Tough Conversations Research Articles

Concerns about practice: supporting staff by fostering a climate of psychological safety.

The nursing profession is under growing pressure and many nursing staff find it increasingly challenging to maintain standards and provide safe, effective and efficient care that meets the needs of patients. Nurses' job satisfaction is predicated on feeling supported, including when there are concerns about practice - whether their own or that of their colleagues. This article discusses how nurse managers can support staff to challenge suboptimal practice, admit their own errors and learn from these by fostering a climate of psychological safety. This includes adopting a relational model of leadership; cultivating open communication; providing clarity on roles and expectations; ensuring transparency and fairness in performance management; having supportive 'tough conversations' with staff; demonstrating objectivity when investigating concerns; and promoting a 'just culture'.

Time for tough conversations: Ableism in the life journey of young adults with visual impairment.

Visual impairment (VI) profoundly impacts many aspects of life and is well documented in various cross-sectional studies. Young people's views on growing up with VI are largely unexplored in the Indian context. This study explores a critical concept called "ableism" as they navigate through childhood and adolescence. The study used an exploratory research design, with QUAL+ QUAN methodology, where the data collection occurred almost simultaneously, and the qualitative was the dominant method. For the quantitative data collection , seventy youth with visual impairment aged 18-25 years were recruited through convenient and snowball sampling. For the qualitative data collection, 20 were selected based on purposive sampling. Kessler Psychological Distress Scale (K10) was used with 70 participants as part of quantitative data collection. An empirically based interview guide encouraged participants' reflection on growing up with VI, including the internal and external age-normative and vision-specific challenges. The interviews were analyzed using thematic analysis. Thirty percent of the participants reported psychological distress at varying levels from mild to severe. The account of growing up with VI also centered on a theme labeled "ableism." Six subthemes representing "ableism" are 1) invasion or avoidance, 2) you achieve, and I will respect, 3) disgraceful experiences, 4) you are our inspirational meme, 5) double vulnerability, and 6) internalized ableism. Each subtheme discusses different forms of ableism experienced by young people with VI. Findings are discussed in relation to the limiting attitude and structure of the society that affects the lives of young people with VI. They highlight the need to understand the nuances of ableism which helps to revisit and reflect as a society.

“It’s a Process:” How Faculty Develop and Adopt Empathetic Practices

ABSTRACT Empathy and empathetic classroom practices are a pillar of good pedagogy. These approaches create a learning environment that is adaptable and supportive for all. Building on a small but growing body of literature on the role of empathy in higher education, we explore the genesis of how faculty, across a range of disciplines, began to incorporate empathetic practices into their teaching. Our data come from interviews with 29 faculty members collected between the Spring of 2021 and the Spring of 2022. Our findings indicate that some faculty trace their empathetic practices back to their own educator models, or to their upbringing, while others espouse that their empathy is “naturally” occurring, and still others have had experiences in the classroom that led them to change their pedagogical approach to be more empathetic. Understanding how faculty learn about and implement empathy is important for sociologists because empathy is socially constructed. Empathy has been shown to help students embrace difficult content and have tough conversations. Empathy also helps students connect to faculty and improves student retention.

Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.

Outsourcing government relations: Use of outside lobbyists when in-house capacity exists

To advance their interests by shaping public policies and influencing government decision-making, companies use internal resources, outside lobbyists, or trade associations to lobby. This article examines companies’ use of outside lobbyists even though in-house capacity exists and explores how these resources complement each other. The study aims to offer practical advice to companies and lobbying consultancies regarding the optimal use of internal and external government relations resources. Another aim of the study is to examine how companies monitor the lobbying efforts of the consultancies they hire. Semistructured interviews were conducted with 35 in-house government relations managers and executives to accomplish these goals. The research showed that companies engage with outside lobbyists for two leading reasons: to help with specific issues that have no internal expertise and to provide surge capacity. The interviews identified six ways companies use outside lobbyists: they provide (1) strategic advice, (2) external validation, (3) political intelligence, (4) contact plans, (5) logistical support, and (6) assistance with tough conversations.

Setting Down the Ten Foot Pole

Talking about religion and spirituality has been a taboo topic for a long time. While those in student affairs are no strangers to tackling tough conversations and engaging in identity development, this topic is still kept at a distance. Educating on Religious Diversity and Interfaith Engagement seeks to challenge those in higher education to set down the ten foot pole that has been used to keep conversations about religion and spirituality at a comfortable distance by providing the tools and resources to approach the topic. Through practical examples and a plethora of resources, this book is an engaging read for any level professional. Learn about new ways to engage students with an identity that has been removed from the sphere of public education for many years with this informative and easily read handbook.

Preparing for Tough Conversations: How to Set the Stage for Major Change on Your Campus

Preparing for Tough Conversations: How to Set the Stage for Major Change on Your Campus

Time for the Tough Conversations: Ableism and Racism in the Field of Orientation and Mobility

Time for the Tough Conversations: Ableism and Racism in the Field of Orientation and Mobility

Ölüm Eğitimi İle İlgili Yapılan Çalışmaların Bibliyometrik Analizi: 1970- 2021

Death education should be part of the process, if education means to provide the ultimate aim of human happiness and general well-being. Death education may help parents in tough conversations and support children's understanding of death by forestalling questions in children’s minds at this challenging period such as Covid-19 pandemic. This study aims to analyze the studies on “Death Education” which are indexed in the Web of Science Core Collection, KCI and SciELO databases within the Web of Science All Databases by bibliometric method. Since the first study on “Death Education" was conducted in 1970 in the reviewed literature, studies from 1970 to 2021 were included in the analysis. Web of Science All Data Bases were scanned using the keywords “death education”, “teaching death and dying”, “death and dying course” and “death pedagogy”. 442 publications were analyzed according to databases, research areas, years, authors, document types, journals, countries, languages and visual network maps of 314 publications were anlalyzed according to co-authorship, co-word and co-citation. Findings displayed that the most research was conducted in the field of Education and Educational Research, the most prolific author was Ines Testoni, the most published journal was Death Studies and the most published year was 2020. It was also observed that only two studies from Turkey took place. Given that studies on Death Education in the national literature is scarce and this study is the first bibliometric study on Death Education, it is believed that this study will shed light on future publications on Death Education.

Conversations about structural racism are uncomfortable. That’s the point.

Conversations about structural racism are uncomfortable. That’s the point.

Editors' Note: Education Research: The Medical Student Perspective on Challenging Conversations

In their qualitative study of Johns Hopkins medical student experiences with challenging patient encounters, Willis and colleagues illustrate an important knowledge gap in medical student education. Among their findings, Willis's team reports that delivering bad news was a frequent challenge faced by medical students when speaking with patients. Furthermore, it appeared that over time (from second to fourth years of medical school), engaging in these tough conversations was no easier. In fact, over half of respondents indicated a lack of knowledge and experience in these difficult encounters, a major limitation of our education process. In response, Amin and Ullah reflect that the trainee–patient dynamic tends to improve with time and mentorship. Both the commenters and the investigators of this study agree that the challenges faced by medical students change with time because experience and confidence grow. However, the fact that trouble with difficult conversations persists throughout the last year of graduation highlights the need for continued mentorship, or a focused longitudinal curriculum on communication skills, to cultivate this important physician attribute. In their qualitative study of Johns Hopkins medical student experiences with challenging patient encounters, Willis and colleagues illustrate an important knowledge gap in medical student education. Among their findings, Willis's team reports that delivering bad news was a frequent challenge faced by medical students when speaking with patients. Furthermore, it appeared that over time (from second to fourth years of medical school), engaging in these tough conversations was no easier. In fact, over half of respondents indicated a lack of knowledge and experience in these difficult encounters, a major limitation of our education process. In response, Amin and Ullah reflect that the trainee–patient dynamic tends to improve with time and mentorship. Both the commenters and the investigators of this study agree that the challenges faced by medical students change with time because experience and confidence grow. However, the fact that trouble with difficult conversations persists throughout the last year of graduation highlights the need for continued mentorship, or a focused longitudinal curriculum on communication skills, to cultivate this important physician attribute.

Review: Revenge of the She-Punks: A Feminist Music History from Poly Styrene to Pussy Riot, by Vivien Goldman

Review: <i>Revenge of the She-Punks: A Feminist Music History from Poly Styrene to Pussy Riot</i>, by Vivien Goldman

Permissible Narratives: The Promise of Latino/a LiteratureMestizos Come Home! Making and Claiming Mexican American Identity

Book Review| March 01 2021 Permissible Narratives: The Promise of Latino/a LiteratureMestizos Come Home! Making and Claiming Mexican American Identity Permissible Narratives: The Promise of Latino/a Literature. By González, Christopher. Columbus: Ohio State Univ. Press. 2017. xii, 194 pp. Cloth, $129.95; paper, $29.95; e-book, $29.95.Mestizos Come Home! Making and Claiming Mexican American Identity. By Davis-Undiano, Robert Con. Norman: Univ. of Oklahoma Press. 2017. xxi, 312 pp. Cloth, $29.95; e-book available. Bernadine Hernández Bernadine Hernández Bernadine Hernández is an assistant professor in the department of English at the University of New Mexico. Her forthcoming book is titled Border Bodies: Racialized Sexuality, Sexual Capital, and Violence in the Nineteenth Century Borderlands (Univ. of North Carolina Press, 2022). Her publications appear in Transgender Studies Quarterly, Women’s Studies Quarterly, Comparative Literature and Culture, among others. She specializes in transnational feminism and sexual economies of the US borderlands, along with American literary studies/empire from the mid-nineteenth century to the early twentieth, borderlands theory, and Chicana/Latina literature and sexualities. Search for other works by this author on: This Site Google American Literature (2021) 93 (1): 154–156. https://doi.org/10.1215/00029831-8878590 Cite Icon Cite Share Icon Share Facebook Twitter Email Permissions Search Site Citation Bernadine Hernández; Permissible Narratives: The Promise of Latino/a LiteratureMestizos Come Home! Making and Claiming Mexican American Identity. American Literature 1 March 2021; 93 (1): 154–156. doi: https://doi.org/10.1215/00029831-8878590 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter Books & JournalsAll JournalsAmerican Literature Search Advanced Search Now more than ever, Latino/a studies is on the brink of change. From invoking the X to in Latino/a studies programs nationwide to having the tough conversations that 1960s and 1970s Chicano nationalists ignored regarding Indigenous and Black Latinos/as/x, the field is shifting. Permissible Narratives: The Promise of Latino/a Literature by Christopher González and Mestizos Come Home! Making and Claiming Mexican American Identity by Robert Con Davis-Undiano are two vastly different texts that continue the conversation on the future of Latino/a studies.Permissible Narratives is an astute study of how readership has contended with the development of Latino/a literature over the last fifty-plus years. The book is part of the Cognitive Approaches to Culture Series from Ohio University Press and is unique because it employs a cognitive narratology framework to examine what is permissible in Latino/a narrative and what is foreclosed as... Copyright © 2021 by Duke University Press2021 You do not currently have access to this content.

Review of Dare to lead: Brave Work. Tough Conversations. Whole Hearts.

Review of Dare to lead: Brave Work. Tough Conversations. Whole Hearts.

Tough conversations about DNACPR decisions.

Doctors must involve patients and those close to them in decisions about cardiopulmonary resuscitation, updated guidance says

Tough Conversations: Development of a Curriculum for Medical Students to Lead Family Meetings.

Few educational interventions have been developed to teach Family Meeting (FM) communication skills at the undergraduate level. We developed an innovative curriculum to address this gap. Fourth year medical students during 2011-2013 (n = 674) completed training for conducting a FM. To assess the effectiveness of this training, students completed a FM Objective Structured Clinical Exam (OSCE) that included 15 domains rated on a 1-5 point Likert scale. Tasks included discussing prognosis, establishing goals of care and demonstrating conflict resolution skills. Students received one-to-one feedback from standardized family members and faculty observers. Group debriefings with faculty were held after the OSCE. Analysis of faculty feedback narratives revealed four themes in which students required improvement: 1) Discussing prognosis, 2) Explaining palliative care/hospice, 3) Avoiding medical jargon, and 4) Discussing cultural/religious preferences. Evaluation total mean score was 28.2 (Min 15, Max 63; SD 7.57), and identified student's need to; 1) Ask more about the degree of knowledge family members want, 2) Ask religious beliefs, and 3) Assess family members' level of education ( p < 0.001). Qualitative analysis of group debriefings suggested that student perception of the OSCE experience was positive overall. Students found the case to be realistic and immediate feedback to be helpful. Conducting a FM is an advanced skill. This study shows that it is possible to train fourth year students to lead FMs and identify their strengths, needs using a FM OSCE.

Our take: building engagement cultures

Purpose Leadership is about mobilizing self and others to attain a common purpose. The actions chosen to accomplish this are guided by a set of core values. Yet many companies lack the investment in establishing a common purpose and set of core values. Effective leaders use the principle of purpose to establish a direction that will motivate and capture the energy of those needed for success. In other words, they build engagement. The key to having an engagement culture is the top team. Organizations that have strong engagement cultures are populated with senior leaders that make everyday – and everyone – count daily. The purpose of this paper is to discuss the four key principles that must be deployed to build an engagement culture. Design/methodology/approach There are a wide variety of engagement/culture surveys on the market today, but the real key to having an engagement culture is the top team. Effective leaders constantly seek out new ways to improve. They use the principle of purpose to establish a direction that will motivate and capture the energy of those needed for success. They demonstrate stewardship, provide feedback and consistently inquire into the quality of their plans, as well as the effectiveness of their organizations and their own leadership. The approach of this paper requires four key principles to be deployed to build an engagement culture: align the top team through the development of a core purpose; senior leaders embrace stewardship; senior leaders practice feedback; and senior leaders model caring and listening. Findings To build a culture of engagement, leaders must require that developing engaged work teams be a part of the business strategy. This means engagement becomes the way the company operates, not something done in addition to the company’s work. In other words, it is a fundamental tenet of the company that business performance is achieved by leveraging the organization’s human capital. High-performing leaders make employee engagement non-negotiable, by establishing two things: importance and accountability. Organizations that have strong engagement cultures are populated with senior leaders that make everyday – and everyone – count daily. If an organization is to build a culture of engagement, then it must first be modeled by leaders. These leaders are not afraid of tough questions, comments or challenges. They seek out those who will engage in the tough conversations to build their capability and that of the organization. Originality/value High-performing leaders make employee engagement non-negotiable, by establishing two things: importance and accountability. The approach of this paper involves leveraging the talents of the organization’s employees and engaging them to produce stronger business performance. The world’s best-in-class organizations understand that human capital yields organic growth and creates brand loyalty. When senior leaders align their top team through the development of an engaged workforce, we then see an engagement culture emerge that drives business performance and creates a true competitive advantage for the organization.

Multicultural Education: Tough Conversations, Questions, and Realities

Multicultural Education: Tough Conversations, Questions, and Realities

Tackling tough conversations

Every month, Caroline Carr answers questions from readers on how to improve their wellbeing. This week's question comes from ‘Shivanti’, a healthcare assistant (HCA) working in a hospital in Devon. If you have a question for Caroline, email bjhca@markallengroup.com .

Those Tough Conversations

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