Evidence-Based Research Project Group Four

1. Evidence-Based Research ProjectGroup Four By: JammieGaleaz, Tammy Hoekwater, Sandra Martini, and Aundrea Robinson-Burris,

2. PICO question: does the functional dynamic of a nursing health care team without conflict versus a nursing health care team with conflict reveal a difference in the nurse's perceptions of their ability to provide quality patient care in an inpatient hospital setting?

3. Three types of conflict TASK rRELATIONSHIP PROCESS

4. Quality indicator For the purpose of this project we measured quality patient care based on mortality rates. There are other factors that could be used to measure quality patient care, but based on the data that we collected the data using this indicator was the most compelling.

5. When Team styles And Philosophies clash: Conflict is created CONFLICT Nursing Team Styles ~Freeman, Miller & Ross, (2000)~

6. CONSEQUENCES OF CONFLICT POSITIVE • “Conflict benefits team functioning if the discussion leads to better treatment of the patient” NEGATIVE Conflict can “harm team functioning because during the debate, team members may be distracted from the immediate needs of the patient and may become emotional which may impair their decision making and performance.” ~Greer, Saygi, Aaldering & Carsten,( 2012)~

7. NURSES’ PERCEPTIONS OF CONFLICT IS OVERALL NEGATIVE “The overall picture emerging from the intragroup conflict literature is that conflicts are generally negative for team outcomes.” “Although benefits of task conflict may exist, achieving such outcomes may be very difficult in practice.” ~Greer, Saygi, Aaldering & Carsten, (2012)~

8. Conflict produces Stress Stress Produces Adverse Patient Outcomes BY INCREASING MORTALITY RATES. (Wheelan, Burchilland Tillen, 2003, p. 532) AND Affects the perception of nurses about their ability to provide Quality patient care. (Spence-Laschinger & Leiter, 2006,)

9. Mortality rates Environments with high levels of conflict Nurses reported that they operated at LOWER levels of group functioning (teamwork) and produced • Higher mortality rates Environments with low levels of conflict Nurses reported that they were at HIGHER levels of group functioning (teamwork) and produced Lower mortality rates ~Wheelan , Burchill and Tillin,( 2003) p532.~

10. Is there a resolution ?

11. FIVE ways to resolve Conflict TO REDUCE STRESS • INTEGRATING/PROBLEM-SOLVING • SMOOTHING/OBLIGING • DOMINANCE • AVOIDANCE • COMPROMISE ~Tabak N, & Orit K. (2007) ~

12. Integrating: “’I try to work it out with the doctor (other party), in order to gain a better and more appropriate understanding of the problem.’ When the controversy is complex, this approach is essential for drawing on the best of the talents and knowledge of both sides…” • Obliging: “’I try to fulfill the doctor’s wishes.’ This approach is appropriate when one side believes they may be in error or that the issue is more important to the other side.” • Dominance: “’I use my expertise to try to get my ideas accepted.’ Compulsion or coercion are applied to ensure that one point of view wins.” Associated with the lowest level of stress outcome. • Avoidance: “’I try to keep my doubts to myself in order to avoid negative emotions.’ This approach is useful when the conflict is trivial or when the potentially damaging effect of confronting the other side is greater than any advantage generated by solving the conflict.” This approach generates the highest stress level for the nurse and greatly reduces job satisfaction. • Compromise: “’I negotiate with the doctor (other party) in order to reach an agreement.’ the nurse looks for a solution that gives (both sides) something of what each wants.” ~Tabak N, & Orit K. (2007) ~

13. Avoidance is not a FEASIBLE solution to conflict Repressing conflicts causes stress to escalate over time and increases the difficulty of its resolution (Greer, Saygi, Aaldering & Carsten, 2012, p. 939).

14. Resolve Conflict Improve Teamwork IMPROVE PATIENT OUTCOMES

15. Recommendations • “Nurses should be made aware of the importance of collaboration and co-operation and be encouraged to learn the most constructive ways to settle conflict.” • “Nursing managers should devote more effort to giving nurses an opportunity to study the topic of conflict and its resolution.” • “Nursing instructors and mentors should provide an opportunity for their students to study and experience organization theory, assertive behavior, problem-solving, conflict resolution, and building good relations with their colleagues.” ~Tabak N, & Orit K. (2007) ~

16. References  Freeman, M., Miller, C., & Ross, N. (2000). The impact of individual philosophies of teamwork on multi-professional practice and the implications for education. Journal Of Interprofessional Care, 14(3), 237-247. Greer, L. L., Saygi, O. Aaldering, H., & de Dreu, C. K. W. (2012). Conflict in medical teams. Medical education, 46, 935 – 942. Kalisch, B., Weaver, S., and Salas E. (2009). What does nursing teamwork look like? A qualitative study. Journal of Nursing Care Quality, 24(4), 298-307. TabakN, & Orit K. (2007). Relationship between how nurses resolve their conflicts with doctors, their stress and job satisfaction. Journal of Nursing Management. 15 (3), 321-331. doi: 10.1111/j.1365-2834.2007.00665.x Wheelan, S., Burchill, C., & Tilin, F. (2003, November). The link between teamwork and patients' outcomes in the intensive care units. Retrieved from American Journal of Critical Care website: http://ajcc.aacnjournals.org/ content/12/6/527.full.pdf.html