Two page article review

Who Let the Dogs Out?

managing Conflict With Courage and Skill Pettrcy, /f;V, MS „ he ability to communicate effectively is an essen- tial skill for every job setting. Many nurses enter the joh market because they are unhappy or frustrated in their current work environment, often because of unresolved conflict. In healthcare, people work closely together and rely on their colleagues imd other team members when caring for patients and their families. These team mem- bers come from vaiying backgrounds and cultures, and hold diverse values. This diversity, in addition to the innate stress and urgency in most acute care hospital settings, makes conflict a common occurrence. If a group does not resolve conflict effectively over time, a toxic and negative work environment is created.

Effective communication skills will greatly enhance nurses' ability to influence their environment. The American Association of Critical-Care Nurses (AACN) li'adership Development Workgroup identified conflict management as 1 of 4 key leadership or "influencing skills."' Conflict management is a process of working through opposing views to reach a common goal.

Key Components and Sti-ategies Controlling ILmotional Responses Controlling emotional responses is the first com- ponent of conflict resolution. Recognizing your per- sonal bias is essential in being ahle to hear other perspectives on an issue. In conflict situations, we may react almost immediately with anger or hurt, and not be clear regarding the underlying reason behind this reaction. Our instinctive response is either "fight." which may be exhibited as sarcasm or anger, or "flighl," exliibited as avoidance or silent treatment.

[hese options can be expressed as "silence or vio- lence." It is important to reflect on your emotions and to identify the "story" that is behind them.

Lisa Pettrey is the director of Heart, Vascular and Critical Care Services in Columbus, Ohio.

Increased self-awareness is key to identifying the story that is creating your emotional response.

Although it is difficult (or seemingly impossible) to take time to reflect on these issues during a busy day on a nursing unit, the more awareness you haye of your values, preferences, and "hot buttons," the easier this is to accomplish. Several resources such as person- ality inventories (DiSC tool, Myers-Briggs personality type indicators) are listed in the "Tor More Infor- mation" box on page 24. These tools can provide greater insight into your personal style and preferences.

With greater self-awareness, your abilit\' to regulate or control your emotions improves because you know more about what underlies your emotional response.

Self-regulation is 1 of the 5 components of emotional intelligence; it is defined as the ability lo control or redi- rect disniptive impulses and moods, and the propensity to suspend judgment, to think before acting.' Even a few moments of restraint before reacting in haste can greatly improve your ability' to handle a situation effec- tively. Feelings are normal and natural, but when not handled appropriately, they can get us into trouble.

Seeking understanding involves exploring issues from diverse points of view and obtaining understand- ing of other perspectives. Steven Covey' lists "Seek flrst to understand, then to be understood" as one of his "Seven Habits of Highly Effective People" in his land- mark book. Our normal instinct is to be understood, to make our case.

We listen with the intent to reply, not to understand. Ifyou are on the "edge of your seat" wait- ing for a break in the conversation so that you can jump in, you cannot be truly listening. Most of us are forming our reply while the other person is talking. The skill of active listening is even more difficult if stakes or emo- tions are high, but when an effort is made to deeply lis- ten to what another person is saying, defenses go down and effective communication begins to take place.

Identifying Common Needs and interests Identifying common needs and interests refers to cleariy stating what you need and clearly hearing Critical Care Careers 2003 CRITICAL CARE NURSE / SUPPLEMENT, FEBRUARY 2003 21 what others need, then listing everyone's concerns.

Many times when emotions are controlled and dialogue has hegun, it becomes clear that there is a common goal, interest, or purpose thai can be identified. Look for the "tliird story," or the one tbat a keen observer who had no stake in the issue wotild tell/ Seeking Mutual Benefit Seeking mutual henefit involves building on mutual needs or goals and seeking a win-win solution. Generate and invent multiple options. Weigh ibe options, select- ing the best. If practical or possible, trial the solution.

Courage and Commitment Tbese skills require commitment and practice.

Many of us are afraid to address issues in ibe work- place.

We are fearful of retribution, burting other peo- ple's feelings, or making Ibe situation or relationship worse. Ibc strategies of "silence or violence" are not effective ways of coping. Oftentimes, we do not dis- cuss our frustrations and grievances witb coworkers, but they know there are concerns because we avoid tbem, drop sarcastic barbs, or tell otber coworkers. Tbey know there is a problem, but may not understand what happened. Tbis frequent scenario leads to greater hurt and ultimately toxic work environments. If our intent is to strengthen a relationship, improve our ahility to work with others, or advocate for a patient, effective conflict resolution is always tbe best cboice.

Practical Strategies and Support Seif-awareness is the core of all leadersbip and influencing skills, and conflict resolution is no excep- tion. Utilize some of tbe strategies listed in Table 1 to provide you with information about your preferences and ways of interacting. Understanding your person- ality type and preferences are essential in beginning to effectively interact witb otbers. Identifying your "pet peeves" and knowing wbat pushes your buttons can make a tremendous difference in your ability to man- age confiict. These personalit)' inventories can also be applied as a group and can provide inslgbt into tbe specific Strengtbs and cballenges tbat will result from tbe mix of types witbin tbat group.

For nursing units or other workgroups, there are many strategies tbat can be employed as a group.

The creation of "group norms" for the team can clarify expectations regarding key work issues and communi- cation. These differ from clinical standards, ihey are nonns that reflect the culture of a unit and address team Table I Conflict Resolution' Baseline assessment Establish a baseline for how you deal with conflict in general. For this exercise to be elTective, you must be honest. Identify which of the following statements reflects your usual approach:

1 dy to pursue my own goals and sUuitl rny groiuid.

I try to cooperate by giviîig in on some points in exchange ibr others.

I try to point out factors everyone agrees on and not dwell on points of disagreement.

I try to get eveiyone involved in working out a solution and deal with all concerns.

I try to ease tension and let others take responsibility for solving problems.

KEY:

a = compelilive, b = compromising, c = accommo- dating, d = collaborating, c ~ avoidance This baseline reflects how you deal witli conflict in general.

Clear-cut, riglit and wrong ways to deal with conflict are not always apparent. Certain sitviations call for certain responses. Recognizing the dilVerent approaches to deal wiLh conflict can help you to see different ways to resolve it. Knowing your baseline can help you sec ai^eas in wtiich you need to strengthen or modify your appn)adi.

Sharing exercises Discuss how a conflict situation was handled hy using the 4 skills.

Role-playing Identify a situation that has meaning and assign roles to menihers to act out the conflict. Choose a situation that is mcaningftil to the group members.

Variations on role-playing Make role assignments that ai-e similar to current roles or assign opposing roles.

Assumptions on conflict • You have 50% responsibility for causing and resolving the conflict.

• Most conllicts can be resolved and many prevented using the light a]>proach.

• You can't change people. You can change your own behavior.

• Most people aren't evil. They behave the way they do because they don't know how tlieir behavioi" affects oLhei-s or becatise they have a sti'ong need to do what they do.

Five things to do when faced with conflict 1.

Remember that any conflict represents only a small pait of your life.

Take action to resolve the conllict. Doing something constructive is a great way to spend your energy rathei- Uian beating your head against a wall.

Remember that conflict Is not pei-sonal.

Give it space.

Put conflict in its place emotionally or even physically to allow a cooling oiî period.

Review the situation for future i-eierence. Dealing with conflict can be a terrific learning tool.

22 CRITICAL CARE NURSE / SUPPLEMENT, FEBRUARY 2003 Critical Care Careers 2003 issues that often cause conflict. They can also set expec- tations regarding how staff members communicate with each other. Tor example, 1 group norm may state that if a staff member has an issue with a peer, she can go to 1 other person for advice and coaching, btil that she can- not talk to anyone else about the issue unless she has addressed it with the peer. Another norm might slate that staff members must offer assistance to their peers if their own work is complete before sitting down. Staff must hold each other accountable for the norms.

Safe practice and role-playing can often be helpful.

Practicing the skill of providing feedback to others by using situations that are meaningful to the group can greatly Increase skill. When role-playing a situation, it may be helpful to have team members play roles opposite to their normal roles. For example, a patient care technician and a nurse may role-play a situation, each playing the other's role.

Application of conflict situations to the 4 key com- ponents can be helpful. An application example is provided in Table 2. The same process can be used in a staff meeting or team meeting using a situation that is creating conflict on a unit, or the model can be applied to personal conflict situations.

Summary Although nurses often think in terms of clinical ability when discussing competence, strong interper- sonal communication skills are also essential for effec- tive practitioners. Conflict management skills are key to creating work environments with good retention, work satisfaction, and high-quality measures. Nurses desir- Tlable 2 How does this apply to mc.with patients and families?' Setting: It was a very busy evening on the unit, and Sarah hadn't even had time to get to dinner. Slie was caring lor one newly admitted patient whose hlood pressm-e was fluctuating eiralically. and slie was aiso assigned Mr Archnian. ¡\s she was leaving Mr Archman's room, she saw his wife appi'oaching. Mrs Arcliman iisked Sarah when Dr Gutzman had last heen to see her husband. Sarali wasn't sure bul Üiought he liad been in earlier. Mi-s Ai-chman hecame verj^ upset, "I demand that the doc- tor talk to me immediately. I haven't seen him for two days." Sarali knew she didn't have time to dea! with these complaints.

Sarah feels angry aiid fi-ustraled that she has to deal with a problem that she did not cause. Sarali recognizes that Mrs Arcliman is upset tor many reasons besides the lack of communication bul that is no reason to take it out on the nurse. Sarah knows from t:alking witli other staff that Mrs Archman is a demanding family member, and some staff members have heen trying to avoid her.

Control emotions and bias Seek understanding Identify needs and common interests Seek mutual benefits Outcome As Sarali is faced with Mrs Arcbman, she takes a dee|i hreatb and says. "I would like to talli with you about your concerns. Right now.

1 have to check on another patient.

Would you like to sit dowii? I will be with you in a few minutes." Mi-s Archman takes a seat in hei- husband's room. This allows Sai-ah to gather her thoughts and make sure her other patient is cared for.

Once Sarah completes her work on her other patient, she returns to Mrs Archman and says, "You seem to be very upset about your husband's cai-e. What can I do to help you?" Mis Archman gives Sai-ah a list of concerns ahout her husband's caj-e and says that tile 2 higgest concerns are that no one seems to talk to her about his condition and tbat she hasn't been able to rest since he was admitted. Sarah encouraged Mrs Archman to express her fears ahout her husband's status and explained some of the treatments and procedni'es tbat had occun-ed in the last 24 houi-s.

Sarah went on to explain that the staff and the doctors are all working together to give the highest quality of care to Mr .Archman. She noted that staff is busy but there may be a way to provide the communication Mrs Archman wants, thus heipijig her to be more relaxed so she could rest. Mi's Archman agi'eed that what she wants is the best for her husband. Sarah identified ways the stall' could help to keep Mi-s Archman informed by calling lier at home each moniing and meeting with her when sbe comes into the unit. Sarah also helped Mrs Archman I'ÜCILS on specific questions to ask her husband's physician and write them down so she would get the infonnation she wants.

Sai-ah shared hei- plan with the other stall", and they agreed it might he helpful.

Later in the shift, Sarah saw Mrs Archman as she left the unit to go home. Mre Archman said, "You have been veiy helpful and seem to really care. Thank you." The staff noted tliat Mrs Archman was much more relaxed when she came to the unit. Mr Archman's condition improved, and a basket of cookies arrived on the unit from the couple when he was discharged from the hospital.

Critical Care Careers 2003 CRITICAL CARE NURSE / SUPPLEMENT, FEBRUARY 2003 23 For More Information DiSC: Dimensions of Behavior Personal Profile. Syslam 2800 Series. Chicago. 11: Carlson Learning Company, Center for Internal (^ange; 1994.

Effective Communication. Feedback, and Listening. Available at:http://web.c.b8.neu.c;du/-(:wertheiin/interper/ feedbark.htm. liLt[)://wwvv.di.scoveryoiirpersonality.rom/ MBTl.hüiii? source=looksniai't Stirijrc PM.

Kleint:i- A, eds. Vie Fifih Discipline Fieläbook: Strategies und Tools for Building a Learning Organization.

New Yock, NY:

Bantam Doublcday; 1994.

Bvans S.

Cohen SS, Hot Buitims: ¡low io Hesolve Conflict and Cool Even/one Down.

New York. NY: Haiper Cotliiis; ^ÜOL innian-Ebel B, 1999. Taik Is Not Cheap!

Saving tke High Cost of Misunderstanding at Work and Home. Marietta, Ga: Bard Press.

Gilbert i\fA, Haw to Win an Argiimenl: Surefire Strategies for Getting Your Point Acnm, 2jid ed.

.New York, N>': MJF Books; 2001.

Tssaiis W, SL'iige P.

Dialofíiie and the Art of Thinking Together:

A IHoncering Approach ta Communicating in Business and in Life.

New York, NY; Doublcday Putîlications; 1999.

ing to learn to communicate with courage and direct- ness can master these skills, contributing to environ- tiienis where caregivers can collaborate in providing the highesl quality care.

.ACKNOWLEDGMKM The ;iulhin' acknowit'ilgcs ilic tW)-il)()2 l,i:adfi-slil|) Itodopaiem Work Oroup for liii'ir ilulicUfd work ami amtrilnilidiis Üial Mi)cd créale It's Afí About You: A tihiepn'ntjbr Injhiencing ¡'riictia'.

referenciid in Ihis article.

.American Assodalion of Crilical-Care NursfS.

//\ Alt About You:

A Bluiipriitt for Influencing Practice.

Aliso Viqo. CíiÜl": AACN: 200i¿, 2. PatUTson K, Greiiny J, McMillan R, Switzler A. Crucial Conversation:

Tnob for i'atking Wien Stakes Are. High. \f!w Vbr-li. NY: McGraw-Hill:

2üO2;31.

3 Goliíüían D. Wiirking With Emotional Intelligence.

New York, XY: Baiitüiii Uooks:

1998.

Covey S.

Seven Habits of Highli/ Effective Pmpk.

N'e\v Yni-k, NY: Simon & Srhiister: 1989:235-240.

5. Slorif D, Patton B. Hepii S. Di/fkiilt Conversations: How to DÜCIÍÜÍÍ lV¡i(ii \kitte>y MosI New York, N>': IVnjriiifi Piil.iiam; 2000:149, You know we care because we are nurses who have traveled in your shoes Your Next Travel Assignment?

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