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Conflicts in Providing Quality Care

Conflicts and issues arise when a person receives nursing care in the home for the family. It is important for the case manager, home care, occupational or office nurse and other disciplines to assess for conflicts and issues. Nurses can assist with the issues so that the patient and family caregivers all maintain their highest level of health and function.

Nurses need to inquire about the family's physical and emotional preparation for the role of home caregiver. The complex decisions families must make about symptoms, untoward efforts of medications and treatments.

The health care provider must gather some background information as to how long caregiving has been occurring, and to watch for stress-related illness. Long term caregivers make significantly more physician calls for themselves and had more reports of emotional disorders than short-term caregivers. Two perspectives on Caregiving on Home Care: the visiting nurse and the nurse who is the home caregiver.

In the columns below issues, conflicts or some simplistic solutions are listed. Read all of these in the right hand column identified each conflict. In the text box at the end of the end of the table type what you would do for 3 of the conflicts/issues you have identified.

Issues/Conflicts in Providing Quality Home Care

Family Caregiver Concerns

Quality Nursing Care Needed

Identify the conflict or issue and what can be done to ensure quality care.
80% of seniors who need care are cared for at home; more than half of the caregivers are women who also work full- or part-time. Assess the potential health hazard created by such "role overload" by the caregiver.
The family's experiences a profound loss of control. Care by an outside agency may not meet the family's standards. A nursing home may not be a possibility, either financially, morally, or ethically.
Lack of privacy is a complex stressor encountered. Schedule visits for convenience and inquire about use of respite care.
End is never in sight. There is no light at the end of the tunnel. The caregiver cannot "pace him- or her-self"; it simply isn't known when the caregiving responsibilities will increase or decrease
Conflicting loyalties, caregivers wrestling with guilt and/or sense of incompetence. Caregiving is a total family issue, clarify assumptions made by extended family members and professionals.
The primary caregiver cannot give up all outside activities for caregiving. Worry about the patient's treatment if there are misunderstandings or conflicts.
Long term home care is expensive for families. Discuss the final implication that any treatment plan will have on family finances.
Families will verbalize their frustrations, anger, guilt at feeling angry, and a sense of fatigue. Grant families permission to express and manage these feelings.
Caregiving in isolation is lonely. Gratitude for all is often missing. Nurses can provide gratitude and some socialization.

Norma Stephens Hannigan, MPH, MS, RN, CS, FNP
Clinician at Home
Family Caregiver, Clinician Reviews, June 1996

Your assignment is to read the previous table clinical situation and identify one quality of care conflict between public, patient, clinician or managed care organization point of view. Describe the points of view and potential. Use the text box below to complete this assignment.

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