4.2.d Ambiguity Leads to Conflict
Conflict arises because, as in any situation involving teamwork, individual members are all different. While there may be diversity of opinions, expectations, and experiences among members of a team and among the people receiving care, all participants almost always share a common goal. When the shared goals and differences are not articulated, confusion and conflict arise (12,13,17).
Conflict is rooted in ambiguity. Ambiguity of intention, information, purpose, expectations, understanding, direction, relationship, and/or role (4). Ambiguity can be felt by the care provider, the team, and/or the person receiving care. Here are examples of how ambiguities cause conflict.
Ambiguity of intention occurs when someone believes that a person’s intention is unclear or doesn’t align with their own intentions. E.g. A nurse wonders if an obstetrician is recommending a cesarean section because the provider's going off shift rather than because of a clear clinical indication.
Ambiguity of information occurs when the information given is incomplete, irrelevant, or appears to be out of context. E.g. A midwife reports to the nurses that “the blood pressure is fine now” but they weren’t aware that there was a concern earlier.
Ambiguity of purpose occurs when the reason for a decision or action is unclear. E.g. A nurse starts an IV on a person without explaining why. The person heard “it is standard procedure to have one.”
Ambiguity of expectation occurs when people have different ideas and expectations. E.g. A midwife requests an obstetrician to come immediately to assess their client with severe high blood pressure in labour, but the obstetrician appears to not prioritize the in-person consultation over assessing an lower risk person.
Ambiguity of understanding occurs when there is a lack of understanding on how to act upon information. E.g. A physician says to a nurse “she has high blood pressure… I’ll be back to reassess her after you get things started.”
Ambiguity of direction occurs when a plan of action is not clear enough to be executed. E.g. A physician and midwife are sharing care for a client in labour, each managing one aspect of care, but the break relief nurse doesn’t know which provider to call when a new clinical situation develops.
Ambiguity of relationship occurs when an assumption is made about the balance of power between people. E.g. A client receives conflicting information from a nurse and a midwife about whether she should restrict fluids in labour or not, and the client assumes that the midwife knows more than the nurse about the matter.
Ambiguity of roles and responsibilities occurs when there is lack of clarity or adherence to the roles and responsibilities given to a person. E.g. A client with severe high blood pressure does not understand what role her midwife has in her labour care after her care is transferred to an obstetrician.
Personal Reflection
Think of an example in your own experience where conflict arose due to ambiguity of understanding. Reflect on how you could have avoided this, or mitigated it quickly once you identified the ambiguity.