This activity for 1 contact hour has been approved by the Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation.

Provider approved by the California Board of Registered Nursing, Provider Number CPE 14462 for 1 contact hour.

This course meets the qualifications for 1 hour of continuing education credit for MFTs and LCSWs as required by the California Board of Behavioral Sciences. Provider # PCE 3457

At the completion of this course the the learner will be able to:

1. Describe components of effective communication

2. Identify an approach to use when confrontation arises.

3. Acknowledge the importance of original documentation in situations of verbal conflict.

I. Leaders To Make A Change

Job deblockedions that include more responsibility either that of manager, supervisor, team leader or charge person are generally inherently people who are leaders. Leaders exhibit traits such as intelligence, initiative, are willing to take risks and be creative in their roles. Leaders also demonstrate qualities such as integrity, courage, energy, optimism, perseverance, balance, self-assurance, and the ability to handle stress. When a problem arises leaders are those individuals who take actions that apply critical thinking, listening, and communicating. Therefore, when verbal conflict arises in the workplace these leaders are generally drawn in to bring about reconciliation, peace and understanding to the situation. Fear and lack of confidence in dealing with verbal conflict can undermine any leader and allow a situation to become out of control.

When initially providing education or tools to manage conflict it is better to start with an established core group of leaders who are in a capacity to exercise their new abilities and influence change as an individual with the support of co-workers. As the leader becomes more proficient with his/her abilities to communicate, they become a voice for change that others will be drawn to out of self-interest and working conditions will continually improve.

Wit and Wisdom

Some people are nice and they get sick.
Make them well and they are nice, real quick.
Some people are mean and they get sick.
We might make them well, but nice? There's a trick!
We think with just the right magic words we can fix everything.
Oh! How absurd!
Some people's problems are bigger than me.
Maybe they'll get well but nice, they won't be.
Some people's problems run deep and wide.
We care for them, but take it in stride.
Julia W. Balzer Riley.

II. Do Not Tolerate Abuse

When nurses were surveyed about how they handled conflict, avoidance was generally the answer. Sources of conflict will vary and the backgrounds of the individuals involved will also influence the degree of conflict and the timeliness of its resolution. Abuse of any kind, either physical or verbal, in the workplace should not be tolerated. Avoiding the situation is a means of escape.

Verbal abuse, by some, is used to attract attention, express anger, have a sense of power, or reach some other unknown personal goal. Poor communication, the environment, and differing views can lead to verbal conflict. As professionals we do not want to engage in the conflict as it is unprofessional and can create a disturbing scene. Aggressive behavior that often accompanies verbal arguments threatens our emotional and physical safety. Rather than avoid, escape, or engage; the goal is to put a stop to the abusive behavior, be treated with respect, overcome fear, and gain control of the situation.

III. Effective Communication

When we engage in conversation, we communicate by two methods, verbal and nonverbal/body language. As professionals we have the responsibility to communicate with others effectively, with respect, and a display of compassion. For there to be an effective communication of information between two people, messages must be received and understood. Participants must take turns listening and comprehending the shared information. Cultural differences, noise, preconceived ideas, language and other barriers may exist that prevent communicating these messages. People are creatures of emotion, prejudice, and varied motivation, things to keep in mind when attempting to communicate and especially when trying to resolve a disagreement.

Listening is essential to effective communication. When we are listening we show interest with our body language, pay attention, make eye contact, and even moderate our voice (um-hum).

When a verbal argument/confrontation arises begin controlling the communication by moving the conversation to a private area, do not yell, show you are listening, explain your position (not excuse your actions), follow up on what you say you are going to do. Also, to effectively communicate without creating judgment try substituting the word 'but' with 'and', and starting comments with 'I' instead of 'you'.

For example: You are angry about the situation, but you don't want to hear my side of it.

Replace with:

I can understand your feelings about this, and I think if you will listen to my ideas you may feel differently.

By explaining your feelings and expectations on the subject it helps prevent the other person from becoming defensive and escalating the situation. Effective communication does not always come easily and may be hard to portray when emotions rise, but with practice, confidence, and some self control the payoff is worth the investment.

IV. Confrontation

Confrontation does not always involve hostile or aggressive individuals; in fact there are times, that as leaders, we must confront others when their behavior is harmful to them or others and when their behavior invades your rights or rights of others. When confronting another individual the goals are to first, make the other person aware of their behavior; second, make a suggestion for change that still protects their self interests while being thoughtful of others.

Confrontation as well as communication takes thought, energy, caring, and patience. It takes learned and practiced skill that when used will allow you to take action in a calm, controlled, assertive (not aggressive) way, that prevents you from being immobilized and scared and allows you to be empowered. Many avoid communicating when confronted because they are scared of what to say or are afraid they might say too much; conversely, one may later regret not speaking up.

If is important to note that before a conflict arises or confrontation becomes necessary, that you make yourself a priority thus protecting your mind and body from potential harm. Keep yourself healthy spiritually, mentally, and physically so that you will have the energy and peace of mind necessary to speak thoughtfully and effectively. Keep in mind that with attention to feelings, honesty, and speaking up respectfully you may be able to diffuse a bomb before it explodes.

V. C.A.R.E. Approach to Confrontations

Now that there has been discussion of who should take action, what behaviors require action and the definitions of communication and confrontation in detail you are probably asking yourself; how do I do this, what do I practice? When confronting others it is important to convey concern for the feelings of both parties, using neutral words so as not to blame, and demonstrate assertiveness rather than aggression. The following is a tool adapted from "Bower and Bower, 1991" that may be used as a format to confront others. This is the C.A.R.E. approach:

Clarify the behavior that is problematic, the behavior is the focus not the individual. E.g. "John you have your clothes spread out over the bedroom and all your notes and articles for your paper are strewn around the living room and on the kitchen table."

Articulate why the behavior is a problem, include how it may be harmful to them or others and/or invades their rights or hurts feelings. E.g. "I am feeling annoyed that are shared space is so messy."

Request a change in behavior in a respectful manner. E.g. "I'd like you to keep your belongings in your area of our den."

Encourage the requested change by pointing out the positive aspects of the change and the negative aspects of no change. E.g. "That way it will be cleaner and more spacious for both of us in the apartment."

Again, make necessary word substitutions to keep neutrality and prevent blame. As a nurse or authority figure you may present a perspective on how a change can occur and still serve their best interests. This caring approach can be utilized in many situations and with practice will improve your overall communication skills resulting in better working conditions for everyone.

VI. Communicating With Aggressive Clients

"Unless you stop the crack you will rebuild the wall." African Proverb

When presented with a client or co-worker that becomes aggressive it is necessary to quickly gain control of the situation before the fire is fueled any further. As you attempt to calm and gain control be aware of your own safety and allow yourself to acknowledge any threat you may perceive, if you truly feel threatened you may ask for assistance from security or police as needed.

To begin with, get to the source of the problem by asking for more information. This shows your interest in their problem and acknowledges their feelings. Then ask for clarification of the problem using an open ended question. E.g. "I see that you are angry with me ________, could you tell me what about __________ upsets you?"

Next, if you feel it is appropriate, point out the effects of their negative behavior, this will heighten their awareness of their actions. E.g. "You may not realize that you are yelling and swearing at me, this makes me feel uncomfortable. I would be glad to have a conversation with you when you can lower your voice and not swear."

If necessary you may need to confront them regarding their behavior using the C.A.R.E. tool discussed earlier as well as the responses discussed in section III. Most helpful may be the option of taking a time-out from the situation. Excuse yourself and take a break or time-out, use this time to write down the thoughts and feelings of each party, write down what the request really is and then develop a response. Many times this will simplify the situation, calm emotions and allow you to respond appropriately.

In most cases if you are providing care that meets the standards for your facility and show courtesy while doing so you can't go wrong!

VII. Supporting Co-workers and families

In the case of verbal conflict, the saying rings true that there is strength in numbers. As the leader or peer, standing with the nurse that is engaged in a conflict to physically and emotionally show your support is helpful. Too, ask a co-worker to come stand with you when you feel threatened or need the support to express your feelings and expectations regarding a given situation. Another idea is to develop a code word among workers that could be used when conflict arises and support is needed quickly without retelling events in their entirety.

Often in my own nursing practice I find families that become frustrated with the communication with the physician. This may be due to their schedule, bedside manner, language barriers, preconceived notions, or any number of varied reasons. As a patient advocate and co-worker to the physician I sometimes feel torn between my obligations to the two. As a result, I encourage families to write down their questions and concerns prior to the physician visit and then try to be present to facilitate communication between the two. In doing so I feel I am able to support the family unit, create better communication between pt. and doctor while supporting the physician, show my availability to both parties and helps to prevent conflict.

VIII. Documentation

Health care professionals can reduce legal problems when they document accurately and completely. Documentation is essential in any legal case, never alter or discard original notes. Be sure to chart exact words used, even if this includes profanity, this will help demonstrate the state of mind of the individual. When documenting a situation of verbal conflict be sure to use as many examples as necessary to make the story complete. The aim should be to maintain physical and verbal protection in the workplace by proper documentation of events.

In conclusion this course has presented useful tools to improve communication, understanding, conflict resolution, and dealing with confrontation in the workplace for health care professionals among clients and co-workers alike.