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Professor Robinson
This worksheet is based on a conflict negotiation model taught in the public training program of
the Louisiana State Civil Service. Begin by reading the below scenario. Then, working as a team,
complete the worksheet.
Scenario
Emilio Sanchez was born and resides in Mexico, and was visiting his aunt Tania in the
US when he fell off a ladder at her home. Emilio is a 22-year-old single man who works as an
assembler in a manufacturing facility. He has a secondary school education, and speaks, reads,
and writes fluent Spanish. Mr. Sanchez took English courses in high school and his
comprehension is good, but he has trouble carrying on a conversation in English. His English
reading and writing skills are extremely minimal.
Mr. Sanchez was in otherwise good health when the accident occurred, but he suffered a
traumatic brain injury (TBI) when he fell, as well as a fractured tibia and wrist. His wrist and leg
are giving him little pain, but the TBI is a concern. He definitely improved while an inpatient,
but he has continued problems with balance and with following instructions without multiple
reminders and prompts. Speech therapy was initiated as he was nonverbal for a few days after
the accident. All therapy stressed the use of the English language. Each therapist commented that
Mr. Sanchez had difficulty following simple commands in English and preferred to communicate
in Spanish even though only one therapist was somewhat fluent in Spanish.
Mr. Sanchez enjoyed his inpatient therapy, but the clinical staff wasn’t sure he was taking
it seriously as he seemed to want to socialize – which was difficult since other patients didn’t
understand Spanish. He became increasingly distracted and uncooperative when tasks involved
speaking or understanding English.
Mr. Sanchez is being discharged soon. His aunt, who would like to provide home care for
him, is also not fluent in English but can speak, read, and write more than Emilio. She doesn’t
want to send him to a rehab facility, and it’s uncertain whether the primary concern is financial
or cultural. She does seem invested in his recovery, as she visited him almost every day and has
been willing to let a caseworker do a home visit prior to discharge. The treatment team, however,
feels very strongly that Mr. Sanchez needs to get to an inpatient rehabilitation facility where his
intensive therapy will assuredly continue.
You are his caseworker and must balance the needs of Mr. Sanchez with the realities of
the situation regarding his aunt’s desire to take him home and the therapy staff’s desire to have
him go to a skilled rehab facility.
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1. Identify the problem. Do you have a sense that this is a symptom of a larger issue?
Emilio Sanchez is a resident in Mexico who was currently visiting his aunt Tania in the
U.S. An accident occurred when Emilio fell off a ladder from his aunt Tania’s home and suffered
from a traumatic brain injury (TBI). In result, he had multiple problems, such as the difficulty of
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balance, following directions, and he became an inpatient receiving therapy including speech.
However, another concern was the language differences as a barrier to quality and safety in his
care. Emilio’s English writing, reading, speaking, and comprehension is extremely limited and
minimal, while his aunt is also not fluent in English. Therefore, they both do not have the ability
to fluently understand the treatment plan directed by his healthcare providers nor do they have
the full understanding on how to apply other options for his care upon his discharge. Despite this
current situation, there is a sense that this is a symptom of a larger issue. This communication
between treatment team members, Emilio and his family member is a core component of health
care. In order to have a proper prognosis and diagnosis, it is critical to collect accurate and
instructions with a translator, and appropriately educating the patient and families. At the time of
Emilio’s care in the hospital, there was a lack of counseling and effective communication or
comprehension between the clinicians, health care providers, the patient, and the patient’s family
member. Due to the absence of comprehension and effective communication, it puts the patient
at risk for safety, the provision of health care needs, errors, and overall poor quality care.
Poor quality care may lead to other chronic health conditions or disability issues. At this
time there are other concerns such as financial barriers that we are unaware of meaning would
Emilio and his family member be able to continue paying for their medical bills and other
personal bills which leads to unforeseen circumstances where they may not have anywhere to go
after treatment. Due to the language barrier, it also puts the risk of Emilio and family members
not receiving the full treatment that is needed to properly heal his brain injuries and fractures he
received after his fall. The other problem I see is not only for this specific patient; however, the
other incoming patients that only speak one language. They will continue to have these barriers
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with communication and other issues that may increase the risk of their health. The organization
is not offering a patient-centered communication and delivering the utmost care that they can by
engaging their patients during the most critical parts of their healing duration.
2. Identify emotions. Identify the emotions of the characters in the scenario, and how they
may be affecting the problem.
Although Emilio may seem to be enjoying his inpatient therapy, his clinicians and health
care providers stress the language barriers while trying to provide the proper care. Healthcare
provider’s attitudes, language, and cultural barriers may negatively impact their views towards
their patients. Despite the difficult encounter with Emilio, they seem to be aware of their
emotional reactions and remove themselves to avoid potentially negative situations. Due to the
cultural and language differences, the treatment team has the desire for Emilio to receive further
We have also identified various emotions from Emilio and his Aunt Tania who may
become stressed due to the poor communication among all the healthcare providers. Meanwhile,
Emilio may experience a number of emotional changes or behavioral difficulties due to this
traumatic brain injury. In this case, Emilio may experience deficits in his communication skills
like listening to his therapists, awareness of the appropriate use of non-verbal communications
and taking turns in conversations. The healthcare providers seemed hesitant to go above and
beyond for a patient that had recent traumatic brain injury by not giving him the support and care
he needed especially during his beginning treatment. The healthcare professionals were aware
that his English was minimal yet they continued the treatment process in English but faulted the
patient. I felt the negativity from the healthcare professionals not offering care and empathy. This
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lead to a bad treatment where Emilio felt lonely and stopped by socially active perhaps due to
3. Identify the impact. How is this problem affecting team members or the workplace in
general?
Although healthcare providers and staff members are trying their best to provide quality
care, often time the lack of trains impedes their ability to implement competent care. According
to this case, ineffective communication may lead to host a number of issues and concerns. Which
may result in language and cultural barriers jeopardizing the hospital system’s effectiveness and
disadvantage of individuals who do not speak or who are not able to speak fluent English. As
language barriers demonstrate one of the great contributors to health disparities, which is a
significant implication.
The teamwork is very poor because each teammate is not effectively communicating with
each other and using all their resources within the organization. They were not offering Emilio
and his family member the top quality care or service per say because they wanted the patient to
participate during the treatment and during socialization. However, not once did I read that they
offered Emilio and the patient the language that they needed to fully understand the treatment
process and how to communicate effectively. Miscommunication led Emilio being discharged to
another treatment center yet Emilio nor his aunt seems to understand what the protocol is and
how to effectively treat Emilio so his aunt wants to take him home without proper equipment or
treatment at home. This barrier with miscommunication may become life-threatening for Emilio
if they do not effectively inform Emilio’s aunt the reason he must stay at the treatment center for
a while longer. This may potentially lead to a lawsuit if they wrongfully discharge a client
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without a proper understanding of the potential risks of taking Emilio home or even to offer a
safe place for Emilio to continue his treatment plan at home effectively.
Emilio- whom is the most affected by this situation, as he will make the primary decision on
whether he would like to pursue treatment in a skilled rehab facility. He had a traumatic brain
injury and the treatment seemed to be effective yet we are unsure of how much longer he needs
Aunt Tania- whom is also most affected by this situation, as she is the only family member who
is supportive and the willingness to provide home care treatment. Although she can understand
English a bit more than Emilio, she doesn’t seem like she completely understands the reason why
Emilio needs to be discharged to another treatment center. Aunt Tania is proactively helping
Emilio yet she wants to take him home. We are also unsure if she wants to take him home due to
financial issues or because she does not fully understand Emilio's diagnosis.
Clinical staff- They have provided care for Emilio although, he appeared to be distracted and
difficult to communicate with. They did not effectively communicate or properly offered quality
Therapists- The therapist has difficulty communicating with Emilio during his treatments. They
made several remarks by providing him with multiple reminders and instructions in order to
follow through. Although they had one staff that can speak Spanish, the team of therapists did
not offer the language support he needed despite his traumatic brain injury.
Treatment Team- The team desire for Emilio to continue his need for intensive treatment as an
inpatient in a rehabilitation facility. I felt that the treatment team did not offer the best
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communication with the family member, the aunt who is going to be taking care of Emilio by
explaining the need for the treatment process and how much longer he needs treatment to have a
successful recovery.
Case Worker- This professional worker will play a significant role in assisting and directing
Emilio and his family to the proper care. Additionally, the caseworker will be a great resource
management, as they are driven by their client’s needs and the right of self-determination is
emphasized. The caseworker should be able to offer resources to the patient and the aunt during
this time when there’s a lack of communication by offering advocacy and support.
With further assistance from a caseworker it could lead to successful outcomes. For
instance, this is a possibility that Emilio and his aunt will receive various resources and
therefore, they will both have further support and assistance to identify Emilio’s choice of
treatment care upon discharge. The caseworker should help the patient and the family member to
bridge the gaps with communication barrier and offer language assistance by providing
interpreters throughout the discharge process to make sure that the aunt has equipment at home
for Emilio and understand how to offer him treatment at home if she will be taking care of him.
However, after the aunt finds out that it may be too difficult for her to fully offer that assistance
to Emilio it would be best that he stays at the treatment center to further receive his treatment.
Also, the patient should be aware of all the treatment process so that he can make the final
decision if he is alert and oriented. Only because the aunt wants to take him home does not mean
Emilio should go home, the patient always has his choice unless he is unable to make that
decision for himself. At this time, we are unsure of his alertness due to his traumatic brain injury.
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Meanwhile, the hospital will create a better understanding of how to overcome language
barriers upon this encounter. It is significant to understand the role that communication and
language play a critical role, especially among healthcare organizations experience culturally
diverse populations. The hospital should consider utilizing technology by using Skype or
smartphone cameras with other language organizations that offer interpreters on the web or in
person (Kumar, 2016). Today, many healthcare organization utilize language interpreters over
the phone or in-person interpreters in the healthcare field; however, this is a very expensive and
challenging barrier that most people go thru because of the limited languages people currently
6. Identify the style. Which style of conflict resolution will you use in this situation?
Accommodating
Avoiding
Collaborating
Competing
Compromising
Accommodating is one style in managing conflict that is the most passive conflict
resolution. The style is known to accommodate the needs of others but may find that they are
unable to achieve an outcome that is acceptable or appropriate to them. As it may decrease the
Another passive approach is the style of avoidance when managing a conflict. This
approach is utilized when individuals tend to accept decisions of resolutions without further
Although the style of avoidance is not as effective, it has its benefits as it can potentially solve
The style of collaborating involves all parties to aim a win-win solution. Such an
approach is essential when conflicts do not seek a solution in an urgent matter, in addition, the
conflict may involve many individuals across all levels of the organization.
The competing style of conflict resolution can be potentially seen as aggressive with an
individual who appears to take the “firmest stand” while causing others to feel involved or taken
contribute towards a conflict resolution and working together as a team. A solution will then be
Upon identifying the various styles of conflict resolution, our chosen style that we would
like to utilize in this situation would be to collaborate with the healthcare team and with the
patient. The organization should have collaborated with their healthcare professional team to
make sure they took care of the patient and also collaborated with the patient would be to utilize
the team effectively. For example, the case study mentioned that there was on therapist who
spoke fluent Spanish should have offered interpretations to Emilio during his treatment process
to not only effectively offer treatment but to make sure that he is doing well. During the
assessment Emilio was unable to see whether his treatment was truly effective since he stopped
participating throughout the end of his treatment. I am concerned that there was not enough
collaboration with the entire healthcare professionals that Emilio worked with. Offering the
patient’s language capacity would eliminate the confusion the healthcare workers spoke about
the patient during his treatment process because we are unsure what was going on throughout his
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stay whether he was happy or if there were any issues. How can they know whether his treatment
was becoming successful when they were unable to speak with him effectively? Communicating
is the most important part of healthcare and this case study, unfortunately, lacked in that which
did not offer the best patient-centered care that healthcare wants to offer to their patients.
critical for the team to understand the mechanics of effective conflict management to navigate
arguments or disagreements among others with competence and care. For instance, when
utilizing the collaborative conflict management style, this style is to seek solutions that can
potentially satisfy both or all parties. Collaborative teamwork among healthcare professionals are
team to continue the improvement in decision making, while other healthcare professionals assist
in increasing other team member’s awareness of their skills and knowledge. To perform
effectively in clinical practice, it has been shown that good communication encourages
collaborative effort in order to prevent or avoid potential errors from occurring. By addressing
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the issue with good communication skills through collaborative work will create an opportunity
A conflict management style the team should have utilized was collaboration with the
healthcare professionals and with the patient’s need is a high importance especially in the
healthcare field (Mossanen, 2014). Patients have difficulty communicating with healthcare
providers during their most critical care and in this situation Emilio was in that type of situation.
Emilio is a ethnic minority that is fluent in Spanish and limited in the english language. Conflict
occurs when there are difference with language and the healthcare professionals want to offer the
best medical care; however, patients typically want a holistic approach where they can receive
information and make sure that they get to participate in the critical moments of their time (Van
Keer, 2015). Emilio not only was suffered from a traumatic brain injury, but he was also
nonverbal due to a complex medical reason as well as the communication barrier. Emilio was in
a critical medical condition and this situation was relationally challenging for the healthcare
professionals due to the language barrier and his medical situation that resulted in the most need
for communication with a family member. Although the Aunt tried her best to offer assistance by
being proactively visiting the treatment center and offering support to the patient there was a lack
Communication with the aunt between healthcare professionals may be challenging, but
at the same time they should have offered effective communication rather than hindering to
speak with the aunt in regards to Emilios situation. There were also conflicts around healthcare
professionals where they all decided not to assist the patient to the fullest because they couldn’t
understand his language nor why he was acting differently during the end of the treatment.
Rather trying to communicate effectively with the patient they lacked in communication skills
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and their own professional judgement to offer suggestions that can potentially offer the highest
The hospital should have been trained on offering all patients language capacity the best
they can and offer communication support and recognize everybodies differences.
Communication is one thing, but to understand medical jargon is another issue that people deal
with. Hospital staff should have been more knowledgeable on how they could overcome these
communication challenges and conflicts by asking assistance with other team members who
spoke spanish fluently to make sure that they are aware how the patient is feeling and if there
were any medical issues his dealing with (Van Keer, 2015). The root cause of why Emilio had
difficulties and didn’t seem to wanting to socialize with other patients since he couldn’t speak
english fluently nor could other patients speak spanish fluently. Was he really being distracted
The caseworker should collaborate with healthcare professionals and with the patient
Emilio to make sure they understand his decision on whether he can stay at the Inpatient
treatment center versus going back home. In this case the case worker should get an interpreter to
offer the spanish language to see how Emilio feels and then if at any given chance Emilio can no
longer make his own decisions the aunt can decide to him to go home or not. This will eliminate
any conflict and other situations healthcare professionals are unaware of. The healthcare
professionals should not make assumptions of what the patient’s decision should be. This will
offer empathy to listen to the patients will then speaking with the family members with the
patient’s decisions to allow the aunt to understand what is occurring and what’s best for the
patient especially since there may be language barrier and poor understanding of Emilio’s
Follow-Up Questions
1. What cultural and communication factors do you need to take into consideration when
selecting an appropriate conflict management strategy?
Everybody comes from different cultures and communication styles so how do you
approach these types of situations when it’ll be different for another individual. First and
foremost, healthcare professionals should be aware that each and every individual comes from
different models of life and their communication methods differ. This way the healthcare
provider can understand the situation and diagnose the issue that they have which may require
different types of intervention skills (Zuker, 2014). One type of approach that can be used if to
let the patient speak and understand where they are coming from despite challenges. Second they
should be able to understand the patients differences and also communicate healthcare treatment
any differences. Third would be helpful to come to an agreement by working together. Fourth
once an agreement is made then you’ll able to satisfy by sides the patient and the healthcare
team. Fifth would be to manage conflict by creating an intervention that works for both parties.
Lastly communicate constantly to make sure that the results driven are the results the patients
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want and the healthcare providers are aware that they are in progress of making a difference to
2. How might cultural differences be confused with other physical, cognitive, communicative,
or environmental characteristics in this case?
In this case, there was a language barrier, potential education barrier, financial barrier,
and also lack of close relatives such as a direct parent that was in the situation. In this case the
healthcare professionals only thought to themselves without collaborating with each other to
eliminate the language barrier they were having instead they blamed the patient Emilio that he
was being unsocial, but rather there may have been environmental differences Emilio was unable
to comprehend due to his medical diagnosis of traumatic brain injury and perhaps changes that
3. What do you see as the role of the patient’s aunt in your conflict management strategy?
She seemed like she was competing with the patient Emilio. The reason I state that is
because she didn’t seem to acknowledge what Emilio’s thoughts were nor did the healthcare
professionals thoughts. We are unsure whether she spoke with Emilio to find if he wanted to go
home or whether it was the aunt’s thought and that’s why I pick competing due to her
4. Why did your team feel that this conflict resolution style was the best approach for this
situation?
Collaborating the conflict that the healthcare professionals had with the patient should
have been an immediate strategy they could have considered. The reason collaboration is
important is to develop an intervention plan that works best for the patient. Each and every
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patient is different and the approach they took by just ignoring the language barrier is a no-no. I
felt as if the healthcare professionals in their positions should have known better that his
diagnosis was Traumatic Brain Injury and he also had a language barrier - only able to speak
spanish fluently should have been considered. They should have offered spanish with all
healthcare professionals to eliminate any confusion and offered the best quality care they could
offer.
5. How did you utilize emotional intelligence during your conflict resolution negotiations?
Emotional intelligence is to capture and understand where the patient is coming from
despite their differences during a conflict. Emotional intelligence acknowledges each individuals
differences, but still maintains that strong link to offer the best care during any type of conflict.
During the conflict resolution, collaboration was a number one belief that we had that can help
the patient cope with the situation. Not only where the healthcare professionals all avoiding to
help this patient, but the patient himself had no control over the situation. Emilio was not part of
it, but yet the healthcare professionals blamed him in the end for not participating and being
6. Describe the collaboration and negotiations that your team went through while working on a
resolution to this scenario.
During the resolution scenario it was pretty clear on what type of conflict strategy we
should have used in this scene where there was a lack of communication and empathy
throughout the entire case study. We made sure that we first communicated how we felt about
the study then we expressed what should have been eliminated and what should be best used for
this conflict management style pick. Collaboration was what we decided on.
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References:
Kumar, A., & Maskara, S. (2016). Overcoming language barrier in healthcare settings using
information and communication technologies. Saudi Medical Journal, 37(3), 328.
http://doi.org/10.15537/smj.2016.3.13706
Levit, L., Balogh, E., Nass, S. (2013). Committee on Improving the Quality of Cancer Care:
Addressing the Challenges of an Aging Population; Board on Health Care Services;
Institute of Medicine; Delivering High-Quality Cancer Care: Charting a New Course for
a System in Crisis. Washington (DC): National Academies Press (US); 3,
Patient-Centered Communication and Shared Decision Making.Available from:
https://www.ncbi.nlm.nih.gov/books/NBK202146/
Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming
language barriers in healthcare: A protocol for investigating safe and effective
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Mossanen, M., Johnston, S. S., Green, J., & Joyner, B. D. (2014). A Practical Approach to
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Van Keer, R.-L., Deschepper, R., Francke, A. L., Huyghens, L., & Bilsen, J. (2015). Conflicts
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http://doi.org/10.1186/s13054-015-1158-4
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Zucker, D. (2012). Tools for Productively Managing Conflict. Journal of Investigative Medicine
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776–778 http://doi.org/10.231/JIM.0b013e31824e9828