Conflict- This nurse practitioner must

Scenario: 61 year old male (Mr. Smith) who is status post MVC. Patient suffered from multiple rib fractures, fractured  leg, and a fractured forearm. Upon arrival patient GCS 15, with labored breathing. It was discovered that this patient developed a pneumothrax from rib fractures. 

Within 2 hours, patient deteriorated and required mechanical ventilation. After 3 days, patient was downgraded from mechanical ventilation to bipap, then vapotherm (heated high flow nasal cannula) on day 7. During the morning of hospital day 8, while on vapotherm patient’s oxygen saturations decreased to 50%, his heart rate dipped to the 20s, and eventually stopped. 

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After code blue situation, patient was intubated and placed back on mechanical ventilation. He was weaned on day 10, then was on vapothem by day 14. Patient still GCS 15 was told by his nurse practitioner that the only course of action for him was longterm ventilation and wanted permission to perform a tracheostomy. The patient asked the nurse practitioner for clarification on the procedure, the outcome, and prognosis. Once he heard that he may require mechanical ventilation indefinitely, he asked about initiating a DNR/DNI. He did not want another code blue situation. When the nurse practitioner explained that with DNR/DNI and his refusal to allow the tracheostomy, they did not believe that he could breath independently. 

The patient asked to be transferred to palliative/hospice care so that he could pass away in comfort of his home rather than in the hospital setting.

The patient’s family didn’t agree with Mr. Smith’s decision and attempted to obtain power of attorney so that they could override his decision. Mr. Smith made his wishes clear and his family spent many hours discussing with attorneys, hospital chaplain, and the nurse practitioner to get Mr. Smith to change his mind or to have him deemed incompetent. 

Conflict– This nurse practitioner must discuss Mr. Smith’s request with the family and help them understand that Mr. Smith considered all of their feelings,  but chose quality of life rather than simply being alive. Further, because Mr. Smith is of sound mind, the ultimate decision is Mr. Smith’s to make. 

Style of conflict

  • Avoidance
    • Accommodation
    • Competition
    • Compromise
    • Collaboration

Sportsman, S. (2005). Build a framework for conflict assessment. Nursing Management, 36(4), 32-38

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