Ladder of Influence, Essay Example

Introduction

The case study example requires a greater understanding of Mia and the ability of nurses to be effective in addressing her specific needs in a timely manner. It is important to recognize the limitations that exist within this case and the challenges that Mia faces in her efforts to be treated by the nursing staff in a timely manner. In the emergency room, where tensions are high, staffing may be limited, and there may be large numbers of patients waiting for care at any given point in time, nurses may often appear frustrated with these conditions and may react accordingly, even if their responses are viewed unfavorably by others. However, patients may also misunderstand or misconstrue information that they hear or believe that they have heard, thereby contributing to a negative nurse-patient relationship. These factors are instrumental in determining how to manage the patient’s plan of care and may lead to other complications that are unwarranted or unnecessary. In this example, miscommunication and misperception play an important role in shaping Mia’s relationship with the nurse whom she has overheard. The use of a ladder of inference in this case study is likely to shed some light in regards to Mia’s thought process as she has been observed in the emergency department and may shape her entire experience, all because she overheard a statement incorrectly. The following discussion will address this example in greater detail and will emphasize the use of the ladder of inference in order to identify Mia’s thought process relative to the words that she has heard in the emergency room setting.

Analysis

The ladder of inference is defined as follows: “the Ladder of Inference describes the thinking process that we go through, usually without realizing it, to get from a fact to a decision or action” (Mind Tools, 2014). For example, making decisions or assumptions without having all of the facts is a challenging yet common premise that occurs rather frequently in different situations; therefore, individuals must learn how to make decisions for which they have only facts and to refrain from making decisions when they do not have the entire story (Mind Tools, 2014). This concept demonstrates that information retrieved under false assumptions or pretenses may be hazardous to an individual or a relationship because it could lead to unnecessary conflicts or other negative behaviors (Mind Tools, 2014). Therefore, it is important to identify whether or not assumptions or inferences have been made based on false evidence or pretenses and to determine how to best move forward in addressing these assumptions in order to achieve greater progress (Mind Tools, 2014).

In particular, nurses working with patients may face difficult challenges with respect to patient care and treatment that are grounded in assumptions, some of which may lead to the refusal of much-needed care. Some patients might believe that they heard a derogatory statement from a nurse, but their perception of the situation is largely inaccurate. This is the case for Mia, as she has misconstrued a conversation between two nurses as negative feedback against her personally. This is a difficult situation to face and requires all possible misunderstandings to be worked out as best as possible. Furthermore, it is evident that the nurse who made the comments to begin with did not have bad intentions when making them. However, Mia did not hear the comments in their entirety and this created a situation that was difficult to manage. Nonetheless, the situation between Mia and the nurse is not that uncommon and requires a further understanding of the latter of inference and the steps that are involved in making assumptions regarding communications that take place.

When assumptions are made that distort the truth of a situation, then the potential exists for disastrous consequences, including conflicts (Health, 2013). The following steps of the ladder of inference represent the different perceptions of a situation, accompanied by the facts and realities of the situation on different levels (Mind Tools, 2014).

Reality and facts (Mind Tools, 2014): In the situation involving Mia and the nurse, the nurse’s full communication addressed her frustration with the current staffing situation that led to the failure of the team to address Mia’s situation at a maximum level. Under these conditions, it was evident that the nurse’s actual communication was grounded in her frustration with the situation, not with Mia herself. However, as the next steps demonstrate, Mia saw things differently than the nurse.

Selected reality (Mind Tools, 2014): Based upon the words that Mia heard, she quickly recognized that she was a burden rather than a patient to be supported by the nursing staff. She became quickly distraught by the situation and no longer wanted to remain in the company of the nursing staff. This quickly escalated her frustration and she left the emergency room at her own will, even though she had not received the desired level of treatment. Mia noted to her mother that she wanted nothing to do with the emergency room in the future.

Interpreted reality: Mia interpreted the situation incorrectly since she did not have all of the facts; however, she did not realize that her judgments were made in error at the time. This was a difficult situation for Mia to accept because she was already in a vulnerable state and could not overcome these challenges easily. Therefore, she acted on instinct and asked her mother if they could go home, in spite of her continued pain. Mia reacted quickly without thinking about the situation long-term and what it might mean for her health in the short run. This was a difficult challenge for Mia because her emotions essentially got in the way of her good judgment to remain in the emergency room to gain treatment.  Mia’s frustrations made the decision to leave the ER for her, with her physical pain taking a backseat to her emotional pain and anger.

Assumptions (Mind Tools, 2014): In this example, Mia made assumptions regarding the statements made by the nurse that led to her abrupt departure from the emergency room. These assumptions also led to her quick frustration with her situation and the nurses in the ER and her dismissal of their treatment without knowing all of the facts and what the charge nurse was really thinking about her case.

Conclusions (Mind Tools, 2014): Mia drew abrupt conclusions regarding the nurse’s statements and these led to her quick frustration and disenchantment with the emergency department setting, as well as her departure without receiving full treatment.

Beliefs (Mind Tools, 2014): In this case, Mia believed that she was unwanted in the emergency room and that nobody had an interest in handling her condition and providing her with treatment, although up to the point where she overheard the nurse, she appeared to be satisfied with the attention that the nurses were paying to her.

Actions (Mind Tools, 2014): Mia’s immediate action was to leave the emergency room without obtaining the proper treatment, which further placed her health in jeopardy. This was a difficult situation but Mia’s emotions got in the way of her health at that moment in time.

This situation offers an example of the different challenges that nurses face as they attempt to effectively communicate with their patients regarding matters of importance so that no miscommunication is observed. These efforts require nurses to be proactive in their responses to patients and in their communications with each other so that patients will not misconstrue conversations in negative ways. At the same time, it is evident that the ladder of inference may serve as a valuable teaching tool in order to prevent assumptions from being made that could have a negative impact on nurse-patient relationships and patient outcomes (McMillan, 2010). These efforts require nurses to take responsibility for their statements and to recognize the potential for miscommunication that might occur (McMillan, 2010). Minimizing these situations provides an opportunity to address critical topics in an open and honest manner without the potential for interference or other concerns that could limit the effectiveness of these communications (McMillan, 2010). The ladder of inference also demonstrates the importance of developing strategies that will have a positive impact on patient care outcomes, while also minimizing any conflicts that might occur (Eisaquirre, 2008). These factors support the continued growth and development of nursing practice settings so that communications are clear and concise across every situation or circumstance (Eisaquirre, 2008).

Conclusion

Nurses possess a responsibility to their patients and to each other to effectively communicate in order to minimize boundaries and to provide a basis for exploring the different insights that exist in regards to patient care and wellbeing. However, in the nursing work environment, miscommunication is likely to occur from time to time and create a challenging framework that requires further examination. In the case example, the nurse and patient have experienced a strong level of miscommunication that requires further examination using the ladder of inference. This supports the identification of information using the different steps of the ladder in order to accomplish the desired objectives. These factors support the development of new perspectives to identify the reasons behind miscommunication and the factors that are critical in determining the source of miscommunication to begin with. It is important to use the ladder of inference so that nurses and patients are provided with the tools and resources that are required to prevent miscommunication and misunderstandings that might exist within the nursing environment and that support the development of new approaches to improve communication skills between nurses and patients.

References

Eisaquirre, L. (2008). Communicating effectively during conflict. Retrieved from http://www.mediate.com/articles/eisaguirreL3.cfm

Health, D. (2013). Communication in nursing: handling difficult discussions. Retrieved from http://www.nursetogether.com/nursing-communication-difficult-discussion

McMillan, M. (2010). The ladder of inference. Retrieved from http://www.nursetogether.com/nursing-communication-difficult-discussion

Mind Tools (2014). The ladder of inference. Retrieved from http://www.mindtools.com/pages/article/newTMC_91.htm