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We've talked about empathy in the last section, simple examples were shown to expose students the possible conditions. A health professional must always consider his patient circumstance - and try to achieve the BEST conflict resolution. In all cases, try to empathize or "feel" the situation and act accordingly.

1.2) HONESTY

Honesty is an important issue in any provided professional healthcare setting as it bestows trust, a very important in any health professional-patient relationship. In many practices there' the health professional will encounter stress, pressure, responsibility, appointments and so forth and often in context of the scenario a little white lie may not necessarily cause harm but also would not explain and get out of a tough situation either. Thus, the key is for student's to examine the attitudes towards honesty and integrity in a professional setting.

Scenario 1:

You are a nurse on the cancer ward in a private hospital. One day you accidentally forget to provide a patient the anti-nausea drug written up with his pain relieving medication, as you were tired and just managed to finish a busy night shift in the emergency department. Consequently, the patient becomes very nauseous. None of the other nurses or doctors knows about your oversight (as patients can still experience nausea despite having the preventative medication). You decide not to fill the incident report and remain incognito in regards to your mistake. However, several days later the patient questions you about the episode of severe nausea. What do you tell him?

Selections:

a) You tell him that it is a common reaction to some pain relieving medications.

b) You tell him that you forgot to give him an anti-nausea drug and that these mistake occur unfortunately, as apart of the nursing staff there's much to handle around the hospital.

c) You tell him you forgot to give him an anti-nausea drug and apologize saying you were tired from a working night shift.

d) You tell him that another nurse has forgotten to give him an anti-nausea drug and apologize on the other nurse's behalf.

e) You tell him you did give him an anti-nausea drug and it showed that the drug had not worked well.

The preferred answer is (c).

Discussion:

This scenario deals with nurse being faced with a potentially embarrassing situation [apart from the issue of deliberate medical negligence behaviour]. The biggest temptation is to cover up initial mistake as suggested in options (a), (d) and (e), but this is dishonest [big consequences when exposed]. By apologizing and providing an honest explanation might win the patient's understanding as the answer (b). Answer (c) is absolutely truthful.

Scenario 2:

You are a medical student who is trying to insert a drip into an elderly patient. The patient keeps referring to you as a young doctor and you become aware that the patient doesn't knows you are only a medical student with little experience. After three unsuccessful attempts, you are hesitant to continue, but the senior doctor has informed that he wants you to complete the procedure. At this stage it is obvious that the patient is getting upset at being made to suffer such discomfort. What do you do?

a) You apologize to the patient and inform him not to worry, as you are good at this and only having minor problems.

b) You tell the patient you have performed such procedure many times and just having a bad day.

c) You apologize to the patient and offer him the choice of a more experienced person to carry out the procedure.

d) You tell the patient you are aware that he is not comfortable with the situation, it needs to be done in his best interest.

e) You tell the patient that you are just learning and if you were to fail again, the procedure will not be performed at all.

The preferred answer is (c).

Discussion:

This situation requires honest communication with your patient. The patient's well-being and quality of life is always your prime objective [the reason you want to be a doctor]. And thus, to get someone more experienced to conduct the procedure as in (c) might be the most appropriate course of action after all. Answers (a) and (b) show blatant dishonesty.

2.1) CONFLICT RESOLUTION

This is an important interaction skill where the health of a patient is reliant not only on good communication between patient and their health care professional, but also between health care professionals. There is a good possibility that miscommunication can be potentially deletrious to the proper care of the patient. There are opportunities where a conflict between health professionals or patients needs to be mediated by another healthcare professional. The key is for student's to examine health professional attitudes and skills with regards to treatment of disagreements and efficient conflict resolution.

Here are some general pointers to take into account at a professional level:

- FOCUS on the PROBLEM: Important to focus relevant issues surrounding a problem to find a solution. How did the problem surface and how to solve is alway more important than pushing the blame.

- TEAM Approach: Blaming singles out group/people. This may cause offense and destroy relationships at a professional level. There's a saying an offender brother is harder to win than a strong city. In unison, solve the problem.

- Compromise: Each party will have a point of view but conflict resolution will reach a ground of compromise that is acceptable to all.

- End Product: It is important that all parties are satisfied with the compromise.

Scenario 1:

You are a nurse in a full and busy maternity ward. Under your care is a young woman recently given birth to twins. She has an adoring husband, and many relatives and friends are constantly bringing her flowers and cards. Sharing the room with the young lady are two other woman. One suffers hayfever and consequently with the increasing number of flowers she's showing signs of an allergic reaction. She starts complaining about her reaction. How do you handle this situation?

Selections:

a) You remove the flowers from the room and inform the mother of twins that she should no longer receive any flowers.

b) You tell the patient suffering from allergies that there isn't much to do as flowers are acceptable in the hospital.

c) You apologize to to the patient and offer her a change of rooms.

d) You apologize about the discomfort and offer patients medication and preventative care to alleviate the allergies.

e) You discuss the situation with the patient receiving the flowers and ask whether she could have them kept at home for her by her family.

The preferred answer is (e).

Discussion:

Patient's well-being is prime responsibility for the health professional. Every patient in hospital has the right to feel comfortable. Although there is no rule about receiving flowers in hospital, they are causing discomfort to one of your patients. Option (a) is extreme and there is no communication with the patient. Choices (b) have nothing to help the patient with allergies while choice (c) is realistic it is not necessarily the ideal solution - not every hospital has such luxury of changing rooms, especially for something not as urgent. Option (d) is a short-term measure and generally patients would not appreciate taking extra unnecessary medication. The most fair and democratic approach is to explain the situation and find a solution proving to be most beneficial for all parties concerned - option (e).

Scenario 2:

You are a nurse caring for two elderly female patients. One of the patients passes his time reading books whilst the other has a portable television which she watches for her comfort. The reading patient is not happy about the constant noise, complaining that she can't concentrate or sleep. She has spoken to her lady with the television but unfortunately did not heed to her requests for quiet and peace. The patient complains to you about the situation. What do you say?

Selections:

a) You let her know the patients has two more days left in the hospital and be patient with her.

b) You kindly direct the reading patient to the clinical nurse consultant.

c) You explain to both patients to be considerate of each other, and ask the patient to lower the volume of the television or use some headphones.

d) You offer the reading patient some ear plugs and remind him to curtain up around his bed for privacy.

e) You suggest the reading patient to argue her case to the hospital and get her moved out of the ward.

The preferred answer is (c).

Discussion:

As a healthcare worker you shouldn't ignore the conflict situation but resolve it and focus on the patient's well-being and comfort [which in this case, are being compromised]. Answer (c) is the preferred answer. It is better to speak politely and friendly to both parties concerned and to negotiate a compromise between patients that will ensure a comfortable hospital environment. Option (d) may seem attractive but doesn't resolve the conflict - it's helping only the compromised patient through preventative aids that may not be applicable to all patients.