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Norms and Nurse Management of Conflicts: Keys to Understanding Nurse-Physician Collaboration
Abstract
In this cross-sectional study, registered nurses from 36 emergency rooms completed an abridged version of the Organizational Culture Inventory (Cooke & Lafferty, 1989) and responded to nine hypothetical conflict vignettes. Stepwise regressions were performed with nurse conflict style intentions as dependent variables and 10 independent variable (three sets of norms, five measures of conflict styles expected to be used by the physician, gender, and education). Nurses' expectations for physicians to collaborate and strong constructive and aggressive norms were found to explain a moderate amount of variance (32%) in nurses' intentions to collaborate in conflicts conducive to nurse-physician collaboration. The findings of this study provide support for the proposed theoretical framework and can be used to design interventions that promote nurse-physician collaboration.
... Some associations with aggressive and passive culture were not as expected. Overall, constructive and aggressive culture was associated with the adoption of proactive conflict strategies (Keenan et al. 1998) Measures of effective management practices, individual wellbeing (burnout, job satisfaction and intention to quit) and perceived unit effectiveness in French intensive care units were positively correlated with 4 constructive scales and mostly negatively with 8 security scales (Minvielle et al. 2005). ...
... Principal components analysis of subset of 48 items (4 from each scale) generally confirmed 3 factors explaining 47.5% of the variance, although individual security items did not load >0.40 on expected scale (Shortell et al. 1991) Principal components analysis (constrained to 3 factors) of subset of 36 items explaining 47% of the variance confirmed the constructive culture factor, but problems were noted with the aggressive and passive factors (Keenan et al. 1998). ...
... n=196 nurses from 36 emergency rooms in US (Keenan et al. 1998). ...
Compendium of Organisational Culture Instruments that accompanies Jung et al. (2009) Instruments for Exploring Organisational Culture: A review of the Literature, Public Administration Review, 1087-1096
... In fact, studies suggest that physicians perceive themselves as much more supportive and respectful of nurses than nurses actually report (Back & Arnold). This may result from the aforementioned differences in training or, as Keenan, Cooke, and Hillis (1998) suggest, these perceptions may arise from the fact that physicians and nurses are not socialized to collaborate, and feel that they should not have to interact. Regardless of the reasons for physician-nurse conflict, research suggests that nurses often feel powerless in their positions and unable to resolve their differences with managers and administrators, thus resulting in higher turnover and discontent in nursing positions (Forsyth & McKenzie, 2006). ...
... Nurses and physicians have long operated under a paradigm that places the physician in a dominant position over the nurse (Keenan et al., 1998). A common concern voiced by the participants is being treated as "just a nurse." ...
... Others explained that they simply said their refusal to carry out the orders was a matter of licensing regulations, and therefore not in their scope of practice, or simply against their morals. According to Keenan et al. (1998), nurse-physician conflict often results from a disagreement over a specific order. ...
This study examined hospital-based nurses’ experiences of structurational divergence. I used a semi-structured narrative approach to interview 10 hospital-based nurses and data was analyzed using phenomenological methods. This resulted in the identification of the following three themes, which capture instances of structurational divergence and resulting interpersonal, intrapersonal, and organizational conflicts: Managing Overload, Identifying and Negotiating Boundaries, and Substituting and Advocating. I also discovered an additional theme, Eating their Young.. Results have implications for future research in health and organizational communication and reflect the importance of research into the communication between and amongst nurses, patients, and physicians and the impact of that communication on patient health outcomes.
... 28 The conflict in nurse-physician relationships is generally addressed as a result of the continuing traditional paradigm of physician dominance over nurses on patient care issues. 27 Furthermore, the conflict issues should be viewed with understanding of the changes in nursing, including the increasing the need for nursing care with the growth of the chronically ill population, the enlarging range of nurses' roles and responsibilities in patient care, and the nursing profession's rejection of the traditional paradigm in the nurse-physician relationship as an inappropriate mechanism. 28,29 As a resolution to the conflict in nurse-physician relationships as well as among nurses, researchers suggest collaboration between professionals based on trust and respect as colleagues. ...
... 28,29 As a resolution to the conflict in nurse-physician relationships as well as among nurses, researchers suggest collaboration between professionals based on trust and respect as colleagues. 23,[27][28][29][30] Despite their differing academic backgrounds, both the members of professions may be likely to collaborate with each other when they share one common goal and the same values, that is, the benefit of their patients. 27 Efforts for collaboration could be initiated by comprehensively identifying and understanding the issues at stake from both perspectives. ...
... 23,[27][28][29][30] Despite their differing academic backgrounds, both the members of professions may be likely to collaborate with each other when they share one common goal and the same values, that is, the benefit of their patients. 27 Efforts for collaboration could be initiated by comprehensively identifying and understanding the issues at stake from both perspectives. Effective communication between nurses and physicians by listening to and learning from each other would reduce conflict in their professional relationships and prevent conflicts from developing into ethical problems. ...
Background
The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice.
Research objectives
The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments.
Research design
The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale.
Participants
The study sample included 993 staff nurses working in a university hospital in South Korea.
Ethical considerations
This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent.
Findings
The most frequently and disturbingly encountered issues across nursing units were “conflicts in the nurse–physician relationship,” “providing care with a possible risk to your health,” and “staffing patterns that limit patient access to nursing care.” The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues.
Discussion
Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit.
Conclusion
This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses’ reflection on their experiences.
... In this hierarchical relationship the physician gave the order and the nurse fulfilled it. This traditional relationship has been studied at length and has been found to be a barrier to nurse physician collaboration (Baggs, Schmidt, Mushlin, Eldredge, Oakes, & Hutson, 1997;Higgins, 1997;Keenan, Cooke, & Hillis, 1998;Rosenstein & O'Daniel, 2005;Stein, 1967;Tschannen, 2004;Vahey, Aiken, Sloane, Clarke, & Vargas, 2004;Zelek & Phillips, 2003). ...
... The author found that when nurses scored teamwork as high, they also perceived collaboration as high. Collaboration was studied along with conflict by Keenan et al. (1998), who found that nurses have been expected to act deferentially towards physicians, resulting in a lack of satisfaction on the part of nurses. As a result, the nurses may use negative conflict strategies such as avoidance or aggression, to manage the conflict. ...
... This method can work as long as providers are negotiating in the best interest of the patient. Keenan et al. (1998) studied the nurses' perceptions of the conflict management styles of nurses and physicians and found that nurses report use compromising and collaborating but also report that physicians use more dominating styles such as avoiding and competing. Boone et al. (2008) Collaboration in the healthcare industry should not be conceptualized using theories and frameworks from other professions. ...
Purpose: Effective collaboration has been identified as essential to quality patient care processes and outcomes. Yet, the conceptual and theoretical basis for understanding and practicing collaboration remains underdeveloped and imprecise. These factors may hamper the study of collaboration and therefore the optimization of care processes and outcomes. The purpose of this study was to understand the social processes associated with collaboration between nurses and physicians, with the intention of theory development.
Background: Collaboration, or a lack thereof, has been shown to impact both provider and patient satisfaction and outcomes. JCAHO now requires proof of collaboration for accreditation. Many organizations state that their providers collaborate for the betterment of patient care. However, a thorough literature search determined that a theory of nurse-physician collaboration based in healthcare has yet to be published. Without theoretical support it is difficult to devise precise measurement instruments to truly understand the current level of collaboration and develop strategies for improvement.
Method: A grounded theory study was conducted with the intent of developing a theory to support nurse-physician collaboration.
Sample: Data were collected from 15 nurses and 7 physicians with a wide range of experience and training from a variety of units thus allowing the theory to be applicable to a range of professionals.
Research Question: The purpose, or main concern, of this study was to conceptually understand if and how nurse-physician collaboration takes place with the intention of theory development.
Results: Results indicated that the process of nurse physician collaboration involves 9 stages: something needs our attention; knowing who to talk to; finding the right perso; coming together; exchanging ideas and information; developing the plan; getting everybody on the right page; making it happen; and monitoring progress. The core category of working together toward a common goal describes how nurses and physicians collaborate for patient care. It is anticipated that this theory will add to the body of knowledge and contribute to the understanding of collaboration between these two disciplines.
... La validez y fiabilidad de este instrumento también han sido demostradas satisfactoriamente (Cooke y Szumal, 1993). Este instrumento así como el modelo teórico en que se sustenta han sido usados en diversas investigaciones (Ghinea y Brãtianu, 2012; Gundry y Rousseau, 1994; Keenan, Cooke y Hillis, 1998; Pool, 2000; Xenicou y Simosi, 2006) y aplicado a más de 2 millones de individuos a nivel mundial (www.humansynergistics .com). ...
... La explicación podría provenir de la falta de significación de la subescala cultura de oposición, puesto que esta parece a nivel teórico lo contrario de la subescala cultura de aprobación, por lo cual es lógico concluir que el si DOCS no se ajusta a la primera a nivel teórico ni psicométrico, tampoco debería ajustarse a su opuesta. Atendiendo pues, al tamaño y sentido de las correlaciones, creemos que el DOCS es un cuestionario de gran utilidad a la hora de detectar y analizar culturas constructivas, aspiración cada vez más importante para muchas organizaciones (Gillespie et al., 2008; Keenan, Cooke y Hillis, 1998; Oggbona y Harris, 2000; Zheng, Yang y McLean, 2010). Las correlaciones negativas que se han obtenido en las dimensiones agresivo y pasivo defensivas indican, a nuestro entender, lo que una Cultura constructiva no debe favorecer. ...
The Denison Organizational Culture Survey (DOCS) is one of the most used instruments in the study of organizational culture. The aim of this study was to evaluate the convergent validity of the Spanish version of the DOCS using the Organizational Culture Inventory (OCI) developed by Cooke and Lafferty. This instrument is the most widely used and researched tool in the field of organizational psychology. The convergent validity of these instruments was evaluated using Pearson’s correlation analysis. The sample comprised 344 members from different research groups of a Spanish university. A poor correlation was found between the DOCS and the aggressive-defensive culture dimension of the OCI. However, high correlations were found between the DOCS and the constructive culture dimension of the OCI, suggesting that the latter dimension provides the main conceptual and psychometric equivalence between the two instruments. Thus, the DOCS may be a tool that is specialized in the evaluation of constructive cultures.
... Different people have approached conflict management differently. Early empirical studies of conflict ought to relate conflict style preferences to personal characteristics (Keenan et al. 1998) based on the premise that an improved understanding of the role of the personality type. In later studies, the influence of context on an individual's conflict style choices was examined (Keenan et al. 1998). ...
... Early empirical studies of conflict ought to relate conflict style preferences to personal characteristics (Keenan et al. 1998) based on the premise that an improved understanding of the role of the personality type. In later studies, the influence of context on an individual's conflict style choices was examined (Keenan et al. 1998). In present scale conflict concept, effect of conflict on person, inter-individual and intra-individual conflict management practices were considered. ...
Conflict is inevitable and a dysfunctional conflict can lead to appreciable loss of man-hours. If dealt skillfully a destructive conflict can be converted into functional conflict. Recognising the conflict and attacking the issues demands an assessment of both the conflict and the conflict handler. The present paper will show development of conflict management proficiency scale based on Likert scaling technique that can be used by employers to help managers gain insight into their personal styles of conflict management. The scale is focused on the concept of conflict, the effect of conflict and the practices adopted to manage conflicts. The scale was developed on the responses of 300 managers of public and private sector organisations. The items were screened through item -total correlation and item -difference analysis. The final list had 24 items, each asked to be responded in terms of their own degree of agreement and disagreement on five -point scale. It was tested for its reliability and validity by both split half method and test -retest method by calculating Karl Pearson's coefficient. The reliability score of the scale by split half method came to be 0.82 and by test -retest method it was 0.79. The index of reliability by split half method was 0.903 and by test -retest it was 0.89. When the CMP score for managers was calculated, the scale could differentiate the respondents of higher and lower level of CMP.
... In terms of profession, the nurse-physician relationship is hierarchical (Nair et al., 2012), with nurses stereotypically functioning in deference to physicians (Hendel et al., 2007). Moreover, nurses typically enact caring behaviors and tend to avoid assertive behaviors allowing the physician to take a position of ascendancy in decisionmaking (Keenan et al., 1998;Nair et al., 2012). In terms of gender, women in male-dominated groups, such as medicine, have been found to be more susceptible to stereotypes especially if they have low self-confidence (Cohen & Swim, 1995). ...
While gender and professional status influence how decisions are made, the role played by health care professionals’ informational role self-efficacy appears as a central construct fostering participation in decision-making. The goal of this study is to contribute to a better understanding of how gender and profession affect the role of self-efficacy in sharing expertise and decision-making. Validated questionnaires were answered by a cross-sectional sample of 108 physicians and nurses working in mental health care teams. A moderated mediation analysis was performed. Results reveal that the impact of sharing knowledge on informational role self-efficacy is negative for nurses. Being a nurse negatively affects the relation between informational role self-efficacy and participating in decision-making. Informational role self-efficacy is also a strong positive predictor of participation in decision-making for male physicians but less so for female physicians.
... The ICU is an important setting for improving communication about the goals of care since the current quality of communication is often poor (Wall et al., 2007). Nurses and physicians make up the largest group of healthcare providers, and both daily confront complex problems with no easy solutions (Keenan et al., 1998). Nurses do not work in isolation; rather they collaborate and interact with other members of the healthcare team to provide quality patient care (Doran et al., 2002). ...
... Indeed, regarding IPC, studies have reported that conflict among professional roles has caused decreases in job satisfaction, 12 as well as friction, clashes and collision. [13][14][15] In addition, conflict management mode choices among physicians and nurses for dealing with their conflict have been reported. 16 The role ambiguity between health professions elicited by TPC is expected to evoke even greater resistance and conflict than IPC. ...
Objectives
To clarify the process of how caregivers in a nursing home integrate the perspectives of rehabilitation into their responsibilities through working with a physical therapist.
Design
This study was conducted under an action research approach.
Setting
The target facility was a nursing home located in Japan. The researcher, a physical therapist, worked at the nursing home once a week from April 2016 to March 2017. During the study period, he created field notes focused on the dialogue and action of caregivers regarding care, responses of caregivers to the physical therapist and reflections as a physical therapist. Caregivers were also given a short informal interview about their relationship with the nursing home residents. For data analysis, two researchers discussed the content based on the field notes, consolidating the findings.
Participants
The participants were caregivers who worked at the target facility. Thirty-eight caregivers agreed to participate. Average age was 39.6±11.1 years, 14 (37%) were male and average caregiver experience was 9.8 years.
Results
Two cycles of action research were conducted during the study period. There were four stages in the process of how caregivers in the nursing home integrated the perspectives of rehabilitation through their work with the physical therapist. First, caregivers resisted having the rehabilitation programme carried out in the unit because they perceived that rehabilitation performed by a physical therapist was a special process and not under their responsibility. However, the caregivers were given a shared perspective on rehabilitation by the physical therapist, which helped them to understand the meaning of care to adapt the residents’ abilities to their daily life. They practised resident-centred care on a trial basis, although with a sense of conflict between their new and previous role, which emphasised the safety of residents’ lives and personhood. The caregivers increased their self-efficacy as their knowledge and skills were supplemented by the physical therapist and his approval of their attempted care. They were then able to commit to their newly conceived specialty of care as a means of supporting the lives of residents.
Conclusions
The process of working with a physical therapist led to a change in caregivers’ perception and behaviours, which occurred in four stages: resistance to incorporation, recapture of other perspectives, conflicts and trials in the role of caregiver and transformation to a resident-centred perspective.
... Collaborating groups take into focus all the relevant dimensions for discovering new values and innovative solutions to routine issues. In collaboration whole hearted efforts, initiatives and cooperation low naturally, thus the groups involved in collaborative activities immensely and steadily bene it from collective wisdom with the bonanza of cohesion and further cementing of mutual bonds (Keenan, Cooke, & Hillis, 1998). Pakistani society is high power distance and it mostly depends on group relationships as per the cultural practices. ...
... Since its introduction in prototype form in 1983, the inventory has been used by thousands of organizations, completed by over two million respondents, and translated into numerous languages. The OCI has been used in a wide array of organizations, such as nuclear power plants, research laboratories, universities, consulting firms, sales organizations, governments, hospitals, etc., for a variety of purposes, including to enhance system reliability and safety (Haber et al., 1991;Keenan, Cooke and Hillis, 1998;Shurberg and Haber, 1992), facilitate strategic alliances and mergers (Slowinski, 1992), predict the type of leadership that characterizes an organization's culture (Eppard, 2004), provide data for the development of person-organization fit selection criteria (Belova, 2003), find cultural elements critical to reducing turnover (Vukotich, 1996), or decrease stress levels (van der Velde and Class, 1995). ...
... Perhaps, one reason that nurse-doctor collaboration is not widespread is that nurses and doctors have not been socialised to collaborate with each other and therefore do not believe they are expected to do so. 28 It is believed that the occupations clash because nurses and doctors structure work in radically different ways and, although they work side by side, they tend to misunderstand the methods and inner logic of one another's work. 29 At the same time, in clinical communication of medical mistakes, for example, Lachman 30 suggests that nurses must internalise the willingness to speak out and do what is right in the face of forces that would lead a person to act in some other way. ...
Background::
There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result, a number of ethical decision-making models have been developed to tackle these problems. However, this study argued that the ethical dimensions of nursing practice are still not clearly understood and responded to in Brunei.
Research aim::
To explore how Bruneian nurses define ethical concerns they meet in everyday practice in the medical surgical wards of three Brunei hospitals.
Research design::
A qualitative study was employed. Interviews were conducted with 28 practising and administrative nurses of three hospitals. Interview data were analysed via a constant comparative method.
Ethical consideration::
The study's protocol was reviewed and approved by the Ethical Committee of the School of Health in Social Science at the University of Edinburgh and the Medical Health Research Ethics Committee of the Ministry of Health, Brunei.
Findings::
The nurses described three ethical dimensions in their practice, namely: 'nurse at work' which illustrates the ethical dimensions within the work environment; 'nurse and doctor' which elucidates the ethical dimensions in the nurse and doctor relationship; and 'nurse and patient' which further examines ethical aspects in patient care. Nurses responded to the ethical dimensions in the ward setting with the aim of avoiding the conflict and maintaining ward harmony.
Discussion::
The data provide new insights into how nurses respond to ethical dimension in the ward settings where it puts strong emphasis on the nurses' understanding of responsibility placed upon them as professional nurses.
Conclusion::
With these findings, it is recommended that further support is needed for nurses to be aware of the ethical dimension in their practice and to respond to ethical concerns accordingly.
... Nurses and physicians constitute the largest healthcare professional group. They confront complex problems (Keenan et al., 1998) and contribute to care quality (Doran et al., 2002). Research shows that poor verbal communication between physicians and nurses was responsible for 37 per cent of all errors (Donchin et al., 1995). ...
Purpose:
The purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience.
Design/methodology/approach:
In total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data.
Findings:
Nurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse-physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage.
Practical implications:
Hospital managers do not provide sufficient support for Greek nurses in their working environments.
Originality/value:
The authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses' working in these hospitals.
... Using avoidance strategy contributes to poor communication, which leads to poor patient outcomes including medication errors, I.V. errors, and patient falls, in addition to create high stress levels among nurses. (20)(21)(22) The American Association of Critical-Care Nurses standards for healthy work environments identified that mastering conflict management and communication skills are crucial to maintain quality of patient care, improving staff moral and patient safety. (11) Thus, successful healthcare organizations have to create a culture of mutual understanding and cooperation; in addition to equip their nursing staff with appropriate strategies to manage workplace conflict. ...
... Surgeons described good collaboration as when nurses can anticipate and follow instruction, while nurses described it as respecting their input (Makary et al., 2006). Nonetheless, briefings should allow for open communication regardless of hierarchical culture so as to not risk optimal patient care (Keenan et al., 1998;Knox and Simpson, 2004). ...
Preoperative briefings have been proven beneficial for improving team performance in the operating room. However, there has been minimal research regarding team briefings in specific surgical domains. As part of a larger project to develop a briefing structure for gynecological surgery, the study aimed to better understand the current state of pre-operative team briefings in one department of an academic hospital. Twenty-four team briefings were observed and video recorded. Communication was analyzed and social network metrics were created based on the team member verbal interactions. Introductions occurred in only 25% of the briefings. Network analysis revealed that average team briefings exhibited a hierarchical structure of communication, with the surgeon speaking the most frequently. The average network for resident-led briefings displayed a non-hierarchical structure with all team members communicating with the resident. Briefings conducted without a standardized protocol can produce variable communication between the role leading and the team members present.
... The key to assembling a successful collaborative team within a healthcare organization is to put together a multidisciplinary team in which the health care professionals treat a patient independently but share information, pool their knowledge, and jointly evaluate or develop an appropriate plan of care (20) . Nurses and physicians constitute the most important caregivers providing care to the critically ill (21) . As a result; if there is effective nurse-physician collaboration; health organizational outcomes will be improved. ...
... The Robert Wood Johnson Foundation has stated that interprofessional collaboration contributes to the use of individual and collective skills and experience of team members, allowing them to function more effectively and deliver a higher level of care than when each would work alone. Clinical nurses, nurse managers, and physicians make up the largest group of healthcare providers, and all confront complex problems on a daily basis ( Keenan et al. 1998). However, communication between professions does not always flow as it should. ...
Interprofessional collaboration is crucial in hospitals because healthcare teams face challenges, such as complexity of clinical practice, high variation in clinical demand, ever-changing teams, and heavy workload. Moreover, communication between professionals does not always flow as it should. Ineffective or absent interprofessional collaboration has a negative impact on patient outcomes, such as medication errors, failure to rescue, increased hospital-acquired infection rates, and extended lengths of stay. Ineffective collaboration between healthcare workers was linked to two out of every three sentinel events (severe adverse events) reported to the Joint Commission’s databases. Developing effective teams and redesigned systems is vital to achieving safer, timelier, more patient-centered, effective, efficient, and equitable patient care. We can look at the Interprofessional Education Collaborative or IPEC competency framework for the competencies teams need to master to achieve role clarity, clear communication, and excellent teamwork and create a climate of mutual respect and shared values. The TeamSTEPSS educational intervention package can be used for improving team performance. In order to ensure the best possible patient outcomes, a smooth flow of collaboration and communication in the triangle between clinical nurses, nurse managers, and physicians can overcome turbulence and uncertainty in healthcare settings.
... Perhaps, one reason that nurse-doctor collaboration is not widespread is that nurses and doctors have not been socialised to collaborate with each other and therefore do not believe they are expected to do so. 28 It is believed that the occupations clash because nurses and doctors structure work in radically different ways and, although they work side by side, they tend to misunderstand the methods and inner logic of one another's work. 29 At the same time, in clinical communication of medical mistakes, for example, Lachman 30 suggests that nurses must internalise the willingness to speak out and do what is right in the face of forces that would lead a person to act in some other way. ...
Background: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result a number of ethical decision making models have been developed to tackle these problems. However, in this thesis it has been argued that the ethical dimensions of nursing practice are still not clearly understood and responded in Brunei. Design and method: This thesis describes a qualitative analysis into the Bruneian nurses’ perceptions of ethical dimensions in nursing practice. Drawing on constructivist grounded theory as a method of inquiry, twenty eight practicing and administrative nurses were individually interviewed. The nurses described how ethical dimensions were perceived in their practice, by means of the difficulties they are facing in the real world of nursing practice; how they have responded to these difficulties, and why they make such responses. Findings: The nurses described three ethical dimensions in their practice, namely ‘nurse at work’ which illustrates the ethical dimensions within the work environment; ‘nurse and doctor’ that elucidates the ethical dimensions in the nurse and doctor relationship and ‘nurse and patient’ which further examines ethical aspects in patient care. ‘Taking responsibility’ and ‘shifting responsibility to others’ were identified as approaches that the nurses took in responding to the ethical dimensions with the aim of avoiding the conflict and maintaining ward harmony. These responses provide new insights into how nurses’ response to ethical dimension in the ward settings where it puts strong emphasis on the nurses’ understanding of responsibility placed upon them as a professional nurse. ‘Negotiating ethical responsibility’ emerged as a core category within the data which illustrate that nurses’ responses to the ethical dimensions form a continuous process, involving constant consideration of the two types of responses. The core category described that ethical dimensions in the nurses’ practice were contextualised in the ‘ethical responsibility’ that is placed upon them within the nursing organisation. This thesis has expanded the current theoretical knowledge of ethical dimensions by elaborating on the concerns experienced in nursing practice and the responses individual nurses utilise to negotiate and discharge their ethical responsibilities at work. The study has also extended emphasis to the reasoning and responses that nurses are engaged in, whilst at the same time, negotiating ethical responsibility regarding the context in which they are placed during their working hours. This core category provides a number of possible implications for future research, nursing practice, education and policy, which would facilitate the exploration of ethical understanding for nurses in Brunei, and enable the provision of an ethical environment, so making ethical dimensions more transparent.
... Diese Haltung ist ein Grundpfeiler interprofessioneller Zusammenarbeit (Suter et al., 2009;McCaffrey et al., 2011). Damit stehen unsere Ergebnisse im Widerspruch zu Keenan et al. (1998), welche beobachteten, dass ÄrztInnen in der Zusammenarbeit wenig Konsensbereitschaft zeigen. Es könnte jedoch sein, dass diejenigen, die an unserer Studie nicht teilgenommen haben, weniger gut zusammenarbeiten, sodass die Ergebnisse bei einer größeren Teilnahme weniger positiv ausgefallen wären. ...
Patientenprozesse im Akutspital werden durch interprofessionelle Zusammenarbeit massgeblich geprägt.
Deren Qualität ist entscheidend für positive Patientenergebnisse und hohe Arbeitszufriedenheit. Wir übersetzten die Collaborative Practice Scales (CPS) und befragten 128 Pflegende und 104 ÄrztInnen in einem
Deutschschweizer Universitätsspital. Von ihnen bewerteten 55 Pflegende und 29 ÄrztInnen ihre Zusammenarbeit als relativ zufriedenstellend. Die interne Konsistenz beider Skalen war gut. Die Faktorenanalyse bestätigte bis auf ein Item die ursprüngliche Struktur der CPS für Pflegende. Aufgrund des geringen Rücklaufs bei ÄrztInnen wurde hier auf die Faktorenanalyse verzichtet. Rückmeldungen vor allem der ÄrztInnen weisen auf mangelnde Verstehbarkeit einzelner Items hin. Die CPS eignen sich grundsätzlich, die Qualität interprofessioneller Zusammenarbeit zwischen Pflegenden und ÄrztInnen wiederzugeben. Wir empfehlen die klinische Anwendung erst nach linguistischer Validierung.
Interprofessional collaboration between nurses and physicians
___________________________________________________________________________________________________________
Application and initial validation of the Collaborative Practice Scales (CPS)
Patient processes in acute care hospitals are significantly characterized by interprofessional collaboration.
Its quality is vital to achieve positive patient outcomes and high levels of job satisfaction. We translated the
Collaboration Practice Scales (CPS) and assessed 128 nurses and 104 physicians in a university hospital in
German-speaking Switzerland. Of all respondents 55 nurses and 29 physicians ranked their collaboration as
comparatively satisfactory. Both scales demonstrated good internal consistency. Factor analysis confirmed
the original CPS structure for nurses except for one item. Due to the poor response rate of physicians factor
analysis has been dispensed here. Comments mainly from physicians point to insufficient understandability
of some items. In principle the CPS are suitable for displaying the quality of interprofessional collaboration
between nurses and physicians. After linguistic validation, its wording should be adapted prior to any clinical application.
... Staff turnover in acute care and nursing home settings may inhibit the establishment and development of close working relationships between nursing and medical staff, particularly in the nursing home context where physicians are based in external surgeries (Tjia et al. 2009). Nurse-physician communication and relationships have been studied extensively and positive relationships have been reported to result in higher job satisfaction for nurses and physicians, sharing of disciplinary knowledge and improved patient outcomes (Prescott & Bowen 1985, Keenan et al. 1998, Manojlovich 2010). Difficult relationships have resulted in poor job satisfaction, feelings of professional isolation, and errors in patient assessment and management (Donchin et al. 1995, Manojlovich 2010). ...
Aims and objectives:
To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.
Background:
Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.
Design:
A qualitative study using semi-structured interviews and thematic analysis to examine data.
Methods:
24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.
Results:
Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.
Conclusions:
Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.
Relevance to clinical practice:
Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.
... The concept of collaboration has some currency within most professional mental health disciplines (Graham & Barter, 1999); and as such, has been applied to a wide-range of interpersonal relationships, including the social workers role as a clinician (Tyron & Winograd, 2002) and inter-professional relationships in general (Abramson & Mizrahi, 1996;Keenan, Cooke, & Hillis, 1998). Recognizing that collaboration has tended in the past to lack a clear and consistent definition within the literature review that is available, Henneman, Lee and Cohen (1995) conducted a comprehensive concept analysis of inter-professional collaboration, and; after examining the range of definitions and descriptions of collaboration in general, identified the following; a collaborative model cannot be said to be present when commitment to a joint venture is absent; willing participation; a team approach; shared planning and decision making; shared responsibility for outcomes; shared contribution of expertise; and a non-hierarchical relationship in which power is shared and based on knowledge rather than on role or title. ...
This article briefly looks at the collaboration between allied mental health professionals and social workers and their perceived relationships with respect to services provided to clients, by examining perceptions of their corresponding relationships.
... This is interesting insight in light of the physician-nurse relationship, assuming the traditional and mutually understood paradigm of physician dominance and nurse deference, where the physician"s opinion always prevails (Keenan, Cooke, & Hillis, 1998). But, this traditional paradigm is changing. ...
... It has been administered for a variety of purposes, some of which are: as an outcome indicator (Balthazard and Cooke, 2004); to measure organizational culture in manufacturing firms and examine the relationship between the type of culture and the firm's performance on quality measures (Rastrick and Corbett, 1998); to measure organizational culture in hospitals (Callen et al., 2009;Keenan et al., 1998;McDaniel and Stumpf, 1993;Seago, 1997Seago, , 2000; to predict the kind of leadership style that characterizes an organization's culture (Eppard, 2004); to investigate organizational culture in small, community-based residential services providers for people with intellectual disabilities (Gillett and Stenfert-Kroese, 2003). This wide range of applications has produced an extensive information base regarding the ways in which culture operates in different types of organizations (Balthazard et al., 2006). ...
Many high-hazard industries around the world have explicitly recognized the critical role that human, management and organizational risk factors play in major accidents. The findings of accident investigations and risk assessments demonstrate a growing recognition that the cultural context of work practices may influence safety just as much as technology. The objective of this paper is to establish a relationship between the concepts of safety culture and organizational culture in a Nuclear Power Plant (NPP). This study permits the identification and quantification of the possible mechanisms for improving the safety culture in the NPP acting on organizational culture. It therefore provides a methodology to identify potential strategies for safety improvement. Probabilistic (Bayesian) Networks (BNs) have been used to determine the relationships between the organizational culture and safety culture in a quantitative form. To this aim, we considered data from a survey conducted of every employee at a Spanish NPP. The resulting data-driven models allow us to establish the probabilistic relationship among organizational culture factors, including the 12 OCI (Organizational Culture Inventory) scales, that have an influence on safety culture. The study yielded a ranking of organizational cultures that can be used to improve safety culture in a NPP.
... Zum anderen könnten die Einschätzungen der typischen Ver-treterInnen der Ärzteschaft und der Pflege auch ein Genderstereotyp reflektieren, da mit der typischen Pflegekraft vermutlich eine weibliche Person beurteilt wurde, während sich die Befragten als typische/n VertreterIn der Ärzteschaft vermutlich eine männliche Person vorgestellt haben [15,25]. Da Pflege und Ärzteschaft nicht hinreichend zu Kollabortation sozialisiert werden und die Ärzteschaft nur ungern ihre Machtposition aufgeben möchte, ist es wesentlich, die beiden Professionen zu unterstützen und zur Zusammenarbeit zu motivieren; eine bedeutsame Strategie in diesem Zusammenhang ist die Verdeutlichung der positiven Folgen interdisziplinärer Kooperation [22]. Interdisziplinäre Besprechungen und angemessene Schulungs-und Teamentwicklungsmaßnahmen sind wichtige Ansätze, um die verschiedenen Berufsgruppen näher zusammen zu bringen und Konflikte zu vermeiden [2]. ...
Interdisciplinary collaboration between nurses and physicians contributes to optimal patient outcomes. Both insufficient knowledge of each other's roles and competencies and the power position of physicians impede nurse-physician collaboration. Health care managers play an important role in the promotion of nurse-physician collaboration. Leadership is associated with masculine traits, but female attributes are crucial in social relationships. Austrian health care management students (n = 141, response rate: 93 %) rated themselves, the typical nurse and the typical physician with respect to masculine and feminine traits using the Bem sex-role-inventory (BSRI). The respondents saw themselves as equally masculine and feminine (androgynous self-concept); nurses were rated as significantly more masculine than feminine, whereas physicians were described as masculine sex-typed and significantly less feminine than nurses. For health care managers who also have to promote interdisciplinary collaboration an androgynous self-concept can be regarded as advantageous. They need to reflect on their ideas about nurses and physicians in order to manage the challenge of promoting interprofessional co-operation.
... The concept of collaboration has some currency within most professional disciplines (Graham & Barter, 1999). It has been applied to a range of interpersonal relationships, including therapistpatient (Tyron & Winograd, 2002) and interprofessional relationships (Abramson & Mizrahi, 1996;Keenan, Cooke, & Hillis, 1998). Recognising that collaboration has tended to lack a clear and consistent definition within this literature, Henneman, Lee and Cohen (1995) conducted a comprehensive concept analysis of inter-professional collaboration. ...
This study investigated collaboration between mental health professionals and family caregivers by examining perceptions of their routine relationships. Independent samples of professionals (N=240) and family caregivers of adults with severe mental illness (N=270) responded to items developed to measure 14 facets of collaboration. Principal component analyses and standard multiple regressions were performed. Five components, accounting for 55% of the variance, were identified in professionals' perceptions of collaboration whereas two components, accounting for 56% of the variance, were identified in family caregivers' perceptions. Components capturing the behaviours and attitudes of the other party were the best predictors of both family caregiver and professional perceptions of overall collaboration. The results suggest that relatively simple collaboration models can describe routine professional-caregiver interactions, although professionals possess a more differentiated concept of collaboration than family caregivers. Unexpectedly, both professionals and caregivers tended to attribute responsibility for collaboration to the other party. Training programs in which mental health professionals and family caregivers jointly learn the best ways to work together may be valuable.
... It has been administered for a variety of purposes, including to direct, evaluate, and monitor organizational change (e.g. Gaucher and Kratochwill, 1993); identify and transfer the cultures of high performing units (Human Synergistics, 1986); study and enhance system reliability and safety (Haber et al., 1991;Shurberg and Haber, 1992;Keenan et al., 1998); facilitate strategic alliances and mergers (Slowinski, 1992); promote collaborative relations within and across units (Leeds, 1999); and test hypotheses on the relationship between culture and antecedent variables (Klein et al., 1995a). This wide range of applications has produced an extensive information base regarding the ways in which culture operates in different types of organizations. ...
Purpose
This paper aims to describe how organizational culture is manifested in behavioral norms and expectations, focusing on 12 sets of behavioral norms associated with constructive, passive/defensive, and aggressive/defensive cultural styles.
Design/methodology/approach
The organizational culture inventory, a normed and validated instrument designed to measure organizational culture in terms of behavioral norms and expectations, was used to test hypotheses regarding the impact of culture. Data are summarized from 60,900 respondents affiliated with various organizations that have used the instrument to assess their cultures. Also presented is a brief overview of a practitioner‐led assessment of four state government departments.
Findings
The results of correlational analyses illustrate the positive impact of constructive cultural styles, and the negative impact of dysfunctional defensive styles, on both the individual‐ and organizational‐level performance drivers. The results clearly link the dysfunctional cultural styles to deficits in operating efficiency and effectiveness.
Originality/value
The concept of organizational culture is derived from research in the field of organizational behavior characterized by use of qualitative methods. Yet, one of the most powerful strategies for organizational development is knowledge‐based change, an approach that generally relies on the use of quantitative measures. Although both methods share the potential for producing cumulative bodies of information for assessment and theory testing, quantitative approaches may be more practical for purposes of knowledge‐based approaches for organizational development generally, and assessing cultural prerequisites for organizational learning and knowledge management specifically.
... Avoiding conflict results from low levels of concern for the self and others. It involves reducing the importance of the issues, and attempting to suppress thoughts about them ( Keenan et al, 1998). In avoiding conflict the individual simply refuses to address it, and is unassertive and uncooperative. ...
Nurse managers work in environments in which conflict frequently arises and can be difficult to resolve. This study explored how diverse backgrounds among nurse managers influenced their conflict management styles. A total of 321 nurse managers, working in referral hospitals in the Sultanate of Oman, were surveyed using an adapted version of the Rahim Organisational Conflict Inventory II (ROCI-II) scale, and a response rate of 271 (86%) was obtained. Data were analysed using the SPSS statistical package. The one-sample Kolmogorov- Smirnov test was used to determine the conflict management styles used by nurse managers. A nonparametric Spearman's rho test was used to determine whether there was any relationship between age and number of years of experience and conflict management style. The Mann-Whitney U-test was used to compare male and female managers with regard to conflict management styles. The findings indicated that conflict management styles varied according to the nationality, gender, age, marital status and number of years of experience of the nurse managers. In addition, the grade and education level of nurse managers played a role in conflict management. These findings have implications for policy makers and nurse managers in helping them to understand the effect of diverse nursing backgrounds on conflict management, and the need to develop new approaches with regard to conflict management styles.
... Communication is one process that has been associated with job satisfaction ( Blegen, 1993). Nurses and physicians together make up the largest component of healthcare providers ( Keenan, Cooke, & Hillis, 1998), and communication styles between nurses and physicians, viewed from the perspective of nurses only, have been shown to contribute to nurses' job satisfaction ( Coeling & Cukr, 2000). The contribution of each group to the overall effectiveness of communication has not been established ( Rosenstein, 2002). ...
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... According to Xenikou & Furnham (1996), of the four questionnaires mentioned, OCI is the most reliable measure of organizational culture. It is also a validated survey used in a wide array of organizations, including manufacturing and hightechnology firms, research and development laboratories, schools and universities, governments, hospitals, etc. (McDaniel & Stumpf 1993, Seago 1997, Keenan et al. 1998, Seago 2000, Callen et al. 2009 The OCI is the questionnaire used in this Study to measure organizational culture. This questionnaire focuses on the behavioral norms and expectations associated with the values shared by an organization's members. ...
The objective of this study is to show how to improve the Safety Culture in one Nuclear Power Plant acting on organizational culture styles. To establish this relationship, probabilistic Bayesian network models have been used. Data was gathered through a survey, in June 2007, in a Spanish Nuclear Power Plant (Sta. MarÃa de Garoña). The safety culture questionnaire was based on the five characteristics established by the International Atomic Energy Agency (IAEA). To assess organizational culture, the Organizational Culture Inventory (OCI) was used. The OCI questionnaire focuses on the behavioral norms and expectations associated with the values shared by members within an organization. The outcome of the study indicates that constructive styles have the greatest influence on safety culture. In contrast, the defensive styles do not, in general, exhibit a clear relationship with Safety Culture. Detailed studies of each OCI style show the specific actions which help enhance or hindrance the safety culture. © 2012 Taylor & Francis Group.
... Communication researchers have highlighted the influences of organizational environments and group dynamics on individuals' communicative patterns (Keenan, Cooke, & Hillis, 1998;Marin, Sherblom, & Shipps, 1994). Because interpreters generally work where the contexts of institutions (e.g., United Nations, diplomatic occasions, hospitals, courts, and immigration services) are strong, it is crucial to examine how the institutional contexts have influenced interpreters' performances. ...
This paper used medical interpreting as an example to examine the recent attention to the communicative nature of translation and interpretation. In presenting the historical development of community interpreting, I examined the reasons why the communicative aspect of translation and interpretation has been ignored in the traditional translation studies. The recent research on community interpreting highlighted the fact that the neutrality envisioned in traditional ideology (i.e., translators as conduits) is not practiced even among professionals. I provided a brief overview of efforts from various disciplines (Le., anthropology, sociology, applied linguistics, psychology, and communication) to resolve such discrepancies, which led to the recent attention to the communicative perspective of translation and interpretation. I argued that interpreters' choice of interpreting strategies is not solely dependent on their linguistic ability or interpreting competence. Various factors (e.g., communicative goals, social identities, institutional contexts, contextual factors) may influence interpreters' performances. Communication as a discipline provides well-grounded theories on how these factors may influence interpersonal interactions. Using the constructs and concepts developed in communication research, I presented a theory of medical interpreting that incorporates an interdisciplinary understanding of the communicative perspective of interpreting.
... highlighted the influences of organizational environments and group dynamics on individuals' communicative patterns (Keenan, Cooke, & Hillis, 1998;Marin, Sherblom, & Shipps, 1994). Because interpreters generally work where the contexts of institutions (e.g., United Nations, diplomatic occasions, hospitals, courts, and immigration services) are strong, it is crucial to examine how the institutional contexts have influenced interpreters' performances. ...
This paper examines the distinct characteristics of liaison interpreting and explored the contribution of liaison interpreting to the theoretical development of translation studies. The historical development and theoretical themes of translation studies suggest that the ideology and codes of conduct of consecutive interpreting are heavily influenced by theories of translation and simultaneous interpreting. An overview of the theoretical development of interpretation across various disciplines (e.g., anthropology, sociology, applied linguistics, discourse analysis, psychology, and communication) suggests that the latest development of examining interpreter-mediated conversations as a communicative activity will allow researchers to explore the dynamic and interactive aspects of interpretation. I propose. a new field of investigation, liaison interpreting, in lights of its potential contributions to various disciplines. The distinct characteristics of liaison interpreting (i.e., the dynamics of interpreting activity, the mediation of roles and identities, and the contextual influences of interpreting) provide researchers rich resources to explore the complexity of interpreting as a communicative activity coordinated between mUltiple parties and to develop effective models to facilitate interpreter-mediated interactions.
... Nurses and nursing students should be prepared for identifying feelings of distress and constructively employing their 'voices' in workrelations within health organisations. This should be done by teaching the skills of communication, negotiation and assertiveness, since conveying ideas in a forceful and even confrontational manner seems to increase the likelihood of successful collaboration (Keenan et al. 1998) and nurses who feel adequately consulted by physicians are more likely to initiate the consultation process (Van Niekerk & Martin 2002). ...
Aim:
To increase understanding of what it is like for nurses to care for patients in pain.
Background:
Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses' relations with patients and doctors, it may be fruitful to study nurses' experience of caring for patients in pain to increase understanding of the above problem.
Design:
A phenomenological study involved 20 dialogues with 10 experienced nurses.
Results:
The findings indicate that caring for a patient in pain is a 'challenging journey' for the nurse. The nurse seems to have a 'strong motivation to ease the pain' through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are 'reading the patient', 'dealing with inner conflict of moral dilemmas', 'dealing with gatekeepers' (physicians) and 'organisational hindrances'. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse.
Conclusions:
Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses' knowledge in this respect may hitherto have been too narrowly defined.
Relevance to clinical practice:
The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses' clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.
... When nurses are straightforward in their requests, this could be explained by their perceptions of being respected and having a voice, and therefore in keeping with Van Niekerk and Martin (2002) that nurses who feel adequately consulted by physicians are more likely to initiate the consultation process. The use of assertiveness further matches the argument of Keenan et al. (1998) that conveying ideas in a forceful and confrontational manner increases the likelihood for successful collaboration. We claim that when nurses choose to bypass the gate by bending rules (Blondal & Halldorsdottir, 2009; Ware et al., 2011) despite the risk of jeopardising their career, this might indicate a lack of self-confidence, negotiating competence or communicational competence skills. ...
İş yerinde, bir veya birden fazda çalışana bilinçli bir şekilde psikolojik ve fiziksel zarar veren davranışlara iş yerinde şiddet adı verilmektedir. İşyerinde şiddet; sözel, fiziksel ve psikolojik saldırı, psikolojik baskı ve yıldırma, zorbalık, tehdit, korkutma, yaralama, zarar görme ile sonuçlanabilecek tiim şiddet davranışlarını içermektedir. Yönetim ve organizasyon literatürü; bireysel çatışma yönetimi yaklaşımlarını beş grupta toparlamaktadır. Bunlar: kaçınma yaklaşımı, işbirliği yaklaşımı, uzlaşma yaklaşımı, uyma yaklaşımı ve zorlama yaklaşımıdır. Çalışanların iş yerinde yaşadıkları anlaşmazlıklara karşı tercih ettikleri bireysel çatışma yönetimi yaklaşımlarının iş yerinde şiddetle yakından ilişkisi bulunmaktadır. Araştırmanın temel amacı çalışanların tercih ettikleri bireysel çatışma yönetimi yaklaşımları ile iş yerinde yaşadıkları şiddet arasında ilişki olup olmadığının tespit edilmesidir.
Objective:
The head nurse is the first line manager in a working unit who is responsible for preventing and solving conflicts. Unmanaged interdisciplinary conflicts can result in decline quality of the healthcare service. This study explores the head nurses' experiences in preventing interdisciplinary conflicts.
Method:
This study was a qualitative study using descriptive-phenomenological approach. Data were collected through in-depth interviews with twelve head nurse of a central hospital in Jakarta, Indonesia. The data were then analyzed by employing Colaizzi's method.
Result:
The results of this research revealed four themes: (1) integrated-effective communication is a form of interdisciplinary conflict prevention; (2) a head nurse need to have wide insights and supple character to prevent conflicts with doctors; (3) a head nurse is responsible for coordination and negotiation to prevent interdisciplinary conflicts; and (4) a head nurse creates conducive working environment to prevent interdisciplinary conflicts.
Conclusions:
A head nurse can prevent conflicts and direct interdisciplinary conflicts to be positive to provide quality healthcare service.
ميترا پيامي بوساري و همكارانمجلهي علمي، پژوهشي دانشگاه علوم پزشكي و خدمات بهداشتي، درماني زنجان، دورهي ١٦، شمارهي ٦٥، زمستان٨٧٧٥Types and Major Causes of ConflictsExperienced by Nurses: AQualitative Analysis4HAAbedi, 3FAhmadi, 2HEbrahimi, 1Payami Bousari M1Dept. of Nursing, Faculty of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran2Dept. of Nursing,Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran3Dept. of Nursing,Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran4Dept. of Nursing, Faculty of Nursing and Midwifery, Islamic Azad University, Khorasgan Branch, Khorasgan, IranCorresponding Author:Payami Bousari M, Dept. of Nursing, Faculty of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, IranE-mail:mitra_payami@yahoo.comReceived: 1 Dec 2008Accepted:9 Mar 2009Background and Objective: Conflicts among health care personnel including nursing personnel who require extensive interaction with different people, is common and almost inevitable. As there is not sufficient information about the causes, types, and dimensions of interpersonal conflicts among clinical nurses and the adverse effects of these conflicts on the function of nursing team in Iran, we aimed to perform this study in order to find out causes of different inter-group or inter personal conflicts among nurses using qualitative research method and Grounded Theory Approach (GT). Materials and Methods: The data was collected through interviews. Constant comparison method was used in order to perform qualitative analysis. Results:Open coding process resulted in emergence of causal conditions and different types of conflicts within the nursing society. Exposure to imposed conditions, confronting with opposition, disagreement anddestructive behaviors were indicative of characteristics of conflicting events and tasks, process, relational and marginal conflicts which were major categories of conflict in clinical settings. Feeling threats towards benefits was recognized as the main apprehension of participants. This core variable can explain howconflicts occur and develop within nursing society according to conflicts of benefits.Conclusion:The findings showed that individual factors and intra as well as extra-organizational factors were major and/or contextual causes of inter-group conflicts among nurses.One of the significant and interesting findings in this study was that the conflicts did not affect the occupational function of nurses despite the significant effect on marginal issues in their work environment.The study also showed that these conflicts are part of simulation process in nursing tasks.Key words: Occupational Conflicts, Interpersonal Conflict, Nursing, Clinical Environment.
(PDF) Types and Major Causes of Conflicts Experienced by Nurses: A Qualitative Analysis. Available from: https://www.researchgate.net/publication/329091431_Types_and_Major_Causes_of_Conflicts_Experienced_by_Nurses_A_Qualitative_Analysis [accessed Nov 21 2018].
Purpose
Organisational culture (OC) shapes individuals’ perceptions and experiences of work. However, no instrument capable of measuring specific aspects of OC in community pharmacy exists. The purpose of this paper is to report the development and validation of an instrument to measure OC in community pharmacy in Great Britain (GB), and conduct a preliminary analysis of data collected using it.
Design/methodology/approach
Instrument development comprised three stages: Stage I: 12 qualitative interviews and relevant literature informed instrument design; Stage II: 30 cognitive interviews assessed content validity; and Stage III: a cross-sectional survey mailed to 1,000 community pharmacists in GB, with factor analysis for instrument validation. Statistical analysis investigated how community pharmacists perceived OC in their place of work.
Findings
Factor analysis produced an instrument containing 60 items across five OC dimensions – business and work configuration, social relationships, personal and professional development, skills utilisation, and environment and structures. Internal reliability for the dimensions was high (0.84 to 0.95); item-total correlations were adequate ( r =0.46 to r =0.76). Based on 209 responses, analysis suggests different OCs in community pharmacy, with some community pharmacists viewing the environment in which they worked as having a higher frequency of aspects related to patient contact and safety than others. Since these aspects are important for providing high healthcare standards, it is likely that differences in OC may be linked to different healthcare outcomes.
Originality/value
This newly developed and validated instrument to measure OC in community pharmacy can be used to benchmark existing OC across different pharmacies and design interventions for triggering change to improve outcomes for community pharmacists and patients.
A hospital round is a long tradition in which nurses and physicians communicate to develop an integrated plan of care together with the patient. There is insufficient knowledge of care professionals’ experiences of communication during hospital rounds, particularly in surgical units, where the physician is frequently absent during daily care. Hence, the aim of this study was to describe nurses’ experiences of communication with physicians during hospital rounds in a surgical unit. Nine qualitative unstructured interviews with nurses were conducted and analysed using Burnard’s description of content analysis. ‘An encounter involving opportunities for and challenges to teamwork’ was found to be the predominant theme. The hospital round in a surgical unit is a short encounter that can be challenged by missing patient care goals, difficulties in transmitting messages and frustration over unshared information. Further studies are needed to overcome existing knowledge gaps about communication during hospital rounds.
Background: Ineffective communication among healthcare team members is associated with decreased collaborative efforts and adverse patient outcomes. The impact of empathy on collaboration with colleagues and patient interaction has been previously demonstrated. Studies have yet to measure the impact of (Nonviolent Communication [NVC]) on empathy in nursing students. Purpose: The purpose of this mixed methods study was to test a communication intervention (NVC) with baccalaureate student nurses to examine its effect on empathy. Methods: A mixed methods single group pre/post test design incorporating the Interpersonal Reactivity Index (IRI) to measure empathy was used. A paired samples t test was calculated to compare means scores pre and post intervention. One-way ANOVA was used to examine between group differences. Interpretive methods were used to analyze qualitative data collected via journal entries during the training and focus groups immediately following and 2 years post intervention. Results/Findings: Quantitative results revealed an increase in empathy (69.1 to 71.4, p = .037) post training. Qualitative analyses demonstrated positive impact of NVC in empathizing with self and others. Clinical impact was especially noted when working with psychiatric patients. Conclusion: Incorporating NVC into nursing education could feasibly prevent future hardship as students advance their nursing careers. Further research may be needed to capture the larger impact that NVC could have on nurses and nursing students.
Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties.
We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies.
Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams.
Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated.
Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes.
Review is limited to quantitative assessments of teamwork in internal medicine.
There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes.
Changes in the health care environment have required concomitant changes in approaches to health care, and the roles and functions of health care professionals worldwide. The nurse practitioner (NP) role was first introduced in the United States of America (US) in the 1960s to help address critical health care needs that were designed to improve access to health services. The NP role has continued to evolve in the US and other countries including Canada and the United Kingdom (UK) across a range of health care settings.
In Australia, New South Wales (NSW) was the first state to consider the potential for the NP role in 1990 (NSW Department of Health, 1992). The purpose of this research was to trace and document the early development and implementation of the NP role in NSW.
This study adds to the nursing literature by documenting historical events in the inception of the NP role, particularly factors that affected the development and its implementation of the NP role in the NSW health care system. In addition the study preserves the oral histories of figures who were instrumental in the introduction of this new clinical career pathway for nurses, and a new model of care into the Australian health care system. This thesis constitutes original historical research into the development of the NP role in NSW. An historical, descriptive design was used that included recorded interviews with 10 pioneer nurse practitioners and 17 key stakeholders involved in the development of the NP role. Documents were collected that were central to the key historical events, and these documentary accounts were compared and contrasted with the information provided through the interviews. The data was analysed using qualitative thematic analysis.
The development of the NP role began at a nursing conference in 1990 because a nurse asked the NSW Health Minister whether he supported the NP role. This one question triggered a cascade of events. Between 1990 and 1998 the NP role was legislated and the title of the NP protected through the Nurses Amendment (Nurse Practitioners) Act 1998 (NSW). During this time four committees were formed, four reports had been generated and 10 pilot projects undertaken. In 1997, the NSW Minister for Health established an implementation process for NP authorisation, education and regulation. On May 11, 2001 the NSW Minister for Health announced the first NP to be appointed into a position in remote NSW and in September 2002, NPs were introduced into metropolitan areas of NSW.
Disparate visions and vested interests in relation to the NP role inevitably affected the
development of the role and the way it was enacted. Stakeholders who had a ‘sense of gain’
and supported the NP role saw its benefits for the health care system, and for nursing. Those
who fought to maintain the status quo were ultimately driven by a sense of ‘loss and fear.’
There was considerable fear about the effect of the NP role on the roles of other health care
professionals. There was much interplay between those trying to maintain the status quo and
those who were trying to counterbalance the sense of loss and fear. The development and
implementation of the NP role became an arduous process of negotiation and compromise.
Further complexities arose in understanding tradition’s historical legacy on the NP role. The
findings illuminated that some doctors were not only resistant to the NP role but had not
adapted to the professional status of nursing. Similarly, the findings indicate that there are
still many nurses who have not adapted to the advancement of nursing. As a consequence,
they also hanker for the supposedly good old days, and strongly opposed new developments
such as the introduction of NPs.
The findings attest to significant disruption to professional-working relationships with some
health care professionals torn between their personal, professional and organisational commitments. Long-term professional relationships between the NPs, nurses, doctors and managers were challenged.
The study’s findings demonstrate the need to assess an organisation’s readiness when introducing a new nursing role and an assessment of the environmental conditions to support role implementation. The findings also revealed the importance and influence of language in introducing a new nursing role such as that of the NP. There was confusion surrounding the use of certain terms (e.g., advanced practice) within and beyond nursing. The NPs found the authorisation process particularly challenging. The findings show that,
with any newly introduced process, there needs to be detailed guidance and an assessment that candidates are able to meet the requirements set by the regulatory body.
Only because of the resilience and perseverance of the nurse leaders, the NPs and others who
supported the role, has the NP movement been able to gain momentum. One of the principal findings of this study has been the political maturation of the nurse leaders during the development of the NP role that, in turn, has benefited nursing.
There was considerable resistance to the NP role by some powerful medical organisations and the findings show that it is important to engage the media and educate the public about the NP role and its value, to help garner support early on in the development of the role. In addition, because of the political nature of the role, NPs require education in using and managing the media and also education about managing themselves in the politics of health care.
This paper explores the concept of communication between doctors and nurses within an orthopaedic and trauma directorate using an audit approach. The directorate is part of a large teaching hospital in the UK, serving an immediate city population. By trawling past research and using a communications audit, this paper identifies five main influences on written and verbal communications and provides recommendations for action.
Research on conflict management in organizations is thriving, yet historically it has been primarily micro in its orientation, focusing almost exclusively on individual and small group processes. Although a micro approach to conflict management is certainly valid, from a levels of analysis perspective, by limiting the focus on conflict management to the individual and small group level, current conflict management paradigms may be underspecified (House et al., 1995). Many phenomena in organizations - whether it is innovation, leadership, or job attitudes, involve multiple levels of analysis, and conflict management should be of no exception. In this theory paper, we introduce a complementary macro theory of conflict cultures, or shared norms that specify how conflict should be managed in organizational settings. We propose a typology that includes four distinct organizational conflict cultures, collaborative conflict cultures, avoidant conflict cultures, passive-aggressive conflict cultures, and dominating conflict cultures, which are differentiated by two dimensions - active versus passive conflict management norms, and prosocial versus antisocial conflict management norms. We discuss top down processes (e.g., leadership, organizational structure and rewards, industry and societal factors) and bottom-up processes (e.g., personality, demographics, values) that facilitate the development of distinct conflict cultures. We explore organizational outcomes of conflict cultures as well as moderators of proposed effects. We conclude with theoretical and practical implications of a conflict culture perspective.
Charles Taylor called for a retrieval of the ethic of authenticity that has been distorted in modern notions of autonomy and self-fulfillment. Via exchanges with others who matter to us, he proposed that human identities develop through the use of rich language draped in shared horizons of significance. The fostering of these dialogical ties beyond purely instrumental purposes, along with the recognition of the human dignity in all, may avert the fallen ideal of authenticity. Nonviolent communication affords the skillful dialogue with others cradled in a shared sense of significance and supports the development of a meaningful identity-one that is formed through the realization of what exists beyond the self. The purpose of this article is to argue that nonviolent communication facilitates the retrieval of the ethic of authenticity. Narratives from nursing students' journals on the use of nonviolent communication skills will be used to support the argument.
This study investigated potential personality predispositions to interpersonal conflict-handling behavior. The design of the study represents an advancement over previous research as both males and females were studied in a controlled context of conflict introduced via a business simulation game. Jungian personality dimensions and conflict-handling modes were assessed and a significant relationship was found between subjects' decision-making preference (thinking-feeling) and their choice of conflict-handling behavior. Some sex differences in conflict-handing behavior were also found. The findings of this study have implications for conflict management, personnel selection, and placement of individuals in organizations.
This study explored the relationship between referent role (superior, subordinate, and peer) and the styles of handling interpersonal conflict (integrating, obliging, dominating, avoiding, and compromising). These styles were measured by the Rahim (1983c) Organizational Conflict Inventory-II with a national random sample of managers (N = 1,219). The results of a multiple discriminant analysis indicated that the respondents were mainly obliging with superiors, integrating with subordinates, and compromising with peers. To a lesser extent, they were compromising and dominating with superiors and avoiding with subordinates.
36 experienced managers took the role of supervisors whose position was to eliminate job rotation. Workers' (3 male undergraduates) positions were that rotation should be retained. Supervisors approached this controversy cooperatively, competitively, or tried to smooth over differences and avoid controversy. Results indicate that supervisors who tried to avoid an open controversy did not explore or understand workers' arguments, but did think the arguments were reasonable and sometimes integrated them into their decisions. Supervisors in the competitive-controversy condition neither explored nor understood the workers' arguments, rejected their position, and made decisions that reflected only their own point of view. Supervisors in the cooperative-controversy condition explored, understood, accepted, and combined workers' arguments with their own to make a decision. It is concluded that controversy within a cooperative context can result in curiosity, understanding, incorporation, and an integrated decision. (10 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Supervisors rated 106 subordinates' use of 5 conflict resolution strategies identified by R. R. Blake and J. S. Mouton (1964). The relationship between the commitment measures and conflict resolution strategies depended on the sexual composition of the supervisor–subordinate dyad. For example, males reporting to females used smoothing, compromise, and confrontation when they were committed to the position. (8 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"In our article 'A Theory of Access,' Nancy Peluso and I define and elaborate a term that is frequently used but rarely defined. We did not do this in order to seek a consensus on meaning. We did it to produce an analytic framework for empirically exploring instances of benefit appropriation and explaining those appropriations within a larger social and political-economic context. Further, we did it so that studies of benefit appropriation can be conducted in a comparative manner—so that those interested in empirical analysis of this particular question can talk to each other and can build a larger body of comparative knowledge. Conceptual clarity is about internal consistency and not necessarily about consensus. It enables us to know how our ideas are similar, how they differ, and why."
This study has sought to investigate the Jungian psychological correlates of an individual's choice of different interpersonal conflict-handling modes: competing, collaborating, compromising, avoiding, and accommodating. These five modes were defined according to the two basic behavioral dimensions of assertiveness and cooperativeness and were also related to integrative and distributive dimensions. The results suggest that the Jungian functions related to judging (thinking vs feeling) and the type of enactment (introverted vs extraverted) are significantly related to an individual's conflict-handling behavior. The study concludes with a schematic illustration of these Jungian functions plotted upon the basic behavioral dimensions which define and characterize the five conflict-handling modes.
This critique indicts conflict style literature for focusing on disagreements rather than incompatibilities, for downplaying the role of interdependence between parties in assessing interpersonal conflicts, and for failing to cast interpersonal conflict within an organizational system. This article also questions the exhaustiveness and representativeness of the two-dimensional models that form the five styles. It argues for reframing communication to include nonverbal and contradictory messages, multiple meanings, linkages between message tactics and strategic behavior, and inconsistencies between intentions and communicative tactics as conflict develops. Finally, it argues for contingency and political models of organizing to guide researchers in selecting appropriate variables and models to study interpersonal conflicts.
This article presents original data on the conceptualization, item development, reliability, and validity of the Conflict Management Message Style (CMMS) instrument. This instrument consists of communicative messages used with recalls of critical incidents that typify three distinct styles for handling interpersonal conflicts in organizations: concern for self, concern for issue, and concern for other. In tests with 1,500 subjects, the CMMS demonstrates low to moderate internal reliability, good convergent validity, and positive correlations between peer and self-ratings. These findings, however, are confounded in part by the social desirability of the three styles.
This article investigates the correlation of personality variables and inter-group conflict resolution modes. In the first of two -research approaches, EPPS scores of 64 college students on aggression, dominance, affiliation, and achievement were correlated with preferences for confronting, forcing, and smoothing. A field study correlated EPPS variables of 19 boundary personnel with ratings on resolution modes by 57 interorganizational correspondents. As hypothesized, achievement was positively correlated with confronting under both research approaches. Only students' aggression scores correlated weakly and positively with preference for forcing. Affiliation and smoothing were also weakly and positively correlated with the students but not in the field.
The degree of association between supervisor and subordinate perceptions of the supervisor's leadership style, use of power by the supervisor, and the supervisor's conflict‐management style was studied in 87 organizational units representing five service‐oriented organizations. The ability of the supervisors’ and subordinates’ perceptions, individually and jointly, and the discrepancy between these perceptions to predict subordinate satisfaction with supervision and work, subordinate solidarity with supervisor, and degree of subordinate anxiety about communicating with the supervisor were also examined.
This book provides an invaluable reference tool for professionals and researchers in diverse fields—emergency medicine, medical care organization, organizational psychology and sociology, for example—who are concerned with the improvement of health care systems. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"In this article an attempt has been made to sketch out a theory of cooperation and competition and apply this theory to the functioning of small groups… , (i) social situations of cooperation and competition were defined; (ii) some of the logical implications inherent in the definitions were pointed to; (iii) with the introduction of psychological assumptions, some of the definitions of the two objective social situations were then drawn; (iv) the psychological implications, with the aid of additional psychological assumptions, were then applied to various aspects of small-group functionings to develop a series of hypotheses about the relative effects of co-operation and competition upon group processes; and (v) finally the concept of group was defined and linked with the concept of cooperation, thus making all of the preceding theoretical development with respect to cooperation relevant to group concepts." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
develop an integrated overview of the complex fabric of variables involved in conflict and negotiation / the major parts of this fabric include (a) the sequence of events in the conflict/negotiation process, (b) structural variables which shape that process, (c) outcomes of the process, and (d) third-party interventions to manage conflict/negotiation / separate models are developed for each of these parts, along with a more general model or paradigm that shows the interrelationships between them
special attention has been given to topics that are central to conflict and its management but which have not received sufficient analysis / one involves the prevailing motivational/behavioral assumptions used to explain or predict conflict/negotiation behavior / the deficiencies of prevailing rational-economic assumptions are noted, and a more complex model of motivation is introduced that incorporates emotions and normative reasoning as well as rational-economic reasoning / a second topic involves the goals of conflict management / it is argued that much of the divergence in conflict management prescriptions within the literature is based on confusion among quite different goals / a framework is developed to categorize these goals, based on one's choice of beneficiary and time frame (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Organizational Culture Inventory (R. A. Cooke and J. C. Lafferty, 1983) measures 12 sets of shared behavioral expectations associated with 3 types of cultures: constructive, passive-defensive, and aggressive-defensive. These cultural norms are hypothesized to influence thinking and behavior, motivation and performance, and satisfaction and stress of organizational members. Tests of 3 types of reliability and 2 types of validity on data provided by approximately 4,890 Ss indicate that the inventory is dependable for assessing normative aspects of culture. Obtained alpha coefficients support internal consistency; tests for interrater agreement show that significant variance in individuals' responses is explained by their organizational membership; and tests for differences across time show temporal consistency. Factor analysis provides general support for construct validity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Because women and men managers occupy different roles at work and at home, role theory suggests that they would use different conflict resolution behaviors in each role. This study tested this theory empirically using the Thomas-Kilmann Conflict Mode instrument to measure the five conflict resolution styles of 201 managers (99 males and 102 females) in both situational roles. Sex differences were examined along with hierarchical rank. Both genders tended to handle conflict more competitively at work than at home, and used the accommodating style more frequently at home than at work. At home, low-level women managers were more willing to collaborate and less willing to avoid conflict than at work; men managers overall were less likely to compromise at home than at work.
This study examined the impact of an employee's sex on the management of superior—subordinate conflict and how behavior during such interaction affected perceptions of the constructive use of disagreement and performance on the job. Male (n = 55) and female (n = 40) management personnel described how they dealt with differences and disagreements involving their immediate supervisor and how he/she responded to such conflict. Significant differences emerged between the perceptions of males and females reporting to males concerning the behavior of their supervisors. Preliminary analyses suggested that the sex of a supervisor was unrelated to female subordinates' perceptions of conflict management. No differences were observed between the likelihood with which male and female subordinates would use various methods to deal with disagreement. The manner in which the subordinate dealt with conflict was significantly related to perceptions of the constructive use of disagreement in the female sample but not in the male sample. None of the five methods of managing conflict examined in the study were related to supervisor evaluations of either the subordinate's performance or effort on the job.
It is argued that conflict in organizations can be interpreted, in many cases, as conflict over who is to exert influence, and that this conflict, in turn, is caused by structural incongruencies in the distribution of potential influence in groups and organizations. Potential influence is described in terms of the structural relations defined by Structural Role Theory. At the psychological level, conflict is explained as a result of incompatible expectations among people about their relative influence, their desire to protect valued roles, and to maintain a sense of freedom. The implications of the present hypothesis for specifying the range of conflict situations, the type of conflict behavior, and conflict management are explored.
This study investigated interpersonal conflict that occurred on the job. Members of 36 superior-subordinate dyads representing 10 organizational subunits completed the Employee Conflict Inventory (ECI). An independent sample of employees (N = 169) from the same subunits completed the Profile of Organizational Characteristics which was used to measure organizational climate. Results from the ECI indicated that dyad members held similar perceptions concerning the topics and sources of superior-subordinate conflict; technical and administrative issues were the most frequent topics, and differences in perception and knowledge were the primary reasons. Although perceptions of the other party's management of conflict were similar to the respondent's description of self, they differed significantly from the other's own self description. Conflict management was related to status differences as well as to attitudes toward conflict and corresponded to response styles predicted to emerge in consultative organizational climates.
This investigation represents an attempt to develop and validate a research instrument (Manifest Needs Questionnaire) capable of measuring the four needs of achievement, affiliation, autonomy, and dominance using behaviorally-based scales. The instrument is designed to measure such needs with specific reference to work settings and with minimal time requirements for completion. Results of both laboratory and field studies among 640 subjects indicate that the instrument exhibits acceptable levels of convergent, discriminant, and predictive validity, as well as reasonably high test-retest reliability and internal consistency. Results are compared to other, lengthier instruments designed to measure similar needs.
Sumario: Introduction -- Statistics guide -- Command reference -- Examples -- Glossary
Collaboration, a relationship of interdependence, requires the recognition of complementary roles. Traditionally, physicians generally have not demonstrated collaboration in their work with nurses; nurses, on the other hand, have more often sought a collaborative relationship. But the rapidly changing, increasingly complex and constraining world of health care requires that doctors, nurses, and the institutions that educate and employ them reevaluate the doctor-nurse relationship and assess the value of making it a more collaborative one. This essay deals with the phenomenon of collaboration, why there are compelling reasons to promote it, the barriers that exist between nurses and physicians in achieving collaborative relationships, and strategies to promote change. Comments of experienced observers and summaries of the pertinent research literature are presented.
True collaboration between clinical nurses and physicians in acute care settings can be difficult to achieve. The author describes a patient care unit dedicated to the study and development of such collaborative relationships. She reports an unexpected favorable outcome of such collaboration: the decline in incidents of moral outrage among nurses faced with moral dilemmas. This decline is attributed to such factors as mutual trust and respect between nurses and physicians, an appreciation that the two practice areas are interdependent, and the development of a synergistic alliance between the two that enhances patient care.
Health Services Research has a growing need for reliable and valid measures of managerial practices and organizational processes. A national study of 42 intensive care units involving over 1,700 respondents provides evidence for the reliability and validity of a comprehensive set of measures related to leadership, organizational culture, communication, coordination, problem solving-conflict management and team cohesiveness. The data also support the appropriateness of aggregating individual respondent data to the unit level. Implications for further research are discussed.
The relationship between the doctor and the nurse is a special one, based on mutual respect and interdependence, steeped in history, and stereotyped in popular culture. The underlying interaction can often be characterized as a game. In 1967 one of us described how doctors and nurses related to one another at that time.1 In this article we address the question of change. From our observations we are convinced that there have been major changes in the doctornurse relationship over the past two decades. To describe these changes we will briefly review the relationship that prevailed in 1967 and contrast it . . .
This study compared perceptions of 163 nurses and physicians of the current and ideal status of the decision-making authority of professional nurses. Each nurse and physician agreed or disagreed with 25 items, in two contexts, in the Authority in Nursing Roles Inventory (ANRI). Items in the ANRI describe a variety of nursing roles, functions, and behaviors in health and patient care. The results of the study were statistically significant overall both between and within professional groups. Disparities in several specific areas were revealed. The findings support the premise that in spite of expanded nursing roles emphasizing nursing authority, there are disagreements between nurses' and physicians' perceptions of the current and ideal authority of nurses as well as areas of dissatisfaction within each professional group. Implications of continuing conflicts between nurses and physicians as barriers to professional nursing role enactment, as well as strategies to address the problem, are discussed.
Collaboration between nurses and physicians has emerged as a result of recent research as a key variable in explaining patient outcomes from intensive care. However, the term has lacked a generally accepted definition, and this creates problems for new research. The use of the term in studies related to collaborative practice is reviewed here. Content areas for an instrument that could be used to examine collaborative work are suggested.
A qualitative analysis of the satisfaction of nurses with clinical decision making, the nature of the decision making, nurses' involvement in the process and factors that influence decision-making behavior is presented. The data were obtained from interviews conducted with physicians and nurses as a part of a study of nurse turnover and vacancy in hospitals. Staff nurse involvement in decision making is described as being interdependent; nurses reported general satisfaction with their involvement, while physicians generally resisted the decision-making discretion of nurses. Nurses on specialized and critical care units were more satisfied than were nurses who worked on general medical-surgical units. Trust and control were central issues. Implications for considering what knowledge, skill and decisional authority are needed for patient care are discussed.
We prospectively studied treatment and outcome of 5030 patients in intensive care units at 13 tertiary care hospitals. We stratified each hospital's patients by individual risk of death using diagnosis, indication for treatment, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. We then compared actual and predicted death rates using group results as the standard. One hospital had significantly better results with 69 predicted but 41 observed deaths (p < 0.0001). Another hospital had significantly inferior results with 58% more deaths than expected (p < 0.0001). These differences occurred within specific diagnostic categories, for medical patients alone and for medical and surgical patients combined, and were related more to the interaction and coordination of each hospital's intensive care unit staff than to the unit's administrative structure, amount of specialized treatment used, or the hospital's teaching status. Our findings support the hypothesis that the degree of coordination of intensive care significantly influences its effectiveness.
The aim of this study was to determine whether ongoing discussion among nurses, physicians, and consumers influenced their collaborative beliefs and behavior. A stratified experimental sample of 72 professionals and consumers met in small, multidisciplinary groups on a monthly basis for 2 years to discuss health care relationships. Prior to the onset of these groups, and after their conclusion, the experimental sample, a randomly selected control group of 72 persons, and a matched control group of 72 persons all completed the Management of Differences Exercise, the Multidimensional Health Locus of Control Scales, and the Health Role Expectations Index. Contrary to predictions, the experimental group (M = -6.85) declined more than controls (M = -4.63, p less than .05) in their beliefs regarding the value of shared versus physician-dominated responsibility for health care and increased more (M = 1.58 versus M = -.53, p less than .007) in their beliefs that powerful individuals such as physicians influence the consumer's health status. Results indicate that ongoing discourse may have enhanced traditional, status quo beliefs regarding the authority and power of the physician rather than fostering collaborative values.
We prospectively studied treatment and outcome in 5030 patients in intensive care units at 13 tertiary care hospitals. We stratified each hospital's patients by individual risk of death using diagnosis, indication for treatment, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. We then compared actual and predicted death rates using group results as the standard. One hospital had significantly better results with 69 predicted but 41 observed deaths (p less than 0.0001). Another hospital had significantly inferior results with 58% more deaths than expected (p less than 0.0001). These differences occurred within specific diagnostic categories, for medical patients alone and for medical and surgical patients combined, and were related more to the interaction and coordination of each hospital's intensive care unit staff than to the unit's administrative structure, amount of specialized treatment used, or the hospital's teaching status. Our findings support the hypothesis that the degree of coordination of intensive care significantly influences its effectiveness.
Disagreement between physicians and nurses regarding patient care is not always a negative factor and often serves to protect patients. How disagreement is handled, however, and whether it is adequately resolved may adversely affect patient care. Physicians and nurses were questioned regarding the nature of their relationship, areas of disagreement related to patient care, and how disagreement gets resolved. Seventy percent of the physicians and 69% of the nurses described relationships as mostly positive. Disagreements were categorized into four areas, with the greatest number relating to the patient's general plan of care. Resolutions of these disagreements were described by 65% of physician and 53% of nurse as competitive in nature. Few examples of joint problem-solving (collaboration) were seen.
THE relationship between the doctor and the nurse is a very special one. There are few professions where the degree of mutual respect and cooperation between co-workers is as intense as that between the doctor and nurse. Superficially, the stereotype of this relationship has been dramatized in many novels and television serials. When, however, it is observed carefully in an interactional framework, the relationship takes on a new dimension and has a special quality which fits a game model. The underlying attitudes which demand that this game be played are unfortunate. These attitudes create serious obstacles in the path of meaningful communications between physicians and nonmedical professional groups.
The physician traditionally and appropriately has total responsibility for making the decisions regarding the management of his patients' treatment. To guide his decisions he considers data gleaned from several sources. He acquires a complete medical history
The aim of this study was to determine whether a series of systematic dialogue sessions among nurses, consumers, and physicians would result in consensus regarding (a) unique areas of nursing practice as differentiated from medical practice and (b) areas of common practice shared by both professions. A stratified sample of 72 nurses, consumers, and physicians met monthly for 20 months in small multidisciplinary groups to discuss areas of health care such as health promotion and maintenance, communication in health relationships, access to medical records, illness self-care, cost considerations, and ethics. Perceived areas of role differentiation between nurse and physician were identified through analysis of (a) verbatim transcripts of the structured dialogue sessions and (b) a subsequent Likert-type inventory completed by all dialogue participants. While no unique nursing domain emerged from the respondents' data, a substantial percent of responsibilities and behaviors were viewed as overlapping areas of practice for nurses and physicians. The data suggested (a) demonstrated health-care arenas where nursings' role is formally acknowledged, (b) lack of clarity within the nursing profession regarding competencies unique to the discipline of nursing, and (c) a continuing public image of nursing as an extender of functions performed by the physician.