Presentation on theme: "Horizontal Violence or Generational Conflict: Is Care-Fronting the Answer Yvonne Wesley, RN, Ph.D., FAAN Independent Health Consultant www.ywesleyconsulting.com."— Presentation transcript:
1 Horizontal Violence or Generational Conflict: Is Care-Fronting the Answer Yvonne Wesley, RN, Ph.D., FAANIndependent Health Consultant
2 OverviewUpon completion of this session, participants will be able to:Define Horizontal Violence and Generational ConflictCompare and contrast HV and GC similarities and differencesIllustrate the effect of Care-Fronting on HV and GC
3 Horizontal Violence Antagonistic behaviors such as: Weinand, M. R. (2010). Horizontal violence in nursing: history, impact, and solution. JOCEPS: The Journal Of Chi Eta Phi Sorority, 54(1),Antagonistic behaviors such as:Gossiping, undue criticism,Innuendo, scapegoating,Undermining, passive aggression,Bickering , blaming behaviorsSabotageEmotional dumping, indiscriminate venting
4 Weinand, M. R. (2010) Why susceptibility among nurses Antagonistic behaviors among oppressed people i.e.: womenNursing predominately womenAntagonistic behaviors, a form of self-hateDemonstrated in the classroom with faculty dominating student nurses.Nurse managers and supervisors cited as frequent users of bullying culture & top down style
5 Weinand, M. R. (2010) End Product from HV Overwhelming sense of negativity cultivatedAggression breeds aggressionLow moraleHigh turnoverIncreased absenceLow productivity
6 vs. identification of problems Weinand, M. R. (2010)Formal training in teamwork, positive feedback, conflict management and confrontationskillsSolutions to the problemEmbrace transformational leadershipInspire and challenge staff;Utilize active listening,Advise and coach staff;Have a positive visionReward resolutionvs. identification of problems
7 King-Jones, M. (2011)King-Jones, M. (2011). Horizontal Violence and the Socialization of New Nurses. Creative Nursing, 17(2),overt and covert nonphysical hostility,criticism, sabotaging, undermining, infighting, scapegoat, and bickeringunkindness, discourtesy, divisiveness, and lack of cohesivenessbelittling gestures, verbal abuse, gossiping, sarcastic comments, faultfinding, devaluing comments,disinterest and discouragement, and controlling behaviors
8 King-Jones, M. (2011) HV stems from oppression HV is how oppressed people cope with powerlessnessHV, a display of powerlessness & negative emotionsKnowledge is power -- a cycle of power and resistanceTo resolve HV, address the dynamics of power and conflict
9 Generational Conflict Hahn, J.A. (2011), Managing Multiple Generations: Scenarios From the Workplace. Nursing Forum, 46(3),Increased numbers of generations working together creates more opportunity for misunderstandingVeterans, [born before 1945]Baby Boomers, [born ]Generation X, [ ]Gen Y/Millennials [ ]
10 Hahn, J.A. (2011) Veterans – before 1945 Baby Boomers – ‘46 to ‘64 Grew up in times of political and economic uncertainty,lived experience of the Great Depression and World War IINursing as a helping profession and unselfishExpect rewards for hard workBaby Boomers – ‘46 to ‘64Strong sense of duty, called workaholicsLived experience of prosperityLook to empowerArrive early to work
11 Hahn, J.A. (2011) Generation X – ’65 to ‘76 Independent, self-directed, and techno-savvyLatchkey kidsGrew-up quicker and stayed adolescents longerQuality of life important their parents work long hours and experienced downsizingMillennium/Gen Y – ’77 to ‘97Technology and instant communicationAccepting multiculturalismAfter-school activities, such as swimming, soccer, danceWant work-life balance
13 CarefrontingKupperschmidt, B. (2006). Addressing multigenerational conflict: mutual respect and carefronting as strategy. Online Journal Of Issues In Nursing, 11(2),Kupperschmidt argues that professional nurses must care enough about their patients, profession, colleagues, and themselves to ‘carefront’ disrespectful behavior
14 Kupperschmidt, B. (2006).Treating each other with respect is a nurse's ethical responsibilityCarefronting, a model of communication used when professional nurses care enough about themselves and their patients to confront disrespectful behavior face-to-face
15 Kupperschmidt, B. (2006)Failure to confront is dishonest communicationCarefronting embodies forgiveness, caring and valuing, while addressing the anger in the disrespectful behavior, and focuses on the here and now
16 Kupperschmidt, B. (2006)The goal is the ability to work together to provide safe patient care in an environment based upon mutual respectKean University GraduatesBivins & Primus Developed the:Perceived Carefronting Ability Questionnaire
17 A newly registered nurse Renee is working alongside Jeanette, a nurse of twenty five years in a busy trauma emergency room. Patient Glendale, a frequent flyer, presents complaining of chest pain radiating to his right arm, his history includes hypertension managed with a beta blocker and drug seeking behavior.Jeanette blurts out, “Back so soon. Ran out of your Percocets in three days did you?” Renee goes to his bedside places him on the cardiac monitor, performs and EKG and tells the physician the patient may be experiencing a heart attack.Jeanette waltzes over, rolls her eyes, sighs and sarcastically says, “This rookie needs to go back over there and complete his history and physical before jumping to conclusions. Embarrassed Renee walks away. Later she seeks out Jeanette and asks to speak to her in a private area.
18 Yvonne Bivins MSN RN Nadia Primus MSN RN Carefronting Techniques based on Kupperschmidt (2006)When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction).Because it portrays me as someone in a rush (what does it look, sound or feel like).Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response)In the future talk to me in private (what behavior you want to see).Are you committed to treating me as respected colleague? (What you want them to do?)If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).
19 Number of Participants Pre-testPost-testBaby Boomer RNs74Generation X RNs178
20 Yvonne Bivins MSN RN Nadia Primus MSN RN A paired t test compared pre and post mean scores of the participants’ perceived ability to utilize Carefrontingpre-test M= , SD=4.15post-test M= 43.08, SD=3.08Highest possible score being 50 and the lowest 10Alpha set at p<0.05There was no significant difference t(11) = -2.17, p = The 95% confidence interval for the mean difference between the two means was to 0.03.
21 Yvonne Bivins MSN RN Nadia Primus MSN RN An independent t test compared Baby Boomer to Gen X mean scores on perceived ability to utilize CarefrontingNo significance difference in the Baby Boomer & Generation X mean scorespre-test t(24) = .992, p = .33post-test t(11) = .154, p = .88
22 Carefronting Techniques based on Kupperschmidt (2006) When you called me a rookie and said I jumped to a conclusion (what was the action). I felt humiliated (your reaction).Because it portrays me as someone in a rush (what does it look, sound or feel like).Was it your intention to embarrass or humiliate me? (repeat what the action was, STOP! wait for a response)In the future talk to me in private (what behavior you want to see).Are you committed to treating me as respected colleague? (What you want them to do?)If there isn’t a change, I will arrange a meeting with the supervisor to discuss your actions (what is the consequence).
23 Take home Message Caring enough to confront may help Carefronting comes from a place of love, not bitterness or hateHorizontal Violence and Generational Conflict are a problem within nursingBoth are highly detrimental to the body of Black nurses