Implementing and sustaining evidence-based practices in long-term care.

Managing and Mitigating Conflict in Health-Care Teams

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    This Best Practice Guideline focuses on nursing teams and processes that foster healthy work environments. The focus for the development of this guideline was managing conflict among nursing and healthcare teams with the view that while some conflict is preventable, healthy conflict can also be beneficial.

    For the purpose of this document, conflict is defined as: a phenomenon occurring between interdependent parties as they experience negative emotional reactions to perceived disagreements and interference with the attainment of their goals (Barki & Hartwick, 2004).

    Registered Nurses’ Association of Ontario. (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, ON: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams

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    This RNAO developed tool helps determine where your organization is in relation to the implementation of the best practice guideline recommendations for Managing and Mitigating Conflict in Health-Care Teams. This is an organizational assessment tool comparing current practice to evidence-based practice.

    Developed by the RNAO Long-Term Care Best Practices Initiative, September 2013. Registered Nurses’ Association of Ontario. (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, Canada. Registered Nurses’ Association of Ontario.

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    This peer-reviewed online article addresses the challenges faced by nurses working with colleagues from four generational cohorts and the role of leadership in facilitating respect among them.

    © 2006 OJIN: The Online Journal of Issues in Nursing

    Kupperschmidt, B., (2006, May 31). Addressing Multigenerational Conflict: Mutual Respect and Carefronting as Strategy [Online]. The Online Journal of Issues in Nursing, 11(2). American Nurses Association. Website: http://nursingworld.org/default.aspx.

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    St. Joseph’s Health Centre Guelph demonstration site project funded by Nursing Secretariat of Ontario’s Ministry of Health and Long-Term Care describes approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues.

    Reference: O’Brien, J., Ringland, M., & Wilson, S. (May 2010). The Demonstration Projects: Advancing Leadership in Long Term Care. Nursing Leadership. Vol. 23 Special Issue. Retrieved from Nurse Executive Leader Toolkit available at http://neltoolkit.rnao.ca/sites/default/files/Advancing%20Nursing%20Leadership%20in%20Long-Term%20Care.pdf 

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    This booklet provides practical suggestions for the employer, supervisor and worker to participate in the reduction of bullying in the workplace. © 2013 Public Services Health and Safety Association (PSHSA).

    Public Services Health & Safety Association, 2010, Bullying in the Workplace: A Handbook, Date Retrieved June 8, 2015, http://www.pshsa.ca/wp-content/uploads/2013/02/BullyWkplace.pdf

     

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    Our approach to conflict is not a fixed part of our character, it is learned behavour that we can change. Dana Caspersen, author of "Changing the Conversation: The 17 Principles of Conflict Resolution" offers two simple, transformative actions that we can choose, which can fundamentally change the conflict conversations in our lives.

    Web Address or Source: https://www.youtube.com/watch?v=WfQeH3092Sc 

    Reference: Retrieved July 17,2017 from https://www.youtube.com/watch?v=WfQeH3092Sc 

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    This guideline outlines the key factors associated with conflict with clients, colleagues and in the workplace, and offers strategies for preventing and managing conflict that has escalated. It also highlights the role of nurses in formal leadership positions, as well as the importance of the debriefing process in the prevention and management of conflict. 

    College of Nurses of Ontario.  (2018). Conflict Prevention and Management. Toronto, ON: Author. Retrieved from http://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf

    © 2019 College of Nurses of Ontario

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    Conflict is a part of life. Most of us will do almost anything to avoid it. In this video Dr. Jennie Byrne explains a simple healthy nonaggressive step-by-step process for resolving your conflicts or issues with others that can even strengthen your relationships leaving you feeling empowered in your life and in your relationships.

    Web Address or Source: https://www.youtube.com/watch?v=DSGy5yvC0hM

    Reference: Retrieved July 17,2017 from https://www.youtube.com/watch?v=DSGy5yvC0hM

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    This article reviews various conflict styles, interest-based relational approaches, and a five-step conflict resolution process for resolving conflicts effectively.

    Copyright © Mind Tools Ltd, 1996-2014. All rights reserved.

    MindTools.com. (n.d.). Conflict Resolution: Resolving Conflict Rationally and Effectively [Online]. Retrieved from http://www.mindtools.com/pages/article/newLDR_81.htm [Accessed: June 6, 2014].

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    Several case scenarios provide additional information about the impact of the conflict and how conflict can be addressed, managed and/or mitigated.

    Registered Nurses’ Association of Ontario. (2012, September). Appendix D of Managing and Mitigating Conflict in Health-care Teams Best Practice Guideline. Toronto, ON, Canada: Author. pp.78-82. Retrieved from: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams.

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    This list outlines the fundamental principles and assumptions about conflict in health-care teams.

    Registered Nurses’ Association of Ontario. (2012, September). Managing and Mitigating Conflict in Health-care Teams Best Practice Guideline. Toronto, ON, Canada: Author. p.6. Retrieved from: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams.

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    Les lignes directrices sur les pratiques exemplaires portent principalement sur le personnel infirmier, les équipes soignantes et les processus qui favorisent la mise en place de milieux de travail sains. Ces lignes directrices traitent de la gestion et de l’atténuation des conflits interpersonnels au sein des équipes de soins de santé. Elles partent du principe que même s’il est possible d’éviter certains conflits, des conflits sains peuvent également être bénéfiques. Aux fins du présent document, un conflit se définit comme étant un processus dynamique intervenant entre des personnes interdépendantes ou des groupes interdépendants enclenché par une réaction émotionnelle négative en raison d’un désaccord perçu ou d’une interférence dans l’atteinte de leurs objectifs (Barki et Hartwick, 2004).

    Association des infirmières et infirmiers autorisés de l’Ontario (2012). La gestion et l’atténuation des conflits dans les équipes de soins de santé. Toronto, Canada : Association des infirmières et infirmiers autorisés de l’Ontario. http://rnao.ca/bpg/language/la-gestion-et-l%E2%80%99att%C3%A9nuation-des-conflits-dans-les-%C3%A9quipes-de-soins-de-sant%C3%A9

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    This list includes strategies that individuals can use to learn how to manage and mitigate conflict in the workplace.

    Registered Nurses’ Association of Ontario. (2012, September). Managing and Mitigating Conflict in Health-care Teams Best Practice Guideline. Toronto, ON, Canada: Author. p.36. Retrieved from: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams.

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    This guide demonstrates effective techniques, skills and attitudes for identifying and addressing conflict among co-workers or any setting. Alberta Learning Information Service (ALIS) provides information on education and training, educational funding, job search, labour market trends, and workplace issues. © 2004, 2007 Government of Alberta, Human Services.

    Reference: Alberta Learning Information Service. (2007). Let's Talk: A Guide to Resolving Workplace Conflicts. Alberta, Canada: Government of Alberta Human Services. Retrieved from: https://alis.alberta.ca/pdf/cshop/letstalk.pdf

     

     

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    An exploratory descriptive approach was used to allow frontline nurses to describe and explore incidents of conflict in their places of work. The themes that emerged from the data fell into several broad categories, labelled what happens (nurses eat their young, the nurse-doctor game, lack of support from nurse leaders), why it happens (oppressed group behaviour, power over), and how nurses respond (betrayal, disillusionment, fighting back, communication, moving on). Conflict was described as having a negative impact on the quality of work life.

    Reference: Bishop S.R. 1997. Nurses and Conflict: Workplace Experiences. Retrieved July 17,2017 from http://dspace.library.uvic.ca:8080/bitstream/handle/1828/669/bishop_2004.pdf?sequence=1 

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    Practice guidelines are documents that help nurses understand their professional responsibilities and legal obligations in order to make safe, effective and ethical decisions in nursing practice. This practice guideline helps nurses understand their roles and responsibilities in preventing and managing conflict with clients and colleagues.

    College of Nurses of Ontario. (2018). Professional Standards, Revised 2002. Toronto, ON, Canada: Author. Retrieved from http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

    Copyright © College of Nurses of Ontario, 2009.

     

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    These tables provide specific behavioural recommendations to support individuals and teams in managing and mitigating conflict in health-care teams.

    Registered Nurses’ Association of Ontario. (2012, September). Managing and Mitigating Conflict in Health-care Teams Best Practice Guideline. Toronto, ON, Canada: Author. pp.39-41. Retrieved from: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams.

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    For the purpose of this document, Interprofessional is defined as: Multiple health disciplines with diverse knowledge and skills who share an integrated set of goals and who utilize interdependent collaboration that involves communication, sharing of knowledge and coordination of services to provide services to patients/clients and their care-giving systems.

    This best practice guideline, Developing and Sustaining Interprofessional Health Care: Optimizing patients/clients, organizational, and system outcomes is intended to foster healthy work environments. The focus in developing this guideline was identifying attributes of interprofessional care that will optimize quality outcomes for patients/clients, providers, teams, the organization and the system.

    This guideline identifies best practices to enable, enhance and sustain teamwork and interprofessional collaboration, and to enhance positive outcomes for patients/clients, systems and organizations. It is based on the best available evidence; where evidence was limited, the recommendations were based on the consensus of expert opinion.

    Registered Nurses’ Association of Ontario. (2013). Developing and Sustaining Interprofessional health care. Toronto, ON: http://rnao.ca/bpg/guidelines/interprofessional-team-work-healthcare

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    Gain knowledge in leadership practices that result in healthy outcomes for nurses, patients/clients, organizations and systems. This guideline addresses:

    • System resources that support effective leadership practices and behaviours for formal leaders and nurses at the point of care
    • Organizational culture, values and resources that support effective leadership practices and behaviours at all levels
    • Personal resources that support effective leadership practices across the continuum of care
    • Anticipated outcomes of effective nursing leadership

    2nd Edition, 2013

    Registered Nurses’ Association of Ontario. (2013). Developing and Sustaining Nursing Leadership. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/developing-and-sustaining-nursing-leadership

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    Learn how the decision making process must ensure that appropriate structures and supports are in place to maximize the nursing effort resulting in the best possible care and positive outcomes for the patients/clients, nursing personnel, and the organization. This panel has been developing a guideline to be used as a reference to assist in workload planning and workload management decision making. Published: 2017

    This guideline provides evidence-based recommendations for RNs and RPNs on best nursing practices for developing and sustaining effective staffing and workload practices.

    Registered Nurses’ Association of Ontario. (2017, January). Developing and Sustaining Effective Staffing and Workload Practices. Toronto, ON, Canada: Author. Retrieved from: http://rnao.ca/bpg/guidelines/developing-and-sustaining-effective-staffing-and-workload-practices.

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    Effective nursing practice is dependent on an effective therapeutic relationship between the nurse and the client. This guideline addresses the qualities and capacities of an effective therapeutic relationship, the state of knowledge, and the knowledge needed to be effective. To implement a therapeutic relationship successfully, an organization's characteristics and workplace values must be supportive and in place. An organization readiness assessment based on the best practice recommendations is provided. Supplement: 2006

    Registered Nurses’ Association of Ontario. (2002). Establishing therapeutic relationships. Toronto, ON, Canada: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_Relationships.pdf

     

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    The goal of this best practice guideline is to strengthen collaborative practice among nurses, because effective collaborative practice is essential for working in health-care organizations. In this guideline, we focus on collaborative practice amongst three types of nursing professionals – registered nurse (RN), registered practical nurse (RPN) and nurse practitioner (NP) – and explore what fosters healthy work environments for them, aware that collaboration must align with the needs of the patient or client. This best practice guideline was developed to assist nurses, nursing leaders, other health professionals and senior managers to enhance positive outcomes for patients/clients (individual/family/group/community), nurses, and the organization through intra-professional collaborative practice. This guideline was based on the best available evidence and where evidence was limited, the best practice recommendations were based on the consensus of expert opinion. This guideline identifies:

    • best practices for intra-professional practice; and
    • the organizational culture, values and relationships, and the structures and processes required, for developing and sustaining effective intra-professional nursing practice among nurses.

    Registered Nurses’ Association of Ontario. (2016). Intra-professional Collaborative Practice among Nurses . Toronto, ON, Canada: Author. Retrieved from: http://rnao.ca/bpg/guidelines/intra-professional-collaborative-practice-among-nurses 

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    SBAR TeamSTEPPS Long-term care is a video on using the SBAR tool to improve communication in the team. TeamSTEPPS is an evidence-based framework to optimize team performance across the health care delivery system.

    Reference:. TeamSTEPPS®. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD), USA. SBAR TeamSTEPPS Long-term care. Retrieved from https://www.youtube.com/watch?v=zDOARcgH_Ew 

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    Addresses team development, team structure, set up, roles and responsibilities and conflict management styles.

    Reference: Health Quality Ontario (April 2013). Quality Improvement Primers: Teamwork Primer. Queen’s Printer for Ontario, 2013. Retrived from Health Quality Ontario available at http://www.hqontario.ca/Portals/0/Documents/qi/qi-teamwork-develop-primer-en.pdf

    Individuals may reproduce these materials for their use provided that proper attribution is given to the appropriate source. The recommended citation for this resource guide is: Health Quality Ontario (April 2013). HQO is funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions expressed in this publication are those of the authors and do not reflect the official views of the Ministry.

    © Queen’s Printer for Ontario, 2013

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    This document presents and discusses the components of the Five Dysfunctions of a Team Model and provides a team assessment tool to determine to what degree the five dysfunctions exist in your team.

    Web Address or Source: https://www.isasw.org/uploaded/calendar_icons/Conference_Resources/2016_June_Heads_Meeting/FiveDysfunctionsofaTeamPatrickLencioni1.pdf

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    Tips on  how to manage and mitigate conflict (e.g. how to be “self-aware” during conflict, five responses to conflict, steps to resolve conflict, questions to ask when conflict arises, barriers to resolution, etc.).

    Registered Nurses’ Association of Ontario. (2012, September). Managing and Mitigating Conflict in Health-care Teams Best Practice Guideline. Toronto, ON, Canada: Author. pp. 86-88. Retrieved from: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams.

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    This guide reviews Lencioni’s 5 dysfunctions of a team model and discusses and provides clear tables related to building trust and what people need to feel trusted, mastering conflict, achieving commitment, engaging in conflict resolution, accountability, and focusing on results.

    Reference: https://www.psychometrics.com/wp-content/uploads/2016/11/Psychometrics-Lencioni-Guide.pdf

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