Scenario Setting
Discuss about the conflict witnesses in a clinical setting that holds importance in terms of patient care delivery.
Conflicts are recognized as the differences in opinion between two or more individuals or groups as a result of differences in values, attitudes, beliefs and behaviors. In relation to workplace settings, conflicts are found to be arising from two different sources; staff to manager interactions and staff to staff interactions. Interpersonal conflict is perceived to be a disagreement involving dissatisfaction, the outcomes of which might be drastic. Workplace conflicts experienced in the healthcare settings are complicated due to the fact that they involve complex relationships based on emotions of individuals. In such a setting professionals are to engage in communication with the diverse human resources who have different opinions and beliefs. It is crucial that professionals attempt to prevent conflicts among them for promoting best quality health care delivery. Divergences and disagreements exiting in healthcare settings hold the potential to have a negative impact on the process of care delivery as a result of communication gap. It is therefore essential that healthcare professionals, including nurses, aim to identify sources of conflicts and implement suitable measures to resolve the same at the earliest. The present paper is based on a conflict witnesses in a clinical setting that holds importance in terms of patient care delivery. The paper provides details of the scenario setting and the conflict scenario at the initial stage. The contributory factors of conflict are then outlined in the paper. The next section is an analysis of the conflict scenario and takes into consideration the impact on patients, nurses and the organization. A root cause analysis of the scenario is then presented. At the end, suitable conflict resolution strategies are outlined that can resolve the concerns. A conclusion is drawn at the end of the paper.
Nursing placement in healthcare settings are vital for understanding issues that are commonly faced by professionals in diverse scenarios. Placements are the opportunities to engage in learning skills for addressing real-life scenarios that can guide nursing practice. For my clinical placement I was required to work in the Intensive Care Unit (ICU) in a reputed hospital in Saudi Arabia. ICUs are the special department of a health care facility that is responsible for providing intensive treatment to patients. Professionals are to cater to the needs of patients suffering from life-threatening and severe health conditions requiring close support and monitoring for ensuring better outcomes. I had joined the Medical ICU (MICU) in the setting that aimed at being committed to provide excellent care with compassion and teamwork. The unit could accommodate ten patients as its maximum capacity. Three staff nurses were to be at duty in each shift, and the unit also had one manager and one medical officer to take in charge. Patients were to be transferred directly into the unit from the emergency department if needed, or from the general ward in case of deterioration in the condition of the patient. MICUs are to provide interdisciplinary care to those requiring continual care in a technologically advanced setting.
Scenario
Having worked at the MICU for a few days there was a realization that the nurse’s turnover rate was considerably high in the unit as compared to that of other professionals at the unit and at other units of the same setting. The contributing factors for the same were poor level of communication among the coworkers, inappropriate attitude of the physician towards the nurses, lack of acceptance, bullying, and lack of respect. There were more than one instances when conflict among the professionals was evident that had far reaching complications. The ultimate outcome was dissatisfaction on the part of the patients due to poor health outcomes.
On a particular day while I was on duty, the physician had come on round at the unit to follow up his patient who had been complaining of urinary tract infection at that time frame. The patient was a 76 year old woman admitted to the general ward at the initial stage due to pneumonia. She had later been transferred to the MICU for deterioration in her condition. Her medical history included type 2 diabetes diagnosed twenty years previously. Upon assessing the patient based on her complaint, the physician shouted at the nurses regarding failure to catheterize the patient in early shift. The reason for his anger was that catheterization was recommended at the time of admission of the patient. To this the nurse manager showed disagreement regarding the inessential need of catheterization for the patient. She mentioned that her decision was based on previous experiences of similar patient situations.
It was further pointed out by the physician that the nurses had also missed administering the insulin dose to the patient. The nurse manger who was responsible for the overseeing the concern related to the error previously had differences of opinion with the physician. Further, the manager also had interpersonal conflicts with the nurses working at the unit. She therefore did not address the concern of medication mismanagement and inappropriate catheterization as deemed fit. No clear instructions were given to provide care for urinary tract infection and the nurse manager demonstrated poor leadership skills. She disregarded the concerns of the professionals and the patient put forward at different point in time. As a result of the conflict there was a rapid deterioration in the condition of the patient and had to remain admitted at the MICU for further seven days. In addition, it was noticed that in case nursing professionals put forward a complaint regarding interpersonal problems, the manager adapted an avoidance strategy. This further deteriorated the working environment in the unit. During my placement one nurse had resigned from her job due to dissatisfaction related to poor work environment.
Contributory Factors of Conflict
Significantly, healthcare teams function on the basis of contribution of different professionals, and so is the case for MICUs. Nevertheless, conflict is common in teams where professionals respond to different clinical situations in different manner. Since teamwork in clinical settings is highly complex, the sources of conflicts are also varied. In an MICU, the contribution of each professional is crucial, and thus the chances of conflict are amplified to a great extent Zerwekh, and Garneau (2017). McKibben (2017) commented that different personalities of healthcare professionals collide under the circumstances where critical decisions are to be taken, leading to conflicts. Some of the underlying causes of conflict include lack of inter-professional respect, disagreements, negative emotions, lack of resources and lack of suitable leadership. Healthcare teams constitute key members who bring in particular skills and knowledge to care delivery process. As a result they demonstrate different perspectives on how a particular situation is to be addressed (Brown et al., 2011).
According to Pecanac and Schwarze (2018) collegiality stems from working relationships that lead to respect for other’s ability. This entails collaboration and apt critical decision making between healthcare professionals. Conflict arises when mutual recognition is lacking. Some examples include blaming for perceived poor outcomes and whistle blowing by a professional regarding a misstep. The behavior is the cause of escalation of conflict and one feels injured due to hurtful behavior whereas the other feels anger. In the present case the physician took in-appropriate approach for addressing the concern poor treatment being given to the patient suffering from UTI. As he shouted at the nurses the nurse manager felt un-recognized and underestimated.
Disagreements between professionals regarding treatment procedures are also a noteworthy cause of conflict. Decisions regarding treatment processes are related to intervention options and professional judgment on the basis of outcomes experienced earlier (Aberese-Ako et al., 2015). In the present scenario the cause of conflict was also attributed to the disagreement between the nurse manager and the physician regarding what was the most appropriate and effective care process for the patient. As pinpointed by Hartog and Benbenishty (2015) much of the conflicts arising in clinical settings due to disagreements are related to moral principles of what is good for a patient. This might or might not be based on scientific evidences, such as in the present case. When treatment processes are dictated on to team members without involvement of them or without discussion, there lie immense chances of disagreements, leading to conflicts. Caregivers might form evidences based on previous experiences and knowledge (Moreland & Apker, 2016). In the present case the physician had dictated the need of catheterization for the patient without the involvement of the nurse manager, leading to conflict between the two.
Pointing out how leadership styles determine conflict resolution in settings, Barr and Dowding (2015) stated that leadership is the capability of promoting adaptive changes as per the need. Appropriate leadership has the focus on taking the input of subordinates in a decision making process and making them feel valued within the workplace. As highlighted by the researchers, leadership is a function of knowing the needs of team members and building a trusted relationship that is mutually beneficial. Absence of proper leadership skills can lead to conflicts within teams where in there lays scope of variance between the leader and the subordinate. Gopee and Galloway (2017) had opined that autocratic leaders emphasize on productivity without human considerations. As the leader is engaged in commanding over the subordinates, chances of conflicts is high. In the present case, the nurse manager demonstrated autocratic leadership skills, promoting Unitarism perspective, ultimately leading to conflicts with the nursing professionals.
Conflicts in healthcare settings have far-reaching aftermaths, with patient care being impaired considerably. According to Wujtewicz et al., (2015) conflicts in ICUs concern all professional groups, patients and the respective family members. Undesirable situations have their own dynamic nature. The first stage of emerging conflict is the ‘hidden conflict’ wherein there is evidence of difference of opinion between the two parties. In case either of the parties do not change their mind, the conflict is escalated. In situations when it is unresolved, the conflict is the cause of stagnation. Negotiation might not be possible under such situations. The final stage is a long process in which interpersonal relations undergo a drastic change. In this regard McKibben (2017) had stated that conflicts in healthcare settings might be differently perceived by professionals authorized to make clinical decisions for patients. The impact of conflicts is serious not only for the patients, but also for the physicians, nurses and the care organization. In case of patients, the primary outcome is delayed valuable therapeutic decisions that reflect lower quality treatment. Lack of effective decisions, concerning withdrawal or continuation of treatment, leads to prolonged and unjustified stays at the ICU. In relation to the ICU team, the emergence of conflicts is the cause of manifestation of lower efficiency of work, lack of coherence, and illogical behavior (Maung et al., 2015).
Strong interpersonal relationships are critical for any healthcare unit to achieve the desired goals and demonstrate efficiency. In the present case multiple concerns could be identified in relation to conflicts among nurses as well as between the nurse manager and the physician. The end result in this case was severe impact on the patient care delivery. The time of discharge of the patient was unnecessarily delayed. Moving forward, the impact of conflict could also be witnessed in case of the nursing professionals. Owing to repeated incidents of dissatisfaction in the workplace due to conflict with the manager, the nurse resorted to resigning from the setting. Nurses who are in conflict with physicians exert a negative impact on subordinates including lack of job satisfaction, increased feeling of exhaustion and increased chances of leaving the setting (Lancaster et al., 2015; Galletta et al., 2016). In the present case as the manager conferred to the avoidance strategy towards concerns of the professionals, it was perceived to be a non-strategic approach toward problem solving. Altered interpersonal relationship was the apparent outcome. The nurse manager did not consider enhancing professional relationship through adhering to professional boundary.
Poor leadership skills were reflected through the action of the nurse manager that led to further damage. The most crucial element for an organization is to have a manager who demonstrates suitable leadership skills. Suitable leadership skills must possess three dimensions, namely task orientation, relationship orientation and effectiveness (Leineweber et al. 2014). Task orientation implies that the manager directs the efforts of the subordinates in achieving set goals. Relationship orientation implies that the leader respects and trusts the subordinates, and feels for their concern. Effectiveness implies that the manager style is altered as per the situation. As the manager in the present case did not adapt the dimension of effectiveness, the management style was not matched as per the situation. She considered adhering to the autocratic leadership style which was ineffective in overcoming the situation. Caricati et al., (2015) reported that impact of events of poor conflict management is cascaded throughout an organization even if it stem from a particular unit. The reputation of the setting is hampered when cases of poor care delivery as a result of poor leadership demonstration come into the limelight.
Study of McKibben (2017) reports that root causes of conflicts in organization are related to the structure and culture within which the professional groups are embedded. While structure and systems are defined in an conscious manner with intent around a particular direction, culture usually emerges in natural manner. The root cause of conflict can be identified by looking into four different aspects. The first aspect is the extent to which conflict is created as a result of organizational structures outside the work group. The second aspect is the extent to which the conflict is in response to a dynamic pressure. The third aspect is the extent to which conflicts occur by interaction with other organizational units. The fourth aspect is the extent to which the work group can control the aforementioned factors. In the present case, the scope for conflicts was increased due to a lack of policy overseeing the outcomes of conflicts in the organization. The system of the setting did not put in place a mitigation strategy for conflicts that can penalize professionals when engaging in in appropriate behavior hampering process outcomes. Further, conflict was also a result of poor communication between different disciplinary paradigms, such as the nurse and physician. It can be mentioned that the setting did not have any provision for enabling regular communication between members of an interdisciplinary teams such as the ICU. Lastly, the team working in the ICU did not have appropriate control over the factors permitting interpersonal conflict.
It has been acknowledged repeatedly that conflicts create negative interpersonal relationships that hold the potential to hinder the process of achieving meaningful outcomes. Dysfunctional conflict is the driving factor behind professional stress, and distortion in the clinical setting (Salas-Vallinaet al., 2017). How conflict is taken care of is critical to the ability to move forward towards organization’s mission. As highlighted by Huber (2017) the appropriate way of handling conflicts is to compromise and accommodate other’s point of view. The mentioned strategy is applicable when one of the two individuals has more power than the other, such as a nurse and a physician. Compromise involves acknowledging the fact that the other person might be having better approaches to situations. It nevertheless requires that each individual gives up on ego and come up with logical proposals for resolution of the case.
Healthcare settings at the present times are struggling hard to come in terms with the evolving needs of the sector. Changes in care delivery approaches have led to increased risk of conflicts. Beardsley and Lo (2014) had proposed the third-party conflict management model that is beneficial in resolving conflicts through problem solving, forcing and avoiding. The key to problem solving is identification of concerns of the involved parties and finding a suitable solution that is capable of addressing the concerns. Forcing implies to the imposition of decisions by the individual for resolving the conflict. Avoidance can be the strategy when one does not want to get involved in the conflict. The concept of problem solving is applicable to the present situation. When one demonstrates problem solving behavior, the other party takes a positive note on that and shows interest in resolving the issue. It would have been appropriate in the present situation if either the nurse manager or the physician had showed problem solving behavior and contributed to control of stressful situations (Regan et al., 2016).
Effective and strong leadership skills are notable in success of healthcare settings. Different situations demand different leadership skills. While autocratic leadership has been constantly criticized for its drastic impact on setting outcomes, transformation leadership has been much appreciable for leading to conflict resolution at different levels (Salas-Vallina et al., 2017). It would have been appreciable if the nurse manager demonstrated transformational leadership skills in place of autocratic leadership skills. Transformational leadership has the emphasis on interpersonal relationships that foster self-actualization through creativity, confidence, respect, acceptance and achievement. Such form of leadership helps in establishing the professional bond between the leader and the subordinate (Almost et al., 2016). Effective implementation of transformational leadership leads to agreements regarding shared valves, common goals and consequential purposes. While disagreements are confronted, team members can be motivated in the best possible manner. As a result, best ideas can be integrated into the care delivery process (Trastek et al., 2014).
Conclusion
Conflicts in healthcare settings are inevitable and are commonly experienced by nursing professionals. The issue holds significance due to the negative impact it has on patient care delivery. Conflict resolution requires skills and accurate knowledge for eliminating chances of disagreements and discrepancies. While differences in opinions and values are difficult to be avoided, professionals are to demonstrated competencies to resolve such differences so that a consensus can be reached upon. The present paper reflected on a clinical scenario where conflict management was directly linked with patient care outcomes. The analysis based on conflict management literature brought into limelight the contributory factors for conflicts in clinical settings and their importance. Recommendations have been put forward to resolve and handle such conflicts in an appropriate manner. The paper holds implications for nursing professionals and healthcare settings aiming a managing conflicts and reducing undesirable impacts on working environment. Since organization productivity is impaired as a result of conflicts, it is recommended that professionals have a proactive approach in developing skills to manage conflicts. Learning suitable conflict handling would help nurses to have more job satisfaction through better patient outcomes. Further, nurses would be treated with a more positive outlook as a result of their conflict handling capability. This would in turn foster a positive working culture and increase scope for professional development in future.
References
Aberese-Ako, M., Agyepong, I. A., Gerrits, T., & Van Dijk, H. (2015). ‘I Used to Fight with Them but Now I Have Stopped!’: Conflict and Doctor-Nurse-Anaesthetists’ Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital. PloS one, 10(8), e0135129. DOI: https://doi.org/10.1371/journal.pone.0135129
Almost, J., Wolff, A. C., Stewart?Pyne, A., McCormick, L. G., Strachan, D., & D’souza, C. (2016). Managing and mitigating conflict in healthcare teams: an integrative review. Journal of advanced nursing, 72(7), 1490-1505. DOI: https://doi.org/10.1111/jan.12903
Barr, J., & Dowding, L. (2015). Leadership in health care. Sage. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=hySJCwAAQBAJ&oi=fnd&pg=PP1&dq=conflict,+autocratic+leadership,+healthcare&ots=dhGX5viV2Q&sig=eUOJ8NYIdfJAHWo_MZVjIBJs1Cc#v=onepage&q=conflict%2C%20autocratic%20leadership%2C%20healthcare&f=false
Beardsley, K., & Lo, N. (2014). Third-party conflict management and the willingness to make concessions. Journal of Conflict Resolution, 58(2), 363-392. DOI: https://doi.org/10.1177/0022002712467932
Brown, J., Lewis, L., Ellis, K., Stewart, M., Freeman, T. R., & Kasperski, M. J. (2011). Conflict on interprofessional primary health care teams–can it be resolved?. Journal of interprofessional care, 25(1), 4-10. DOI: 10.3109/13561820.2010.497750
Caricati, L., Guberti, M., Borgognoni, P., Prandi, C., Spaggiari, I., Vezzani, E., & Iemmi, M. (2015). The role of professional and team commitment in nurse–physician collaboration: A dual identity model perspective. Journal of interprofessional care, 29(5), 464-468. DOI: https://doi.org/10.3109/13561820.2015.1016603
Galletta, M., Portoghese, I., Carta, M. G., D’aloja, E., & Campagna, M. (2016). The Effect of Nurse?Physician Collaboration on Job Satisfaction, Team Commitment, and Turnover Intention in Nurses. Research in nursing & health, 39(5), 375-385. DOI: https://doi.org/10.1002/nur.21733
Gopee, N., & Galloway, J. (2017). Leadership and management in healthcare. Sage. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=GRgjDgAAQBAJ&oi=fnd&pg=PP1&dq=+leadership,+healthcare&ots=R4OuzdBMD1&sig=US6eb_VxZ1-NR1qoql93v_5XRXg#v=onepage&q=leadership%2C%20healthcare&f=false
Hartog, C. S., & Benbenishty, J. (2015). Understanding nurse–physician conflicts in the ICU. Intensive care medicine, 41(2), 331-333. DOI: 10.1007/s00134-014-3517-z
Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=OTg1DwAAQBAJ&oi=fnd&pg=PR1&dq=nursing+management,+book&ots=QqCBvLigYF&sig=YyFHxZ4uo9zjmXhsESUivYUsCgY#v=onepage&q=nursing%20management%2C%20book&f=false
Lancaster, G., Kolakowsky?Hayner, S., Kovacich, J., & Greer?Williams, N. (2015). Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel. Journal of Nursing Scholarship, 47(3), 275-284. DOI: https://doi.org/10.1111/jnu.12130
Leineweber, C., Westerlund, H., Chungkham, H. S., Lindqvist, R., Runesdotter, S., & Tishelman, C. (2014). Nurses’ practice environment and work-family conflict in relation to burn out: a multilevel modelling approach. PLoS One, 9(5), e96991. DOI: https://doi.org/10.1371/journal.pone.0096991
Maung, A. A., Toevs, C. C., Kayser, J. B., & Kaplan, L. J. (2015). Conflict management teams in the intensive care unit: A concise definitive review. Journal of Trauma and Acute Care Surgery, 79(2), 314-320. DOI: 10.1097/TA.0000000000000728
McKibben, L. (2017). Conflict management: importance and implications. British Journal of Nursing, 26(2), 100-103. DOI: https://doi.org/10.12968/bjon.2017.26.2.100
Moreland, J. J., & Apker, J. (2016). Conflict and stress in hospital nursing: Improving communicative responses to enduring professional challenges. Health communication, 31(7), 815-823. DOI: https://doi.org/10.1080/10410236.2015.1007548
Pecanac, K. E., & Schwarze, M. L. (2018). Conflict in the intensive care unit: Nursing advocacy and surgical agency. Nursing ethics, 25(1), 69-79. DOI: https://doi.org/10.1177/0969733016638144
Regan, S., Laschinger, H. K., & Wong, C. A. (2016). The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration. Journal of nursing management, 24(1). DOI: https://doi.org/10.1111/jonm.12288
Salas-Vallina, A., López-Cabrales, Á., Alegre, J., & Fernández, R. (2017). On the road to happiness at work (HAW) Transformational leadership and organizational learning capability as drivers of HAW in a healthcare context. Personnel Review, 46(2), 314-338. DOI: https://doi.org/10.1108/PR-06-2015-0186
Trastek, V. F., Hamilton, N. W., & Niles, E. E. (2014, March). Leadership models in health care—a case for servant leadership. In Mayo Clinic Proceedings (Vol. 89, No. 3, pp. 374-381). Elsevier. DOI: https://doi.org/10.1016/j.mayocp.2013.10.012
Zerwekh, J., & Garneau, A. Z. (2017). Nursing Today-E-Book: Transition and Trends. Elsevier Health Sciences Retrieved from https://books.google.co.in/books?hl=en&lr=&id=xXINDgAAQBAJ&oi=fnd&pg=PP1&dq=nursing,+book&ots=4MB3HcAo37&sig=MYSvmF1w6SQN0NabLk-623anhyA#v=onepage&q=nursing%2C%20book&f=false
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
