Resolving Conflict Between Nurse and Client

1. Resolving Conflict Between Nurse and Client

2. Def: CONFLICT • Tension rising from incompatible needs, in which the actions of one frustrate the ability to the other to achieve a goal. • Conflicts are inevitable?

3. Nature of Conflict : • content problem issue • Relationship or process issues • Causes of Conflict: • Misunderstanding • Poor communication • Difference in values • Personal clashes • Stress

4. Personal Conflict Management • Avoidance • Accommodation • Competition • Collaboration

5. Factors Influence Response • Gender • Culture • Level of relationship • Importance of solution • Significant other • General capabilities

6. Types of conflict: Intrapersonal vs interpersonal • Types of behaviors: Assertive vs aggressive • Dysfunctional conflict

7. Conflict resolution • Identify conflict issues • Know your own responses to conflict • Separate problem from people involved • Stay focus on the issue and underlying motivation behind the position of the other person took. • Identify available options • Established decision-making process

8. Assessing of Nurse – Client conflict Self-awareness and self-monitoring Knowledge about the stages of conflict (see Box 14-3, pp 375) The overt conflict???? The conflict is covert

9. Nursing strategies to enhance conflict resolution • Prepare for encounter • Organize for information • Manage own anxiety or anger • Time the encounteruse therapeutic relationship • Take one issue at a time • Mutually generate options and solutions • Make request for behavioral change

10. Evaluate conflict resolution • Identify clients intrapersonal conflict resolution • Talk about it • Use tension reducing actions • Defuse intrapersonal conflict with the nurse • Evaluate

11. Interpersonal conflict • Demonstrate respect • Use “I” statement • Make clear statement • Proper pitch and tone • Analyze personal feelings • Focus on the present

12. Conflict with angry client • Conflict with violent clients

13. Techniques for dealing with the anger • 1. Pause-- The patient experiences being understood, is therapeutic • 2. Stepping back/backing off--lets patient diffuse the emotion • 3. Consider motivation-- Secondary gain? Hidden agenda? • 4. Empower the pt • 5. Admit physician limitations • 6. Empathy

14. Actions • 1. Active listening-- Paralanguage skills, position, posture, eye contact, facilitative responses, silence. • 2. Framing--“Sounds like what your telling me” • “Let’s see if I have this right” • 3. Reflecting content--Factual as well as nature and intensity • 4. Identifying and calibrating the anger-- Sometimes content is evident, but nature of anger is unclear • “That situation really got to you, didn’t it?” • “I can imagine how angry I’d feel if that happened to me” • “It seems you’re not sure whether you should trust me further after I didn’t get that test result back to you last week” • 5. Requesting and accepting correction- “Did I get that right”

15. Strategies for the Angry Patient • The initial response should be to remain calm, keep still and establish eye contact. • 'Step back' from the emotionally charged situation and try to analyze what is happening. • Ask the patient to sit down and try to adopt a similar position (the mirroring strategy) without any aggressive pose. • Address the patient (or relative) with the appropriate name, be it Mr. or Mrs. Jones or a first name.

16. Appear comfortable and controlled. • Be interested and concerned about the patient and the problem. • Use clear, firm, non-emotive language. • Listen intently. • Allow the patient to ventilate their feelings and help to relieve their burdens. • Give appropriate reassurance (do not go overboard to appease the patient). • Allow time (at least 20 minutes). • Search for a hidden agenda. • Recognize the relationship between anger and fear.

17. uncover the source of anger • Rapport Building • "I can appreciate how you feel." • "It concerns me that you feel so strongly about this." • "Tell me how I can make it easier for you."

18. Confrontation • "You seem very angry?" • "It's unlike you to be like this." • "I get the feeling that you are upset with…" • "What is it that's upsetting you?" • "What really makes you feel this way?"

19. Facilitation, clarification • "I find it puzzling that you are angry with me." • "So you feel that….." • "You seem to be telling me…." • "If I understand you correctly…" • "Tell me more about this." • "I would like you to enlarge on this point…it seems important."

20. Searching • "Do you have any special concerns about your health?" • "Tell me about things at home." • "How are things at work?" • "How are you sleeping?" • "Do you have any special dreams?" • "Do you relate to any one who has a problem like you have?"

21. Difficult patients • Have done their research, provide a self-diagnosis, and want to argue with your diagnosis • Don't feel like you're providing enough personalized one-on-one time with them • Become agitated and physical with you • Are frustrated with your facility's policies or practices • Are confused due to a medical, physical or mental condition • Have fear due to the diagnosis, illness, or symptoms they are experiencing

22. Care of difficult patient • Identify the underlying causes of a difficult patient • Develop an approach to deal with difficult patients that results in a more consistent, positive outcome • Handle the physically aggressive patient with techniques that reinforce a safe environment for all • Establish documentation techniques to increase protection for yourself and your facility • Calm down the angry patient with effective communication strategies • Discover best practices for dealing with the patient's family

23. Violent patients • Verbal management usually should be attempted first • have a well-organized behavioral strategy • In high-risk settings, such as emergency rooms or psychiatric outpatient clinics, offices should be set up with an emergency buzzer, code word, or signal that can discreetly alert other staff of a potentially volatile patient. • should be clear on how to respond, including whom to call (e.g., security, police) and how to provide for the safety of other staff or patients in the area.

24. Violent patients • Whenever violent behavior is a concern, the patient should be seen with staff (clinical or security) located either nearby or in the same room. • working in high-risk settings should set up their interviewing space so that both the clinician and the patient have easy, unobstructed access to the door. • Never sit behind a desk, and remove heavy or sharp objects. Consider avoiding jewelry and neckties when working with such patients. • In the event the patient escapes, do not run after him or her. • If a weapon is revealed, do not attempt to retrieve it; instead, attempt to engage the patient in conversation, signal for help, and encourage the patient to place the weapon in a neutral place.