Managing lateral violence and its impact

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This presentation and workshop that followed was with a group of forward thinking teachers, teacher assistants, and administrators.

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  • Need to look to the past and the present Answers are all within your community, within your teachings, this presentation will hopefully help you on your journey or assist you in helping others on their journey. Look on the bright side. The good thing is that you can’t be as bad as the nursing profession!!!
  • New nurses finding that to survive and succeed one needs to be able to throw one’s weight around in this fashion may constitute a pool of new recruits to the culture. Many more, however, are deciding that this is not for them. Health care facilities cannot afford this loss. Often, experienced nurses have firm views on the necessity for younger nurses to endure what they themselves had to endure in their "training" for the profession. This theory states that lateral violence occurs because women have not been socialized to appreciate themselves or the roles they play. Women are often socialized to believe they are not as strong or smart as men and their role in life is to serve men. In addition, nurses often are not empowered during the educational and enculturation processes to value themselves as people and as health care providers. To be able to engage a physician in a discussion over differences in approaches to patient care, the nurse must feel equal in power, professional stature, and professional knowledge. If nurses do not have such feelings and are frustrated, angry, or fearful, they often will vent their feelings laterally or downward.
  • Tackling the nursing shortage and addressing retention and recruitment requires action. It is not enough to train RNs and LPNs with skills and competencies. We need to make it easier for them to stay and be a part of the team. Many senior nurses expect graduates to hit the ground running," says Judith Tompkins, chief of Nursing Practice and Professional Services and executive vice-president of Programs at the Centre for Addiction and Mental Health (CAMH) in Toronto. "When there is a lack of collegiality and mentoring from peers, young nurses are thrown into the workforce and are left feeling unsupported."
  • Women were more often the perpetrator – 65% Men target men and women equally Women target other women 70% of the time
  • How many generarations are we working with today?
  • Mellington believes there may be certain workplaces that are more susceptible to workplace bullying. Key indicators of what should be looked for are: - organisational change (such as a takeover or change in management); - workplace characteristics (for example, a greater representation of minority groups or high job instability and uncertainty about on-going employment); - workplace relationships (including low levels of consultation or poor communication); and - work systems and structures (for example, no policies or procedures, no clear job descriptions or insufficient training).
  • Major characteristics of oppressed behavior stem from the ability of dominant groups to identify the “right” norms and values and from their power to enforce Them. Connection of lateral violence in nursing to the behaviors of oppressed groups, where inter-group conflict is seen in the context of being excluded from the power structure. Nurses generally don't have sufficient control over their work environment and have a high degree of accountability coupled with a low degree of autonomy.
  • Goode, D. & Napolitano, L. (2007). Statement on violence in the workplace: the council on surgical & perioperative safety. Journal of perianesthesia nursing. 24(2), 72-74.
  • Reasons for bullying behavior. A British study suggests that nursing has always condoned intimidating behavior.7 The profession established itself at a time when public health was a reform movement, requiring its practitioners to educate the "lower orders" in health-related behavior for their own good. A bossy and controlling manner was seen as part of the nurse’s role. The first published academic analysis of the behavior as a negative characteristic, however, may have only appeared in 1984; this was in the form of advice to nurses on how to manage the stress associated with this kind of behavior.8 http://content.healthaffairs.org/cgi/content/full/21/5/189 Overt examples: Verbal abuse from surgeons, anaesthetists, coworkers, abrupt responses, vulgar language Refusing to perform assigned tasks, reluctance or refusal to answer questions, return phone calls or pages Shouting, yelling or other intimidating behaviour Physical violence Temper-tantrums Physical abuse, throwing instruments, pushing and inappropriate body contact Covert examples: Judging others on age, gender, sexual orientation, ethnicity or size Failure to respect privacy, and broken confidences Blaming and gossiping behind a colleague’s back Scapegoating and Humiliation, Infighting and bickering Sabotage such as setting up a new hire for failure Withholding needed information or advice Obnoxious behaviour making the Nurse feel inadequate Undermining behaviour such as ignoring questions, constantly criticizing or excluding individuals from discussion, quietly exhibiting uncooperative attitudes during routine activities Aggressive or mocking body language such as non-verbal innuendo, raising eyebrows or making faces, condescending language or voice intonation
  • Undermining behaviour such as ignoring questions, constantly criticizing or excluding individuals from discussion, quietly exhibiting uncooperative attitudes during routine activities Aggressive or mocking body language such as non-verbal innuendo, raising eyebrows or making faces, condescending language or voice intonation
  • What Is Cyberbully?   Cyberbully is when a child is tormented, threatened, harassed, humiliated, embarrassed or targeted by another child using the Internet, mobile phone, or other type of digital technology.   It has to be a child on both sides.  If it is an adult, it is not considered cyberbullying and is called cyber-harassment or cyberstalking and is a very serious crime.  Cyberbullying is very serious also, but it doesn't always break the law.  Sometimes it does break the law , and even when it doesn't, it is definitely wrong and children do usually get in trouble with parents or school.    You have to be very careful if you are the victim of a cyberbully.  If you try to take things into your own hands, you may end up being a cyberbully yourself without even realizing it.  Always report bullying of any kind to an adult or someone who can help you.
  • Emotional abuse committed directly or indirectly by a group. Who will fix this, and will it really help??? Is it just teasing? Often we try to gain consensus with eye rolling.
  • We often accept bad behaviors we witness because we believe professionals who display disruptive behaviors are very skilled, really care, and are aggressively advocating in their best interest. Sometimes staff witness lateral violence events but are not prepared to support their colleague for fear that they might be the next victim. Ignoring the victim’s behavior and distress seemed to be the way both staff and the organization responded to the issue. There may be a style of management at various levels and institutions that is based on fear rather than respect.
  • “ I wish we wouldn’t fight” she said He said “ I never knew we were!” Perception and knowing who you are communicating with is so important.
  • Physical Fatigue or insomnia Stress GI distress Headaches, depression Increased blood pressure Psychological Shame or guilt Prolonged duress stress disorder or post traumatic stress disorder Substance abuse. Increased stress, anxiety, irritability Poor concentration, feeling overwhelmed Inability to concentrate Social Isolation Loss of libido Loss of self confidence, decreased self esteem Avoidance and withdrawal behaviors, disconnection from others Increased use of tobacco, alcohol, and other substances Griffin, m. Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of continuing nursing. 2004; 35(6): 257-263. Cortina & Magley, 2003; Gilmour & Hamlin, 2003; Longo & Sherman, 2007; Normandale & Davies, 2002 May also be PTSD and suicidal ideation Individual factors: Type A personality Emotional state – anger, burnout Inadequate conflict management skills Beliefs and expectations No time for reflection No acknowledgement of the emotional work required
  • Here is an example from me recent past, a letter I sent to CBC in Saskatchewan Hello Morning Edition, I fell for Shae and hope that she has a good year at school.   But, I have to say that I support Premier Wall in his decision to not act to hastily on implementing an ‘anti-bullying’ law. I have done much research in lateral and horizontal violence in adults, especially in the nursing profession. In my experience, I find that low level resolution is fundamental to empowering victims and bullies and the parents or teachers that often intervene with good intentions. These good intentions can have detrimental effects, can reinforce bad behaviours, and educate children that adults are the key to solving all their problems. In the process we create zero-tolerance policies that punish bullies, putting the bully into the victim role, making them mad at us as adults, and angrier with the original victim. We teach children to be aggressive against bullies, and that this is the best way to solve problems. Teasing, taunting, and verbal abuse without physical harm can be resolved by empowering bullies and victims to resolve their own problems, without adults swooping in to take sides and ‘fix’ things; this would be great. A lot of our focus in education, and in life is on the victim, but those victims, like we have seen with school shootings, can turn into bullies, and the bullies, can turn into the victims.   Please review the Bullies to Buddies website, I have no affiliation with this website, but feel that the free manuals will help so many parents and teachers as we start the new school year.     https://bullies2buddies.com/View-category.html   https://bullies2buddies.com/Download-document/10-Student-Manual-How-to-Stop-Being-Teased-and-Bullied-Without-Really-Trying.html
  • What to do? When staff don't have control but must be accountable, you can see where they might not be happy with one another. Other unhealthy coping strategies include taking up smoking, using alcohol excessively and abusing prescription medication. Anti-harassment and diversity initiatives can make a big difference.
  • It is discouraging that many people do not resolve stress, or see formal ways to deal with the problem. This information just validates how much we need to work on finding ways to stop LV and VV from happening.
  • Identify the problem Produce the codes or themes of the problem See the situation as experienced by the participants Aalyze the situation Act In Pedagogy of the Oppressed , Freire says: Submerged in reality, the oppressed cannot perceive clearly the “order” which serves the interests of the oppressors whose image they have internalized. Chafing under the restrictions of this order, they often manifest a type of horizontal violence, striking out at their own comrades for the pettiest reasons. to change the situation It is possible that in this behavior they are once more manifesting their duality. Because the oppressor exists within their oppressed comrades, when they attack those comrades they are indirectly attacking the oppressor as well.
  • Drama triangle here Gary Harper’s drama triangle can be helpful to start discussions on bullying. http://www.joyofconflict.com/editor_articles/ConflictDrama-VictimVillainHero.htm
  • “ I feel (state a feeling) when you (describe the behavior). I would really like to do something about this situation so that it will not happen again. I’m wondering if you have any ideas about possible solutions. Here are some of my ideas. (State alternative solutions and come to an agreement on one of them.) Now, since this problem has come up before, I want some assurance that the problem will work this time. (Negotiate positive and/or negative consequences.) I feel much better now that we’ve spoken about this issue. I appreciate your willingness to work this out with me.” 2. What do you say after you hear that someone has been backstabbing you? D “I’d like to talk with you in private. I heard from another nurse that you said I didn’t know what I was doing, that I am a terrible nurse.” E “When I hear that someone has been saying things about me and I don’t know why, or even what situation it pertains to, I feel sabotaged and set up to fail.” S “I want to be a good nurse, and I can’t do that without your honest feedback and support. Can you say what you feel and think directly to me in private?” C “Without that support, I am sure to fail. I will have to find another place to work, even though this is the specialty I had chosen.” (Bartholomew 2007) Changing your perception of the problem can be a challenge. An example of changing your perception of a problem might be to see a difficult boss as an opportunity to work on coping with someone who is disorganized and demanding. If you feel irritated because your house is cluttered with toys, maybe change your perception to one that the clutter is a signal to be grateful for young children in the home. Changing your perception could also mean changing your view of an emotion. Instead of trying to never feel anger, you look at your frustration as a source of information, perhaps a signal that you need to speak up for yourself. http://www.psychologytoday.com/blog/pieces-mind/201202/got-problem-the-good-news-is-you-only-have-four-options
  • Overall we are communicators. As teachers, similar to nurses, someone is always watching you. We need to set good examples, walk the walk, and talk the talk.
  • We do not accept bullying in our schools or other workplaces so why is it ok in Nursing? Is it the culture that was learnt by nurses 30 years ago and has propitiously been taught to new nurses. Explore individualism versus collectivism.
  • Denial that behavior is a problem Manager condones the behavior Manager exhibits the behavior Negative behavior is accepted as the norm Information about negative behaviors is suppressed Manager protecting someone because they are a ‘good’ employee Employee fear of retaliation causes ‘silencing of voice’ Policies are in place but not enforced Manager lacks confrontation skills Time pressure used as an excuse not to confront perpetrators Human resources department not consulted or not helpful Blame is often shifted to the victim, or the victim has guilt and blames themselves. Unfortunately, the victim often becomes the bully or the villain.
  • Cognitive Rehearsal Techniques Introduced by Dr. Martha Griffin in her study with new graduate nurses Taught nurses about the behaviors Provided suggestions for what to say in response to each behavior Provided laminated cards with the information that nurse could put behind her ID badge Gave nurses the opportunity to practice responding to lateral violence behaviors Bullies to buddies research
  • Collectivism vs individualism
  • Freedom of speech? Can we say anything to anyone?
  • http://content.healthaffairs.org/cgi/content/full/21/5/189
  • Backstabbing workshop example A staff member begins complaining to you about a coworker’s sloppy work habits. D – I don’t think I’m the right person for you to be talking to about this. E – It won’t solve the problem for you to talk to me about it – you need to speak directly with Sally. S – I want you to stop talking to me about Sally when she is not here to defend herself.  C – Talking behind someone’s back has a negative effect on work relationships. You and Sally would both benefit from the chance to talk honestly about your concerns.
  • Issues such as this, within both organizations and professions, need to be brought out into the open in a non-blaming way with a focus on the future
  • the existence of such a culture needs to be recognized and challenged before the strategies can become effective. publicly admit to the existence of a culture that condoned bullying behavior and to commit to changing this culture.
  • “ I feel (state a feeling) when you (describe the behavior). I would really like to do something about this situation so that it will not happen again. I’m wondering if you have any ideas about possible solutions. Here are some of my ideas. (State alternative solutions and come to an agreement on one of them.) Now, since this problem has come up before, I want some assurance that the problem will work this time. (Negotiate positive and/or negative consequences.) I feel much better now that we’ve spoken about this issue. I appreciate your willingness to work this out with me.” 2. What do you say after you hear that someone has been backstabbing you? D “I’d like to talk with you in private. I heard from another nurse that you said I didn’t know what I was doing, that I am a terrible nurse.” E “When I hear that someone has been saying things about me and I don’t know why, or even what situation it pertains to, I feel sabotaged and set up to fail.” S “I want to be a good nurse, and I can’t do that without your honest feedback and support. Can you say what you feel and think directly to me in private?” C “Without that support, I am sure to fail. I will have to find another place to work, even though this is the specialty I had chosen.” (Bartholomew 2007) Changing your perception of the problem can be a challenge. An example of changing your perception of a problem might be to see a difficult boss as an opportunity to work on coping with someone who is disorganized and demanding. If you feel irritated because your house is cluttered with toys, maybe change your perception to one that the clutter is a signal to be grateful for young children in the home. Changing your perception could also mean changing your view of an emotion. Instead of trying to never feel anger, you look at your frustration as a source of information, perhaps a signal that you need to speak up for yourself. http://www.psychologytoday.com/blog/pieces-mind/201202/got-problem-the-good-news-is-you-only-have-four-options
  • Bartholomew, K. (2007). Stressed Out About Communication Skills . Marblehead. MA: HCPro,Inc. Cox, S. (2007). “Good communication: Finding the common ground.” Nursing Management 38(1). http://www.bullyonline.org/workbully/serial.htm http://www.helpguide.org/mental/eq8_conflict_resolution.htm http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Combating-Disruptive-Behaviors.html http://stoplateralviolence.blogspot.ca/ http://www.slideshare.net/itjil/incivility-disclosing-and-disarming-the-incivility-elephant-in-academic-and-practice-nursing
  • Managing lateral violence and its impact

    1. 1. ACTC Education ConferenceCulture and HarmonyOctober 4th and 5th, 2012 Managing Lateral Violence and its Impact Greg Riehl RN BScN MA
    2. 2. Outline• What is lateral violence?• What causes of lateral violence? • Who is doing it? • Types.• Effects.• What can be done?• Discussion .
    3. 3. Objectives1. Identify terms used to describe lateral violence.2. Increase awareness.3. Explore experiences with lateral violence.4. Discuss strategies to manage lateral violence behavior.
    4. 4. Objectives1. Describe the concept of lateral violence.2. Recognize the presence of lateral violence in the workplace.3. Apply current concepts believed to underlie lateral violence as a workplace problem.4. Describe methods of dealing with lateral violence in the workplace.
    5. 5. Honesty Change Hope Prisoners, vacationers, keeners, Communication will be key for today’s work on Lateral Violence We have 2 ears and one mouth, listening should always be 2:1 I do not have the power to fix Lateral Violence, but you do.
    6. 6. Bullying in School – is this learned? Our politicians spew hate and lies and cannot work together Our newscasts report violence first and foremost Youth are preoccupied with violent video games and media in general These negatives often outweigh any positive examples students encounter.
    7. 7. MythsLateral Violence can’t happen to me Lateral Violence can’t be prevented
    8. 8. Dealing with Lateral Violence Dealing with lateral violence is dealing with poorly expressed anger. Poorly expressed anger can be due to failure to recognize anger and take constructive action when possible or failure to find healthy ways to blow off some of the anger-related stress or failure to discuss the precipitating cause of the anger. Expressing internalized anger is associated with less stress and depression, more optimism, and a stronger sense of self-efficacy. (Thomas, 2003, 108).
    9. 9. Lateral Violence• Exists on a spectrum, from seemingly ordinary behaviour such as gossiping or criticism, to intimidation, racism and outright physical intimidation or harm.
    10. 10. Definition for Where I Work Lateral Violence (LV), also called Horizontal violence, Nurse-to-Nurse violence, incivility, and disruptive behaviours, creates an unpleasant work environment and has harmful effects on individual nurses, patient safety, and health care organizations. Johnson, 2009 & Dimarino, 2011
    11. 11. Who gets targeted? Anyone who is different from the group norm on any major characteristic  Experience  Education  Race/ethnicity  Gender Targeted person’s gender  79% Female  21% Male
    12. 12. Who is Doing the Bullying? 2009 survey by Workplace Bullying Institute:  Main perpetrator’s gender  65% Female  35% Male 2009 WBI survey sited in New York Times:  Men target men and women equally  Women target women 70% of the time Canada ranks 4th in the world in workplace violence, USA 7th, Argentina #1
    13. 13. Why? Nurses practice in a historically patriarchal environment.  Oppression leads to low-self esteem.  Nurse exert power over one another through lateral violence.  Lateral violence is perpetuated through the culture of nursing (new nurses, curriculum, etc).  “Nurses eat their own”  “See one do one teach one”
    14. 14. Why? Some professionals can receive preferential treatment from administration. Crowded working conditions Overworking conditions Too many demands Mistrust between experienced staff and the new staff Mistrust between subordinate and supervisor Ineffective classroom and or practice management skills Luparell 2008
    15. 15. Who is doing it? Coworker-on-coworker aggression  Directed toward individuals at same power level  Intended to cause psychological pain  Does not include physical aggression Intergroup conflict  Shift to shift  Cliques within a workgroup  Department to department
    16. 16. Risk Factors for Violence in Health• Working directly with volatile people especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychiatric diagnoses• Working when understaffed especially during mealtimes, visiting hours, and when on call• Transporting patients• Long waits for service• Overcrowded, uncomfortable waiting rooms• Working alone• Poor environmental design• Inadequate security• Lack of staff training and policies for preventing and managing crisis with potentially volatile patients• Drug and alcohol abuse• Access to firearms• Unrestricted movement of the public• Poorly lit corridor, rooms, parking lots, and other areas Goode, D. & Napolitano, L. (2007). Statement on violence in the workplace: the council on surgical & perioperative safety. Journal of perianesthesia nursing. 24(2), 72-74.
    17. 17. Warning Signs Drugs and alcohol abuse Gambling Addiction Sudden shifts in behaviour Job performance goes down Threats of violence Preoccupation with violence Co-workers complaining
    18. 18. Workplace Violence & HarassmentExperts identify two primary categories of lateral violence. Overt(direct) Covert (passive)
    19. 19. Lateral Violence Overt  Verbal abuse from coworkers, abrupt responses, vulgar language  Refusing to perform assigned tasks, reluctance or refusal to answer questions, return phone calls or pages  Shouting, yelling or other intimidating behaviour  Physical violence  Temper-tantrums  Physical abuse, throwing, pushing & inappropriate body contact
    20. 20. Lateral Violence Covert - Passive  Judging others on age, gender, sexual orientation, ethnicity or size  Failure to respect privacy, and broken confidences  Blaming and gossiping behind someone’s back  Scapegoating and humiliation,  Infighting and bickering  Sabotage such as setting up a new hire for failure  Withholding needed information or advice, or taking credit  Obnoxious behaviour making people feel inadequate
    21. 21. 10 Most Common Forms of LateralViolence Where I Work1. Non-verbal innuendo,2. Verbal affront,3. Undermining activities,4. Withholding information,5. Sabotage, Griffin. 2004
    22. 22. 10 Most Common Forms of LateralViolence Where I Work6. Infighting,7. Scapegoating,8. Backstabbing,9. Failure to respect privacy, and10. Broken confidences. Griffin. 2004
    23. 23. Cyber Lateral Violence Cyber bullying through email, internet, and social media, not just student to student . . . Sometimes when you try and ‘fix’ things, you end up being the bully  Sending emails without greetings  CAPS LOCK, BOLD, etc Words and Tone can cause a lot of trouble!!!!!!!!!!!!!!!!!!!!!! What about ‘Sticks and Stones may break my bones, but names will never hurt me?” do you teach this? Does this work with freedom of speech and charter rights?
    24. 24. Mobbing A group of coworkers, or students gang up on another person – often with the intent to force them to leave the group. Emotional abuse committed directly or indirectly by a group Five phases of Mobbing 1. Conflict 2. Aggressive acts 3. Management Involvement 4. Branding as Difficult or Mentally ill 5. Expulsion
    25. 25. Who else is involved?• Students? Parents? Friends?• They may accept bad behaviors they witness because they believe professionals who display disruptive behaviors are very skilled, really care, and are aggressively advocating in their best interest.
    26. 26. Bystanders, Managers, Leaders Sometimes staff witness lateral violence events but are not prepared to support their colleague for fear that they might be the next victim. Ignoring the victim’s behavior & distress often seem to be the way staff and organizations respond to the issue. There may be a style of management at various levels and within institutions that is based on fear rather than respect.
    27. 27. "Lateral violence cannot thrive whenemployers become ethically and legallyresponsible."
    28. 28. Dance of Incivility… A dynamic interaction between people inconflict. When viewed as a dance rather thana struggle for power and control, the potentialfor healing is enhanced.
    29. 29. Health Impacts on Victims • Physical/Body • Emotional • Mental/Mind • Spiritual
    30. 30. Do Nothing Research shows how targets deal with being bullied; "not doing anything about it (the bullying) was the most common method taken by a target in response to being bullied. And, reporting the bullying or making a complaint were reported to be the most unsuccessful method taken in trying to resolve bullying. The action deemed most successful by respondents were "no action" and "seeking a new job","
    31. 31. Impacts on Systems Negative Impact on the work environment: Communication and decision making Collaboration and teamworkleading to: ⇑ employee disengagement ⇓ job satisfaction and performance ⇑ risk for physical and psychological health problems ⇑ absenteeism and turnover
    32. 32. We All need to ask ourselves:• “Did I participate in bullying?”• “Did I support this kind of behavior in others?”• “Did I intervene if and when I observed it?” “We must work to uncover and reverse atrocities, one person, one company, and one law at a time” Bullyproof Yourself at Work, G & R Namie
    33. 33. What to do?• Awareness• Education• Dialogue• Zero tolerance policy• Be confident• Develop effective coping mechanisms• Confront the situation• Rehearsal• Monitor for bullying groups/cliques• Carefully select new employees• Enact policy and procedure• Refuse to be a victim• Listen• Code of conduct• Don’t accept it!
    34. 34. Safe Place Where is the safe place where you work? What makes it “safe”? Will you be able to respond to lateral violence when it happens?”
    35. 35. Cultural Security A culturally secure environment cannot exist where external forces define and control cultural identities. The role for government and other third parties in creating cultural safety is ensuring that our voices are heard and respected in relation to our community challenges, aspirations and identities. In this way cultural security is about government and third parties working with us to create an environment for a community to ‘exert ownership of ourselves’. Through this ownership we are empowered.http://www.hreoc.gov.au/social_justice/sj_report/sjreport11/chap4.html
    36. 36. How do we deal with the stress? 75% talk to family, friends, colleagues 50% experience a desire to resign 49% lose interest in job, disengage 23% use more sick time 35% use formal channels  23% HR representative  12% Union or professional organization representative
    37. 37. Paulo Freire Methodology:• In Pedagogy of the Oppressed, Freire says:• SEE the problem or situation lived by clients• ANALYZE the factors (personal, cultural, institutional) that contribute to the problem• ACT to change the problem or situation
    38. 38. Colonialism is not over The colonized man will first manifest this aggressiveness which has been deposited in his bones against his own people. This is the period when the [ ] beat each other up, and the police and magistrates do not know which way to turn when faced with the astonishing waves of crime in North Africa. ... While the settler or the policeman has the right the livelong day to strike the native, to insult him and to make him crawl to them, you will see the native reaching for his knife at the slightest hostile or aggressive glance cast on him by another native; for the last resort of the native is to defend his personality vis-a-vis his brother. Pedagogy of the Oppressed, Freire
    39. 39. Lateral Violence in Students The truth is that most of the violence in the world is committed not by bullies but by victims! A student sees himself as a victim. He used to be the victim of the kids who enraged him by calling him names. Now, in addition, he feels himself to be the victim of the crooked adult society. Society takes his tormentors side against him and punishes him for trying to stop his bullies. He is now angrier and therefore more dangerous than before the wise adults disciplined him for being a bully! Victims Bullies Hero’s
    40. 40. DESC COMMUNICATION MODEL• Describe – the behavior• Explain – the effect the behavior has on you, coworkers, patient care• State – the desired outcome• Consequences – what will happen if the behavior continues?
    41. 41. Are certain workplaces moresusceptible? Mellington believes there may be certain workplaces that are more susceptible to workplace bullying. Key indicators of what should be looked for are:  organizational change (such as a takeover or change in management);  workplace characteristics (for example, a greater representation of minority groups or high job instability and uncertainty about on-going employment);  workplace relationships (including low levels of consultation or poor communication); and  work systems and structures (for example, no policies or procedures, no clear job descriptions or insufficient training).
    42. 42. Culture of SilenceBecause we set ourselves up to be healers, orhelpers, this kind of behaviour is in theshadows. We don’t know what to do about it,so we try to disown it.•In practice, this means that we can’t staysilent when another person’s actions “makesus cringe.•Having the conversation is what matters . . . itshows that both professionals shareresponsibility for behaviour affecting staff andstudents.
    43. 43. My Culture needs to change• New nurses personalize their experiences and assume they are unique to themselves," she says.• "Our program empowered nurses to advocate for themselves. As it liberated them, retention rates improved. We attribute this to recognition of lateral violence. Newer nurses can learn from those whove gone before."
    44. 44. Why Don’t We Stop Lateral Violence?• “It’s not a problem in our work area”• “Everybody does it – just get used to it”• “If I say anything, I’ll be the next target”• “We have policies but they aren’t enforced”• “She sets herself up for getting picked on”
    45. 45. What can you do?• Dialogue is ultimately far more effective than pointing fingers• Cognitive Rehearsal TechniquesModel the behaviour that you want When adults deal with problems with violence, children learn to deal with their problems the same way, isolation, violence, etc. http://www.authorsden.com/visit/viewArticle.asp?id=46624
    46. 46. What do we do with bullies? Kick them out? Discipline? Isolate them? Dissocialize them? Similar to a criminal, who has broken the law, punishment rarely has positive consequences Dignity + Respect = no bullying
    47. 47. Dignity + Respect = no bullyingThe solution or approach to address bullying is to promote itsreal enemy - dignity and respect; because with these principles, bullying can not prevail.Bullying is ultimately about isolation - isolating workers andmaking them feel inadequate. If this is so, then the antidote tobullying lies in working together.
    48. 48. Emotions Anger is the emotion behind violence. It is the desire to destroy or defeat an opponent. Our anger not only makes us become enemies, it escalates the problem and makes others continue doing exactly what we don’t want them to do! It is time for us to start teaching our children, from the earliest ages, what Freedom of Speech really is. This means we have to solve our routine conflicts with our family members, our colleagues, and our students, without getting angry over the words they say.
    49. 49. Rehearsal Research has demonstrated the benefit of rehearsal for new employees experiencing lateral violence. i.e.  When a staff member makes a facial gesture (such as raising an eyebrow), the participant was instructed to say, “I see from your facial expression that there may be something you wanted to say to me. It’s OK to speak directly to me”. Griffin, M. (2004) Teaching Cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263 .
    50. 50. Confront Behaviour . . . Really?• If one speaks critically or takes a questioning stance then one may be positioned as disloyal, ungrateful or may even be labeled as the bully.• The way forward is to focus on implementing strategies to reduce the opportunities for bullying behavior to occur.• Take personal responsibility for the situation.
    51. 51. Confront Behaviour• Confront behavior and acknowledge if it has been there for a long time but was never discussed.• Take personal responsibility for the situation.• Try to reach consensus to actively bring about change by developing, publishing, and implementing strategies.• Some people are shocked to discover that they actually contribute, either inadvertently or otherwise, to a bullying culture by their actions or inactions.
    52. 52. Teamwork and Communication• Teamwork in this area involves many staff in solving problems related to these issues.• Policy documents on bullying and intimidation need to be developed. • Specify the sorts of behavior that will not be tolerated, and include, within the policy, the "rights" of individuals to be treated fairly and with respect.• Effective anti-bullying practices must include a statement of exactly what constitutes bullying.• We need to work with everyone, bullies, targets, and bystanders.
    53. 53. Tackling a Culture ofIntimidation• Developing more open communication and increased access to senior management.• Ensuring that supervisors receive adequate training and support for their role.• Ensuring that policies refer specifically to managing bullying & that these standards are maintained through an effective performance management system.• Providing accessible professional development opportunities for all staff.• Developing policy on bullying/lateral violence in the work-place and conflict resolution mechanisms.
    54. 54. Discussion, questions,comments!!!Thank you for your participation
    55. 55. Workshop
    56. 56. Objectives1. Explore personal and community awareness of lateral violence.2. Describe an experience with lateral violence behaviour.3. Discuss strategies to manage lateral violence behaviour.
    57. 57. Review Workplace Bullies Sydney-based clinical psychologist and workplace bullying specialist Keryl Egan has formulated three workplace bully profiles: the accidental bully, the narcissistic bully, and the serial bully. Egan describes the accidental bully as emotionally blunt, aggressive and demanding. "This person is task orientated and just wants to get things done, tends to panic when things are not getting done, and goes into a rage about it. This person is basically decent, they dont really think about the impact of whats happened or what they have done. They are responding to stress a lot of the time." Importantly, Egan believes this type of bully can be trained or coached out of the bullying behaviour.
    58. 58. Three Workplace Bullies The second profile formulated by Egan is the narcissistic bully, who is grandiose and has fantasies of breath-taking achievement. "This type of bully feels they deserve power and position. They can fly into rages whenever reality confronts them. This person is very destructive and manipulative, they dont set out in a callous way to annihilate any other person - its purely an expression of their superiority."
    59. 59. Three Workplace Bullies Finally, Egans third profile is that of the serial bully "who has a more sociopathic or psychopathic personality. This type of bully is intentional, systematic, and organised and the bullying is often relentless. They usually get things done in terms of self interest, not in the interest of the company." Egans serial bully employs subtle techniques that are difficult to detect or prove and training or coaching is always unsuccessful; simply, the serial bully is often:  grandiose yet charming,  authoritative, aggressive and dominating,  fearless and shameless,  devoid of empathy or remorse,  manipulative and deceptive;  impulsive, chaotic or stimulus seeking; and  a master of imitation and mimicry.
    60. 60. DESC COMMUNICATION MODEL• Describe – the behavior• Explain – the effect the behavior has on you, coworkers, patient care• State – the desired outcome• Consequences – what will happen if the behavior continues?
    61. 61. Goal This is for you to decide . . .
    62. 62. 1. PROBLEM DEFINITION Cycle for program VALUES/NEEDS development► Community values are key in identifying 1. Problem Definition problems. 5. Evaluation Specificity, values,► In sub-groups, describe define needs your community’s values when it comes to lateral violence.► How do you feel about lateral violence? 4. Implementation of 2. Problem► What is the perception the Action Plan Analysis of the situation within the community?► What does your community need in 3. Work Plan order to reach the goal? 62
    63. 63. Small Group Work In sub-groups, describe your community’s values when it comes to lateral violence. How do you feel about lateral violence? What is the perception of the situation within the community? What does your community need in order to change?
    64. 64. Defining the ProblemExamples of VALUES & Community SPECIFICITIES facing lateralviolence •Importance of the elders as role models. •Role of enlarged family (grand-parents, parents and children). •Conservative communities are not overly enthusiastic about hearing more ‘bad’ news. •FEAR of the unknown. •Judging, stigmatizing, isolation of bullies and victims. •Don’t know that there is even a problem. •Not much dialogue or communication among community members. 64
    65. 65. Defining the problem• We need to learn about the services available and services needed.• We need to stop the propagation of lateral violence among each other.• We need to reduce the risk factors and increase communication.• We need to know who’s affected. Bullies, victims, targets, and heroes.• We need to better accompany our community members.Confrontation is difficult but results in the resolution of lateral violence behaviour.
    66. 66. Cognitive Rehearsal Techniques• Recognize the behavior when it occurs• Plan ahead for ways to respond• Practice new responses before you need them
    67. 67. Questions Have you witnessed anyone practice lateral violence since you have started your employment? Did you respond to the lateral violence when it happened? What tools have you used to respond to lateral violence? Have you ever thought about leaving your position at the school? Did any of the lateral violence keep you from learning what you needed to know? Do you have any recommendations?
    68. 68. Contact information Greg Riehl RN BScN MA Aboriginal Nursing Student Advisor Aboriginal Nursing Student Achievement Program SIAST, Wascana Campus Email: greg.riehl@siast.sk.ca Email: gregriehl@sasktel.net Ph:  306.775.7383 w Ph: 306.529.4783 c  

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