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Task Focused and Patient Centered Communication Behaviors

Introduction

Nurses are entrenched in a complex system of clinical relationships some of which include nurse-nurse, nurse-patient and nurse-physician. Communication forms the basis for these relationships and it depends on the nurse’s ability in listening, assimilating, interpreting, discriminating, gathering and sharing of information within dynamic systems comprising of various disciplines and hierarchies (Anderson & Mangino, 2006). Communication is complex, encompassing skill, emotion, cognition and value. Formulation and implementation of daily care plans is among the most vital patient related communications. These activities call for shared responsibility in order to enhance clear, concise, relevant and timely exchange of patient information across disciplines usually in chaotic environments. Lack of effective communication between patients, families and the healthcare team is one of the leading causes of medical errors. It also accounts for over 60% of sentinel event causes reported to The Joint Commission on accreditation of healthcare organizations since 1995 (Manning, 2006).

Relationships provide a foundation for building communication. Relationships change over time and vary between and among nurses as well as other members of the healthcare team. It is quite difficult to develop and nurture clinical relationships in dynamic healthcare environments because there is less opportunity. For instance, an initial encounter with a nurse may occur when there is a need to contact an unfamiliar physician to offer assistance in an emerging critical event. It is not easy to trust unknown colleagues on judgment, decision-making and clinical knowledge (Walrath et al., 2006). The patterns of communication are highly variable. The factors that influence these communication factors consist of individual style differences, education, gender, previous experiences, perspectives, culture, fatigue, stress, social structures and established hierarchies. Environments for clinical care are often noisy, hectic and full of interruptions especially in common places (Miller, 2006). Conversation avoidance devices like personal digital assistants, audiotape players, text pagers and cell phones interfere with the ability of nurses to listen to other people. It is, therefore, worth noting that the complexity of clinical communication increases the chances of communication failure and hence results into inadvertent patient harm (Corless et al., 2009). However, adoption of certain standardized approaches and tools can provide solutions to the improvement of clinical communication, which in turn prevents medical errors (Manning, 2006). This paper will focus on what other people have written regarding the task focused and patient centered communication behaviors in the nursing field, particularly within the context of the United States.

Quality and Safety in Nursing Education (QSEN)

The issues of safety and quality identified in the healthcare system of the United States have led to a call to modify healthcare education, to prepare graduates to work in teams and within healthcare systems that encourage patient safety. The funding by the Robert Wood Johnson Foundation enabled the American Association of Colleges of Nurses and a National Nursing Advisory Board to create six nursing competencies for Quality and Safety Education for Nurses (QSEN). This include patient-centered care, evidence based practice, teamwork and collaboration, quality improvement, safety, and informatics. The competences presented a systematic pedagogical structure for redesigning of course content in order to prepare nursing students to uphold safety and quality while caring for patients. The course redesigning integrated various active learning modalities including simulation, which is ideal for implementing QSEN due to its multiple levels of skills, knowledge and attitudes that are possible to practice and evaluate in each competency (Brady, 2011).

The National Organization of Nurse Practitioner Faculties (NONPF) issues documents that outline the anticipated competencies for nurse practitioner practice to make sure that every nurse practitioner is ready for delivery of safe and high quality healthcare. There are frequent assumptions that quality and safety, in resemblance to patient-centered healthcare, are central to nursing teaching and practice. Conversely, new insights on safety and quality of patients are now on the forefront via the national commission secretaries highlighting the magnitude of this problem in the present healthcare system (Walsh, Jairath, Paterson, & Grandjea, 2010). The Institute of Medicine challenged nursing and medicine faculties to embark on upon educational experiences to ensure adequate preparation of all graduates at all levels for the delivery of patient-centered care with a greater emphasis on evidence-based practice, informatics and quality improvement (Pohl et al., 2009).

Many national commissions have documented substantial problems associated with quality and safety in the healthcare system of the United States. The conclusion from reports of multiple national committees is that providers ought to possess a set of competencies that are different from those developed in the existing educational programs (Day & Smith, 2007). Health professionals that use scientific evidence have to describe the constituents of good care, identify and if possible, close loopholes in good care, and be acquainted with the activities they can initiate. Ideas, execution and will are necessary to incorporate the mentioned competencies in nursing education. Nursing has no agreed competencies that apply to all nurses. On the contrary, medicine has IOM competencies in place (Cronenwett et al., 2007) comprising of patient-centered care, teamwork, evidence based practice and collaboration, quality improvement and informatics (National League for Nursing, 2008). Nevertheless, an incredible historical will to guarantee safety and quality for patients lies at the centre of nursing. This is evident in nursing publications, accreditation guidelines and standards of practice. The American Association of Colleges of Nursing Task Force on the Essential Patient Safety Competencies for Professional Nursing Care, lately completed an improvement to the Essentials of Baccalaureate education for Professional Nursing Practice to incorporate exemplars of safety and quality competencies. The only challenge to this initiative is the lack of teaching materials, teaching strategies as well as the learning assessment techniques with the exception of schools claiming to execute comprehensive safety and quality curriculum (Cronenwett et al., 2007).

The settings of healthcare delivery are redesigning in response to staggering reports regarding to severe safety and quality issues. Emerging perceptions of safety and quality and other related competencies for practice necessitates redesigning of nursing education programs (Day & Smith, 2007). Nurses are the key players in transforming quality and safety in healthcare. New expectations and roles for nurses call for urgent transformation of the nursing curricula and fresh competencies for graduates in order to match patient care needs and practice setting. Nurse educators and nurse executives are required to address the need to develop faculties via strategic partnerships. In order to achieve this vision, practice settings are preparing personnel through investments in education in the effort to attain a new safety and quality culture (Smith, Cronenwett, & Sherwood, 2007). The major target of health professions education should be development of knowledge, skills and attitudes (KSAs) suitable to safety and quality competencies (Sherwood & Drenkard, 2007). Communication behaviors play a primary role in the implementation of the six QSEN competencies for nursing. The following sections discuss the six QSEN competencies for nursing consisting of: patient-centered care, safety, quality improvement, teamwork and collaboration, evidence based practice and informatics.

Patient-centered care promotes active involvement of patients in their own care, thus improving quality and safety by incorporating the patient and family as vigilant partners. Many delivery settings practice patient-centered care by having visiting hours and information transparency to ensure patient and family needs are considered. Faculty and students get exposure to variations in the way clinicians establish partnerships with patients and families. Model units can also help students to develop and apply their skills in clinical environments. Clinicians should design patient education that correspond to cultural health beliefs, deliver care to different families and integrate patient preferences in care plans (Sherwood & Drenkard, 2007).

Teamwork and collaboration skills are necessary for the delivery of healthcare that is coordinated across interdisciplinary settings, teams and timeframes. Education on communication focuses on the development of empathy and the ability to educate and assess patients and families. Communication competencies ought to emphasize on skills in conflict resolution as well as the ability to conduct critical conversations across care teams, including effective use of management strategies in partnership with nursing and inter-professional colleagues. Effective communication within teams is a fundamental aspect of a positive nursing working environment. The protected learning environment for student nurses may limit the opportunity of practicing teamwork skills in the educational experiences. Poor working relations and inadequate communication are often the root causes of safety and near miss events. Nurses need to graduate with skills in team communication to assist in environments where errors occur (Sherwood & Drenkard, 2007).

The third QSEN competency for nursing is the evidence-based practice. Safe and high quality healthcare call for knowledgeable workers practicing from a scientific evidence framework. Nurses encounter fast expanding evidence in all nursing areas including decision-making. Care protocols and standards should originate from scientific evidence (Sherwood & Drenkard, 2007). Furthermore, learning experiences need to motivate students to work from an inquiry spirit where there is constant examination of actions in view of new evidence. Staff can train students on when it is appropriate to deviate from evidence in order to honor the patient’s references (Day & Smith, 2007).

Quality improvement is another important competency in QSEN. The extent to which healthcare services increase the possibility of accomplishing desired health outcomes consistent with the current knowledge determines the quality of care. The permeation of quality initiatives in healthcare has demanded a lot of time from chief nurse executives. Nonetheless, continuous improvement of quality in hospitals attributes to recognition of nursing excellence. The methods and outcomes of quality improvement in student and faculty experiences may be limited to assessment and compliance to care guidelines in particular settings. Innovative practice-academic partnerships can help improve competencies for outcome and quality improvement. Faculty can improve the quality by dealing with practice problems in their specialties and using the experience to establish case studies for students. In addition, faculty can encourage question formation and literature searches to help students gain knowledge of terminology in quality improvement (Sherwood & Drenkard, 2007).

Regarding safety, building a safer healthcare system is designing care processes that prevent or minimize harm. It is the right of patients to be assured of reliable and safe treatment plan implementation to accomplish optimal outcomes. Safety science deals with knowledge of teamwork, quality measurement, use of information and information technology and communications of errors with patients. Poor working relations and communication failures are the primary causes of untoward events in healthcare. Students can practice team communication, function in interdisciplinary teams and learn safety terminology like “do not use”. Clinicians can assist students in safety data collection, analysis and benchmarking against national standards. Both faculty and clinicians can develop problem-based learning tools and case studies associated with safety competencies for staff and across all health professions students (Sherwood & Drenkard, 2007).

Competency informatics enables nurses to seek and assess information source, use electronic systems and provides skills for navigating computer systems to support decisions and flag errors. There is an increase in the use of electronic information by patients and this necessitates nurses to have knowledge concerning their evaluation and application. Faculty should work with partners to help students learn about navigation of electronic health record and evaluation of technology potentiality to cause or mitigate error (Sherwood & Drenkard, 2007). New learning approaches that rely greatly on simulation laboratories is helpful in developing informatics competence among students (Day & Smith, 2007). Some schools and practice partners are working with vendors who supply a variety of electronic systems or manikins to help students develop informatics as well as other QSEN competencies (Sherwood & Drenkard, 2007).

Patient Centered Communication Behaviors

     Patient-centered communication (PCC) refers to a group of communication behaviors and strategies, which enhance mutuality, shared understandings and consequently shared decision making in day-to-day encounters of healthcare (Brown, 1999). It enables the patients to influence and participate in their healthcare. PCC is the root of patient-centered healthcare (Stein-Parbury, 2009). Patient-centered healthcare involves the provision of care that respects and responses to patient’s needs, preferences, and values while ensuring the guidance of patient values in all clinical decisions (Brown, 1999). A patient-centered approach to healthcare shifts the focus of nurses from a task orientation to patient-centeredness where the values and needs of patients are considered. Patient-centered care makes communication and relationship with patients the basis for nursing practice (McCarthy, O’donovan, & Twomey, 2008). A recent research study into experiences of patients with nurses’ communication indicates that nurses focus more on task, as opposed to communicating with patients. This shows that not much has changed towards embracing the patient-centered approach and perhaps most healthcare institutions still lack practices and systems that present the core values of patient-centered care (Stein-Parbury, 2009).

     The Institute of Medicine identified patient-centeredness as one of the key aims in the carrying out the project of restructuring the American healthcare (Institute of Medicine, 2001). There is evidence indicating the use of certain patient-centered strategies by advanced nurses and patients in clinical practice to co-produce clinical discourse that are highly individualized (Brown, 1999). A study was conducted at a big children’s hospital in order to determine the extent to which PCC affects satisfaction with both communication and care. The study required parents of child patients to report on the communication practices of nurses, physicians and other hospital team members during their latest stay in the hospital. The results of the study linked the use of PCC behaviors, particularly immediacy and perceived listening to the satisfaction with communication and care. Additionally, the study indicated a frequent use of PCC behaviors with children in better health than those on poorer health status. Generally, a few people enjoy receiving healthcare because they often get distressed whenever they visit physicians. Patient anxiety may result from lack of supportive and patient-oriented communication behaviors among the healthcare providers (Wanzer, Booth-Butterfield, & Gruber, 2004).

     Many government policies and initiatives have promoted service-user involvement and patient-centered communication as basic concepts in the delivery of high-quality healthcare. The World Health Organization (WHO) also encourages these initiatives by incorporating indicators of health services responsiveness, which is a combination of health system effectiveness and patient satisfaction, in its World Health Reports (Jones, 2007). For instance, some major policy programs have recently resolved to focus on patient-centered communication importance between patients and health professionals in delivering initiatives like shared decision-making (Institute of Medicine, 2001). In addition, various nursing literature have reflected and supported these initiatives. The assimilation of these concepts in both literature and health policy to enhance nursing practices raises questions as to what constitutes suitable and effective clinical communication. This scenario calls for more research concerning nurse communication practices as they transpire in clinical practice (Jones, 2007).

     Among the limitations of research on nurse-patient interaction, is the lack of work that sufficiently explores communication styles in natural clinically based conversations between patients and nurses rather than collecting research data from focus group discussion and staged interviews with nurses or interactions between nurses and the patients’ family members. Aled Jones from School of Health Science, Swansea University, United Kingdom, collected and analyzed research data from student-patient interactions in order to gain some insights into the present interaction practices between student nurses and patients. At the end of the study, he concluded that students experience difficulty in applying the principles of effective communication learnt from the classroom into their individual interactions with patients (Jones, 2007).

     According to Amy Wilson-Stronks, the health disparities project director-Division of Quality Measurement and Research, New York, the patient centered communication standards produced by The Joint Commission (TJC) will go a long way in supporting the work being undertaken by Patient Education Managers (PEMs). PEMs have been advocating for writing of patient materials using clear language and communication techniques that enable patients to understand their respective medical conditions, treatment options and how they would comply with a treatment plan. Dialogue between the healthcare provider and the patient is a prerequisite for positive health outcomes (Wilson-Stronks, 2010). One of the new standards established by TJC, the United States organization that certifies healthcare organizations (Krautscheid, 2008), describes dialogue as a two-way conversation where the healthcare providers gives patients information in an understandable manner while allowing them to provide their own information, as well. Effective communication in healthcare requires providers to learn appropriate education techniques like avoiding medical jargons and using plain language. It is also necessary to use examples in communicating including the use of diagrams, models and pictures to demonstrate procedures and conditions (Wilson-Stronks, 2010).

Task-Focused and Socio-Emotional Communication Behaviors

     Task-focused communication refers to behaviors that are necessary for assessment and problem solving. It involves conversations between patients and healthcare providers whose primary interest is to gather information to help in providing care for the patient. Task-focused communication may involve giving information, asking information and use of skills like clarifying answers from others and asking questions (Pearcey, 2007). Task-focused communications can be being either formal or informal. Formal conversations encompass admission interviews, discussions of advance directives, health assessments or patient-family education. In this kind of conversation, the healthcare provider initiates the interaction with a specific intention of gathering information that will help in diagnosing or treating the patient’s problems. On the other hand, informal conversations can involve asking of simple questions by the nurse such as, “What do we offer you for your meal today?” Like in formal conversations, the focus of informal conversations is to obtain information needed for caring for the patient. In both cases, the healthcare provider initiates the conversation in order to know how best they care for the patient (Mauk, 2010).

     Task-focused communication behaviors of care providers reflect problem-solving skills involving expertise in consultation. Patients also have a role in problem solving. Task-related patient behaviors include an accurate and full reporting of the present and previous symptoms and relevant medical behaviors, comprehension, attentiveness and recall as well as active participation in the patient care process. Additionally, behaviors like compliance and utilization of healthcare may be part of the task functions of patients although not directly expressed within the medical encounter. Socio-emotional communication behaviors are hard to operationalize than the task-focused behaviors. Their aim is to build relationships. Socio-emotional communication focuses on issues with great emotional significance and this call for advanced listening skills. In this type of communication, issues of self-esteem, empathy and trust are fundamental. A health care provider can sometimes initiate a task-focused conversation that can result in great emotional implications (Sanghavi, 2006).

     An investigation was carried out in order to determine associations among task-focused and socio-emotional behaviors of physicians during a medical encounter. The study used audiotapes and transcripts of two standardized cases of patients presented to 43 primary care practitioners by trained, patient simulators. Transcripts were scored for proficiency of the physician and the content analyzed to evaluate the communication process and information content. There was classification of physician communications as either socio-emotional or task-focused. The findings of the study indicated that the physicians used a physician-oriented or a patient-oriented approach; there was no relationship between verbal and nonverbal socio-emotional measures; the physicians adopted either both proficiency and information-giving style or social orientation with patients and finally, the medically informative physicians demonstrated more anxious and interested voices, as opposed to the less informative physicians. The conclusion of the study is that the more medically informative physicians had voice quality despite the less time spent in socio-emotional utterances.

Use of Simulations in Nursing Education

     Improvements in healthcare require integration of academia and practice to bridge nursing education gaps and help in the accomplishment of quality outcomes. Technological explosion has brought about tremendous changes in various sectors of life including nursing (Connor, Honey, Diener, Veltman, & Bodily, 2009). Human patient simulation is a technology that allows nurses and other healthcare team members to refine and apply their skills in real clinical situations and take part in their learning experiences as a way of meeting their educational needs. Simulated clinical situations similar to actual clinical environments help clinicians to gain experiences, learn skills and develop competencies in a planned and prescribed manner (Kobokovich & Beyea, 2004).

     A human patient simulator is a very sophisticated and technologically advanced mannequin in infant, child or adult size. They completely integrate with computer software that enhances the development of pre-planned situations resembling a wide range of clinical situations. Majority of human patient simulators possess anatomically correct pulses; produce heart, lung and bowel sounds; and respond to pharmacological and medical interventions with anticipated physiological responses. It is possible to program these simulators to speak, hence enabling interactions with clinicians, as is the case with actual patients. Human patient simulators are equipped with different features that support various learning experiences. For instance, some simulators allow for the application of wound or trauma care kit or insertion of a chest tube. Such features support the ability of educators to develop learning scenarios that address different clinical needs or problems (Kobokovich & Beyea, 2004).

     Simulation proves to be a suitable strategy for teaching safe clinical practices in nursing education. However, there are barriers to the strategy such as space, cost and faculty resources. Computer-based social simulations demands less resource and are effective in development of skills in critical thinking (Sleeper & Thompson, 2008). A pilot study was carried out to compare resource demand and learning outcomes of students for computer-based versus traditional simulations. The results of the study suggested that the computer-based simulations are an efficient and effective learning strategy for developing patient-centered care competencies (McKeon et al., 2009). Hence, simulation is the mainstay for clinical learning in nursing education, particularly in areas regarding to safety, team building, problem solving and communication (Tanner, 2006).

     Social simulation is a computer-based simulation that interacts with characters, images or documents to make decisions, which determine the sequence of events for students (NexLearn, 2007). Social simulation enhances knowledge retention and skills in critical thinking (Decker, Sportsman, Puetz, & Billings, 2008). The current software enables faculty to establish customized simulation even without the expertise of a graphic artist, designer and sophisticated programmer. A recent study compared the effectiveness and efficiency of traditional manikin-based versus computer-based simulation in order to facilitate education of students on patient-centered care. The study intended to explore the opportunity for enhancing the achievement of student competencies and for reducing financial and workload resource related to simulation education. The findings of the study suggested that both simulations have similar impacts in imparting the patient care competencies in students (McKeon, Norris, Cardell, & Britt, 2009). This supports the assertion that irrespective of the simulation method employed the success of any simulation is dependent on the faculty’s ability to design scenarios that are appropriate to the learning outcomes and realistic with several learning points (Kyrkjebo, Brattebo, & Smith-Strom, 2006).

     Another study was conducted to assess the usefulness of clinical simulations in improving self-efficacy of nursing students in clinical skills as a preparation for real clinical experiences. The analysis of the study data suggested that experiences with clinical simulations could be effective in boosting the self-efficacy of students in patient care. The study also supports the use of clinical simulations in preparing students for real clinical experiences. Due to the current limited availability of clinical placements for undergraduate students in nursing, the clinical simulations offer a suitable option for equipping students with practical skills within a safe environment, without harm to living patients (Bambini, Washburn, & Perkins, 2009). A certain study sought to explore the effects of high-fidelity simulations on the development of clinical judgments in students. The study’s conclusion was that high-fidelity simulation presents students with a forum for advancing their skills in clinical judgment although further research on the same is necessary (Lasater, 2007). It is noteworthy, therefore, that simulations play an important role in equipping and assessment of nursing students for necessary skills and experiences and thereby promoting patient-centered care.

     Nursing programs need to graduate nurses who are ready for practice and who show quality and safety in patient care as well as interdisciplinary communication. A faculty used structured clinical assessment simulations to conduct a quality improvement project in the attempt to evaluate the ability of every nursing student to perform in various aspects of patient care, including effective communication with physicians through telephone in emergent situations. The project involved results reporting of a three-year evaluation of student nurse performance. Alterations in teaching-learning strategies, which comprised of integration of a standardized communication tool, resulted in improvement of student competency. Communication is essential in providing quality and safe healthcare and this emphasizes the need to ensure preparation and assessment of communication competency for all nursing students before exiting their study programs (Krautscheid, 2008).

     In conclusion, reinventing safety and quality education in nursing demands the creation of learning systems and conditions that resemble the clinical microsystem where students learn and discover, test new ideas and attempt to innovate (McKeon et al., 2009). In order to transform care, safety and quality, education ought to be the basis of every clinical course and create opportunities for examining and improving real-life practice problems to prepare nurses for practice (Batalden & Davidoff, 2007). Furthermore, nurse educators need to collaborate with clinical leaders to utilize simulation in creating reliable virtual clinical microsystems where students learn important safety and quality competencies (McGill, & Hobbs, 2008). Computer-based simulation proves to be an effective and efficient technique for nurses to establish and preserve safety and quality competency for better patient outcomes (McKeon et al., 2009).

Roter Interaction Analysis System (RIAS)

     The Roter Interaction Analysis System (RIAS) is a method of analyzing processes applied to taped medical encounters approved by national and international researchers in over 200 communication studies. The RIAS coding framework captures the key patient-centeredness markers and shows the basic functions of medical visits such as data gathering, patient counseling and education, emotion response, and activation and partnership. The communication analysis unit is a complete thought made by the patient or the provider. There is statements allocation to one of 40 categories that are both mutually exclusive and exhaustive. These codes comprise of content, process and affective categories, for patient and providers (Gorawara-Bhat & Cook, 2011). RIAS codes can be used when combined into summary composites or individually to characterize medical dialogue in various ways including the total amount of talk in the visit, patient-centeredness index and the ratio of the provider to patient talk, which indicates verbal dominance. Additionally, coders rate the visit’s effective tone in relation to negative and positive emotion on a 6-Linker scale (Roter & Larson, 2002).

     The RIAS has demonstrated significant reliability and predictive validity to different patient outcomes. The reliability of RIAS across categories ranges from .7 to .9 based on Pearson correlation coefficients. Many researchers have continuously reported similar reliabilities. The coding system has proved to be superior to others regarding its predictive validity to patient effects like compliance, comprehension and satisfaction. The RIAS system is useful in studies that relate communication to physician satisfaction, physicians’ malpractice experience and patient satisfaction. It also helps in evaluation of different types of communication training programs together with residency training and medical education (Gorawara-Bhat & Cook, 2011).

     RIAS, a method of coding medical dialogue, has been used extensively in the United States and Europe and has been utilized in medical exchanges, in Africa, Asia and Latin America. The ability of the system to provide reasonable sensitivity, depth and breadth while preserving practicality, reliability, flexibility, functional specificity and predictive validity to various patient outcomes has contributed to its rapid adoption and dissemination (Haig, Sutton, & Whittington, 2006). A recent study sought to measure the RIAS reliability and to know the volume of technology-related utterances in launched telemedicine clinics and the practicability of using RIAS within the setting. The study’s results showed that traditional RIAS categories associated with task-focused and socio-emotional clusters had fair to excellent reliability levels in the telemedicine setting. The summary technology-related category exhibited reliability for providers, patients and presenters. The study conclusion acknowledged RIAS reliability when applied across several participants within telemedicine setting. The combined technology-related cluster is reliable especially in understanding the patterns of communication with patients who are new to the telemedicine setting. Therefore, the use of RIAS is useful in facilitating comparisons between telemedicine, traditional and face-to-face clinics (Nelson, Miller, & Larson, 2010).

     The RIAS evaluates cure-oriented (instrumental or task related) and care-oriented (affective or socio-emotional) behaviors by coding statements made in provider-patient visits into categories (Roter, 2011). Concisely, RIAS is famous for its use in the assessment of provider-patient communication in conventional face-to-face consultations, particularly in telemedicine. There have been concerns that suggest that interaction analysis researchers ought to consider using the RIAS when studying communication between provider and patient in telemedicine. These include multiple participants, missing information, nonverbal behavior, and reliability and validity. Besides comparison of telemedicine to face-to-face consultations, a modified RIAS can be used in comparison of televideo consultations to each other, across diverse specialties and technical specifications (Roter, Larson, Beach, & Cooper, 2008). An altered RIAS can accommodate differences in the present technology environment, as well as constant changes in provider-patient communication. An increase the knowledge of interaction patterns that lead to better outcomes causes increased emphasis on development of training programs and other interventions to improve provider-patient interactions in telemedicine (Nelson et al., 2010).

     Netherlands Institute of Primary Health Care used RIAS to observe video recordings, in order to explore communication patterns between nurses and elderly patients in two diverse settings. The study consisted of nurse-patient communication in a sample of 181-videotaped interactions, involving 109 patients and 47 nurses. The observation of the video recordings using RIAS yielded 23 types of verbal behaviors. Further analysis produced two socio-emotional categories and three task-related communication categories. The study data analysis by use of RIAS showed that there was a higher amount of socio-emotional interaction within both settings than what the previous studies reported on nurse-patient interaction. The study further indicated that communication in elderly home care was more task-related as compared to communication in elderly homes (Caris-Verhallen, Kerkstra, Van Der Heijden, & Bensing, 2006). The results of this study, therefore, show the reliability of the RIAS in exploring provider-patient communication patterns.

Conclusion

     Human communication is a complex process involving the exchange of ideas, feelings and thoughts, and people communicating constantly via verbal and nonverbal means. Therefore, it is vital for nurses to realize the importance of effective communication in their practice, especially in regards to its purpose and role in their interactions with patients (Dellasega, Milone-Nuzzo, Curci, Ballard, & Kirch, 2007). In nursing practice, effective communication entails the ability to comprehend patients’ idiosyncratic experiences of illness and health, to convey meaningful information that enhances their wellbeing, and to create an opportunity for patients to participate in their care to their desired extents. Communication in nursing practice plays a major role in building useful relationships with patients. Communication competence is a continuous reflection and deepening self-awareness process. Competent communicators may make errors, but they recognize them and contemplate on the ways of addressing similar situations in the future. This is essential in development of communication skills, which is a continuous learning process throughout the nursing career (Stein-Parbury, 2009).

     The Joint Commission identified communication errors as the primary cause of sentinel events in healthcare systems. One of The Joint Commission’s National Patient Safety Goals is to enhance the effectiveness of communication within healthcare providers (Krautscheid, 2008). Previous documentations show the key role of effective communication in healthcare practice and the necessity of communications skills education (Brown, Crawford, & Carter, 2006; Sheldon, Barrett, & Ellington, 2006). This emphasizes the need for nursing programs to graduate nurses who demonstrate safety and quality in patient care including interdisciplinary communication. Faculty can use clinical assessment simulations to evaluate the ability of every nursing student to perform various aspects of care with the inclusion of effective communication with physicians through phone during emergencies (Krautscheid, 2008). However, there are multiple and variable dilemmas concerning approaches to education of communication skills in undergraduate nursing curricula. The dilemmas range from difficulty in demonstration of effectiveness of skills training, use of counseling models and encounter of social barriers to the use of communication skills (Parry & Brown, 2009; Üstün, 2006).

     The amount of clinical skills training at the undergraduate level is increasing dramatically in order to produce nurses who are ready for practice. The number of students entering training is also on the increase and more are now competing for clinical placements. It is, therefore, necessary for students to have basic, practical and interpersonal skills before entering the clinical environment to enable them to explore further learning opportunities once they join the setting. Working pattern changes and the safety culture within healthcare have lead to clinical training review, which has increased demand for trainings that are non-patient based (Maran & Glavin, 2003). Clinical simulations provide numerous learning opportunities for reinforcing students’ understanding of difficult concepts in practice of skills and techniques associated with communication, delegation and teamwork (Howard, 2009). Integration of simulation with clinical practice will, therefore, go a long way in improving clinical experience and consequently improve patient care (Maran & Glavin, 2003).

     The RIAS system is useful in studies that relate communication to physician satisfaction, physicians’ malpractice experience and patient satisfaction. It also helps in evaluation of different types of communication training programs together with residency training and medical education (Gorawara-Bhat & Cook, 2011). An altered RIAS has the ability to accommodate differences in the present technology environment, as well as constant changes in provider-patient communication. An increase in the knowledge of interaction patterns that lead to better outcomes, causes increased emphasis on development of training programs and other interventions to improve provider-patient interactions in healthcare (Nelson, Miller, & Larson, 2010.

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EHM2 TASK 2: DEVELOPING ORGANIZATIONAL ETHICS AND SOCIALLY RESPONSIBLE BEHAVIOR

Purpose of the CSR

Corporate Social Responsibility (CSR) is an essential inspection for stakeholders in corporate ethics. CSR's purpose is to help organizations enhance and not just operate. Suppose a company actively integrate CSR into their companies. In that case, it is expected that these companies will be aware of the impact their business operations have on society in terms of social, economic, political, and environmental aspects, as well as others. The ideal outcome of using CSR would be that a company would become self-aware and better the environment they work in, among many aspects.

It is typical to break down the impacts of CSR into three separate categories. The pragmatic reason or the theory of how an organization or company can use its power in society in a responsible way. If the company does not use practical reasons, it will risk losing its company (Wang et al., 2020). Ethical reasoning is the obligation and requirement of an organization to do the right thing ethically for its stakeholders and society (Wang et al., 2020). The last of the categories is strategic reasoning. Strategic reasoning is the understanding or reasoning that businesses and consumers depend on each other and will benefit each other in society by providing services and goods, but also with things like bringing jobs to the area.

Primary and Secondary Stakeholders

To make an applicable CSR, primary and secondary stakeholders must be identified when assessing the company's ethical footprint to implement paradigm toys successfully. A CSR cannot appropriately recognize moral effects without identifying both primary and secondary stakeholders. They likewise can't get bits of knowledge for how they can work as an organization to draw in with the climate around them with society.

For paradigm toys, the primary stakeholders will be the people or gatherings who are straightforwardly impacted by choices or activities made by the association. On account of Worldview toys, this would be the workers, the clients and individuals who have contributed or hold a monetary stake and essential partners in the organization.

The secondary stakeholders of Paradigm Toys are people who are not directly financially invested or related to the company's activities and operations. Still, they will be indirectly affected by the company's choices. This group would be parties or individuals and can be many people such as lawmakers or other government bodies or officials, vendors, competitors, and even the media. All of these groups are affected indirectly by their interactions with the organization.

Responsibility to Stakeholders

The primary objective of CSR is driving the higher-up leaders, such as directors of paradigm toys, to create and implement ethical measures that would ensure corporate and social responsibilities to the stakeholders that have been mentioned previously. To be more specific, moral and societal standards must meet the needs of stakeholders and are continuously monitored to support their ethical standards. We can make sure that policies, procedures and practices are in place to ensure that the products delivered to consumers are of the utmost quality and that the options for consumers to get issues resolved quickly if their needs are not satisfied by the products. Many opportunities are measurable and observable that can meet the needs of all stakeholders. Examples of this for direct stakeholders would be ensuring that employees' wages are livable and competitive compared to competitors in the industry and that the salary can satisfy the basic needs of living and other financial markets of an employee. A "what-if analysis" can also be done to understand and determine if dividends for investors would be best served for both the short and long term or if it would be in the best interest of investors to forego bonuses and reinvest any capital that would be used back into the company to serve better the financial needs of said shareholders (Carroll & Brown, 2018).is

When considering indirect stakeholders, there are multiple opportunities in which we can reach out and engage in improvement opportunities for societal and ethical impacts as a company. Being assertive and proactive in fostering relationships with local and government officials is essential. Creating rapport and inviting these individuals to our facilities will show that our best interests are to be allies to the government in movements and agendas that are best for the people they serve. It would also be beneficial to engage in opportunities to lower or reduce the waste of products, such as using recyclable boxes for our toys or recyclable or biodegradable plastics in the toys themselves. These are merely ideas or opportunities that we can use to encourage leaders and directors to use and, in turn, challenge leadership to come up with their unique ideas.

Fostering Ethical Culture and Ethics Analysis

Another equally important aspect of CSR is identifying and defining the ethical culture within the said organization. Ethical culture in any company can be best defined and described when it is continuously worked on and cultivated. Businesses that maintain a culture of ethics by interacting with other organizations by rules, policies, codes of conduct, performance indicators, communication and training programs, informal company proceedings, culture, rituals, ETC. 

While Paradigm Toys works toward establishing and creating a strong and highly regarded ethical culture, it will have many impacts, including on the company's internal and external reputation. The organization's leadership has a unique opportunity to help create this ethical shift and, in turn, create a "trickle-down effect" throughout all other parts of the company to successfully implement this new culture and organization-wide. This will allow them to participate in ethical morality opportunities identified in the CSR. This will also enable them to integrate these opportunities into their routine (Carroll & Brown, 2018). Implementing these changes can be done in several ways, such as positively enforcing the company policy and using incentives that would encourage employees to follow the new culture and standards that are expected of them. Management can also indirectly influence the success of implementing this new ethical culture by continually working towards being respected by those below them or subordinates and continuing to lead the company with courageous and inspiring actions that others will also desire to emulate.

The reason behind an audit of the ethical culture of the company is to "determine if the culture is aligned to support ethical behaviour [via] regular and comprehensive audits of all relevant cultural systems, both formal and informal (Carroll & Brown, 2018). What is discovered in the audit will aid in determining the company's next steps in its action plan. Suppose the company does not meet the standards or is not in alignment with ethical behaviour. In that case, the company will be immediately required to assess and change their ethical culture companywide. It has been shown in studies that "ethical culture will take years to develop and take years to change. A poor ethical culture within the company can be detrimental to its future success. It is critical to the company's continued existence that they are audited frequently to ensure that the company is functioning at the highest standards of society and ethics and that issues are identified early on to adapt and remove harmful components as quickly as possible.

Ethical Dilemma & Potential Solutions

When audits are performed or practised, it is common to find ethical dilemmas within the organization. In reality, all organizations face different circumstances that create the potential for unethical difficulties to arise throughout the organization's life. In the auditing process, it is essential to observe employees and how they embody the company's policies and other business sectors in different companies and their ethical cultures (Etter et al., 2019). One common problem witnessed throughout the auditing process is ethical issues that come from the company's attendance policy. The audit for Paradigm Toys observed the same ethical dilemma relating to the attendance policy throughout the company. 

It appears that one of the reasons that the attendance policy is such an abused company policy is that management often is dealing with the challenge of creating attendance policies, including things as disability standards, sick, and bereavement that can be applied in a diverse number of circumstances as well as universally at the same time (Etter et al., 2019). We often view a policy that can foster good attendance practices for one group of employees, but for others, it can be harmful to another group. Because of this, a loose policy that can apply to the needs and circumstances of most employees will leave areas for exposure and abuse for other employees to take advantage of, which is when we see most of the abuse of the policy.

To make a lasting positive change to the current policy, several avenues can be explored as solutions for the company to put into place. A couple of these solutions will be explained in detail. The first solution would be for the organization to identify and record any suspicions of employees abusing the current policy to make it more generalized or dynamic to locate the loopholes being used (Etter et al., 2019). A second solution that can be implemented would be to create an entirely new policy that considers and addresses patterns or repeat sick times requests and makes requirements for more detailed documentation from medical professionals. This can be investigated if an employee develops a design of calling in sick or taking PTO for longer than expected amounts of time, such as multiple days during the week. The two options posed as solutions stated previously can provide improvements to the current policy that is in place.

On top of the posed suggestions previously stated, there is also an opportunity to find value in performing research and dedicating time to research practices that have been proven successful in other companies who have implemented and adhered to the policy once it was implemented. Another option is to look into the current policy and clarify and use wording that is more explicit and defines when sick time-, bereavement-, short- and long-term disability, FMLA and when can be used and making sure that the policy is clearly explained and easy to understand. It is also essential to ensure that employees have and understand the policy when they are first hired.

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Implementation Proposal

After taking a look at the current policies in place at this company, we believe that the solution is creating a new policy about patterns of abusing or using extensive amounts of sick time and needing additional documentation, as was suggested previously. We feel that it is the most ethical solution because it protects the company from employees continually abusing the policy. Still, this solution also protects those employees who need the procedure by creating an evident and apparent approach from the get-go that will be expected to be followed.

To be able to roll out this solution, we will rely upon our human resources department to assess the current policy and create an amendment to the policy that would incorporate the new requirements of needing additional documentation. It will be necessary to ensure that it was adequately communicated to management and down the chain of command (Nguyen et al., 2018). It would also be beneficial to potentially explore the idea of explaining the new policy in meetings and pieces of training to go over these changes and make sure that all employees are aware of and understand these recent changes. With new employees, it would be essential to implement programs and training to ensure they understand the exercise. Implementing training to change and fix the attendance issue at Paradigm Toys is necessary. When creating a new training program, three different aspects should be considered when forming and building this program. These components are conflict solution, safety, and creating a positive environment.

In concerns to conflict resolution, it can be embodied in different forms. This can be related to multiple aspects such as employee-to-employee conflicts, employee and leadership conflicts and even management to manage disputes. The struggle has been viewed in any form in the organization, and understanding this can help to have better reach by making training programs that can impact many levels of the organization (Nguyen et al., 2018). The training has been seen to be the most valuable in previous situations when it has been done around identifying both sides of the conflict's needs, disappointments and expectations related to the competition, and a clear path for leadership to follow if the conflict is unable to be resolved. Similarly to the attendance policy mentioned earlier, if employees and leadership fail to improve the employee adhering to the procedure, the issue can be escalated to the Human Resource department if further action is necessary.

A necessary part of the training programs is also safety training. Safety training will allow a sense of security that Paradigm toys have protected itself from liability and promoted overall safety for the employees while they are working for the company. At the same time, they are employed by Paradigm Toys (Nguyen et al., 2018). Aside from educating employees on policies and procedures while working with the organization, it is essential to make sure that employees can prove that they understand the policies through safety examinations or employee contracts that prove they were educated and that the employee understands all policies, procedures and practices that are expected of them. It is crucial to ensure understanding of these policies, and helping employees understand the importance of the policy will also help improve adherence to the new safety practices. As employees can better understand the necessity of safety policies, it will create a culture of safety and, in turn, lead to fewer workplace incidences or accidents that could cause issues in the future, such as being exposed to unwanted liabilities or being short-staffed.

As the training is being created to have a flourishing positive work environment, it would directly impact the culture of positivity and overall satisfaction and joy in employees and their current position and standing in the company. As employees create happiness and fulfilment in their jobs and careers with the company, the employee morale, output o and success of the company will improve in many aspects.

For the training to be impactful and beneficial companywide, the activity must be as interactive and hands-on as possible. However, due to the restrictions of COVID-19, many of our employees are currently working remotely and are not permitted to come back to the corporate offices for the time being (Zhang et al., 2019). For this reason, I would recommend that the new training be offered in a hybrid format with a mixture of a PowerPoint presentation and role-playing either over virtual meetings or in person, whichever is most plausible for the company. The display in a combined format will aid in keeping the audience engaged because it requires active participation and holds the meetings and practice activities professional. By including both employees and management in training, it can help all parties to feel comfortable in working together. 

The training should be in an open format, allowing participants to feel comfortable asking any questions they may have and getting answers. It would also be recommended to have handouts for reference if they need to look back on it for information on how to contact human resources or read the policies (Zhang et al., 2019). The programs will be the most successful when the employees are mandated to engage with the course material and digest it rather than just reading through and acknowledging documents. The training should only be the first step in creating successful changes and having them implemented and welcomed throughout the organization. The movement needs to remain relevant. It is vital that management continually use and practice training aspects, such as implementing suggestions and instructions from the training. 

Paradigm Toys and its leaders and management need to embody what the culture is and have it been in line with CSR. By doing this, Upper management needs to develop and audit the culture of ethics, understand and identify potential ethical violations or dilemmas, solve problems, and find ways to address the issue (Latapí et al., 2019). They also should ensure that their ethics training is practical and thorough. By Paradigm Toys keeping high standards for the ethics culture, they have no reason not to be recognized and treated as a highly ethical company. 

The organization has always been proud of the culture of ethics and its positivity and reach in all aspects of society, both directly and indirectly. Paradigm Toys continues to self-evaluate and think critically of themselves in how they can improve, as well as creating steps for the company to take actions to implement changes that may be needed, so they can continue to have these high standards that they pride themselves on (Latapí et al., 2019). They also can influence society and the corporate world to safeguard the reputation that they have strived so hard to create to make it so successful in the industry.

References

Carroll, A. B., & Brown, J. A. (2018). Corporate social responsibility: A review of current concepts, research, and issues. Corporate social responsibility. https://www.emerald.com/insight/content/doi/10.1108/S2514-175920180000002002/full/html 

Etter, M., Fieseler, C., & Whelan, G. (2019). Sharing economy, sharing responsibility? Corporate social responsibility in the digital age. Journal of business ethics, 159(4), 935-942. https://link.springer.com/article/10.1007/s10551-019-04212-w 

Latapí Agudelo, M. A., Jóhannsdóttir, L., & Davídsdóttir, B. (2019). A literature review of the history and evolution of corporate social responsibility. International Journal of Corporate Social Responsibility, 4(1), 1-23. https://jcsr.springeropen.com/articles/10.1186/s40991-018-0039-y?uc=racialjustice 

Nguyen, M., Bensemann, J., & Kelly, S. (2018). Corporate social responsibility (CSR) in Vietnam: a conceptual framework. International Journal of Corporate Social Responsibility, 3(1), 1-12. https://link.springer.com/article/10.1186/s40991-018-0032-5 

Wang, C., Hu, R., & Zhang, T. C. (2020). Corporate social responsibility in international hotel chains and its effects on local employees: Scale development and empirical testing in China. International Journal of Hospitality Management, 90, 102598. https://www.sciencedirect.com/science/article/pii/S027843192030150X 

Zhang, Q., Oo, B. L., & Lim, B. T. H. (2019). Drivers, motivations, and barriers to the implementation of corporate social responsibility practices by construction enterprises: A review. Journal of cleaner production, 210, 563-584. https://www.sciencedirect.com/science/article/pii/S0959652618334516 

EHM2 TASK 1: ETHICAL THEORIES, LEADERSHIP, AND THE ETHICAL LENS INVENTORY

A: Ethical Leader

The ethical leader I will be discussing today is a former manager of mine, Kenny (name changed for privacy). I worked with and under him for under two and a half years, performing numerous functions for the company we were employed with. The two ethical traits that will be evaluated below are his encouragement of personal growth and initiative and his willingness to lead by example.

Ethical Traits Demonstrated

The first ethical trait, encouragement of personal growth and initiative, is a perfect trait to have as a leader. Encouraging initiatives shows that you respect your employees and believe in them. This allows the team members to contribute in ways they may have been afraid to. This will help the project or team by offering new and creative ways to reach the goal.

The second trait, willingness to lead by example, shows that he would never ask his employees to do anything he would not do himself. This, in my mind, separates a leader from a manager (Lemoine et al., 2019). He is not just sitting back, barking orders, but joining in the fight, climbing into the trenches when needed. This shows employees that he is with them, supporting them, not just expecting results from them.

How Was Ethical Conduct Exhibited

The best way to describe how Kenny showed ethical conduct was by establishing trust and mutual respect for colleagues and employees. With this, he treated his team as co-workers rather than subordinates. By treating us this way, he earned more trust and respect from us, the team (Lemoine et al., 2019). Doing this opened doors for conversations, even those uncomfortable, and a flexible work environment that kept the team happy. He could elevate himself when needed, but that was rare.

B: Deontological and Consequentialist Perspectives

The discussion in this section will be related to the accompanying situation: "You are an agent for a clinical gadget organization that produces fake joints. Your organization has fostered a counterfeit knee joint that is more affordable than the opposition and will emphatically diminish recuperating time for patients. Nonetheless, creating a serious and possibly deadly disease in a little level of patients is likewise known. The organization won't unveil this expected secondary effect. You believe you have an obligation to unveil this issue, however you consented to a nondisclosure arrangement when you were recruited and stress over potential repercussions” (Ruehle, 2019).

When going through the scenario, you can see how there can be different perspectives. The two views to be discussed are the Deontological and the Consequentialist. Our textbook teaches us that consequentialists are a philosophical theory in which the person choosing right vs wrong looks at the results based on the consequences that will come from it (Ruehle, 2019). Of this theory, is the idea of the practical, also one of the better-known theories, focusing on an outcome that would benefit society and offer the least harm to those involved? Based on the previous sentence, a utilitarian would look at the situation, comparing the consequences of both sides, with questions similar to those below: 

If I choose to hide the information, who is affected? What if I disclose it?

The answer to both is - everyone will be affected either way.

If I do/don't disclose, what are the consequences?

Do: I could lose my job, affecting my family, but for the patient's benefit.

Don't: Patients could die, affecting their families. It could later affect the company's reputation when the information is found.

The Deontological theory, as described in the textbook, is one in which the person evaluates a situation and bases decisions on values, such as fairness, honesty, loyalty, and respect for human beings or property (Ruehle, 2019). With this stated, this person would look at the outcome with respect for the human being in the scenario (the patient), regardless of what this would do to the company. This, in turn, would push to have the information shared, as it would benefit the patient who may or may not choose to use the product.

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C: Level of Cognitive Moral Development

When it comes to cognitive moral development, you need to look at the situation and ask yourself a few questions to determine its ethicality. Based on the above scenario from section B, I will answer the following questions:

Which action would most likely serve the greater good in society?

This question falls into the post-conventional morality, stage 5 (Kleshinski et al., 2021), due to the ask for the greater good. In the scenario we are analyzing, the answer would be protecting the lives of future patients instead of the company from losing sales.

If I reveal this information, will I get into trouble and possibly even lose my job?

This question falls into stage 1 of the conventional level, obedience and punishment orientation (Kleshinski et al., 2021). The individual may be swayed in their decision and action, fearing retribution or firing if they reveal this information without company-expressed consent.

Which action best aligns with my long-held belief in the principle of justice?

What do the laws say, and what would a law-abiding citizen do?

Questions 3 and 4 would fall under stage 6 in the post-conventional level, universal principles (Kleshinski et al., 2021). This level reviews the laws and possible legal repercussions involved, as well as ethical regulations of justice and the rights of patients.

If I keep quiet, will I get some reward? 

Worrying about a reward would fall under the pre-conventional level, stage 2, about individualism and exchange. The person is thinking about a discussion of a reward for their silence, in the form of a bonus, raise, or related item of value to them.

D: Ethical Lens Inventory

At the beginning of this course, it was asked that I, as a student, take an Ethical Lens Inventory. The selected site offered a quiz called a 'game', in which questions were asked, and then it provided me with results based on my answers. The below sections will be a review of what it revealed.

Preferred Ethical Lens

According to the game's results, my preferred lens is the Blended Responsibilities and Results. This means I use personal reasoning skills and intuition to balance personal principles and long-term goals to meet autonomy. I will always look at my values and past experiences to make ethical decisions.

Based on the positioning of the dot in the graph, I am very near the centre. This suggests that in some situations, I may not prefer any particular lens and would choose my approach to any condition being authentic in the world rather than towards any lens.

Analysis of Lenses per Setting

Based on the situation (work, social, personal, etc.), I feel that my preferred lens is a good fit. I follow the same decision-making whenever I work with my family or volunteer at my rescue squad. I am always learning from my past, wanting to be better in the future, and always trying to be authentic and using personal principles.

Primary Value and Classical Virtue

Looking at my results, my primary values are no preference between Rationality and Sensibility and Mild Autonomy. Because Mild Autonomy is the only one that I do not incline towards, I will discuss this. Having a preference for autonomy over equality means respecting the individual rather than the group as a whole (MacQuillin, 2022). This means that while aiming for personal goals, people may be able to influence me slightly, but I will still make decisions based on myself and a good life. Autonomy also should that I defend the rights of each person involved in a situation, looking for them to take responsibility for their actions and to choose their own goals.

As for a virtue identified, I can choose between temperance and prudence or the ability to be moderate and self-restrained when making decisions about daily affairs. I will discuss temperance or being moderate and self-restrained (MacQuillin, 2022). Abstinence helps me not worry about others' opinions or expectations but focus on myself and my goals. This will allow me to avoid greed and gluttony while maintaining discipline and self-control.

PRIMARY vs SELF-IDENTIFIED VALUE AND VIRTUE

My primary value from Primary Value and Classical Virtue is Autonomy, which falls into the personally identified value of Customer Satisfaction. I will put an individual and their feelings above a group of people in each of these values. I have noticed at work that a customer wants to be heard and handled individually, and blanket responses do not go over well (Sila, 2022). Treating them as an individual fits autonomy very well. My discussed virtue is temperance, which aligns with another personally identified value of self-discipline. I have found myself working towards strengthening this value in myself after a life of freedom in past years. As I better myself, I see self-discipline growing. In doing this, I notice that others' opinions do not matter to me anymore, aligning with the definition of Temperance given in the ELI.

ELI DISCUSSION

In my ELI, it was identified that my Blind Spot is the belief that motive justifies the method or being satisfied with too little good. This is found in my mild preference for autonomy, which means I am reluctant to second-guess guess what people want; I may take the path of expedience and be satisfied with too little good (MacQuillin, 2022). With the above, I may lose sight of my goals and the consequences of my actions concerning those goals. This happens by not holding myself or others accountable for our actions. I will decide that consistency is only for people who do not recognize me and are not essential to my goals. 

MITIGATION OF ELI DISCUSSION

To mitigate my Blind Spot as identified above, I have devised two methods. Those methods are regularly tracking and reviewing my personal goals and enforcing accountability. Setting a schedule to review my dreams and track progress towards them will help me stay on track and hopefully identify where I may get stuck or sucked into my blind spot. Then, forcing myself to remember accountability for myself and others will keep me on a steady path without skipping items, or cutting corners, thus setting myself up for better success and the team for a better overall image.

ELI'S APPLICATION TO ETHICAL SITUATIONS AT WORK

When reviewing my ELI and trying to align it with a situation at work, I think back to when we had an issue with the software offered to our clients. The parent company sent a party-line to use with every involved client, but it was vague and generic. My manager Kenny (from section A), and some team members had a quick meeting regarding the line. We all felt it was unfair to hide information about the outage, as it may have been company-caused and affected our clients negatively and financially (Palanski et al., 2021). We argued back up the chain that we should be more transparent with our clients, especially those impacted the hardest.

This type of discussion and behaviour falls into my value of autonomy. I wanted the clients to be treated as individuals, based on their specific impact, rather than the group, as a whole, with a public party-line.

E. Ethical Lens Inventory Attachment

Attached along with this document is a PDF of my Ethical Lens Inventory.

 

References

Lemoine, G. J., Hartnell, C. A., & Leroy, H. (2019). Taking stock of ethical approaches to leadership: An integrative review of honest, authentic, and servant leadership. Academy of Management Annals, 13(1), 148-187. https://journals.aom.org/doi/abs/10.5465/annals.2016.0121 

Kleshinski, C. E., Wilson, K. S., Stevenson-Street, J. M., & Scott, B. A. (2021). Principled leader behaviours: An integrative framework and extension of why leaders are fair, ethical, and nonabusive. Academy of Management Annals, 15(1), 1-36. https://journals.aom.org/doi/abs/10.5465/annals.2019.0029 

MacQuillin, I. (2022). Normative fundraising ethics: A review of the field. Journal of Philanthropy and Marketing, e1740. https://onlinelibrary.wiley.com/doi/abs/10.1002/nvsm.1740 

Palanski, M., Newman, A., Leroy, H., Moore, C., Hannah, S., & Den Hartog, D. (2021). Quantitative research on leadership and business ethics: Examining the state of the field and a plan for future research. Journal of Business Ethics, 168(1), 109-119. https://link.springer.com/article/10.1007/s10551-019-04267-9 

Sila, I. (2022). A stakeholder view of quality management and CSR through feminist ethics. Quality Management Journal, 29(1), 51-79. https://www.tandfonline.com/doi/abs/10.1080/10686967.2021.2003729?casa_token=tifol8EoBLcAAAAA:SteMy5FLr3ad53lZ0WGGKz0rw19L9Bt5IWp6PD2r_Q1fXvqxJzSR6663NehIYr7NH-pcP8v4PJV_MjY

Ruehle, C. R. (2019, September). Investigating Ethical Considerations of Machine Learning Adoptions Within Organizations: A Systematic Literature Review. In Proceedings of the Ninth International Conference on Engaged Management Scholarship (2019). https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3454120 

EHM2 TASK 3: CODE OF ETHICS AND LEGAL RESPONSIBILITY ANALYSIS

A. Company’s Code of Ethics: Target

A.1.

The subject of corporate social responsibility (CSR) is widely used in Target's broad set of rules. Target worked effectively at conveying what they mean for social, monetary, and ecological change by covering clear goals that express quantifiable results for our planet. Target's set of rules examines a shared obligation to regard fundamental liberties. Fair work rehearses by colleagues and colleagues, focusing on the world through manageability endeavours and putting resources into the networks through generosity and volunteerism. The business naturally includes us with others, and we frequently follow up for the benefit of others (Smith, 2021). Many parts of a decent CSR strategy are examined exhaustively in Target's set of principles record.

A.2.

Target's code of ethics unequivocally addresses how the organization consents to legitimate orders. The implicit principles subtleties the organization's position on keeping a zero capacity to bear resistance with legitimate infringement. Target's broad set of principles urges colleagues to be careful in noticing resistant ways of behaving and supports a commitment to voice concerns when occasions of thought manhandling happen. With wellbeing, security, and administrative drives, infringement of compensation and work regulations, safeguarding individual data, and directing business decently, Target's implicit set of principles underlines prerequisites for all representatives and colleagues to know and consolidate in their day-to-day work the regulations that oversee moral and fair strategic policies to guarantee lawful consistence (Smith, 2021). Target's broad set of principles sums up that when worker activities disregard the law and affect the Objective brand, legitimate outcomes could happen, including punishments, arraignment, fines, and prison time.

A.2.a.

Organizations should observe guidelines, guidelines, and regulations to prepare for extortion and misuse. Rules and guidelines are upheld in the working environment to shield representatives and organizations from arraignment, claims, and fines. Ramifications for organizations with resistant strategic approaches with legitimate commands incorporate criminal arraignment and charges, efficiency misfortunes, penalties, and punishments (Smith, 2021). The ramifications of resistance aren't restricted to lawful punishments. Roundabout expenses for an organization can be huger and incorporate pessimistic reputational costs, business interruption or conclusion, and individual liabilities. The Government Exchange Commission (FTC) directs many regulations and guidelines to safeguard shoppers against organizations with out-of-line and misleading practices (2017). If the FTC finds organizations are resistant to the law, it can force a most extreme common punishment of $40,000.00.

A.2.b.

Target implements internal safeguards to protect business data and the organization's assets. To guard against illegal or unethical theft of property, abuse, misuse, or unauthorized disclosure of non-public and intellectual property, Target put in place protections to manage business operations effectively and avoid disruptions in work efforts. Two ethical safeguards Target enforces to prevent illegal and unethical acts for physical security in the workplace are tracking physical property through asset management and empowering employees through security awareness. 

To ensure the impact of communicating ethically is understood by all employees, Target publishes the Delegation of Authority policy and Social Media Guidelines to enforce the understanding of communicating responsibly. The protections include publishing policies that address Records and Information Management, Information Security, and the Acceptable Use of Information Resources. Other physical security protections include contacting assets protection or corporate security when suspicious or dishonest activity is observed. 

A.3. 

Ethical conduct in the workplace encourages a culture of moral decisions. Leaders are modelling acceptable behaviour to help to drive employee engagement, happiness, and retention. Target's code of ethics is a proposal to comply with the company's code to promote a culture of integrity and accountability. Target's code of ethics does a great job of fostering an ethical culture. Entrenched in Target's code of ethics, employees are equipped with the knowledge and tools to do what's right when ethical dilemmas arise (Giwa et al., 2020). Every topic in Target's code of ethics is a commitment to the values, behaviours, and code of the company and resources that actively reinforce ethical standards. The communication of expectations is a powerful organizational influence tool (Johnson, 2019).

A.4. 

To do what's right, people have to hold themselves and others accountable for how they act and conduct business. Reporting unethical behaviour is a test of character. Leaders encourage teamwork and create structures, processes, and programs that allow a positive ethical culture to flourish. Target gives employees three resources to use to reinforce an ethical culture when raising alleged ethical code violations for deliberate reasons. Target provides employees with a channel to voice concerns, seek guidance, or report violations. Employees have the option to talk with their immediate supervisor or a member of Human Resources. When reporting unethical actions, employees can call the compliance hotline or visit Target's integrity URL (Giwa et al., 2020). Employees can report an unethical violation by email or writing to the ethics and compliance board. Reporting non-compliant violations is handled anonymously and confidentially. Target bans retaliatory behaviour against employees when unethical conduct is reported and takes protection seriously. 

A.4.a.

If I observe an ethical violation, I will follow company procedures for reporting unethical behaviour. I have a great working relationship with my direct leader and would elect to speak with her directly for a directive on how to address suspected unethical acts of conduct. As an alternative option, I would call the internal compliance hotline. I believe a hotline encourages people to report wrongdoings due to its convenience and anonymity. 

B. Three Factors an Employee Might Consider Before Deciding To Report Unethical Conduct Observed At Work

Unethical Behaviors Policy 

Purpose: Unethical behaviour adversely affects workplace morale and contributes to opposing outcomes. This policy establishes guidelines for addressing unethical behaviour by individuals at the organization, including employees and business partners (2015). 

Policy: It is the organization's policy that every team member lives the values, understands the code, follows the law, and takes action when witnessing conduct that undermines the foundation of ethical culture.

Unethical conduct will not be tolerated at the organization. Unethical behaviour is any manner of interaction that harms workplace morale and includes but is not limited to:

Illegal activity and non-compliance with the law;

Hurts the Target brand;

Egregious breach of values, behaviours, and code.

B.1. 

Procedure:

I. Guidelines to Prepare for Reporting Unethical Concerns 

Target's code of ethics requires employees to observe standards of business and ethics by understanding the code requirements, living the values in daily actions, and reporting assumed violations of the code. There are ethical reasons why people blow the whistle on unethical behaviour or actions. Employees must weigh important personal and organizational considerations before blowing the whistle (Turyakira, 2018). An individual assessment should include research to ensure the unethical act is valid. The employee should know why they feel strongly about a given issue, understand the force behind their intentions, consider the moral and financial implications, be prepared for others to learn of their identity contingent on the occurrence and outcome, and ready to live with the consequences, determine the best timing, discuss the issue with family, and have an alternate course of action if the expected outcome doesn't occur.

Organizational considerations should start with gathering the report contents, including the suspected person's name, description of the instance, and any pertinent documentation regarding the violation (Turyakira, 2018). Organizational considerations must include discussing the unethical example with a direct lender, making sure the concern is the correct type of issue to report, compiling evidence to support the claim, reviewing company policy on how to internally report the violation, contacting the company's compliance officer if applicable, be prepared to follow the chain of command, take the concern outside the company if still unresolved, or find other employment. Employees must cooperate in internal investigations of unethical behaviour.

B.2.

II. Reporting a concern

Ultimately Target's ability to enforce the code is based on the commitment of its employees to follow the code requirements and report suspected ethical violations. If an employee decides to blow the whistle on illegal and unethical behaviour, internal and external reporting steps must be followed. Internal reporting steps must include fully following company protocol. Unethical concerns should be reported following the chain of command, starting with the immediate supervisor. If the immediate supervisor has taken part in the problem, the employee should proceed to the next management level. After management has been notified, reporting steps include contacting human resources, the compliance officer or reporting the concerns to senior leaders such as the CEO or president of the company. Reporting can be done in person, by phone, or in writing.

Following applicable laws and regulations, Target will determine whether law enforcement or an external government agency should be notified. Employees must follow external reporting steps if they decide to report unethical behaviour. After all specified internal steps have been performed, the exterior reporting step should report the probable ethical violation to the external compliance hotline (Podgorica et al., 2021). A report will be created, and the appropriate teams will be engaged for further follow-up. Confidentiality and anonymity will remain intact but could be released to the public at some point, depending on the type of complaint and statute.

C. One Advantage and One Disadvantage of Paying Whistleblowers

The False Claims Act enables whistleblowers to bring suit on behalf of any wrongdoer who is currently defrauding the US government (2020). A person considering filing a lawsuit under the False Claims Act on behalf of the government should thoroughly educate themselves on the rewards, protections, benefits, and perils for whistleblowers. The potential rewards and risks associated with whistleblowing can be significant. The rewards system with the False Claims Act encourages people to come forward to help stop wrongdoing and hold offenders accountable (2020). Advantages include moral, ethical, and financial tips. The moral and ethical benefits for whistleblowers outweigh the risks (Podgorica et al., 2021). A whistleblower's entitlement to financial rewards ranges from 15% to 30% depending on the unique circumstances with a successful outcome. Disadvantages could include retaliation from an employer such as loss of employment or demotion, negative feedback or harassment from work colleagues and family members, direct or indirect threats against personal safety, struggles from stress and anxiety with anonymity, and lengthy or unfavourable outcomes.

D. The Changes That Organizations Have Made Based On the US Sentencing Guidelines

Corporate adoption of practical ethics and compliance programs was greatly influenced by the Federal Sentencing Guidelines, developed by the US Sentencing Commission (USSC) on November 1, 1991. Since 1991, the Federal Sentencing Guidelines for Organizations have provided a criminal justice framework to deter and punish organizational misconduct (Patuzzo et al., 2018). These guidelines encourage organizations to implement internal control systems by mandating penalties when internal systems fail. Initially, individual defendants were prosecuted. With the new sentencing guidelines, organizations were held responsible and accountable when a sole employee was indicted on a crime. This changed the way organizations viewed the efficacy of ethics and compliance programs and how they drove their business operations. Developing an ethical corporate culture gained more momentum for the organization's top management (Patuzzo et al., 2018). Compliance initiatives, codes of ethics, and compliance programs provide the standards and guidelines for ethical behaviour. They reinforced adherence to the laws that governed ethical conduct and were critical to avoiding penalties and fines.

When organizations are criminally liable for illegal actions, the liability is based on several factors. Culpability factors used to determine fines under the US Sentencing Guidelines are the organization's size, prior history of similar criminal conduct, and the role of obstructing or impeding an investigation. Penalties are based on a base fine and a culpability score. The base fine corresponds with a determined offence level, the organization's monetary gain, and the ensuing loss caused by the criminal offence. 

The culpability score is increased or decreased based on aggravated or mitigating factors. Aggravating factors are the size of the organization by factoring the number of employees in the organization or the number of individuals involved in criminal activity, prior history of misconduct conduct, and the role of obstructing or impeding an investigation (McPhail et al., 2018). Mitigating factors are whether an effective compliance program was in place at the time of the offence, if the organization self-reported the crime and was fully cooperative, and if they accepted responsibility for the criminal activity. 

Corporate compliance, ethical culture, and ethical decision-making are vital components for the success of every business operation, regardless of the industry. An effective compliance program will protect organizations and employees to avoid fraud, abuse, and practices that inevitably interrupt business operations. Compliance violations can result in fines, penalties, lawsuits, and loss of reputation.

References

Giwa, A., Milsten, A., Vieira, D., Ogedegbe, C., Kelly, K., & Schwab, A. (2020). Should I Stay or Should I Go? A Bioethical Analysis of Healthcare Professionals and Institutions' Moral Obligations During Active Shooter Incidents in Hospitals—A Narrative Review of the Literature. Journal of Law, Medicine & Ethics, 48(2), 340-351. https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/should-i-stay-or-should-i-go-a-bioethical-analysis-of-healthcare-professionals-and-healthcare-institutions-moral-obligations-during-active-shooter-incidents-in-hospitals-a-narrative-review-of-the-literature/8BD07C0B94642107FA962FA07FF22C3B 

McPhail, I. V., Stephens, S., & Heasman, A. (2018). Legal and ethical issues in treating clients with pedohebephilic interests. Canadian Psychology/psychologie canadienne, 59(4), 369. https://psycnet.apa.org/record/2018-55269-008 

Patuzzo, S., De Stefano, F., & Ciliberti, R. (2018). The Italian code of medical deontology. historical, ethical and legal issues. Acta Bio Medica: Atenei Parmensis, 89(2), 157. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179026/ 

Podgorica, N., Flatscher-Thöni, M., Deufert, D., Siebert, U., & Ganner, M. (2021). A systematic review of ethical and legal issues in elder care. Nursing Ethics, 28(6), 895-910. https://journals.sagepub.com/doi/abs/10.1177/0969733020921488

Smith, H. (2021). Clinical AI: opacity, accountability, responsibility and liability. AI & SOCIETY, 36(2), 535-545. https://link.springer.com/article/10.1007/s00146-020-01019-6 

Turyakira, P. K. (2018). Ethical practices of small and medium-sized enterprises in developing countries: A literature analysis. South African Journal of Economic and Management Sciences, 21(1), 1-7. https://journals.co.za/doi/abs/10.4102/sajems.v21i1.1756 

 

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