Incorporating Gibbs Reflective Cycle in a Group Setting

This incident that I would like to analyze using the Gibbs’ (1988) reflective cycle happened a few weeks ago. Our group was composed of seven members and meetings were held online using the social media platform. This group was considered as a closed group as we have decided not to take more members and stick with each other until the end of the semester (Yalom & Leszcz, 2005). We would only conduct group meetings in weeks where we are required to do assignments as a group. This conflict arose from a group assignment where we needed to record a conference video.

For me, the instructions were self-explanatory; however, some of my groupmates were confused about the goal of the recording assignment as they found the instructions ambiguous. Not having a leader in the group to facilitate the group chat, there was chaos as we all were messaging at the same time and were not respecting each other's time to speak or express how each of us understood the directions. Before starting the video conference, some panicked as one of our group members could not be contacted. Since all of us scheduled the recording time weeks prior, we were all getting anxious to finish the assignment as soon as possible as we had midterms coming up.

I decided to privately message one of our groupmates, "Mia," who was having a hard time following the directions. I suggested that we all should be on the same page to produce an excellent outcome and asked what her understanding of the instructions was. I was also hoping to get her insights on how the activity should be done as I felt that no one was listening to me in the group chat. To my surprise, she lashed out at me and said how discourteous I was to message her privately. I then clarified that I chose to message her privately as I was having a hard time getting my ideas across in the group chat as the topic suddenly shifted to one group mate who decided not to show up at the last minute. Moreover, I wanted to get her opinion to verify my comprehension of the aim of the assignment.

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Mia then verbalized, "Just so you know I can read, and if you have something to say, say it in the group. I do not particularly appreciate being privately messaged as we are not friends outside of school. I find this demeaning and disrespectful." This surprised me as from time to time, she would privately message me to ask about school-related matters such as instructions, deadlines, instructor's email addresses, and more; hence I thought it was okay to do the same. Since it was not my intention to annoy her, instead of explaining my side, I just apologized if she felt that her boundaries were violated.

The next day during clinical rotation, I did not know how to act around her, and the atmosphere was becoming awkward. To my shock, when I attempted to approach her, she exclaimed: "I thought you are not talking to us?" I responded: "What? no, who told you that?" She then said that "Alice," another groupmate, who knew about what happened, tried to talk behind my back and told them damaging things that I never said. Right then and there, in front of Mia, I decided to respectfully confront Alice, where she denied that she said anything to them. Mia, bewildered, stopped talking, shook her head, and continued with her work. Seeing this reaction from Mia, I decided to shake off the negativity and focused on my initial assessment. This is where I developed emotional dissonance.

Feelings

This negative experience made me feel attacked, violated, and misunderstood that I was on the verge of tears. I felt like I was "ganged up on" when my true intentions were to share my understanding of the instructions, to get my group member's insights, and to present an outstanding assignment. I was also embarrassed when she confronted me during clinical as one of the nurses heard the commotion. I could not contain my emotions and felt my arms getting heavy. I was shaking. I felt like throwing up. I was having a panic attack inside, but I had to show a positive face to my instructor, the nurses, and my clients.

According to Abraham (2000), this is called emotional dissonance, where there is a clash between experienced and expressed feelings due to self-efficacy demand in the workplace. To compose myself, I stood up, walked in the hallway to calm myself down as I know that it could negatively affect my clinical performance. That time, I was furious; I felt belittled. I felt my blood rushing into my head. However, being a responsible adult who is older than Mia, my cultural values include understanding, protecting, and valuing opinions of the younger ones. This helped clear my head of negative thoughts and anger slowly. I started to be mindful of my actions and practiced self-awareness. I told myself, "there should be a reason why she acts this way, along the way I may have done something that offended her or her values. I may have been over-involved; perhaps we are just going through the storming stage."

This prompted me to go back to where it all started. I believe what lead us to this disagreement is our feelings prior to the conflict. We all felt frustrated and anxious not only about the instructions but because of a group member that we felt was not putting enough effort into the assignment. Moreover, the stress of having clinical twice a week and the pressure of upcoming midterm exams contributed to these negative feelings. Also, I realized that having only three hours of sleep before the clinical shift due to studying for the exams contributed to be not being able to control my emotions at first.

Evaluation

The incident was extremely challenging for me and I feel like the conflict had not been resolved at all. We chose not to talk about what happened and mutually decided to move on with our lives and normally communicate with each other after the incident without addressing the problem. This left me with a pang of guilt as it affected the whole group negatively as they witnessed the conflict. What did not work me was holding on to my anger for too long, which I understand could have resulted in an unpleasant outcome as I had anger issues in the past. Nevertheless, after talking to a group member who reassured me that we were going through the storming stage due to lack of group cohesion.

This is relevant to Bruce Tuckman's (1965) definition of the storming stage, where he stressed that controversial communication can occur, leading to rivalries and aggression (as cited in Tuckman & Jensen, 2010). I felt more hopeful that we could resolve the conflict that arose by respectful communication. However, I realized that this stage should not be viewed as necessarily bad. According to Arnold and Boggs (2011), the storming stage includes members becoming comfortable to argue or disagree openly, and when this argument is managed correctly, relationships can be strengthened, and productive outcomes can be achieved (p.227). On the other hand, what went well during this interaction is that I was able to handle myself in a professional manner where I get to test my level of mindfulness and self-awareness. Moreover, I realized the importance of being able to self-reflect, especially in distressing emotional challenges choosing to focus on the positive learning experience instead of dwelling on the negative feelings.

Analysis

I believe that several factors escalated the conflict. These factors include lack of communication, lack of ground rules, lack of group cohesiveness, personality clashes, stress, violating boundaries, and lastly, avoidance. All the chaos in the group resulted from not having clear group goals as well as a lack of clear leadership in the group. Moreover, I believe that in order to address all these, I should have been more assertive and offered to facilitate the group as I know I have the ability to lead a group in the past successfully.

As a student nurse, it is important to recognize that I will be functioning in a complex group of relationships with other student nurses, patients, physicians, and instructors and will experience conflict, role confusion, and incompatible goals (Moreland, 2012). Given the conflict factors mentioned above, nurses at all levels may face difficulties in caring for patients while being "each other’s own worst enemy" (Moreland, 2012). However, several studies reiterate the importance of using a unique communication approach to understanding how nurses view conflicts and themselves, which can predict the nature of interpersonal communication such as feelings of helplessness during a conflict or willingness to confront a conflict (Moreland, 2012).

Firstly, having no ground rules can threaten the integrity of the group as it suggests how the members should behave; cohesive groups abide by these rules that can encourage conflict alongside support and allows members to openly express disagreement in a respectful manner (Yalom & Leszcz, 2005). Yalom and Leszcz (2005) emphasized that covert hostility may hinder cohesiveness development and interpersonal learning within the group, which can negatively impact the group therapeutic process. As we all know, it is not comfortable to continue to communicate with someone you dislike or have had an unresolved conflict in the past, but conflict resolution is essential in order to foster personal growth as well as encourage meaningful communication between group members (Yalom & Leszcz, 2005). This sadly happened within our group.

What we could have done to resolve this was to assign a leader, discuss ground rules and norms, and encourages open communication within the group. However, being familiar with the stages of group development, I understood that this uncomfortable experience would help us be a solid and stronger team as long as we come up with a successful resolution that will lead to the development of group-specific operational norms that will enhance group cohesiveness (the norming stage) (Arnold & Boggs, 2011, p. 227).

All in all, I realized that we skipped some variable steps that should have been done in the forming stage such as having a brief introduction even though we are known to each other, exploring the group's purpose or goals, clearly outlining each member's roles and responsibilities, and most importantly discussing boundaries such as communicating with each other outside the group setting which lead to power struggles and poor conflict resolution (Arnold & Boggs, 2011, p. 242).

Conclusion

While recalling what happened during the clinical, I realized that I would have done several things differently. I recognized in the beginning that our group did not go through the forming stage properly where expectations, purposes, and ground rules should have been discussed. Being an effective leader in the past, I should have initiated an introductory meeting where we could have learned more about each other and "find common threads in personal experiences," which I believe would have contributed to a group that is organized and a group that encourages open communication.

Without setting clear ground rules, I did not realize that I was violating Mia’s boundaries by messaging her outside the group. Moreover, I realize that I should have been more assertive when I felt that I was being attacked. I should have respectfully defended myself and voiced my opinions while explaining that I did not have the intention to offend Mia by messaging her privately. Assertive behavior, according to Arnold and Boggs (2011) includes forming goals and acting upon those goals in a consistent and clear manner while taking full responsibilities of consequences of actions; an assertive person stands up for own rights and the rights of others with an ability to appropriately express negative and positive feelings and thoughts; this demonstrates self-respect (p. 275).

The conflict created anxiety that prevented me from performing at my best capacity, which can compromise client care. I realized that telling myself to "pick my battles" and not addressing the conflict or avoidance could lead to future problems that influence the group relationship making it a lose-lose situation (Arnold & Boggs, 2011, p. 273). The British Columbia College of Nursing Professionals' [BCCNP] (2018) RPN Entry-Level Competencies under collaborative practice highlights the ability to recognize potential conflict and share the responsibility to resolve conflicts within the team; it also emphasizes the ability to address the conflict assertively and apply effective conflict-resolution techniques as well as reconciliation approaches for the team to be efficient and accomplish goals in a timely manner. Moreover, BCCNP (2018) also stressed that negotiation and proper communication should occur in order to mitigate barriers to become an effective team optimizing health care outcomes. This allowed me to acknowledge that instead of being passive-aggressive during the beginning of a clinical day, I should have asked Mia for a minute to talk about what happened and we can resolve our conflict. Moreover, I should have been very careful about the boundaries that we have as team members.

Action Plan

Having a growth mindset has given me an edge to consider challenges as opportunities for learning and discovering new strategies that would develop my skills as a nurse. This experience has urged me to look for ways to advance and improve in terms of conflict-resolution and assertiveness. I acknowledge the need for me to enhance my assertive skills, especially when working with peers, fellow nurses, and other professionals. Before semester five ends, I will enroll in a group based assertive training program located in Surrey BC, complete assertiveness workbooks on the Centre for Clinical Interventions website, complete Linehan's (1993) Dialectical behavior therapy (DBT) assertive skills training worksheets, and read at least three evidence-based articles and materials every week that discuss enhancing assertive skills. Moreover, I will watch evidence-based videos every week that tackle how to be assertive, especially in the nursing field and start journaling my non-assertive behaviors in order to start modifying them (Beagrie, 2006). 

In an article that I have read, I discovered that assertive training is much more effective when done in a group; this is like hitting two birds in one stone for me as I will get a chance to observe how a group training is conducted as well as how to effectively form goals and ground rules. According to McCabe and Timmins (2003), assertiveness is one of the most important skills for today's professional nurse in order to promote effective communication. Being able to "speak up" or being assertive is emphasized in the nursing field in order to establish safe communication and teamwork in healthcare settings (Mansour & Mattukoyya, 2019). I recognize that lack of assertiveness will hold me back not only career-wise but also in my personal life; since I have learned to recognize my passive side of sometimes being submissive or having a hard time setting limits with others, I want to work on not only being confident and building my self-image but also understanding and empathizing with others (Beagrie, 2006). According to Beagrie (2006), in order to speak up for self, it is crucial to practice in a real situation continuously; however, one should, of course, be mindful and self-aware not to cross any limits. Moreover, it is imperative to check emotions at all times; as I have had anger issues in the past, I should be really careful and must come across as rational, calm, and respectful at all times--- as not doing so could appear as aggressive which can negatively affect relationships (Beagrie, 2006).

Lastly, being mindful of body language is essential in order to make the other person feel comfortable, which can prompt them to actively listen to my concerns (Beagrie, 2006). Linehan's (1993) Dialectical behavioral therapy (DBT) skill group training manual is also an effective tool wherein the second module is focused on assertiveness training that helps nurses reflect, be mindful, be self-aware,  learn to say "no" and resolve interpersonal conflicts in approaches that, while maintaining self-respect, will improve and preserve relationship; this helps recognize/manage emotions, increase positive emotions, and overcome vulnerability to negative emotions which is very useful for me as someone with anger issues in the past ( Wolpow, Porter, & Hermanos, 2000).

References

Abraham, R. (1998). Emotional dissonance in organizations: A conceptualization of consequences, mediators and moderators. Leadership & Organization Development Journal, 19(3), 137-146. doi:http://dx.doi.org/10.1108/01437739810210185

Arnold, E., & Boggs, K. U. (2011). Interpersonal relationships: professional communication skills for nurses. St. Louis, MO: Elsevier/Saunders.

Beagrie, S. (2006). How to be more assertive. Occupational Health, 58(5), 24. Retrieved from https://search.proquest.com/docview/207314977?accountid=195685

British Columbia College of Nursing Professionals. (2018). RPN entry-level competencies. Retrieved from http://www.rpnc.ca/sites/default/files/resources/pdfs/RPNRC-ENGLISH%20Compdoc%20%28Nov6-14%29.pdf

Tuckman, B. W., & Jensen, M. A. C. (2010). Stages of small-group development Revisited1. Group Facilitation, (10), 43-48. Retrieved from https://search.proquest.com/docview/747969212?accountid=195685

Mansour, M., & Mattukoyya, R. (2019). Development of assertive communication skills in nursing preceptorship programmes: a qualitative insight from newly qualified nurses. Nursing Management, 26(4), 29–35. doi: 10.7748/nm.2019.e1857

McCabe, C., & Timmins, F. (2003). Teaching assertiveness to undergraduate nursing students. Nurse Education in Practice, 3(1), 30–42. doi: 10.1016/s1471-5953(02)00079-3

Moreland, J. J. (2012). Nursing the identity: The mediating roles of learned helplessness and interaction involvement in predicting willingness to confront conflict and anticipated turnover (Order No. 3528034). Available from Health Research Premium Collection. (1070409531). Retrieved from https://search.proquest.com/docview/1070409531?accountid=195685

Wolpow, S., Porter, M., & Hermanos, E. (2000). Adapting a dialectical behavior therapy (DBT) group for use in a residential program. Psychiatric Rehabilitation Journal, 24(2), 135–141. doi: 10.1037/h0095107

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. New York: Basic Books.