Conflict Management Styles Used by

Nurse Managers in the Sultanate of

Oman

Zaid Al-Hamdan R.N, MSN

Thesis submitted in partial fulfilment of the

requirements of the award of
DOCTOR OF PHILOSOPHY

DE MONTFORT UNIVERSITY
June 2008
 sbAtract

The purpose of this study was to explore the conflict management styles used by
nurse managers in the Sultanate of Oman. Statistically significant differences related
to demographic variables, including age, gender, nationality and educational level
were examined, as well as years of experience as registered nurse or nurse manager
and years in the current post. An approach combining quantitative and qualitative
methods was employed to obtain a more precise and complete view of conflict
management styles used by nurse managers from different levels, nationalities and
genders with different nursing qualifications working in the same environment.

A total of 271 nurse managers participated in the quantitative part. They completed a
form adapted from ROCI II (Rahim,1983). Three focus group interviews were
conducted in three hospitals involving twenty nurse managers at first and middle
levels from different nationalities. Percentage, means, standard deviations and non-
parametric tests were used to analyse the quantitative data.

The results of this study indicate that nurse managers use different styles of conflict
management, although there were differences in the choice of styles according to
gender, nationality, nursing education, nursing management level and marital status.
In addition to the five styles, the outcomes of the focus group interview discussions
showed that nurse managers manage conflict by reporting it to a higher authority in
order to avoid confrontation. The discussions provide explanations for the choice of
styles used by nurse managers. The results show that the nurse managers’ styles
depend on the other party’s position and gender; the majority of the participants
agreed that age, years of experience, gender and nursing education played a role in
conflict management style.

This study has implications for nurse managers, health policy makers, nursing
educators and human resource departments in the nursing profession.
Table of Contents
Abstract ...................................................................................................................... 2
Table of Contents ........................................................................................................... 3
List of Tables ................................................................................................................. 7
List of Figures ................................................................................................................ 9
Dedication .................................................................................................................... 10
Chapter One: Introduction ........................................... Error! Bookmark not defined.
1.1. Introduction ....................................................... Error! Bookmark not defined.
1.2 Significance of the study.................................... Error! Bookmark not defined.
1.3 Statement of the problem ................................... Error! Bookmark not defined.
1.4 Conceptual framework ....................................... Error! Bookmark not defined.
1.5 Aims and objectives ........................................... Error! Bookmark not defined.
1.6 Research Questions ............................................ Error! Bookmark not defined.
1.7 Research Hypotheses ......................................... Error! Bookmark not defined.
1.8 Definition of Terms............................................ Error! Bookmark not defined.
1.9 Oman: geographic and demographic features.... Error! Bookmark not defined.
1.10 Development of health services and health care in Oman .... Error! Bookmark
not defined.
1.11 Health Care in Oman ....................................... Error! Bookmark not defined.
1.12 Nursing workforce ........................................... Error! Bookmark not defined.
1.13 Summary .......................................................... Error! Bookmark not defined.
Chapter Two: Literature Review ................................. Error! Bookmark not defined.
Section One: Introduction ........................................ Error! Bookmark not defined.
2.1.1 Introduction ..................................................... Error! Bookmark not defined.
2.1.2 The process of literature review ...................... Error! Bookmark not defined.
Section Two: conflict and conflict management .... Error! Bookmark not defined.
2.2.1 Conflict: a concept analysis ............................ Error! Bookmark not defined.
2.2.1.1 Definition and Uses of the Concept “Conflict” ...... Error! Bookmark not
defined.
2.2.1.2 Defining attributes ................................... Error! Bookmark not defined.
2.2.1.3 Stages of conflict...................................... Error! Bookmark not defined.
2.2.1.4 Types of conflict ...................................... Error! Bookmark not defined.
2.2.1.5 Related concepts ...................................... Error! Bookmark not defined.
 2.2.1.6 Antecedents .............................................. Error! Bookmark not defined.
2.2.1.6.1 Individual characteristics ...................... Error! Bookmark not defined.
2.2.1.6.2 Environmental factors ........................... Error! Bookmark not defined.
2.2.1.7 Consequences ........................................... Error! Bookmark not defined.
2.2.1.8 Empirical Referents ................................. Error! Bookmark not defined.
2.2.2 Conflict Management Styles ........................... Error! Bookmark not defined.
Section Three: conflict and conflict management within nurse's context ........Error!
Bookmark not defined.
2.3.1 Sources of conflict for Nurse Managers ......... Error! Bookmark not defined.
2.3.2 Nurse Managers and styles of Conflict Management .... Error! Bookmark not
defined.
2.4 Culture and conflict Management Styles ........... Error! Bookmark not defined.
2.5 Conflict Management styles studies in Arab Countries .... Error! Bookmark not
defined.
2.6 Gender and Conflict Management Strategies .... Error! Bookmark not defined.
2.7 Other variables in conflict management styles .. Error! Bookmark not defined.
2.7.1 Conflict management styles and management level .. Error! Bookmark not
defined.
2.7.2 Educational Level ....................................... Error! Bookmark not defined.
2.7.3 Years of experience..................................... Error! Bookmark not defined.
2.7.4 Age .............................................................. Error! Bookmark not defined.
2.8 Summary ............................................................ Error! Bookmark not defined.
Chapter Three: Method and Methodology................... Error! Bookmark not defined.
3.1 Introduction ........................................................ Error! Bookmark not defined.
3.2 Research Methodology ...................................... Error! Bookmark not defined.
3.2.1 Positivism.................................................... Error! Bookmark not defined.
3.2.2 Post Positivism ............................................ Error! Bookmark not defined.
3.3 Research Design................................................. Error! Bookmark not defined.
3.4 Research Instruments ......................................... Error! Bookmark not defined.
3.5 Validity and Reliability ...................................... Error! Bookmark not defined.
3.6 External Validity ................................................ Error! Bookmark not defined.
3.7 Standards for Qualitative Research .................... Error! Bookmark not defined.
3.7.1 Credibility ................................................... Error! Bookmark not defined.
3.7.2 Transferability ............................................. Error! Bookmark not defined.
 3.7.3 Dependability .............................................. Error! Bookmark not defined.
3.7.4 Confirmability ............................................. Error! Bookmark not defined.
3.8 Population and Sampling ................................... Error! Bookmark not defined.
3.9 Data Collection Methods ................................... Error! Bookmark not defined.
3.9.1 Quantitative Data Collection....................... Error! Bookmark not defined.
3.9.2 Qualitative Data Collection.......................... Error! Bookmark not defined.
3.9.2.1 Organising of the Focus Groups ............ Error! Bookmark not defined.
3.9.2.2 Planning for the focus groups ................ Error! Bookmark not defined.
3.9.2.3 Conduct of the focus group interviews .. Error! Bookmark not defined.
3.10 Data Storage ..................................................... Error! Bookmark not defined.
3.11 Data Analysis ................................................... Error! Bookmark not defined.
3.11.1 Data Analysis of the Questionnaire .............. Error! Bookmark not defined.
3.11.2 Data Analysis for the focus group ................ Error! Bookmark not defined.
3.11.2.1 Data Transcription ................................. Error! Bookmark not defined.
3.11.2.2 Data Management .................................. Error! Bookmark not defined.
3.11.2.3 Reading and Memoing ........................... Error! Bookmark not defined.
3.11.2.4 Description ............................................. Error! Bookmark not defined.
3.11.2.5 Classification.......................................... Error! Bookmark not defined.
3.11.2.6 Interpretation .......................................... Error! Bookmark not defined.
3.12 Pilot Study........................................................ Error! Bookmark not defined.
3.12.1 Survey questionnaire ................................. Error! Bookmark not defined.
3.12. Focus Group ................................................ Error! Bookmark not defined.
3.13 Ethical Issues ................................................... Error! Bookmark not defined.
3.13.1 Ethical Approval ....................................... Error! Bookmark not defined.
3.13.2 Ethical Consideration ................................ Error! Bookmark not defined.
3.13.2.1 Principle of Beneficence ........................ Error! Bookmark not defined.
3.13.2.2 Freedom from Exploitation .................... Error! Bookmark not defined.
3.13.2.3 Risk/Benefit Ratio .................................. Error! Bookmark not defined.
3.13.2.4 Protection of Human Rights................... Error! Bookmark not defined.
3.14 Informed Consent............................................. Error! Bookmark not defined.
3.15 Summary .......................................................... Error! Bookmark not defined.
Chapter Four: Results .................................................. Error! Bookmark not defined.
4.1 Quantitative Result............................................. Error! Bookmark not defined.
4.1.1 Justification for the data analysis techniques .. Error! Bookmark not defined.
 4.1.2 Response rate .................................................. Error! Bookmark not defined.
4.1.3 Demographic Information ............................... Error! Bookmark not defined.
4.1.4 Conflict management styles used by nurse managers .... Error! Bookmark not
defined.
4.1.5 Age and conflict management styles .............. Error! Bookmark not defined.
4.1.6 Conflict management styles and years of experience as registered nurse
.................................................................................. Error! Bookmark not defined.
4.1.7 Conflict management styles and gender ......... Error! Bookmark not defined.
4.1.8 Conflict management styles and nationality of the participants ..............Error!
Bookmark not defined.
4.1.9 Conflict management styles and nursing qualification .. Error! Bookmark not
defined.
4.1.10 Conflict management styles and nursing management level .................Error!
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4.1.12 Conflict management styles and marital status ............ Error! Bookmark not
defined.
4.1.13 Summary of the quantitative results ............. Error! Bookmark not defined.
4.2 Qualitative Results ............................................. Error! Bookmark not defined.
4.2.1 Participants’ characteristics ............................ Error! Bookmark not defined.
4.2.2 Focus group list of questions .......................... Error! Bookmark not defined.
4-2.3 Main themes for the focus group interviews: . Error! Bookmark not defined.
4.2.4 Summary ......................................................... Error! Bookmark not defined.
Chapter Five: Discussion ............................................. Error! Bookmark not defined.
5.1 Introduction ........................................................ Error! Bookmark not defined.
5.2 Styles of conflict management used by nurse managers .. Error! Bookmark not
defined.
5.3 Attitudes toward conflict.................................... Error! Bookmark not defined.
5.4 Sources of conflict for nurse managers in Sultanate of Oman Error! Bookmark
not defined.
5.5 Culture and conflict management styles ............ Error! Bookmark not defined.
5.6 Gender and conflict management ...................... Error! Bookmark not defined.
5.7 Nursing education and conflict management ..... Error! Bookmark not defined.
5.8 Management level and conflict management styles ....... Error! Bookmark not
defined.
 5.9 Marital status and conflict management styles .. Error! Bookmark not defined.
5.10 Age and years of experience ............................ Error! Bookmark not defined.
5.11 Limitations, recommendations and conclusion.... Error! Bookmark not defined.
5.11.1 Limitations .................................................... Error! Bookmark not defined.
5.11.2 Recommendations ......................................... Error! Bookmark not defined.
5.11.3 Conclusion .................................................... Error! Bookmark not defined.
Appendices ................................................................... Error! Bookmark not defined.
Appendix A: Participants’ information sheet ......... Error! Bookmark not defined.
Section A-1: Information Sheet ........................... Error! Bookmark not defined.
Section A- 2: Informed Consent .......................... Error! Bookmark not defined.
Section A- 3: Questionnaires instruments............ Error! Bookmark not defined.
Section A- 4: Invitation for the Focus Group Interviews ... Error! Bookmark not
defined.
Section A-5: Conflict Management Styles instrument ....... Error! Bookmark not
defined.
Appendix B: Focus group interviews transcript ...... Error! Bookmark not defined.
Appendix C : Summary of the focus group themes for each question .............Error!
Bookmark not defined.
Appendix D: Ethical approval ................................. Error! Bookmark not defined.
List of Tables
Table 1.1: Demographical statistics ............................. Error! Bookmark not defined.
Table 1.2: Distribution of Population by Governorate/Region ... Error! Bookmark not
defined.
Table 1.3: Health services indicators in the Sultanate of Oman . Error! Bookmark not
defined.
Table 1.4: Health human resources indicators in Sultanate of OmanError! Bookmark
not defined.
Table 1.5: Mortality indicators .................................... Error! Bookmark not defined.
Table 1.6: Health care indicators ................................. Error! Bookmark not defined.
Table 1.7: MOH Hospitals inpatients morbidity according to age groups and disease
category during 2005 ........................................... Error! Bookmark not defined.
Table 1.8: Geographical distribution of MOH Hospitals as of December 31, 2005
.............................................................................. Error! Bookmark not defined.
Table 1.9: Nurses number in the Sultanate of Oman since 1975 Error! Bookmark not
defined.
Table 1.1‎0: Distribution of MOH nurses according to the gender and percentage of
Omani nurses ....................................................... Error! Bookmark not defined.
Table 1.11: Ministry of Health workforces by Category as of 31 December 2005
.............................................................................. Error! Bookmark not defined.
Table 2.1: The different names for the five styles of conflict management .........Error!
Bookmark not defined.
Table 2.2: Summary of research findings on conflict management styles used by
nurses ................................................................... Error! Bookmark not defined.
Table 2.3: Summary of research finding on conflict management styles in Arab
culture .................................................................. Error! Bookmark not defined.
Table 3.1: Differences between positivism and post positivism. Error! Bookmark not
defined.
Table 3.2: Types of research triangulation .................. Error! Bookmark not defined.
Table 3.3: Summary of the reasons for the selection of focus groups by the researcher
over other qualitative methods ............................. Error! Bookmark not defined.
Table 3.4: Items distribution for each conflict management style .... Error! Bookmark
not defined.
Table 3.5: Pearson corrected Item–Total Correlations and Median Intercorrelations of
the Items of ROCI–II Subscales .......................... Error! Bookmark not defined.
Table 3.6: Numbers of participants and response rate from each hospital ...........Error!
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Table 3.7: Guiding questions for the focus group interviews ..... Error! Bookmark not
defined.
Table 4.1: List of the research questions and research hypotheses ... Error! Bookmark
not defined.
Table 4. 2: Number of respondents as a percentage of total staff ..... Error! Bookmark
not defined.
Table 4.3: Nationality of participants .......................... Error! Bookmark not defined.
Table 4.4: Marital status of participants ...................... Error! Bookmark not defined.
Table 4.5: Distribution of the sample according to management level ................Error!
Bookmark not defined.
Table 4.6: Participants' nursing qualifications ............. Error! Bookmark not defined.
Table 4.7: Years of experience as RN for each nursing management level .........Error!
Bookmark not defined.
Table 4.8: Years of experience as nurse manager for each nursing management level
.............................................................................. Error! Bookmark not defined.
Table 4.9: Years of experience in present post for each nursing management level
.............................................................................. Error! Bookmark not defined.
Table 4.10: One-Sample Kolmogorov-Smimove test for the normal distribution and
preference for styles of conflict management for the participants ................Error!
Bookmark not defined.
Table 4.11: Relationship between age of participants and conflict management styles
.............................................................................. Error! Bookmark not defined.
Table 4.12 :Relationship between years of experience and conflict management styles
.............................................................................. Error! Bookmark not defined.
Table 4.13: Relationship between years of experience as nurse manager and conflict
management styles ............................................... Error! Bookmark not defined.
Table 4.14: Relationship between years of experience in the current post and conflict
management style................................................. Error! Bookmark not defined.
Table 4.15: Gender and conflict management styles ... Error! Bookmark not defined.
Table 4.16: Preference of conflict management styles according to gender ........Error!
Bookmark not defined.
Table 4.17: Conflict management styles used by nurse managers according to
nationality of the participants............................... Error! Bookmark not defined.
Table 4.18: Preference for conflict management styles according to nationality of the
participants ........................................................... Error! Bookmark not defined.
Table 4.19: Nursing qualification and conflict management styles .. Error! Bookmark
not defined.
Table 4.20: Relationship between participants’ nursing qualifications and conflict
management style................................................. Error! Bookmark not defined.
Table 4.21: Nursing management level and conflict management styles .............Error!
Bookmark not defined.
Table 4.22 :Relationship between participants’ management levels and conflict
management style................................................. Error! Bookmark not defined.
Table 4.23: Marital status and conflict management styles ........ Error! Bookmark not
defined.
Table 4.24: Relationship between marital status and conflict management style Error!
Bookmark not defined.
Table 4.25: Criteria of the focus group of the focus group interviews participants
.............................................................................. Error! Bookmark not defined.
Table 4.26: Source of conflict for nurse managers ...... Error! Bookmark not defined.

List of Figures
Figure 1.1: Map of the Sultanate of Oman .................. Error! Bookmark not defined.
Figure 1.2: Map of the Sultanate of Oman showing the ten Health Regions (MOH,
2003) .................................................................... Error! Bookmark not defined.
Figure 2.1: Relationship between conflict level and organisation performance
(adapted from Rahim 1985) ................................. Error! Bookmark not defined.
Figure 2.2: A two –dimensional model of conflict management styles adapted from
Rahim (1985......................................................... Error! Bookmark not defined.
Figure 4.1: Distribution of the participants according to age ..... Error! Bookmark not
defined.
Figure 4.2: Participants’ years of experience ............... Error! Bookmark not defined.
Figure 4.3: Participants’ years of experience as nurse manager . Error! Bookmark not
defined.
Figure 4.4: Participants’ years of experience in current post...... Error! Bookmark not
defined.
Figure 4.5: Gender and conflict management styles .... Error! Bookmark not defined.
Figure 4.6: Conflict management styles and nursing education . Error! Bookmark not
defined.
Figure 4.7: Conflict management styles and current position .... Error! Bookmark not
defined.
Figure 4.8: Conflict management styles and martial status ........ Error! Bookmark not
defined.
 Dedication

To my father

He constantly encouraged me to complete my PhD

But before I could finish it he died

This is dedicated to him

Never will I forget you or your words to me

I Love You dad