Providing Effective Feedback and Motivation

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The following course content

Introduction   

Being able to provide effective feedback and motivation to learners is a crucial skill. Nurse leaders can benefit from this skill in their professional lives by learning how to provide feedback to their direct reports. Nurses need effective feedback and motivation from their leaders to work towards becoming competent. Clinicians need coaching and feedback in order to grow into strong nurses. Being able to provide this skill means supporting both professional and personal growth.  

Motivation and feedback are closely related. When nurses feel supported in their profession they feel increased motivation. Increased motivation is correlated with increased engagement, better work performance, and decreased burnout. This is especially important in a demanding profession like nursing.   

Motivation 

Motivation is a psychological concept and a teaching tool. It is closely related to feedback. Nurses who receive effective communication show increased motivation in their professional lives. Motivation can be defined as a mental impulse that influences human behavior, including learning. It is the basis of all our thoughts and behaviors. Motivation can direct the attitude of a learner and can be the driving force to satisfy an individual’s need (6). It influences how people decide to spend their time, where they focus their efforts, and how one views and feels about a task. Motivation can be very complex and can mean different things to different people. For maximum effectiveness, learners should be exposed to various sources of motivation. Learning and motivation go hand in hand. Without efficient motivation, optimal learning may not occur. Motivation leads to more interest in learning, increased engagement, and therefore, higher levels of success. When learners feel they have power over their success, they are more motivated to do well. 

People are motivated by different things. Not all these things can be touched or even seen. Some factors may be more subjective. There are two types of motivation: intrinsic and extrinsic (7). Intrinsic and extrinsic motivation share a similarity in that they both work towards goal attainment. Intrinsic motivation involves doing something because its pleasurable rather than for an external reward or recognition. Extrinsic motivation is done to receive praise, rewards, or approval. 

The Importance of Feedback 

What is feedback and why is it so important? Feedback is a tool that, if used effectively, can encourage growth and improve healthcare with the goal of client safety (1). It is an important part of the learning process for nurses and should be used by nurse leaders in all settings. It can be broken down into three categories: appreciation, coaching, and evaluation. All three are needed to reach people with different learning types. Feedback needs to be effective to foster change. To be effective, it should encourage learning and help the recipient grow without causing harm. Nurse leaders are presented with many opportunities to give feedback. They should make this a routine practice with their employees in order to promote the change or practice that is needed. This communication may be positive or present as an opportunity for improvement. In either case, providing feedback must be done in a way that supports a positive reception and an opportunity for discussion. 

New nurses are especially in need of effective feedback. It can greatly influence their performance and outlook of the profession. New and probational nurses are assessed in many ways. A nurse may not be able to fully develop and may not realize what their strengths and weaknesses are without receiving consistent feedback (2). This could lead to a nurse not being clinically sound in the workplace. Other benefits of feedback include better client outcomes and increased compliance. 

Feedback Literacy 

Feedback literacy, as defined by Carless and Boud (2018), includes understandings, capacities, and dispositions required to make sense of information. It also includes using this information to strengthen work or learning strategies (4). Literacy describes the learner’s role in feedback. The learner is viewed as an active participant in retaining the given information. There are four main categories of feedback literacy: 

1. Appreciating feedback:  
   1. Recognizing and defining feedback. 
   2. Is this feedback helpful? 
   3. What does it tell me about my progress? 
   4. What should my next steps be? 
2. Making judgements: 
   1. How am I doing vs. how I thought I was doing? 
   2. How am I doing compared to my peers? 
   3. How am I doing vs. passing standards? 
3. Managing affect: 
   1. Is this feedback motivating or demotivating? 
   2. What can I do if this feedback upsets me? 
   3. Has this feedback increased or decreased my self-confidence? 
4. Taking action: 
   1. Will I use or ignore this feedback? 
   2. What can I do?  
   3. How will I do it? 

Feedback literacy works best when messages are clear and true, and when there are agreed upon feedback expectations. This should be implemented with the goals of performance improvement and achieving success. 

Effective Feedback 

Now that the importance of feedback is apparent, it is also imperative to learn how to make it effective in our professional lives. Providing effective feedback means having conversations about one’s progress, clinical practice, and lays out objectives and areas of improvement (3). It is important to note that the way feedback is delivered is equally as important to the way it is received. Both the deliverer and the receiver need to be competent in this exchange. In the end, it is up to the person receiving the feedback to make use of what they are told. They can decide to accept the information or not. 

We should also be aware of any barriers to this process (5). The first potential barrier is a lack of direct observation of tasks or job performance. For feedback to be effective, it should be directly based off observation of the learner’s performance. This can be challenging in a complex setting. Another barrier is being afraid to upset the person receiving the information. Performance critique can be challenging to provide if it involves constructive criticism and could be disappointing to the learner. Lastly, a lack of external feedback may cause learners to generate their own information, but their self-assessment may be wrong.  

Overall, effective feedback is planned, explicit, descriptive, behavioral focused, specific, concise, verified by the recipient, and honest (5). It should contain both negative and positive components. The difference between effective and ineffective communication is the aim of the message. This is an integral part of the learning process and helps reinforce best practices and acts as motivation for the learner. The goal of providing this communication should be to improve the learner’s performance. 

One important goal of this learning process is to increase the capability of learners to build their own self-assessment. Nurse leaders should help their teams become less reliant upon external feedback sources and instead be able to distinguish effective versus ineffective information, look for constructive criticism when needed, and learn to provide effective feedback themselves (10). Learners should learn to question any information provided and decide if it is beneficial for them or not. 

Models 

As a leader in the healthcare setting, it is imperative to utilize different feedback models in different encounters. Not every model is right for every situation. Some encounters should be shorter (1-5 minutes) and are known as micro-feedback. This is usually done at the end of each day. Other encounters will be longer (5-20 minutes) and are called macro-feedback. These encounters are usually planned, less frequent, and more detailed and structured. There are six feedback models (12). The models are both similar and different, can be complex or simple, and are focused on the teacher or the learner. 

The six feedback models are as follows: 

1. Feedback Sandwich: This is a fairly structured method of giving feedback and involves a one-way transmission of feedback with no input from the student. It involves a “sandwich” of information given. The first level of the sandwich is a positive piece of information. The middle layer is critical feedback. The last layer is another positive reinforcement. 
2. Pendleton Rules: Similar to the feedback sandwich, this model involves the learner offering their thoughts on their performance, followed by the teacher giving their feedback. This model helps the student begin to use self-assessment skills and is best suited for macro-feedback. It may be useful for teachers with little experience giving feedback. 
3. One-Minute Preceptor: A good model to use in micro-feedback conversations and in clinical settings that are busy. It is brief, straight to the point, and can be used during client care. First, a specific item is discussed, then, the learner provides their rationale. Lastly, a discussion is had to review the positive findings and improvement needed. This model involves an effort by both the teacher and the learner and helps the learner develop decision-making skills and clinical understanding. 
4. SET-GO: This model is best for providing group feedback. Feedback is given in a non-judgmental way, and the group of learners are asked to give their own insight into the situation. They are encouraged to come up with solutions. The group also establishes goals and ways in which the goals can be reached. Peer feedback is encouraged with the SET-GO model. This model is most effective when the learners have feedback skills themselves. 
5. R2C2: This model provides feedback based on assessment and performance. After assessment results are reviewed, the learner’s reaction to the assessment results is also explored. In this model, the educator must first have a positive, respectful, trusting relationship with the learner. This is a learner focused model and facilitates the learner’s ability to practice self-assessment. This model requires the teacher to be skilled at providing feedback. 
6. ALOBA: This is a learner centered model. The goal is a conversation based on the learner’s needs supplemented with the teacher’s thoughts. Self-assessment is encouraged, and the learner is asked to think about their needs and what is important to them. Next, there is a conversation that includes suggestions on how the learner can reach their goals and meet their needs. The learner is an active participant in this model instead of a passive feedback receiver. An experienced feedback giver is needed for this model to facilitate conversation and provide high quality feedback. 

It is apparent that there are many possible feedback models to choose from. Some may be better than others depending on the person, setting, context, or goal. Nurse leaders should ruminate the various models and integrate them into their practice. They should also be willing to accept feedback on their own skills. 

A Reliable Source 

When it comes to feedback, the person providing it must be trustworthy. They must be a credible source or their words might not be received well by the learner. The feedback-giver needs to speak from a place of experience and expertise. If the learner views them as inexperienced or unworthy of providing such information, they are less likely to learn from the information provided (11). The feedback-giver should also display a caring nature to the learner. If the learner feels the teacher does not care about them or is not invested in them, they are less likely to trust the information given.  

Nursing Leadership Implications 

Nurse leaders act as teachers for their nursing teams (learners). Providing constructive criticism is an integral part of their role and necessary for the success of their nurses. These conversations should be done with the goal of achieving structured results and performance improvement. This results in healthcare workers encouraged to modify their behavior in order to achieve desired clinical outcomes (8). Feedback can be looked at as a dialogue between teacher and learner that allows the learner to grow and develop. Feedback has evolved from simply providing information to change a behavior to the idea that it should be used for performance improvement and as part of a sociocultural interaction. Also, information is received better when it comes from a trusted source. In the healthcare setting, feedback is subjected to different environmental factors. These include workload and client care, organizational structure, time constraints, performance observation, feedback expectations and what the learners do with the critique provided.  

Feedback is an important part of coaching for nurses at every level. It is an important tool in the development of leadership skills, critical thinking, goal setting, and communication skills. Through coaching and feedback, nurses get a better understanding of needed areas of improvement and can strive towards higher achievement and meeting workplace standards. Coaching has the ability to affect both individuals and organizations. Coaching also has an effect on self-development. This includes self-efficacy and self-awareness. Receiving coaching is dependent upon the manner in which it is given. Overall, coaching has been shown to improve performance, communication, role effectiveness, resilience, and workplace culture (9). 

Conclusion

The importance of feedback and motivation is apparent now more than ever. This is a crucial piece in a learner’s development. Nursing is becoming more demanding, and nurses need to feel supported emotionally and professionally. Nurse leaders need to be competent in their ability to motivate and coach those around them. Effective feedback has the potential to motivate strong, competent nurses. It also has the potential to make them want to remain in their role as competent clinicians. Providing feedback is no easy task though. Not everyone is built to be a leader that is responsible for providing feedback to clinicians. Effective information should be given by effective leaders to make the most impact on the learner. Effective leaders inspire learners to do their best work.  

The feedback receiver is also an important piece of the puzzle. They should be willing to practice self-assessment to help receive the information provided and should be able to differentiate between effective and ineffective feedback. When effective information is part of the healthcare setting, staff will feel increased motivation and a higher morale. They will feel empowered with performance-based information provided to them. This has a direct impact on the quality of client care provided and on the organization as a whole.  

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