[Skillful negotiations and conference technics this year's theme. Professional interest in negotiations?].
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Collective Bargaining↗
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Results for “Negotiating”
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The art of negotiation. An everyday experience.
The art of negotiation permeates every aspect of one's professional and personal life. Nurse administrators who use a scientific method of negotiation to augment professional judgment and decision making can create a climate conductive to success. The author reviews the definition and purpose of negotiation, examines concepts associated with negotiation and communication, analyzes the steps in the negotiation process, relates the negotiation process to the change process, and describes strategies for conducting effective negotiation.
Cooperative Behavior↗
A negotiation model for the doctor-patient relationship.
A model has been developed to help physicians negotiate with patients in more explicit and effective ways. This model provides physician teachers and learners with a framework and a common language to describe the dynamic nature of the doctor-patient negotiation. This framework consists of three dimensions: content, relationship levels, and the problem-solving phases. The constructs of disease, illness, sickness and the patient's context are used to describe the content of negotiation: this is what the doctor and patient are talking about. Autonomy, power, control and responsibility are the constructs that define the relationship levels: autonomism, egalitarianism, parentalism, and autocracy. These levels describe how the doctor and patient relate to one another during their negotiation. The problem-solving phases are relationship building, agenda setting, assessment, problem clarification, management and closure. Teachers and learners can use this model to describe how the doctor and the patient affect the negotiation process, and how the process in turn affects the doctor-patient relationship and medical care. With practice using this model, physicians can increase their repertoire of negotiating strategies that will efficiently enhance doctor-patient collaboration, the problem-solving process and the health of the patient and family.
Authoritarianism↗
Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules.
This study compares the responses of opiate addicts at a London drug treatment centre to two outpatient methadone-based detoxification programmes. These involved either a fixed (non-negotiable) dose reduction schedule or a flexible, negotiable withdrawal schedule. In the negotiable condition, subjects were less likely to complete the detoxification programme and the mean reduction in dose achieved by the subjects in the negotiable condition was less than that in the fixed group. There was no difference between groups in programme retention at 6 weeks though subjects who remained in treatment in the negotiable group tended to extend their detoxification period beyond this point. The overall response of subjects in both groups was unsatisfactory. Only 13% of the subjects initially allocated to detoxification or 28% of those who actually started detoxification completed treatment; urine screening showed that heroin abuse was a continuing problem during treatment. The implications of these results for detoxification and drug treatment services are discussed.
Adult↗
A study of role negotiation between nurses and the parents of hospitalized children.
The role of the parent of a hospitalized child has changed considerably over the past 30 years. Where parents were previously expected to had responsibility for care over to their child's nurses, there is now an expectation that parents will be extensively involved in the care of their hospitalized children. The negotiation of roles between nurses and parents has been advocated by workers concerned about conflicts between nurses and parents. However, it is not known whether such negotiation takes place between nurses and parents. It is clear that power is not evenly distributed between nurses and parents: issues of territory, stress, anxiety, uncertainty, control and conflicts arising from parental competence all place the parent in a weaker position. It is argued that the nurse holds the initiative in the decision about whether negotiation takes place. A small study is described in which nurses were invited to describes their response to their perception that a parent wanted to increase or decrease her or his involvement in her or his child's care. The critical incident technique (Flanagan 1954) was used to collect data. Nurses' responses were categorized into categories of 'encouragement', 'explanation/advice' and 'negotiation'. Responses were then placed in more specific subcategories. The inter-rater reliability of the categorization was measured. Owing to the limitations of the study, the results can only be regarded as suggestive. Nevertheless, significant association was found between the category of response and the grade of staff, with a stratified pattern of category of response demonstrated. The implications of the study for future research are discussed.
Attitude of Health Personnel↗
"Adherence" and the negotiated approach to patienthood.
A study was conducted on adherence to treatment referrals made in the psychiatry walk-in clinic of a general hospital. One hundred thirty patients were administered the patient request form, a general information questionnaire, and a postinterview evaluation questionnaire. Information on adherence was obtained from the hospital records. Forty-one percent of the patients adhered to the treatment referral. Adherence was significantly related to negotiation, as predicted. Another significant predictor of adherence was the patient's getting the plan he wanted. Adherence was not found to be related to demographic measures or scores on the patient request form. The index of negotiation also correlated significantly with the patient's evaluation of the interview, replicating previous findings. The relationship of adherence and negotiation is discussed.
Adult↗
The negotiation of death: clinical decision making at the end of life.
The ability of medical science to prolong biological life through the use of technology raises the question of how far physicians should go in treating the terminally ill patient. In clinical decision making involving the dying patient, physicians, patients and families bring various perceptions and interpretations to the situation. These different realities must be negotiated in order to define the meaning of the situation and the meaning of various medical technologies. The patient's demise becomes a negotiated death, a bargaining over how far medical technology should go in prolonging life or in prolonging death. A case study of the process of ethical decision making in the foregoing of life-supporting therapy in an intensive care setting is presented and analyzed. The decision making process in this case follows a 'cascade' pattern rather than a controlled, reflective model. While ethicists view the withholding and withdrawing of life-supporting treatment as morally equivalent, physicians tend to make a distinction based on the perceived locus of moral responsibility for the patient's death. In the author's interpretation the moral responsibility for the patient's death by withdrawing treatment is shared with family members, while the moral responsibility for the patient's death by withholding treatment is displaced to the patient. The author suggests that an illusion of choice in medical decision making, as offered by the physician, begins a negotiation of meanings that allows a sharing of moral responsibility for medical failure and its eventual acceptance by patient, family and physician alike.
Aged↗
Evaluation of the initial interview in a walk-in clinic. The clinician's perspective on a "negotiated approach".
A negotiated approach to the conduct of the initial interview has been developed from the need for a more flexible and active exchange between clinician and patient. The setting is the walk-in clinic of the psychiatry service in a large urban general hospital, staffed mostly by first-year residents and staff social workers. These clinicians [26] were asked to evaluate the utility of the negotiated approach. They rated the approach both from their perspective and from that of 136 patients they interviewed. Although the clinicians evaluated the approach positively, they associated their satisfaction much more with the aims of a diagnostic approach than a negotiated one. The clinicians do not perceive that patients share satisfaction in their instrumental objective of understanding (a diagnostic goal), and the clinicians do not perceive that they share satisfaction in the patient's instrumental objective of participating in the treatment planning. The sharpest divergence between the clinician's and perceived patient satisfaction was over two evaluation/outcome measures: the treatment plan being wanted and attainment of symptom relief. These measures correlated much better with perceived patient than clinician satisfaction. Divergence in perspective between clinician and patient was discussed with regard to possible sources, the effect of setting, and the implication for the delivery of services.
Adolescent↗
Examining the process and dilemmas of reality negotiation.
Reality negotiation is the process people use to examine information from their environment and make judgments about the accuracy and importance of that information. Although this process has been found to be inaccurate, nurses often express discomfort when clients hold perceptions of reality that run counter to their own views. Nurses in these circumstances see the client as denying or as having unrealistic hopes. This article examines reality negotiation in light of this clinical dilemma, focusing on three areas: 1) the assumptions made regarding the nature of reality; 2) the potential and real outcomes of different types of reality negotiation; and 3) the process by which reality is redefined and how unrealistic perceptions are threatened and/or abandoned. These issues are explored as they relate to nursing research and practice.
Adaptation, Psychological↗
[Strategies of interpersonal negotiation in children 18-24 months of age (conflict, avoidance and resolution of the conflict)].
This research seeks to determine the social competence of children between 18 and 24 months of age. It took place in two consultation centers (PMI) (50 children of North African origin) and two nurseries (20 native children). Each child is observed in a "natural" setting: in a waiting room and during free activity. The sequences in its behavior allow us to pinpoint the conflicts arising between the child and its peers as to who gets what and how an object is used: it also allows us to analyze the negotiating tactics it brings into play: resolution or avoidance tactics. Three conclusions can be drawn: 1. The ways of negotiating depend on the context; 2. The young child's negotiating shows processes of becoming less self-centered that go from mere anticipation to coordinating viewpoints; 3. Each child shows an interactive style. This research could contribute to creating a preventive policy: the pedagogy of conflict and a program for learning to interrelate socially.
Attitude↗
Patient-physician negotiation.
The low level of patient compliance with physician management regimens is widely recognized. Although numerous studies either have measured levels of noncompliance or have attempted to fathom the essential elements of patient-physician interaction, they do not indicate how complicance may be increased. Negotiation is a process by which two active and equal participants negotiate to obtain their respective goals (which are often at odds). Without appropriate negotiation, which requires the patient's active participation, the physician cannot hope to motivate the patient. Patients will continue to be noncompliant as long as they are treated as inferiors in the process.
Attitude of Health Personnel↗
Negotiating self-care in rehabilitation nursing.
The authors conducted a study to examine nurse and patient perceptions of self-care and the performance of self-care in rehabilitation settings. The grounded-theory method was used to conduct and analyze in-depth interviews of 12 nurses and 12 rehabilitation patients. Every nurse and every patient had expectations regarding who would control each aspect of the patient's self-care. When these expectations were noncongruent, negotiation usually occurred. Successful negotiation resulted in a balance of self-care, the optimal balance between nurse and patient control.
Humans↗
Negotiating reality after physical loss: hope, depression, and disability.
The utility of different reality negotiation strategies among 57 persons who had traumatically acquired severe physical disabilities was examined. It was predicted that a sense of goal-directed determination ("agency"; Snyder, 1989) would predict lower depression and psychosocial impairment scores soon after injury. To meet the demands of rehabilitation and social integration, however, it was hypothesized that a sense of ability to find ways to meet goals ("pathways") would predict lower depression and psychosocial impairment among persons who had been disabled for a longer period. The expected interaction was significant in the prediction of psychosocial impairment but not of depression. The sense of pathways was predictive of impairment and depression regardless of the time since injury. Results suggest that in the reality negotiation process the different components of hope as defined by Snyder have salient effects on perceptions of ability to function in social capacities.
Activities of Daily Living↗
Social validation of component behaviors of following instructions, accepting criticism, and negotiating.
This study evaluated whether behaviors often taught as part of social skills training are judged favorably by others. Community judges evaluated the performances of people in various situations requiring one of three social skills: following instructions, accepting criticism, and negotiating to resolve conflicts. These skills were displayed in videotaped scenes by actors with and without mental retardation who acted out roles that had different types of authority relationships, and when different components or clusters of behavior (nonverbal, specific verbal, or general verbal behaviors) were performed well or poorly. The highest ratings by judges were of videotaped scenes that depicted correct use of all behaviors, regardless of which skill was being examined, whether or not the actor had mental retardation, or what the relationship was between the two actors. The lowest ratings were of videotaped scenes that depicted poor performance of all behaviors, and intermediate ratings were obtained when only some of the behaviors were performed poorly. These results, as well as the verbal responses of judges to questions, indicated that the different behaviors commonly used in teaching the skills of following instructions, accepting criticism, and negotiating are relevant to judgment of social performance, and are likely to be reinforced and maintained by social contingencies.
Activities of Daily Living↗
What issues should be considered when negotiating an employment contract? Employment contracts for CRNAs: protecting yourself amid the new economic realities.
Severe imbalances in the supply and demand for nurse anesthesia services are giving CRNAs a new and substantial economic worth in the health care provider marketplace. As a result, CRNAs are using written employment contracts increasingly to delineate their scope of practice, limit their liability, and protect their new economic value. This article discusses basic points that every anesthetist should consider in negotiating such contracts. Practical suggestions are offered for conducting negotiations as both an employee and independent contractor.
Contract Services↗
Negotiating criteria and setting limits: the case of AIDS.
The classification of clinical problems, such as AIDS, requires choices. Choices are made on epistemic (i.e., knowledge-based) and non-epistemic (i.e., action-based) grounds. That is, the ways in which we classify clinical problems, such as AIDS, involve a balancing of different understandings of clinical reality and of clinical values among participants of the clinical community. On this view, the interplay between epistemic and non-epistemic interests occurs within the embrace of particular clinical contexts. The ways in which we classify AIDS is the topic of this paper. We consider the extent to which we construct clinical reality; we examine a suggested classification of AIDS; and we conclude suggesting that the choice regarding how to classify AIDS is the result of negotiation among participants in the clinical community.
Acquired Immunodeficiency Syndrome↗
Negotiating educational programs for children with developmental disorders: assessment, interpretation, demonstration, support (AIDS).
An approach to negotiating educational programs for children with multiple developmental problems is presented using two case examples from an interdisciplianry setting, the University Affiliated Cincinnati Center for Developmental Disorders. The use of the AIDS (Assessment, Intervention, Demonstration, Support) approach offers the schools evidence that the professional educator and psychologist are working in good faith and will not abandon them prematurely. Proper school placement through mediation also allows the school personnel to receive credit from the family for making the necessary changes, therefore not losing face with the parents. This approach seems particularly applicable to children with multiple and chronic problems who do not fit single special educational/diagnostic categories or labels.
Child Psychiatry↗
Negotiating with clinical agencies for nurse practitioner student experiences.
Selecting appropriate agencies and preceptors for pediatric nurse practitioner (PNP) students is vital for an optimal clinical educational experience. Agencies that are committed to the role of the nurse practitioner are usually willing to teach students. This article explores the process of negotiating clinical placement for PNP students. Those PNPs who wish to serve as preceptors may also benefit from this information.
Clinical Competence↗