Different kinds of confrontation

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:

John tells you that he smokes only a few cigarettes a day. He has yellow stains on the fingers of his left hand, smells of smoke, and wheezes on inspiration. His wife says he smokes two packs a day.

Confrontation that involves an explicit request for a change in behavior along with feedback is the focus of this chapter.

Situations in which confrontation is appropriate

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).

To avoid being labeled aggressive, we often refrain from saying anything about others’ unproductive or destructive behavior. Later, we watch our clients or colleagues get into trouble because of their misdirected actions and then we feel guilty and regret that we did not take the opportunity to speak up. In other situations we fume because we do not quite know how to confront those who have violated our rights or the rights of others and we stew in frustrated helplessness. The next time you hesitate to confront others when you believe it needs to be done, remember this: short-term gain, long-term pain. Being nonassertive may get you off the hook for now, but in the long run the problem will only escalate.

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.)

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).

Examples of care confrontations

The three situations outlined in the following sections demonstrate how you can confront someone in an assertive way without being aggressive.

Situation 1

Your roommate is untidy. He leaves his clothes strewn around the bedroom you share, and the bathroom looks like a pharmacy. Frequently his notes and textbooks are laid out all over the apartment. Although he does a major cleanup about every 2 weeks, he slides back into his messy ways and you have to put up with his disarray for the rest of the time. Not only is this mess aesthetically displeasing to you, it makes you hesitant to invite friends over. You confront your roommate with the following:

Clarify

John, you have your clothes spread out over the bedroom, and all your notes and articles for your paper are strewn around the living room and on the kitchen table.

Articulate

I’m feeling annoyed that you are messing up the shared space in our apartment.

Request

I’d like you to keep your personal belongings in your area of our den.

Encourage

That way it’ll be more spacious for both of us in the apartment, and I’ll feel free to invite friends over without worrying about whether the place is a mess.

Presented with this respectful and assertive confrontation, John will most likely comply and change his behavior. If such a confrontation does not result in the desired behavior change, you have the option of indicating a negative consequence, such as, “If you don’t become neater, I will . . . ” (and give a possible consequence, such as hire a cleaning service and charge him, find another roommate, or move out).

Situation 2

Your colleague Janet is upset. She has been trying to lose weight for the past 6 months. You notice that she has a pattern of starting off successfully on Mondays and going back to binging on high-calorie foods by the end of the week. Afterward she fasts for several days and then overeats again. You think that these feasts and famines are not helpful for Janet and that it would be better if she distributed her calories more evenly. Janet knows you struggle with the same issue and you have often shared your challenges.

After you have asked her permission to express your views, you confront Janet about her unproductive behavior in this way:

Clarify

Janet, I notice you do well on your diet at the beginning of the week and then you have ups and downs of eating more than you want to or eating so little that you are starving.

Articulate

I think one reason you are unsuccessful in losing weight is because you don’t have an adequate intake of calories on a consistent basis.

Request

I’d be interested in attending Weight Watchers again and I just learned there will be a class at lunchtime here at work. Perhaps we could go back together and support each other. If we stick to their meal plan you might not be as hungry and will be less likely to binge.

Encourage

If you can cut out the overeating, you won’t feel guilty and have to starve yourself. What do you think?

The respectful and clear way this confrontation is delivered is likely to invite Janet to consider your idea and possibly implement it. An accusatory confrontation would only be ignored.

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