Communications in Health Care

Healthcare Core CurriculumCompetency #4: Managing Conflict

Dede Carr, BS, LDAKaren Neu, MSN, CNE, CNP

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ObjectiveDescribe the communication skills that are important when managing conflict

Competency #4-Managing Conflict

“…Peace is not the absence of conflict but the presence of creative alternatives for

responding to conflict—alternative to passive or aggressive responses,

alternatives to violence”Dorothy Thompson

“The inability to share….to communicate – that’s the biggest

problem in the world…that’s how people get themselves in

all these troubles”V. Satir

Quotes

“Consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings, or actions” (Sullivan & Decker, p. 185)

Conflict is common & important part of the change process

Is natural & normal part of lifeDifference between disagreement & conflict: Disagreement is like a “mini” conflict; based on

personal, cultural, logistical, or other differences Some disagreements grow into conflicts, but not all

do Should address disagreements with potential for

conflicts before they actually become conflicts (Carroll, p. 126)

What is conflict?

Neither good or bad Can be either constructive & creative (growth) or destructive (destruction) Natural & normal part of everyday life Can be handled in positive or negative ways

◦ Can be a positive force for personal growth & social change

Some level of conflict in an organization appears desirable, although the optimum level for a specific person or unit at a given time is difficult to determine

(Marquis & Huston, p. 489)

Conflict is….

Internal & external discord that results from differences in ideas, values, or feelings between two or more people (Marquis & Huston, p. 487)

Because people have interpersonal relationships with others having a variety of different values, beliefs, backgrounds, & goals, conflict is an expected outcome

(Marquis & Huston, p. 487)

Conflict is ……..

Personality Preferred communication style Whether a person prefers to engage in

conflict or avoid it Level of tolerance for multiple or

competing perspectives Partly due to inborn & learned traitsTraining Skills Communication skills (Carroll)

Components of How People Handle Conflict

We are all different and have different personalities. Our differences can make a team strong and productive and/or present challenges.

(Team Building Inc.-2010) Ego. One’s ego can be a major cause of conflict. Our ego

wants us to be right and if we aren’t, then we tend to become very defensive. Perhaps the quickest way to diffuse a conflict is to own your own mistakes. (Carroll)

Personality

Some people are: While others are:

Outgoing, talkative, spontaneous Serious, quiet, introspective

Intuitive, shoot for the hip Detailed, evaluate, ponder, and

Feeling and emotional Logical and analytical

Concerned for people Concerned for concepts

Structured, ordered, planned Flexible, go with the flow, unplanned

When trust and faith between individuals has been broken.◦ When one puts faith and trust in another, and

that confidence is broken, it can create an emotional response that elevates to conflict.

◦ When trust has been broken, the strongest emotion is released and that often times leads to conflict

(Team Building Inc)

Causes of Conflict

When a disagreement has been left unresolved, the emotions connected to the issue remain strong and intact.◦ An unresolved disagreement is often times put

in the “closet,” but the emotions remain and these emotions may show their face at the next disagreement. Because the emotions have remained, during the next conflict these emotions are often times greater than need be.

(Team Building Inc)

Causes of Conflict

Poor communication that can lead unclear expectations.◦ Have you ever given clear instructions to a

person only to have those instructions misinterpreted?

◦ Perhaps you have given directions to someone and they still did not comprehend the message.

◦ That can lead to frustration, which can be a major source of conflict (McNamara, n.d.)

Causes of Conflict

What is Conflict in Workplace? Healthcare brings people of different ages,

genders, income levels, lifestyles, ethnic groups, educational levels, & professions together for the purpose of restoring or maintaining people’s health.

Differences of opinion over how to best accomplish goals are a normal part of working with people of various skill levels & backgrounds.

Workplace itself, can be a generator of conflict

(Marquis & Huston, pp. 490-491)

Competition between groups Increased workload Multiple role demands Threats to professional identity & territory Threats to safety & security Scarce resources Cultural differences Invasion of personal space

(Whitehead, Weiss, & Tappen, p. 100)

Causes of Conflict in Workplace

Competition between groups: Disagreements or tension between over professional territory (may be between physicians & nurses)

Increased workload: Emphasis on cost reduction & increased pressure to get as much work as possible out of each employee, sometimes more than employee can realistically do (staff shortages)

Multiple role demands: Inappropriate task assignments (asking nurses to mop floor & care for clients too)-often for cost control efforts, but may lead to disagreements about who does what task & who is responsible for outcomes (Whitehead, Weiss, & Tappen, p. 100)

Causes of Conflict in Workplace

Threats to Safety & Security: When roles are blurred, cost saving is emphasized, & staff members face layoffs; Peoples economic security is threatened

Scarce Resources: Inadequate money for pay raises, equipment & supplies, or additional help can increase competition between departments & individuals as they scramble to grab their share of the little there is to distribute

(Whitehead, Weiss, & Tappen, p. 100)

Causes of Conflict in Workplace

Causes of Conflict in Workplace Cultural Differences: Different beliefs

about how hard a person should work, what constitutes productivity, & even what it means to arrive at work “on time”

Invasion of Personal Space: Crowded conditions & constant interactions that occur at a busy nurses’ station can increase interpersonal tension & lead to battles over scarce workplace/workspace

(Whitehead, Weiss, & Tappen,

p. 100)

There are five dimensions of conflict that are helpful in conflict resolution and management. These are important questions to ask oneself when dealing with situations and one or more persons, groups, teams, units or departments and organizations.

There are various types of conflict, factors that may influence the development of conflict, resolution strategies, and outcomes or results.

Remember as a person, respect of self and others, personal attitude, and communication are key to one’s role in a situation or event, in conflict development, resolution, and outcomes. This is true no matter what the situation is, who is involved, and what strategy is used to resolve it.

See the following slides for explanations of the dimensions, influencing factors, and conflict resolution strategies.

Notes & Explanations of Slides

Qualitative Nature: Person can be totally overwhelmed in one conflict situation, yet handle several simultaneous conflicts at a later time

Difference is in quality or significance of that conflict to the person experiencing it

Although quantitative or qualitative conflicts produce distress at the time they occur, they can lead to growth, energy, & creativity by generating new ideas & solutions

(Marquis & Huston, p. 487)

If handled inappropriately, quantitative or qualitative conflicts can lead to demoralization, decreased motivation, & lowered productivity

(Marquis & Huston, pp. 489-490)

Conflict

1. Who or how many parties are involved?2. What are the sources of conflict? What is it over?3. Relationship between/among conflicting parties?

The type of relationship that exists between conflicting parties will determine the intensity of the conflict.

4. How long has the conflict been in existence? If the conflict has been lasting over a long period of time, it may be more difficult to resolve.

5. The Process: How do we choose to deal with the conflict?

(Mertz & Lieber)

Five Dimensions of Conflict

Who or how many parties (categories of Conflict) are involved?

Internal – Is the conflict within oneself? I value supporting the corner grocery store but because their prices too higher, I am going to shop at a big box store.

Interpersonal-Conflict between 2 or more individuals Ex: Your boss schedules you to work 3 week-ends in a row and that is not acceptable to youIntragroup-Conflict within a group. A group defined as

3 or more people who share a specific role or identity Ex: Conflict among nursing assistants on clients’ care

teamIntergroup-Conflict between 2 or more groups. Ex: Housekeeping department & dietary department

(Mertz & Lieber)

Conflict Dimension #1

Categories of Conflict

Interpersonal

Intrapersonal

Intergroup

(Marquis & Huston)

Intrapersonal: Disturbance or conflict within a single

individual Internal struggles to clarify contradictory

values or wants Example: An employee can experience internal

conflict about whether to stay in current position, which he likes, or to move to another higher-level position which has a much higher pay rate, but less flexible hours

Be self-aware & conscientiously work to resolve intrapersonal conflict when first felt—essential to one’s physical & mental health

(Marquis & Huston, pp. 490-491)

Intrapersonal Conflict

Occurs between people, groups, or work teams May involve disagreement about values or

philosophy Often due to differing or incompatible personalities

or work styles Example: New hired employee begins to press for

changing a documentation system based on previous experience; employees who are used to & comfortable with present system do not see sufficient reason to change

(Marquis & Huston, pp. 490-491)

Interpersonal Conflict

Interpersonal: “Horizontal violence” or “bullying” between two or more people with differing values, goals, & beliefs

Significant issue confronting healthcare profession (nurses & new graduates)

If conflict not reported or managed, consequences are absenteeism & turnover (Marquis & Huston, pp. 490-491)

Interpersonal Conflict

Intra-group: Conflict within a group. A group can be defined as 3 or more people who share a specific role or identity

Intergroup: Conflict occurs between two or more groups of people, departments, or organizations

Example: Healthcare workers experience intergroup conflict with family & work issues◦ Healthcare workers experience more work interference

with family than conflict caused by family interfering with work

◦ Two political affiliations with widely differing or contradictory beliefs (Marquis & Huston, pp. 489-490)

Intergroup Conflict

What are the sources of conflict? What is it over? Resources-Are the people, or the groups, in conflict

over more staff assistance on a unit, equipment & supplies, [who has right to sources?]

Values-Conflict over beliefs, choices & perspectives, & preferences; “What is important?” Occurs when people or groups differ over beliefs, culture, cultural practices, etc. Differing views for tasks or goals for providing care that clients may reach positive outcomes

Psychological Needs-Conflict over power & control & emotional needs; This source of conflict deals with a person(s) need for love, respect, safety, affirmation, approval, friendship, power of one’s own fate

(Mertz & Lieber)

Conflict Dimension #2

Relationship between/among conflicting parties. Type of relationship that exists between conflicting parties will determine the intensity of the conflict & the outcome.

Know one another-How long have the parties involved in the conflict known each another? Does the relationship matter? Does the relationship matter to both or one of them? How much?

Climate-Do you trust or are you suspicious of the person that you are in conflict with? Is the relationship emotionally tense or calm, friendly or hostile, or open or resistant? Is one group friendly with the other group or are they hostile towards one another?

Power-Do parties come to the conflict with equal power or a power imbalance? Does any one party control the resources & decision–making process? (Mertz & Lieber)

Conflict Dimension #3

What is the degree of interdependence between the conflicting parties? (In other words, do the actions of one person or group seriously impact the others involved in the conflict?)◦ How often do the parties see or interact with one

another?◦ Is a positive relationship valued equally by both

parties?◦ Does each party need the cooperation of the other to

achieve important goals? How well do the parties know one another?

◦ Does it matter if conflicting parties come from different cultures and know little about the other? (Mertz & Lieber)

Conflict Dimension #3

How long has the conflict been in existence? Conflict lasting over a long period of time may be more difficult to resolve.◦ Length-How long has the conflict continued? Are the

parties that first started the conflict still involved?◦ Intensity-How emotional is the conflict? Could the

conflict end in a loss of a job, a marriage?◦ Frequency-How often has the conflict reemerged? Are

there times conflict has escalated to severe levels? Did conflict develop in stages?

◦ Perception-Do all the people involved in the conflict see it as a conflict? Is the conflict seen as serious or irrelevant?(Mertz & Lieber)

Conflict Dimension #4

The Process: How do we choose to deal with the conflict? In every conflict, all parties involved make choices to take some

action they think will help them get what they want & need. Choices may be spontaneous or calculated, constructive or

destructive. Conflicts can develop in stages & consequently may involve

many different responses as the conflict proceeds. ◦ Avoidance-Perhaps you choose to deny the conflict, ignore it, or back off.◦ Diffuse-Postpone the conflict, wait.

Engage-Get involved in the conflict, work through & resolve the conflict.◦ Direct Force or Competition◦ Accommodation – to adapt or adjust◦ Compromise◦ Use Collaborative Problem-Solving

(Mertz & Lieber)

Conflict Dimension #5

No Conflict Latent Conflict Perceived Conflict Felt Conflict Manifest Conflict Conflict Aftermath(Marquis & Huston, p. 492)

Stages of Conflict Resolution

Latent conflict or "unstable peace," Implies existence of antecedent conditions Conditions are ripe for conflict although no conflict

has actually occurred & none may ever occur Exists whenever individuals, groups, organizations,

or nations have differences that bother one or the other, but those differences are not great enough to cause one side to act to alter the situation

Differential power, resources, differing interests or values all have the potential to spark conflict if a triggering event occurs (Brahm)

1st Stage of Conflict Resolution

Perceived Conflict or Substantive Conflict Intellectualized & often involves issues and

roles Indicates cognitive awareness of stressful

situation Exists when there is a cognitive awareness on

the part of at least one party that events have occurred or that conditions exist favorable to creating overt conflict.

Groups recognizes that a conflict is emerging and start to look for possible explanation

Conflict can be resolved before it is internalized at this stage (Marquis & Huston, p. 492)

2nd Stage of Conflict Process

Felt Conflict or Affective Conflict: Occurs when conflict is emotionalized Presence of affective states such as stress, tensions,

anxiety, anger, hostility, fear, mistrust Organization, groups or individual become more

internally cohesive. Other groups in the organization are viewed with suspicion as outsider. “Us versus them” mentality begins to really take hold

Example: Person perceives conflict & does not feel it (No emotion attached to conflict, but person views it only as a problem to be solved) or

Person may feel conflict, but not perceive the problem (Person is unable to identify cause of felt conflict)

(Marquis & Huston, p. 492)

3rd Stage of Conflict Resolution

Manifest conflict or Overt Conflict: Action is taken & behavior results from the above three stages

Action may be to withdraw, compete, debate, or seek conflict resolution

Conflicting parties are actively engaging in conflict behavior which is usually very apparent to non-involved parties;

Feelings of conflict are now translated into actions & words which could either be constructive or obstructive to problem solving process (Marquis & Huston, p. 492)

4th Stage of Conflict Resolution

Conflict Aftermath Either positive or negative If conflict well-managed: involved people

believe that their position was given a fair hearing

If conflict poorly managed: Conflict issues remain & return later to cause further conflict

(Marquis & Huston, p. 492)

5th Stage of Conflict Resolution

Individuals are uncomfortable with or reluctant to address conflict for many reasons

Fear of retaliation Fear of ridicule Fear of alienating others Sense that one does not have a right to speak up Past negative experiences with conflict situations

People learn patterns of dealing with manifest conflict early in their lives & family background, & experiences often directly affect how conflict is dealt within adulthood (Marquis & Huston, p. 492)

Reluctance to Conflict Resolution

Generational Differences: Older people may have had more experience with handling conflicts or may have a particular strategy for dealing with them; there may also be power & cultural issues that may play a role in the generational differences

Gender Differences: Men more aggressive; women apt to try to avoid conflict

Power: Single power concept of dominance with victory of one side over another

Culture: “Nurses & other healthcare workers with diverse cultural backgrounds bring to the workplace different conflict behaviors that directly impact the outcomes of conflicts”

Action an individual takes to resolve conflict is often influenced by culture, age power position, & up-bringing (Marquis & Huston, p. 492)

Influences on Conflict Resolution

Now that you know about many factors that may influence conflicts, the next slides will present some conflict resolution outcomes and strategies.

Strategies are not necessarily good or bad; however, there are advantages and disadvantages for each and the one selected depends on the parties involved, the situation, and the resources to resolve the issue, which includes time.

As you read and study the slides, think of a time you have seen the strategies in action. Consider the outcomes. Was the strategy effective or ineffective and why?

Notes & Explanations

Win–Win

Win–Lose

Lose–Lose

(Marquis & Huston, p. 492)

Conflict Resolution Outcomes

The optimal goal in resolving conflict is creating a win–win solution for all involved

Win-Win Conflict Resolution

Winning & losing are goals for games, not for conflicts

Win-Lose Conflict Outcome

Avoiding Compromising Competing Accommodating Collaborating Confronting Negotiating

Common Conflict Resolution Strategies

Parties involved are aware of conflict, but choose not to acknowledge it or attempt to resolve it

May be indicated in trivial disagreements, when:◦ Cost of dealing with conflict exceeds benefits of

solving it, ◦ Problem should be resolved by people other than

you, ◦ One party is more powerful than the other, or ◦ Problem will resolve itself

(Marquis & Huston, p. 492)

Avoiding Approach in Conflicts

Each party gives up something, as well as gets something Method used when both sides have a reasonable,

important goal & losing is not required Advantages Effective for interpersonal conflicts Produces an “everybody” wins something scenario Efficient method when issues have higher importance &

there is limited time for resolutionDisadvantages Winning & losing exchanges are seen unfair & providing an

advantage to one side Conflict may resume if one side perceives that what it gave

up was more important than benefit received May not be as effective if one party is inherently less

powerful than other (Carroll, p. 129)

Compromising Approach to Conflicts

Method in which one side wins & other loses Sometimes called “forcing” – winner forces loser to

accept his/her perspective on the conflictAdvantages Useful if issue is critical or limited time to resolve issue Can help to move critical, but unpopular decision

quickly through organizationDisadvantages Losers tend to resent losing Anger & resentment increases Losing side of agreement may be less willing to engage

in future conflicts or disagreements & may regularly adopt a withdrawing or avoiding style (Carroll, p. 129)

Competing Approach to Conflicts

Conflict resolution method called “smoothing” or “cooperating” is used when a person ignores his/her own feelings about an issue in order to agree with (accommodate) the other side

Advantages: If issue minor, accommodating allows parties to move to issues of more importance

One side accommodating on one issue can make other side willing to accommodate on another issue

Disadvantages Can become power struggle: one trying to get other to give in More conflict rather than less can ensue if parties disagree

about importance of issues being accommodated Parties that consistently ignore feelings can wind up feeling

frustrated or used & maybe less willing to cooperate in future(Carroll, p. 128-129)

Accomm0dating Approach

Method: Both sides in conflict work to develop outcome that’s best for both sides

Emphasis on creative problem solving that meets each side’s key goals

Advantages Seeks a permanent solution that achieves goals & objectives Creative & allows parties to develop new solutions, rather

than trading win/loss optionsDisadvantages May requires significant resources, especially time Requires all parties commitment to success, possibly leaving

process open to interference by parties who do not want a resolution to conflict

All parties must have significant creative, critical thinking, &problem-solving skills (Carroll, p. 129)

Collaborating Approach to Conflicts

Method attempts to block conflict from start Very powerful method brings parties together,

clarifies issues & achieves outcomesAdvantages Prevents conflict from ever really developing Powerful & decisive; no ambiguityDisadvantages Can make minor conflict seem much more

important than it is Does not allow positive aspects of conflict to

develop Can create an organizational climate of conflict

intolerance (Carroll, p. 130)

Confronting Approach to Conflicts

Method –extension of compromise, with higher stakes & more deliberate techniques to bargain for each side’s give & take

Whether Win-Win, Win-Lose, or neutral (split the difference) situation depends on how much of a relationship parties wish to continue after negotiations are finished(Carroll, pp. 129-130)

Negotiating Approach to Conflicts

Advantage Useful for high stakes issues Solution usually seen as formal & more permanent than

compromise Does not require consensuses Conflicts tend to reoccur once negotiations are finishedDisadvantages Getting an agreement can be lengthy & involved Negotiations often seen as permanent, can be a

problem if one side decides they are unsatisfied with results

Results may be less satisfactory if one side feels it has to give up too much to negotiate for what it wins

(Carroll, pp. 129-130)

Negotiating Approach to Conflicts

Communication is no different than other areas of our lives.

In order to be successful in communicating with one another we must practice communicating.

Our needs must be met during the communication process in order for the process to be successful

Needs1. Respect-treat people with respect2. To be listened to3. To be understood4. To be loved & accepted5. To be taken seriously6. To move toward resolution

Communication in Conflict Management

Respect: Put energy in being present for loved ones instead of being distracted by difficulties with other

The capacity to recognize & respond to the things that matter to the other person

Calm, non-defensive, & respectful reactions A readiness to forgive & forget, & to move past

the conflict without holding resentments or anger The ability to seek compromise & avoid punishing A belief that facing conflict head on is the best

thing for both sides (Segal & Smith)

Conflict Management: Respect

Nonverbal communication plays a big role in conflict resolution 

The most important information exchanged during conflicts & arguments is often communicated nonverbally.

Nonverbal communication is conveyed by emotionally-driven facial expressions, posture, gesture, pace, tone & intensity of voice.

The most important communication is wordless (McNamara, n.d.)

Conflict Management Communication

Nonverbal communication cues can play five roles: Repetition: they can repeat the message the person is

making verbally Contradiction: they can contradict a message the

individual is trying to convey Substitution: they can substitute for a verbal message.

For example, a person's eyes can often convey a far more vivid message than words and often do

Complementing: they may add to or complement a verbal message. A boss who pats a person on the back in addition to giving praise can increase the impact of the message

Accenting: they may accent or underline a verbal message. Pounding the table, for example, can underline a message

(McNamara, n.d.)

Nonverbal Communication

Tips for managing and resolving conflict : Managing & resolving conflict requires ability to quickly reduce stress & bring one’s emotions into balance. One can ensure that the process is as positive as possible by sticking to the following conflict resolution guidelines:

Listen for what is felt as well as said. When we listen we connect more deeply to our own needs & emotions, & to those of other people. Listening in this way also strengthens us, informs us, & makes it easier for others to hear us (Segal & Smith)

Conflict Management

Make conflict resolution the priority rather than winning or "being Right".  Maintaining & strengthening the relationship, rather than “winning” the argument, should always be your first priority. Be respectful of the other person & his/her viewpoint.

Focus on the present. If you’re holding on to old hurts & resentments, your ability to see the reality of the current situation will be impaired. Rather than looking to the past & assigning blame, focus on what you can do in the here-and-now to solve the problem

(Segal & Smith)

Conflict Management

Pick your battles. Conflicts can be draining, so it’s important to consider whether the issue is really worthy of your time & energy. Maybe you don't want to surrender a parking space if you’ve been circling for 15 minutes. But if there are dozens of spots, arguing over a single space isn’t worth it.

Be willing to forgive. Resolving conflict is impossible if you’re unwilling or unable to forgive. Resolution lies in releasing the urge to punish, which can never compensate for our losses and only adds to our injury by further depleting and draining our lives.

(Segal & Smith)

Conflict Management

Manage stress quickly while remaining alert and calm. By staying calm, you can accurately read & interpret verbal & nonverbal communication.

Know when to let something go. If you can’t come to an agreement, agree to disagree. It takes two people to keep an argument going. If a conflict is going nowhere, you can choose to disengage & move on. (Segal & Smith)

Conflict Management

Control your emotions and behavior. When you’re in control of your emotions, you can communicate your needs without threatening, frightening, or punishing others.

Pay attention to the feelings being expressed as well as the spoken words of others.

Be aware of and respectful of differences. By avoiding disrespectful words & actions, you can resolve the problem faster (Segal & Smith)

Conflict Management

The following slides are a presentation of communication styles one of most important factors in conflict management (communication).

In health care, assertive communication is frequently used and is most effective, however all styles are present. We all have used the styles presented at one time or another.

Note the various styles and think about the ones you use most frequently.

The following slides describe the communication styles and provide some examples. Think of some examples of each as you study the style.

Notes & Explanations of Slides

Different Communication Styles1.Assertive2.Passive/Nonassertive or Submissive3.Aggressive4.Passive-Aggressive

Communication in Conflict

Promotes client safety by minimizing miscommunication with healthcare team

People who use assertive communication are: Honest, direct, & appropriate while being open to ideas & respecting rights of others

Characteristic is use of “I” rather than “you” statements “You” statements-blame & put listener into defensive

position “I” statements encourage discussion Nurse: “I am

concerned about….” to physician will gain attention of Dr. for benefit of client. Important that Nurse be clear, concise, organized, & fully informed when verbally presenting client concerns (Berman et al., p. 482)

Assertive Communication

Includes standing up for your rights without infringing on the rights of others.

Assertive behavior results in an "I win; you win" outcome.

Assertion involves expressing beliefs, feelings & preferences in a way which is direct, honest, appropriate & shows a high degree of respect for yourself & for others.

"When you talk, I can't hear the movie. Please keep it down."

"I really like it when you wear that shirt. You look great!" Assertiveness Script: "When you __(behavior)__ , I feel/ I

think ________ ; So, I would like __(new behavior)____ .“ (Johnston)

Assertive Communication

You typically get off from work at 4:30PM. One day your boss comes up to you at

3:30PM and says, “Oh, by the way, you need to stay at work today until 6:00PM.”

You have other activities planned to do after work, so staying late is an imposition.

What would be different ways you could respond to your boss?

Practice using some assertive communication.

Situation

With this style, people allow their rights to be violated by others; give up their own rights (directly or indirectly) & defer to the rights of another person

Meet the demands & requests of others without regard to their own feelings & needs as they believe their own feelings are unimportant

"I lose; you win" outcome; Usually avoid confrontation

(Berman et al., p. 482)

Submissive or Passive/Nonassertive

Violates one’s own rights through inaction or by failing to express one’s thoughts, feelings or desires

Some experts believe that people who use this style are insecure & try to maintain their self-esteem by avoiding conflict (avoiding negative criticism & disagreement from others)

(Berman et al., p. 482)

Example: "We can do whatever you want. Your ideas are probably better."

Submissive or Passive/Nonassertive

Person strongly asserts legitimate rights & opinions with little regard or respect for others ideas or opinions

Often perceived as personal attack by other person because aggressive communication humiliates, dominates, controls, or embarrasses other person

By lowering other person’s self-esteem, aggressive person may feel superior which helps to increase his/her self-esteem

Can take several forms: screaming, sarcasm, rudeness, belittling jokes, & personal insults

"I win; you lose" outcome; Overbearing, demanding, competitive, & forceful

Example: "Hey, I'm in a hurry. Get out of my way." (Berman et al., pp. 482-483)

Aggressive Communication

Passive-aggressive behavior is a pattern of expressing negative feelings in an indirect way — instead of openly addressing them

Appear to agree with the requests of others; may seem enthusiastic about them, but they don't perform a requested action on time or in a useful way, and may even work against it.

Use nonverbal behavior to express anger or resentment that they can't express verbally.

An indirect attempt to control or punish others

(Hall-Flavin)

Passive-Aggressive Commumication

Example - You say: “Oh, OK, I’ll stay. I need to change a lot of plans and people

will probably be really mad at me, but that’s OK - don’t worry about me. I guess what I had planned isn’t that important. I don’t mind - really (deep sigh). I hope my friends will still talk with me after canceling at the last minute.”

Example: "I’m sorry I'm so late. I didn’t realize this was such a big deal."

Example: "Oh, don’t bother, I'll just have to do it myself."

Example: Showing up very late to a meeting that one didn't really want to attend and then making up excuses for the lateness that deflects attention from the real reason one was late (Hall-Flavin)

Passive-Aggressive Communication

Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Communicating. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp. 459-85). Upper Saddle River, NJ: Prentice Hall

Brahm, E. (2003, September). Latent conflict stage. Retrieved from http://www.beyondintractability.org/essay/latent_conflict/

Carroll, P. (2006). Nursing leadership and management: A practical guide. Clifton Park, NY: Thompson Delmar Learning

Hall-Flavin, D.K. (2009, April 8). Signs & symptoms of passive-aggressive behavior. Retrieved from http://www.mayoclinic.com/health/passive-aggressive-behavior/AN01563

Marquis, B.L. & Huston, C.J. (2009). Managing conflict. In B.L. Marquis & C.J. Huston (Eds.). Leadership roles and management functions in nursing: Theory and application (6th ed.) (pp. 487-512). Philadelphia, PA: Wolters Kluwer-Lippincott Williams & Wilkins

References

Mertz,G. & Lieber, C.M. (2004). Education for social responsibility: Five dimensions of conflict. Retrieved from http://www.sd70.bc.ca/_SocialResp/resources/Misc.%20SR%20Lessons%20-%20high%20school/ESR_Five_Dimensions.pdf

Segal, J. & Smith, M. (2010, November). Tips for managing and resolving conflicts. Retrieved from http://helpguide.org/mental/eq8_conflict_resolution.htm

Sullivan, E.J. & Decker, P.J. (2001). Effective leadership and management in nursing: Theory applied (5th ed.). Upper Saddle River, NJ: Prentice Hall

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