Preventing Conflict among dialysis patients and their dialysis staff

1. Decreasing Dialysis Patient-
Provider Conflict
Reynel Dan Galicinao

2. Objectives
At the end of this session, the participants will be able to:
1. Describe the conflict resolution model
2. Recognize causes and types of conflict
3. Identify tips to defuse anger
4. Develop ways to prevent future conflict

3. Overview
• Prevailing attitudes, past behaviors, customs and traditions comprise
culture
• When cultural expectations of staff and patients differ significantly,
conflict is likely to occur
• Sometimes, simply enhancing sensitivity to these differences can reduce
conflict
• The level of conflict in the dialysis clinic must be addressed
• Conflict resolution training for staff

4. Causes of Conflict
Physical Environment Unit cleanliness, temperature, noise level
Treatment Related Infiltration, medication errors, machine alarms
Staffing Number and composition of staff, staff
assignment
Staff Professionalism/Training Staff talking about personal issues,
competence
Financial Nonpayment of fees
Nonadherence Missed/shortened treatment, not following
medical advice
Scheduling Wait time, appointment time
Disruptive Behavior Yelling, cursing, inappropriate sexual remarks,
touching

5. “CONFLICT” RESOLUTION MODEL

6. C reate a calm environment
O pen yourself to understanding others
N eed a nonjudgmental approach
F ocus on the issue
L ook for solutions
I mplement agreement
C ontinue to communicate
T ake another look

7. Create a Calm Environment
• You need to be aware of the
physical surroundings, as well as
the thoughts and feelings you are
experiencing because of the
conflict

8. Open Yourself to
Understanding Others
• It is important to acknowledge the
perspective and feelings of the
other individual(s) involved

9. Need A Nonjudgmental
Approach
• As a dialysis professional, it is
important for you to maintain an
objective and professional
approach as you address the
conflict
• Keep in mind that words
exchanged in the heat of an
argument are often not intended
as personal attacks

10. Focus On The Issue
• When conflict occurs, there is a
tendency to lose sight of the issue
that started the disagreement
• What starts out as a concern about
starting dialysis on time can quickly
become a disagreement about the
facility staff, the clinic operations,
or the physician care

11. Look For Solutions
• Not all conflicts can be resolved
nor are all conflicts based on valid
complaints
• But working in collaboration with
the patient will improve the
likelihood of a positive outcome

12. Implement Agreement
• If you take the time to work
through the conflict, it is likely that
you will reach a stage of
agreement when changes will need
to be put into action

13. Continue To Communicate
• Effective resolution of a conflict
requires follow up communication
• This allows you to monitor the
progress being made
• This demonstrates to the patient
your commitment to resolving the
conflict

14. Take Another Look
• Handling a conflict, like
successfully performing dialysis
related tasks, requires practice,
understanding, education, and
monitoring
• Regardless of whether a conflict is
minor or major, reviewing the
steps used in addressing the
conflict will be beneficial

15. Types of Conflict
• Verbal expression of a difference of opinion
that causes discomfort or distress
Verbal
Disagreement
• Words with intent to demean, insult, belittle
or degrade
Verbal/Written
Abuse
• Words expressing intent to harm, abuse or
commit violence
Verbal/Written
Threat
• Gestures or actions expressing intent to harm,
abuse or commit, violencePhysical Threat
• Bodily harm or injury or attackPhysical Harm

16. 6 TIPS FOR DEFUSING ANGER

17. 1. Breathe Deeply
• Get your heart rate and breathing
to a normal rate
• Doing this in front of an angry
person can also “model” this
technique for them

18. 2. Remove Yourself
• If possible remove yourself from
the situation and deal with the
anger when you or they are
feeling calmer or “centered”
• Let the other person know that
you definitely want to talk, but at
another time

19. 3. Reframe the Situation
• Consider another possibility for
the conflict or outcome
• Help others understand their
anger by providing “plausible
alternative reasons” for the
situation

20. 4. Ignore Personal Attacks
• In the long run, it will gain you
more respect

21. 5. Exercise Regularly
• Exercise allows your body to build
up energy reserves and stimulates
the release of endorphins, the
body’s natural calming hormones
• This as a preventative technique

22. 6. Violence is Unacceptable
• If you are concerned that a situation
is about to become violent, you
should make every effort to distance
yourself and your patients from the
violent individual
• Do not put yourself in a situation
where you are in an isolated area
with a potentially violent person
• It is important that your facility be
prepared to deal with any
potentially violent situation