ACOSTA, Hillary Joy I.

November 8, 2020
3NUR – 1 RLE 1 Mrs. Margaret M. Natividad

A Study of Interpersonal Conflict Among Operating Room Nurses

Authors: Tsui-Fen Chang & Chung-Kuang Chen & Ming-Jia Chen

APA format: Chang, T., Chen, C., & Chen, M. (2017). A Study of Interpersonal Conflict Among
Operating Room Nurses. The Journal of Nursing Research, 25(6), 400-410. doi:
10.1097/JNR.0000000000000187
Source of the Article: Journal of Nursing Research
Key terms used for the Search: operating room, nurses, interpersonal conflicts

GUIDE QUESTIONS:

1. Identify a current issue that affects patients and nursing care in your current clinical area.

The operating room is considered as one of the most high-risk and high-stress departments
in the hospital. OR nurse staffs are required to work quickly with irregular shift schedules and
must work with other professionals. One issue that can affect patient and nursing care is the
miscommunication among the healthcare team that can lead to interpersonal conflicts. The
healthcare team is not only limited to the OR medical doctors and OR nurses, but it also
includes nurses from other departments, medical personnel, and the patient’s family. According
to the study, interpersonal conflict is an inevitable part of medical practice. Hence, it is important
for medical professionals to make critical decisions with deficient information under strict time
limitations. If they are unable to be acquire this skill, conflicts may arise. The healthcare team
should all work together and have a team collaboration to provide care for the patient during the
perioperative phase.

2. Develop a clinical question following the PICO format

Clinical question: Besides Thomas’ 5 modes, are there any classifications for the strategies for
managing interpersonal conflict?

a. What is the population of interest, identify sample size and sampling technique
used including sample appropriateness?
- 201 OR nurse volunteers who had been employed as an OR nurse for at least 6 months.
They are from a medical center, 4 regional hospitals, and 4 community hospitals in
Taiwan. There are 192 female and 9 male participants. Among the 201 OR nurses, there
are 23 head nurses and 178 staff nurses.

b. What is the Intervention implemented or the Interest of the study?

- The researchers used a questionnaire to interpret and analyze which interpersonal
conflict management strategy and targets of the interpersonal conflict are among the
healthcare team in the OR.
 c. What is the comparison? Or is there a comparison group used if not what is the
current applicable practice or status?
- According to the study, there are 5 modes to classify the strategy for managing conflicts
namely competing, compromising, avoiding, accommodating, and collaborating. These
are all applicable to OR nurses in the hospitals located in the center of Taiwan. Are
these also applicable to other hospitals in Taiwan as well as to the other departments in
the hospital?

d. What is the outcome of interest?

- A harmonious environment in the OR can lead to a successful patient outcome because
interpersonal conflicts are avoided.

3. Conduct evidence search using Pubmed, EMBASE, CINAHL or other online databases
available. Identify or present 5 titles relevant to the PICO question and categorize
according to the level of evidence. Present results in a table following this format:

Author Title of the Population Intervention/ Outcome Key Results/ Level of

(year) Article Comparison Issues Evidenc
e
Barton, Conflict Nurse Process Collaborative Conflict can Level V
A. (1991) Resolution managers, model – modes of result from
by Nurse physicians, concerned with conflict differences in
Managers administrators sequence of management data,
, allied health events (5 should be methods,
professionals distinct events: encouraged. goals, or
and peers frustration, values.
conceptualizati
on, behavior,
interaction, and
outcome)

Structural
model – 4
factors that
influence the
way conflict is
handled within
organizations:
behavioral
predispositions,
social
pressure,
incentive
structure, and
Cavanag The conflict Hospital Thomas- Nursing In Level VI
h, S. J. manageme personnel Kilmann (1974) managers both the staff
(1991) nt style of (145 staff Measure of differed in nurse and
staff nurse and 82 Differences their overall nursing
nurses and managers); Exercise conflict manager
nurse only female (MODE) management group, the
managers staff working profile from most
full-time in the based on a staff nurses in commonly
hospitals two- that they used used conflict
were dimensional compromise management
included. model that almost as style was
Subjects compares the frequently as avoidance.
were taken degree to which avoidance. Typically, this
from general individuals This approach style is
medical/surgi satisfy their seems well associated
cal units and own suited to the with
from concerns role of the individuals
any shift, (assertiveness) nurse not pursuing
intensive care and needs with manager, for either their
units and the degree to compromise is own
other which an effective needs/concer
specialized individuals approach to ns (w those of
units attempt to conflict another
were omitted satisfy the resolution Person. This
concerns of when issues style need not
others are be
(cooperation) complicated, considered
and solutions an ineffective
five orientations need to be one, but can
represent the found swiftly. be of value in
conflict Collaboration a clinical
management may also be setting.
styles: an important
accommodatio style that can
n, avoidance, be used to
collaboration, settle
competition, problems
and when groups
compromise of
people are
seeking
opposing
goals. A
compromising
style
may be
viewed as a
mediating role
between
individuals
and
groups.
Ting- Managing individualists culture-based for one to practical and Level
Toomey intercultura (independent situational enact ideal constructive VII
and l conflict selves) and model - to conflict intercultural
Oetzel effectively collectivists explain the competence, conflict
(2001) (interdepende multifaceted he/she must competence
nt selves) and nature of acquire three skills that can
members of intercultural things—in- be used to
small and conflict depth manage
large power situations knowledge, “everyday
distance heightened culture-based
cultures mindfulness, intimate
and conflicts,
constructive group
conflict skills conflicts, and
—and be able organizational
to apply them conflicts”
in an ethical
manner in
various
intercultural
contexts.
Chen, A Study of Participants questionnaire Major findings hospitals Level V
C.-K., Job Stress, included 121 was used and of this study should
Lin, C., Stress nurses with includes four were as ensure set
Wang, Coping more than elements follows: (a) standard
S.-H., & Strategies, 6 months of covering a stress level operating
Hou, T.- and Job work demographic and frequency procedures
H. (2009) Satisfactio experience at and work- perception of for the OR,
n for seven related data, OR nurses strengthen
Nurses hospitals in a stressor were the designed-
Working in Yunlin and scale, a stress significantly in security of
Middle- Chiayi coping strategy related to the the OR
Level Counties. scale, and a job type of working
Hospital satisfaction hospital; (b) environment,
Operating scale. the most and provide
Rooms intense adequate
stressor safety
perceived by protection
OR nurses equipment
was patient to safeguard
safety; OR staff and
(c) the patients; (b)
stressor most the OR
frequently department
perceived by should
OR nurses increase the
was quantity and
administrative the quality of
feedback; (d) stress relief
 although all courses; (c)
job stressors the OR
were department
positively should
related to improve the
destructive OR
stress coping environment
strategies, and the
professional administrative
status, patient management
safety, and skills; and (d)
OR the OR
environment department
were also should offer
positively self-esteem-
related to related
constructive training
stress coping programs to
strategies; (e) assist OR
factors nursing staff
including work to adopt
rewards, OR constructive
environment, stress coping
and strategies.
administrative
management
of job
satisfaction
were inversely
related to
destructive
stress coping
strategies;
and (f) factors
including work
rewards, OR
environment,
and
administrative
management
of job
satisfaction
were
inversely
related to all
job stressors.
Elena Conflict Academic A cross- The most Further Level V
Losa resolution workplace sectional common style examination
Iglesias, styles in volunteers design was used by of the
 M., & the nursing from faculty at used whereby a nurses overall difference in
Becerro profession two large standardized to resolve conflict-
de universities questionnaire workplace solving
Bengoa in Madrid, was conflict was approaches
Vallejo, Spain, and administered to compromising between
R. (2012) clinical nurses working , followed academic and
workplace in one of two by competing, clinical
volunteers distinct avoiding, nursing
were drawn organizational accommodati environments
from nursing settings: ng, and might shed
staff at two academic or collaborating. light on
different clinical. There was a etiologic
hospitals and significant factors, which
primary care Thomas– overall in turn might
health Kilmann difference in enable
services in Conflict styles nursing
Madrid. They Mode between management
were Instrument was nurses who to institute
identified as used to worked in an conflict
either full examine academic vs. management
professor, conflict a clinical interventions
assistant resolution style setting (p = that are
professor, or 0.005), with tailored to
scholarship the greatest specific work
professor; difference environments
and within the seen for the and
clinical accommodati adapted to
setting, as ng style. Of different
either nursing those nurses employment
supervisor, for whom levels.
registered accommodati
nurse, or on was the
nursing primary style,
assistant. 83% worked
in a clinical
setting
compared
to just 17% in
an academic
setting

4. What intervention/ innovation was used or implemented in the study/ies reviewed?

Since the study is about analyzing the interpersonal conflict among operating room nurses,
the data were gathered by distributing questionnaires to 201 OR nurses working in ORs in
Changhua, Yunlin, and Chiayi Counties in central Taiwan. The questionnaire greatly helped in
achieving the purpose of the study and arriving with the results. Thus, it successfully helped in
identifying the different interpersonal conflict management capabilities of OR nursing staff. It
also helped in relating the demographics of OR nurses with work-related variables,
interpersonal conflict management style, and target of interpersonal conflict.

5. What are the implications of the findings to patient care?

One of the implications of the findings to patient care is that the conflicts within the OR team
must be resolved immediately to be able for the team to work collaboratively and deliver quality
care. With that being said, the findings imply that there is a need for the environment for
communication in the operating room to be made more friendly to encourage Junior OR nurses
to adopt constructive interpersonal conflict management strategies, prior experience in other
departments is a factor that must be considered when recruiting new nurses in the OR, and
lastly, hospitals should provide and sponsor more interpersonal conflict management training
courses among their OR nursing staffs. It implies that having the ability to respond and manage
interpersonal conflicts in OR nurses is very important.

6. Does the intervention support/contradict current nursing practice? Support your answer
using other relevant references (suggestion: use Nursing reference center, current
clinical practice guidelines, books and other references)

The data gathered from the questionnaire allowed the researchers to conclude that the
conflict management strategies of OR nurses reveal that integration is the most frequently
adopted strategy while domination is the least frequently adopted strategy. It is similar to the
findings of Tomey and Poletti (1991) which states that nurses tend to adopt a collaborating and
compromising strategy for the cooperativeness conflict management style while competing and
avoiding strategy for the assertiveness conflict management style. Another finding is that
arbitration was the second most frequently adopted strategy which is similar to the findings of
Ting-Toomey and Oetzel (2001). It states that arbitration, a moderation in both assertiveness
and cooperativeness management style, is frequently adopted in Asian cultures. According to
the study, OR nurse leaders use integration, compromising, and arbitration management
strategies than their other nursing peers, whereas OR nurses with experience in other
departments were more likely to use integration and arbitration strategies. Next, junior OR
nurses use avoiding and accommodating strategies in handling conflicts than their senior peers.
It may mean that they are at a disadvantage in terms of job position, hospital, resources, and
work environment familiarization during interpersonal conflicts. This finding is similar to the
findings Eason and Brown (1999). On the other hand, participants with prior training in conflict
management were more likely to use integration and arbitration strategies. This may indicate
that undergoing trainings provide participants with greater knowledge and skills for dealing with
interpersonal conflicts.

7. Would this practice change/improve process of patient care? Patient outcomes?

 After conducting the study and discussing the results, the researchers were able to interpret
the data gathered. The findings imply that hospitals must pay for more attention to workplace
bullying and work to improve the OR communication environment, consider hiring new OR
nurses who have prior experience in other departments and hospitals, and provide for more
interpersonal conflict management training courses for the staff. In addition, one finding implies
that OR nurse leaders and OR nurses with past experiences have more experience in dealing
with interpersonal conflict and thus prefer to handle conflicts in a relatively more cooperative
manner than their peers. Therefore, having an experience in an OR with friendly communication
environment will help in improving the conflict management strategies of junior OR nurses. As a
result, they will be able to remain in their jobs with a cooperative approach in dealing the
conflicts. They could also deliver efficient and quality care for the patient; further improving the
patient outcomes. If there is an effective team collaboration, the patient outcomes will also be a
success.