Design, Implementation, and Evaluation of an Interdisciplinary Consciousness-Raising and Transformational Change Intervention for Hospital-based Nurses

Being a nurse can be exciting, rewarding, stressful, and challenging. Researchers have used words and phrases such as "horizontal violence," "bullying," and "all of the responsibility with none of the authority," to describe some of what nurses routinely confront in a range of workplace environments. While these challenges are not unique to nurses, there are many facets of nurses' workplaces that can create such difficulties.

This project conducts and evaluates a series of workshops will be based on the work of Dr. Anne Nicotera and Marcia Clinkscales. These researchers have described a phenomenon called Structurational Divergence (SD). In any organizational environment, such as a hospital, there are multiple cultures. In this context, the term "culture" is used more broadly than ethnicity, and refers to shared occupational and professional identity (e.g., nurse, physician, pharmacist, administration, ICU, oncology, etc.). Each culture has its own rules and meaning systems which are often not verbalized, but are taken for granted. These cultures and meaning systems coexist and often conflict. Any event or decision about how to act is based on or interpreted through one's own meaning system. For example, an oncology nurse is likely to interpret the actions of an ICU nurse with a different cultural lens, a different meaning system. When these cultures clash, the clash can lead to SD. If an individual is at a nexus of incompatible meaning systems, when the rules or expectations of two cultures repeatedly and intractably clash, the individual can be thrust into a vicious circle of unresolved conflict, goal frustration, and inability achieve development, which further feeds the underlying unresolved conflict. This is SD. Thanks to generous funding from the George Mason University Center for Consciousness and Transformation, we are able to offer and conduct an in-depth assessment of a series of workshops designed to help nurses recognize SD in the workplace and to develop communication skills to improve the environment for all.


Anne Nicotera

Dr. Anne Nicotera is a nationally-recognized scholar of organizational and interpersonal communication. Her current focus is communication in healthcare contexts. Her research is grounded in a constitutive perspective, driven by the assumption that communication creates and constitutes organizational realities and cultures that then constrain those very communication processes from which they were created. Her topical areas of research include culture and conflict, diversity, race and gender, and aggressive communication, with a particular interest in nursing communication. She has published her research in numerous national journals, such as Health Communication, Human Communication Research, and the Journal of Applied Communication Research. She has also published five books and numerous chapters in scholarly monographs, including a chapter in the 2009 Handbook of Applied Communication Research that presents a theoretical model of race as political identity grounded in social construction.

Her current research is centered in the development of a body of theory around a phenomenon she has labeled structurational divergence (SD). SD is a particular phenomenon of conflicted interaction that is rooted in the intersection of multiple incompatible meaning systems. She is currently investigating how SD, as experienced by nurses in a hospital setting, is linked to horizontal violence (bullying), burnout, destructive aggression, nursing turnover, and patient outcomes. She is also currently studying the unique organizational structure and form of hospitals and healthcare systems. More broadly, she is developing a theory of diversity rooted in structuration theory. She is interested in using this new theoretical construction to structuration theory and SD theory to cultural competence training for healthcare practitioners who serve traditionally marginalized populations

Dr. Margaret M. Mahon

Dr. Margaret M. Mahon is an Advanced Practice Nurse in palliative care and ethics. She came to George Mason University in 2005 because of the wealth of palliative care resources in the region. Since that time, she has continued her palliative care research. Her current studies include an exploration of oncology nurses' understanding of palliative care (with Jim McAuley, PhD, Communication), patients' experiences of serious illness (with Gary Kreps, PhD, Communication), a study of patients' symptom burdens (with Carlos Gomez, MD), and a study of interventions with maternally bereaved children (with Margaret Shepard, PhD, RN). In addition, she is exploring how the informed consent process has changed (with Charles Harrison, MD). In addition, Dr. Mahon has been working with Dr. Nicotera to bring a nursing perspective to the extensive work Dr. Nicotera has done on nurses' workplace environment, including the important concept of SD.

Her practice has included work as an APN in palliative care (GWU Hospital), as well as working as an APN in palliative care and ethics at the Hospital of the University of Pennsylvania. While there she co-chaired the hospital ethics committee and was a Senior Fellow at the University of Pennsylvania Center for Bioethics. She currently serves on the Ethics Committee for the National Hospice and Palliative Care Organization and chairs the Research Committee for the Hospice and Palliative Nurses Association.

Dr. Sandra Cheldelin

Dr. Sandra Cheldelin is the Vernon M. and Minnie I. Lynch Professor of Conflict Resolution at the Institute for Conflict Analysis and Resolution (ICAR). Throughout her career in the academy she has been an active reflective practitioner. A licensed psychologist and expert in organizational conflict, she conducted large and small scale mediations, coached senior executives to create healthy work environments, resolved interpersonal, intergroup and inter-organizational conflict, designed institution building mechanisms and supported collaborative leadership. She has worked with more than 150 organizations including colleges, universities, medical schools, treatment facilities, corporations, associations, religious institutions and community organizations. She has been keynote speaker and invited lecturer on workplace issues of violence, change, race, gender and conflict. She has facilitated large-scale interethnic and interfaith community dialogues on topics of fear, terrorism, violence and suspicion. Cheldelin has convened large and small groups for a variety of purposes including the development of a national policy on policing for victims of violent crime, creating a 10-year institutional strategic plan, and designing and implementing neighborhood strategies for building community resilience. She is coauthor (with Ann Lucas) of Conflict Resolution, (Jossey Bass, 2004) and co-editor (with Daniel Druckman and Larissa Fast) of Conflict: from Analysis to Intervention (Continuum, 2003). She serves on a variety of conflict resolution related boards.