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Chapter 023
- 1. Chapter 23 Conflict: The Cutting Edge of Change All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.
- 2. Objectives Determine the nature and sources of perceived and actual conflict. Assess preferred approaches to conflict. Determine effective approaches to conflict. Identify conflict management techniques that will prevent lateral violence and bullying. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 2
- 3. Conflict Disagreement in values or beliefs within oneself or between people that causes harm or the potential to cause harm Conflict is a catalyst for change and has the ability to stimulate either detrimental or beneficial effects. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 3
- 4. Types of Conflict Intrapersonal Interpersonal Organizational All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 4
- 5. Better Understanding of Stress and Conflict Important factors to consider Context (e.g., particular work environment) Extent to which leaders respect staff concerns Cultures that condone “shame and blame” Use of compromise to avoid dealing with the conflict Understanding that unresolved stress leads to poor patient outcomes All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 5
- 6. The Stages of Conflict Frustration Conceptualization Action Outcomes All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 6
- 7. Modes of Conflict Resolution Avoiding Accommodating Competing Compromising Collaborating All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 7
- 8. Self-Assessment: Avoidance If you tend to use avoidance often, ask yourself: Do people have difficulty getting my input and understanding my view? Do I block cooperative efforts to resolve issues? Am I distancing myself from significant others? Are important issues being left unidentified and unresolved? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 8
- 9. Self-Assessment: Avoidance (Cont.) If you seldom use avoidance, ask yourself: Do I find myself overwhelmed by a large number of conflicts and a need to say “no”? Do I assert myself even when things do not matter that much? Do others view me as an aggressor? Do I lack a clear view of what my priorities are? Do I stir up conflicts and fights? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 9
- 10. Self-Assessment: Accommodation If you use accommodation often, ask yourself: Do I feel that my needs, goals, concerns, and ideas are not being considered by others? Am I depriving myself of influence, recognition, and respect? When I am in charge, is “discipline” lax? Do I think people are using me? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 10
- 11. Self-Assessment: Accommodation (Cont.) If you seldom use accommodation, ask yourself: Am I building goodwill with others during conflict? Do I admit when I’ve made a mistake? Do I know when to give in, or do I assert myself at all costs? Am I viewed as unreasonable or insensitive? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 11
- 12. Self-Assessment: Competing If you use competing often, ask yourself: Am I surrounded by people who agree with me all the time? Do people avoid confronting me? Are others afraid to share themselves and their needs for growth with me? Am I out to win at all costs? What are others saying about me? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 12
- 13. Self-Assessment: Competing (Cont.) If you use seldom use competing, ask yourself: How often do I avoid taking a strong stand and then feel powerless? Do I avoid taking a stand to escape risk? Am I fearful and unassertive to the point that important decisions are delayed and people suffer? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 13
- 14. Self-Assessment: Negotiation/Compromise If you use negotiation often, ask yourself: Do I ignore large, important issues while trying to work out creative, practical compromise? Is “gamesmanship” a part of my negotiations? Am I sincerely committed to compromise or negotiated solutions? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 14
- 15. Self-Assessment: Negotiation/Compromise (Cont.) If you seldom use negotiation, ask yourself: Do I find it difficult to make concessions? Am I often engaged in strong disagreements, or do I withdraw when I see no way to get out? Do I feel embarrassed, sensitive, self-conscious, or pressured to negotiate, compromise, and bargain? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 15
- 16. Benefits of Compromise Supports a balance of power between self and others in the workplace May require mediation Involves an impartial helper Both sides must acknowledge disparities Not about winning or losing Key: What works best in this situation? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 16
- 17. Steps to Resolving Conflict Name the conflict (identify the problem) Identify your reaction to it Search for cause Identify a common goal Generate solutions Select and plan innovative solution Implement Evaluate Repeat as needed All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 17
- 18. Guidelines for Confrontation I.D. need for confrontation Timing Clearly I.D. problem I.D. behavior required Establish credibility Remain empathic Avoid personal attacks Use genuine humor if appropriate All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 18
- 19. Managing Lateral Violence and Bullying Lateral violence: Aggressive and destructive behavior or psychological harassment of nurses against each other. Bullying: Real or perceived power differential between the instigator and recipient must be present in bullying. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 19
- 20. Self-Assessment: Collaboration If you tend to collaborate often, ask yourself: Do I spend valuable group time and energy on issues that do not warrant or deserve it? Do I postpone needed action to get consensus and avoid making key decisions? When I initiate collaboration, do others respond in a genuine way? Does the group exhibit hidden agendas, unspoken hostilities, and/or manipulation? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 20
- 21. Self-Assessment: Collaboration (Cont.) If you seldom use collaboration, ask yourself: Do I ignore opportunities to cooperate, take risks, and creatively confront conflict? Do I tend to be pessimistic, distrusting, withdrawing, and/or competitive? Am I involving others in important decisions, eliciting commitment, and empowering them? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 21
- 22. Assessing the Degree of Conflict Resolution Quality of decisions Quality of relationships All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 22
- 23. Exercise 23-3 Consider a conflict you would describe as “ongoing” in a clinical setting. Talk to some people who have been around for a while to get their historical perspective on this issue. Then consider the following questions: What are their positions and years of experience? How are resources, time, and personnel wasted on mismanaging this issue? What blocks the effective management of this issue? What currently aids in its management? What new things and actions would improve its management in the future? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 23
Notas do Editor
- [Introduce concept of conflict as being neither “good” nor “bad.”] Conflict is generally understood to be defined by various authors as: A clash in individuals’ or groups’ values, differences in beliefs, attitudes, and expectations (Conerly and Tripathi, 2004) More than simple disagreements: Conflict arises from a strong sense, a feeling of incompatibility. It represents an escalation of everyday competition and discussion into an arena of emotional or even hostile encounters that puts a strain on personal or interpersonal tranquility, or both (Scott, 1990). Conflict can be a strategic tool when addressed appropriately, and it can actually serve to deepen and develop human relationships (Porter-O’Grady, 2003). Some of the first authors on organizational conflict (Blake & Mouton, 1964), for example, claimed that a complete resolution of conflict might not even be desirable and may in fact thwart the stimulation of growth and change for the better. Why study conflict? To maximize strengths within groups To learn more about why individuals within groups choose/need conflict at some times more than others To produce better outcomes, including patient-care related goals
- Increasing our knowledge of the role stress plays within conflict is critical. Our society is known for being particularly stressful and stress-producing. We already know that stress leads to fatigue, which can lead to an increase in medical errors. Our culture within health care, furthermore, has been built on a tradition of secrecy, shame, and blame when it comes to our failure to prevent medical errors. Gender differences exist and may explain at least in part why women are known for either avoiding or using compromise and why men may be known for aggressive techniques…none of which may completely solve a conflict. Finally, our knowledge of the aeronautic, military, and submarine industries and the recent SBAR communication tools they have spawned (see IHI Website for additional information on SBAR) have focused on toolkits characterized by clear, succinct exchanges of information. Their widespread use is based on the premise that a stressful situation is more likely to lend itself to conflict and negative patient outcomes. Think about the last time you tried to convey information to a physician about a patient’s status: How did you feel? Were you anxious/nervous? Did you forget some critical details that you remembered too late? Was the physician hearing/acting upon what you were saying? Why or why not?
- Frustration: Remember, when people or groups perceive that their goals may be blocked, they feel frustrated. This frustration may escalate into a stronger emotion, such as when people become angry or just give up. Have you ever seen someone get angry over nothing? If you have, then you have seen a misunderstanding based on someone’s inability to gauge the situation accurately. Suppose you did not discuss the patient’s treatment plan/care plan with him or her and (this happens frequently, unfortunately) when the patient does not carry out his or her part of the plan, you label this patient as “noncompliant” and feel frustrated that the patient is uncooperative, when in all likelihood, the patient had a completely different set of priorities at the start from those of the nurse. At the same time, the patient may view the nurse as controlling and insensitive. When such frustrations occur, it is a cue to stop and clarify the nature of major differences and make sure everyone is “on the same page.” Conceptualization: I like the idea of the “snapshot” image; for example, when we see or are confronted with something, our mind forms a mental judgment about what actually happened. Everyone involved has an individual interpretation of what the conflict is and why it is occurring. Most often, these interpretations are different and involve the person’s own perspective, which is based on personal values, beliefs, and culture. Regardless, conceptualization forms the basis for everyone’s reactions to the frustration. The way the individuals perceive and define the conflict has a great deal of influence on how creative those involved may be in trying to resolve the problem and what type of outcomes can come about. For example, within the same conflict situation, some individuals may see the conflict itself as very threatening and may label everyone involved as “insubordinate” and become so angry at the threat to their role that they fall back on rigid adherence to policy and procedure. Others may view conflict as trivial bickering and become critical of everyone involved, as in, "We've been over this subject already. Why can't you just drop it?" and complain or withdraw.
- One can think about and consider many things when selecting an approach to resolving conflict: nature of the differences, underlying reasons, importance of the issue, strength of feelings, commitment, and goals involved. Preferred and previously effective approaches can be considered, but they need to match the situation. Not everyone has the same experiences nor the memory of the same conflict! Sometimes, a third party may be introduced into a conflict so that mediation can occur. Mediation is a learned skill for which advanced training and/or certification is available. The mediator is usually an impartial helper who assists each party in the conflict to better hear and understand the other. Mediation is not so easy. In our American society, for example, much focus is placed on who can control whom with a lot of emphasis on winning. The successful individual involved in conflict resolution and negotiation often moves beyond winning, and even beyond avoidance, accommodation, and compromise, which are more about trying not to disturb the status quo. In the nursing practice arena, often an added difficulty occurs in negotiating conflicts when at least one of the parties, which has historically been the physician when it comes to quality of care issues, is viewed to be (or views himself or herself) on an unequal or uneven playing field.