NUR 696 Evidence Based Practice Sarah Koepp Marla

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, RN, NE-BC current Chief Nursing Officer at Avera Mc. Kennan 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 Mc. Kennan 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 Mc. Kennan 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 & Fineout. Overholt, 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 Pub. Med® • 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, 2015 a)

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-Acknowledgement. Reflect/Reframe-Listen (openly)-Ask (questions) • Must engage in Self-care activities (Gerardi, 2015 b; 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: ü TJC: Every hospital should have wide- spread conflict engagement education ü Magnet™: Clear, collaborative way to resolve conflict ü Institute a training program with conflict intelligence reflection ü Education will involve case studies and role play activities ü 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 • Patients • Staff & Leaders Organizational Planning • 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. (2015 a). Conflict engagement: A new model for nurses. American Journal of Nursing, 115(3), 56 -61 Gerardi, D. (2015 b). 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.