Category: Communication

Metaphors for Other

Philosophy provides people with a basis to reflect on various aspects of life and the meanings behind them. In Chapter 13 of her book Philosophy of Communication Inquiry, Annette Holba introduces her selection of metaphors for the Other, with one of the major arguments revolving around connections between the metaphors. Chapter 13 explains the meaning of each metaphor and explores the nature of the Other.

Before reviewing the metaphors, it is important to understand the Other, which is only one of two forms. The first form, the capitalized Other, represents unique, personal other, whereas the second one, uncapitalized other, has a common meaning (Holba 250). As Holba uses the capitalized form, her discussion reflects a more individualized approach to the metaphors, of which the author distinguishes four (Holba 251). The first metaphor for the Other is empathy, and it can be described as an experience of another persons experience (qtd. in Holba 253). The next metaphor includes welcome and hospitality and refers to unconditional welcoming as a communicative gesture of saying yes to the Other (Holba 254-255). The third metaphor is acknowledgment, which provides ones attention to others and a space for them in a persons life (Holba 256). The last metaphor is derivative I, and it comes from a place of response rather than telling or dictating, putting the Other before the self (Holba 285). The metaphors reflect the personal relationship between the self and the Other.

Chapter 13 of Philosophy of Communication Inquiry explains in detail the meaning of each metaphor for the Other and makes connections between them. Empathy refers to understanding other persons experiences, whereas welcome and hospitality invite another person to ones life. After the invitation, acknowledgment provides a place for another person, and the derivative I offers a response to that persons happenings. Combined, the metaphors can suggest a way of communicating with other people.

Metaphors for Community

The process of communication involves various groups of people. Chapter 14 of Annette Holbas book Philosophy of Communication Inquiry presents the authors collection of metaphors for social communities. It is important to notice that Holba mentions a social philosophy that emphasizes the importance of society over the individual (264). With that being said, Chapter 13 explores connections between metaphors for Community and relationships within it.

Metaphors for Community explain a basis for communication between people. Holba recognizes four metaphors that are witness, dialogic civility, professional civility, and self in community (265). Witness refers to something more than simply seeing and sharing, as it also involves acting towards the experiences of the Other (Holba 267). Dialogic civility implies for communication to be meaningful, with one person listening to the Other and responding with respect (Holba 267-268). Professional civility originated with orientation to a particular profession but can refer to any community, as it promotes good within any social context (Holba 271-272). Lastly, self in community encourages to know the self and its specific features in a community (Holba 273-274). Metaphors for Community demonstrate particular aspects of communication between the self and the Other.

Chapter 14 assists in understanding the communication process between members of a community. Upon reading the chapter, one can assume that witness refers to the responsibility of an individual to participate in another persons life. When people engage in such participation and start communicating, dialogic civility expects them to be active listeners and responders, whereas professional civility prohibits any impolite behavior. Finally, to participate in communication, one should know themselves and their role within a community.

Work Cited

Holba, Annette. Philosophy of Communication Inquiry: An Introduction. Cognella Inc, 2021.

Introduction

Proper communication of a public policy is very important if the policy is to be successful. Many politicians tend to forget that delivering the message of their policies properly to the public is as important as the policy itself (Woll, 1974, p. 4). In our case, the governor should be careful not only about the designing and implementation of the plan but also about the presentation of it to the general public. An inadequate presentation of the plan could result in a negative reaction from the community and thus, ultimately will increase the chances of failure for that policy. The governor has to carefully choose her members of the task force and then gradually display her initiative to the public.

To whom should the governor seek advice?

The plan of the governor is an ambitious plan but it implies two distinct fields: crime prevention and fighting along with effective management. The first phase of the project is an education-related phase. By education-related is meant a message should be sent to the society that any sort of deviation will be punished and is better for the community that itself engages in crime prevention efforts. The second phase, which begins after phase one is completed, would be a financial re-administration task.

So, one category the governor should seek advice from is public relations, communications, experts. She would also need the advice of experts on community relations, on the group and individual level. Of course, she would need the advice of criminology experts and crime-fighting experts, the police force. Of course, she would need the advice and constant help of a good administration expert. A final round of advice should be done with community leaders that can be helpful for the positive transmitting of the messages to the communities.

Who should be involved in the task force?

From the above mentioned we can understand that she would need a coordinator in her task force. He, or she, is the administrative expert who would be in charge of the administration of the implementation of the plan. He would be in contact with all the other members and coordinate their work. A public relations officer, communication officer, should be also included in the task force.

This person would be in charge of the design and deliverance of the public communications to be made during this campaign. This is an important aspect as he will be responsible for the creation of a positive perception of the plan by part of the community. Without this positive perception from the public, the plan and work of the task force will certainly not be completed adequately. The chief of police should be another member. His experience will be necessary for crime prevention techniques and the effectiveness of police work. In order that the message of crime-fighting be strong, the police force should be as effective as it can. A social psychologist and a sociologist would be the next members of the task force. These peoples experience is needed in creating a plan that is adequate to the communities norms and values and to the common psycho-social relations formed within the society. These specialists also can deal with the re-education process of the detainees and give good advice regarding the issue. One should not forget that if you want that your message to the public has a positive impact you have to play according to societys norms and values, both material and spiritual (Rice & Atkins, 2001, p. 5).

As mentioned above a general coordinator should be appointed to coordinate the implementation of the plan. And finally, other community leaders, like religious institutions leaders, sport and cultural leaders, or other poverty-related or human rights NGOs, must be included as part of the task force. These people are in direct contact with peoples daily problems and can serve as a connection between the task force and society.

The language she should address members of the task force

Another advice would be that the governor takes individual contacts with the people she intends to include in the task force. In these private meetings she would give them a general outline of her plan and then she should focus on the requirements she has from each of these task force members. She should ask for their thoughts and ideas of the specific part of the plan that these people will have to deal with. This way she would make them feel individually included in a big societal project and invite them personally, privately, to give their contribute. This will not just be a different language for each of the individuals to be involved into the task force. It will be a mix of rational explanation of what is expected from them along with an expression of both, the governor and task force member, of their thoughts, ideas and beliefs regarding the present situation of the society and what should be done.

This different mixed language of rationality and willingness of what should be done will not make the members confuse about the project but get them more involved in it. They will have a clear picture of what is expected from them along with a general picture of what is indented to be done and how should all the parts involved in it proceed in order to succeed. But it should be noted that after meeting them personally the governor should make a meeting with all the members of the task force. Here the language used should be less rational as possible and an exchange of thoughts, ideas and beliefs for the situation of the community along with a presentation again of what this plans intentions are.

Announcement to the public

The announcement of the project to the public should be carefully prepared involving not just the presence of the governor herself but of all the members of the task force. By presenting herself along with all the members of the task force she gives a message to the public that his would be an all-inclusive plan involving some of the most prominent figures known to the community. It will be an effort for the community in order to reach at the very heart of its problems, not just some political effort for campaign. The general ideas and thoughts of what is expected from this plan and the purpose of it should be communicated to the public demonstrating that the government, experts of different fields and community leaders are all joint to benefit the society by fighting together the problems affecting it.

This communication will create an atmosphere is something new coming that will be seen as the beginning of the end for the problems of the community. Of course the governor would expect to receive tough questions from the journalists regarding the plan. Most of them can accuse her of trying to use this plan as a sort of camouflage and distract the attention from the real problems of society. Other questions could be related to the effectiveness of the plan.

Barriers of communication between members of the task force

Since all the members of the task force come from different background this will enact as a barrier of communication between them. As mentioned above it will be the duty of a coordinator to coordinate the work between the members of the task force and the other structures implementing the plan afterwards. The main concern here is the barrier of communication between the community leaders group within the task force and the specialist-expert group of it. Since the community leaders deal every day with different problems of the community they tend to have a more emotional language then the experts whom like to use a more rational language for explaining and resolving problems. This situation within the task force can be overcome with the willingness of the members to understand each other, and, especially, it will need the leadership of the governor to keep the task force intact.

Communication of the plan to the operational staff for implementation

The best option would be that the field experts of the task force transmit to the operational staff the part of the plan involving them. For example the chief of police will transmit to the police force the part of the plan which is expected to be implemented by them. The administrator expert can do the same with administrators. But here the task force should be careful and vigilant. During this passing down process there can exists different filters which will reduce the real implementation of the plan. These filters are unavoidable within different levels of the hierarchy (Farmer, 1995, p. 14). In order to avoid this filters the task force members should be vigilant and control the correct understanding and implementation of the plan by the operational staff. Different check-ups can be made for this purpose. The installment of a feedback system also would help in this.

References:

Rice, R. & Atkins, Ch. (2001). Public Communication Campaigns. California, Sage Publications.

Farmer, D. (1995). The language of public administration. Alabama, university of Alabama Press.

Woll, P (1974). Public Policy. Washington, The University Press of America.

Introduction

Local governments, smaller administrative units that encompass the workings of the central governments, federal governments, public, and private organizations are the ones that put together the complex responsibilities of managing the local authorities.

It has been noted that local governments have better understanding of the local need.

Local governments have a better understanding of local needs, and that these local leaders have more understanding of local needs than any one else due to their close interaction (Jae 428). At the same time, local office holders have the ability and insight to make appropriate judgments in solving any crisis that may arise locally.

Due to their proximity to the public, it has been said that Local governments have the ability to provide quick and efficient services as needed than the central government because they managers have ability to work in close relationship and provide supervision at the site of service provision (Jae 430).

This has exposed the local managers to close scrutiny from the public and other stakeholders like elected officials of the city. The close relationship is brought about due to such factors as collection of taxes, cleaning and beautifying the city. It has also been noted that the public also have much confidence in the central governments than any other institutions of government that this confidence translate into commitment because citizens and the local businesses can connect tax payment and development (Robert & John 30). As immediate witnesses to voters needs and reactions, local governments have the

Potential to build community consensus around controversial issues, hence local governments have the ability to communicate effectively with the citizens than any other institution.

As Lisa and Rosemary (89) puts it Local government do not stand alone- they find themselves in new relationships not only with state and federal governments, but often with a widening spectrum of other public and private organizations as well. The results of this re-forming of local governments calls for new collaborations and managerial response that occur in addition to governmental and bureaucratic processes-as-usual, bringing locally generated strategies into play, management technique referred to by public administration experts as Jurisdiction based management (Joaquin 33)

The local authority officials are faced with numerous challenges that are sometimes difficult to navigate such challenges as; being faced with unfamiliar responsibilities, making changes to suit the new goals, fixing old problems created by a predecessor, managing employees, handling high stakes issues across the board, critical decision making, managing broad aspect of works, pressure coming from the public, partners, central governments and politicians, working with people from all cultural background, and many more challenges.

After a thorough investigative research on economic development strategies of 237 cities in Illinois, Indiana, Michigan, Ohio, and Wisconsin, Agranoff and Michael (49) analyzes how city municipal officials do work jointly with other bodies in solving complex issues in the municipalities especially how they (officials) navigated through the strategic partnerships, contractual relationships, networks and alliances, coalitions, committees, consortia, and other councils in meeting the demands and expectations of the public in service delivery.

They came up with a comprehensive and specific collaborative model that encompasses jurisdiction-based based management as the chief embodiment of economic network management (Agranoff & Michael 43). In this model they concluded that:

1. The local manager is portrayed as driven by a strategic rationale based in the jurisdiction.
2. The local agenda takes precedence over extra-jurisdictional demands
3. Actions are carried out jointly by multiple, interdependent organizations, and
4. Problems are resolved by facilitating and furthering interaction inside and outside city hall (Robert & John 35).

Communication with boards and commissions

The municipals managers have uphill tasks in communicating with appointed boards and commissions who may not clearly understand the immediate needs of some proposed developmental programs (Lisa& Rosemary 44). The municipal managers must have long term plans that enables them have long term goals and objectives in the future. (Lisa & Rosemary 48-49).

That is the service levels and outcomes are well organized and chosen that will articulately illustrate both long and short term impacts of these programs (Comfort 11) Once the goals and objective are well coordinated, communicated and integrated across the organizational hierarchy, the board members will have no option but to approve these proposals, since as confirmed by (Comfort 16), most of the problems emanating from the municipal management boards are though lack of appropriate communication.

As a municipal manager, information on resources available should be well understood, that is, the availability of skills/manpower, and finances should be well understood and communicated to the board and commissions (Lindell & Ronald 55).

The municipals senior managers should be in a position to work together. They should be able to share ideas, discuss issues, learn from each other, and be in a position to develop approaches that are consistent with the policy, goals, and aspirations of the municipal council (Meier & Laurence 66) as this would be beneficial in developing a working relationship in the municipality. Again, the administrators should be willing to use entrepreneurial approach to broaden their perspective in the need of the community (Comfort 6). This calls for proper and strategic alliances with the said community members and their groups, public agencies, private and voluntary sectors (Joaquin 22).

Internal staff

Staff management has been said to be the most complicated aspect of management in any organization. As Ellen Schall illustrate in her narration of personal experience as Director of the Department of Juvenile Justice, In any service agency, whether in public or private sector, staff are likely to treat the clients or customers as they believe themselves to be treated. That staff that are treated harshly will, in all likelihood, turn around and impose that harshness on the people over whom they have some power.

It is therefore empirical that for any successful city manager, they should be ready to relate to their employees and staff who have direct link with the public in their daily activities than the manager. The manager and his/her team therefore, in any good management practice, should have good relationship based on mutual understanding. The management should also be willing and ready to evaluate the current workforce and the future needs of such workforce (Robert & John 19).

That is, a long term plan should be put as regards staffing, the skills, and competencies that are necessary in order to achieve the specific goals. In this line, staff development is also an important aspect; the municipal authority should be willing to set a portion of annual budget for staff development purposes that can fill the knowledge gaps (Jae 55). The municipal should also be willing to adopt unambiguous human resource policies where fairly competitive remuneration practices are traditionally practiced across the organizational structure (Robert & John 29-31).

The municipal should also have clear incentive systems that would recognize and reward any staff with good performance. This means the municipal management should have clear performance indicator that would be used to measure the staff performance and reward accordingly. This can also be done through regular acquisition and use of employee feedback hence giving the staff opportunity to constitute the goals and plans for performance and learning (Jae 71)

Ellen advises that whether the manager gets the full support of the political leaders or not, they have to keep in mind the critical importance of finding ways to attend to staff, which is particularly true in the public sector, where other less incentives are less available.

Public health and safety are integral part of any organization. In a municipal setting where the risks such as accidents are numerous, an effective communication should be in place to the employees so that they are able to know what to do when such an eventuality occurs (Lindell & Ronald 81-83). The municipal management should put in place safety measures that would help mitigate any environmental, health and safety risks that may arise within the organization or within their area of jurisdiction. If well communicated, the staff would be able to take precaution and understand their roles and responsibilities in case of an emergency (Lindell & Ronald 85)

In hiring and firing their staff, a clear policy should be in place on the procedures to be followed. They should communicate clearly their plans both to the eternal and internal potential employees. They should know where their key attraction and retention issues are such that they can attract more qualified and competent employees. Their motto should be to be a better employer or put simply as an employer of choice (Comfort 99).

Good communication management practices can never be complete without proper management of information technology. This is a very critical aspect of communication channel (Comfort 132). It therefore follows that a good management practice will embrace technological advancements that would allow their employees/ staff, public and other interested parties have access to all the information that are necessary for the interested party. This will call for installation and integration of both hardware and software in an appropriate and timely manner (Comfort 140)

City leaders, Mayor/Counsel

Municipal managers have the challenging tasks of balancing vested interests from political leaders and the public. As Ellen draws her conclusion on politicians, she says that political leaders are known to seek publicity and recognition for their personal benefit. She says Department of Juvenile Justice was often ignored as an agency. In New York City terms, it was small. It dealt with issues that, in the absence of scandal, did not command attention&..Mayor Koch was known for a focus on himself. This clearly illustrates how politicians are viewed, from a perspective of a management practitioner. Despite all that, she says, one should have the ability to handle authority fairly, with maturity, and to tell the truth up (to the boss), down (to subordinates), and sideways (to peers) (Ashworth 18).

As Ashworth (2) puts it in his advice letter to his nephew, Kim, A large portion of your time will as a public servant will be spent with elected politicians, trying to convince them of policy initiatives or changes you have found to be needed. And part of your experience will include being kicked around or being on the receiving end of abuse from elected officials& All these illustration show how difficult politicians are difficult to deal with.

He goes a head to advise that one has to tolerate all the ungrateful legislators who may be so unkind to him in his service, they (legislators) can close ranks quickly if you do not stay in your allotted subordinate role with legislators (Ashworth 7). That as a civil servant, one should be able to stay calm and in control of himself or herself, and resist any temptation of being impatient and arrogant in dealing with the politicians (Ashworth 9).

And that as a public servant, politicians will always have a preconceived mind that you have taken a position on certain issues. So as a precaution, you should never state publicly your opinion because it will justify their imagined political affiliation. The politicians, according to Ashworth, are always striving to make the voters indebted to them, to seek survival, so they would always want to give favors to the people they know will vote for them. The effective way of communicating the idea of any new policy is though the politicians accomplices, since they have the upper hand in convincing the politician on any issues.

In communicating or presenting the budget to the board, the process should be clear and entails the highest level of transparency (Agranoff & Michael 67). This would provide the board with little opportunity to make unnecessary demands on the budget. The public will also have the opportunity to contribute to the budgeting process (Agranoff & Michael 69).

When communicating the budget proposal to the board and the public, the municipal management must have analyzed and articulated the result they want to achieve within the present financial year and beyond. Such proposals should clearly link the desired result with the allocated resource, giving a clear-cut benefit and risks associated with the budget, i.e. both the long term and short term benefits should be well stated (Agranoff & Michael 102).

The municipality should also be ready to allow their performance be evaluated by the external auditors and apply acceptable performance indicators in assessing their overall performance. This will give the public and other stakeholders confidence in the performance. They can also use these indicators to assess regularly the efficiency and effectiveness of its operations to find opportunities to save costs and better manage expenditures (Lisa & Rosemary 16).

The public

The public satisfaction, even though complex, is seen as the benchmark for measuring the municipal governments success (Robert & John 4). It therefore requires that the public are well acquainted with information about the issues of the municipality that would enable them provide the necessary input in the decision making process. (Robert & John 5). Good management practice therefore requires the management team to get good and appropriate information about the satisfaction level of the citizens (Meier & Laurence 24).

Using appropriate communication technique, the municipal should be able to get sufficient information in terms of prioritization, performance measurement criteria, decision making on the service improvement and delivery criteria (Meier& Laurence 26). By listening to the public, the municipality would be able to respond, in timely manner, to the requests or complaints from ratepayers (Milward, Keith & Provan 201).

According to David Osborne, Senior partner, Public Strategy Group, In todays age of permanent fiscal crisis, public agencies are under constant pressure to reduce costs and reduce quality. Competitive contracting is often the fast way to do that- if it is managed well. As a way of demonstrating good communication to the public, the municipal managers should be in a position to employ critical thinking in the management of the contracts.

They should be ready to show commitments to the coordination and monitoring of the contracted works that would communicate to the public that the proposed services are carried out as planned. This would require them to work as a team with the public and private sector in general (Agranoff & Michael 72).

It has also been noted that some good governance practices come from the way municipal government approach public opinion enquiry. A case in point is in Central America, where a non profit making organization, International Republican Institute (IRI) is partnering with local municipalities managers and mayors to help them strengthen their capacities to responsibly and effectively govern. They use polls and focus group discussions to identify the gaps in the service delivery, thus the municipalities are able to get unbiased information on where the public feel they should be more transparent and accountable.

According to IRI, the data found have helped the partner municipalities to help their plans in a more responsive manner, meeting the local political demands, economic needs and solve social challenges.

For example, according to IRIs findings in Honduras, municipal service delivery democracy highly influences public perceptions of Hondurans. IRI therefore began the process partnering with the local municipals in 2008 to enhance accountability and transparency, through the use of free flow of information between the citizens and the municipal governments, a program being conducted through the new decentralization initiative

It is a common knowledge that many major cities in United States have diverse people from different cultural backgrounds, practicing different cultures with diverse languages. For example, Municipal government of Toronto, a city that has people from diverse cultural background had the challenge of communicating their program of making household container for organic waste for the city residents who are from highly diverse background.

They designed containers after conducting a survey on the diversity of the population, getting statistics of how diverse the population was. They used this statistics to design appropriate number of containers with different names such as green bin, green bucket, and green tub to cater for this diversity. This is a good case for effective communication within a municipal council.

Venders/contractors

These are the group of people or small organizations that supplement the services of a municipality. The municipality may decide to offer the tender for a particular service or supply to another firm. The mission and aim of the municipality could be to offer good service that is cost effective and quality (Robert & John 77). And that the success of the municipality wholly rely on the teamwork, respect and mutual trust, commitment to the highest standard of quality, responsibility, accountability, and dedication (Joaquin 5).

However, the process may generate some controversies due to vested interests from some other board members, who may feel obliged to benefit some of their close allies or friends. As a public servant in the municipality, one is expected to uphold the highest standard of ethics in dealing with such issues (Joaquin 4).

It should be well articulated in the policy statement of the municipality. For instance the policy statement of the Inland Empire Utilities Agency is to maintain the highest standards of ethics from its board members, Executive Managers, and Agency employee with their decision making. Accordingly, it is the policy of agency that Board Members, Executive Managers, and Agency employees shall maintain the highest standard of personal honesty and fairness in carrying out their duties.

In case of any complaint in any procedure that a member of the board may feel was breached, a well drafted complaint procedure should be put in place. For example all the problems related to interference from a board member in the process of tendering should be reported to appropriate channel and that the law must be followed in dealing with such issues. Most of the public offices, controlled by politicians, through their power of influence, are likely to face much verbal complaint than written one. To tackle this problem, people should be encouraged to present their complaint in written form for ease of reference and record keeping (Meier & Laurence 56)

As practiced by Ontario Municipal government in their emergency department (Ontario Disaster Relief Assistance Program, ODRAP), they have put a clear roles and responsibilities they will take in case of disaster in their area of jurisdiction. In case of a disaster, ODRA respond by assisting individuals, small businesses, other small organizations, farmers get back to their feet. However, they have made it clear to the public that this form of help should not be an alternative to insurance coverage and that in such events; every individual should be prepared to carry the responsibility for their losses.

Other city staff/ other departments

In a city there are several of other departments and staffs that the city council would be working with in collaboration to achieve the aspiration of serving the city residents diligently. It therefore follows that such interactions will require appropriate collaboration mechanism for successful and effective service delivery to be accomplished. Some researchers have argued that age of a relationship is a characteristic that distinguishes collaboration from other less intense relationships.

They say that collaboration is a sign of long term interaction of participants in a relationship where trust and clear expectation become important guiding principles (Agranoff & Michael 104). It is also said that assessment of network performance shows stability as an important component of an effective network of social service providers (Milward & Provan 59)

Although common knowledge may have it that collaboration in public management is not new (Comfort 96), its evolution in the municipal management is important since policy making has become a complex issue that require contribution of all sectors of the government to participate fully. In their study of network effectiveness, Provan and Milward (91) found out that some of the poor and ineffective networks had experienced disruptions since they had not had time to develop the necessary trust and established expectations that would guide their activities together as a team, making the service delivery process unworkable and joint goals unachievable.

They also found out that responses as a team to any form of disaster was uncoordinated and poorly communicated across the city, with no particular team in full control and responsibility. And that the disaster recovery process was mainly ad hoc where any member just stepped up to assist in the disaster mitigation (Lindell & Ronald 61)

From these findings it is possible conclude that a proper and effective communication between the municipal managers and other city staff is highly encouraged. This will enhance timely networking and effective service delivery. As Provan and Milward (103) suggests, giving evidence of the incidences in the wake of Hurricane Katrina, that one should not spontaneous take emerging arguments too far and that what might simply look like an urgent collaboration strategies to tackle the disaster may have began several years with long- standing form of relationship that no one can understand how it worked.

It is worth noting that any form of good collaboration is preceded with some long standing effective communication with the collaborators in the social service delivery and that some collaboration emerges due to an individuals managerial skill (Lisa & Rosemary, O. 2008). However, city managers should be willing to initiate good communication channels and establish a bonding relationship with other city staffs. This should be done through the establishment of proper channel of communication and clear separation of mandates in the service delivery process. According to Agranoff & Michael (121), good management practice requires that municipal managers to meet with other city staffs to share tips, advice, and good practice.

In general, effective communication is very essential in the management of the municipalities and other public offices. On that line information technology has become integral part of a good management practice. Mostly called e-government in the reform sector, it has opened up many possibilities in the improvement of internal managerial efficiency and the quality of public service delivery to citizens (Jae 3). Its use has also reduced the red tape to communication in the municipalities (Jae 6).

Following the initiative of the federal government, many local governments adopted Information Technology to enhance communication in order to improve their local governance initiatives (Jae 9). This has seen them making several improvements on their websites and or creating new ones in order to enhance better internal communication procedure and external managerial services improvements (Jae 8).

However, many researchers argue that some of the constraints faced by these municipalities are due to their insufficient fund, privacy issues and technical know- how (Jae 5). However study also suggest that municipal government that have positively embraced the information technology have got good response from the partners and the public in general, and that their service delivery process has improved tremendously (Jae 7)

According to (Meier & Laurence 19), good management should evolve around the set objective, where decisions are made, goals are identified, priorities and posteriorities are set, and organization structure designed for specific purposes of institutions. Two, participative management is important to enhance good understanding throughout the organization (Meier& Laurence 89).

This can be done through bringing out the basic views, basic dissents, the different approaches to the same task and the same problem within the organization (Meier & Laurence 98). Another is that an objective feedback can be give by managers to the junior staff in the process towards achieving the municipals objectives and goals (Milward & Provan 43). Overally, literature has it that management by objective in municipalities has proved an effective way of disseminating the services and has enhancing communication within these councils (Milward & Provan 55).

Conclusion

In Local government, just like any other public service, require proper and adequate communication so as to alleviate lack of information dissemination. That plans and objective must be communicated appropriately to the board, public should be brought into full view of any plan to uplift their standards of living, the conflict o interests should be dealt with before any contract is given to any organization or body Meier & Laurence 41)

Again, as (Ashworth 14) puts it, as a public servant, one should be prepared to face all sorts of unexpected situations, from the hostile to bizarre, from intimidating to outrageous. He illustrates, using his own experience that public service career aspirant should be ready to withstand all the negativities and judgmental nature of those you encounter like politicians. That a successful career in public service demands discipline, and informed thought, intellectual and personal growth and broad reading.

Works cited

Agranoff, R. & Michael M. 2003. Collaborative Public Management. Washington, DC. Georgetown University Press.

Ashworth, K. 2001. Caught Between the Dog and the Fireplug, or, How to Survive Public Service, Washington D.C, Georgetown University Press.

Jae, M. 2002. The Evolution of E-Government among Municipalities: Rhetoric or Reality? Public Administration Review, Vol. 62, No. 4, pp. 424-433, Blackwell Publishing on behalf of the American Society for Public Administration. Web.

Robert, R. & John, E. 1992. A Foundation of Good Management Practice in Government- Management by Objectives, Public Administration Review, Vol. 52, No. 1, pp. 27-39. Web.

Central America Good Governance- Advancing Democracy in Guatemala and Honduras. Web.

Joaquin, R. 2005. Collaborative Public Management- New Strategies for Local Governments, the Journal of Federalism 35(4):637-639;

Lisa, B & Rosemary, O. 2006. Parallel Play, Not Collaboration: Missing Questions, Missing Connections. Public Administration Review.66 (supplement to issue 6): 161-167.

B Lisa, B & Rosemary, O. 2008. Big Ideas in Collaborative Public Management. New York. ME Sharpe.

Comfort, L. 1993. Self-organization in Complex Systems, Journal of Public Administration Research and Theory, Vol. 4(3): 393-410.

Lindell, M. & Ronald W. 2000. Household Adjustment to Earthquake Hazard: A Review of Research, Environment and Behavior. 32(4): 461-501.

Meier, J., & Laurence, J. 2001. Managerial strategy & behavior in Networks: A model with evidence from U.S. Public education. Journal of Public Administration Research and Theory 11:27194.

Meier, J. & Laurence, J. 2005. Managerial Networking: Issues of Measurement and Research Design. Administration & Society. 37 (5): 523-541.

Meier, J. & Laurence J. 2006. Modeling Public Management: Empirical Analysis of the Management-Performance Nexus. Paper delivered at the Empirical Study of Organizations and Public Management, Texas A&M University

Milward, H. & Keith, G. Provan. 2000. Governing the Hollow State, Journal of Public Administration Research and Theory. 10(2): 359-380.

Robinson, E., Britt, B & Kelley, S. 2006. The Development of Collaborative Response to Hurricane Katrina in the Dallas Area. Public Works Management & Policy.10 (4): 315-327.

The tongue is vital for communication and understanding of the ideas, values, emotions, and desires of the other people. It could be assumed that language creates new conceptions of self-identity, as it is an essential component of ones personality and can change ones perceptions, attitudes, and values. The analysis of this phenomenon is conducted with the help of the texts presented in the reading section. In the article How to Tame a Wild Tongue by Gloria Anzaldua, the author describes her personal experience in learning as a Spanish speaker, who experienced a change in attitude due to acquiring a new language (Anzaldua 2951).

In turn, text Speaking in Tongues by Zadie Smith focuses on the impacts of the language on ones traits and provides an example of Barack Obama to show an ability of a person to successfully combine different characteristics (Smith 2). The article is entirely different from the first one, as Smith is a native English speaker (1).

Firstly, the opinions of Anzaldua are discovered. Anzaldua tells a story about different Spanish dialects, which are present on the territory of the United States of America (2951). In this text, the author, as a Spanish speaker, refers to the fact that repeated attacks on our native tongue diminish our sense of self (Anzaldua 2951). She emphatically claims that language is a part of her identity. Anzaldua sees a strong connection between Spanish language and her personality, I am my language (2951). This fact helps her save the memories of her childhood and develop the values, which are a part of her family.

Anzaldua also mentions one more interesting fact related to a change of the attitude and persons values when choosing another language (2951). English, not Spanish, will be the mother tongue of most of Chicanos and Latinos, she claims (Anzaldua 2951). In this case, it can also be concluded that people tend to change their attitudes and standards by choosing a different language. The parts of the values still exist, but it is impossible to maintain their significance on the same level as they used to in the past. A combination of languages helps to create a unique identity with a critical understanding of the world from a different point of view.

Speaking of Speaking in Tongues, Smith also addresses the idea of the uniqueness, and the tongue influences the attitude of a person (1). However, his perception is different, as he is a native English speaker. Many thousands of men and women&have sloughed off their native dialects and acquired a new tongue, he says (Smith 1). In general, it is clear that people forget about their cultural principles and morals and acquire a new identity with a new language. It seems to have an adverse impact on society, but people still get some benefits from this transformation.

They gain a new ability to combine several mentalities in one and to understand the desires and wants of the other cultures. Barack Obama is one of the bright examples. Despite his cultural background, he can see the world from a dissimilar perspective (Smith 2). In this case, it could be concluded that the tongue serves several duties, as it keeps the old personality and creates a new one at the same time.

It could be said that the tongue is an essential element in the personality generation process, as people tend to adapt to the change of the primary spoken language. Moreover, the tongue has a significant influence on ones values and perceptions. It might even question the existence of the native langue, as a person, who is living in a foreign environment, might experience changes in personality, as the spoken language is also different.

Language is one of the mightiest and most influential tools of leadership. Leaders use the power of speech and language to affect their followers, explain ideas and beliefs, and gradually change the world. Many famous leaders struggled for justice and the well-being of their people: among others were Nelson Mandela, Susan B. Anthony and Liliuokalani. Using strong, argumentative, and persuasive language, leaders force people to realize the inequity in societies and empower followers to confront injustice.

Interestingly, mentioned leaders used to apply the same proclamation: their speeches were based on belonging to citizenship. As concerned citizens, they claimed fair rights and justice for everybody. Mandela talked about the equity of all South African, and Anthony argued that women should vote as citizens of the USA. Liliuokalani was fighting for the sovereignty of Hawaii, calling herself a humble citizen (Temmen 348). Their claims were understandably supported by solid evidence and reasoning.

Diction may be defined as the art of speaking; speech should be expressive, clear, and understandable. Mentioned leaders diction affected followers: they heard leaders thoughts and wanted to hear more. Language has significant power, and it may be highly inspiring and engaging. Leaders used rhetorical devices such as logos, pathos, and ethos to brighten and make their speeches more persuasive. Logos appeals to logic, and Anthonys fight for womens rights involved the usage of this device. In her speech, Anthony claimed that any class of people without the right to vote was a degraded class in the labor force, appealing to the working-class audience (Styer 405). She also used ethos, appealing to ethics, promoting fair treatment for all people, anti-slavery and social equality. Pathos, an appeal to emotion, was frequently used by Mandela before going to prison: his early speeches were sharp and passionate (Arora et al. 242). The use of rhetorical devices helped those leaders to strengthen their arguments and highlight essential ideas.

Leaders must use strong claims supported by relevant evidence and reasoning to be heard and effectively confront injustice. The examples of Mandela, Anthony, and Liliuokalani reveal the power of speech, the opportunities, and the changes that may be reached with the help of persuasive language. Speech should consist of strong arguments supported by evidence and reasoning. While intensifying the claims is possible with the help of diction with appropriate rhetorical devices.

Works Cited

Arora, Poonam, et al. Broadening the frame around sustainability with holistic language: Mandela and Invictus. Humanistic Management Journal, vol. 3, no. 2, 2018, pp. 233-251. Web.

Styer, Meridith. Susan B. Anthonys Extemporaneous Speaking for Woman Suffrage. Womens Studies in Communication, vol. 40, no. 4, 2017, pp. 401-418. Web.

Temmen, Jens. So it happens that we are relegated to the condition of the aborigines of the American continent: Disavowing and Reclaiming Sovereignty in Liliuokalanis Hawaiis Story by Hawaiis Queen and the Congressional Morgan Report. Postcolonial Justice, edited by Anke Bartels et al., Brill, 2017, pp. 333-355.

There are several modes of communication in linguistics, including written and spoken words. Each of these modes has a potential list of advantages and disadvantages. In this particular case, one of the quick and easy solutions would be to just call a friend using the telephone. If the subject matter is long and complicated, it may be better to talk it over with a friend to gauge their reaction and convey all the necessary emotions. Better transfer of emotions is one of the benefits of spoken word, compared to a written one. However, there is a higher level of possibility of misunderstanding or misinterpretation of some words due to network connection or speech impediments. This disadvantage becomes an advantage in the written word modes of communication, like a physical letter or an email note. The main difference between the two is the speed of their delivery. On the other hand, letters are now viewed as a more sentimental and special way of showing care.

It is a common belief that people spoke more correctly in the past. However, this question depends on various factors, including the different attitudes and media traditions. First, this usage of more formal speech varies from country to country. In the example of the US, in the middle of the last century, it was less acceptable to speak informally in public. This phenomenon was portrayed in media and movies that were seen as an elevated and formal form of art. Compared to the current age, filmmakers now prefer to show a realistic depiction of peoples everyday informal and flawed speech. These factors form the basics of the common belief.

Work Cited

Haber, Janosch, and Massimo Poesio. Patterns of polysemy and homonymy in contextualized language models. Findings of the Association for Computational Linguistics, 2021.

In recent decades, the amount of information in the world has grown at an alarming rate. This complicates the process of finding the main and useful facts in the entire data stream. However, there are areas in which public awareness is needed: health care in particular. For example, the American Heart Association (AHA) has been trying to educate the public about heart disease for several years (Wilcox, Cameron, and Reber 134). As it turned out, their attempts were practically unsuccessful.

There are several ways to draw the attention of a broad audience to medical issues. First, it is required to attract any audience, in particular, passive ones. To do this, educational campaigns need to be loud, unusual, and attention-grabbing. These include, for example, large and bright banners with catchy slogans. Second, it is necessary to make the messages easy to understand. To do this, one needs to study the target audience and understand their age, interests, and other characteristics. This will help determine what is most important for them and use it in the message to the public.

Third, it is undoubtedly necessary to use multiple channels of influence on people. Free options involve the Internet: for example, posts on social networks and videos on special platforms. It is important to create engaging content and reach the widest possible audience. In addition, it is necessary to create interesting learning events to attract the largest number of people. Fourth, word of mouth can be a powerful way to educate people. To do this, doctors may ask patients to tell their close people about their services and about heart disease in general. If doctors provide quality services, then patients will gladly recommend them to other people. All of this will help raise public awareness of heart issues.

Reference

Wilcox, D. L., Cameron, G. T., and Reber, B. H. Public Relations Strategies and Tactics, 11^th ed. Pearson, 2014.

In most cases, aging is an inevitable stage of peoples life span, which is accompanied by various noticeable changes in the body, psyche, and the perception of themselves and the surrounding world. In this regard, the primary role of registered nurses (RN) is to determine patients conditions and help them feel better and comfortable through offering sound practices. In particular, the most shared physical changes are related to the cardiovascular, nervous, urinary, and endocrine systems, muscles, bones, joints, eyes, and ears (Mayo Clinic Staff, 2020). For instance, elderly clients can have hypertension, Alzheimers disease, weakened eyesight, fragility, and arthritis. Concerning psychological and social dimensions, cognitive skills, especially memory and concentration, also experience impairment. Patients mostly feel solitude, low interest in daily activities, anxiety, and even depression. Sexual performance and needs may also face significant problems, including the inability to enjoy sex, impotence, poor erection, and vaginal dryness.

Mayo Clinic is one of the best community resources delivering a comprehensive range of health prevention, promotion, and maintenance services. Specifically, the facility in Rochester provides services on preventing and treating Alzheimers disease, arthritis, menopause, osteoporosis, incontinence, high blood pressure, and sleep disorders (Mayo Clinic Staff, 2019). Considering Maslows hierarchy of needs, the elderly should possess such health strength as good relationships with family, since love and belonging are among the most acute needs of individuals at this age. RN can help relieve a sense of loneliness by demonstrating empathy and respect for the older persons and facilitate communication through verbal and documentation skills that eliminate barriers while exchanging information.

Maintaining appropriate communication with a senior person is a necessary nursing implication since it promotes patients motivation, enhances interest in lif, and alleviates anxiety and depression. Interaction can also teach individuals to be more adaptive or independent and boost a connection between older people and family. Thus, research on the impact and development of useful practices that will facilitate communication between nurses and patients is considered to be beneficial for RNs in the geriatric practice.

References

Mayo Clinic Staff. (2019). Healthy aging: Beyond 50. Mayo Clinic. Web.

Mayo Clinic Staff. (2020). Aging: What to expect. Mayo Clinic. Web.

Initially, I already understood that it was important for nurses to communicate with patients to create a more favorable environment for recovery. Moreover, this was confirmed by many articles I studied and my personal experience communicating with medical staff. All of them proved that communication is necessary for nurses to ensure positive results in the treatment of patients and accelerate recovery. In Markus Engels book, he also describes his experience of patient care and explains the positive and negative communication patterns that can affect patients health. He showed by his example that compassionate interactions with patients are an essential tool for treatment. However, in many institutions, communication with patients is formal due to the high burden on nurses.

Marcus has an unpleasant interaction with many orderlies in the chapter Introduce yourself, Regardless of Your Role (Engel, 2010). In this chapter, many orderlies prepare Marcus for preoperative preparation, but none introduce him to them; instead, they start touching him and going about their business (Engel, 2010). Marcus is blind and cannot see what will happen to him. This makes him uncomfortable because he does not know who they are. The chapter Unpleasant Wound emphasizes how to communicate with patients. The nurse who cleans Marcus wounds calls them terrible wounds that need to be treated in this chapter (Engel, 2010). Marcus was uncomfortable when the nurse said the scars were ugly, as if it was his fault. Reading this book reinforced my beliefs about how nurses should interact with their patients. I have always believed that a nurses job is to build relationships with their patients so they feel at ease, trusted, and ready to help. The most important thing I learned from this book on communication is always to communicate who I am and what I am doing here, as well as to monitor how I formulate my thoughts.

Studying the Humanistic Psychosocial Concepts for Nursing course helps me understand that the patient needs to be looked at as a person, not as an anamnesis. Initially, although I understood that it was essential to communicate with patients, this was needed more in order not to miss the appearance of new symptoms or not to start the old ones. However, in learning, I realized that it is psychological and emotional communication with important people. It is essential to understand that illness and hospitalization can be terrible, traumatic experiences for patients. Upon admission to the hospital, there is a severe disruption of life in its routine, and now they must begin to perceive the hospital as their home as long as they remain there as patients. Listening to patients concerns, even if they seem insignificant in current exposure, can prevent more severe problems that could jeopardize patient safety.

Furthermore, in the future, I will go beyond the narrow medical aspect of treating diseases and strive to improve the effects of hospitalization stress on patients by providing appropriate communication, support, and empathy. This is also important for hospital staff because, in my opinion, when doctors communicate better with each other, coordination of care and compliance with the treatment regime improves. Interaction between medical team members affects the quality of working relationships and job satisfaction and impacts the patients sense of security. Effective communication between the patient and the nurse contributes to compliance with the treatment regimen and more active self-control of long-term chronic conditions.

Reference

Engel, M. (2010). Im Here: Compassionate Communication in Patient Care. Orlando, FL: PhillipsPress.

Introduction and Problem Identification

It is impossible to imagine a competent medical system without adequate communication. Medical institutions whose leaders promote effective communication among their followers find it easier to solve emerging challenges and improve patient outcomes. Thus, the purpose of this project is to explain how to achieve effective communication between nurses, patients, and their family members, leading to better outcomes. The project will present background information on the issue, literature review, and proposed action plan.

Problem Statement

The problem statement is articulated with the help of the Johns Hopkins Question Development Tool as the guide (Johns Hopkins Hospital, n.d.). Effective communication is significant because it allows nurses to provide their patients with information on their health, treatment methods, and preventive measures. Furthermore, nurses should also address family members to contribute to better outcomes. If a medical establishment does not have effective communication strategies, possible issues are likely to emerge. It is a clinical problem with an educational focus that can result in effectiveness concerns, unsatisfactory patients, and variation in practice. The challenge of ineffective communication still remains a significant problem in different units. Thus, it is necessary to formulate a PICO question and conduct a literature search to identify the most suitable solutions. The initial EBP question is whether effective communication between nurses, patients, and their family members can make a difference regarding the length of stay.

Problem Background

When individuals are unable to cooperate and pursue a common goal, the chances are high that they will ignore the effectiveness of the established care procedures and create room for medication errors. Portney (2020) argues that poor communication remains one of the major causes of poor health outcomes and preventable deaths in different medical facilities. Furthermore, Tulsky et al. (2017) admit that poor communication by health care professionals contributes to physical and psychological suffering in patients (p. 1361).

Stakeholders

This project involves several stakeholders whose roles can be instrumental in changing the situation. The first category of stakeholders is that of all medical professionals whose goals and experiences depend on the nature of communication. The second group is comprised of patients and community members who expect to receive high-quality services from their respective health units. Finally, medical units can also suffer from ineffective communication because unsatisfied patients can create a negative image of the health care establishment.

PICOT Question

The PICO(T) question formulated for the project is clear and concise. In hospitalized patients suffering from infection diseases (P), does creating regular simulation and role modeling rounds to contribute to communication excellence between nurse, patient, and family to discuss patient health status and progress (I), compared with irregular patient status reports (C), allow for better communication and increase the quality of care by reducing the length of stay (O) within the admission period (T)? This articulation stipulates that the proposed search terms include nursing, patient, and communication. The terms and the year of publication form the basis of a search strategy to use. The given question reflects the current evidence because it addresses a topical issue. Finally, the PICO(T) question shows that the project is aimed at determining how and whether education communication can contribute to a shorter duration of stay among hospital patients.

Literature Support

Review of Literature

At this stage, it is necessary to find literature that can answer the question above. It was decided to look for the articles in the ScienceDirect, PubMed, Springer Link, and NCBI databases, and ten suitable studies have been found. The Johns Hopkins Individual Evidence Summary Tool demonstrates the analysis and the reliability of the sources (Johns Hopkins Hospital, n.d.). The following information will show how it is possible to address the problem under consideration.

On the one hand, one should state that ineffective communication between nurses and relatives of patients can result in sadness, anger, and anxiety (Chan, 2017). Furthermore, Crawford et al. (2017) argue that cultural differences resulting in communicating inefficiencies can lead to adverse outcomes. At the same time, numerous patients admit that they appreciate the attention paid to them by nurses Chan et al. (2018). On the other hand, Curtis et al. (2016) stipulate that communication facilitators decrease family distress and reduce hospital length of stay. Furthermore, Wocial et al. (2017) also mention that effective communication is associated with reduced length of stay. That is why the following articles will explain how it is possible to improve nurses communication skills.

Blake and Blake (2019) and Bussard and Lawrence (2019) mention that nursing lab simulation and role modeling are a sufficient way to increase nurses communication skills. Donovan and Mullen (2019) stipulate that simulation programs result in higher nurses confidence while working with patients. In addition to that, Bullington et al. (2019) state that a phenomenologically-based communication training approach helps nurses train communication skills. Finally, Dittman and Hughes (2018) also say that nursing participation in multidisciplinary patient rounds increases communication proficiency.

Intervention Description

Proposed Intervention

The proposed intervention is to organize regular simulation and role modeling rounds to contribute to communication excellence among nurses. It is necessary to develop a learning plan that will guide the rounds above. They will teach nurses how to include their patients and encourage family members in communication to offer proper support. This intervention will go further to allow key stakeholders to be involved in improving the level of communication.

Setting

The targeted setting for the proposed study is a healthcare unit. The hospital will have caregivers, practitioners, nurse leaders, and health managers. The facility will also identify patients who are expected to participate throughout the study period and benefit from effective communication. In this setting, it is necessary to make sure that patient length of stay is decreased, and their satisfaction can be an additional positive outcome.

Barriers

Several barriers have the potential to disorient or affect the success of the proposed project. Firstly, the introduction of the new educational program means that a change model will be necessary. Secondly, the issue of time might affect the nature and success of the proposed project. This outcome is possible since most stakeholders will be involved in critical processes aimed at improving the experiences and results of the targeted patients.

Outcomes

The given project is going to result in a few essential outcomes. Firstly, it is likely to increase the quality of care by reducing the length of stay. Secondly, patients and their family members will be satisfied with the work of nurses, which will combine their efforts to recover. Finally, it is more likely that improved communication between nurses and patients will result in better health outcomes of the latter.

Action Plan

It is reasonable to take some action to improve the situation, which implies a few milestones. Thus, Milestone 1 means that it is necessary to find general information and develop educational programs. Milestone 2 refers to organizing the educational environment, including the necessity to make sure that all nurses attend simulation and role modeling rounds that will occur once a week over a 3-month period. When it comes to Milestone 3, a critical task is to present the materials to the attendees. The rounds will explain the potential to improve communication skills to reduce patient length of stay and offer role modeling exercise to develop these skills. Finally, the assessment of knowledge is performed at Milestone 4, which is necessary to check whether nurses are ready to implement the theoretical information in practice. The details of this action plan are presented by the John Hopkins Action Planning tool (Johns Hopkins Hospital, 2017).

John Hopkins Nursing Evidence-Based Practice Model

Introduction to Model

This practicum project uses the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model as the basis for all activities. The process of this model has 19 steps, which are conducted in three phases abbreviated as PET, as shown in Figure 1.

The initial stage, Practice Question, includes steps from 1 to 6:

1. The first activity is to recruit [an] interprofessional team (Dang & Dearholt, 2017, p. 46). It is vital to invite members who are directly related to the problem. This implies the participation of nurses and physicians as frontline workers, as well as patients and families, pharmacists, and local committee members.
2. The next step is to define the problem  this stage does not imply that the solution is already known to the team; members discuss the issues with each other and other stakeholders to see how the problem should be formulated.
3. The third step is to develop the EBP question  it can be focused on learning, operational, or clinical change. Moreover, the project often benefits from a foreground question more than a background question (Dang & Dearholt, 2017). The latter does not offer any solutions, while the former outlines possible ways of improvement. The established way of creating an effective question is PICO(T) mnemonic (Dang & Dearholt, 2017).
4. After developing the question, the team should identify relevant stakeholders. Many people are involved in the improvement of clinical practice, and they should be informed about the project and its steps. Stakeholders include staff, managers and leaders, discipline representatives, patients, families, policymakers, advocates, and organizations.
5. The fifth step is to determine who is the leader of the project; this position implies responsibility for facilitation and communication. The leader should have experience in the field of the problem and EBP question as well as in working with interprofessional teams and understanding the organizational structure.
6. The final step in the first part of the process is to schedule team meetings. The team should pick and reserve a room with adequate space, ask members to bring calendars, choose a way to record information, and establish a timeline. Project resources and files should also be considered to keep track of all data.

The second phase, Evidence, covers steps 7-11 and deals with data:

1. During this step, the team determines the type of evidence to use and members responsible for the process. Then, such sources as the librarian (or a health information specialist), experts, practice guidelines, standards, organizational data, quality improvement data, patient surveys, and more are utilized.
2. The collected evidence is appraised  each piece is investigated to determine the level and quality of information. In the PET process, the evidence is rated on a 5-level scale, where level I is the highest (Dang & Dearholt, 2017). It is necessary to discard evidence pieces that are low both in quality and level.
3. The remaining information is summarized, distributing data by level of evidence. The findings that are relevant to the EBP question are recorded in a table with an appropriate level.
4. Next, the evidence is investigated on each level to determine the quality and strength of findings in each group. The team looks at the overall volume of data and whether it is enough to make a strong argument for change.
5. After appraising the evidence, the team develops recommendations for change based on the final synthesis of evidence. The advice can be compelling, good and consistent, good but inconsistent, and insufficient or nonexistent; it is recorded on the Synthesis Process and Recommendation Tool (Dang & Dearholt, 2017). As a result, the decision is made to either recommend a change or investigate further.

The final phase of the project is Translation, which includes steps 12-19:

1. The twelfth step is to decide whether the recommendations are fit for translating into the selected setting. In some situations, change, although positive for patient outcomes or other quality measurements, is not possible for the organization due to time, money, or other constraints.
2. If the recommendation is a good fit for the setting, the team needs to create an action plan. It may include the development of a new standard, system, pathway, or process, implementation timeline, feedback channels, and other details.
3. The team needs to secure support for the project, working with department leaders and organizations to gather financial, human, and material resources.
4. The implementation of the developed action plan is the following step. Here, communication with stakeholders and education are vital to ensure adherence and understanding.
5. Next, outcomes of the implementation must be evaluated, using the information from the Question Development Tool.
6. The team has to report the findings to stakeholders to disseminate new knowledge and ensure that all valuable members of the community are informed of successes, problems, and barriers.
7. After considering the outcomes of the project, team members can identify new steps for change. These can incorporate new EBP questions, lessons, calls for additional research, training, new tools, and information dissemination.
8. Finally, the team needs to disseminate findings to the organization as well as sources of knowledge, such as clinical journals and conferences.

Use of Model to Support Project

The step-by-step explanation of the model and its attention to detail makes the JHNEBP process extremely useful to clinical change projects. The model has been implemented in this project on all stages, including the formation of the problem and the EBP question. In this case, the PICO(T) tool described in the third step was used for the project. Moreover, evidence gathering was also conducted following the models steps  the literature review appraising the knowledge about simulation and role modeling rounds corresponds to steps 7-11. As a result, the projects authors proposed the intervention for the chosen setting and found barriers to change as well as milestones for completion. The JHNEBP process will guide the project in the next chapters, helping to create an action plan and assess its outcomes. These steps allow the researchers to see which activities are the most important on each stage of the intervention  the JHNEBP defines the roles of the interprofessional team and the importance of information analysis and feedback.

Implementation

Based on the JHNEBP model and the evidence collected above, the recommendations are to organize role modeling and simulation rounds for nurses to increase communication quality. First, the selected team for the EBP project will develop an educational program for nurses to explain the importance of role-playing for communication prior to starting simulation rounds (Reeves et al., 2017). The educational program will address the importance of rounds in improving nurse-patient communication. Then, the nurses will be informed about the projects approach to learning  simulation and role modeling are forms of active learning that offer realistic experiences and facilitate real-world interactions and boost nurses confidence. Finally, the participants will receive information about their upcoming simulation rounds, including the schedule, simulated ward rounds content, and the feedback channels and a platform to share their reflection.

Then, the team will schedule simulation rounds for each nurse to occur once a week for three months. While the rest of the week will remain unchanged for participants, one day a week, they will meet with the designated team member (instructor) for a simulation round. Each simulation will last no more than 30 minutes, and the debriefing will take up about 15 to 30 minutes as well. The topics of conversation will include patients current state, progress, questions and problems, and pre-discharge review. The team will create a feedback channel for nurses and patients to collect information about outcomes and gather quality improvement data. For nurse participants, the instructor will guide the first reflection in a focus group to facilitate a discussion of training benefits and challenges. In the following reflections, the participants are encouraged to lead the discussion. The nurses will pick the main points at the end of each debriefing, which will be regarded as feedback for the project. For patients, patient satisfaction surveys will serve as the main channel of information.

Finally, the team will review the collected information and appraise it, setting new questions. The gathered data will include patient satisfaction survey results (with the focus on the quality of nurse-patient communication) as well as the length of stay for patients who were and were not included in the project. The PICOT question identifies the desired outcome as better communication and reduced length of stay; therefore, these two data sets are essential for the project. Aside from this knowledge, nurses feedback will be evaluated to present the set of positive and negative comments about the implementation and outcomes. Upon documenting and discussing the results of the study, the team will disseminate the knowledge to stakeholders. A formal presentation will be held for medical professionals, management, and advocates (with an electronic version for referencing), and a poster presentation with highlights will be available for the general audience.

As for the timetable of events, the preparation stage for the rounds to start should be completed in two months, during which team members make the schedule, gain approvals from the unit leaders and management, and inform nurses about the upcoming simulation rounds. After the three months of the intervention, one month is designated for feedback appraisal and final discussions; overall, the project should take up six months.

The project is feasible because it does not take up much of the nurses time  they will contribute about one hour once a week for three months, allowing them to practice without sufficient additional stress. Moreover, it can be easily added to the existing schedule to help nurses interact with each other. The recommendation is supported by evidence that finds the benefits of such simulation training to be substantial to patient outcomes and nurse-patient interactions (Häggman-Laitila et al., 2016; Wershofen et al., 2016). Financial resources will be necessary for nurse training as well as paper-based and electronic materials to record data (such as feedback and patient surveys).

References

Blake, T., & Blake, T. (2019). Improving therapeutic communication in nursing through simulation exercise. Teaching and Learning in Nursing, 14(4), 260-264.

Bullington, J., Söderlund, M., Sparén, E. B., Kneck, Å., Omérov, P., & Cronqvist, A. (2019). Communication skills in nursing: A phenomenologically-based communication training approach. Nurse Education in Practice, 39, 136-141.

Bussard, M. E., & Lawrence, N. (2019). Role modeling to teach communication and professionalism in prelicensure nursing students. Teaching and Learning in Nursing, 14(3), 219-223.

Chan, E. A., Wong, F., Cheung, M. Y., & Lam, W. (2018). Patients perceptions of their experiences with nurse-patient communication in oncology settings: A focused ethnographic study. PLoS ONE, 13(6), 1-17.

Chan, Z. C. Y. (2017). A qualitative study on communication between nursing students and the family members of patients. Nurse Education Today, 59, 33-37.

Crawford, T., Candlin, S., & Roger, P. (2017). New perspectives on understanding cultural diversity in nurse-patient communication. Collegian, 24(1), 63-69.

Curtis, R., Treece, P. D., Nielsen, E. L., Gold, J., Ciechanowski, P. S., Shannon, S. E., Khandelwal, N., Young, J. P., & Engelberg, R. A. (2016). Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. American Journal of Respiratory and Critical Care Medicine, 193(2), 154-162.

Dang, D., & Dearholt, S. L. (Eds.). (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines (3^rd ed.). Sigma Theta Tau International.

Dittman, K., & Hughes, S. (2018). Increased nursing participation in multidisciplinary rounds to enhance communication, patient safety, and parent satisfaction. Critical Care Nursing Clinics of North America, 30(4), 445-455.

Donovan, L. M., & Mullen, L. K. (2019). Expanding nursing simulation programs with a standardized patient protocol on therapeutic communication. Nursing Education in Practice, 38, 126-131.

Häggman-Laitila, A., Mattila, L. R., & Melender, H. L. (2016). Educational interventions on evidence-based nursing in clinical practice: A systematic review with qualitative analysis. Nurse Education Today, 43, 50-59.

Johns Hopkins Hospital. (2017). John Hopkins nursing evidence-based practice. Appendix I: Action planning tool [PDF document]. Web.

Johns Hopkins Hospital. (n.d.). John Hopkins nursing evidence-based practice. Appendix B: Question development tool [PDF document]. Web.

Johns Hopkins Hospital. (n.d.). John Hopkins nursing evidence-based practice. Appendix G: Individual evidence summary tool [PDF document]. Web.

Portney, L. (2020). Foundations of clinical research: Applications to evidence-based practice. F.A. Davis Company.

Reeves, S. A., Denault, D., Huntington, J. T., Ogrinc, G., Southard, D. R., & Vebell, R. (2017). Learning to overcome hierarchical pressures to achieve safer patient care: An interprofessional simulation for nursing, medical, and physician assistant students. Nurse Educator, 42(5S), S27-S31.

Tulsky, J. A., Beach, M. C., Burtow, R. N., Hickman, S. E., Mack, J. W., Morrison, R. S., Street, R. L., Sudore, R. L., White, D. B., & Pollak, K. I. (2017). A research agenda for communication between health care professionals and patients living with serious illness. JAMA Internal Medicine, 177(9), 1361-1366.

Wershofen, B., Heitzmann, N., Beltermann, E., & Fischer, M. R. (2016). Fostering interprofessional communication through case discussions and simulated ward rounds in nursing and medical education: A pilot project. GMS Journal for Medical Education, 33(2). Web.

Wocial, L., Ackerman, V., Leland, B., Benneyworth, B., Patel, V., Tong, Y., & Nitu, M. (2017). Pediatric ethics and communication excellence (PEACE) rounds: Decreasing moral distress and patient length of stay in the PICU. HEC Forum, 29, 75-91.