Case Study: Conflict Management
Conflict Management is illustrated in the following two cases:
Mrs. T and Continuity of Team Care
(Case developed by Nancy L. Wilson, L.M.S.W.,
and Judy Farness, M.S.N., G.N.P.)
Mrs.
T is an 82-year-old widow who lives in a personal care home and receives
care from a geriatric team in a teaching clinic and hospital. Mrs. T has
end-stage dementia; however, her family (including a very involved local
daughter and an out-of-town son) has not been ready to enroll her in hospice
care. One evening she is admitted to the hospital after fracturing her
hip. An experienced resident on the geriatric service saw her in the emergency
room (ER), performed the workup, and arranged for an orthopedics surgical
consultation.
The
next morning Mrs. T’s care was discussed in the team meeting. The resident
immediately became upset and defensive, explained that the patient had
presented to the ER, and stated that the standard of care was workup and
surgical intervention for a broken hip.
The Care of Mrs. D
(Case developed by Nancy L. Wilson, L.M.S.W.,
and Judy Farness, M.S.N., G.N.P.)
Mrs.
D is a seventy-six–year–old widow who suffers chronic pain because of
degenerative joint disease in her spine. She gets relief using pain medication
that requires a prescription for a controlled substance. Mrs. D and her
only involved daughter acknowledge a known history of drug dependence.
Mrs. D’s prescription restricts her to receiving ten days of pills (100)
at one time. The patient is chronically worried that she will run out
of these pain pills over the weekend so begins calling, usually within
the week the medications are refilled (remember there is only enough for
ten days and we ask that patients give us at least twenty-four hours’
notice on a refill). As a result the office nurse is regularly getting
phone calls asking for what seems to be early refills. If a long weekend
or a holiday is coming up, the patient calls even earlier. The usual protocol
is for the office nurse to get the primary care provider to approve the
refill. With this patient, there is always a hassle with the patient,
the nurse, and the provider, and it is extraordinarily frustrating to
have to go through this week after week. The nurse ends up making lots
of phone calls to the pharmacy, patient, and primary care provider, explaining
all of this. The office nurse is angry with both the patient and the doctor
for putting her in the middle and for the amount of her time these interactions
consume. The physician doesn't want to deal with these issues, and it
is clear to him that medication needs to be monitored and not prescribed
indiscriminately. Attempts to interact on this problem have been generally
unsuccessful, possibly because it is seen as an "office problem."
