NUR 696 Evidence Based Practice
Sarah Koepp, Marla Michaels, Sandi Thorson, Becky Tomaselli
Conflict Engagement
Education:
Does Self-Assessment
Impact Perceived Ability
to Utilize Skills learned
in Training?
Service and Seminar Project
Meet the Graduate Student Team
Sarah Koepp
Marla Michaels
• Nurse Manager of a General
Medicine Unit at M Health
• Twin Cities, MN
• Ambulatory Charge Nurse in a
pediatric nephrology clinic
• Kansas City, MO
Sandra Thorson
Becky Tomaselli
• Women’s Health; Post-Partum
Unit
• Sioux Falls, SD
• Director of Nurse Practice for a
national specialty pharmacy
• Near Orlando, FL
Service and Seminar Project
Acknowledgments
• Judy Blauwet, , DNP, MPH, BSN, RN former Chief Nursing Officer at
Avera Mckennan Hospital and University Center
• Lori Popkes, MBA, BA, RN, NE-BC current Chief Nursing Officer at
Avera McKennan Hospital and University Center
• Carla Borchardt, DNP, MS, RN, NE-BC Director of Professional Practice
• Courtney Ehlers, MSN, CPN Director of Women’s and Children’s
Division at Avera McKennan Hospital and University Center
• Darcy Sherman Justice, , MS, RN, NE-BC Director, Nursing Integration
•
•
•
•
Jamy Anderson, RN Nurse Manager
Lana Shogren, Administrative Assistant
Cinnie Noble, founder of CINERGY Coaching
Claudia Dietrich, MS, RN, NE-BC, University of Mary Project Advisor
Background Information
• Health ministry of the Benedictine and Presentation Sisters
• Avera McKennan Hospital & University Health Center
• 300+ bed hospital serving eastern South Dakota and
surrounding region
• Mission is to make a positive impact in the lives and health of persons
and communities by providing quality services guided by Christian
values.
• This includes the staff at Avera!
Significance of Problem
• Conflict is normal and present
in every industry.
• Healthcare workers operate in
a chaotic environment
• Conflict affects staff
satisfaction, patient
outcomes, and cost of
services
(Brinkert, 2010; Porter, O’Grady, & Malloch, 2001: Trossman,
2011)
Asking an Answerable Question
P
“The first step in
Evidence Based
Practice is to
formulate the
clinical issue into a
searchable,
answerable
question”
(Melnyk & FineoutOverholt, 2011, p. 27)
Nurses in the Women’s and Children’s Division
I
Conflict Intelligence
C
Intelligence scores pre and post education
O
Increased Intelligence
PICO Question
Do nurses who are surveyed
pre and post educational
intervention perceive having
increased conflict
intelligence?
External Data Search
Databases Searched
• Each team member chose an area to research
• CINAHL®, Google Scholar®, Medline®, and PubMed®
• Chose articles that tried to hit combined key words
• Also searched reference lists of key articles
Topics Searched
• Conflict Engagement/Resolution; Staff Satisfaction;
Patient Safety; Adult Learning Principles; Conflict
Assessment Tools, Educational Modules for Staff
Theme 1
Out with Conflict Resolution; In with
Conflict Engagement
• Switch from Resolution to Engagement in mid 2000’s
• Staff need to “intentionally engage” with focus on
relationships
• Conflict is inevitable in any relationship
• Processes which support conflict engagement
• Create connection and cultivate curiosity
(Gerardi, 2015a)
Theme 2
Conflict Engagement Tied to Patient Safety
• 1988: Donabedian’s Model of Patient Safety
• 1999: IOM’s report To Err is Human: Building a Safer Health
System
• 2008: Rather than confront a safety issue, 40 percent of
healthcare providers have kept quiet or remained passive during
patient care events.
• 2014: Nurses are more comfortable telling doctors about errors
rather than approaching peers
(Donabedian, 1988; Baker, Gustafson, & Beaubien, 2003; The Joint Commission, 2008;
The Advisory Board Company, 2014)
Theme 3
Staff Who are Engaged in Conflict Have Increased
Job Satisfaction
• Nurses want to focus on delivering quality patient care
• Workplace environment strengthened
• Conflict Intelligence- giving and receiving constructive feedback
• Utilize PEARLA: Presence-Empathy-AcknowledgementReflect/Reframe-Listen (openly)-Ask (questions)
• Must engage in Self-care activities
(Gerardi, 2015b; Lux, Hutcheson & Peden, 2013; Trossman, 2011)
Internal Data Search
Internal Staff Surveys
• Employee opinion surveys
• Human resources data
Organizational Conflict Assessment Survey
• Recommended by Joint Commission
• CNO completed modified survey based on
assessment tool created by Scott & Gerardi
(2011)
Recommendations
This project
WILL:
This project
will NOT:
 TJC: Every hospital should have widespread conflict engagement education
 Magnet™: Clear, collaborative way to
resolve conflict
 Institute a training program with
conflict intelligence reflection
 Education will involve case studies and
role play activities
 Explore the link between satisfaction,
safety, and conflict. The evidence is
widely accepted.
Implementation: Building Blocks to Success
Change Theory
• Lewin’s (1951) Theory
• Unfreezing, Moving, Refreezing
Key Stakeholders
Organizational Planning
• Patients
• Staff & Leaders
• Mission, vision, values
• Work closely with contact
Barriers/Drivers of Change
• Adult Learners (barrier)
• Patient Outcomes (driver)
• Magnet™ and TJC (driver)
Project Measurement
• Conflict Intelligence Self Assessment courtesy of
CINERGY®
• 20 questions given pre and post education
• Conflict intelligence assessed in four categories
(Conflict Intelligence Self-Assessment, 2015)
Human Subject Protection
• EBP project not primary
research
• No patients are involved in
this project
• Working closely with Avera
Mckennan ’s IRB committee
• Following recommendations
from UMary IRB
Conclusion & Application
Increases staff
satisfaction &
Outcomes
Magnet and TJC
recommendation
Increase
Conflict
Engagement
Intelligence
Targeted
education
about conflict
engagement
References
Baker, D.P, Gustafson, S., Beaubien, J. (2003, October 20). Medical teamwork and patient safety: The
evidence-based relation. American Institutes for Research.
Brinkert, R. (2010). A literature review of conlict communication causes, costs, benefits and
interventions in nursing. Journal of Nursing Management, 18(2), 145-156.
Conflict Intelligence Self Assessment. (2015). Cinergy…Peacebuilding One Person At a Time. Retrieved
from http://www.cinergycoaching.com/resources/self-assessment-tools/
Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA, 260(12), 1743-1748.
Gerardi, D. (2015a). Conflict engagement: A new model for nurses. American Journal of Nursing, 115(3),
56-61
Gerardi, D. (2015b). Conflict engagement: Creating connection and cultivating curiosity. American
Journal of Nursing, 115(9), 60-65.
Lux, KM, Hutcheson, JB, & Peden, AR. (2014). Ending disruptive behavior: Staff nurse recommendations
to nurse educators. Nurse Education in Practice, 14(1), 37-42.
The Advisory Board Company (Eds.). (2014, October 30). Proceedings from University of Minnesota
Health Instilling Frontline Accountability Best Practices for Enhancing Individual Investment in
Organizational Goals. Edina, MN.
The Joint Commission. (2008, July 9). Sentinal event alert issue 40 behaviors that undermine a culture of
safety. Retrieved from http://www.jointcommission.org/assets/1/18/SEA_40.PDF
Trossman, S. (2011, September-October). The art of engagement: nurses, ANA work to address
conflict. The American Nurse, 43(5), 1, 8.