GROUP DYNAMICS

Group dynamics is the social process by which

people interact in a group environment. The
influence of personality and power of behaviour on
the group process can influence the dynamics of
any group.

Group dynamics is the study of groups and

group processes. Groups can work effectively
only if their members stick to certain desired
norms, which Cartwright has termed principles of
group dynamics.
Principles of group dynamics
1. To use a group effectively as a medium of change, the
members who are to be changed and the members who are
to wield an influence for change must have a strong sense
that they belong to the same group, i.e. the differences
between the leaders and the led should be broken.
2. The more the members like a group, the greater influence it
would exercise on them.
3. Successful efforts to change subparts or individuals of a
group would result in making them conform to the norms of
the group.
4. The greater the status of a group member in the eyes of
other members, the greater the influence he will exercise on
them.
5. Strong pressure changes a shared perception by
members for the need for the change, making
the source of pressure for change lie within the
group itself.
6. All the members of a group must share
information relating to need for change plans for
change, and the consequence of change.
7. Any change in one part of a group produces a
strain in other related parts: this can be reduced
only by eliminating change or by readjusting the
related parts.
 Theoretical Aspects of Group Dynamics
1. Kurt Lewin(1943,1948 and 1951) is the founder
of the movement to study groups scientifically. He
coined the term ‘group dynamics’ to describe the
way individuals and groups act and react to
changing circumstances.
2. Wilfred Bion (1961) studied group dynamics
from a psychoanalytic perspective. Many of his
findings were reported in his published books,
especially Experiences in Groups. The Tavistock
institute has further developed and applied the
theory and practices developed by Bion.
3. William Schutz (1958 and 1966) looked at
interpersonal relationship from the perspective
of three parameters: inclusion, control and
affection. This became the basis for a theory of
group behaviour that sees groups as resolving
issues in each of these stages in order to be able
to develop each to the next stage. Conversely, a
group may also devolve to an earlier stage if it
is unable to resolve outstanding issues in a
particular stage.
4. Bruce Tuckman (1965) proposed the four – stage
model called Tuckman’s stages for a group.
Tuckman’s model states that the ideal group
decision-making process should occur in four
stages:
a. Forming (to get on or get along with others)
b. Storming (letting down the politeness barrier
and trying to get down to the issues even if
tempers flare up)
c. Norming (getting used to each other and
developing trust and productivity)
d. Performing (working in a group to a common
goal on a highly efficient and cooperative basis)
 Group Task Roles
There are 11 tasks that each group performs. A
member may perform several tasks, but for the
work of the group to be accomplished, all of the
necessary tasks will be carried out either by
members or by the leader. These roles or tasks are
as follows:
1.Initiator: Proposes or suggests group goals or
redefines the problem. There may be more than
one initiator during the group’s lifetime.
2.Information seeker: Searches for a factual basis
for the group’s work
3.Opinion seeker: Seeks opinions that clarify or
reflect the value of other member’s
suggestions.
4. Information giver: Offers an opinion of what
the group’s view of pertinent values should be.
5. Elaborator: Provides examples or extends
meaning of suggestions given and how they
could work.
6.Orienteer: Summarizes decisions and actions,
identifies and questions departures from
predetermined goals.
7. Coordinator: Coordinates and clarifies
suggestions, ideas, and activities of the group.
8. Evaluator: Questions group accomplishments
and compare them with a standard.
9. Procedural technician: Facilitates group
action by arranging the environment.
10. Energizer: Stimulates and prods the group to
act and raise the level of its actions.
11. Recorder: Records the group’s
accomplishments and activities.
Stages of Group Development
Bruce Tuckman (1965) developed a four – stage model of group
development. He labelled the stages, Dr Seuss – style:

1. Forming: The group members come together and gets to

initially know one other and form a group
2. Storming: A chaotic vying for leadership and trialing of
group processes.
3. Norming: Eventually, agreement is reached on how the
group operates (norming).
4. Performing: The group practices its craft and becomes
effective in meeting its objectives. Ten years later, Tuckman
added a fifth stage
5. Adjourning: The process of ‘unforming’ the group, that is,
letting go of the group structure and moving on.
 TEAM WORK IN NURSING
All over the world, the most successful
management have always developed a team for
efficient organization of their work.
In team nursing, a team leader is responsible for
coordinating a small group of licensed and
unlicensed personnel to provide patient care to a
small group or a patient. A team is a group of
people with a high degree of interdependence
geared towards the achievements of a goal or a task.
Making Assignments by Team Leaders

The team leader gives each member a patient or a

specific responsibility. The members of the team
report directly to the leader who then reports to
the charge nurses or and manger. There are
several teams per unit and patient assignment is
made by each team leader. The factors to be
considered in making assignments by the team
leader are as follows:
1. Know the patient and his /her individual needs.
2. Consider priorities of patient.
3. Revise assignments as emergencies arise.
4. Distribute as emergencies arise.
5. Distribute work load according to emotional level of
team members.
6. Implement sound suggestions offered by team
members.
7. Write assignment clearly.
8. Promote growth and optimal functioning of each
member.
9. Provide atmosphere for job satisfaction.
10. Be a teacher as well as leader.
11. Evaluate the effectiveness of patient care.
Nature of Team work
Coordinated action by a group whose team members
contribute responsibly and enthusiastically towards task
achievement is known as teamwork. It works best in a
supportive environment. The essentials of teamwork are:
1. A group
2. A leader
3. A common goal
4. Regular interaction
5. Coordination
6. Responsible contribution of each member
7. Team spirit
Characteristics of an Effective Team
Characteristics of an Effective Team

1. The working atmosphere is informal, relaxed and

comfortable. There are no obvious tensions and
people are interested and involved.
2. There is a lot of discussion in which virtually
everyone participates, but it remains pertinent to
the task of the group. If the discussion gets off the
subjects, someone will bring it back on track
shortly.
3. The objectives of the group are well understood
and accepted by the members after free
discussion, followed by commitment of the
members.
4. Members listen to each other. Every idea is given
hearing. Members are not afraid to offer extreme
views.
5. There can be disagreement and the group is
comfortable with this and does not have to avoid
conflict or keep everything on the plane of
sweetness. Light disagreements are not
suppressed or overridden. Options are carefully
examined and the group works for resolution.
6. Most decisions are reached by a kind of consensus
in which everybody is in general agreement and
willing to go along. Members are honest
concerning their part of the work and voting is
kept to a minimum.
7. Criticism is frank, frequent and relatively
comfortable. There is little evidence of
personal attack, either openly or in a hidden
fashion. The criticism is constructive and
directed towards problem solving
8. People are free in expressing feeling and
thoughts. There is little pussyfooting and
there are few hidden agendas. Everybody
seems to know how others feel about any
matter being discussed.
9. When action is taken, clear assignments are
made and accepted.
10.The chairperson of the group does not
dominate nor does the group defer unduly to
him or her. Leadership shifts occur as
circumstances dictate. There is little evidence of
a struggle fort power; the issue is not who
controls, but how to get the job done.
11.The group is aware of its own operation and
examines how well it is doing. Maintenance of
the group is a priority that gets regular
attention
TRUST
In team nursing, trust plays the main role. Trust
is a central issue in all relationships. It lies at
the heart of collaboration and is essential to
organizational effectiveness. Trust exists when
we make ourselves vulnerable to others where
we cannot control subsequent behaviour. By
trusting another person, we become dependent
upon them. The level of trust governs
subsequent behaviour.
High trust: This leads to openness about feelings,
clarity about goals and problems, self disclosure,
more searching for alternatives instead of jumping to
conclusions, greater levels of mutual influence,
closeness, increased motivation, increased comfort
with each other, tolerance of differing viewpoints, and
better utilization of expertise and abilities.
Low trust: This leads to the following conditions: self-
protective behaviour; controlling environments;
ideas, facts, conclusions and feelings ignored;
disguised and distorted; people becoming
suspicious; non-receptive and perceived
manipulation; attempts to be truly open being
rejected; efforts to build trust not successful;
misinterpretation and misunderstanding
Dependence on a relationship requires taking
the first step in trusting another person
despite uncertainty about the consequences.
If neither person takes the risk of trusting, at
least a little, the relationship remains stalled at
a low level of suspicion and caution. Trusting
others competence, judgment, helpfulness or
concern results in greater willingness to be
open. The foundation of a trusting relationship
is, believing that the other person has
integrity.
Indications of bad teamwork include:
Frustrations, grumbling and retaliation, miserable
facial expressions, unhealthy competition,
dishonesty and lack of openness, contribution by
only a few members with managers laying down
the rules, poor interpersonal relationship
between managers and employees, and lack of
development within the team.
Lack of team development occurs because:
There are perceived or real pressures.
1. It is seen as the job of the personnel department or
training officer.
2. Conflict exists between the team’s culture and that of
the organization.
3. Team leaders lack the skills and willingness to make it
happen.
4. There is fear of the consequence of development.
Sometimes poor teamwork results in jobs not getting done
in time or even not done at all because there is no clear
understanding or rules within a team. People tend to work
in isolation, and they neither offer nor receive the help of
their colleagues. There is also lack of creativity.
 Team work in Nursing Practice
Many studies have lead to the conclusion that teamwork
results in higher staff job satisfaction, improved quality of
care, increased patient safety, greater patient satisfaction,
more productivity, and a decreased stress level. But the
teamwork of nursing staff on a patient care unit has
received very little attention from researchers. In one of
these studies, an intervention to enhance staff
engagement and teamwork was tested on a medical unit
in an acute care hospital. The results showed that the
intervention resulted in a significantly lower patient rate,
staff ratings showed improved teamwork on the unit, and
there was lower staff turnover and vacancy rates.
Although patient satisfaction ratings were approached,
they did not reach statistical significance.
Highly functioning teams have also been shown to
offer a wider range of support to in experienced staff.
There have been a plethora of studies outside health
care that highlight the value of teamwork. For
example, one investigation of flight crews
demonstrated the link between teamwork and safety.
The researchers evaluated the impact of tiredness on
error rate and found that staff who had flown together
for several days made fewer errors than teams who
were rested and had not worked together for very
long. The tired team actually made more errors, but
because the team had worked together, they were
able to compensate and catch one another’s near
misses.
This is due to less stress, knowledge of the
strengths and vulnerabilities of other team
members, and the practice of monitoring
performance and giving feedback to one
another.

Numerous studies have tested interventions to

improve teamwork. The approaches include
teamwork skills training, cross – training, crew
resources training, simulation, role playing,
automation, post training feedback, team –
building activities, and a combination of training
and action groups.
Specifically within health care, there has been
a growing awareness of the need to improve
teamwork. In July 2004, the Joint Commission
on the Accreditation of Health Care
organizations (JCAHO) released a Sentinel
Event Alert on the prevention of infant deaths.
Its database showed that nearly three-
quarters of hospitals cited communication
breakdown and teamwork problems as a
major reason for these deaths. The JCAHO
recommended that hospitals conduct formal
team training to the obstetrical / prenatal
personnel.
In a study by Dynamics Research Corporation, error
patterns and weakness in emergency department
teamwork were assessed, and a prospective evaluation
of a formal teamwork training intervention was
conducted. Improvements were obtained in five key
team work measures, and most importantly, clinical
errors were significantly reduced. Hope et al. found that
a team-building initiative for health profession students
resulted in an improved interdisciplinary
understanding, teamwork skills and team atmosphere.
In another study, teamwork of emergency department
physicians and nurses significantly increased the
quality of team behaviour, attitude towards teamwork
and decreased clinical errors.
 Tools and Issues That Support Teams
1. In groups and out groups: Most members want to be at
the core of decision- making process and influence other
members. In other words, they want to be part of the in
group and researchers have demonstrated that those who
feel ‘in’ cooperate more, work harder and more
effectively, and bring enthusiasm to the group. The more
we do not feel a part of the key group, the more ‘out’ we
feel, the more we withdraw, work alone, day dream and
engage in self-destructive behaviours. There are often
intergroup conflicts when such individuals want to be ‘in’.
They create a division that prohibits the team from
accomplishing its goal.
2. Power and control: Everybody wants at least
some power and everybody wants to feel he/she
is in control. When faced with changes that we are
unable to influence, we feel unimportant and
experience a loss of self-esteem.
3. Appreciation for individual skills: It is
important for all to feel as though their
contribution is needed and valued and they are
respected for what they have to offer to the
workplace. Therefore, although in a group
everyone has weakness and there is a need to
point these out, it is important to spend time in
ongoing correction. It is better to focus on
people’s strengths, and acknowledge and
emphasize what people do well.
4. Group agreements: One of the most helpful
tools available is to have team agree on the
ground rules and how they function in relation
to one another. The following qualities are
essential for the group to work harmoniously
together:

a. Trust: Trust is a major issue within a group

and one of the first questions to come up in
the group is who can be trusted.
a. Team spirit: Each member of the team participates in the
decision – making process. The team leader is responsible
for facilitating a cooperative environment among team
members and encouraging each member to work towards
the same goal. Since decision making occurs at all levels,
every member of the team feels his or her contribution is
of value in order to have a winning team.
b. Leadership skills: The team leader must possess excellent
communication skills. Conflict resolution techniques,
delegation abilities, effective decision – making abilities
and strong clinical skills, provide a working team
environment for the members. If a team environment
does not exist then the members might not assure
individual accountability necessary to provide quality
patient care.
c. Nurse Manager’s role: The nurse manager,
nurse in charge and team leaders must have
management skills to effectively appoint the
team nurses for patient care. The unit manager
must determine which registered nurse is skilled
and who is interested in becoming a nurse in
charge or team leader. The nurse manager
should provide adequate staff to the team
nursing system by providing continuing
education about management techniques and
group activities. By addressing this factor, the
manager aids the team to function optimally.