An Examination of Conflict Management among Family Caregivers of Residents in Long Term Care Facilities: A Mixed-Methods Study

Abstract

Family-staff conflict in long term care (LTC) is a daily reality that has adverse outcomes for residents, staff and families. However, to date it has not been empirically evaluated from the family caregiver's perspective. Multiple barriers exist in examining conflict, including its sensitive nature, which may have precluded such study, as well as lack of theoretical integration. In order to examine family-staff conflict and its management in LTC, this study has merged two independent bodies of literature, that of family caregiving in LTC and organizational behaviour literature on conflict, namely the theory of cooperation and competition (Deutsch, 1949). Through the application of a theoretical approach, the objective of the study was to examine the predictors and outcomes of conflict and its management in 107 family caregivers in LTC using self-report measures. Family caregivers experienced multiple conflicts with staff concerning a range of care-related issues, and primarily reported the use of cooperative conflict management, which was positively related to trust, communication, power and sense of community (SOC). Family caregivers' trust in staff was identified as the main predictor of competitive conflict management, whereas family caregivers' perceptions of power in LTC and SOC predicted cooperative conflict management. Cooperative conflict management mediated the relationship between frequency of conflict and satisfaction with care, meaning that conflict management is the mechanism by which conflict and satisfaction are linked in this family caregiver sample. Another aim was to gain a greater understanding of family caregivers who experience conflict most frequently, as these families have been identified to require a disproportionate amount of limited LTC resources and may be at greatest risk of adverse outcomes. Ten family caregivers completed comprehensive interviews concerning their experience of conflict with staff and conflict management in LTC. These 'high conflict' family caregivers described employing primarily competitive conflict management, as well as engaging in a variety of other strategies to address conflicts with staff. The implications of the conflict management strategies reported by family caregivers for key caregiver outcomes (i.e., satisfaction with care and caregiver burden) and recommendations for intervention in family-staff conflicts are discussed.