
System Thinking and Social Change
Using these resources, you will explore how applying systems thinking principles can be used to promote positive social change. As you review these resources, consider how you might apply systems thinking to create change. How might these concepts benefit the greater good?
· Hernández, A., Ruano, A. L., Marchal, B., San Sebastián, M., & Flores, W. (2017). Engaging with complexity to improve the health of indigenous people: A call for the use of systems thinking to tackle health inequityLinks to an external site. . International Journal for Equity in Health, 16(1), 26–31. https://doi.org/10.1186/s12939-017-0521-2
· Stroh, D. P. (2014). Systems thinking for social change: Making an explicit choiceLinks to an external site. . Reflections, 14(3), 35–42.
· Stroh, D. P., & Zurcher, K. (2012). A systems approach to increasing the impact of grantmakingLinks to an external site. . Reflections, 11(3), 31–43.
Ethical Consideration
Through these resources, you will investigate how the application of systems thinking principles and tools can assist managers in understanding and mitigating ethical dilemmas. As you review these resources, consider some ethical concerns that you may have encountered in your personal and professional life. Can you think of any ways in which systems thinking principles could have done anything to address or alleviate those concerns?
· Bardoel, E. A., & Haslett, T. (2006). Exploring ethical dilemmas using the “drifting goals” archetypeLinks to an external site. . Journal of Management Education, 30(1), 134–148. http://dx.doi.org/10.1177/1052562905280836
· Noga, T., Pant, L. W., & Shaw, L. (2011). Recalibrating ethical dilemmas using the “fixes that fail” archetypeLinks to an external site. . Journal of Business Ethics Education, 8(1), 115–118.
· Steele, R., & Derven, M. (2015). Diversity & inclusion and innovation: A virtuous cycleLinks to an external site. . Industrial and Commercial Training, 47(1), 1–7.
· Werhane, P. H. (2002). Moral imagination and systems thinkingLinks to an external site. . Journal of Business Ethics, 38(1/2), 33–42. https://doi.org/10.1023/A:1015737431300
Important Documents and Resources for the Week
Goldratt, E. & Cox, J. (2014). The goal: A process of ongoing improvement (4th ed., pp. 124–236). North River Press. Note: This resource will be used for this week’s Discussion.
,
2
The Goal – Part 2
Lakenya Campbell
Walden University
Improving Business Performance
Prof Stauffer
July 23rd, 2025
The Goal – Part 2
In The Goal, Goldratt emphasizes how systems thinking and focusing on constraints over local efficiencies drive effective business management. Three passages from Chapters 17–28 illustrate these principles.
First, Goldratt (2014) states, “We can’t release materials according to a schedule if the bottlenecks can’t handle it” (p. 133). This passage is compelling because it challenges the traditional push-production mindset. By aligning material release with the capacity of bottlenecks, the Bearington team prevents excess inventory and work-in-progress, which aligns with throughput accounting principles that prioritize system flow over local efficiencies (Corbett, 2006). Effective business management requires managers to synchronize inputs with system constraints to prevent hidden inefficiencies and delays in customer delivery.
Second, Goldratt (2014) observes, “Activating a non-bottleneck to its maximum is an act of irresponsibility” (p. 137). This challenges the common belief that high local utilization equals productivity. Instead, non-bottlenecks should be activated only as needed to support the system’s flow. This aligns with systems thinking, where sub-optimization can damage overall performance (Hudson, 2017). It demonstrates that “breaking the rules” of maximizing utilization makes sense when prioritizing system throughput and delivery performance.
Third, the statement, “The bottleneck should never be idle,” (Goldratt, 2014, p. 161) is vital in managing constraints. It highlights the need to protect bottleneck uptime to maximize throughput, even if it means deviating from standard practices like fixed lunch breaks or rigid job classifications. This passage shows why the team’s techniques, including process reorganization and priority shifts, are effective. It also aligns with the principle that managing constraints, not eliminating them, enhances system performance (Weiss, 2004).
Reflection
“If I had only known this back when I was managing cross-functional projects, I would have prioritized identifying and managing system constraints rather than pushing teams for constant activity. This approach would have reduced burnout and bottlenecks during critical project phases and allowed us to deliver quality work on time. I also would have challenged the belief that busyness equals productivity, fostering a culture of flow, continuous improvement, and focus on the true organizational goal.”
References
Corbett, T. (2006). Three-questions accounting. Strategic Finance, 87(10), 48–55.
Goldratt, E. M., & Cox, J. (2014). The goal: A process of ongoing improvement (4th ed.). North River Press.
Hudson, J. D. Jr. (2017, October). CL6 allows three shots at better improvement: Instead of bickering over methodologies, find synergies between theory of constraints, lean and six sigma. Industrial and Systems Engineering at Work, 49(10), 43–47.
Weiss, E. N. (2004, February 20). A brief note on the theory of constraints. Darden School Foundation, University of Virginia. https://hbsp.harvard.edu/
,
2
Improving Business Performance: An Evaluation of USPS (United States Postal Service)
Student’s Name
Institutional Affiliation
Course Name
Instructor’s Name
Date
Improving Business Performance: An Evaluation of USPS (United States Postal Service)
Part 1: Business Improvements
The USPS is an autonomous, government-operated agency in the executive branch. As one of the few agencies officially allowed by the U.S. Constitution, it delivers mail and packages nationwide. Delivery to over 160 million locations six days a week by the USPS has long been considered essential to the national logistics and communication ecology. The necessity to objectively assess an institution providing vital public services under systemic constraints sparked this analysis. USPS has battled with rising financial losses, inefficient operational infrastructure, and competition and regulatory obligations. Due of its visibility and complexity, USPS is a good candidate for this analysis, which employs TOC, TA, and systems thinking to find sustainable ways to improve performance. This paper investigates underlying limits, provides focused treatments, and analyzes each improvement using theory and practice.
Organizational Overview
Industry Context and Offerings
The USPS delivers letters, parcels, and business mail nationwide and internationally. It has a universal service commitment to deliver to all US addresses regardless of location or cost. USPS offers First-Class Mail, Priority Mail, Express Mail, bulk business mail, media mail, and packages. Individuals, organizations, and government agencies use these services for everything from personal correspondence to e-commerce deliveries. The agency provides post office boxes, money orders, passport applications, and mailing supplies. It is unique in that it competes with FedEx, UPS, and Amazon while meeting government legal and operational requirements.
Operational and Financial Health
USPS employs approximately 600,000 people and has over 31,000 retail locations. It processes 425 million mailpieces daily and has one of the nation's largest fleets. The organization's growth and scope have also presented obstacles. Many facilities and logistics operations use antiquated infrastructure and manual methods. USPS struggles to compete with private enterprises that use current technology and simplify processes because to these inefficiencies. Due to dwindling mail volumes, stiff labor costs, and retiree benefit pre-funding, the company has had chronic losses for over a decade. According to the USPS 2022 Annual Report to Congress, the agency lost $4.9 billion, continuing a 15-year trend of losses over $2 billion. E-commerce has increased package deliveries, but operating expenses and systemic liabilities have outweighed revenue increases.
Systems Thinking and Operational Summary
The USPS functions as a vast and complex system with numerous interrelated components. From a systems thinking perspective, its operations can be divided into several interconnected subsystems, each playing a role in service delivery: mail and package intake (customer-facing retail and drop-off points), processing and sorting (regional and national distribution centers), transportation (air and ground logistics networks), and delivery (last-mile carriers and delivery routes). Information flows from customers to frontline workers and back through multiple digital and manual channels. Feedback loops exist in the form of customer service inquiries, tracking systems, and internal quality control mechanisms. However, these feedback loops are often ineffective due to outdated IT systems and bureaucratic inertia. The systemic inefficiencies create a negative ripple effect across the organization, from delayed mail processing to route-level delivery issues. The lack of synchronization between physical and digital infrastructure, compounded by rigid policies, results in diminished agility and responsiveness. This inefficiency stifles USPS’s ability to adapt to the rapidly evolving logistics landscape.
Identification and Analysis of Organizational Constraints
Theory of Constraints (TOC): Foundational Framework
The Theory of Constraints (TOC), first introduced by Eliyahu M. Goldratt in his seminal work "The Goal," provides a systematic approach for identifying and resolving performance-limiting bottlenecks in organizational systems. TOC posits that any manageable system is limited in achieving more of its goals by a very small number of constraints. These constraints may be physical (e.g., equipment or space limitations), policy-based (e.g., regulations, procedures), or market-driven (e.g., customer demand). By systematically identifying and addressing these constraints, organizations can improve overall throughput and operational efficiency (Goldratt & Cox, 2014). For the USPS, all three types of constraints—physical, policy, and market—are currently limiting organizational performance in distinct and overlapping ways.
Constraint 1: Physical Constraints – Aging Infrastructure and Inadequate Sorting Equipment
A critical physical constraint facing USPS is the widespread use of outdated mail sorting and processing equipment. Many of the machines currently in use are over two decades old and are prone to mechanical failures, inefficiencies, and high maintenance costs. Some facilities still rely on manual sorting for specific mail classes or delivery zones. The outdated equipment significantly slows down processing time, increases the likelihood of errors, and contributes to high labor costs. This bottleneck impacts First-Class and package deliveries, especially during holidays when volume rises. Monteiro (2018) found that outdated physical infrastructure makes it difficult to grow operations, resulting in missed service targets and customer unhappiness. USPS financial troubles and borrowing restrictions hinder capital investment, exacerbating this constraint.
Constraint 2: Policy Constraints – Legislative and Governance Limitations
USPS's legislative structure is another major restriction. The 2006 Postal Accountability and Enhancement Act (PAEA) mandates the corporation to pre-fund retiree health benefits for future employees up to 75 years in advance, which is the biggest policy constraint. No other federal agency or private enterprise has this requirement, which has burdened USPS financially and diverted billions from capital investment and operating improvements. USPS cannot set prices or add services without Congressional approval. This regulatory environment limits innovation, adaptability, and market response. Policy restrictions, especially those that limit budgetary flexibility and decision-making autonomy, are hardest to overcome in public sector organizations, according to Dalton (2009).
Constraint 3: Market Constraints – Shifting Customer Preferences and Competitive Pressure
USPS faces significant market constraints as consumers increasingly turn to digital communication and private courier services. The proliferation of email, electronic billing, and digital advertising has sharply reduced the volume of First-Class Mail, historically one of USPS's most profitable segments. At the same time, e-commerce has fueled the rise of private logistics competitors such as Amazon, FedEx, and UPS, who offer faster, more trackable, and often cheaper delivery options. These competitors benefit from technological agility and fewer regulatory constraints, allowing them to adapt rapidly to consumer demands. As Fox (2012) explains, market constraints force organizations to redefine their value proposition to remain relevant. USPS’s value proposition is increasingly being challenged by both technological obsolescence and customer expectations for faster and more customized services.
Recommendations to Address Constraints
Recommendation 1: Comprehensive Infrastructure Modernization
To address the physical constraint of outdated infrastructure, USPS must prioritize a phased yet aggressive infrastructure modernization plan. This should include the replacement of obsolete sorting machines with automated high-speed systems equipped with optical character recognition and barcode scanning technologies. Integration of RFID tracking and real-time monitoring systems would further enhance logistics visibility and customer service. Additionally, investment in energy-efficient vehicles and smart route optimization software can improve last-mile delivery effectiveness. According to Aghili (2011), combining throughput metrics with Six Sigma principles significantly enhances the efficiency and reliability of operations. USPS can finance these upgrades through public-private partnerships, lease agreements, and capital grants linked to sustainability and innovation goals.
Recommendation 2: Targeted Legislative Reform and Regulatory Autonomy
To overcome policy constraints, USPS must intensify efforts to advocate for legislative reforms, particularly the repeal or amendment of the PAEA’s pre-funding mandate. This can be achieved through coalitions with labor unions, state governments, and advocacy groups to apply coordinated political pressure. Additionally, USPS should seek increased autonomy over service pricing and the development of new product lines. Hudson (2017) emphasizes that organizations must align their internal policies with external strategies to create a dynamic performance environment. Gaining regulatory leeway would enable USPS to respond more nimbly to competitive threats and operational needs. Legislative reform would not only relieve financial pressure but also unlock opportunities for innovation and strategic investment.
Recommendation 3: Strategic Service Diversification and Market Repositioning
To counteract market constraints, USPS must reframe its service offerings to meet contemporary consumer expectations. This involves expanding into adjacent service areas such as financial services (e.g., postal banking), digital identity verification, and government document processing. These services are particularly needed in underserved rural and low-income urban areas where USPS already maintains a physical presence. By leveraging its trusted brand and nationwide infrastructure, USPS can offer value-added services while generating new revenue streams. Piraseth and Kannappan (2013) argue that service diversification, when aligned with customer needs and organizational capabilities, can serve as a powerful countermeasure to market displacement. Partnerships with local governments and digital platforms can further support implementation.
Throughput Accounting Evaluation
Overview of Throughput Accounting
Throughput Accounting (TA) shifts the financial focus from cost-centric decision-making to maximizing organizational throughput. TA is built on three core metrics:
· T (Throughput): The rate at which the system generates money through sales, calculated as sales revenue minus variable costs.
· I (Inventory): The money tied up in the system in the form of unsold goods, equipment, or resources.
· OE (Operating Expense): The money spent to convert inventory into throughput.
Corbett (2006) explains that traditional cost accounting can misguide decision-making by emphasizing local efficiencies at the expense of system-wide performance. TA, by contrast, promotes a holistic approach that aligns with the TOC philosophy.
Application to Recommendation 1: Infrastructure Modernization
Implementing automated sorting and real-time tracking technologies would increase throughput (T) by accelerating mail processing and improving delivery reliability. It would also reduce labor-intensive tasks, thereby lowering OE. Although I may increase temporarily due to initial capital outlays, the long-term reduction in equipment failures and rework would stabilize inventory. Kirli (2016) demonstrated that logistics firms implementing automation realized up to a 35% improvement in T and a 20% reduction in OE within the first two years.
Application to Recommendation 2: Legislative Reform
Eliminating the pre-funding mandate would result in a significant and immediate reduction in OE. These savings could then be redirected toward infrastructure investments and service innovations, increasing T in the medium to long term. While this recommendation does not directly affect I, the improved financial flexibility would allow for better inventory management and capital planning. Kadhim et al. (2020) argue that aligning policy reforms with TA metrics ensures that financial decisions contribute directly to system-wide efficiency and profitability.
Application to Recommendation 3: Service Diversification
Expanding into financial and digital services would open new revenue streams, thereby increasing T. Initial investments in infrastructure, staff training, and marketing may increase I and OE temporarily. However, leveraging existing post office locations minimizes overhead, making the cost-benefit ratio favorable over time. Albright and Lam (2006) observed that strategic diversification, when managed using TA principles, can deliver sustainable performance gains even in highly regulated environments.
Conclusion
The USPS is an indispensable institution that is presently constrained by outdated infrastructure, rigid policies, and shifting market dynamics. Applying the Theory of Constraints reveals the core limitations that must be addressed to elevate the organization’s performance. Throughput Accounting offers a robust framework for evaluating the financial impact of proposed interventions, while systems thinking ensures that solutions are sustainable and holistic. By modernizing its physical infrastructure, advocating for necessary policy reforms, and diversifying its service offerings, USPS can improve operational efficiency, restore financial stability, and enhance its value proposition to the American public. The path forward requires bold leadership, cross-sector collaboration, and an unwavering commitment to continuous improvement. However, the potential rewards—both in terms of organizational health and public service delivery—make the effort unquestionably worthwhile.
References
Aghili, S. (2011). Throughput metrics meet Six Sigma. Management Accounting Quarterly, 12(3), 12–17.
Albright, T., & Lam, M. (2006). Managerial accounting and continuous improvement initiatives: A retrospective and framework. Journal of Managerial Issues, 18(2), 157–174.
Corbett, T. (2006). Three-questions accounting. Strategic Finance, 87(10), 48–55.
Dalton, M. A. (2009). What’s constraining your innovation? Research Technology Management, 52(5), 52–64.
Fox, K. (2012). Seeing the forest for the trees: Theory of constraints reduces cost of government. The Public Manager, 41(3), 10–13.
Goldratt, E., & Cox, J. (2014). The goal: A process of ongoing improvement (4th ed.). North River Press.
Hudson, J. D. Jr. (2017). CL6 allows three shots at better improvement. Industrial and Systems Engineering at Work, 49(10), 43–47.
Kadhim, H. K., Najm, K. J., & Kadhim, H. N. (2020). Using throughput accounting for cost management and performance assessment: Constraint theory approach. TEM Journal, 9(2), 763–769. https://doi.org/10.18421/TEM92-45
Kirli, M. (2016). Throughput accounting in strategic cost management: An application. Annals of Dunarea de Jos University. Fascicle I: Economics and Applied Informatics, 22(2), 78–87.
Monteiro, V. (2018). TOC in the emergency room. Industrial and Systems Engineering at Work, 50(7), 38–42.
Piraseth, R. M., & Kannappan, S. (2013). The synergy of continuous process improvement. Industrial Engineer, 45(6), 41–45.
What is the difference between qualitative and quantitative research methods? Give an example of each.
Submission Instructions:
Objectives:
Purpose:
Directions:
Video: https://youtu.be/W3hMmZQAdhw
MH708
COUNSELING INTERVIEW CRITIQUE
1. MSE – Perform a mental status exam on the patient. You should be able to complete most of the exam from the video, but if there is a section that you cannot complete, you may write “unable to assess.” If there is more than one patient in the video, you may choose one of the patients.
2. Communication skills – Use the handout from the Module 2 lecture to identify communication skills used by the therapist and give examples. Were these appropriate to the timing and issues being discussed?
3. Reaction to the session – Discuss your personal feelings about the session. This is not a commentary on whether the therapist did a good job, but rather, how did this session make you feel.
4. Therapy framework – Please list the principles of the framework of the applicable theory and which the counselor addressed and which he/she did not. Give examples.
5. What could the counselor have done differently and why – Within the currently used therapy, what are some different counseling skills, responses, and interventions that you might have used instead and why? If you cannot think of anything that should have been done differently, then what would be the next step in the therapeutic process?
6. Progression – Did the therapist and patient work on any goals? Did they make progress towards those goals? Please explain why you feel it did or did not progress how you anticipated.
7. Applicability – How might this psychotherapy approach relate to your future work as a PMHNP? In other words, how (cite examples) will you be able to use and apply the knowledge and/or skills of this psychotherapy in your further work?
,
Therapeutic Communication Techniques To encourage the expression of feelings and ideas
Active Listening– Being attentive to what the client is saying, verbally and non-verbally. Sit facing the client, open posture, lean toward the client, eye contact, and relax. Sharing Observations– Making observations by commenting on how the other person looks, sounds, or acts. Example:” you look tired” or “I haven’t seen you eating anything today”. Sharing Empathy– The ability to understand and accept another person’s reality, to accurately perceive feelings, and to communicate understanding. Example “It must be very frustrating to know what you want and not be able to do it”. Sharing Hope– Communicating a “sense of possibility” to others. Encouragement when appropriate and positive feedback. Example “I believe you will find a way to face your situation, because I have seen your courage in the past”. Sharing Humor– Contributes to feelings of togetherness, closeness and friendliness. Promotes positive communication in the following ways; prevention, perception, perspective. Sharing Feelings– Nurses can help clients express emotions by making observations, acknowledging feelings, and encouraging communication, giving permission to express “negative” feelings and modeling healthy anger. Using Touch– Most potent form of communication. Comfort touch such as holding a hand, is especially important for vulnerable clients who are experiencing severe illness. Silence– Time for the nurse and client to observe one another, sort out feelings, think of how to say things, and consider what has been verbally communicated. The nurse should allow the client to break the silence.
Providing Information– Relevant information is important to make decisions, experience less anxiety, and feel safe and secure. Example “Susie is getting an echocardiogram right now which is a test that uses painless sound waves to create a moving picture of her heart structures and valves and should tell us what is causing her murmur”. Clarifying– To check whether understanding is accurate, or to better understand, the nurse restates an unclear or ambiguous message to clarify the sender’s meaning. “I’m not sure I understand what you mean by ‘sicker than usual’, what is different now?” Focusing– Taking notice of a single idea expressed or even a single word. An example is “On a scale of 0 to 10 tell me the level of the pain you are experiencing in your great toe right now.” Paraphrasing– Restating another’s message more briefly using one’s own words. It consists of repeating in fewer and fresher words the essential ideas of the client. For example the client says “I can’t focus. My mind keeps wandering.” The student nurse says,” You’re having difficulty concentrating?” Asking Relevant Questions– To seek information needed for decision making. Asking only one question at a time and fully exploring one topic before moving to another area. Open-ended questions allows for taking the conversational lead and introducing pertinent information about a topic. For example “What is your biggest problem at the moment?” or “How has your pain affected your life at home?” Summarizing– Pulls together information for documentation. Gives a client a sense you understand. It is a concise review of key aspects of an interaction. Summarizing brings a sense of closure. Example “It is my understanding that your arm pain is a level 1 since you’ve taken a Vicodin one hour ago. Taking your pain medication before physical therapy seems to help you complete the activities the doctor wants you to do for your rehabilitation. Is this correct?” Client responds “Yes It really helps to take the medicine before I do my physical therapy because it helps reduce the pain in my arm.”
Self-Disclosure– Subjectively true personal experiences about the self, are intentionally revealed to another person for the purpose of emphasizing both the similarities and the differences of experiences. These exchanges are offered as an expression of genuineness and honestly by the nurse and disclosures should be relevant and appropriate. They are used sparingly so the client is the focus of the interaction: “That happened to me once, too. It was devastating, and I had to face some things about myself that I didn’t like. I went to counseling and it really helped…..what are your thoughts about seeing a counselor?” Confrontation– Helping the client become more aware of inconsistencies in his or her feelings, attitudes, beliefs, and behaviors. Only to be used after trust has been established, & should be done gently, with sensitivity: “You say you’ve already decided what to do, yet you’re still talking a lot about your options.”
Non-therapeutic Communication Techniques
“Blocks” to communication of feelings and ideas Asking personal questions – Asking person questions that are not relevant to the situation, is not professional or appropriate. Don’t ask questions just to satisfy your curiosity. “Why aren’t you married to Mary?” is not appropriate. What might be asked is “How would you describe your relationship to Mary. Giving personal opinions– Giving personal opinions, takes away decision-making for the client. Remember the problem and the solution belongs to the patient and not the nurse. “If I were you I’d put your father in a nursing home” can be reframed to say,” Let’s talk about what options are available to your father.” Changing the subject– “Let’s not talk about your insurance problems it’s time for your walk” Changing the subject when someone is trying to communicate with you is rude and shows a lack of empathy. It ends to block further communication, and seems to say that you don’t really care about what they are sharing. “After your walk let’s talk some more about what’s going on with your insurance company.” Automatic responses– “Administration doesn’t care about the staff,” or “Older adults are always confused.” These are generalizations and stereotypes that reflect poor nursing judgment and threaten nurse-client or team relationships. False Reassurance– “Don’t worry, everything will be all right.” When a client is seriously ill or distressed, the nurse may be tempted to offer hope to the client with statements such as “you’ll be fine.” Or “there’s nothing to worry about.” When a patient is reaching for understanding these phrases that are not based on fact or based on reality can do more harm than good. The nurse may be trying to be kind and think he/she is helping, but these comments tend to block conversation and discourage further expressions of feelings. A better
response would be “It must be difficult not to know what the surgeon will find. What can I do to help?” Sympathy– Sympathy focuses on the nurse’s feelings rather than the client’s. Saying “I’m so sorry about your amputation, it must be terrible to lose a leg.” This shows concern but more sorrow and pity than trying to understand how the client feels. Sympathy is a subjective look at another person’s world that prevents a clear perspective of the issues confronting that person. A more empathetic approach would be “The loss of your leg is a major change, how do you think this will affect your life?” Asking for Explanations– “Why are you so upset?” A nurse may be tempted to ask the other person to explain why the person believes, feels or is acting in a certain way. Clients frequently interpret why questions as accusations. “Why” questions can cause resentment, insecurity and mistrust. It’s best to phrase a question to avoid using the word “why”. “You seem upset. What’s on your mind?” Approval or Disapproval–“You shouldn’t even think about assisted suicide, it’s just not right.” Nurses must not impose their own attitudes, values, beliefs, and moral standards on others, while in the professional helping role. Judgmental responses by the nurse often contain terms such as should, ought, good, bad, right or wrong. Agreeing or disagreeing sends the subtle message that nurses have the right to make value judgments about the client’s decisions. Approving implies that the behavior being praised is the only acceptable one. Disapproving implies that the client must meet the nurse’s expectations or standards. Instead the nurse should help clients explore their own beliefs and decisions. The nursing response “I’m surprised you are considering assisted suicide. Tell me more about it…” gives the client a chance to express ideas or feelings without fear of being judged. Defensive Responses– “No one here would intentionally lie to you.” When clients express criticism, nurses should listen to what they are saying. Listening does not imply agreement. To discover reasons for the client’s anger or dissatisfaction, the nurse must listen uncritically. By avoiding defensiveness the nurse can defuse anger and uncover
deeper concerns: “You believe people have been dishonest with you. It must be hard to trust anyone.” Passive or Aggressive Responses– “Things are bad and there is nothing you can do about it.” Or “Being is sick is bad and it’s all your fault.” Passive responses serve to avoid conflict or sidestep issues. They reflect feelings of sadness, depression, anxiety, powerlessness, and hopelessness. Aggressive responses provoke confrontation at the other person’s expense. They reflect feelings of anger, frustration, resentment and stress. Assertive communication is a far more professional approach for the nurse to take. Arguing– “How can you say you didn’t sleep a wink when I heard you snoring all night long!!” Challenging or arguing again perceptions denies that they are real and valid to the other person. They imply that the other person is lying, misinformed, or uneducated. The skillful nurse can provide information or present reality in a way that avoids argument: “You feel like you didn’t get any rest at all last night, even though I thought you slept well since I heard you snoring.” –Author Unknown
Scenario: A 13 year old boy is accompanied by his parents into the community mental health clinic for the evaluation of Attention Deficit Hyperactivity Disorder (ADHD). Both parents are impatient, demanding and requesting for you to start their child on a CNS stimulant medication.
Based on this scenario, respond to the following prompts:
