Contextual influences on nurses' conflict

management strategies
Marin, Mary J; Sherblom, John C; Shipps, Therese B . Western Journal of Communication ; Salt Lake City
 Vol. 58, Iss. 3,  (Summer 1994): 201.

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ABSTRACT (ABSTRACT)
Several contextual influences on nurses conflict management strategies are investigated. In situations involving
conflict inherent in professional truth-telling/deception dilemmas, characteristics of professional role and
organizational situation are important influences upon nurses' choices of a conflict management strategy.

FULL TEXT
Organizational managers spend 20% of their time dealing with conflict (Thomas &Schmidt, 1976), and a conflict
management literature has developed that examines and measures conflict and its management as an individual
personal characteristic (Hocker &Wilmot, 1991). This personal characteristic has been variously treated as a style,
trait, strategy, or behavior. In each case, however, a characteristic attributed to an individual person is focused on
and little attention is paid to the influences of the larger context within which that person's conflict management
strategy choices are made. Over the past few years criticism has grown concerning this over-emphasis of the
personal to the neglect of contextual influences (Conrad, 1991; Knapp, Putnam,
Davis, 1988; Putnam &Poole, 1987). Yet, little research addressing these contextual influences has been done.
Instead, research "has continued to focus on attitudes, traits, or interpersonal dynamics..." (Nelson, 1989, p. 377).
The present study examines the conflict management strategies used by nurses when they are confronted by
patients who have been purposefully uninformed by physicians about some aspect of the patient's care. Part of
the nurse's role is to act as a patient advocate, insuring that the patient obtains that information. This role
expectation is clear (American Nurses Association, 1976). Acting in this role, however, brings the nurse into
conflict with the physician. So, the nurse must decide to collude with the physician, withholding the information
from the patient and avoiding the conflict (in itself a conflict management strategy); or through an alternative
strategy for managing the conflict with the physician, act to ensure that the patient gets the information. What are
the contextual influences upon the nurse's decision and choice of a conflict management strategy? The answer to
that question is an important one, because how this conflict is managed has serious consequences for the nurse,
the physician, and the patient.
DECISION MAKING AND CONFLICT
Decision making is a largely cognitive task concerned with obtaining one "best" decision or solution. Fann and
Smeltzer (1989) describe decision making as based on the reduction of informational uncertainty and message
equivocality. Hirokawa and Rost (1992) call decision making the "efforts to analyze a task, assess evaluation
criteria, and identify the positive and negative qualities of alternative choices" (p. 284).
Conflict occurs in this decision making process when a basic, underlying incompatibility in perspectives or
orientations makes a single solution impossible, or unlikely. This incompatibility of perspective and subsequent
inability to arrive at a single decision bring an increased emotional component not necessarily present in all
decision making situations. Nadler, Nadler, and Broome (1985) call conflict "a state of social relationship in which
incompatible interests between two or more parties give rise to a struggle between them" (p. 90). Cushman and
King (1985) use Thomas's (1976) definition in calling it "a condition in which the concerns of two or more parties

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appear incompatible" (p. 117).
Conflict is a pervasive, inevitable, normal part of organizational life (Roloff, 1987). It develops as a struggle over
values, scarce resources, rewards, status, and power; and occurs when individuals or groups experience
frustrations in attaining their goals and concerns because of the incompatibility of their perspectives (Shockley-
Zalabak, 1991).
In the present decision making situations, interpersonal conflict is created by the conflicting professional
responsibilities of nurses to patients and physicians. Illustrating their feelings of conflict, nurses described these
dilemmas as: "a no win situation because someone would end up a victim, the doctor or the patient"; "you're
damned if you do, damned if you don't"; "you want to make sure the patient knows what is going on, but you're not
the doctor. It'd probably be a real sticky situation"; "As a patient advocate...it's important to tell them [patients]
what their rights are"; but "it would get me into trouble with the surgeons." As one nurse noted, "it affects my
loyalty to the medical community as well as my loyalty to the patient."
Abbott (1988) traces the beginnings of conflict between nursing and medicine back to Florence Nightingale's
vision of nursing as an "independent authority and training" separate from medicine (p. 71). Bok (1989) argues
that, "Sharp conflicts are now arising [because] doctors no longer work alone with patients....Nurses care for these
patients twenty-four hours a day compared to a doctor's daily brief visit, and it if, the nurse many times that the
patient will relate to..." (p. 226). Differences in the underlying principles and, at times, incompatible perspectives of
nursing and medicine are a major source of this conflict between nurses and physicians.
Physicians work from a medical ethic to cure the patient. With this underlying principle of cure comes the
physician's role in making decisions in the best interest of (and for) the patient and the physician's therapeutic use
of information. "Many patients rely on their faith and trust in doctors to cope with illness, preferring to hand over
responsibility for the management of the illness to the doctor" (Lupton, 1994, p. 59). Physicians frequently confront
situations in which they "reveal, hold back, or distort [information in ways that] matter profoundly to their
patients....Doctors use information as part of the therapeutic regimen; it is given out in amounts, in admixtures,
and according to timing believed best for patients. Accuracy, by comparison, matters far less" (Bok, 1989, pp. 222).

A nursing ethic exists separate from this medical ethic. The nursing ethic is based on an underlying principle of
patient care (Twomey, 1989). Caring is of central importance to the professional values of nurses and has been
called the essence of nursing (Morse, Bottorff, Neander, &Solbert, 1991; Sherblom, Shipps, &Sherblom, 1993). Built
upon this principle of care are concerns for the patient's informed consent and right to know what is happening,
will happen, and did happen to them; and the nurse's role as patient advocate to insure that right. Crowley (1989),
Nokes (1989), and Twomey (1989) all emphasize the importance of this right to information as an underlying
principle in the ethical decision making and actions of nurses.
This difference in ethical orientation of cure versus care creates a context in which the necessity and desirability of
relating information to patients can bring nurses and physicians into conflict. The conflict is constrained by, and
must be managed within, that context.
CONFLICT MANAGEMENT
Conflict management has been measured in a number of different ways, but five measurement instruments have
become predominant in the communication literature. Each instrument provides its own terminology for conflict
management strategies, although there is some alignment among the terms and strategies described. These
instruments and the research that has employed them comprise the bulk of the conflict management literature
(Knapp et al., 1988; Putnam, 1988).
Thomas and Kilmann's (Thomas, 1988) Management of Differences (MODE) measures behavioral intentions
reflecting a person's intended outcomes, rather than a person's behaviors. These behavioral intentions are termed:
collaboration, competition, accommodation, compromise, and avoidance. In collaboration, an individual requests
and provides feelings, information, and rationale, and identifies areas of agreement and difference. Competition
occurs when verbal dominance is expressed by quoting facts and authorities and a position is firmly stated.

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Accommodation is characterized by giving support to others, glossing over differences, and playing down
disagreements. Avoidance is identified by not responding to the other's statement or to the problem or situation at
hand, by avoiding unpleasant issues or situations, and by not stating any knowledge of a problem situation.
Compromise involves minimizing differences and seeking concessions (Thomas, 1988; Van de Vliert &Kabanoff,
1990; Womack, 1988a).
Hall's Conflict Management Survey (CMS), describes an individual's predisposition and preference for handling
conflict as: win-lose, yield-lose, lose-leave, compromise, or synergistic (Womack, 1988b). These five modes are
accessed across four general contexts--personal, interpersonal, small group, and intergroup. Conflict behavior is
treated as influenced by the situation, but the test focuses on the strategies a person implements in these
different conflict situations (Womack, 1988b). While Hall's CMS is a comprehensive instrument that evaluates
conflict in various contexts, the contexts remain broadly defined. CMS is best used as an assessment of a
personal predisposition or preference for conflict and not as a strong predictor of the actual choices made in
specific circumstances (Shockley-Zalabak, 1988).
Rahim's (1986) Organizational Conflict Inventory II (ROCI-II), measures five conflict management styles:
integrating, obliging, dominating, avoiding, and compromise. The styles are treated as personal "orientations
towards conflict and sets of strategies/tactics for achieving
variety of goals" (Weider-Hatfield, 1988, p. 352). Different forms are available to assess a respondent's conflict
management behavior with different target groups (superior, subordinate, or peer). These target groups define
several general relational contexts within which conflict can occur and that can influence the conflict management
style employed.
Putnam-Wilson's (Putnam, 1988) Organizational Communication Conflict Instrument (OCCI), focuses on goal-
oriented disagreements while describing concrete verbal and nonverbal behaviors. OCCI identifies three types of
personal strategies: nonconfrontational, solution-oriented, and control. OCCI is designed to assess an individual's
conflict strategies in specific hypothetical situations about issues that produce conflict. OCCI does not assume
styles are consistent within the person or across situations. Instead it examines specific targets and situations
and assesses the person's verbal and nonverbal behaviors. Consequently, OCCI is somewhat sensitive to perceived
situational influences of conflict, but it still focuses attention on the individual person rather than the contextual
influences (King &Miles, 1990).
Ross-DeWine's (1988) Conflict Management Message Style (CMMS) assesses conflict by examining three self-
reported message types: self-oriented, issue-oriented, and other-oriented messages. The intent of CMMS is to
assess an individual's style of managing conflict through an analysis of verbal messages (Ross &DeWine, 1988).
CONFLICT IN CONTEXT
In any organization communicators must consider a variety of contextual influences upon their conflict
management strategy choices (Conrad, 1991). King and Miles (1990), argue that an examination of these
contextual influences is critically important to developing a fuller understanding of conflict management. Knapp et
al. (1988) challenge researchers to ground context at the forefront of their research on conflict in organizations;
and Hocker and Wilmot (1991) argue that "one cannot understand conflict dynamics by examining individuals in
isolation" (p. 129).
Each of these past research measures, in its own way, acknowledges the influence of context. However, none
focuses on examining specific, multiple, simultaneous, contextual influences. They assess an individual's
disposition (MODE, CMMS); or a personal strategy that is influenced in general ways by the situation (CMS), the
relationship (ROCI-II), or both (OCCI) (Womack, 1988b). In each case, however, they center on personal styles and
treat the choice of a conflict management strategy as a 'trait' belonging to a person---something someone does
(Hocker &Wilmot, 1991).
Thomas's (1976) theory of the dimensions of conflict management is the most suggestive approach for dealing
with the influence of context. Thomas theorized two dimensions of context as influential upon the choice of a
conflict management strategy. His first, an integrative dimension, represents the total amount of satisfaction

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available for both parties from the conflict resolution. His second, a distributive dimension, indicates the likely
distribution of that satisfaction or the extent to which each party will feel satisfied with the resolution. Thomas's
conceptualization of these dimensions will be used to interpret the present analysis.
Thomas and Kilmann's (Thomas, 1988) management of differences instrument, however, does not provide a
method to investigate these multiple influences and constraints of a context upon the conflict management
choices. To look at these contextual influences, conflict management strategies are more appropriately assessed
through interviews. Putnam and Poole (1987) and Knapp et al., (1988) both recommend interviewing. Wilson and
Waltman (1988) argue that "Open-ended instruments...[like interviews] demonstrate greater sensitivity...[to]
conflict strategies than do closed-ended reports" (p. 382). Interviews provide a researcher access to a fuller
understanding of the context within which personal choices are made, to the influence of the context upon those
choices, and to the respondent's perceptions of the context and its influence.
The present study uses interviews with nurses to code their choice of a conflict management strategy and to
better understand the contextual influences upon those choices. The purpose of the study is to demonstrate the
presence of contextual influences, in general, by providing specific examples of that influence. As an individual
study, it must examine a relatively small set of the possible influences and hold others constant or ignore them.
Therefore, the influences examined in the present study are presented as examples of contextual influence rather
than as a definitive set of those influences. Other aspects of the context may also prove influential upon further
examination.
To create the conflict situations for the nurses to manage, the present study uses five truth-telling/deception
dilemmas (one recalled event and four hypothetical situations). Each situation represents an instance in which a
physician has purposefully deceived a patient through inadequately informing, shading, or otherwise manipulating
the information given to that patient. Each dilemma raises the issue of whether the nurse should collude with the
physician in withholding that information from the patient or act to ensure that the patient obtains the information.
Making this decision, however, invokes a professional-interpersonal conflict situation for the nurse with the
physician and the patient, that must be managed.
McCornack (1992) argues that deception, or the manipulation and shading of information, frequently occurs when
individuals "are confronted with situations in which they must reconcile the competing goals of conveying
information that their conversational partners are entitled to have and minimizing the damage that conveying that
information might cause" (p. 1). Reconciling these competing goals is the nurse's dilemma in each situation.
Respondents consistently argue that patients have a "right to know" the information, but conveying it to them
brings a nurse into conflict with the physician. Withholding the information, however, can precipitate both conflict
and physical or emotional damage to the patient.
The dilemmas and potential for conflict are real to the nurse respondents. They expressed no difficulty recalling a
truth-telling/deception dilemma that had occurred within the past two years of their professional practice, and they
often commented that the hypothetical dilemmas reminded them of experiences in their professional practice.
Unfortunately, little prior work has been done on physician and nurse deception of patients and the conflict it
engenders. Kalbfleisch (1992), for example, in her extensive review of deception, cites only concerns with patient
deception of physicians. The present study suggests an important new area for deception, as well as conflict
management, research. However, our current investigation will focus only on managing the conflict engendered by
these dilemmas.
RESEARCH QUESTIONS
The present study investigates how the conflict management strategies selected by nurses in response to specific
truth-telling/deception dilemmas are affected by the contextual influences of those dilemmas.
RESEARCH QUESTION 1: At a general level, the research question asks if aspects of the organizational context
influence a person's choice of a conflict management strategy.
RESEARCH QUESTION 2: More specifically, the research asks how influential are certain relational, situational,
professional, and organizational contextual characteristics upon a nurse's choice of a conflict management

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strategy.
METHODS
PARTICIPANTS
Thirty-three female staff nurses, each holding a Bachelor of Science in Nursing (BSN) degree and having at least
one year of experience, participated in the study. Participants were volunteers solicited from three hospitals in a
large metropolitan area. The nurses' ages ranged from 22 to 57 years, with a median age of 26 years. The number
of years of experience ranged from 1 to 30, with a median of 3 years of experience.
Gender is part of the context in which conflict occurs and the genders of the participants in conflict is a likely
influence upon the choice of a conflict management strategy. In the present study gender was a constant and
differences in gender were not examined. All of the volunteer nurse respondents were female and all of the
physicians mentioned in the recalled dilemmas were identified by them as male (i.e., referred to by them as "he").
When physician gender was made explicit by the text of the hypothetical dilemmas, physicians were also referred
to as "he." Even when physician gender was not made explicit by the dilemma text, respondents referred to the
physician as "he." One respondent raised the question of physician gender and suggested that it might make a
difference in her response, but then went on to discuss her response to a male physician. No other respondents
raised the issue. This constancy in gender assignments identifies both an implicit part of the conflict management
context and a limitation to the present study.
THE DILEMMAS
For the first dilemma, the nurse was asked to remember an incident that had occurred within the past two years in
which a physician either withheld or distorted the information given to a patient with whom she was involved in
care-giving. Upon recalling the incident, the nurse was asked to identify the problem, state what she considered
doing to resolve the problem, her ultimate course of action, her expected resolution, and her evaluation of that
resolution. These recalled events included incidents such as a patient having her pain medication reduced while
being told that it was being increased; a patient going for an ultrasound, and while uninformed, being prepared for
more invasive surgery to drain an abscess; and cases of cancer patients not being told that they had only a short
time to live.
After discussing this recalled event each nurse was asked to read and respond to four hypothetical dilemmas. The
hypothetical dilemmas used in the present study were developed through the work of Shipps (1988). She reviewed
the real-life ethical dilemmas reported by two samples of practicing nurses. The first sample included 715
personally experienced dilemmas submitted by practicing nurses enrolled in a graduate program. Forty-nine
percent of these cases dealt with a lack of truth-telling by physicians. In these dilemmas physicians had withheld
information from patients or otherwise purposefully deceived them. Shipps (1988) obtained a second sample
comprised of 250 case reports from nurses practicing in a large metropolitan area. Fifty-seven percent of these
dilemmas concerned a lack of truth-telling to patients with physicians identified most frequently as engaging in
the deception. Truth-telling comprised the largest single type of ethical dilemma for these nurses. Of the truth-
telling dilemmas, cases of physician negligence or incompetence (28%), informed consent (20%), and withholding
diagnosis/prognosis information (18%) were the most commonly reported.
In the present study, the first hypothetical dilemma involves a patient who is receiving a placebo, asking the nurse
what he is being given. Ethical concerns with the use of placebos were less commonly reported to Shipps (1988)
than other types (only 3%); but the placebo dilemma was used in the present study because it raises issues of a
patient's right to know that are separate from other, possibly more negative, health consequences of deceiving a
patient. The conflict in this dilemma is that the nurse disagrees with the physician's plan of care for the patient,
believes that the patient is in real pain, or does not believe in the use of placebos while acknowledging the
potential clinical benefits of placebo use. As one respondent said, "it's a difficult one because you don't think the
placebo is the answer, but have the physician saying 'this is my assessment of the situation. I don't want him on
high doses of narcotics, so this is my solution.' If you tell the patient the truth, the patient loses that rapport with
the physician; aside from the physician giving you a hard time for not following through on orders. Yet, you can't

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call a psychiatrist or psychologist for counsel. So, it's a kind of catch-22. It's a big problem." Another respondent
admitted, "God only knows what
would say. I'd have to say it was what the doctor ordered. I'd probably keep talking so the patient wouldn't ask me
what it was, because I could not say this was Demoral when it's not."
The second dilemma deals with a physician's negligence. After the completion of a surgical operation in which the
bladder was accidentally nicked by the physician, the nurse discovers that the patient has not been informed about
the accident. The surgical mistake might not be dangerous but could have future health repercussions.
Respondents replied, "in this situation she is liable to sue not only the physician, but the hospital, even me. I would
tell her"; "well, I think you could get around it when a patient asks. I wouldn't tell her that the doctor had nicked her
bladder"; and "it would be difficult if I have an association with the surgeon to say, 'I'm going to tell her that and
he's going to get sued,'"
The third dilemma deals with a patient's informed consent. After talking with a patient about recently signing a
consent form for a surgical procedure, the nurse realizes the patient misunderstood the physician's surgical
intentions which could be life-altering (i.e., radical mastectomy if cancer is found, rather than just exploratory
surgery). The text of that case follows.
Carolyn Jones, a 31-year old female was admitted for the purpose of a breast biopsy. On the night before the
surgery, she signs the informed consent form, which you witness. Later on in the evening she tells you that she is
very frightened but no matter what the results of the biopsy, she will not have a mastectomy. She asks if you have
read of the new evidence that mastectomies don't really make a difference. She has read about this in popular
magazines and wonders if the reports are accurate. You do not want to increase her fear by giving her a great deal
of information, but you do tell her that you have read of the same conclusions in professional journals, At break
you speak to one of the other nurses on duty about this patient and she asks you who the surgeon is who will be
doing the surgery. The surgeon is not someone with whom you are familiar, but you do know his name and tell her.
She responds by saying that he is known to go ahead with the mastectomy if cancer is diagnosed at the time of
biopsy and that this is specially true if the patient is young and viable. Apparently, he is convinced that
mastectomy surgery does improve the chance of survival. After this conversation, you deliberate and finally call
the surgeon. He tells you that it is his decision to make and depending on the outcome of the biopsy, he will decide
then to do a mastectomy or not.
The following examples illustrate how the nurses said they intended to manage this conflict situation.
I know the surgeon will take the matter out of her hands. She needs more information to see what all her options
are. Even though it's the night before surgery and I would get into trouble, I would say, "It's your right to postpone
the procedure, not to have it at all, or to do whatever is necessary for you to obtain what you want." It would get me
into trouble with the surgeon, but it's her body. My intervention is not to stop the procedure, it is to find out what
she wants and to reopen the dialogue with the physician.
I'd sit down and talk to her, probably contact the physician again. He'll probably get really angry with me, but I'd
contact him again and say, "this woman does not know enough and doesn't want a mastectomy." I would make
sure that I document it real well: that I sat down and spoke to the patient, what I said to the physician, his reply to
me--real documentation for if it ever went to court.
My responsibility in this situation is to call everyone involved. The patient's doctor would be first. At the end of the
phone call I would say to him, "This is to notify you that the patient does not want this, and I will note it on her
chart."
would notify all medical and surgical people involved with the patient that the patient does not want this. I would
absolutely document it and make sure that the person I talked to knew that it was documented and that they
needed the patient's consent to get involved. I can't make the physician not do it; but he is going to be a fool if he
goes in and does it.
The final dilemma involves withholding information from a patient who questions the nurse as to whether or not he
has cancer. Diagnosis and prognosis are within the physician's rather than the nurse's role, duties, and expertise;

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but the physician is not going to tell the patient about his inoperable cancer. The text of that case follows.
Mr. Bernard, a 65-year old man was admitted with abdominal pain and a history indicative of bowel obstruction.
Emergency surgery was performed. A colostomy was created to relieve the obstruction but no further surgical
procedures were done, given the extensive metastasis found during the exploratory procedure. A few days after
surgery, the physician made it clear to the nurses that he did not intend to tell the patient of his diagnosis, stating
that the patient was not in any condition to receive news like this. The family was informed, however, and they
made it clear that they wanted their father told, as he was a very independent, proud man, who, in their estimation
would want to know the truth about his condition. However, they found it too difficult to tell him themselves. The
physician again refused. Later that day the patient asked you while you were doing his colostomy care: "Usually,
when people have to wear a bag like this, they have cancer. Do I have cancer?" What would you do?
The nurses responded to this dilemma with the following strategies.
I would tell the patient.
If the family asked me, I would tell them to talk to the doctor and talk him into telling the man.
If the physician was really adamant about it, but I felt as strongly that the patient should know and is able to know,
I probably would go against his advice. [I'd] try to collaborate with him to do what's best for the patient, but if he
still felt strongly, then I really think the physician just doesn't know where the hell he's coming from. I would tell the
patient.
CONFLICT IN THE DILEMMAS
Hocker and Wilmot (1991) identify five key characteristics of conflict as: (1) interdependence, (2) expressed
struggle, (3) perceived incompatible goals, (4) perceived scarce resources, and (5) interference. These dilemmas
created conflict situations for the nurses that embody Hocker and Wilmot's key characteristics.
The nurses maintain a strong working interdependence with physicians. Aiken (1990) describes the nurse-
physician relationship as symbiotic. Their professional goals are to work together to provide the best care for the
patient, and both parties benefit from their close collaboration. The present nurse respondents alluded to this
interdependence in their talk of "loyalty to the medical community," in their need and desire for "a good
relationship" with physicians, in their concerns for not creating a "contradiction for what the physician has told" a
patient, and in their desire to "condone what the physician said, even though I don't want to."
There is a perceived struggle within this relationship as well. Fifty-six percent of the nurses surveyed in a recent
poll were dissatisfied with their current relationships with physicians and the most commonly cited reason was
lack of collaboration ("Nurse-Doctor," 1991). As Geist (1986) points out, the health care team concept is coming
into increasing use in hospitals, and nurses have "perceived themselves in a position to communicate more
frequently with physicians" (p. 21) and to question them more frequently. Anticipated interpersonal-professional
conflict is evident throughout the nurses' responses to these dilemmas as they predict that their actions will "get
me into trouble" with physicians, causing them to "get really angry with me."
Nurses, acting as patient advocates, also perceive incompatible goals when information is withheld from a patient
by a physician. Respondents argued that it is the patient's "right to know," it "is a big moral issue" if I don't share
the information, and "I'm guilty if I don't tell the patient the right information," because the patient "may be in real
pain" (placebo), "should be looking for complications" (nicked bladder), "is going to be terribly upset" (mastectomy),
and "needs to prepare for death" (cancer). Alternately, in their attributions of why physicians do not want to share
the information, nurses suggested physician concerns with "medical malpractice," "pride," "not wanting to sound
too pessimistic," and "a bond that developed" making it difficult for the physician to tell the patient that he is dying.

Information is a scarce resource. The conflict arises over who should control that information and who has a right
to it. This conflict over the control of the information is between the physician and the nurse. Both have access to
the information, but differ over whether it should be shared with the patient. The physician acts, from the nurse's
perspective, either for curative or personal reasons to withhold the information. The nurse must then decide to act
either as the patient's advocate to disclose, or as the physician's colleague to conceal, that information. The

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conflict over the use of this information resides with the nurse, and in the relationship between the nurse and
physician. This conflict arises when the physician withholds the information, the patient has a right to know it, and
the nurse feels an obligation to act in the patient advocate role: "it's very important for us to tell them what their
rights are....You'd want a nurse to be your advocate." Ultimately, the nurse must decide, act, and then manage the
resulting conflict with the physician.
Finally, interference is perceived. The decision making roles of nurses and physicians are distinct but may, at
times, collide. In each dilemma, the information being withheld from the patient is relevant to some aspect of
diagnosis or prognosis, concerns within a physician's decision making sphere. The nurse's action, taken as patient
advocate, may require, or be perceived to be, interference with that physician's decision. As one respondent
described their roles and conflicting goals, "I do not feel it's my place to tell her. That's the physician's place.... It's
my role to make sure that the patient knows."
CONFLICT IN CONTEXT
Gutknecht and Miller (1986) describe six levels of context on which organizational conflict occurs: (1)
intrapersonal, (2) interpersonal, (3) intragroup, (4) intergroup, (5) intraorganizational, and (6) interorganizational.
The conflict embodied in these dilemmas takes place and is influenced by these six levels. The nurse respondents
described influential aspects of each of these contextual levels.
Respondents talked of feeling intrapersonal tension in statements such , "I'm going to feel very anxious," "I was
angry," and "this one really pisses me off." The interpersonal relationship was referred to in statements like, "it
depends on the physician," "some are easy to talk to, some difficult," and "some will listen to you, others won't."
Intragroup conflict came out in their assessment of anticipated support from their head nurse, "she'd lecture me"
and in statements about relations with nursing colleagues, "if I go ahead with everybody else and let them say this
is how things are supposed to be, I'm never going to be happy with myself." Intergroup differences appeared in
statements referring to the different roles of physicians and nurses, "it's the physician's place to tell," "I don't think
it's the nurse's place," "I don't think it's the nurse's responsibility," and "legally, I don't think I would tell them."
Intraorganizational conflict arises from the different sources of organizational authority and power. Hospitals can
be dominating in their hierarchical structures (Holmer, 1990), with "differences in status and power" (Redland,
1984, p. 104) between physicians and nurses. Respondents referred to these differences in statements of, "I'm just
a nurse," and "I think of doctors as authority figures." Respondents also identified alternative sources of power,
such as their head nurse, to support their position in conflict with physicians, "I'm sure she would be willing to
assist and intervene." Interorganizational conflict exists between the different models for providing health care.
These models frame the organizational understandings of the power and working relationships of nurses and
physicians. Differences in these understandings were articulated by a nurse who said, "I started in a very
authoritarian hospital where all physicians were godly figures...then I chose to go to an area where I would have
more independence."
CONTEXTUAL INFLUENCES UPON CONFLICT MANAGEMENT CHOICES
The conflict decisions nurses make in these dilemmas are influenced by these multiple levels of organizational
context, yet the influence of these individual contextual levels is not easy to disentangle. Multiple levels of context
occur simultaneously and interact to construct the conflict, and to constrain its management choices.
Past research has cited relational, (Canary &Spitzberg, 1990; Papa &Pood, 1988; Tjosvold, 1990) situational, and
organizational influences (Conrad, 1991; King &Miles, 1990; Sullivan, Albrecht, &Taylor, 1990; Thomas, 1988;
Wheeless, Wheeless, &Riffie, 1989) as important in conflict management. But, as Putnam and Poole (1987)
suggest, the specific influences upon conflict management vary with the context. The present study, therefore,
examines a number of relational, situational, and organizational influences, from across the multiple levels of the
context, and uses discriminant analysis to organize them into underlying dimensions of contextual influence.
Influences considered important in the present study include the hospital care model in which the nurse practices;
the action a nurse perceives as possible; the anticipated support for that action; whether telling the patient the
truth is beyond the scope of the nurse's professional role; the perceived importance of telling the truth to the

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patient; the dilemma seriousness; the trust a nurse has in the physician, head nurse, nursing administrators, and
hospital administration; the frequency with which the dilemma has occurred in the past; and how upsetting the
situation is to nursing practice. The measurement of each of these potential influences is described below.
Hospital care model identifies the professional health care model of the hospital in which the nurse practices.
Three hospitals were selected for the current study because of their reputations for support of a particular
professional model of nursing practice. One hospital follows a "medical model" of practice and is "physician-
oriented" in its decision-making. Physicians make the decisions and give orders concerning patient care to the rest
of the health care team. The second hospital encourages nurses to participate in the decision-making as part of
the health-care team. In the third, the organizational role and professional relationship expectations are ambiguous
and ambivalent. Soliciting respondents from among nurses working at these three hospitals was a purposive
sampling technique designed to better represent the diversity of organizational contexts in which nurses work and
manage conflict (Smith, 1988).
Characteristics of role conflict, ambiguity, and boundary uncertainty are implicit in these different hospital health
care models; and are important considerations in the context of conflict and conflict management (Hardy &Hardy,
1988). Role conflict is the presence of incompatible role expectations such as the conflicting expectations in these
dilemmas for carrying out the doctor's orders and for simultaneously being a patient advocate. Role ambiguity is a
lack of clarity in role expectations and in the degree of anticipated professional and institutional support for
engaging in role-specific actions. Role boundary uncertainty is the clarity with which job responsibilities, and
working relationships, are defined. These role issues are significant concerns for nurses (Hardy &Hardy, 1988), and
were investigated, in the present study, through queries concerning the actions the nurse perceived as possible,
the anticipated support for those actions, and the perception of the scope of nursing practice.
The actions the nurse perceives as possible in a situation were measured through five choice options: (1) tell the
patient the truth or take action to prevent physician action; (2) attempt to obtain the truth for the patient by
working trough others (e.g., physicians, family, etc.); (3) remain neutral even if uncomfortable; (4) speak or act to
maintain deceit without actually lying; or (5) lie directly to the patient. The nurse's anticipated support from her
head nurse, administrative personnel, and peers was measured by three categories: (1) generally supportive of the
nurse telling the truth to the patient; (2) neutral or supportive either way; or (3) generally supportive of the nurse
not telling the truth to the patient. Whether telling the truth to the patient is perceived to be beyond the scope of
the nurse's professional role was measured with three categories: (1) within the scope; (2) not sure; and (3) beyond
the scope.
Perceptions of the consequences of deceiving or telling the patient the truth are also important considerations in
these dilemmas and were measured in to ways: as the perceived importance of the consequences to the patient
and as differences in dilemma seriousness. The perceived importance of the consequences to the patient of telling
the truth were measured by three category choices: (1) clear or likely benefit; (2) don't know or perhaps harm,
perhaps benefit; and (3) clear or likely harm. Dilemma seriousness was manipulated through the use of
hypothetical dilemmas. In these dilemmas the seriousness of sharing or withholding information varied with the
situation. There is no strict hierarchy intended in this dilemma seriousness, but there are important differences.
Respondents suggested a possible consequence to sharing the information in the placebo dilemma as drug
addiction, but the likelihood of this or other serious consequences appeared remote. The accidently nicked bladder
was held serious in its potential for future legal, as well as physical, complications. Discussion of the possible
mastectomy consequences focused on the seriousness in emotional devastation to the patient, "she's going to be
terribly upset," "she's going to be devastated," and "she could have deep emotional problems." The cancer dilemma
elicited concerns for the patient's family: "cancer is a disease that affects the whole family," "the whole family has
it," and "it is a family issue."
Trust is another characteristic considered important in managing conflict (Tjosvold, 1990). The present study
investigates the nurse's trust in the physician and the head nurse, the nurse's two most immediate professional
working relationships. It also inquires about trust in nursing administrators including supervisors, clinical

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coordinators, and directors; and trust in the non-nursing hospital administration.
To allow respondents flexibility in reporting their experiences of trust, scales were developed that consist of a line
drawn between bi-polar opposites. At one end of the line appear the number zero and the words NO TRUST. At the
other end appear the number one hundred and the words COMPLETE TRUST. Participants reported their relative
amount of trust by marking an X on this line. The line itself is 100 millimeters long and the participants' scores
were recorded as the number of millimeters along the line they placed their X.
Finally, the frequency with which a dilemma had occurred within the nurse's practice and how upsetting the
conflict situation is to professional nursing practice were measured on 100 millimeter scales. Appendix A contains
examples of these contextual influence scales.
THE INTERVIEWS
The interviews were conducted by a female researcher who is a registered nurse. The interviews were completed
over a nine month period, audio taped, and later transcribed. Prior to the interviews, approval to enter the hospital
was obtained. Each hospital's nursing department provided a list of names of nurses who met the research criteria
(i.e., BSN degree with a minimum of one year's experience) and who were staff nurses on non-critical care medical-
surgical units. Names were randomly selected from these lists and those nurses were invited to participate in the
study. All the nurses who participated were volunteers, receiving copies of the hypothetical dilemmas and the
interview agenda prior to the interview. Use of human subjects procedures meeting the criteria and approval of all
three hospitals' research review committees were followed. Interviews of 2-4 hours in length were conducted
individually, either at the participant's place of work or, upon her request, in her home. Privacy was considered a
priority during the interviews.
The interview format was a series of open-ended questions probing the nurse's responses to the conflict dilemmas
and how the nurses viewed these dilemmas within the context of their relationships with physicians and patients.
The interview proceeded through the recalled incident and each of the hypothetical dilemmas with the participant
describing the conflict in the situation, talking through what she would think about doing, describing what she
would finally decide to do, and suggesting anticipated consequences of her actions. This format and question
sequence follows the work of Brown (1988) and Brown and Gilligan (1991) for eliciting responses to moral conflict.
The Interview Schedule appears in Appendix B.
CODING CONFLICT MANAGEMENT STRATEGIES
The conflict management strategy intended by the nurse was operationalized as what the nurse said she did (in
the recalled event), or would do (in each hypothetical dilemma). After reading and discussing background
materials and coding definitions, two raters (one nurse and one non-nurse) independently read and coded the
interview transcripts for the conflict management strategies. Data were coded using the categories developed by
Thomas (1976) and used by Redland (1984) in coding her data. This coding scheme provides five categories:
collaboration, competition, accommodation, avoidance, and compromise.
The compromise category provides a particular coding challenge. Van de Vliert and Kabanoff (1990) report that
compromise is not an independent category but one that has more in common with accommodating and
collaborating. Neither of the coders identified any instances of the compromise strategy in the present data.
Redland (1984) also found no use of compromise in her study of nurses' conflict management. This lack of
compromise strategies may be due to the nurses' strategy choice patterns or to the systematic coding of
compromise strategies as accommodating or collaborating. As the present study could not distinguish
compromise from the other strategies it was dropped from further consideration and the four discernable
categories were analyzed.
In the present data, nurse strategies to "talk it over" and "work it out" with the physician in a non-threatening way
were coded as collaboration. Strategies that included directly telling the patient, confronting the physician and
demanding that the physician tell the patient, telling the patient to confront the physician, or writing up a formal
complaint about the physician were coded as competition. Going along with the physician's plan or actively
participating in it in some way was coded as accommodation. Deciding to do nothing, changing the subject,

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leaving the room, and avoiding the patient and issue, were coded as avoidance.
The raters used one third of the interviews for training to develop and clarify their coding technique. After the
training period, raters independently coded the rest of the data. Coding reliabilities were computed following Fleiss
(1981); and the coding of the conflict management strategies was considered reliable (Cohen's K=.87). Raters
recoded the training data and discrepancies were easily resolved.
STATISTICAL DESIGN
Responses were obtained for each of the five scenarios (the recalled experience and the four hypothetical
dilemmas) from thirty-three nurses. Following Hand (1981) and Klecka (1980) and the example presented by
Klecka (Nie, Hull, Jenkins, Steinbrenner, &Bent, 1975) the unit of analysis in the present study is the response, not
the individual respondent. This response identifies the specific course of action developed by the nurse for the
particular dilemma presented. While partial observations were lost in the audiotaping and transcribing process,
there were 164 complete strategy decisions obtained and they were treated as the observations. The conflict
management strategy types of collaboration, competition, accommodation, and avoidance formed the groups to
be discriminated; and discriminant analysis was performed to identify the important contextual influences upon
these strategy choices. Eisenbeis and Avery (1972) develop the methodological appropriateness of using
categorical as well as interval level discriminators in this analysis.
RESULTS
DESCRIPTIVE STATISTICS
General descriptive statistics show that respondents trust their head nurse's handling of the situation the most
across all scenarios (mean=81.52; SD=14.17). They trust the nursing administration (mean=68.93; SD=23.03) and
physicians (mean=62.26; SD=23.63) somewhat less, and the hospital administration the least (mean=56.90;
SD=23.73). Overall trust ratings were consistent but varied according to the relationship type (Cronbach's
alpha=.68). These measures of trust were further corroborated through discussions with the participants at the
end of the interviews in which they verbally described the need for trust in these situations and the influence that it
has upon their course of action.
Our nurse respondents had experienced these types of dilemmas in their professional work during the past two
years; but fortunately, both for the nurses and their patients, these dilemmas had occurred with relative
infrequency (mean=16.71; SD=13.49). While occurring infrequently, these dilemmas proved upsetting to the
nurse's practice when they did occur (mean=67.48; SD=24.25).
THE DISCRIMINANT ANALYSIS RESULTS
The contextual variables: hospital care model; action the nurse perceives as possible; anticipated support for that
action; whether telling the patient the truth is beyond the scope of the nurse's professional role; perceived
importance of telling the truth; dilemma seriousness; trust in the physician, head nurse, nursing, and hospital
administrators; frequency with which the dilemma has occurred in the past; and how upsetting the situation is to
nursing practice; were entered as discriminating variables for the discriminant analysis. Together, they correctly
predicted the conflict management strategy chosen by the nurse 73.27% of the time (chi-square=84.14, df=9,
p<.005). These contextual elements proved to be significant influences upon the individual's choice of a conflict
management strategy.
Three discriminant functions, the maximum number extractable, distinguished among the four conflict
management strategy types--collaboration, competition, accommodation, and avoidance. Table 1 shows the
results of extracting these functions. (Table 1 omitted). The eigenvalues, percent of variance, and associated
canonical correlations show the relative importance of each function.
Function one's relatively large eigenvalue (.638), large percentage of discriminated variance (61%), and strong
canonical correlation (.624) show its ability to discriminate among the conflict management strategy choices. The
Wilk's lambda (.427) before this first function is removed shows the power of the set of contextual variables to
discriminate among the four strategies. The Wilk's lambda (.699) after this function is removed shows that some
of the discriminating power has been extracted by this first function, but that considerable discriminating ability

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still exists in the variables. A second function is derived which has the ability to discriminate further among the
groups (eigenvalue=.308, 30% of discriminated variance, canonical correlation .485). The Wilk's lambda (.915) after
this function has been removed reveals that there is relatively little discriminating power left in the variables. The
third function extracted is weak and does not contribute much to further discriminating among these groups
(eigenvalue=.093, 9% of discriminated variance, canonical correlation=.291).
The structure matrix (Table 1) presents the standardized discriminant function coefficients representing the
relative contribution of each variable to each of the functions. Asterisks appearing after the coefficient indicate the
largest loading for that contextual characteristic.
The action the nurse perceives as possible: tell the patient the truth, attempt to obtain the truth for the patient,
remain neutral, help maintain the deceit, or explicitly lie to the patient, contributes to the first function
(coefficient=.543). Whether the nurse thinks that telling the truth is beyond the scope of a nurse's professional
practice, isn't sure, or feels that telling the truth is within the scope of that practice, also makes a contribution
(coefficient=-.425). The hospital care model, in its physician-orientation, team orientation, or ambiguous
orientation, further contributes to this discriminating function (coefficient=-.309). Finally, how upsetting this type
of incident is to the nurse's professional practice contributes (coefficient=-.230). Each of these contributors
identifies a concern for the professional nursing role in the dilemma. The nurse's perception of her role as a
professional nurse is the primary function that discriminates the choice of a conflict management strategy for
these female nurse respondents in these situations.
The second function, somewhat less important than the first, but still an important dimension in the nurses'
decision making, considers the situational and organizational contexts in which the conflict management decision
must be made. The strongest contributor to this function is the degree of support the nurse expects for her
decision from her head nurse, other nurses, and the hospital administration (coefficient=.518). A second
contributing consideration is the seriousness of the dilemma's consequences (coefficient=.417). A third
contributor is how frequently this type of situation has occurred in her practice (coefficient=.239). The fourth
indicates the degree of trust the nurse feels for the hospital's upper nursing administration (coefficient=-.192).
Each of these contributors express something about the nurse's perception of the situational and organizational
context within which she must manage the conflict.
The third function, which does not contribute much to distinguishing the conflict management strategy chosen,
consists of relational influences. How much the nurse trusts the physician, the head nurse, and the hospital
administration; and how important the nurse feels telling the truth to the patient is in this situation are the
contributors to this function.
Figure 1 displays the conflict management strategy group means (group centroids) on the first two discriminant
functions. (Figure 1 omitted). This plot shows that the first function, perceptions of the professional nursing role,
distinguishes the choice of using a competitive strategy from the non-competitive strategies. Competition
(mean=.44) is distinguished from avoidance (mean=-.93), collaboration (mean=-1.63), and accommodation
(mean=-1.88) by this function.
The second function, characterized by aspects of the situational-organizational context, discriminates among the
non-competitive strategy choices. Avoidance (mean=1.42) is discriminated from collaboration (mean=-.29) and
both of them are distinguished from accommodation (mean=-1.29). Avoidance and accommodation are further
distinguished from competition (mean=-.04) along this dimension.
These results show that the nurse's perceptions of the professional nursing role and of the situational-
organizational context within which she works, are major influences upon her selection of a conflict management
strategy. Interview probes verified that, while these are not the only contextual influences upon their decisions, the
nurses frequently felt constrained in their choice of a conflict management strategy by both their professional
nursing role and their situational-organizational role.
DISCUSSION
Past research has found personal attributes, characteristics, style, traits, and behaviors to be important influences

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upon conflict management decisions. The present study makes four contributions to that research. First, the
present investigation does not argue against the influence of personal attributes to conflict management
decisions, but suggests that personal attributes be viewed within a larger set of contextual influences. Second, the
present research demonstrates the importance of additional contextual influences. Third, the present study offers
empirical support for Thomas's (1976) conceptualization of underlying dimensions to those contextual influences.
Fourth, through the use of interview responses, the present study suggests the multiplicity, complexity, and
interaction of those influences.
First, personal characteristics are, no doubt, important influences upon conflict management decisions. Past
research has found personal characteristics to be influential and, in the present study, nurse respondents often
referred to personal characteristics that influenced their decisions, both when describing their general approaches
to conflict as in, "I'm too passive," or "I was petrified of any confrontation," and in describing their approach to a
specific conflict situation. The personal characteristic of being female, for instance, appeared particularly salient
for these nurses in their response to the mastectomy dilemma. Many respondents explained their feeling a need to
act in this dilemma that they did not feel in the other dilemmas, "because I am female," "I am a woman," and "we
are in the same shoes." This observation of an event-specific salience suggests that while personal characteristics
may act as important influences upon conflict management, that influence is more or less observable, depending
upon the particular conflict situation. Further research data and direct investigation of this issue are needed to
verify this assertion, but the present data suggest an interesting, as yet not fully explored, question about the
influence of personal characteristics.
Second, personal characteristics are not the only influences upon the choice of a conflict management strategy.
The present discriminant analysis explores some additional contextual influences. The results of this analysis
show that a nurse's perceptions of the professional nursing role and of the organizational situation are important
influences upon the conflict management decisions. The action a nurse sees as possible within the hospital, the
appropriate role of a nurse, the hospital care model, and how upsetting the incident is to nursing practice, all
influence how willing and likely a nurse is to engage in a particular strategy to manage that conflict. Assessments
of the amount of anticipated support, seriousness of dilemma consequences, frequency of occurrence, and issues
of trust, also influence that decision. These characteristics of professional role and organizational situation are
important influences upon the conflict management decisions.
Third, Thomas (1976) theorized two dimensions to the contextual influences on conflict management strategy
choices. He conceptualized these as distributive and integrative dimensions.
Thomas's distributive dimension relies on an assessment of the power distributions and the degree of
commitment to the issues involved in the conflict. For Thomas, this dimension distinguishes competitive from
accommodative strategies. In the present study, function one, the perceptions a nurse has of the professional role,
discriminates between the use of competitive and non-competitive strategies. This discrimination is based upon
the nurse's assessments of that professional nursing role in terms of power relationships (e.g., does a nurse,
within that role, have the power to obtain the truth; how much power does a nurse have within the hospital care
model), and the degree of professional commitment to the conflict issue (e.g., is it beyond a nurse's role; how
upsetting is it to nursing practice). This empirically discovered function appears similar to Thomas's distributive
dimension.
Thomas's integrative dimension distinguishes avoidance from collaboration and rests upon an assessment of the
type of conflict issue and degree of conflict present. In the present results the second discriminant function
distinguishes among avoidance, collaboration, and accommodation strategy choices; and shows that a nurse's
assessment of the specifics of the organizational situation influences the choice of one of these non-competitive
strategies. If, for example, the nurse expects little or no institutional support in the conflict situation, anticipates
little harm to the patient, has experienced the problem frequently in the past, and has little trust in the nursing
administration, there is little reason to expect success using a collaborative strategy. Avoidance is, however, a very
reasonable strategy to choose. If, on the other hand, institutional support is anticipated, the situation is unusual,

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the nurse trusts the upper nursing administration, and avoidance may have the consequence of great harm for the
patient, a collaborative strategy can be more reasonably engaged in, and may even be a professional and
organizational expectation.
The two functions that emerge in the present analysis represent Thomas's dimensions relatively well. The results
of the present study, therefore, provide some empirical support for the contextual dimensions theorized by
Thomas to be influential upon an individual's conflict management choices.
Fourth, the present study uses interviews to collect responses instead of paper and pencil tests. The interview
method allows us as researchers to more fully hear some of the influences our respondents find important in
developing their conflict management strategies. In the present study their strategies were influenced, as
anticipated, by who they are as people (e.g., "I'm too passive," "I am a woman"); by their interpersonal relationships
with physicians (e.g., "You learn how they like to be asked questions and work those angles"); their perceptions of
their roles as nurses (e.g., "I don't think it's the nurse's place"); and the hospital situational and organizational
structures (e.g., "No one was coming to talk to the patient, so I kept going up the ladder" of the hospital hierarchy).
In addition to these influences, however, the interview structure allowed us to hear some of the respondents' other
contextual concerns and considerations for: the patient as a person (e.g., "It would depend upon the patient too,"
"I'd consider my assessment of the patient's emotionality"); for the patient's family (e.g., "It's important because
cancer is a disease that affects the whole family. It's as if the family has it;" "I think it is a family issue. A whole
family issue"); and for larger social and legal contexts (e.g., "I'm anticipating that juries are still into the
authoritarian model of medicine, so they would absolve the nurse") in which nurses make their conflict
management decisions. We had not fully considered these, or many of the other influences respondents
considered important to the contextual contingencies on the strategies they employed. As one respondent
indicated, ultimately, "you deal with each situation individually."
While we were not able to incorporate all of these influences into our present discriminant analysis design,
listening to our respondents discuss their conflict management strategies convinced us of the importance and
complexity of these contextual influences to them. Their discussions helped us better understand their contextual
constraints and aided our interpretation of the discriminant analysis results. We have tried to share some of that
discussion through their quoted responses and in our interpretation of the results.
Finally, our respondents' considerations of contextual influences were numerous and complex. We have focused
our analysis on some that appeared the most salient. If we are to fully understand conflict and its management in
organizations, however, we need to develop a more complete knowledge of the complexity of contextual
influences.
The present analysis is only an initial attempt to investigate some of these influences. By finding that professional
role and situational-organizational influences are salient in these particular contexts, the present study shows the
importance of contextual influences. By focusing on this specific set of contextual influences, however, the
present study does not allow us to identify the approaches to conflict that individual nurses would have preferred
to use or to recognize all of the contextual influences that they see as constraining. Nor can we make general
statements about which contextual influences are most important across conflict situations. Future research
needs to investigate other influences, in other contexts, and examine their interactions with each other and with
personal characteristics. The strength of the present research resides in its examination of specific contextual
influences, in its empirical support for Thomas's (1976) conceptualization of underlying dimensions to those
influences, and in its elicitation of interview responses that suggest the complexity and multiplicity of those
contextual influences.
APPENDIX A
CONTEXTUAL INFLUENCE SCALES
INSTRUCTIONS: Please indicate your best estimate of the trust you have in the professional ability and
performance of the following persons with whom you presently work to respond to this dilemma. Place an X on the
bar from 0 to 100.

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NON-NURSING HOSPITAL ADMINISTRATORS:
0--100
NO TRUST--COMPLETE TRUST
NURSING ADMINISTRATORS: (SUPERVISORS, CLINICAL COORDINATORS, DIRECTORS)
0--100
NO TRUST--COMPLETE TRUST
HEAD NURSES, ASSISTANT HEAD NURSES:
0--100
NO TRUST--COMPLETE TRUST
PHYSICIANS:
0--100
NO TRUST--COMPLETE TRUST
HOW FREQUENT IS THIS KIND OF SITUATION IN YOUR PRACTICE?
0--100
NEVER--VERY FREQUENT
DO YOU FIND IT PARTICULARLY UPSETTING TO YOUR NURSING PRACTICE?
0--100
NEVER--ALWAYS
WHAT ACTION CAN YOU TAKE IN YOUR ROLE AS A NURSE?
1. Tell the patient the truth or take action to prevent physician action.
2. Attempt to obtain the truth for the patient by working through others (e.g., physicians, family, etc.).
3. Remain neutral even if uncomfortable.
4. Speak or act to maintain deceit without actually lying.
5. Lie directly to the patient.
WHAT SUPPORT WOULD YOU EXPECT FROM YOUR HEAD NURSE, ADMINISTRATIVE PERSONNEL, AND
TEAM/PEERS FOR YOUR ACTION?
1. Generally supportive of nurse insuring patient informed.
2. Neutral or support either way.
3. Generally supportive of nurse going along with physician plan.
HOW IMPORTANT IS TELLING THE TRUTH IN THIS DILEMMA?
1. Clear or likely harm.
2. Don't know or perhaps harm, perhaps benefit.
3. Clear or likely benefit.
IS TELLING THE PATIENT THE TRUTH BEYOND THE SCOPE OF NURSING PRACTICE?
1. No, it is within the scope.
2. Not sure.
3. Yes, it is beyond the scope.
APPENDIX B
THE INTERVIEW SCHEDULE
1. Could you describe for me a situation where a patient was deceived or inadequately informed by a physician and
you were not sure what was the right thing to do.
a What was the situation?
b. What was the conflict for you in that situation?
2. In thinking about what to do, what did you consider? Why? Anything else?
3. What did you decide to do? And then? What happened?
FOR EACH OF THE HYPOTHETICAL DILEMMAS:
1. I'd like you to read and focus on this dilemma.

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a What is the conflict for you in this situation?
b. Is there anything else?
2. In thinking about what to do what would you consider? Why? Anything else?
3. What would you do? And then? If that did not work?
4. What do you think would happen?
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Mary J. Marin (M.A., 1992, University of Maine) is a former graduate student in the Department of Speech
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Orono, ME 04469.

DETAILS

Subject: Social research; Nurses; Medical ethics; Management of crises; Interpersonal

communication

Publication title: Western Journal of Communication; Salt Lake City

Volume: 58

Issue: 3

Pages: 201

Number of pages: 0

Publication year: 1994

Publication date: Summer 1994

Publisher: Taylor &Francis Ltd.

Place of publication: Salt Lake City

Country of publication: United Kingdom, Salt Lake City

Publication subject: Linguistics, Theater

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 ISSN: 10570314

CODEN: WJSCDW

Source type: Scholarly Journals

Language of publication: English

Document type: Feature

Accession number: 02107741

ProQuest document ID: 202688540

Document URL: https://search.proquest.com/docview/202688540?accountid=48290

Copyright: Copyright Western States Communication Association Summer 1994

Last updated: 2011-09-15

Database: Arts &Humanities Database

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