Nursing Chapter 4 Homework January February Overview Conflict Dimensions Critical Care Nursing

Chapter 4: Decision Making and Conflict Management

Learning Outcome 1

Define the decision-making process.

Concepts for Lecture

1. Decisions are highly complex conclusions drawn from multiple premises. Decision

2. The analysis is of the premises from which the decision is formulated, not the decision

itself. Two classes of premises make up the basis for decisions in organizations

(sometimes as competing forces):

a. The criterion of efficiency: conserving the scarce resources an organization has at its

3. Finding the best possible outcome results from using critical-thinking skills, or taking

into account multiple changing factors as they relate to an issue. Well thought-out

PowerPoint Slides

1. Decisions

• Highly complex conclusions drawn from multiple premises

Decision making

2. Analysis

• Of the premises from which the decision is formulated, not the decision itself

• Two classes of premises make up the basis for decisions in organizations:

3. Prediction of outcomes

• Well thought-out decisions tend to avoid negative consequences.

• Results from using critical thinking skills.

• Characteristics of skilled critical thinkers:

o Open-minded

o Flexible

Figure 4-1: Illustration of an observed problem with an array of possible causes. In the

center of the figure, the observed problem is stated, and the reader is directed to investigate

possible causes described in the eight spokes that extend out from the center. Each possible

cause forks into two possible responses. The choice of responses at the forks provides

information unique to a situation that provides direction for decision making about

possible solutions to the problem.

Suggestions for Classroom Activities

• Have students examine Figure 4–1 in the text and form groups based on similar

experiences where they share exposure to the same problem events. Clinical groups

Reference

• Simon, H.A. (1976). Administrative behavior: A study of decision making processes in

Learning Outcome 2

List the elements of the decision-making process.

Concepts for Lecture

1. There are several decision-making models, but all essentially share the same steps or

stages: Identify participants, gather pertinent facts, generate alternative decisions, predict

2. When identifying participants charged with formulating a decision, it is necessary to have

adequate representation of all who are going to be directly affected by it. Interest in the

3. Input of pertinent facts should be sought from staff at all levels of experience, because all

contributions influence the outcome of this stage, and ignorance of all factors leads to

4. Generate as many creative alternative decisions as possible, emphasizing quantity, not

quality, giving way to the imagination, and not criticizing any suggestion made. Many

5. When members are satisfied with the list of alternative decisions, the next step is to

6. Selecting the best alternative is important, especially when a group encounters conflicts,

7. Planning for managing consequences involves determining whether negative

PowerPoint Slides

1. The decision-making process

• Basic framework for many decision-making models

• Stages are interdependent.

• As new information becomes available, movement between stages is likely.

• Stages/steps:

o Identify participants.

2. Identifying participants

3. Gathering pertinent facts

• Input should be sought from participants at all levels of experience.

4. Generating alternative decisions

• Use creative-thinking techniques:

o Forced association, think tanks, self-interrogation checklists

5. Predicting outcomes

• For each alternative decision developed

6. Select the best alternative

7. Plan for managing consequences

• Whether negative consequences can be realistically managed

Table 4-1: Techniques for Idea Generation

Table 4-2: Process of Decision Making

Case Study: Charge Nurse Criticizes Nurse’s Decision Making

Suggestions for Classroom Activities

• Have students read Learner Exercise 2 at the end of Chapter 4. Ask students to predict

the outcome for the overall unit of the nurse managers’ decision. Have them examine

the premises on which the decision was made. Following are some probing questions

for them to consider:

(1) Is it likely that the manager’s decision will foster respect of the staff?

Reference

• Hand, E. (2001, June). Tools for the nursing toolbox. Nursing Spectrum, 2(4), 22.

Learning Outcome 3

Analyze the relationship between decision making and leadership.

Concepts for Lecture

1. Decision making requires analysis to find the best outcome from multiple premises, and

involves members of the group as well as a leader. Leadership involves being well versed

PowerPoint Slides

1. Relationship between decision making and leadership

• The decision-making process involves leaders and other workforce members.

Suggestions for Classroom Activities

• Have an in-class discussion on the relationship between decision making and

Learning Outcome 4

Define conflict.

Concepts for Lecture

1. Conflict has a dual nature; it is potentially constructive or destructive. Anger is usually a

response to conflict, which can be both chronic and nonproductive, or situational anger

2. Nurses will encounter conflict that can be intra-psychic (personal), interpersonal, or

intradepartmental, and need to develop understanding and skill in managing them.

a. Personal conflicts: Put an individual in disagreement with work goals. Their

resolution is the responsibility of the individual.

PowerPoint Slides

1. Conflict

• Dual nature; potentially constructive or destructive

• Not all are problematic; some can prevent hindrances to goal attainment

2. Types of conflict

• Personal (intra-psychic)

o Puts individual at odds with work goals.

o Resolution is individual’s responsibility.

• Interpersonal

Suggestions for Classroom Activities

• Create three conflict situations (items that the student can identify with; e.g., time off

Reference

• Kelly, J. (2006 January/February). An Overview of Conflict Dimensions of Critical

Learning Outcome 5

Differentiate conflict management from decision making.

Concepts for Lecture

1. Decision making requires analysis that will lead to the best action among several

predicted outcomes, while conflict management uses decision making along with other

1. Conflict management

• Uses decision making and specific techniques to ideally reach a win–win

outcome.

Suggestions for Classroom Activities

• Decision making and conflict management are very closely allied, with each influencing

the other in a reciprocal way. Poor decisions produce conflicts, and conflict

Learning Outcome 6

Identify categories of potential conflict.

Concepts for Lecture

1. Professional/bureaucratic conflicts result when there is an incompatibility between

2. Nurse–nurse conflicts occur when differing values toward the philosophy of nursing are

3. Nurse–doctor conflicts result from differing expectations of each other in the delivery of

care. The stereotype of physicians’ dominating patient care has submerged nursing until

4. Personal competency gap conflicts occur when nurses’ skill levels interfere with their

5. Competing role conflicts occur when the same person fills the roles of nurse, student,

6. Expressive/instrumental conflicts are the most difficult to manage, and occur when nurses

7. Patient–nurse conflicts result from a difference in the nurse‘s goals and the client’s goals

for care, which can be minimized by maintaining an effective, therapeutic role in client

PowerPoint Slides

1. Professional/bureaucratic conflicts

• Result from an incompatibility between expectations produced by the system and

2. Nurse–nurse conflicts

• Result from differing values toward the philosophy of nursing held by nurses who

3. Nurse–doctor conflicts

• Result from differing expectations of each other in the delivery of care.

4. Personal competency gap conflicts

• Occur when nurses’ skill levels interfere with their own expectations of standards

5. Competing role conflicts

6. Expressive/instrumental conflicts

• Most difficult to manage

7. Patient–nurse conflicts

• Result from a difference in the nurse’s goals and the client’s goals for care.

Case Study: Nurse–Patient Conflict

Case Study: Nurse–Nurse Assistant Conflict

Suggestions for Classroom Activities

• Break students up into pairs or groups, and assign them specific categories of conflict.

Reference

• The International Council of Nurses (INC) Kit 2001, available for purchase online at

www.icn.ch

• Stringer, H. (2001, February). Raging bulls. Nurse Week, 2(2), 10–11.

Learning Outcome 7

Concepts for Lecture

1. Strategies and techniques for managing conflicts are more easily described and

prescribed; they can result in win–win, win–lose, or lose–lose outcomes. All conflicts

differ and require different strategies due to situational factors or strategies giving rise to

legal and ethical problems. Some techniques are:

a. Confrontation: Can be difficult, but its constructive use can be learned; three

prerequisites are necessary to make this approach successful:

(1) Each party must be motivated to resolve the issue.

b. Bargaining: Involves giving something to gain something in return; an arbitrator

is useful in this technique, who must be briefed on both positions; time-

2. Process model of conflict management is composed of four stages:

a. Stage 1: Has four parts, and questions to ask about each part. If it is determined

that the conflict is legitimately non-negotiable by virtue of policy, resources, or

PowerPoint Slides

1. Strategies and techniques in conflict management

• More easily described than prescribed

• Can result in win–win, win–lose, or lose–lose outcomes.

• All conflicts differ, thus requiring different strategies.

• Examples of strategies:

o Confrontation

2. Process model of conflict management

• Stage 1: Has four parts, and questions to ask about each part.

Figure 4-3: Process model of conflict management. Stages occur in a one-way sequence.

The model is adaptable to a variety of situations involving groups, individuals within

groups, or individuals between groups.

Suggestions for Classroom Activities

• As a homework assignment, have students write out a list of the advantages and

Reference

• Sedlacek, J. (1989). Conflict management, University of Kentucky, College of Allied

Learning Outcome 8

Analyze the relationship between leadership and the management of conflict.

Concepts for Lecture

1. Leadership involves the management of conflict, which might be the most challenging

PowerPoint Slides

1. Relationship between leadership and management of conflict

• Leadership involves learning the management of conflict.

Suggestions for Classroom Activities

• Have an in-class discussion about the relationship between leadership and the

GENERAL CHAPTER CONSIDERATIONS

1. Have students study and learn key terms listed at the beginning of the chapter.

2. Have students complete the end-of-chapter exercises either in their book or on the

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