CHARACTERI STI CS OF THE NURSI NG WORKFORCE

Conict management styles used by nurse managers in the Sultanate of

Oman
Zaid Al-Hamdan, Raghda Shukri and Denis Anthony
Aim. The study aimed at investigating the conict management styles used by nurse managers in the Sultanate of Oman.
Background. Conict is inevitable in daily nursing work. Several styles are used to manage conict situations. In previous
studies conducted in Western countries, avoiding and compromising conict management styles appear to be the rst choices for
the nurses. In Arab countries, no study to date has examined the conict management styles used by nurse managers to compare
with the results from studies conducted in Western countries.
Design. Survey.
Method. A questionnaire was distributed to all nurse managers working in the three-management levels from nine referral
hospitals in Sultanate of Oman, 271 were returned, a response rate of 86%. The results were analysed using SPSS SPSS version 16.
Results. Nurse managers in Oman used all ve conict management styles, with integrating style as the rst choice followed in
order by compromising, obliging, dominating and avoiding. These results differ from the results of the studies conducted on
nurses in other countries.
Conclusion. The results of this study have implications for people who work in the hospitals, whether practitioners or policy
makers. Recommendations are offered to improve nurse managers work environment.
Relevance to clinical practice. Conict can affect patient care if handled badly. Poorly handled conict results in lower staff
morale and poorer retention, both adversely affect patient care.
Key words: management, nurse manager, nurses, nursing, organisational behaviour
Accepted for publication: 17 August 2010
Introduction
Conict is inevitable in everyday social, organisational and
professional nursing life. Conict management styles of nurse
managers can inuence the quality of care delivered to
patients. Nurses comprise the largest health care professional
group and are daily confronted with complex problems
involving conicts among staff.
For the purpose of this research, Pondys (1967) denition
of conict was used conict is typically described as a
dynamic process underlying a wide variety of organisational
behaviour and occurs whenever interdependent parties pur-
sue incompatible goals or incompatible relationships develop
between two or more individuals in an organisation.
Conict may occur between two individuals, in small
groups and work teams, or between groups (De Dreu & Van
De Vliert 1997) such as physiciannurse, nursepatient,
nursenurse and nurseother personnel. Because nurse man-
agers deal with internal and external conicts on a regular
Authors: Zaid Al-Hamdan, PhD, RN, Assistant Professor and Head,
Clinical Nursing Department, Faculty of Nursing, Applied Science
University, Amman, Jordan; Raghda Shukri, PhD, RN, Expert,
College of Nursing, Sultan Qaboos University, Muscat, Oman; Denis
Anthony, PhD, RN, Professor of Nursing, School of Nursing and
Midwifery, De Montfort University, Leicester, UK
Correspondence: Denis Anthony, Professor of Nursing, School of
Nursing and Midwifery, De Montfort University, Leicester, UK.
Telephone: +44 116 201 3909.
E-mail: danthony@talktalk.net
2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580 571
doi: 10.1111/j.1365-2702.2010.03557.x
basis, they must understand the importance of and become
skilled in, conict management. Nurse managers are respon-
sible for managing conict created by changes external to the
organisation and for managing intra-organisational inter-
personal conict. In so doing, they control or inuence the
total climate of a patient care unit.
Conict is not an easy matter to contend with, especially in
a hospital, where many different personalities may be
involved. The management of conict tends to be even more
complicated when the parties have different assumptions,
rules and styles that reect their unique personalities and
cultural values. This requires the manager to have knowledge
and skill in the application of conict management styles.
Conict management is an administrative process that
becomes an integral and essential aspect of organisational
activity (Valentine 1995). Conict is often not the issue itself
but the differences in conict management styles create the
greatest tension in a conict situation (Ting-Toomey et al.
2000).
Literature review
Management of conict is extremely important for the
effective functioning of organisations and for the personal,
cultural and social development of human beings. Construc-
tive and creative conict management is a real challenge and
a goal for any professional who is genuinely interested in
assisting others and the organisation as a whole, in changing
unfavourable conict situations into positive, cooperative
and relatively peaceful directions. Effective conict manage-
ment promotes motivation, enhances morale and promotes
individual and organisational growth (Rahim 1986).
Types of conict management
Research into conict management is focused primarily on
the conict situation and on the personsituation interaction
(Knapp et al. 1988). There is no single way of managing a
conict; it is therefore the responsibility of the person or
group to be conscious of the problem, to select the most
suitable strategies depending on the context in which the
problem has emerged and to identify and confront conict at
an early stage. The ve ways of handling conict can be
dened (with synonyms in brackets as authors name them
differently) as avoiding (denial, withdrawal), compromising
(negotiating), integrating (collaborating), obliging (accom-
modating) and dominating (forcing, competing) (Blake &
Mouton 1964, Thomas & Kilmann 1974, Rahim 1983).
Avoiding results from low concern for self and others,
which involves reducing the importance of the issues and
attempting to suppress thought about issues (Keenan et al.
1998). Avoiding simply refuses to address the conict; it is an
unassertive and uncooperative response. This approach is
appropriate when the other party is more powerful (McElha-
ney 1996).
Compromising results from moderate concern both for
oneself and others. It involves intermediate levels of both
assertiveness and cooperation. This approach focuses on
quick, mutually agreeable decisions that partially satisfy both
parties (Rahim 1983). Compromising emerges when there is
negotiation and interchange. Each person gains something
but gives up something else in the process.
Integrating involves one party working with the other to
nd a solution that satises both the parties. It confronts
issues and arises from high concern for self and others.
Collaboration is both assertive and cooperative and involves
an attempt to work with the other person to nd a solution
that fully satises the concerns of both the parties. This
approach leads to mutually satisfying decision-making (Mar-
riner 1982). It involves an exchange of information about
priorities and preferences, shows insights and makes trade-
offs between important and unimportant issues, which mean
each person or group tackles the problem with equal
consideration.
Obliging comes from low concern for oneself and high
concern for others, which is orientated towards accepting and
incorporating the other partys will. It involves unilateral
concessions, unconditional promises and offers of help.
Accommodating is characterised by cooperative but unasser-
tive behaviour. The accommodating individual exhibits self-
sacricial behaviour by neglecting his or her own concerns to
satisfy those of the other person. Accommodation promotes
harmony and gains credits that can be used at a later date
(Marriner 1982, McElhaney 1996).
Dominating focuses on imposing ones will on others and
involves threats and bluffs, persuasive arguments and posi-
tional commitment. Competing is an aggressive, uncompro-
mising approach to conict that is power-driven. The
individual pursues his or her own personal goals without
regard for others. This approach is appropriate to use when a
quick or unpopular decision must be made or to protect
oneself or someone else from an aggressor (McElhaney 1996,
Vivar 2006) or in an emergency situation.
Conict management and nurse managers
The changing and turbulent environment in which nurse
managers now operate demands from them skills and abilities
to guide conict situations towards constructive outcomes
(Hendel et al. 2005). Managing conict well is one of the
Z Al-Hamdan et al.
572 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580
challenges nurses frequently face. Resolving conict in an
effective manner promotes an environment that stimulates
personal growth and assists in providing quality patient care
(Barton 1991).
All nurses, regardless of their position, must effectively
manage conict to provide an environment that stimulates
personal growth and ensures quality patient care (Forte
1997). The challenge for the leader then is not so much the
mere presence of conict but, when it is recognised in the
course of communication, to deal with it effectively and to
achieve resolutions (Vivar 2006). Keenan et al. (1998) notice
that both literature and research studies over the last few
decades relating to conict management in nursing are
limited. We found no studies on conict management styles
used by nurses in any Arab countries and in particular not in
the Sultanate of Oman.
Gender
Largely female nurse managers (of 182 only three were men)
(Marriner 1982) were slightly less competitive and collabo-
rative, as accommodating, slightly more avoiding than their
male counterparts (339 practicing male managers at middle
and upper levels in American business and government
organisations).
Seniority
Avoidance in managing conict is related to the sense of
powerlessness associated with staff nurses and nurse man-
agers roles in their relationships with physicians and upper-
level administrators (Valentine 2001). An avoiding style is
used by nurses because they behave according to the
traditional paradigm of doctor dominance and nurse defer-
ence, because they are frequently busy and because they have
little knowledge of conict management (Vivar 2006). Using
a conict instrument [MODE, (Thomas & Kilmann 1974)],
junior staff (staff nurses) used avoiding as a most common
style (Cavanagh 1988). However, more senior staff (deans,
nurse managers) used compromising and collaborating before
avoiding (Woodtli 1987, Hendel et al. 2005).
Student nurses in Turkey were found (using ROC II) to use
integrating and obliging the most and dominating the least in
conict with faculty members. Students who employed
integrating and obliging evaluated their conict management
skills higher than those who used avoiding and compromising
(Kantek & Gezer 2009). Staff nurses may be using avoiding
more than students because of cultural differences between
countries, but it could equally be because of different cultures
in academic and clinical areas.
Demographic variables
Using an adapted version of MODE, Hendel et al. (2005)
examined the conict management styles of 60 head nurses
from ve general teaching hospitals in Israel. There was no
relationship between most of the demographic characteristics
and the style of conict management used, but the longer
tenure the head nurse had in his or her position, the more
frequently they used collaborating as their preferred conict
management style.
Conclusion
There may be differences in management styles of nurses
dependent on gender, seniority and length of service, some
examples using the same tool (MODE) are seen in Table 1.
However, no research has been located that examined the
conict management styles used by Arab nurses, and it is
possible that the cultural identity of either Arab nurses or
nurses from other cultures working in an Arab country might
have an effect on management styles.
The study
Aim
This paper, based on a doctoral study (Al-Hamden 2008),
explores the styles of conict management used by nurse
managers in the Sultanate of Oman.
Design
Cross-sectional survey.
Sample
All nurse managers working in the Ministry of Health referral
hospitals nine hospitals.
Questionnaire
The Rahim Organisation Conict Inventory II (ROCI II) was
employed (Rahim 1983). ROCI II consists of 28 items and is
used internationally including in the Middle East (Kozan
1989). The ve subscales of conict style have been tested for
retest reliability and internal consistency and found to be
both reliable and valid (Rahim 2004). ROCI II has also been
tested for build, convergent and distinguishable validity and
found to be valid (Rahim et al. 2000). It consists of a series of
items with a ve-point Likert scale (5 = strongly agree
Characteristics of the nursing workforce Conict management styles
2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580 573
1 = strongly disagree) that reects conict management
styles. The ve conict management styles reect different
combinations of concern for self and concern for others
(dual-concern model). With the authors permission, the
researcher adapted the instrument by adding demographic
variables: age, gender, job position, qualications and years
of experience.
Ethical approval
This research was approved by De Montfort University
Ethics Committee and the Ethical Committee at the Ministry
of Health, Oman. All ethical guidelines set by the Ministry
of Health were followed. The participants signed consent
forms.
Data collection procedure
The study was introduced to the head of nursing departments
at the nine participating hospitals. In each hospital, the head
of nursing distributed questionnaires to their staff and when
completed, they were collected from the nursing ofce.
Section one of the questionnaire collected age, gender, years
of experience, management level and nursing qualication.
Section two of the questionnaire consisted of 28 scaled items
on conict management styles measured with a Likert scale.
IBM SPSS STATISTICS IBM SPSS STATISTICS version 16 (IBM Corporation, New York,
NY, USA) was used to analyse the data.
Finding
Two hundred and seventy-ve nurse managers from nine
hospitals participated in this study, which represented 86%
of the total nurse managers in these hospitals; four were
excluded because of missing data. The demographics are
shown in Table 2. The preference of styles used by the
participants is shown in Fig. 1, in descending order integra-
tive, compromising, obliging, dominating and avoiding.
Nationality showed signicant differences for both com-
promising (p = 004) and dominating (p < 0001) with
KruskallWallis. However, after the Bonferonni correction
(division of the standard alpha level of 005 by the number of
pairwise tests, here ve), only dominating remained signi-
cant with Omanis and Jordanians scoring higher and Indians
and Filipinos lower (Fig. 2). Management level showed
signicant differences for obliging and integrating (p =
0001 and 0003, respectively, with KruskallWallis), both
remained signicant after applying the Bonferonni correction.
More senior positions tended to have higher integrating style
and lower obliging (Fig. 3). T
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Z Al-Hamdan et al.
574 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580
Educational level was signicant for all except avoiding
style, but after the Bonferonni correction, compromising and
integrating failed to reach signicance (p = 019 and 0033,
respectively, with KruskallWallis), while dominating and
obliging remained signicant (p = 0006 and 0003, respec-
tively, with KruskallWallis). Those with a bachelor degree
scored lower for dominating and bachelor and masters degrees
scoring lower for obliging (Fig. 4). The only signicant differ-
ence between the genders was for compromising with men
scoring higher (MannWhitney, p = 0009) and this remained
signicant after applying the Bonferonni correction (Fig. 5).
A linear regression analysis was conducted with each
management style as dependent variable and independent
Compromising Obliging Dominating Avoiding Integrant
5
4
3
2
1
264
256
146
69
139
256
181
145
236
Figure 1 Management styles.
Nationality
Jordanian Filipino Indian Omani
5
4
3
2
1
256
43
70
110
58
178
58
145
181
69
139
10
107
146
181
256
Compromising
Obliging
Dominating
Avoiding
Integrant
Figure 2 Nationality and management style.
Table 2 Sample demographics
Variables Frequency Percentage
Gender
Male 52 192
Female 219 808
Marital statues
Single 42 155
Married 215 793
Divorced 9 33
Widowed 5 18
Management level
First level 185 683
Middle level 78 288
Top level 8 30
Nursing qualications
General nursing diploma 147 542
Bachelor of science in nursing 37 137
General and specialised diploma 65 240
Bachelor in nursing and
specialised diploma
11 41
Masters in nursing 11 41
Nationality
Omani 157 579
Indian 61 225
Filipino 14 52
Jordanian 25 92
Other nationalities 14 52
Current position
Top level Middle level First level nurse managers
5
4
3
2
1
43
181
216 245
219
102
110
70
256
145
236
10
50
146
69
181
107
139
256
Compromising
Obliging
Dominating
Avoiding
Integrant
Figure 3 Level and management style.
Characteristics of the nursing workforce Conict management styles
2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580 575
variables age, years qualied as a nurse, years in manage-
ment, years in post, management level (rst, middle and top
level) and education level (diploma, degree or masters). The
stepwise method was employed with input criterion of
p < 005 and output criterion p > 01, and gender, whether
married and the four common nationalities (Omani, Jorda-
nian, Indian or Pilipino) were entered in dummy variable
format as additional independent variables.
Integrative: Higher position and years qualied had
positive b values (i.e. position and longer years had higher
values for integrative), and Indian nationality and years in
post had negative values (i.e. longer in post or being Indian
nationality had lower values) R
2
= 011.
Avoiding: Indian nationality was positive and years qual-
ied negative, R
2
= 003.
Dominating: Omani or Jordanian nationality were posi-
tive, R
2
= 020.
Obliging: Position, education and years qualied were all
negative, R
2
= 011.
Compromising: Only male gender was kept in the regres-
sion equation (positively), R
2
= 003.
Discussion
Conict management styles
Demographic variables affected all management styles to
some extent. More senior and more experienced staff tended
to use integrative more and use obliging or avoiding less.
More highly educated nurse managers tended also to use
obliging less. Managers who had longer time in their current
post tended to use integrative less. Men used compromising
more than women. Omani and Jordanian managers were
more likely to use dominating and Indian managers more
likely to use avoiding and less likely to use integrative styles.
However, these differences between nationalities, manage-
ment and education levels and genders, while signicant,
show similar patterns (Figs 25). Specically, integrating is
rst and compromising second regardless of nationality,
position, education or gender. The highest R
2
gure was 02
(dominating), which means 20% of the variance is explained
by the variables (nationality in this case) which further
implies 80% is not. For compromising, only 3% is explained
(by gender), so virtually all of the variance in compromising is
because of other (unknown) factors.
Men are more likely to use compromising than women. All
nationalities tend to use integrative but Indian managers less
so. Gender, nationality, seniority, experience and education
all have an effect on management styles, but these effects are
too small to change the rank order of the conict manage-
ment styles. The similarities are more striking than the
differences. All management styles are used and after
integrative (which with a mean of 43 is by far the highest);
the other four are similar (ranging from 28 for avoiding to
34 for compromising).
In contrast to the USA (where no study has shown
integrative to be the most employed style), in Oman nurse
managers score most highly in this area and this is true for
Education
Masters Degree Diploma
5
4
3
2
1
256
145
236
256
181
Compromising
Obliging
Dominating
Avoiding
Integrant
Figure 4 Management style by education level.
Gender
Male Female
5
4
3
2
1
264
221
256
145
10
50
107
146
69
139
181
256
Compromising
Obliging
Dominating
Avoiding
Integrant
Figure 5 Management style by gender.
Z Al-Hamdan et al.
576 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580
both genders, all four main nationalities and each manage-
ment level. The results are similar to Tabak and Orit (2007)
study of Israeli nurses (who also found integrative was
associated with less stress), Qatans (2001) ndings in the
Oman but in the education eld and Ozkalp et al. (2009) in
the commercial sector in Turkey. Personality type (extravert
versus introvert) did not signicantly correlate to any of the
conict management styles in a sample of US nurses
(Whitworth 2008), but collaboration (integration) is associ-
ated with higher values of emotional intelligence in nurses in
the United States (Morrison 2008). Emotional intelligence
moderated conict management styles, those with high
emotional intelligence could more effectively employ even
forcing and withdrawing techniques (Salami 2009).
Rahim (1986) suggests that all styles of conict manage-
ment are appropriate in one situation or another. In
addition, Vivar (2006) suggests that there is no appropriate
or inappropriate strategy to deal with conict. The time
available, context, culture and type of personality should be
taken into account. Barton (1991) mentions that each of
the conict handling strategies can be used effectively
depending on the process and on structural factors that
come into play. However, integrating is considered one of
the more effective ways of handling conict to achieve
long-term benet (Thomas 1976, Marriner 1982, 1995,
Rahim 1986).
Integrating or collaborating is a preferred style, because it
is one in which both parties win and concerns are explored in
an environment of openness and equality. In nursing studies,
integrating is found to be the second most frequently used in
three studies conducted on managers either on the clinical
side or on the academic side; Woodtli (1987) in her study
regarding conict management styles used by deans of
nursing, Barton (1991) in her study regarding the nurse
managers in different levels in USA and Hendel et al. (2005)
in their study regarding the conict management styles used
by nurse managers in ve general hospitals in Israel.
Integrating was also found to be the fourth most frequently
used by nurse managers in the USA in Cavanaghs (1988)
study.
Compromising is the second most preferred style used by
nurse managers. This style is in a lose-lose mode. For
compromising, both parties must be willing to give up
something of equal value. In previous research regarding
nursing, compromising is the rst choice for the partici-
pants (Woodtli 1987, Barton 1991, Hendel et al. 2005) or
second choice (Cavanagh 1988, 1991, Kunaviktikul et al.
2000). Compromising is a quick x for the temporary
settlement of complex issues, for inconsequential issues,
when goals are important but not worth major disruption
and for backup when collaboration and competition fail
(Valentine 2001). This approach focuses on quick, mutually
agreeable decisions that partially satisfy both parties (Ra-
him 1983).
Obliging is the third most frequent style used by nurses in
Oman. In this style, one party neglects their own concern to
satisfy those of the other. This style is used in routine work
and when the issue is important to the other party (Valentine
2001). Obliging is the rst choice for staff nurses in
Kunaviktikul et al.s (2000) study, the second for the staff
nurse sample in Cavanaghs (1991) study and the nurse
managers in Easons (1999) study, the third for nurse
managers in Cavanaghs (1988, 1991) study, the fourth for
the dean of nursing schools in Woodtlis (1987) study and the
last for nurse managers in Hendel et al.s (2005) study.
Dominating is the fourth style used by nurse managers in
Oman. In this style, one party neglects the others concerns.
This style is appropriate to protect the patients life and to
avoid putting someone else in danger (McElhaney 1996,
Vivar 2006). In previous nursing research, dominating was
reported to be the third most preferred style by Hendel et al.s
(2005) participants and the last used by those of Woodtlis
(1987), Cavanaghs (1988, 1991), Bartons (1991), Easons
(1999) and Kunaviktikul et al.s (2000).
Avoiding was the least favourite style used by nurse
managers in Oman. Avoiding results from low self-esteem
and high concern for others. Previous nursing research shows
that avoiding is the rst choice for Cavanaghs (1988, 1991)
and Easons (1999) subjects and the third for Woodtlis
(1987), Bartons (1991) and Kunaviktikul et al.s (2000) and
the fourth for Hendel et al.s (2005).
There are specic aspects of nursing in Oman that might
explain the differences compared to Western countries. The
Omanication process, whereby Omani nationals are encour-
aged to take nurse management roles, may be relevant. Most
of the nurse managers are Omani, but most of the medical
staff (72%) are expatriates. Thus, the traditional professional
power of medical over nursing staff may be moderated by a
national power of Omanis over expatriates.
Kozan (1989) found that employees were more accommo-
dating to ward supervisors, more avoiding towards peers and
more forcing towards subordinates. Omani culture maintains
a relatively wide distance in power between various levels
and this could explain why they (and Jordanians) are more
inclined to use dominating (presumably to more junior staff)
than other nationalities. Most of the nurse managers in
Oman are relatively junior (68% are in rst-level manage-
ment) and thus compromising and obliging are also likely
strategies as these managers will often be dealing with peers
or more senior staff.
Characteristics of the nursing workforce Conict management styles
2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580 577
Consequences of different conict management styles
A recent review of conict communication (Brinkert 2010)
shows conict in nursing is costly, with burnout, absenteeism
and turnover worse where conict is not well addressed.
Alternatively, where it is positive, outcomes are seen, for
example nurses working in shifts in Australia showed fewer
physical symptoms where conict was reduced (Pisarski et al.
2008). In community hospitals in Canada, conict manage-
ment was associated with nurses perceptions of their units
effectiveness, with constructive conict management giving
greater effectiveness (Siu et al. 2008). Effective conict
management is associated with positive outcomes in other
professions. For example, clergy in the New York area of the
USA who used collaborative conict management styles were
found (using MODE) to suffer less from burnout than other
styles (Beebe 2007). Teams of teachers in Israel showed
(using ROC II) integrative conict management was associ-
ated with good team performance and dominating with poor
performance (Somech 2008).
Organisational citizenship behaviour is that which is above
the call of duty and not given formal reward, but associated
with efciency and group performance (Salami 2009). In
Nigeria, using the conict resolution strategies scale (Howart
& London 1980), employees using confronting, compromis-
ing and smoothing techniques were more likely to produce
organisational citizenship behaviour than forcing and with-
drawing (Salami 2009).
Developing the requisite skills does not only or necessarily
involve specic training on conict management. Conict
resolution skills were higher in nursing students taught using
a problem-based learning compared with conventional teach-
ing in Turkey (Seren & Ustun 2008); therefore, innovative
educational methods may be associated with improved skills
in handling conict. Thus, good conict management can be
formally taught or indirectly improved by problem-based
learning (for example) and results in better staff relations and
reduced costs.
Recommendations
The results of the present study have implications for
people who work in the hospitals, whether practitioners
or policy makers. Some recommendations based on the
ndings can be used to improve nurse managers work
environment:
For the nurse managers to help staff nurses resolve conict
effectively, they rst must learn how to resolve their own
conicts productively.
The establishment of criteria for selection of nurse man-
agers depends not only on years of experience but also on
personality and management skills.
Training programmes in personal and conict manage-
ment are needed for nurse managers in Oman. These
programmes should be prerequisites for work as a nurse
manager.
Prior training focused on cultural factors must be given to
non-national nurse managers before they arrive in Oman.
Clear policies and job descriptions for all health workers
in hospitals and for nurse managers particularly need to
be developed and implemented to reduce conict situa-
tions in the work place.
Summary
In Oman, nurse managers report an integrative management
style to be the most favoured. This is unlike all other studies
in Western countries where integrative is never the highest
scoring, even in senior management. It may be that the
specic cultural conditions of Oman are more conducive to
integrative management. While there are differences between
the various demographic groups (gender, nationality, senior-
ity and education), what is more striking is the similarity of
them. Males and females, managers of all four main
nationalities and at each management level all reported
integrative management style as the most preferred.
Limitations
Self-reports
The quantitative method used in this study rely on self-
reports, the objectivity of which can be affected by the
attitudes of the respondents. Their responses may simply
reect their own self-image and their views of others, as
individuals and according to their hierarchical positions. Such
factors may distort the accuracy of their self-reporting
regarding their own behaviour and that of others.
Control of variables
When assessing conict management styles, complete control
of all factors which could affect such styles is not possible.
The characteristics of the organisational structure, for one,
were not examined, nor were relationships with colleagues
at the same and different hierarchical levels, the features of
the various levels of authority, the models of care delivery
and the opportunities for continuous professional develop-
ment.
Z Al-Hamdan et al.
578 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580
Relevance to clinical practice
Inappropriate conict management can adversely affect
patient care. For example, if dominating conict management
style is employed in (say) operating rooms, then junior staff
may feel unable to inform a surgeon that they are about to
amputate the wrong leg. Conversely, in a cardiac arrest in
intensive care, someone senior needs to take charge and
dominating is entirely correct. More generally, we have seen
poor conict management affects staff retention and morale,
and this will in turn adversely affect patient care.
Acknowledgements
We thank all nurses who participated in this study and the
ministry of Health in Oman for the facility and cooperation.
We also thank the Applied Science University in Jordan who
partly funded this research.
Contributions
Study design: DA, RS, ZA; data collection and analysis: ZA,
DA, RS and manuscript preparation: DA, ZA, RS.
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