A latent class analysis of adolescent dating violence: Associations with daily conflict management

BACKGROUND

Adolescent dating violence (ADV) is a major public health concern experienced by more than half of adolescents. Previous studies have found considerable diversity in patterns of ADV and suggest that its various forms often occur concurrently and reciprocally within adolescent dating relationships. While multiple robust distal correlates of ADV have already been established, research on situational factors, such as conflict-related variables, is still sparse.

OBJECTIVE

This study aimed to identify patterns of ADV based on the co-occurrence of different types of ADV victimization and perpetration. Multiple correlates of these ADV patterns were examined, including daily conflict-related factors (e.g., occurrence, resolution).

METHODS

A sample of 216 adolescents (M = 17.03 years; SD = 1.49) who were currently involved in a dating relationship completed a baseline assessment followed by 14 consecutive daily diaries.

RESULTS

Latent class analysis revealed five classes, including Low violence (21.8 %), Emotional violence (50.9 %), Emotional and sexual violence (13 %), Psychological violence and control (7.9 %), and Multiple violence (6.5 %). Demographic, relationship, distal, and daily conflict-related indicators differentiated the classes. Findings indicated that youth in the Psychological violence and control and Multiple violence classes were involved in longer-lasting relationships and displayed higher externalized problems and emotion dysregulation, more frequent experiences of childhood traumas, and, notably, more difficulties in managing daily conflicts.

CONCLUSION

Adolescence is a crucial time to reduce the onset, persistence, and adverse consequences of ADV. By identifying situational conflict-related factors associated with ADV victimization and perpetration, this study can inform important prevention efforts.

The "Ladder of Inference" as a Conflict Management Tool: Working with the "Difficult" Patient or Family in Healthcare Ethics Consultations

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties' respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place.

Managing Intractable Natural Resource Conflicts: Exploring Possibilities and Conditions for Reframing in a Mine Establishment Conflict in Northern Sweden

Natural resource management (NRM) increasingly relies on communicative measures to enable reframing in intractable conflicts. Reframing occurs when disputants change their perceptions of a conflict situation, and/or their preferences for dealing with it. However, the types of reframing possible, and the conditions under which they can occur, remain unclear. Through an inductive and longitudinal analysis of a mine establishment conflict in northern Sweden this paper explores to what extent, how, and under what conditions reframing can occur in intractable NRM conflicts. The findings reveal the difficulty in achieving consensus-oriented reframing. Despite multiple dispute resolution efforts, the disputants' perceptions and preferences became increasingly polarized. Nonetheless, the results suggest that it is possible to enable reframing to the extent that all disputants can understand and accept each other's different perceptions and positions, i.e., meta-consensus. Meta-consensus hinges on neutral, inclusive, equal, and deliberative intergroup communication. However, the results show that intergroup communication and reframing are significantly informed by institutional and other contextual factors. For example, when implemented within the formal governance system in the investigated case, intergroup communication lagged in quality and did not contribute to meta-consensus. Moreover, the results show that reframing is strongly influenced by the nature of the disputed issues, actors' group commitments, and the governance system's distribution of power to the actors. Based on these findings, it is argued that more efforts should focus on how governance systems can be configurated so that high-quality intergroup communication and meta-consensus can be enabled and inform decision making in intractable NRM conflicts.

Personal Growth and Emotional Intelligence: Foundational Skills for the Leader

Emotional intelligence (EI) has gained popularity and is being seen as a necessity, spreading beyond the business world, and becoming universal. In that shift, medicine and medical education have started to see the importance. This is evident in mandatory curriculum and accreditation requirements. EI includes 4 primary domains with several subcompetencies under each domain. This article outlines several of the subcompetencies necessary for success as a physician, competencies that can be honed with targeted professional growth. Empathy, communication, conflict management, burnout, and leadership are discussed in an application way to help identify importance of and how to improve each.

Teaching conflict management: An approach to increasing students' value, confidence, and ability

INTRODUCTION

The primary aim was to explore how to effectively teach conflict management. We focused on three aspects of conflict management: (1) the value students place on conflict management, (2) their confidence in their ability to manage conflict, and (3) their skill in navigating conflict scenarios.

METHODS

This approach to teaching conflict management included a consistent educational approach applied by three different instructors at two universities. The class session, provided to second-year student pharmacists, was designed to address ACPE Standards focused on students' conflict management skills. A Likert-style survey, administered pre- and post-classroom intervention, assessed three aspects of conflict management: value, confidence, and ability. The survey also included open-ended questions to explore students' perceptions of conflict management.

RESULTS

Analysis of pre- and post-intervention surveys found that 76 out of 83 students completed both surveys (91.5% response rate). Cronbach's alphas of the value, confidence, and ability scales were 0.82, 0.86, and 0.78, respectively, at pretest and 0.93, 0.86, and 0.90, respectively, at posttest.

CONCLUSIONS

Changes in student beliefs regarding the value of conflict management, as well as their confidence in and ability to engage in a crucial conversation, were statistically significant after one classroom session.

Development and validation of conflict management attitude questionnaire for medical students

BACKGROUND

Medical students should effectively manage conflicts in teamwork and communication with other team members. This study aimed to develop and validate a tool to evaluate attitude of medical students and physicians toward conflict management.

METHOD

A multi-step process was employed to develop and validate a Conflict Management Attitude Questionnaire (CMAQ) based on the steps recommended in AMEE Guide No. 87. First, the initial items were obtained from the literature review and focus group. After cognitive interviews with the medical students and revision of the questionnaire, content validity was performed by experts. The construct validity and reliability of the questionnaire were assessed using exploratory Factor Analysis (EFA) and Cronbach's alpha coefficient, respectively.

RESULTS

This multi-step process resulted in a 12-item, five-point Likert-type questionnaire with satisfactory construct validity. Exploratory factor analysis revealed three factors, comprising the four items from the "perceived interactions in conflict management" subscale loading on the first factor, and five items from the "perceived value of learning conflict management" subscale loading on the second factor, along with three items from the "perceived application of conflict management" subscale loading on the third factor. All subscales described 56.48% of the variance. Validation results showed that Content Validity Index (CVI) and Content Validity Ratio (CVR) were greater than 0.75. Cronbach's alpha coefficient was 0.791.

CONCLUSION

This study showed that CMAQ has valid evidence for assessing the attitude of medical students toward conflict management with favorable psychometric properties and strong evidence of construct validity. However, due to the lack of evidence on any specific questionnaire to evaluate the attitude towards conflict management, future studies should conduct a confirmatory investigation regarding other aspects of medical students' attitudes toward conflict management.

The Relationship between the Conflict Management Strategies and Ethical Leadership Behaviours of Nurse Managers Perceived by Nurses

AIM

The aim of this study was to determine nurse managers' level of ethical leadership perceived by nurses, and to examine its relationship with conflict management strategies.

BACKGROUND

Ethical leadership is about how managers use their power in their decisions and actions, and its source is based on moral and ethical authority. Therefore, it is important to understand the impact of ethical behaviors of nurse managers in the work environment on determining conflict management strategies.

METHOD

The data of this descriptive, correlational and cross-sectional study were collected face-to-face from 285 nurses between April-June 2019. The data collection instruments included the introductory information form, the Ethical Leadership Scale and The Rahim Organizational Conflict Inventory-II.

RESULTS

Ethical leadership scores perceived by nurses in nurse managers were found 3.78, and the highest score was obtained from the behavioral ethics subscale (3.81±.91). In conflict management strategies perceived by nurses, it was determined that they got highest scores from collaborating style (3.76±.90), and lowest scores from competing style (2.90±.94). There was no significant relationship only between ethical leadership and its subscales and competing (r: -.038/-.041, p>0,05). In other subscales, there were positive, moderate and highly significant relationships (r: .466-.747, p<.001). The rate of explanatoriness of communicative ethics subscale in conflict management strategies ranged from 22.3% to 58.0%.

CONCLUSIONS

The study shows that communicative ethics subscale significantly affects the conflict management strategies of nurse managers. Therefore, it is important for nurse managers to communicate bilaterally and be a role model for nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Ethical leaders value trust and respect in their interactions with employees and reflect what appropriate behavior to the situation is. Nurses who perceive that their managers demonstrate ethical leadership behaviors will also evaluate their role in conflict resolution. On the other hand, the power-based, aggressive, non-compromising domination approach that the person imposes on others is not associated with the ethical leadership perception towards their managers by nurses and is a strategy that should not be preferred. Therefore, nurse managers who use appropriate conflict management strategies saw as a role model by nurses.

Exploring prospects of deliberation in intractable natural resource management conflicts

Deliberative processes are increasingly advocated as means to handle intractable natural resource management (NRM) conflicts. Research shows that disputing actors can deliberate and achieve higher degrees of mutual understanding and working agreements under ideal conditions, but the transferability of these findings to real-world intractable NRM conflicts can be questioned. This paper explores the possibilities of designing and realizing deliberation and its expected outcomes in real-world NRM conflicts. We used recommended design principles to set up deliberative processes in two intractable mining conflicts involving indigenous peoples in Northern Sweden and assessed the actors' communication and outcomes using frame analysis. The results show that the recommended design principles are hard, but not impossible, to fully implement in intractable NRM conflicts. Both conflicts proved difficult to deliberate and resolve in the sense of reaching agreements. However, the findings suggest that deliberation, as well as meta-consensus, or structured disagreement, is possible to achieve in settings with favorable conditions, e.g. good and established inter-group relations prior to the conflict. In the absence of these conditions, where relations were hostile and shaped by historical and institutional injustices, deliberation was not achieved. In both cases, polarization among the participants remained, or increased, in spite of the deliberative activities. The study highlights the importance of understanding deliberation as embedded in place specific historical and institutional contexts which shape both process and outcomes in powerful ways. More efforts should focus on alternative, or complementary, ways to handle intractable NRM conflicts, including how contested experiences of history, institutions and Indigenous rights can be addressed.

The nature of conflict in community pharmacy - A pilot study of pharmacists' experiences during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has caused changes that disrupted the status quo of society. As a result, the level of conflict in community pharmacy has increased significantly. With existing conflict research more focused on the management of conflict, it is important to direct attention towards understanding the nature of conflict. This understanding will allow for informed resources to be developed to guide practice, decreasing the occurrence of and negative effects of conflict.

OBJECTIVE

This research explored experiences of pharmacists working in community pharmacies, to identify the occurrence and nature of conflicts which may have been motivated by changes resulting directly or indirectly from the COVID-19 pandemic, to provide directions for future research into the nature of conflict.

METHOD

Person-to-person semi-structured telephone interviews were conducted. Transcripts were analysed using inductive reasoning to identify themes.

RESULTS

Thirteen pharmacists agreed to participate in this study and 9 were interviewed. Analysis revealed 7 themes that described the causes, contributors, management, outcome, and essence of experienced conflict. A model that incorporated existing theory and themes derived from this study was developed to facilitate understanding of the nature of conflict in community pharmacy during the COVID-19 pandemic.

CONCLUSION

Conflict in community pharmacy settings follows a defined model with multiple interrelated themes. Guidance from this model may assist pharmacists in reducing occurrences of dysfunctional conflicts during their practice.

Use of clinical simulation to train healthcare teams in conflict management: A scoping review

OBJECTIVE

To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.

METHODS

A structured literature review was performed with the terms [Clinical Simulation OR Patient Simulation OR Simulation Training OR High Fidelity simulation Training] AND [Conflict OR Conflict Resolution] in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.

RESULTS

10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.

CONCLUSION

Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Use of clinical simulation to train healthcare teams in conflict management: a scoping review

OBJECTIVE

To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.

METHODS

A structured literature review was performed with the terms clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS and DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.

RESULTS

10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.

CONCLUSION

Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Self-compassion mediates the association between conflict about ability to practice end-of-life care and burnout in emergency nurses

INTRODUCTION

End-of-life care (EOLC) is necessary for patients who are not expected to live long. Nurses have positive attitudes toward EOLC, but they encounter difficulties in practice. That situation creates conflict, which can affect burnout. It is essential to manage nurses' conflict about their ability to practice EOLC by enhancing their individual strengths. Focusing on the role of self-compassion may help to prevent burnout related to the conflict about ability to practice EOLC.

OBJECTIVE

The study aim was to assess the mediating effect of self-compassion on the association between conflict about ability to practice EOLC and burnout.

METHODS

A correlational study was conducted with emergency department nurses who practiced EOLC. Self-report measures of conflict about ability to practice EOLC, burnout, and self-compassion were obtained.

RESULTS

Negative aspects of self-compassion mediated the relationship among conflict, emotional exhaustion, and depersonalization (burnout). Self-compassion did not mediate the association between conflict and reduced personal accomplishment (burnout).

CONCLUSIONS

Negative aspects of self-compassion mediated the relationship between conflict and burnout (excluding reduced personal accomplishment). To prevent burnout, it is necessary to screen for nurses with low self-compassion and to provide opportunities to change their cognitive recognition and disclose their conflicts.

Conflict management in the fusion of complementary segmentations of deformed kidneys and nephroblastoma

The fusion of multiple segmentations aims to improve their accuracy in order to make them exploitable. However, conflicts may appear. In this paper, two conflict-management models are proposed for the fusion of complementary segmentations. This conflict-management and fusion procedure, integrated into the SAIAD project, carries out the fusion of deformed kidneys and nephroblastoma using the combination of six independent methods. These methods are based on different criteria, like the adjacent segmented slices, the variation of information, the Dice, the neighbouring labels, the pixel intensity by scanner images, and the fully connected CRFs. The performances of our fusion models was evaluated on 139 scans for three patients with nephroblastoma, and the results demonstrate its effectiveness and the improvement of the resulting segmentations.

Conflict and conflict management in hospitals

PURPOSE

Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.

DESIGN/METHODOLOGY/APPROACH

This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.

FINDINGS

Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers' personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager's age, work experience and management experience.

PRACTICAL IMPLICATIONS

The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.

ORIGINALITY/VALUE

This is the first study conducted in Iran examining the level of conflict, its types and identifying managers' dominant conflict resolution strategies at front line, middle and top management levels.

Using scenarios to explore conflict management practices of nurse unit managers in public hospitals

Background

Workplace conflict is common among nurses globally. Learning how to manage it may reduce related adverse consequences. Inappropriate management of conflict is attributed to decreased productivity, poor morale and financial loss for organisations. Nurse unit managers can play a key role by effectively managing workplace conflict in the units.

Objectives

To explore how nurse unit managers manage conflict in public hospitals and subsequently to make recommendations on how to optimise conflict management skills of nurse unit managers.

Method

A qualitative, explorative, descriptive and contextual study was conducted to explore how nurse unit managers managed conflict based on a scenario provided to them. Purposive sampling was used to select nurse unit managers working in three public hospitals. Eleven nurse unit managers participated in the study. Data were collected in two phases. In phase 1, a conflict scenario was developed in consultation with experienced nurse managers. The conflict scenario was used during phase 2, which involved individual face-to-face semi-structured interviews with nurse unit managers until data saturation. Tesch’s method of thematic synthesis was used to analyse the data. Literature review was undertaken to ascertain what is considered as an appropriate intervention in conflict management.

Results

Three themes emanated from data analysis: nurse unit managers managed conflict appropriately, nurse unit managers avoided the conflict and nurse unit managers managed conflict inappropriately.

Conclusion

While some of the nurse unit managers managed conflict appropriately, additional and continuous education and training is required to optimise the capacity and develop their conflict management competency. The findings could be integrated into orientation, training and preparation of nurse managers by health care organisations and educational institutions.

Brain Awareness and Conflict in Veterinary Medical Practice: What Happens and How to Deal with It

Conflict resolution is a technical skill required in medical environments. This article explores interpersonal conflicts through a brain awareness lens and offers tools for increasing the ability to manage conflict in veterinary medical practice.

Associations among student conflict management style and attitudes toward empathy

INTRODUCTION

Pharmacy education standards include a focus on interprofessional education and communication skills, specifically naming conflict management and patient-centered communication as key areas. This study aimed to explore the association between conflict management style and attitudes toward empathy among first year pharmacy students (P1s) in professional encounters.

METHODS

A cross-sectional design was implemented among two cohorts of P1s who completed an online survey including the Thomas-Kilmann Conflict Mode Instrument professional version (TKCI-P) and the Kiersma-Chen Empathy Scale (KCES).

RESULTS

Those scoring higher on the competing mode reported significantly lower attitudes toward empathy (p < 0.05). Those scoring higher on the accommodating mode reported significantly higher attitudes toward empathy (p < 0.05). Some student characteristics, including gender and race, were significantly associated with KCES score and/or TKCI-P mode.

CONCLUSIONS

These results suggest that awareness and training in empathy and conflict management should be incorporated in curricular content to support the likelihood of future pharmacists to be effective in their future patient and interprofessional interactions.

[Conflict matrix : Risk management tool in the operating room]

BACKGROUND

In business conflicts have long been known to have a negative effect on costs and team performance. In medicine this aspect has been widely neglected, especially when optimizing processes for operating room (OR) management. In the multidisciplinary setting of OR management, shortcomings in rules for decision making and lack of communication result in members perceiving themselves as competitors in the patient's environment rather than acting as art of a multiprofessional team. This inevitably leads to the emergence and escalation of conflicts.

OBJECTIVE

We developed a conflict matrix to provide an inexpensive and objective way for evaluating the level of escalation of conflicts in a multiprofessional working environment, such as an OR.

MATERIAL AND METHODS

The senior members of all involved disciplines were asked to estimate the level of conflict escalation between the individual professional groups on a scale of 0-9. By aggregating the response data, an overview of the conflict matrix within this OR section was created.

RESULTS

No feedback was received from 1 of the 11 contacted occupational groups. By color coding the median, minimum and maximum values of the retrieved data, an intuitive overview of the escalation levels of conflict could be provided. The value range of all feedbacks was between 0 and 6. Estimation of the escalation levels differed widely within one category, showing a range of up to 6 (out of 6) levels.

CONCLUSION

The presented assessment using a conflict matrix is a simple and cost-effective method to assess the conflict landscape, especially in multidisciplinary environments, such as OR management. The chance of conflict prevention or the early recognition of existing conflicts represents an enormous potential for cost and risk saving and might have positive long-term effects by building a culture of conflict prevention at the workplace and a positive influence on interdisciplinary cooperation in this working environment.

Getting past the blame game: Convergence and divergence in perceived threats to salmon resources among anglers and indigenous fishers in Canada's lower Fraser River

This article examines threat perception as a potential dimension of inter-group conflict over salmon fisheries in Canada's Fraser River watershed. Environmental changes and the entry of new user groups are putting pressure on both the resource and regulators, as well as threatening to exacerbate conflicts, notably between First Nation (indigenous) fishers and non-indigenous recreational anglers. While resource conflicts are often superficially conceptualized as cases of competing interests, we build on recent studies suggesting that conflicts are associated with deeper cognitive and perceptual differences among user groups. We report findings from 422 riverbank interviews with First Nation fishers and recreational anglers focusing on perceptions of threat to the fisheries. Responses reveal both substantial agreement and disagreement in threat perceptions between the two groups. These patterns provide a potential roadmap for consensus building, and suggest possible avenues for policy-makers to defuse the "blame game" that often dominates this type of conflict.

Psychological factors in patients with peptic ulcerand functional dyspepsia

BACKGROUND

The role of psychological factors in peptic ulcer disease (PUD) and functional dyspepsia (FD) has not been clearly determined. In this study the role of conflict management styles, psychiatric symptoms, and alexithymia were assessed in patients with PUD and FD and in the healthy individuals.

METHODS

Ninety subjects [30 PUD (15 women, 15 men), 30 FD (15 women, 15 men), and 30 healthy individuals (15 women, 15 men)] in two endoscopy wards of Babol University of Medical Sciences were evaluated. Three groups were matched with regard to demographic variables. Conflict management styles, psychiatric symptoms, and alexithymia were evaluated by appropriate questionnaires.

RESULTS

The patients with PUD reported less mean scores on psychiatric symptoms than the FD patients (depression 12.6±7.5 vs 28±9.5, anxiety 8.2±5.9 vs 18.7±6. obsessive-compulsive disorder 15.7±7.5 vs 21.8±8.4, interpersonal sensitivity 9.5±7.4 vs 16±7, psychoticism 8.03±4.5 vs 14.3±6.3, somatization 12.5±10.8 vs 20.7±8.1, and the total score of psychiatric symptoms 94.4±49.9 vs 160.1±46.6). The mean scores use of unconstructive conflict management styles in PUD patients were lower than FD (dominating 17.7±3.5 vs 20.2±2.7, avoiding 17.5±3 vs 23.8±4.4). Alexithymia symptoms were higher in FD patients than PUD individuals (difficulty in identifying feelings 23.5±6.3 vs 27.8±3.9, difficulty in describing feeling 16.5±4.4 vs 17.3±3.6). The PUD and FD patients had higher scores regarding these variables than the healthy subjects.

CONCLUSION

The results show that both PUD and FD patients experienced more psychiatric symptoms, unconstructive conflict management styles, and alexithymia than the healthy subjects. FD patients had worse psychiatric problems than PUD.

Using a conflict conceptual framework to describe challenges to coordinated patient care from the physicians' and pharmacists' perspective

BACKGROUND

In an effort to increase cost-effectiveness of health care and reduce overall costs, patient-centered medical homes have been proposed to spur fundamental changes in the way primary care is delivered. One of the chief principles that describe a patient-centered medical home is that care is organized across all elements of the broader health care system, including community pharmacies.

OBJECTIVES

To identify and describe challenges derived from a conflict management framework to a physician-pharmacist approach to coordinating patient care.

METHODS

A descriptive, exploratory, non-experimental study was conducted in Wisconsin (U.S. State) from June to December, 2011. Data were collected through two rounds of face-to-face interviews with physicians and community pharmacists. The first round involved one-on-one interviews with pharmacists and physicians. The second round brought pharmacist-physician dyads together in an open-ended interview exploring issues raised in the first round. Content analysis was guided by a conflict management conceptual framework using NVivo 10 qualitative software.

RESULTS

A total of four major themes emerged from the conflict analysis of interviews that illustrate challenges to coordinated patient care: Scarce resources, technology design and usability, insurance constraints, and laws and policy governing patient care. The study findings indicate that both groups of health care professionals work within an environment of conflict and have to negotiate the challenges and strains that exist in the current health care system. Their need to work together, or interdependence, is primarily challenged by scarce resources and external interference.

CONCLUSIONS

Efforts to coordinate patient care through teams of inter-professional health care providers will be more successful if they acknowledge the inherent conflict that exists. Efforts should be made to provide an infrastructure for interdependence and to support interpersonal communication.

Conflicting priorities: emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care

INTRODUCTION

As hospitals compete for patients and their healthcare dollars, the emergency nurse is being asked to provide excellent nursing care to "customers" rather than patients. This has changed the approach in delivering quality care and has created favorable conditions for conflict as the nurse tries to achieve specific patient satisfaction goals.

METHODS

A sample of 9 emergency nurses from 2 hospitals in northern New Jersey participated in focus groups designed to learn about the types of conflict commonly encountered, and to identify the attitudes and understanding of the emergency nurses experiencing conflict and how interpersonal conflict is dealt with.

RESULTS

Thematic content analysis identified an overarching theme of conflicting priorities that represented a perceived disconnect between the priority of the ED leadership to achieve high patient satisfaction scores and nurses' priority to provide quality care. Three interacting sub-themes were identified: (1) staffing levels, (2) leaders don't understand, and (3) unrealistic expectations. The study also found that avoidance was the approach to manage conflict.

DISCUSSION

The core conflict of conflicting priorities was based on the emergency nurses' perception that while patient satisfaction is important, it is not necessarily an indicator of quality of care. Interacting sub-themes reflect the way in which conflict priorities were influenced by patient satisfaction and the nurses' ability to provide quality care. Avoidant conflict management style was used to resolve conflicting priorities because nurses perceive that there is not enough time to address conflict even though it could impact on work stress and patient care.