Nurse Education in Practice 15 (2015) 310e313
Contents lists available at ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Issues for debate
Mediation skills for conflict resolution in nursing education Fung Kei Cheng* Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 27 February 2015
Encountering conflicts among family members in hospital produces burnout among nurses, implying a need for alternative dispute resolution training. However, current nursing education pays more attention to counselling skills training than to mediation. The present report examines the fundamental concepts of mediation, including its nature, basic assumptions and values, and compares those with counselling. Its implications may open a discussion on enhancing contemporary nursing education by providing mediation training in the workplace to nurses so that they can deal more effectively with disputes. © 2015 Elsevier Ltd. All rights reserved.
Keywords: Alternative dispute resolution Confidentiality Counselling Self-determination
Introduction
Mediation as a potential skill for nurses
Members of helping professions, such as hospital service providers, probably equip with counselling skills, by which they can help clients cope with emotional issues. Nowadays, practitioners, including nurses, are working in a culturally diverse environment, in which patients and their family members may view illnesses and treatment differently. For instance, when a patient accepts a treatment proposed by a physician, his/her spouse may suggest trying complementary and alternative medicine that is popular in his/her culture. Their different concerns enable nurses to more likely encounter conflicts among patients' family members in hospital; and thus they have a need to sharpen their capabilities in handling such disputes. Mediation, as an alternative dispute resolution method, aims at resolving conflicts and disputes, and has widely been used for various aspects (Alexander et al., 2003); for instance, family, marriage, finance, property, neighbourhood, and medical events. In response to this growing demand, the present discussion looks into the nature, basic assumptions, and values of mediation by comparing them with those of counselling. This report may open up further discussion on the enhancement of current nursing education by offering mediation training to nurses (including nursing students).
Disputes among patients' family members in hospital affect not only patients, but also nurses and workplace operation; in particular, nurses experience increased workloads and emotional exhaustion. How to equip nurses (including nursing students) with dispute resolution skills has thus become a concern among relevant educational experts, whether for elementary and advanced education programmes. While counselling training plays an effective role in helping patients who are suffering from physical pain and psychological distress, allowing nurses to achieve high levels of work performance and professionalism; these skills may not suffice to settle disputes quickly. In contrast, mediation, a solutionoriented approach, can complement this shortcoming, and has thus drawn the attention of nursing education policy makers. Mediation begins in the 1990s as one of negotiation processes or conflict resolutions (Shapira, 2008). It maintains privacy and respects disputants during such conciliation. Mediators facilitate the development of mutual trust between both parties (case applicants and respondents), and guide them to search for common interests. Expectedly, the disputants can reach a consensus and sign an agreement. Mediation is relationship-oriented, aiming to prevent a lawsuit and solve conflicts within a time frame. These characteristics largely help nurses figure out disagreements on patients and their family members. Benefiting from the high degree of homogeneity between counselling and mediation, in the areas of nature, value system, and ethics, nurses who have received counselling training can learn mediation fairly easily, and vice versa; although the objectives and skill sets of these two disciplines are divergent. As explicated later, counselling tackles emotional, psychological, mental, and spiritual
* Room 534, 5/F, The Jockey Club Tower, Centennial Campus, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong, China. Tel.: þ852 9093 7001. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.nepr.2015.02.005 1471-5953/© 2015 Elsevier Ltd. All rights reserved.
F.K. Cheng / Nurse Education in Practice 15 (2015) 310e313
dissatisfaction, mainly at the individual level; whilst mediation focuses on eliminating quarrels and conflicts among disputants, and on finalising a mediation agreement. This differentiation determines their skill sets, wherein mediation requires sensitivity to time constraints, common ground and varying dynamics among the parties involved, compromise, negotiation, and creative solutions; and these skills may be further discussed in future studies. In spite of their differences, similarities between the skills of both counselling and mediation encompass active listening, facilitation techniques, communication skills, empathic understanding, leadership, engagement, and rapport development. These similarities enable nurses who have received counselling training to learn mediation easily. Having been equipped with a variety of skills and techniques to cater to different needs and contexts, nurses are more confident in carrying out their jobs, and are able to contribute to patients, their families, their hospital, and to the community, which things fulfil the professional code of nursing. Of considerable importance is that nurses can also apply mediation to enhance peer relationships in the workplace, which lessens the possibility of burnout as well. Consequently, a healthy working environment is generated and a healthy workforce is maintained in the public health care system. Nature of mediation as compared with counselling Voluntary participation, in most cases, is the fundamental nature underlying both mediation and counselling. According to the Wipo Arbitration and Mediation Center, 2004, mediation is a non-binding process for conflict resolution, during which no legal obligation will be in force until a mediation agreement has been officially signed. This orientation forms an interaction among disputants and a third party, a mediator, in order to develop a negotiation process (Moore, 2014). Chaired by a mediator, as a neutral moderator, conflicts may be settled as early as feasible and in a constructive manner under the control of the disputants (Craig, 2000), resulting in an agreement with no prior consensus needed. Conversely, emphasising the counsellor-client relationship, counselling is a collaborative process which aims at searching for solutions to cope with the presenting problems through a therapeutic collaboration (Corey, 2009). The major difference between counselling and mediation involves the therapeutic-driven features of the former, tackling individual emotional problems. Thus, mediation and counselling are both centred around evolving solutions. The solution orientation of mediation leads it to be problemfocused, future-driven, forward-moving, and relationship-directed in developing a mutually agreed solution geared towards achieving a winewin situation based on common ground for the disputing parties. This allows mediation to more efficiently and effectively solve conflicts, and it has therefore been employed to minimise legal proceedings in developed (for instance, North America, Europe) and developing (for example, China and India) countries for private and commercial issues (Li, 2006; Xavier, 2006; Doelle and Sinclair, 2010; De Werra, 2014). During conflict management, mediators serve as the pivot on which to manage interpersonal conflicts (Dworkin et al., 1991), including enhancing communication, defining problems, enumerating priorities, exploring alternatives, and facilitating resultant negotiations. However, these tasks work closely with voluntary participation although compulsory mediation has been implemented in some countries for certain contexts, such as divorce mediation for children's benefits in Germany (Alexander et al., 2003). Counselling serves as a bridge for resolving inward or outward conflicts, and leads clients to explore their current resources within a limited time frame. Like mediation, most effective counselling
311
cases are on a voluntary basis, even though mandatory cases are referred to by a variety of sources, such as courts and schools, and are not uncommon (Tohn and Oshlag, 1996; Salem, 2009). Counsellors may experience dealings with various categories of clients (Corey, 2009). First, visitors (for example, involuntary clients) do not come because of their low awareness of problems, and thus show resistance. Second, complainants shift responsibility to the faults of someone else, and are reluctant to take part in the problem-solving process. Third, customers admit deficiencies in their own lives, and are willing to seek professional help, and therefore are cooperative, easier to handle, and have the potential to overcome their predicaments. The challenge for counsellors is to skilfully escalate the voluntary level of the visitors and complainants to the point at which they become customers and are willing to participate in counselling and figure out solutions. Mediators are also likely to encounter all these situations, and can apply similar strategies to identify and manage different types of clients. Basic assumptions The fundamental assumptions behind mediation are twofold. In the first place, human beings are rational and tend towards problem-solving; mediation values disputants' capability of tackling their difficulties when participating in mediation and taking the responsibility for the consequences of their actions (Vindeløv, 2007). In the second place, disputants are experts on their own problems, needs, and acceptance levels. Thus, mediators create a mediating environment and facilitate solution development. Likewise, counselling recognises clients' competence in managing challenges. Counsellors, in a not-knowing manner, help clients re-assess their abilities, and then re-devise their life path, by leading clients to solve their own problems (Corey, 2009). In view of their problem-solving capacity, both mediation and counselling agree that clients are able to find their own way out of troubling situations. The “monopoly of truth” (Vindeløv, 2007, p. 29) has been challenged by the concept of multiple realities, implying that people create meaning from their life stories (Corey, 2009). Therefore, without fault-searching, mediators make very little effort either to explore the truth, or to investigate the past, unless it becomes necessary, which guides disputants to consider the present and the future instead (Liebmann, 2000). Similarly, counselling, based on an emphasis on subjective reality (Held, 1996), respects clients' interpretations of their life meaning, and helps clients adjust their mindset from being problem-focused to solution-focused, facilitating clients to produce positive output through the discovery of their own strengths and resources. Whether this decision is right or wrong is not the key point as long as the clients choose the most suitable options by themselves (Corey, 2009). In terms of objective, both mediation and counselling intend to non-judgmentally facilitate clients to make proper decisions on their own. Ethical concerns and values Mediation ethics refers to the significance of mediation (Cooks and Hale, 1994; Waldman, 2011) and its professional code of conduct, and clearly stipulates the responsibilities and obligations of mediators. Within these ethical guidelines, impartiality spells out that disputants should be treated equally. Mediators must maintain equidistance among clients, exhibiting no preferences, prejudices, bias, or emotions (Dworkin et al., 1991; Chouliaraki and Orgad, 2011). However, mediators often unnecessarily change or give up their own views and personal values. Therefore, they attempt to practise impartiality technically and maintain fairness
312
F.K. Cheng / Nurse Education in Practice 15 (2015) 310e313
Table 1 Commonalities and differences between mediation and counselling. Category Nature Focus Professional Conflict Role Process Basic assumptions Human nature Professional attitude Concept of reality Ethics and values Basic values Emphasis
Mediation
Counselling
Voluntary-based in most cases Mediator Interpersonal Facilitating disputes Negotiation
Counsellor Intrapersonal and interpersonal Facilitating emotional problems Therapeutic collaboration
Human beings are rational, and are capable of tackling their problems under guidance. Non-judgemental Multiple realities Subjective reality Self-determination, confidentiality, neutrality, impartiality Fairness and empowerment
and equity, whereas moral impartiality is only an ideal (Vindeløv, 2007). Impartiality and neutrality intertwine. Neutrality reflects impartiality, and vice versa, according to the strategy based on the ideas that the disputing parties know best (Folger and Bush, 1996), although perceived neutrality is by no means neglected in mediation. A neutral environment should be provided during mediation, in which the parties feel secure and where their engagement is selfdirected engagement (Nye, 2000), in order to yield effective mediation when disputants perceive neutrality and trust among the disputing parties and the mediator. As such, neutrality and impartiality are also important for counselling. In reality, counsellors may evaluate clients, but they bear in mind the principles of unconditional positive regard and acceptance. Acceptance does not imply that there is approval of anything as being right or wrong, but is instead a way to show respect for the clients' choices. It affirms that clients have the right to voice their thoughts and feelings (Corey, 2009). Mediators may refer to the notion of acceptance when they feel hesitation in practising moral impartiality. Practically, mediators are neutral, who professionally put aside their own opinions and make sure that disputants have equal chances for decision-making (Haynes, 1992; Hedeen, 2004). They do not even dictate or suggest choices because disputants are able to conclude a voluntary and mutually-accepted agreement (Welsh, 2001) through empowerment and self-determination (Folger and Bush, 1996; Shapira, 2008). Self-determination is a core characteristic of the mediation that leads clients to identify their problems, whereas mediators are “the least interventionist[s]” (Liebmann, 2000, p. 10). Mediators allow disputants to exercise autonomy and make decisions in a voluntary manner. The 1992 Rules clearly define the self-determination of disputants in mediation (Welsh, 2001), including the following points. First, clients have the right to decide on their own. Next, mutual respect should be maintained among the involved parties. Lastly, mediators must ensure noncoercion and assure that the mediation agreement is beneficial to all disputants (Waddington, 2000). Basically, self-determination and empowerment are interactive (Welsh, 2001; Folger and Bush, 1996; Beck and Sales, 2001). By optimising empowerment, clients focus on setting their own goals and exploring their inner strengths and family and community resources (De Jong and Berg, 2008). Empowerment involves problem-solving skills and conflict resolutions (Zondervan, 2000), stemming from the ownership of the decision-making process and being generated from mutual respect regarding the values and strengths of all parties. It relates to informed choices and decisions induced by the advantage of information (Cooks and Hale, 1994), and warns of potential power imbalances between mediators and
Unconditional positive regard, and acceptance
clients, especially when the mediator has a greater level of knowledge. Confidentiality, another significant ethical consideration, protects clients' privacy and keeps personal information “out of the public eye” (Waddington, 2000, p. 86), through which disputants more openly and honestly express their views and expectations, resulting in trustful relationships among the involved parties. In counselling, the Committee on Professional Practice and Standards (2003) declares restrictions on the disclosure of privileged communication related to certain specific confidential data in legal proceedings. Nonetheless, counsellors must inform clients of the limitations of confidentiality; for example, when related to criminal activities, or life-threatening events, in compliance with local laws, ordinances, court rules, and administrative orders. In order to ensure correct understanding of rights and obligations, a signed informed consent form should be acquired before a session starts. This practice is valid for both mediation and counselling. Concluding remarks Mediation and counselling share similarities, as elaborated upon previously, although they have diverse focuses (refer to Table 1). The growing popularity in employing mediation urges helping professionals, such as nurses, to equip themselves with mediation skills and techniques. The current report examines the fundamental concepts of mediation, including nature, beliefs, values, professional mentality and ethics, and discusses the convergences between mediation and counselling. Inspired by this examination, curricula designers may explore mediation training in the nursing workplace in order to manage conflicts among patients' family members in hospital. Source of funding support Preparation of this article did not receive any funding. Declaration of interest There is no conflict of interest to declare with respect to the present manuscript submitted for publication. Original work The contents of this study are the author's original work. The findings reported in the manuscript have not been published previously, and the manuscript is not being simultaneously submitted elsewhere.
F.K. Cheng / Nurse Education in Practice 15 (2015) 310e313
Acknowledgements I thank Professor Samson Tse for his comments on the earlier draft of this manuscript. References Alexander, N., Gottwald, W., Trenczek, T., 2003. Mediation in Germany: the long and winding road. In: Alexander, N. (Ed.), Global Trends in Mediation. Centrale Fur Mediation, Germany. Beck, C.J.A., Sales, B.D., 2001. Family Mediation: Facts, Myths, and Future Prospects. American Psychological Association, USA. Chouliaraki, L., Orgad, S., 2011. Proper distance: mediation, ethics, otherness. Int. J. Cult. Stud. 14, 341e345. Cooks, L.M., Hale, C.L., 1994. The construction of ethics in mediation. Mediat. Q. 12, 55e76. Corey, G., 2009. Theory and Practice of Counselling and Psychotherapy. Thomson/ Brooks/Cole, USA. Craig, Y., 2000. The multicultural elder mediation project (EMP): empowerment for older, disabled and mentally frail persons. In: Liebmann, M. (Ed.), Mediation in Context. Jessica Kingsley Publishers Limited, UK. De Jong, P., Berg, I., 2008. Interviewing for Solutions. Thomson Brooks/Cole, California, Belmont. De Werra, J., 2014. New developments of IP arbitration and mediation in Europe: the patent mediation and arbitration centre instituted by the agreement on a unified patent court. Rev. Bras. Arbitr. 17e35. Doelle, M., Sinclair, A.J., 2010. Mediation in environmental assessments in Canada: unfulfilled promise? Dalhous. Law J. 33, 117e152. Dworkin, J., Jacob, L., Scott, E., 1991. The boundaries between mediation and therapy: ethical dilemmas. Mediat. Q. 9, 107e119. Folger, J., Bush, R.a.B., 1996. Transformative mediation and third-party intervention: ten hallmarks of a transformative approach to practice. Mediat. Q. 13, 263e278. Haynes, J.M., 1992. Mediation and therapy: an alternative view. Mediat. Q. 10, 21e34. Hedeen, T., 2004. The evolution and evaluation of community mediation: limited research suggests unlimited progress. Confl. Resolut. Q. 22, 101e133.
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Held, B.S., 1996. Solution-focused therapy and the postmodern: a critical analysis. In: Miller, S.D., Hubble, M.A., Duncan, B.L. (Eds.), Handbook of Solution-focused Brief Therapy. Jossey-Bass Publishers, USA. Li, C., 2006. Improvement of Mediation System in China's Commercial Arbitration, Arbitration and Judicature in China. China Society of Private International Law, China. Liebmann, M.E., 2000. Mediation in Context. Jessica Kingsley Publishers Limited, UK. Moore, C.W., 2014. The Mediation Process: Practical Strategies for Resolving Conflict. Jossey-Bass, USA. Nye, R.D., 2000. Three Psychologies: Perspectives from Freud, Skinner and Rogers. Wadsworth, Canada. Salem, P., 2009. The emergence of triage in family court services: the beginning of the end for mandatory mediation? Fam. Court Rev. 47, 371e388. Shapira, O., 2008. Joining forces in search for answers: the use of therapeutic jurisprudence in the realm of mediation ethics. Pepperdine Disput. Resolut. Law J. 8, 243e272. The Wipo Arbitration and Mediation Center, 2004. Guide to WIPO Mediation [Online]. Available. http://arbiter.wipo.int (accessed 26.05.09.). Tohn, S.L., Oshlag, J.A., 1996. Solution-focused therapy with mandated clients: cooperating with the uncooperative. In: Miller, S.D., Hubble, M.A., Duncan, B.L. (Eds.), Handbook of Solution-focused Brief Therapy. Jossey-Bass Publishers, USA. Vindeløv, V., 2007. Mediation: a Non-model. DJØF Publishing, Copenhagen. Waddington, G., 2000. Community mediation in an urban setting. In: Liebmann, M. (Ed.), Mediation in Context. Jessica Kingsley Publishers Limited, UK. Waldman, E., 2011. Values, models, and codes. In: Waldman, E. (Ed.), Mediation Ethics: Cases and Commentaries. Jossey-Bass, USA. Welsh, N.A., 2001. The thinning vision of self-determination in court-connected mediation: the inevitable price of institutionalisation? Harv. Negot. Law Rev. 6, 1e96. Xavier, A., 2006. Mediation: its origin and growth in India. J. Public Law Policy 27, 275e282. Zondervan, D.B., 2000. Community mediation in the USA: current developments. In: Liebmann, M. (Ed.), Mediation in Context. Jessica Kingsley Publishers Limited, UK.
Contents lists available at ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Issues for debate
Mediation skills for conflict resolution in nursing education Fung Kei Cheng* Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 27 February 2015
Encountering conflicts among family members in hospital produces burnout among nurses, implying a need for alternative dispute resolution training. However, current nursing education pays more attention to counselling skills training than to mediation. The present report examines the fundamental concepts of mediation, including its nature, basic assumptions and values, and compares those with counselling. Its implications may open a discussion on enhancing contemporary nursing education by providing mediation training in the workplace to nurses so that they can deal more effectively with disputes. © 2015 Elsevier Ltd. All rights reserved.
Keywords: Alternative dispute resolution Confidentiality Counselling Self-determination
Introduction
Mediation as a potential skill for nurses
Members of helping professions, such as hospital service providers, probably equip with counselling skills, by which they can help clients cope with emotional issues. Nowadays, practitioners, including nurses, are working in a culturally diverse environment, in which patients and their family members may view illnesses and treatment differently. For instance, when a patient accepts a treatment proposed by a physician, his/her spouse may suggest trying complementary and alternative medicine that is popular in his/her culture. Their different concerns enable nurses to more likely encounter conflicts among patients' family members in hospital; and thus they have a need to sharpen their capabilities in handling such disputes. Mediation, as an alternative dispute resolution method, aims at resolving conflicts and disputes, and has widely been used for various aspects (Alexander et al., 2003); for instance, family, marriage, finance, property, neighbourhood, and medical events. In response to this growing demand, the present discussion looks into the nature, basic assumptions, and values of mediation by comparing them with those of counselling. This report may open up further discussion on the enhancement of current nursing education by offering mediation training to nurses (including nursing students).
Disputes among patients' family members in hospital affect not only patients, but also nurses and workplace operation; in particular, nurses experience increased workloads and emotional exhaustion. How to equip nurses (including nursing students) with dispute resolution skills has thus become a concern among relevant educational experts, whether for elementary and advanced education programmes. While counselling training plays an effective role in helping patients who are suffering from physical pain and psychological distress, allowing nurses to achieve high levels of work performance and professionalism; these skills may not suffice to settle disputes quickly. In contrast, mediation, a solutionoriented approach, can complement this shortcoming, and has thus drawn the attention of nursing education policy makers. Mediation begins in the 1990s as one of negotiation processes or conflict resolutions (Shapira, 2008). It maintains privacy and respects disputants during such conciliation. Mediators facilitate the development of mutual trust between both parties (case applicants and respondents), and guide them to search for common interests. Expectedly, the disputants can reach a consensus and sign an agreement. Mediation is relationship-oriented, aiming to prevent a lawsuit and solve conflicts within a time frame. These characteristics largely help nurses figure out disagreements on patients and their family members. Benefiting from the high degree of homogeneity between counselling and mediation, in the areas of nature, value system, and ethics, nurses who have received counselling training can learn mediation fairly easily, and vice versa; although the objectives and skill sets of these two disciplines are divergent. As explicated later, counselling tackles emotional, psychological, mental, and spiritual
* Room 534, 5/F, The Jockey Club Tower, Centennial Campus, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong, China. Tel.: þ852 9093 7001. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.nepr.2015.02.005 1471-5953/© 2015 Elsevier Ltd. All rights reserved.
F.K. Cheng / Nurse Education in Practice 15 (2015) 310e313
dissatisfaction, mainly at the individual level; whilst mediation focuses on eliminating quarrels and conflicts among disputants, and on finalising a mediation agreement. This differentiation determines their skill sets, wherein mediation requires sensitivity to time constraints, common ground and varying dynamics among the parties involved, compromise, negotiation, and creative solutions; and these skills may be further discussed in future studies. In spite of their differences, similarities between the skills of both counselling and mediation encompass active listening, facilitation techniques, communication skills, empathic understanding, leadership, engagement, and rapport development. These similarities enable nurses who have received counselling training to learn mediation easily. Having been equipped with a variety of skills and techniques to cater to different needs and contexts, nurses are more confident in carrying out their jobs, and are able to contribute to patients, their families, their hospital, and to the community, which things fulfil the professional code of nursing. Of considerable importance is that nurses can also apply mediation to enhance peer relationships in the workplace, which lessens the possibility of burnout as well. Consequently, a healthy working environment is generated and a healthy workforce is maintained in the public health care system. Nature of mediation as compared with counselling Voluntary participation, in most cases, is the fundamental nature underlying both mediation and counselling. According to the Wipo Arbitration and Mediation Center, 2004, mediation is a non-binding process for conflict resolution, during which no legal obligation will be in force until a mediation agreement has been officially signed. This orientation forms an interaction among disputants and a third party, a mediator, in order to develop a negotiation process (Moore, 2014). Chaired by a mediator, as a neutral moderator, conflicts may be settled as early as feasible and in a constructive manner under the control of the disputants (Craig, 2000), resulting in an agreement with no prior consensus needed. Conversely, emphasising the counsellor-client relationship, counselling is a collaborative process which aims at searching for solutions to cope with the presenting problems through a therapeutic collaboration (Corey, 2009). The major difference between counselling and mediation involves the therapeutic-driven features of the former, tackling individual emotional problems. Thus, mediation and counselling are both centred around evolving solutions. The solution orientation of mediation leads it to be problemfocused, future-driven, forward-moving, and relationship-directed in developing a mutually agreed solution geared towards achieving a winewin situation based on common ground for the disputing parties. This allows mediation to more efficiently and effectively solve conflicts, and it has therefore been employed to minimise legal proceedings in developed (for instance, North America, Europe) and developing (for example, China and India) countries for private and commercial issues (Li, 2006; Xavier, 2006; Doelle and Sinclair, 2010; De Werra, 2014). During conflict management, mediators serve as the pivot on which to manage interpersonal conflicts (Dworkin et al., 1991), including enhancing communication, defining problems, enumerating priorities, exploring alternatives, and facilitating resultant negotiations. However, these tasks work closely with voluntary participation although compulsory mediation has been implemented in some countries for certain contexts, such as divorce mediation for children's benefits in Germany (Alexander et al., 2003). Counselling serves as a bridge for resolving inward or outward conflicts, and leads clients to explore their current resources within a limited time frame. Like mediation, most effective counselling
311
cases are on a voluntary basis, even though mandatory cases are referred to by a variety of sources, such as courts and schools, and are not uncommon (Tohn and Oshlag, 1996; Salem, 2009). Counsellors may experience dealings with various categories of clients (Corey, 2009). First, visitors (for example, involuntary clients) do not come because of their low awareness of problems, and thus show resistance. Second, complainants shift responsibility to the faults of someone else, and are reluctant to take part in the problem-solving process. Third, customers admit deficiencies in their own lives, and are willing to seek professional help, and therefore are cooperative, easier to handle, and have the potential to overcome their predicaments. The challenge for counsellors is to skilfully escalate the voluntary level of the visitors and complainants to the point at which they become customers and are willing to participate in counselling and figure out solutions. Mediators are also likely to encounter all these situations, and can apply similar strategies to identify and manage different types of clients. Basic assumptions The fundamental assumptions behind mediation are twofold. In the first place, human beings are rational and tend towards problem-solving; mediation values disputants' capability of tackling their difficulties when participating in mediation and taking the responsibility for the consequences of their actions (Vindeløv, 2007). In the second place, disputants are experts on their own problems, needs, and acceptance levels. Thus, mediators create a mediating environment and facilitate solution development. Likewise, counselling recognises clients' competence in managing challenges. Counsellors, in a not-knowing manner, help clients re-assess their abilities, and then re-devise their life path, by leading clients to solve their own problems (Corey, 2009). In view of their problem-solving capacity, both mediation and counselling agree that clients are able to find their own way out of troubling situations. The “monopoly of truth” (Vindeløv, 2007, p. 29) has been challenged by the concept of multiple realities, implying that people create meaning from their life stories (Corey, 2009). Therefore, without fault-searching, mediators make very little effort either to explore the truth, or to investigate the past, unless it becomes necessary, which guides disputants to consider the present and the future instead (Liebmann, 2000). Similarly, counselling, based on an emphasis on subjective reality (Held, 1996), respects clients' interpretations of their life meaning, and helps clients adjust their mindset from being problem-focused to solution-focused, facilitating clients to produce positive output through the discovery of their own strengths and resources. Whether this decision is right or wrong is not the key point as long as the clients choose the most suitable options by themselves (Corey, 2009). In terms of objective, both mediation and counselling intend to non-judgmentally facilitate clients to make proper decisions on their own. Ethical concerns and values Mediation ethics refers to the significance of mediation (Cooks and Hale, 1994; Waldman, 2011) and its professional code of conduct, and clearly stipulates the responsibilities and obligations of mediators. Within these ethical guidelines, impartiality spells out that disputants should be treated equally. Mediators must maintain equidistance among clients, exhibiting no preferences, prejudices, bias, or emotions (Dworkin et al., 1991; Chouliaraki and Orgad, 2011). However, mediators often unnecessarily change or give up their own views and personal values. Therefore, they attempt to practise impartiality technically and maintain fairness
312
F.K. Cheng / Nurse Education in Practice 15 (2015) 310e313
Table 1 Commonalities and differences between mediation and counselling. Category Nature Focus Professional Conflict Role Process Basic assumptions Human nature Professional attitude Concept of reality Ethics and values Basic values Emphasis
Mediation
Counselling
Voluntary-based in most cases Mediator Interpersonal Facilitating disputes Negotiation
Counsellor Intrapersonal and interpersonal Facilitating emotional problems Therapeutic collaboration
Human beings are rational, and are capable of tackling their problems under guidance. Non-judgemental Multiple realities Subjective reality Self-determination, confidentiality, neutrality, impartiality Fairness and empowerment
and equity, whereas moral impartiality is only an ideal (Vindeløv, 2007). Impartiality and neutrality intertwine. Neutrality reflects impartiality, and vice versa, according to the strategy based on the ideas that the disputing parties know best (Folger and Bush, 1996), although perceived neutrality is by no means neglected in mediation. A neutral environment should be provided during mediation, in which the parties feel secure and where their engagement is selfdirected engagement (Nye, 2000), in order to yield effective mediation when disputants perceive neutrality and trust among the disputing parties and the mediator. As such, neutrality and impartiality are also important for counselling. In reality, counsellors may evaluate clients, but they bear in mind the principles of unconditional positive regard and acceptance. Acceptance does not imply that there is approval of anything as being right or wrong, but is instead a way to show respect for the clients' choices. It affirms that clients have the right to voice their thoughts and feelings (Corey, 2009). Mediators may refer to the notion of acceptance when they feel hesitation in practising moral impartiality. Practically, mediators are neutral, who professionally put aside their own opinions and make sure that disputants have equal chances for decision-making (Haynes, 1992; Hedeen, 2004). They do not even dictate or suggest choices because disputants are able to conclude a voluntary and mutually-accepted agreement (Welsh, 2001) through empowerment and self-determination (Folger and Bush, 1996; Shapira, 2008). Self-determination is a core characteristic of the mediation that leads clients to identify their problems, whereas mediators are “the least interventionist[s]” (Liebmann, 2000, p. 10). Mediators allow disputants to exercise autonomy and make decisions in a voluntary manner. The 1992 Rules clearly define the self-determination of disputants in mediation (Welsh, 2001), including the following points. First, clients have the right to decide on their own. Next, mutual respect should be maintained among the involved parties. Lastly, mediators must ensure noncoercion and assure that the mediation agreement is beneficial to all disputants (Waddington, 2000). Basically, self-determination and empowerment are interactive (Welsh, 2001; Folger and Bush, 1996; Beck and Sales, 2001). By optimising empowerment, clients focus on setting their own goals and exploring their inner strengths and family and community resources (De Jong and Berg, 2008). Empowerment involves problem-solving skills and conflict resolutions (Zondervan, 2000), stemming from the ownership of the decision-making process and being generated from mutual respect regarding the values and strengths of all parties. It relates to informed choices and decisions induced by the advantage of information (Cooks and Hale, 1994), and warns of potential power imbalances between mediators and
Unconditional positive regard, and acceptance
clients, especially when the mediator has a greater level of knowledge. Confidentiality, another significant ethical consideration, protects clients' privacy and keeps personal information “out of the public eye” (Waddington, 2000, p. 86), through which disputants more openly and honestly express their views and expectations, resulting in trustful relationships among the involved parties. In counselling, the Committee on Professional Practice and Standards (2003) declares restrictions on the disclosure of privileged communication related to certain specific confidential data in legal proceedings. Nonetheless, counsellors must inform clients of the limitations of confidentiality; for example, when related to criminal activities, or life-threatening events, in compliance with local laws, ordinances, court rules, and administrative orders. In order to ensure correct understanding of rights and obligations, a signed informed consent form should be acquired before a session starts. This practice is valid for both mediation and counselling. Concluding remarks Mediation and counselling share similarities, as elaborated upon previously, although they have diverse focuses (refer to Table 1). The growing popularity in employing mediation urges helping professionals, such as nurses, to equip themselves with mediation skills and techniques. The current report examines the fundamental concepts of mediation, including nature, beliefs, values, professional mentality and ethics, and discusses the convergences between mediation and counselling. Inspired by this examination, curricula designers may explore mediation training in the nursing workplace in order to manage conflicts among patients' family members in hospital. Source of funding support Preparation of this article did not receive any funding. Declaration of interest There is no conflict of interest to declare with respect to the present manuscript submitted for publication. Original work The contents of this study are the author's original work. The findings reported in the manuscript have not been published previously, and the manuscript is not being simultaneously submitted elsewhere.
F.K. Cheng / Nurse Education in Practice 15 (2015) 310e313
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