Chapter 23 1. Identify the benefits of confrontation skills 2. Discuss the steps of the CARE (Clarify, Articulate, Request, Encourage) model of confrontation 3. Identify the relationship between confrontation skills and empowerment 4. Practice confrontation in selected exercises to build confidence in the skills Confrontation skill is “being able to identify and to respond—communicate—provide feedback—regarding those discrepancies in another person’s behavior in such a manner that the other person can grow” (Tindall, 2008). Setting feelings aside and focusing on problem solving, using a calm approach, invite cooperation (Northam, 2009; Gallagher, 2009). Patterson and colleagues (2005) say that to confront is to hold someone accountable, to offer an opportunity to solve problems and build relationships. Their research demonstrated that leaders throughout an organization were successful because they held colleagues, co-workers, and bosses accountable. An example of one type of confrontation is a nurse’s deliberate invitation to clients and colleagues to examine incongruities or distortions between feelings, beliefs, attitudes, and behavior (Egan, 2009). This type of confrontation, designed to make others aware of incongruity, can be offered by nurses when, for example, clients or colleagues are saying one thing and doing another, or obviously feeling one way and exhibiting the opposite emotions. Pointing these discrepancies out can be an invitation to expand their self-awareness. This dimension of confrontation is a gift of feedback, which is covered in Chapter 19. Here is an example of a confrontation to expand self-awareness: Confrontation has two parts: the first is making others aware of the destructiveness or lack of productiveness of their behavior, and the second is making a suggestion about how they could behave in a more constructive or productive way. Two situations warrant confronting clients or colleagues: when their behavior is unproductive or destructive to them and when their behavior invades our rights or the rights of others. In confronting others, we are attempting to get them to change in a way that protects their self-interests or is more considerate of others. One note of warning: be aware that the problem belongs to the other person and it is not our role to “fix” other people to meet our standards of behavior (Cox, 1998). Some nurses shudder at the thought of confronting another person and do not want to discuss their differences. We think about people we know who have a tendency to be argumentative when confronted. We are concerned about the impression others will have if we confront them about an issue (Shih, 2002). Confrontation conjures up images of a heated argument. For most nurses, verbal attacks conflict with their images of themselves as level-headed professionals. Yet confrontation can be a time-saving strategy (Davidhizar and Cathon, 2002). Patterson and colleagues (2005) write about crucial confrontations to avoid silence or violence. Neither of the two extremes—nonassertion or aggression—is acceptable to nurses who want to feel confident and act competently. There is a way to confront others, however, that makes you feel as if you are effectively doing something about troublesome behavior. People can be confronted in such a way that they are unlikely to be offended. Moreover, they may appreciate your perspective and opinions. When you confront your clients or colleagues, it is important to do so in a caring way that shows concern for both your feelings and theirs. The following CARE approach is a caring way to confront others. (The format for this comprehensive confrontation is adapted from Bower and Bower, 2004.) • Clarify the behavior that is problematic. Be specific about the aspect of your client’s or colleague’s behavior that is self-destructive or destructive to others. The behavior to be changed should be the focus so that it is clear that you are attaching no hurtful labels to others. • Articulate why their behavior is a problem. Your articulation may include how their behavior is likely to hinder them or irritate others or how it makes you feel. • Request a change in your client’s or colleague’s behavior. Your suggestions should be offered tentatively and respectfully. • Encourage your clients or colleagues to change by emphasizing the positive consequences of changing or the negative implications of failing to change. Remember, too, not to expect a negative response, to use neutral words without blame, and to stay open to the person’s response rather than jumping to conclusions (Ryan et al, 1996). Respect that the clients’ values may be different from yours and be careful not to take a lecturing tone when you confront them (London, 1998).
Confrontation
Different kinds of confrontation
Situations in which confrontation is appropriate
The care (clarify, articulate, request, encourage) confrontation
Elements of the care confrontation