Directing and Conflict Management in Nursing (PDF)

# **Directing** - The issuance of orders, assignments and instructions that enable the nursing personnel to understand what are expected of them. - Includes supervision and guidance - Actuates efforts to accomplish goals - Connecting link between organizing for work and getting the job done # **El...

# **Directing** - The issuance of orders, assignments and instructions that enable the nursing personnel to understand what are expected of them. - Includes supervision and guidance - Actuates efforts to accomplish goals - Connecting link between organizing for work and getting the job done # **Elements of Directing** 1. **Delegation** - Is the process by which a manager assigns specific tasks/duties to workers with commensurate authority to perform job. - 2 criteria are: 1. ability of worker to carry out the task 2. fairness not only to the employer but to the team as a whole - **Principles of Delegation** 1. Select the right person to whom the job is to be delegated. 2. Delegate both interesting and uninteresting tasks. 3. Provide subordinates with enough time to learn. 4. Delegate gradually. 5. Delegate in advance. 6. Consult before delegating. 7. Avoid gaps and overlaps. - **What cannot be delegated?** 1. Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit. 2. Authority to sign one's name is never delegated. 3. Evaluating the staff and/or taking necessary corrective or disciplining action. 4. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones. 5. Jobs that are too technical and those that involve trust and confidence. - **Sharing of Experiences** - Why nurse managers do not delegate: 1. Due to lack of confidence in their staff. 2. Feeling that only they could do the task better and faster. 3. They fear loss of control if some of their duties are delegated. 2. **Utilizing/Revising/Updating Nursing Service Policies and Procedures** - Nursing service exists for standardization and as a source of guidance for the nursing staff. 3. **Supervision** - To supervise means to inspect, to guide, evaluate, and improve work performance of employees through criteria against which the quality and quantity of work production and utilization of time and resources are made. - **Supervisory Techniques** 1. Observation during rounds. 2. Spot checking of charts through nursing audit. 3. Asking the patients about the care they receive. 4. Looking into the general condition of the units. 5. Getting feedback from co-workers or other supervisors or relatives. 6. Asking questions discretely to find out the problems they encounter in the wards. 7. Drawing out suggestions from the workers for improvement of their work or work situation. 4. **Communication** - Is the transmission of information, opinions, and intentions between and among individuals. - Has Purposes: - Facilitate work - Increase motivation - Effect change - Optimize care - Increase worker satisfaction - Facilitate coordination - **Principles of Effective Communication** 1. Clear lines of communication serve as the linking process by which parts of the organization are unified toward goal achievement. 2. Simple, exact and concise messages ensure understanding of the message to be conveyed. 3. Feedback is essential to effective communication. 4. Communication thrives best in a supportive environment which encourages positive values among its personnel. 5. A manager’s communication skill is vital to the attainment of the goals of the organization. 6. Adequate and timely communication of work-related issues or changes that may affect jobs enhance compliance. - **Communication Model** - This is a diagram depicting a sender, the message, the channel, and the receiver. - **Lines of Communications** 1. **Downward Communication** - Traditional line of communication from superior to subordinate. - Communication is primarily directive and activities are coordinated at various levels of the organization. - Communication aims to impart what the personnel need to know, what they are to do and why they are to do these. - Includes communication includes policies, rules and regulations, memoranda, handbooks, interviews, job descriptions, and performance appraisal. 2. **Upward Communication** - Emanates from subordinates and goes upward. - Usually in the form of feedback to show the extent to which downward communication has been received, accepted, and implemented. - Does not flow as easily as downward communication. - Examples are discussions between subordinates and superiors, grievance procedures, written reports, incident reports and statistical reports. 3. **Horizontal/Lateral Communication** - Flows between peers, personnel or departments on the same level. - Used most frequently in the form of endorsements, between shifts, nursing rounds, journal meetings and conferences, or referrals between departments or services. - Coordination of duties and cooperation among the various departments will be maximized if communication is open to ensure smooth work flow. 4. **Outward Communication** - Deals with information that flows from the caregivers to the patients, their families, relatives, visitors and the community. - Involves how employees value their work. - May be directly or indirectly communicated to their families. 5. **Coordination** - Unites personnel and services toward a common objective. - Prevents overlapping of functions, promotes good working relationships and work schedules are accomplished as targeted. - Coordination with the medical service - Coordination with the administrative service - Coordination with the laboratory service - Coordination with radiology service - Coordination with pharmacy service - Coordination with the dietary service - Coordination with the medical social service - Coordination with the medical records service - Coordination with community agencies, other institutions and civic organizations 6. **Staff Development** - Is provided by nurse instructors under training departments or units or by supervisors and head nurses. - Participation in journal meetings, case presentations, or accessibility for consultations eases the new employee's transition and integration to the agency. - "Shadowing", "big sister" or “buddy” 7. **Decision Making** - Is a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result. - It involves a choice utilizing mental processes at the conscious level and is aimed at facilitating a defined object. - **The Art of Decision Making** - Not making decision that others should make, to preserve morale and authority. - Not deciding on problems that are not pertinent to matters at hand to prevent waste of time and energy. - Not deciding prematurely to prevent prejudice. - Not making ineffective decisions to avoid losing the respectability of the decision maker. - **Process of Decision Making** - Definition of the problem. - Analysis of the problem. - Development of an alternative solution. - Selection of the solution. - Implementation and follow-up # **Conflict Management** - Conflict is as inevitable as change in any organization because of the complexity of relationships within the organization, the interaction among its members or their dependence on one another. - Is a clash between two opposing and oftentimes hostile parties. - Is a warning to managers that something is wrong and needs solution through problem solving and clarification of objectives, establishment of group norms, and determination of group boundaries. # **Sources of Conflict** 1. Human interactions that relate to conflict are characterized by competition, domination and provocation. 2. Factors that provoke conflict are failure to provide assistance or complete information on patient care. 3. Confrontation, disagreements, and anger. 4. Differences in position in the hierarchy. # **Types of Conflict** - **According to Behavior** 1. **Covert conflict** is more dangerous because it is not what it appears on the surface. It results in harbored feelings that drain both physical and psychological energy. 2. **Overt conflict** is usually seen. - **According to Hierarchical Relationships** 1. **Vertical conflict** - Differences in opinions between superiors and subordinates are caused most often by inadequacy in communication, opposing interests, and lack of shared perceptions and attitudes. 2. **Horizontal or line and staff conflict** - Struggle or strife between departments or services. - Lack of consensus and clash of personalities. - **According to Standpoint** 1. **Behavioral**, it is a perceived condition that exists between two parties when one or more parties perceive goal incompatibility and some opportunity for interfering with goal achievement of the other. 2. **Process**, conflict occurs when real or perceived conflict exists in goals, values, ideas, attitudes, beliefs, feelings or action of two or more parties. It can occur intra-personally or interpersonally & intra-group or inter-group. # **Conflict Resolution** 1. **Avoidance** - Is the method commonly used by groups who do not want to do something that may interfere with their relationships. - Appropriate when more information is needed to solve the problem, when it is appropriate for others to solve the problem or when one wishes to reduce tension and gain composure. 2. **Accommodation** - Self-sacrifice - Appropriate when the person is wrong, the opponent is more powerful, or when the issue is more important to someone else. 3. **Collaboration**: - Inspires mutual attention to the problem and utilizes the talents of all parties. - Focuses on problem-solving to find mutually satisfying solutions. - Useful in situations where the goals are too important to be compromised. - Most effective method. 4. **Compromise** - Both parties seek expedient, acceptable answers for short periods when the goals are only moderately important and the parties have equivalent power. - Accommodation and adjustment lead to workable situations rather than to the best solutions. - “lose-lose” solution 5. **Competition** - Expressed through suppression of conflict through authority-obedience approach. - Enforces the rule of discipline. - Assertive position that fosters conflict resolution on the part of the subordinate. 6. **Smoothing** - Disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence. - Accomplished by complementing one's opponent, downplaying differences, and focusing on minor areas of agreement as if little disagreements exist. - Appropriate for solving minor problems. 7. **Withdrawing** - Means that one party is removed thereby making it possible to resolve the issue. It produces the same results as smoothing. 8. **Forcing** - Yields an immediate end to the conflict but leaves the cause of the conflict unresolved. # **Basic Rules on Mediating a Conflict Between 2 or More Parties** 1. Establish clear guidelines and make them known to all. 2. Do not postpone indefinitely. Select a time that is best for all parties. 3. Create an environment that makes people comfortable to make suggestions. 4. Keep a 2-way communication. 5. Stress a peaceful resolution rather than confrontation. 6. Emphasize shared interests. 7. Follow-up on the progress of the plan.