After a brain injury, the road to recovery can be challenging and filled with emotions. Caregivers are faced with additional “stress, anxiety and depression [1]. Families and caregivers may be overwhelmed with the circumstances. There may be situations where they become agitated or even argumentative with the health care providers or clinicians.
Understanding how to manage this conflict is important for maintaining communication and trust with families and patients.
Why do conflicts occur?
After a serious injury, families and caregivers often feel intense emotions, including fear and anger. Coupled with a lack of control over the situation, it is easy for these emotions to spill over.
There are several reasons why family members may become agitated. Some family members feel that their input is not properly acknowledged or considered when making decision about their loved one’s treatment or care plan [2]. Many are also dealing with a swarm of emotions such as grief, anxiety, uncertainties, financial and emotional stresses, added responsibilities, and a change in families dynamics which may affect their cultural norms.
Some families may feel they have not been provided enough information or that the healthcare system is not providing enough support [3]. Sometimes there may be conflicting information provided by a lack of interdisciplinary collaboration. The families are provided with inconsistent information regarding the treatment or expected outcomes [4].
Understanding the struggle faced by the family is an important step in providing conflict management. There should always be a focus on person-centred care principles, including respect and dignity for the patient and the family members, participation and providing continuity of information.
If conflict arises between the family and the health care provider, try the following:
- Listen actively
- Do not take it personally
- Speak in a calm and neutral tone
- Repeat to the families the concerns they vocalized, so they feel heard and you are clear on their concerns
- Acknowledge and be empathetic
- Be honest and consistent in your responses or when relaying information
Managing conflict with patients
Managing conflict with brain injury survivors is substantially different than dealing with their families. There are neurobehavioural changes that may limit communication and comprehension abilities [5]. These factors can be a great source of frustration for the patient and lead to outbursts, anxiety and depression. Understanding the patient’s personal situation, the impact of the brain injury, and that they may lack self control can help the health care worker provide better care.
The TBI Model System [6] suggests the following tools to manage outbursts and conflicts with patients:
- Remain calm
- Don’t take things personally
- Be empathetic and acknowledge their feelings
- Listen
- Do not engage in combative behaviour
- Speak calmly and in a neutral voice
- Redirect the conversation or leave the room for a short time to allow the patient to calm down
Many individuals with brain injury may have trouble with reasoning, problem solving, information processing and concentration [7]. Finding a suitable solution may be challenging. If the situation becomes aggressive or has potential for violence, you may need to ask for assistance or use a non-violent crisis intervention.
Navigating difficult conversations
Difficult conversations can include anything from telling a patient that they may never walk again to explaining how a brain injury will change a person’s lifestyle. Whatever the situation, having these difficult conversations with families and patients is never easy. “Patients and family members highly value effective communication and empathetic relationships with their healthcare providers” [8].
Here are suggested steps for navigating difficult conversations [9]:
- Pick a quiet and private location to have the conversation
- Prepare ahead of time – practice the conversation
- Use simple language
- Have some additional support services (pamphlets, websites, or contact numbers) prepared
- Be encouraging and empathetic
Additional strategies to assist with the initiation of the conversation can include:
- Start off the conversation with an introduction. And remember – always use the patient’s name
- Ask the family if they have any concerns
- Sit rather than stand
- Listen actively
- Discuss the stated concerns and use this opportunity as a starting point
- Use plain language
- If there are moments of quiet, allow it. Families and patients need this time to process their emotions
- Be empathetic
There are several different ways to approach these conversations [10], but the most important aspect is simple, clear communication.
Brain injury survivors and their families/caregivers all face what seems to be an insurmountable amount of stress and anxiety. These emotions can become outbursts or evolve into conflict.
Do not take it personally. Having difficult conversations with the patient and their families is always uncomfortable. Preparing and practicing can help ensure you are using the proper language and providing the most accurate information and supports.
