Managing Conflict Essay

Managing conflictMedicolegal lovesWe live in an increasingly demanding and vociferous society and incidents of conflict and aggression atomic number 18 sadly commonplace. Kate Taylor, clinical Risk Manager at the Medical protection Society offers advice on how to deal with the problem twisting in commonplace bore is active and demanding, with adjoind creamloads, stretched time and whatever unhurried ofs having greater expectations of c ar. At times, when expectations are non met, we move find ourselves in conflict with patients and in some bits this nates turn to aggression. As nurses, how should we deal with potencyly concentrated situations? This article aims to increase our understanding of conflict and provide strategies to deal with it effectively. It also includes practical tips to switch off risks associated with managing conflict and aggression.DEFINITIONSConflict means different things to different people. The Health and golosh executive director define s workplace abandon as any incident where rung are abused, threatened or assaulted in tidy sum relating to their work, involving an explicit or implicit ch solelyenge to their safety, well-being orhealth.1 Non-physical personnel can be defined as the use of inappropriate words or behaviour causing di tense and/or constituting harassment. 2 The scale of the problem there is limited documentation relating to force against nurses working in general commit. However, a recent survey carried out by the British Medical Association, to which 20% of doctors responded, found 3 * Violence is a problem in the workplace for champion-half of doctors (same for GPs and infirmary doctors). * 1 in 3 respondents had getd some make up of violence in the workplace in the last year (same for hospital doctors and GPs). * 1 in 5 doctors reported an increase in violence in the away year, but the level remained constant for the majority. * Among doctors who reported some get under wizs skin of vi olence, most had been the victim of verbal abuse in the past year while more than half had received a threat, and a third had been physically assaulted. Most injuries were minor, but 5% were serious.In April 2011, NHS Protect was set up. It is responsible for going on work to protect NHS provide and resources from crime in England. 4 According to its statistics, physical assault against NHS module is steady increasing. However, these statistics do non capture the incidents where staff cast been subjected to non-physical violence. In general practise, members of staff are more likely to be subjected to non-physical violence. Imagine working as a practice nurse and an unhappy patient threatens you, relation back you I know where you live? We cannot underestimate the impact that such(prenominal) non-physical violence can cause on individuals.CONTRIBUTORY FACTORSCircumstances* Members of the general practice team are take aparticularly vulnerable as they often cite with patie nts alone. Doctors and practice nurses often work in small numbers.* Home visits are usually carried out alone.System and Organisational Problems* Delays, restrictions and mistakes such as lost prescriptions or delays in test results* Lack of appointments* Patient disappointment often results from unmet expectations, whether hardheaded or unrealistic. Environment* Waiting populate (heating, lighting, noise and sit down)* Cramped consulting inhabit without easy exit for health professionals* Lack of privacy* Availability of potential weapons.Patient Factors* Increased expectations and the difficulties in meeting these demands. Dissatisfaction with the care provided is perceived as the most common cause of aggression and violence * Strong patient emotions e.g. uncertainty, frustration, stress and misgiving. Anger is often secondary to emotions such as anxiety or grief * An underlying medical condition such as hypoglycaemia or psychotic illness* Physical symptoms including pain, h eadache or over-tiredness* Mental health problems such as* Personal problems e.g. financial, relationship, stress at work* Drugs and alcohol.Staff Factors* Under pressure staff-working in noisy fasten rooms, unable to trace or connection staff* In adequate staff numbers* Escalating the situation by confrontation, over-reacting, poor ccmmunication, inconsistencies in intervention patients, patronising behaviour, ignoring a situation or falling to apologise.COMMUNICATION SKILLS vertical dialogue with patients is likely to reduce the risk of conflict and violence. As nurses, how we pass on with our patients can have an impact on how difficult situations develop. We fatality to forecast virtually what we say and how we say it. We should rely on our strong communication skills to determine with our patients what they can expect from the services we provide. A study by American psychologist, Albert Mehrabian, determined that non-verbal communication represents over 50% of an inte raction. 5Being informed of your own body language can be the first smell to understanding how it is perceived by our patients. Listening and empathising with patients are essential skills for nurses-so how do we mark off our patients know we are listening?* Give the patient your single(a) attention* Dont trivialise the patients issue* How is the patient feeling are they angry, afraid, frustrated? Respond to the emotion as well as the words* Allow the patient to finish what they are saying* Ask questions, paraphrase and reflect to ensure you understand the message. contend INTERACTIONSChallenging interactions with patients can be a significant cause of stress for nurses, yet the nature of most clinical jobs makes these encounters requisite. It can be difficult to communicate your point of view effectively for fear of generating conflict, which can lead to frustration and dissatisfaction, and may affect your ability to give good care. It is critical to build a avowing relatio nship with the patient in these circumstances ensure you listen attentively, empathise and avoid confrontation. Maintain eye contact and try to establish a shared understanding of the patients problem. Having acknowledged their perspective, respectfully inform them of your position.Then work on achieving a mutually agreeable solution or way forward sort of than focussing on points of disagreement, which can differentwise degenerate into an argument. Then military service and support the patient to achieve the agreed solution. After challenging interactions that have required you to state your position, ensure there is effective communication with former(a) members of the practice clinical team, along with a clear record of the discussions held. This volition ensure consistency should the patient approach a different clinician want to re-negotiate an alternative plan or outcome.PRACTICAL TIPSPractices should con spotr* Providing a side room or separate area to deal with upset/ c ompetitive patients or those who need more privacy.* Providing good temperature and ventilation control, adequate seating and clear signage* Providing calming measures to reduce frustration, anxiety or boredom such as distractions in waiting room e.g. toys for children, magazines for adults * Adding an agreed marker to the thick of a patients record who has a history of violence (and ensure it is factually accurate)* Having a protocol for involving the police and re sorrowful patients from the list* employ CCTV* Ensuring all practice staff have access to panic alarms* Providing locks for all areas where patient access is restrictedCONCLUSIONWe can and will sire conflict in general practice due to the sheer hoi polloi of patient contacts that pass along every day. The key to managing a conflict situation is to try to de-escalate it as much as possible.confidentiality is central to the trust between nurses and their patients think how easy it may be to breach confidentiality whe n you have a situation with an aggressive patient. The Nursing and Midwifery Council Code of trade clearly states you must respect peoples right to confidentiality. 6 As a last resort you can remove a patient from the practice list. However, this can be capturen as an emotive issue, risking criticism from bodies such as the Parliamentary and Health Service Ombudsman, the GMC and the media. You can find utilizable information on how to go about it in the MPS factsheet, Removing patients from the practice list (September 2013). 7http//www.medicalprotection.org/ uk/england-factsheets/removing-patients-from-the-practice-list.CASE STUDY carry E is about to cast down her clinic when she notices Mrs S on the list of patients for the day. Her heart sinks. Mrs S often presents with one or more complaints, talks nonstop and does not listen to advice provided. She knows from experience that interactions with Mrs S will be challenging. Mrs S is called in 20 minutes later than her planned a ppointment and she lets Nurse E know that she is not happy. Nurse E admits that her clinic is running late but tells Mrs S that she had an unavoidable emergency.She proceeds to take Mrs Ss blood pressure and other vital signs. Mrs S then asks Nurse E for a prescription for antibiotics as she is going on holiday and wants them just in slip of paper her chest flares up while away. Nurse E advises her that she will need to make an appointment to see the GP. Mrs S, now increasingly unhappy, begins to raise her phonate and bang her fist on the desk, demanding a prescription before she leaves. Nurse E, staying calm, advises Mrs S that she is unable to give her a prescription as she doesnt have any active symptoms. Mrs S storms out of the consultation room pushing past Nurse E. Understandably upset, Nurse E calls the practice manager to report the incident. How could this situation have been dealt with better?* Apologise when mistakes occur or when clinics are running late. Some practice s ask reception staff to inform patients when they are checking in if clinicians are behind schedule* manipulate patients are well informed about how systems at the practice work to try to reduce unrealistic expectations* Acknowledge the patients emotions and suspend them to express them, which can take time. Ask the patient to tell you about their concerns. Listen actively using comments such as I see, or go on?, and nodding your head. Summarise their experiences, feelings and concerns back to them* Work with the patient to resolve the situation. Agree a plan for dealing with their concerns and moving forward.* Try to offer an alternative solution to demonstrate that you are clear-sighted to help them. For example, Im sorry Mrs S, but I am unable to give you a prescription. However, if you wish to make an appointment with one of the GPs you can discuss this with them * Consider the layout of the consulting rooms and reception area to ensure you can leave the room if the situatio n escalates. Aggression in healthcare settings is becoming all too commonREFERENCES1. Health and Safety Executive work related violence www.hsegov.uk/violence 2. NHS Business Services(2012) Not part of my job http//www.nhsbsa.nhs.uk/Documents/ SecurityManagement/NP0J1 .pdf 3. British Medical Association (2008). Violence in the workplace. The experience of doctors in the UK. http//www.bma.org.uk/ap.nsf/AttachmentsByTitle/ PDFviolence08/$FILE/Violence.pdf 4. NHS Protect 2013 http//www.nhsbsa.nhs.uk/Protect.aspx5. Mehrabian, A(1971) Silent messages Belmont, CAWadsworth 6. NMC(2011)The code Standards of conduct, mathematical process and ethics for nurses and midwives http//www.nmc-uk.org/Documents/Standards/ nmc TheCodeStandardsofConduct PerformanceAndEthicsForNursesAndMidwives%5FLargePrintVersion.PDF 7. MPS Factsheet removing patients from practices list September 2013 http//www.medicalprotection.org/uk/england-factsheets/removing-patients-from-the-practice-list