Managing Conflict: Adapted from Practice Guideline: Conflict Prevention and Management, produced by the College of Nurses of Ontario. To read the full paper, visit www.cno.org. Reprinted with permission from Long Term Care magazine, Vol 18, No 3, pages 7-8. Note: Concerned Friends supports the ideas put forth in this paper. We cannot overemphasize the importance of training long-term care staff (both nurses and personal support workers) in conflict management. Short-staffing, however, undermines even the most highly trained workforce, and this continues to be an issue. It is therefore important that administrators become aware of the relevance of proper training and staffing levels so that they become part of the solution in the management of conflict within their care facilities. March 2009- Nursing is a profession based on collaborative relationships. When two or more people view issues or situations from different perspectives, these relationships can be compromised by conflict. Though conflict is commonly perceived as negative, the experience of dealing with it can lead to positive outcomes for nurses and residents. Nurses who effectively deal with conflict demonstrate respect for their residents, their colleagues and the profession. Conflict that is managed effectively by nurses can lead to personal and organizational growth. However, if conflict is not managed effectively, it can hinder a nurse's ability to provide quality resident care and escalate into violence and abuse. Because of this, nurses need to be aware of the ways in which conflict can escalate and be prepared to prevent or manage it in the workplace. While conflict is an inherent part of nursing, the provision of professional services to residents does not include accepting abuse. Nurse-resident conflict The therapeutic nurse-resident relationship is the foundation for providing nursing services that contribute to the resident's health and well-being. The role of the nurse in the therapeutic nurse-resident relationship is to support the resident in achieving his or her health goals. However, unresolved conflict can impede the attainment of these goals. Key factors It is possible to identify characteristics and situations that are associated with the evolution or escalation of conflict among nurses, residents and their families. Nurses who know how to recognize key factors associated with conflict may prevent its escalation and improve care delivery. Conflict between a nurse and a resident can escalate if a resident is: • intoxicated or withdrawing from a substance-induced state; • being constrained (for example, not being permitted to smoke) or restrained (for example, with a physical or chemical restraint); • fatigued or over stimulated; and/or • tense, anxious, worried, confused, disoriented or afraid. Conflict between a nurse and a resident can escalate if a resident has: • a history of aggressive or violent behaviour, or is acting aggressively or violently (for example, using profane language or assuming an intimidating physical stance); • a medical or psychiatric condition that causes impaired judgment or an altered cognitive status; • an active drug or alcohol dependency or addiction; • difficulty communicating (for example, has aphasia or a language barrier exists); and/or • ineffective coping skills or an inadequate support network. Conflict between a nurse and a resident can escalate if a nurse: • judges, labels or misunderstands a resident; • uses a threatening tone of voice or body language (for example, speaks loudly or stands too close); • has expectations based on incorrect perceptions of cultural or other differences; • does not listen to, understand or respect a resident's values, opinions, needs and/or ethno-cultural beliefs; • does not listen to the concerns of the family and significant others, and/or act on those concerns when it is appropriate and consistent with the resident's wishes; • does not provide sufficient health information to satisfy the resident or the resident's family; and/or • does not reflect on the impact of her or his behaviour and values on the resident. Prevention One part of the therapeutic nurse-resident relationship is providing resident-centered care. Nurses can provide resident-centered care by following the resident's lead about information-giving and decision-making, by attempting to understand the meaning behind the resident's behaviour and by using proactive communication strategies that focus fully on the resident. Nurses can employ resident-centered care strategies to prevent behaviours that contribute to the escalation of conflict. Nurses can: • continually seek to understand the resident's health care needs and perspectives; • acknowledge the feelings behind the resident's behaviour; • ask open-ended questions to establish the underlying meaning of the resident's behaviour; • engage in active listening (for example, use verbal and non-verbal cues to acknowledge what is being said); • use open body language to display a calm, respectful and attentive attitude; • acknowledge the resident's concerns about the health care system and his or her experiences as a resident; • respect and address the resident's wishes, concerns, values, priorities and points of view; • anticipate conflict in situations in which it has previously existed and create a plan of care to prevent its escalation; and • try to understand how their behaviour and values may negatively affect the resident. Management There are many different strategies for managing conflict that can be implemented by nurses before conflict escalates. Conflict-management strategies should be individually tailed to each resident situation. Nurses need to use their professional judgment to determine which strategy is most appropriate for each resident. Nurses can: • implement a critical incident management plan; • remain calm and encourage the resident to express his or her concerns; • avoid arguing, criticizing, defending or judging; • focus on the resident's behaviour rather than on the resident personally; • involve the resident, the resident's family and the health care team members in assisting with the behaviour and developing solutions to prevent or manage it; • state that abusive language and behaviours are unacceptable (if it is not anticipated that this will escalate the resident's behaviour); • step away from the resident if necessary (for example, to regain composure or to set personal space boundaries); • leave the situation to develop a plan of care with the assistance of a colleague if the resident intends to cause harm; and/or • protect themselves and other residents in abusive situations by withdrawing services, if necessary. Debriefing after an incident Sometimes, despite a nurse's best efforts to identify risk factors for conflict and implement strategies to prevent it, conflict may escalate into a critical incident. After a critical incident has taken place, it is important for the nurse involved to collaborate with the health care team to debrief about the situation. Debriefing allows nurses to reflect on and learn from what has occurred. This can provide insight into the factors that led to the conflict as well as contribute to its future prevention and management. Nurses can: • consult with those involved about the meaning of their experiences during the incident with the intent to heal themselves, the resident and the family; • review and reflect on responses and recommend future strategies based on the actions of team members; • reflect on their own behaviour, which may have unintentionally affected the nurse-resident relationship; • help the resident understand how his or her behaviour negatively affected the therapeutic nurse-resident relationship; • develop communication strategies with the resident so the resident can express his or her feelings appropriately; • use best-practice strategies to develop a care plan for dealing with the resident's behaviour; and/or • use anticipatory planning to develop a consistent approach to address the resident's behaviour in the future. |