Case Studies

Chapter 12: Effective Communication and Team Building

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1. Case Study 1
Eric is the nursing supervisor in charge of the hospital operations during the
3-11 PM shift. Joyce is the charge nurse in the emergency department, and
Diane is the charge nurse in the intensive care unit. The three met one
evening to discuss problems with moving clients out of the ED and into beds
in the ICU. As they discuss the issues, Eric sits behind his desk, folds his
hands, crosses his legs, and begins glancing at a paper on his desk. Joyce
sits across from Eric with her legs and arms crossed. She looks directly at
Eric. Diane pulls a chair from the wall, placing it near the corner of the desk,
forming a triangle with the other two participants. She sits down, leans
forward, and smiles.

Questions
A. What are the nonverbal cues from each of the participants?

Correct Answer

Eric: Crossing his legs, using the desk as a barrier between him and the other two, lack of eye
contact
Joyce: Crossing her legs and arms, looking directly at the supervisor
Diane: Moving a chair closer, leaning forward, smiling

Eric initiates the conversation by saying, "There is a problem with the flow between the ICU and
ED involving admitting clients. I want us all to work this out." He continues to avoid eye contact
with the other two. Joyce states, "It's not our problem. If the ICU won't take the clients, they have
to sit. I've had them waiting as long as 6 hours for a bed. That is completely unacceptable." As she
speaks, Joyce points at Diane but stares at Eric. Diane, continuing to smile and maintaining eye
contact, replies, "I understand the problem from your perspective and want to work it out with you.
Let me explain how it looks from the ICU side and we can work together."

B. Identify the verbal and nonverbal facilitative and obstructive messages

from each of the participants in this case.

Correct Answer
 • Eric
Facilitative, verbal: "I want" statement (I want us all to work this out).
Obstructive, nonverbal: Lack of eye contact goes against what he says.
• Joyce
Obstructive, verbal: Defensive (It's not our problem); put-down (That is completely unacceptable)
Obstructive, nonverbal: Staring at Eric and pointing at Diane
• Diane
Facilitative, verbal: Bargaining (I want to work it out with you)
Facilitative, nonverbal: Smile, maintaining eye contact

The three nurses agree on a process to facilitate the transition from ED to ICU. Eric makes a
summary report of the meeting and submits it to the director of nursing with an appointment to meet
the following week. Joyce holds a meeting of the ED personnel the next day and informs them of
changes made to the process. She creates a memo describing changes to the ICU transfer
process and posts it in the department classroom. She requests all staff to read and initial the
memo, noting that they have read and understood the changes. Diane also informs her staff by
holding mandatory meetings at various times throughout the next week. She schedules in-services
for all staff and requires them to relate the pertinent information back to her to determine staff
understanding of their roles in the procedural change.

C. Which of the three displayed upward communication? Was it effectively

handled? Why or why not?

Correct Answer

D. Joyce and Diane both took initiative in distributing the information to the
necessary people. What were the positive aspects to their method of
handling the situation? What were the negatives?

Correct Answer

2. Case Study 2
Cecilia is a recent nurse graduate who worked for 2 years on the medical-
surgical floor as a nursing assistant before being hired as a graduate nurse.
She is eager and curious, and she graduated at the top of her class. Tony,
her assigned preceptor, is an experienced nurse who is focused on
completing his nursing care to the best of his ability. At the beginning of the
shift, Tony explains his strategy for structuring his day. He maintains his
patience with Cecilia, explaining the details of providing nursing care. By the
end of the week, Cecilia questions Tony on his nursing diagnostic decisions,
clinical judgments, and outcome expectations. She even questions him about
 how he relates to physicians. Tony loses his temper, stating, "You worked
here for years, you went to school, you know these things. Why do you have
to constantly question every little thing? Go look it up for yourself!" Taken off-
guard, Cecilia responds, "As a preceptor, you have certain responsibilities for
my transition to nursing practice. I certainly did not mean to undermine your
knowledge by asking questions. I simply want to be an excellent nurse and
feel that you can help me achieve my goal."

Questions
A. What aspects of gender differences may have affected the
communication between Tony and Cecilia?

Correct Answer

Men tend to view their world in a logical and sequential order. Tony was focused on his nursing
care, whereas Cecilia wanted him to break down his processes to gain insights into his routine.
Cecilia was attempting to establish a comfort level with her new position (common for women),
and Tony may have assumed she already possessed knowledge transferred from her role as a
nursing assistant to her role as a graduate nurse. Tony also may be exhibiting the male tendency
of not asking questions, preferring to find the answers for himself and expecting the same of
Cecilia.

B. How was Cecilia assertive in her communication?

Correct Answer

Cecilia openly and honestly communicated her perception of his role as a preceptor. She stood up
for herself while respecting Tony's feelings. She clearly stated her goal of becoming an excellent
nurse and affirmed how Tony could assist her in achieving that goal.

3. Case Study 3
You are participating in the weeklong mandatory hospital orientation program
for new nurse graduates. There are six new nurses, including you, involved in
the session. As you look around the room, you note that none of the faces are
familiar. Some of the participants appear completely at ease, conversing
about their new careers and goals, whereas others silently look over the day's
programmed events. To break the ice, the instructor asks each person to tell
a little bit about themselves, where they graduated, where they will be working
in the facility, and their professional goals.

Questions
A. What type of team was created, and why? What long-term purpose
does it serve?

Correct Answer

This is a potential team. By creating the team during orientation, the facility provides a support
system for the new nurses. It also provides a common ground for the participants, allowing them
to develop a comfort level with the other new nurses.

During orientation, unique group roles emerge. This becomes particularly apparent while working
on case presentations. The following interaction occurs during a brainstorming session:

Joan: "We are told to work through the case study and describe how we would proceed with the
client's care, right?"
Katarina: "Yeah, I came across a similar situation while working as an aide. I think we need to
reassess the client's condition like the nurse did on my old floor."
Tom: "Well, that sounds logical but couldn't we also ask the clients about their history? Maybe
something was missed that might be important?"
Susan: "Okay, so we have one person with experience who thinks we should reassess. We also
have a suggestion to review the client's history for missed information. We all agree some action
should be taken."
Lakeesha: "I think we need to keep in mind that this is a potentially serious problem and we need
to act quickly. I would review the history while assessing the client."

B. What roles did each of the orientees adopt in this scenario?

Correct Answer

Joan: Clarifier
Katarina: Information giver
Tom: Initiator
Susan: Summarizer
Lakeesha: Orienter

C. How do the roles contribute to overall team performance?

 Correct Answer

Clarifier: Restates or questions the issue at hand. Helps to increase understanding of what is
occurring.
Information giver: Relates facts or personal experience relative to the group conversation. This
person can also enhance understanding of the group as well as provide insights into how others
handled similar situations.
Initiator: Provides new ideas or creative ways to handle situations not previously thought of by
other team members. Allows insights into the problem while maintaining the group's goal.
Summarizer: Pulls together all of the ideas to allow conclusions or decisions.
Orienter: Maintains the focus of the group on the identified goals. Especially important if the group
wanders off from the intended focus.

D. Which role(s) do you feel comfortable assuming as a new nurse?

Present a real or potential nursing situation (people involved on the
team, environment) that demonstrates the environment in which you
would feel comfortable contributing to a team process.

Correct Answer

Assessment: Students should identify at least one role within a scenario that demonstrates an
understanding of how they could contribute to a team process.

4. Case Study 4
A continuing issue on your nursing unit is the amount of overtime by staff
nurses. Management decides to form an ad hoc team charged with
addressing the overtime issue. You were chosen to participate, along with the
unit manager, the charge nurses from each shift, a unit secretary, an aide,
and two experienced nurses (one with chronic overtime and one with little to
no overtime).

Questions
A. What is the rationale for selecting each of the various individuals to
serve on the team?

Correct Answer

• New nurse
The participation of the new nurse on the committee allows immersion into the functions of a
committee as well as experience in working with a team to solve a problem. Based on the others'
expertise in the area of overtime, the new nurse can gain an understanding of why overtime
 occurs and how it affects the facility as a whole. Factors affecting the issue both positively and
negatively, as described by those currently experiencing the problem, provide the new nurse with
a better understanding of the various views on the issue.
• Unit manager
The unit manager retains ultimate responsibility for the outcomes of the committee. Additionally,
the manager can provide another view on the effect of overtime from the perspective of budgets,
staffing, and accountability.
• Charge nurses
The charge nurses from each shift provide the perspective of a first-hand view of occurrences on
the unit that affect overtime. Such variables include client acuity, staffing, census alterations
during the shift, client load, and unforeseen circumstances affecting the overtime issue. The
charge nurses report directly to the unit manager regarding overtime concerns.
• Unit secretary
The unit secretary provides information on statistics such as the number of admits and
discharges. In addition, the secretary can offer insights into issues affecting overtime such as the
volume and complexity of physicians' orders at a given time.
• Aide
The aide provides valuable information from the client's perspective. The experienced aide can
supply information on the amount of time needed for client contact based on client needs rather
than on a medical/nursing diagnosis.
• Experienced nurses
The nurse with chronic overtime can present factors affecting overtime. The nurse with little to no
overtime can describe how the factors are overcome, as well as insights into strategies that allow
the nurse to complete work on time. Both nurses can present information on the effect of overtime
on their personal lives.

B. What other hospital personnel could be included on the team? Defend

your choices.

Correct Answer

• Information services
Could provide data on computerized charting; time of day most nurses chart, average length of
time spent charting, methods to decrease amount of time charting, and suggestions to streamline
charting.
• Staff educator
The educator could analyze the work processes of the staff nurses and recommend ways to
adequately manage time. The educator could initiate educational in-services to address identified
problems in the work environment, build teamwork and collaboration among the nurses, and
research how other facilities address similar problems.
• Quality assurance/continuous quality improvement representative
The QA/CQI representative could analyze the current workflow to identify factors affecting staff
performance. The data could provide statistical evidence of workflow patterns and provide
possible answers to address the problems.
 C. What is the purpose for forming this team? How could the goal be
worded?

Correct Answer

The purpose is to address issues concerning overtime. The goal would be to formulate viable
suggestions to address the overtime issue on the unit.

5. Case Study 5
The nursing program at your school decided that they would like input from
students regarding the current structure and type of nursing curriculum
offered. The faculty decides to solicit input from the students in your class.
They will only accept four proposals for change in written form.

Questions
A. Have students form four groups in the class and allow at least 30
minutes for this exercise. Let students decide on their own how their
group will proceed, the format for writing the proposals for changes,
and what changes to include in their proposal. Once done, have
students complete Critical Thinking Box 12-4 in the textbook regarding
the group experience. Discuss their perceptions of the group
assignment.

Correct Answer

Assessment: Guide students to reflect on the group experience and self-evaluate their ability to
facilitate communication.

B. Review "Components of Written Communication" in the textbook. Have

students evaluate their proposals against the suggestions in the text.
What would students change? What would they keep the same?
 Correct Answer

Assessment: Have students discuss their proposals concerning proper titles, format, grammar,
spelling, punctuation, proofreading, and clarity of purpose. Make sure they include the KISS
principle.

C. Have students review the group process. How did each group follow
the processes of forming, storming, norming, performing, and
adjourning? What occurred in each of the stages? Were any of the
stages more useful than the others?

Correct Answer

Assessment: Allow students to describe actions that occurred during the stages and how effective
they perceived their group to be within each process.

D. Review the basic roles of group members in Box 12-3 in the textbook.
Reflect on how students assumed the roles during the group process.

Correct Answer

Assessment: Guide students to reflect on the group process and their perceptions on how
members assumed various roles. What role did students perceive themselves as taking? Were
group members in agreement on who took what role? Have students complete the table below:

ROLE IN THE GROUP STUDENT WHO ASSUMED ROLE

Opinion giver

Opinion seeker

Information giver

Information seeker

Initiator

Elaborator

Coordinator

Orienter
Evaluator of critic

Clarifier

Recorder

Summarizer
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