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Listening for peace: Mediation class serves nurses, patients and care

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Sometimes making peace is as simple as listening well. And sometimes the outcome can literally be life or death.

Bethel College in North Newton, Kansas, is unique among Kansas colleges and universities in making a Peace, Justice and Conflict Studies course part of its general education requirements.

That translates to the nursing program, which is the only one in the state whose graduates must successfully complete Practical Skills for Managing Interpersonal Conflict – a core course in the Kansas Institute for Peace and Conflict Resolution (KIPCOR), for which staff make some adaptations for health-care settings.

Every student admitted to the program takes this four-day intensive course at the beginning of his or her junior year.

“There is plenty of conflict in health care,” says Abby Schrag, a 2016 Bethel nursing graduate who now works in the medical unit at Newton Medical Center. “I think I deal with conflict the most between patients and their families.

“Often there are disagreements about the correct plan of care for my patients, with the actual patient wanting one thing and different members of the family wanting others. This has been especially difficult in end-of-life care or care of patients with dementia.

“The biggest thing the class … has taught me is to really take the time to listen to people and acknowledge their thoughts and feelings. I think people often get so caught up in what they think needs to be done that they don’t take the time to listen to others. Then misunderstandings occur, feelings get hurt and situations get much more complicated than they need to be.”

In fact, there have been studies done that show some links between patient safety and even patient death rates and the way conflict (between health-care providers, between providers and family members) is resolved or not.

KIPCOR began offering the special intensive course for nursing majors about 10 years ago. It happened after former Director of Nursing Gregg Schroeder took Practical Skills for Managing Interpersonal Conflict himself.

“He said all nursing students ought to take it,” recalls Gary Flory, long-time KIPCOR director. For several years, a few would come on faculty recommendation, until finally the class was integrated into the curriculum.

“The first year or two, it was tough,” Flory continues, “because they would say ‘This doesn’t have anything to do with nursing.’”

“We were modifying a mediation course,” adds Sharon Kniss, KIPCOR director of education and training. “Nurses didn’t necessarily identify themselves as ‘mediators.’”

However, as time went on, KIPCOR staff were able to develop the course to be more applicable to nurses, incorporating health-care scenarios into the role playing and making clear that “dealing with conflict is a patient safety issue,” Kniss says.

“The term is ‘emergent mediation.’ You don’t call yourself a mediator, but you learn how to use the strategies and techniques on the spot.

“In more traditional mediation, there is a professional mediator – a neutral third party – and you work through a standardized process with a tangible outcome, such as a written agreement. This is a more informal approach, using skills as the conflict arises.”

“In my role as a nurse, I am the main communicator between patients, their families and the physicians,” Schrag says. “Doctors spend maybe 15 minutes a day, tops, with each of their patients in the hospital. I spend hours every day caring for patients, listening to their needs and facilitating communication between them and their families and their care team at the hospital.”

“We were taught to listen to individuals in a new way – not just to reply, but to understand,” says Lisa Schunn, a 2016 nursing graduate who works at Via Christi St. Francis Hospital in Wichita in the pediatric unit.

“One of the most useful tools in establishing relationships with my patients – and especially their parents – has been actively listening to their concerns and then rephrasing those concerns back to them, using different words, to ensure I understand their feelings.

“While I have never been in their shoes, this helps them recognize I understand what they’re going through while their child is hospitalized and helps establish amazing rapport. More than once patient families have thanked me just for listening.”

“Every day in health care, there is some level of conflict,” says Geri Tyrell, Bethel director of nursing, “where nurses will need to mediate conversations – with peers, families, and the doctors and other health-care professionals who are part of the interdisciplinary team.

“This course sets our graduates apart,” she continues. “They enter the workforce understanding their own communication styles, and others’ communication styles. They are at the novice level of conflict navigation.

“The research shows so much conflict related to health care,” Tyrell notes. “Employers recognize the value of nurses having conflict mediation skills.”

So much so, that KIPCOR recently received a grant from the Kansas Health Foundation for a one-year pilot program to extend the mediation training to other health-care professionals.

“The mediation class gave me a new way to communicate empathy that helps develop trust and understanding between myself and patients [and] coworkers, and in my personal relationships,” Schunn says.

“Good communication skills are so important,” Schrag adds. “I believe that [the] class has helped me to be better at facilitating discussion between many different types of people.”

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