Effective Approaches in Leadership and Management

Nursing Management

Signal-to-Noise Ratio: Filtering Out Ineffective Communication

H aving been married to an audiophile for 36 years,I have been exposed to many terms and phrasesrelating to stereo systems. One such term is sig- nal-to-noise ratio (SNR). The SNR is a measurement that describes how much noise is in the output of a device in relation to the signal level (Audio Precision, 2012). Apparently, it is very important to make this ratio as high as possible, minimizing the noise and maximizing the signal. The very complicated formula for measuring SNR is S/N = 20 loglO(Vs/Vn) (TechTarget, 2013a). It is impor- tant to know that every device has some amount of noise at its output. A small amount of noise may not be objec- tionable if the output signal is strong (Audio Precision, 2012). Sometimes, the noise is not audible at all. However, if a signal level is small, even a very low noise level can have an adverse eftect. In audio electronics, a signal is an electric current used to convey data ftom one place to another. Signal represents the clear, crucial infor- mation that is intended to be broadcast. Noise can be deftned as unwanted energy that degrades the quality of signals (TechTarget, 2013b). Unfortunately, this is not the way it is in the workplace.

Noise aftects communications of all types, including text, programs, images, audio, and telemetry. If you have ever had a static-ftlled telephone conversation or viewed interference on an EKG monitor, you have experienced noise. Communication engineers strive to develop befter ways to deal with noise. The traditional method that has been used is to minimize the signal bandwidth to block noise. The less space the signal occupies, the less noise is heard. However, most people are unhappy when band- width is limited because that also limits the speed of the data. New ftber optic technology is being developed which is far less susceptible to noise (TechTarget, 2013b).

SNR in the Workplace We can relate SNR to workplace environments and

staff management. Signals are communicated to us throughout the day in many different forms. We have sig- nal, input in verbal, written, and non-verbal formats. Signals also come to us in the way of non-verbal aftitudes. Noise can take the form of too much environmental sound that distracts us ftom doing our daily work. It also can come ftom an employee who whines constantly, becoming an ineftective team member. Whining and complaining are not traits of an eftective communicator.

Donna J. Middaugh, PhD, RN, is Associate Dean, University of Arkansas for Medical Sciences, Little Rock, AR.

When we hear whining, we tend to become annoyed and tune out the sender. The same is true with constant com- plainers. We do not want to listen to the woes of some- one who is unwilling to seek solutions. Anything that cre- ates a barrier to good communication can be considered noise. A popular management web site suggests barriers to eftective communication could include any of the fol- lowing: • Unorganized thoughts – haphazard thoughts • Wrong interpretations – using words that may be

misconstrued • Not understanding the receiver – the sender must

understand the receiver ftrst, then pass on the infor- mation

• Ignoring the content – the content has to be clear, clean, and interesting

• Avoiding the listener – lack of eye contact is a good example

• Non-conftrming with the recipient – checking to see if the message was received

• Not understanding the mood of the recipient – wait for an appropriate time to convey your message

• Low pitch and tone – content must not be in too low a pitch and tone or information will not be received

• Impatient listener – listener must be patient enough to absorb the complete information to respond

• Different cultural levels – staff cannot think on the same line as their boss (Management Study Guide, 2013, pp. 1-2)

Effective Communication Signals The question is how to ftlter ineffective communica-

tion or noise and hear only crucial information that is necessary for day-to-day operations. At times, SNR grows excessively noisy. This can lead to garbled messages, when nonsense is taken too seriously and starts to sound important. Signals in effective communication should be:

Vital to doing daily work Clearly delivered so message is understood correctly Concise and not belabor the point Delivered with enthusiasm Delivered in a positive manner Direct to the sender Delivered with an open mind Non-complaining, unless a solution is offered

We are all more receptive to communication or signals delivered in a positive manner rather than negatively. Negative phrasing and language often have the following characteristics:

262 July-August 2013 • Vol. 22/No. 4 M E D S U R G

Signal-to-Noise Ratio: Filtering Out Ineffective Communication

• Tells the recipient what cannot be dori,e.,.,. • Has a subtle tone of blame. • Includes words like can’t, won’t, unable to, which tell

the recipient what the sender cannot do. • Does not stress positive actions that would be appro-

priate, or positive consequences. (Bacal, 2013, p. 2) Positive phrasing and language have the following

qualities: • Tells the recipient what can be done. • Suggests alternatives and choices available to the

recipient. • Sounds helpful and encouraging rather than bureau-

cratic. • Stresses positive actions and positive consequences

that can be anricipated. (Bacal, 2013, p. 2)

Filtering SNP In today’s health care environments”, the art of listen-

ing and paying attention can be lost due to distractions from many sources. Effective nurse managers have the art and skill of dealing with SNR. They can identify a legiti- mate signal versus noise. They know the strength of the signal in the workplace in no way indicates the impor- tance of the message being delivered. Some employees

may speak softly or rarely, but have an important mes- sage. The SNR actually may be reversed, with the noise level far exceeding the softly delivered signal. Noise may be more apparent and noticed due to its intensity and/or frequency, but that does not mean soft signals should be discounted. They may be the most significant of all. The quiet, unassuming employee needs to be heard just as much as the loud staff member. Unfortunately, unlike electrical systems, loudness and frequency do not consti- tute legitimacy. Understanding and appropriately filter- ing SNR represent both an opportunity and a fundamen- tal skill of the successful manager. EiSH

REFERENCES Audio Precision. (2012). Signal-to-noise ratio. Retrieved from httpy/

www.ap.com/solutions/introtoaudiotest/snr Bacal, R. (2013). Using positive language. Retrieved from http://work

911 .com/articles/poslan.htm Management Study Guide. (2013). Role of commurjication barriers

in ineffective communication. Retrieved from http://www. managementstudyguide.com/role-of-communication-barriers-in- ineffective-communication.htm

TechTarget. (2013a). Signal-to-noise ratio (S/N or SNR). Retrieved from http://searchnetwori<ing.techtarget.com/definition/signal-to-noise-ratio

TechTarget. (2013b). Signal. Retrieved from http://searchnetwori<ing. techtarget.com/definition/signal

Improved Hypoglycemia Management continued from page 254

Kwok, R., Dinh, M., Dinh, D., & Chu, M. (2009). Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: Implementation of a dynamic and inte- grated electronic decision support system. Emergency Medicine Australasia, 21, 31-37. doi:10.1111/j.1742-6723.2008.01149.x

Lyeria, F., LeRouge, C, Cooke, D.A., Turpin, D., & Wilson, L. (2010). A nursing clinical decision support system and potential predictors on head of bed positioning for mechanically ventilated patients. American Journal of Critical Care, 79(1), 39-47. doi:10 4037/ ajcc2010836

Manchester, C.S. (2008). Diabetes education in the hospital: Establishing professional competency. Diabetes Spectrum, 21(A) 268-271. doi:10.2337/diaspect.21.4.268

Maynard, G., Huynh, M., & Renvall, M. (2008). latrogenic inpatient hypo- glycemia: Risk factors, treatment, and prevention. Diabetes Spectmm, 21{4), 241-247. doi: 10.2337/diaspect.21.4.241

Murad, M.H., Coburn, J.A., Coto-Yglesias, R, Dzyubak, S., Hazem, A., Lane, M.A Montori, V.M. (2012). Glycémie control in non-criti- cally ill hospitalized patients: A systematic review and meta-analy- sis. Journal of Clinical Endocrinology and Metabolism, 97(1), 49- 58. doi:10.1210/¡c.2011-2100

Pagana, K.D., & Pagana, T.J. (2010). Mosby’s manual of diagnostic and laboratory tests. St. Louis, MO: Mosby Elsevier.

Rycroft-Malone, J., Fontenia, M., Seers, K., & Bick, D. (2009). Protocol- based care: The standardization of decision-making? Journal of Clinical Nursing, 18,1490-1500. doi:10.1111/¡.1365-2702.2008 026 05.x

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2010). Medicare and Medicaid programs; electronic health record incentive program; final rule. Federal Register, 75(144). Retrieved from http://www.gpo.gov/fdsys/ pkg/FR-2010-07-28/html/2010-17207.htm

ADDITIONAL READING Anthony, M. (2008). Relationships among nurse staffing, adherence to

practice guidelines, and patient outcomes in the treatment of hypo- glycemia. Quality Management in Healthcare, 17(4), 312-319 doi:10.1097/01.QMH.0000338552.13136.1e

A Conceptual Model continued from page 220

Queensland Nursing Council. (2005). The scope of practice-framework for nurses and midwives QNC. Retrieved from http://vww. health.qId.gov.au/parrot/html/Documents/NursingScPrac.pdf

Pelchat, D. (2010). PRIFAM: A shared experience leading to the trans- formation of everyone involved. Journal of Child Health Care, 74(3), 211-224.

Shea, C.A. (2008). Psychiatric nursing education at a distance. Journal of the American Psychiatnc Nurses Association, 74(1), 36-38.

Tllus, S.L. (2002). The influence of nursing education on collaborative discharge planning. Journal for Nurses in Staff Development, 18(5), 274-281.

Williams, S. (2008). The role of patient education in the rehabilitation of people with spinal cord injuries. International Journal of Therapy and Rehabilitation, 75(4), 174-179.

Wittmann-Price, R.A., & Fisher, K.M. (2009). Patient decision aids: Tools for patients and professionals. American Journal of Nursing, 709(12), 606-663.

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