Vicki Notes

• There have been major political and socioeconomic changes in health care management.
• One change, related to health care reform and nursing, is examining increasing the quality of care and delivering care faster with less nursing staff.
• For you, as a nurse, to work with groups of people, you must have a basic knowledge of group dynamics and cultural diversity.
• As a nurse, you may lead a focus group, quality improvement team and so on.

• Group dynamics, is actually a field of study that explains how people interact and build unity.
• A group - refers to a collection of people who are attached to one another and held together by forces.
• There are three essential dynamics of the group process:
• Group membership
• Social reality
• And group development
• These all shape attitudes & behaviors of group members
• A group's progression and direction are shaped by members having a common purpose, commitment and identifying with group members.
• The norms of a group help guide an individual in developing a social reality.
• Norms - are pre-existing standards for behavior i.e. personality, attitudes, beliefs, communication patterns & motivation levels.
• When a group meets for the first time , members tend to observe the behavior of others to determine what behaviors will likely be perceived as appropriate.
• In a group, what is being said is referred to as content. And what is being expressed is referred to as the process.
• Groups develops through six stages:
• Orientation
• Forming
• Storming
• Norming
• Performing
• Termination
• Orientation - 1^st stage - In a directive style the group receives an outline of their purpose, goals, rules, responsibilities and each members schedule.
• Forming - 2^nd stage - Here group members are learning about each other through verbal and nonverbal communication. A plan develops with group focus on the problem. The leader is directive, tries to facilitate trust and openness, participation and creativity. Different views, ideas, opinions and thoughts are encouraged.
• Storming - 3^rd stage - Members begin to trust and become cohesive. Leader is less directive but refocuses the group and starts to assign tasks to each member. There is concern, criticism, confrontation and conflict in this phase.
• Norming - 4^th stage - Here there is cohesion, commitment and cooperation, and trusting relationships have been established. The leader is less directive & more supportive. Problem solving starts to result in recommendations.
• Performing - 5^th stage -In this stage there is challenge, consideration, creativity & consciousness. Members are active & accept their roles & responsibilities. The leader starts to function as another group member but still praises. Members begin to accept a leadership role. Elements of leadership, such as authority, influence & power become more evenly distributed among group members. Group members become empowered when they participate in the decision-making process.
• Termination - 6^th stage - Here there is consensus, compromise, communication & closure. Members evaluate goals & objectives of the completed tasks or activities & suggest improvements. Closure may be celebrated with a party or ceremony.

• A person who is not in a position of authority, who is outranked and is new to the organization, can still be a leader.
• Managing or Leading - refers to a person's ability to successfully lead a group of people.
• Organizations have realized that more leading characteristics are needed to be more competitive in the work world.
• Success of an organization or the individual person (nurse) can be examined and fostered through mentoring other nurses in reaching a professional or personal goal (i.e. furthering their education or obtaining certifications in specialized procedures or areas of nursing), in attaining a leadership role (i.e. charge nurse or supervisor) or being rewarded in performance (recognition or raises).
• The nurse leader provides an atmosphere that allows open communication among group members.
• What are the characteristics that may affect attitudes and behavior's of the group members?
• Group size, gender composition, race, ethnicity and age
• Cohesion - refers to the degree of attraction and motivation to stay in the group.
• Commitment - refers to a person's feelings and how they identify and are attached to the group's goals or activities.
• The following are effective technique in group process leadership:
• Use open-ended questions to start discussions.
• Encourage all members to ask questions.
• Respond with a positive comment or summary each time a member makes a contribution.
• Give your full attention to each person's contribution.
• Refrain from negative comments about member's contributions.
• Don't take sides, instead summarize opinion differences. State that issues can be viewed from different perspectives.
• Seek equal input from all members.
• ACTIVELY LISTEN to all members.
• Focus discussion on the purpose of the group.
• Check perceptions of the group.
• Convey the meaning of what a team member has said so that all members can understand.
• Clarify statements. Sort out the confusing and conflicting.
• Restate and summarize major ideas and feelings. Summarize points of opinion differences among team members.
• Encourage open expression of member's feelings and thoughts.
• Avoid frequent questioning. Too many questions at one time are annoying.
• Confirm members' ideas, emphasize the facts and encourage further discussion.

• By the year 2000, one in every three Americans will be a member of a non-white ethnic group.

• Culture - refers to a pattern of values and beliefs reflected in outer behavior.
• Diversity - refers to our differences in perspectives, values, and abilities based upon many variables, including gender, age, lifestyles, handicaps, sexual preference, and culture.
• Culture Diversity - then refers to a person's perspective of others based on their own values and beliefs
• Issues concerning cultural diversity include one's values, beliefs, behaviors, perspective and abilities. (This is part of us being unique human beings).
• We learn at a very early age the values and the behaviors that shape our future thinking and interactions with others. These values and behaviors stem from birthplace, including the region of the country and town we were raised in, personality make-up, family values, socioeconomic status, religious affiliation, race, and gender.

• In the workplace, bias leads to breakdowns in communications, greater chances for making error's, and increased complaints from staff concerning job satisfaction.
• Actions for nurse leaders to promote a harmonious work environment include:
• Openly acknowledge and discuss diversity issues.
• Be educated concerning different cultures.
• Promote educational programs for individuals from all cultures.
• Create a socially comfortable environment for culturally diverse staff members so they can experience the uniqueness of each other.
• Allow for cross-cultural representation in unit activities.
• Promote equal growth opportunities.
• Strive to eliminate prejudice, biases, and stereotyping.
• Monitor standards and norms to assure achievability.
• Reward those who successfully manage diversity.
• Openly discuss conflict with group members.

• Unmanaged diversity can be harmful to an organization and can occur at any level. Society demand that people cooperate with each other. Pathological issues such as racism and sexism undermine the effectiveness of the organization.
• Unmanaged diversity can occur on many levels:
• Occurring on an individual level (Ex: Verbal abuse of nurse by doctor or nurse's pushed to inappropriately obey doctor orders - Conflicts that compromise patient care or result in increased errors. Ex: Nurses mistreating other nurses - Due to low self-esteem they lash out at one another. Ex: Gender related, as in male nurses - male nurses are 4 times more likely to have substance abuse complaints brought against them to their state BON.
• On an Intragroup level (within the same group) - conflict occurs when aggressive leaders enforce uniformity and punish those who do not conform to the group's norms. This irrational thinking discourages individual thinking, which only causes increased conflict within the group and between other groups.
• Intergroup conflict (between other groups) - can be positive or cause fear, resentment, irrationality and distrust, resulting in poor cooperation and problem-solving.

• Managing diversity is a long-term process and occurs in three phases - awareness building, discrimination control and prejudice reduction.
• Awareness building - 1^st phase - Begins with top management providing personnel with a mission or goal statement that addresses diversity. It also includes the development and implementation of a culture audit using a combination of research efforts (i.e. focus groups, survey's and interviews with target personnel interested in exploring a specific diversity issues.
• Discrimination control - 2^nd phase - Is a responsibility of nurse leaders and all levels of management. Discrimination (mistreatment of people based on factors that are irrelevant) and prejudice (inaccurate perception of others) are sensitive and threatening subjects. We have all either been the target or perpetrator of these at some time or another. And we all tend to hold inaccurate perceptions of some other people - these perceptions result in dispersing blame (some type of mistreatment). Another component is reverse discrimination - which refers to laws or policies that may be considered as discriminatory by certain people of certain ethnicity, gender, race or handicap. (Ex: selecting a person of a particular gender over another gender, or a person from a particular ethnic group over someone who may have better credentials or education).
• Prejudice reduction - 3^rd phase - is more difficult to manage than the first two phases because it is abstract, internal and perceptual. When racist comments are discouraged, fewer comments are made. Reduction may be accomplished by those who complain and those who are truly concerned and sensitive to resolving culturally diverse issues.

• The following model is designed to assist nurses in assessing states of conflict and selecting a type of resolution for those under your management.
• There are four basic parts (or transformations) to this model that occur before a personnel (employee) dispute enters the legal system. The four are as follows and occur in this order:
• UNPIE to PIE - UNPIE, an unperceived injurious experience turns into a PIE, a perceived injurious experience (simply put, an incident occurs and at that time the you [the employee] may not perceive it as injury and on further thought begin to see it as an injury). Of course, how you perceive (or view, or react) to this is influenced by your age, experience, gender, personality traits, socioeconomic status and job satisfaction. Legal action is less likely to occur if the employee perceives the organization as caring.
• Naming - Here the specific grievance is described and named.
• Blaming/Attribution - Here employee's either blame themselves or others for injury. Blaming oneself may end the process. Blaming others may result in Claiming. Social position, cultural commitment and perception of prejudices.
• Claiming - If the claim is rejected, then it becomes a legal or labor dispute. Communication issues, insensitivity, and ignorance of each other's motivations can hinder progress toward conflict resolution. Nurse leaders must learn to interpret racial feelings even though these subjects are uncomfortable to discuss.

Reference: Clinical Leadership in Nursing. 1^st ed. 1998. Judith T. Rocchiccioli and Mary S. Tilbury. Philadelphia: Saunders.