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Medicine, Health Care and Philosophy
Published in: Medicine, Health Care and Philosophy 4/2013

Open Access 01-11-2013 | Scientific Contribution

Conflicts and conflict regulation in hospices: nurses’ perspectives

Results of a qualitative study in three German hospices

Authors: Andreas Walker, Christof Breitsameter

Published in: Medicine, Health Care and Philosophy | Issue 4/2013

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Abstract

The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of conflicts among nurses, with doctors, patients and family members. The management has two choices to react to these conflicts. It can either tolerate the conflicts, as long as they do not disturb the daily routine. Or it can increase the degree of organisation by integrating the different viewpoints into its own program and/or by restructuring its organisational units.
Footnotes
1
According to the Residential and Participation Law [Wohn- und Teilhabegesetz (WTG)] in the German Land North Rhine Westphalia, any citizens residing in a hospice should be allowed, inter alia, “a life which can be conducted with the greatest possible degree of self-determination and independence”, “where their privacy and intimate space is protected”, “where they are accorded respect” and “where they can die in dignity” (§ 1 para. 2 WTG) These stipulations are based on the “Charter for People with Special Needs or Requiring Care” [“Charta der hilfe- und pflegebedürftiger Menschen”]. We are grateful to Mr Dirk Kassen at the Ministry of Health, Emancipation, Care and Age of North Rhine Westphalia for drawing our attention to the above.
 
2
In a previous study one of us examined the intrapersonal moral conflicts of hospice nurses and volunteers. Therefore our interest in this study is the interpersonal conflict. The basic question was: which conflict is relevant in practice. To be relevant a conflict consists if at least two parties have different, sometimes contradicting, exclusive positions concerning facts, an actual situation or circumstances. Such conflict has to be apparent otherwise it is not interpersonal.
 
3
Ethics Commission of the Medical Faculty of the Ruhr-University, Bochum, 21.10.2010, Registration-No.: 3850-10.
 
4
The interviews were recorded using a digital recording device after the interviewees had been informed and their written consent had been obtained. They were then transcribed verbatim. During this process the data were rendered anonymous. For the process of transcription, we used semi-interpretative working transcription [Halbinterpretative Arbeitstranskription] (HIAT) within which para-verbal and non-verbal expressions which are significant for the content are recorded; the score notation of transcription was implemented with the assistance of the EXMARaLDA computer programme. During the accompanying observations, handwritten notes were taken; after the meetings they were processed and rendered anonymous.
 
5
Therefore we have no category like “relationship between nurses and doctors/general practitioners” or “relationship among nurses” because the conflicts in these categories are always about the area of medication or care.
 
6
Tavor or Lorazepam is a benzodiazepine which is used for the treatment of anxiety and panic disorder. Properly used the sedation of the patient will be moderate. Lorazepam can lead to addiction.
 
7
There are also situations in which the patients know that they are going into a hospice but they do not know that they are destined to die there. They have an inaccurate understanding of the institution.
 
8
Ralf Dahrendorf writes: “Die Einstellung zu Konflikten, die im Gegensatz zur Unterdrückung und zur ‘Lösung’ Erfolg verspricht, weil sie den sozialen Realitäten angemessen ist, werde ich als Regelung von Konflikten bezeichnen. […] Konflikte verschwinden durch ihre Regelung nicht; sie werden nicht einmal notwendig weniger intensiv; in dem Maße aber, in dem es gelingt, sie zu regeln, werden sie kontrollierbar und wird ihre schöpferische Kraft in den Dienst einer allmählichen Entwicklung sozialer Strukturen gestellt.”
 
9
The same might be expected according to the theory of interaction ritual (cf. Erving Goffman 1971).
 
10
Using Singer’s work as a basis, Werner Link distinguished between conflicts on the one hand and positional differences, irreconcilable tendencies and competition on the other (cf. Link 1979, p. 43).
 
11
Singer reserves the use of the term “conflict” for cases involving differences “in which the collision threatens the stability and viability of the integrated unit” (Singer 1949b, p. 169).
 
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Metadata
Title
Conflicts and conflict regulation in hospices: nurses’ perspectives
Results of a qualitative study in three German hospices
Authors
Andreas Walker
Christof Breitsameter
Publication date
01-11-2013
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 4/2013
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-012-9459-8

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