It is important to remember that the therapeutic nurse-client relationship is the

foundation for providing nursing services that contribute to the clients health and wellbeing. One of the role of the nurse in the therapeutic nurse-client relationship is to
support the client in achieving the clients health goals. However, unresolved conflict
can obstruct the attainment of these goals.
It is critical to be aware of when we are in the middle of a possible conflict in our
environment, so I give you some characteristics and situations that could identify or are
associated with the evolution or rising of conflict among nurses, clients and their
families. If we know how to identify a conflict we can prevent it and improve the delivery
of care.

Conflict between a nurse and a client can escalate if a client is:

a) Intoxicated or withdrawing from a substance induced state;
b) Being constrained (for example, not being permitted to smoke) or restrained (for
example, a physical or chemical restraint);
c) Fatigued or overstimulated; and/or tense, anxious, worried, confused, disoriented or
afraid.
Conflict between a nurse and a client can escalate if a client has:
a) A history of aggressive or violent behavior, or is acting aggressively or violently (for
example, using profane language or assuming an intimidating physical stance);
b) A medical or psychiatric condition that causes impaired judgment or an altered
cognitive status;
c) An active drug or alcohol dependency or addiction;

d) Difficulty communicating (for example, has aphasia or a language barrier exists);

and/or
e) Ineffective coping skills or an inadequate support network.

Conflict between a nurse and a client can escalate if a nurse:

a) Judges, labels or misunderstands a client;
b) Uses a threatening tone of voice or body language (for example, speaks loudly or
stands too close);
c) Has expectations based on incorrect perceptions of cultural or other differences;
d) Does not listen to, understand or respect a clients values, opinions, needs and
ethno-cultural beliefs;
e) Does not listen to the concerns of the family and significant others, and/or act on
those concerns when it is appropriate and consistent with the clients wishes;
f) Does not provide sufficient health information to satisfy the client or the clients family;
and/or
g) Does not reflect on the impact of her/his behavior and values on the client. (Ontario,
2009)
Source
Jennings, B. M. (2011). Work Stress and Burnout Among Nurses. In Patient Safety and
Quality: An Evidence-Based Handbook for Nurses.

retrieved June 16 2015 from

http://www.ncbi.nlm.nih.gov/books/NBK2668/
Ontario, C. o. (2009). Conflict Prevention and Management. Retrieved June 16, 2015,
from http://www.cno.org/: http://www.cno.org/Global/docs/prac/47004_conflict_prev.pdf

Discussion2
It is well documented that the stress and pressure of nursing on a hospital floor make
for more conflict. Stress has been regarded as an occupational hazard since the mid1950s. In fact, occupational stress has been cited as a significant health problem. Work
stress in nursing was first assessed in 1960 when were identified four sources of
anxiety among nurses: patient care, decision making, taking responsibility, and change.
The nurses role has long been regarded as stress-filled based upon the physical labor,
human suffering, work hours, staffing, and interpersonal relationships that are central to
the work nurses do. Since the mid-1980s, however, nurses work stress may be
escalating due to the increasing use of technology, continuing rises in health care costs,
and turbulence within the work environment.

Discussion3
Work stress and burnout remain significant concerns in nursing, affecting both
individuals and organizations. For the individual nurse, regardless of whether stress is
perceived positively or negatively, the neuroendocrine response yields physiologic
reactions that may ultimately contribute to illness. In the health care organization, work
stress may contribute to absenteeism and turnover, both of which detract from the
quality of care. Hospitals in particular are facing a workforce crisis. The demand for
acute care services is increasing concurrently with changing career expectations among
potential health care workers and growing dissatisfaction among existing hospital staff.
By turning toxic work environments into healthy workplaces, researchers and nurse
leaders believe that improvements can be realized in recruitment and retention of

nurses, job satisfaction for all health care staff, and patient outcomesparticularly those
related patient safety (Jennings, 2011)
Source
Jennings, B. M. (2011). Work Stress and Burnout Among Nurses. In Patient Safety and
Quality: An Evidence-Based Handbook for Nurses.
http://www.ncbi.nlm.nih.gov/books/NBK2668/

retrieved June 16 2015 from