Giving and Receiving Constructive Feedback Gerry Altmiller, EdD, APRN, ACNS-BC

Look at Self First Monitor your own behavior It’s difficult Become a vigilant self monitor

The Challenge When confronted, embarrassed, challenged, rather than act emotionally ask yourself: What do I really want for myself? What do I really want for others? How would I behave if I really wanted these results?

Focus for Dialogue Mutual purpose Mutual respect Recognize what both parties want, ie: learn the topic; pass the course; graduate nursing school; reach a solution to problem Mutual respect Choosing words with caring Maintaining the dignity of the other

What is Constructive Feedback? Based on observations Interactive process of critique to provide insight to correct errors and enhance learning Unbiased, analytical reflection of what occurred Should offer logical connections in order to influence successful learning

Purpose of Constructive Feedback Influence future actions Narrows gap between current performance and desired performance Fundamental to learning

Categories of Feedback Constructive or Corrective Considered negative Should be followed with advice for improvement Reinforcing Considered positive

Role of Constructive Feedback in Quality and Safety Essential for continuous quality improvement Identifies areas where improvement is possible Negative consequences if avoided Recognize value for patient safety Helps one develop error detection skills

Role of Constructive Feedback in Teamwork and Collaboration Evaluation is part of team process Debriefing Evaluate effectiveness of team Identify areas where improvement is possible TeamSTEPPS Training Video: Labor and Delivery Debrief Click link above, then Click on arrow to view video

Role of Feedback in Delegation Process Four steps to Delegation Assess and plan Communicate Provide Surveillance and supervision Evaluation Nurse determines if delegation outcome was successful Nurse needs to lead discussion when expectations are not met

Feedback and Professional Development Essential for professional Growth Learned Skill View as opportunity

Focus of Constructive Feedback Address faulty interpretations Provide options for improvement Most effective when focused on Task Process Self-regulation; error detection skills Least effective when focused on Person him/herself Feedback whether positive or negative should always be an unbiased reflection of events

Delivery is Critical Perception is everything Should be Timely Focused on learning Presented with optimistic view Providing Constructive Feedback indicates commitments to another’s learning and reinforces importance of what they do Receivers should view as opportunity for improvement rather than review of deficiencies

Challenges Should not “put down” another May be ignored if couched in subtle language Concern over creating conflicts Can be used to “shame” another Correcting individuals in front of pts or peers Ignoring individual Displaying contempt for lack of knowledge Taking over for another implying incapable Causes disconnection from team

Receiving Constructive Feedback Consider if this is repeating from several sources If perceived as inaccurate, ask for examples and focus on learning Understand that constructive criticism initiates self examination; reflection; growth as professional nurse

Why should students learn this skill? Part of professional practice Increases knowledge Helps us develop expertise Allows us to improve practice

How will Students Use this skill as a Nurse? To support a culture of Safety Can ask questions without fear of criticism Maintain high quality care; CQI As part of delegation process During peer Review Process For transition to practice To increase professional growth & development

Technique Clear communication Concise, precise; no ambiguities sender; receiver; acknowledgement Concise, precise; no ambiguities Use proper terminology Allow opportunity for clarifications if need Confirm any non-verbal cues (facial expression, eye contact, etc) to ensure patient safety

Strategies Model appropriate techniques for others Focus on quality and safety aspects Connect it to patient outcomes Emphasize as opportunity for learning Feedback with strategies for improvement Debriefings after stressful patient situations Be direct with colleagues about unacceptable behaviors Identify individuals that will answer questions Role playing until you feel comfortable Use Reflection

Reflection Challenge yourself to speak with care Continue to speak calmly even if interaction is escalating Appraise interaction afterward What went well? What went poorly? What could I have done Differently?

Key Points Learned skill Maintain dignity of other View as Opportunity Recognize it’s value in maintaining patient safety

Thank you for listening. Reference: Altmiller G. (September, 2012). The role of constructive feedback in patient safety and continuous quality improvement. Nursing Clinics of North America, 47(3). 365-74. Contact: Altmillg@TCNJ.edu