Injustice and conflict in nursing homes: Toward advocacy and exchange

This article examines the relational dynamics and patterns of conflict exhi bited in the two interdependent parties in America's nursing homes. In the framework of the social exchange theory of structural power, it explains ho w the asymmetrical structure of dependence and control in nursing homes eli minates the possibility of fair bargaining-normal conflict-between staff an d patients. In the absence of any opportunity for reciprocal rewards and pu nishment, patients tend to adopt submissive influence strategies, whereas s taff members tend to neglect, exploit, or abuse difficult or resistant pati ents. The author examines the exchange dynamics of adversarial tactics and the prevalence of third-parry conflict in the nursing home, and shows that a partisan, patient-directed ally could rebalance power and eliminate inequ ities in the nursing home environment.