KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING CONFLICT

MANAGEMENT AMONG NURSES OF TERTIARY CARE HOSPITALS

OF LAHORE

BSc. Nursing Post RN 2nd year

SUBMITTED BY

Ali Hasnain
Anmol Anees
Rabia Muhammad Yar
Farah Nazir
SUPERVISOR: MAM

NEW ADVANCE COLLEGE OF NURSING, LAHORE

Session 2022-2024
 NEW ADVANCE COLLEGE OF NURSING, LAHORE

Title of research synopsis: Knowledge, Attitude And Practice Regarding Conflict

Management Among Nurses Of Tertiary Care Hospital

Submitted By
Ali Hasnain
Anmol Anees
Rabia Muhammad Yar
Farah Nazir

Submitted to
Mam

Supervisor Signature Date

Mam

Principal Signature Date

CHAPTER 1

INTRODUCTION

1.1 Conflict
Conflict can be defined as an interactive process manifested in incompatibility, disagreement, or
dissonance within or between social entities. Conflict may ascend as a consequence of opposing
views, opinions, values, preferences, desires, interests, beliefs, and goals. Conflict is a consistent
and unavoidable issue within healthcare teams (Labrague & McEnroe – Petitte, 2017)). Conflict
is a situation where there are at least two differing perspectives, which can lead to nonproductive
results or can be beneficially resolved and lead to quality final products. (Mohamed & Yousef,
2014)

1.2 Causes of Conflict:

Conflicts in healthcare settings can arise due to various factors, including

organizational structures, interpersonal dynamics, resource allocation, and ethical considerations.
Here are some common causes of conflict in healthcare along with references:

Workload and Staffing Issues: Inadequate staffing levels and high workloads can lead to stress
and tension among nurses, especially when they feel overburdened and unable to provide quality
care to patients. This can result in conflicts over task assignments, scheduling, and workload
distribution. (Beckman, 2019)

Communication Breakdowns: Poor communication among nurses, whether due to differences

in communication styles, lack of clarity in instructions, or ineffective handover procedures, can
lead to misunderstandings and conflicts. Issues such as failure to relay important information or
conflicting messages can disrupt workflow and create tension among team members.(Johansen,
2012)

Hierarchical Structures: Hierarchical structures within healthcare organizations may contribute

to conflicts among nurses, particularly when there is a lack of collaboration and respect between
different levels of nursing staff. Power struggles, perceived favoritism, and feelings of being
undervalued can all fuel interpersonal conflicts. (Sakles et al., 2012)
Personality Clashes: Differences in personalities, values, and work styles among nurses can
sometimes lead to conflicts, as individuals may have difficulty understanding and
accommodating each other's perspectives. This can result in interpersonal friction, resentment,
and difficulties in working together effectively as a team.(Sakles et al., 2012)

Ethical Dilemmas: Nurses may encounter ethical dilemmas in their practice, such as conflicting
values or moral principles, which can lead to disagreements and conflicts. For example,
differences in opinions regarding patient care decisions, end-of-life issues, or resource allocation
can create tensions among nurses with varying perspectives. (Johansen, 2012)

Professional Boundaries: Violations of professional boundaries, such as gossiping, spreading

rumors, or inappropriate behavior, can contribute to conflicts among nurses. Issues related to
respect, trust, and integrity may arise when boundaries are crossed, leading to strained
relationships and conflicts within the workplace. (Sakles et al., 2012)

Resource Allocation: Limited resources, including time, supplies, and equipment, can be a
source of conflict among nurses, especially when there are competing priorities and demands for
scarce resources. Disputes over resource allocation may arise, particularly in settings where
resources are stretched thin or unevenly distributed.(Johansen, 2012)

Organizational Culture: Organizational culture plays a significant role in shaping interactions

and relationships among nurses. Conflicts may arise in environments where there is a lack of
support for teamwork, open communication, and conflict resolution, or where organizational
values are not aligned with those of individual nurses. (Sakles et al., 2012)

1.3 Factors affecting conflict:

Conflicts in Hospital setting:
There are numerous sources of conflict in today's health-care system. Divergent management
styles and staff perspectives, limited staff resources in the unit resulting in higher levels of stress,
variances in work group goals, and competition are some of the most significant reasons of
conflict in nursing environments. Furthermore, the nurse-doctor relationship is a major cause of
tension in the nursing unit. Numerous research have examined the interaction between these
health care professionals. Historically, nurses have followed doctors' orders. Power struggles are
thought to be a major source of stress among nursing homes. (Vivar, 2006)
Around the world, disagreements among nurses are regarded as a serious problem in the
healthcare setting. Divergent management approaches, employee attitudes, staffing shortages,
disparities in goals, and rivalry amongst work groups are the main factors contributing to conflict
among nurses. Some of the most significant causes of conflict in nursing settings are the unit's
limited staff resources, which raises stress levels, goals that differ amongst work groups, and
disagreements between the demands of leaders or head nurses and the orientation and viewpoints
of subordinates or staff nurses. In the healthcare industry, more and more disagreements are
being taken to court. Hospital environments are high stress, professional backgrounds are
diverse, and patient care scenarios are complex, thus conflicts are unavoidable. Effective dispute
resolution, however, is essential to preserving a positive workplace culture, guaranteeing patient
safety, and encouraging cooperation among medical personnel. Because conflicts stem from
people's or groups' sense of threats to their goal, all disputes, whether functional or not, are
fundamentally emotional. (Başoğul & Özgür, 2016)
1.5 Conflict management

Handling conflicts in an efficient and effective manner results in improved quality, patient
safety, and staff morale, and limits work stress for the caregiver. The nurse manager needs to
tackle this challenge with consideration because it involves the nurse and other members of the
interdisciplinary healthcare team who need to work together while managing roles and
responsibilities that frequently overlap. These relationships are essential for the unit to operate
well. The nurse manager needs to be able to assist in efficiently resolving conflict in order to
handle it. A clear grasp of the perceived points of dispute and effective communication are
essential for the settlement and management of conflicts. Because poor communication and
teamwork can result in more patient errors, conflict resolution is a crucial component of a
positive work environment. (Johansen, 2012)

1.6 Strategies of Conflict Management

There are primarily five strategies that individuals use in conflict management.

1.Competition:

Competition or forcing is a win–lose orientation. It designates a situation in which one person or

group attempts to acquire complete dominance. This strategy is appropriate when quick
decisions are vital and there is no time for discussion, such as in an emergency. However, it leads
to winners and losers. (Vivar, 2006)

2. Avoidance

Avoidance is employed to deny the person, issue or the situation. People or groups using this
approach ignore that a problem exists. Therefore, there is no active resolution of the conflict.
This conflict behavior is described in the literature as a generally disapproved strategy. However,
avoiding a situation until more information is available and an analysis of the problem has been
made could be an adequate approach of handling conflict. The avoidance mechanism was a very
effective way to affront a conflictive situation at short-term. However, when avoidance lasts long
time, it may be dysfunctional, as it prevents recognition that a problem exists. (Başoğul & Özgür,
2016)

3. Accommodation

Accommodation also called giving in, is the antithesis of competition where cooperation is high
and assertiveness low. It refers to the conciliation that occurs when one person or group is
willing to yield to the other. Accommodation, at times, can appear relevant, as it encourages
people to express themselves. This results in an agreeable relationship between both parties.
(Vivar, 2006)

4. Compromise

Compromise emerges when there is negotiation and swapping between both parties. Each person
gets something but gives something else up in the process. (Erdenk & Altuntaş, 2017)

5. Collaboration

There is a win–win orientation. Each person or group meets the problem with equal concern.
This approach encourages identification of areas of agreement and disagreement, and selection
of a solution to the problem that incorporates both parties’ perspectives. This approach is
certainly the one that will require the most time to resolve the conflict, but it is the most
meaningful to deal with problem. (Erdenk & Altuntaş, 2017)
Understanding the dynamics of knowledge, attitude, and practice regarding conflict management
among nurses in Lahore's tertiary care hospitals is essential for optimizing patient care quality
and ensuring the well-being of healthcare professionals. By addressing challenges and leveraging
strengths identified through this study, healthcare institutions can cultivate a supportive
environment conducive to effective conflict resolution and professional growth.
Problem Statement

Investigating the nexus between knowledge acquisition, attitudinal orientation, and practical
application concerning conflict management is crucial among nurses in Lahore's tertiary care
hospitals. This study aims to elucidate the interplay of these factors, shedding light on how
nurses perceive, understand, and engage with conflict resolution within their professional milieu.
By examining these dimensions, valuable insights can be gleaned to enhance conflict
management strategies and promote a harmonious healthcare environment conducive to optimal
patient care.
Significance of Study

This study investigates the pivotal nexus between knowledge, attitude, and practice concerning
conflict management within nurses working in tertiary care hospitals of Lahore. By delving into
this domain, it aims to unearth the underlying dynamics shaping the efficacy of conflict
resolution strategies among healthcare professionals. The findings hold paramount importance in
enhancing patient care, fostering a conducive work environment, and refining the overall quality
of healthcare services provided within these institutions.
Objectives

The objective of this study is to:

1. To comprehensively assess the existing knowledge base among nurses in Lahore's tertiary care
hospitals regarding conflict management, encompassing both theoretical understanding and
practical applications.

2. To determine the attitudes of nurses towards conflict within healthcare settings, exploring their
perceptions, beliefs, and emotional responses towards conflict resolution strategies.

3. To evaluate current practices employed by nurses in managing conflicts within the complex
dynamics of tertiary care hospital environments, identifying prevalent approaches and evaluating
their effectiveness.
Operational Definition

Conflict Management

Conflict management refers to the process of identifying, addressing, and resolving

disagreements, disputes, or tensions that arise between individuals or groups within an
organization or a particular setting. It involves the application of strategies, techniques, and
communication skills aimed at mitigating the negative impacts of conflict, fostering
understanding, collaboration, and reaching mutually beneficial outcomes. This encompasses
various aspects of conflict resolution, including negotiation, mediation, problem-solving, and
constructive dialogue, with the ultimate goal of promoting harmony, productivity, and positive
relationships among stakeholders.
CHAPTER 2

LITERATURE REVIEW

Ensuring the safety of patients, healthcare personnel, and the environment in healthcare
environments requires good conflict management. Due to their direct involvement in both the
creation and resolution of conflicts in hospital settings, nurses are essential to this process. It is
crucial to comprehend their conflict management practices, attitudes, and knowledge in order to
create focused interventions that will enhance conflict management techniques and reduce risks.
The purpose of this literature review is to examine the body of research on nurses' knowledge,
attitudes, and practices around conflict resolution in tertiary care facilities. This review aims to
identify knowledge gaps, areas for improvement, and potential strategies for improving nurses'
conflict management practices in healthcare settings by synthesizing the results of prior studies.

A study conducted by Nasim Saif and his colleagues assess the knowledge, attitude and practice
regarding conflict management among nurses at work place environment. The aim of study is to
assess the knowledge, attitude and practice regarding conflict management among registered
nurses and to investigate reasons of the conflict and analyze nurses role in conflict resolution in
the work place. A descriptive correlational design was used. The study involved 120 nurse
managers as a sample. The study's findings display the age distribution of participants in five
groups as a percentage. 60% of nurses responded that they utilized accommodation strategies to
reduce stress in the workplace, whereas 73.3% of participants used collaboration and cooperation
techniques to settle conflicts. For a stable environment, the majority of responders use the
smoothing technique, which likewise has 61.5% similarity. Interpersonal disputes are the most
common, followed by harmful communication, while intergroup conflicts are the least common.
Here, there is no therapeutic care-patient dynamic. Faced with potential confrontation, the
majority of salaried nurses exhibited a high degree of professionalism. It is the duty of nurses to
foster a positive work atmosphere and resolve conflicts. (Saif et al., 2023)

A study was carried out by Cristina Garcı´a Vivar intended to put knowledge in conflict
management into practice through reflecting on a nursing case study. Within nursing units,
power conflict is seen to be a major source of stress. Thus, early conflict management training is
essential to nursing organizations’ efficient operation. A nursing case study illustrating power
dynamics in an oncology nursing unit is presented, along with an analysis of the case's lessons
for conflict resolution. There isn't a conflict resolution approach that is right or wrong.
Nonetheless, it's critical in nursing units to recognize the early signs of conflict and take the best
possible action to resolve it. Staff nurses and nurse managers require a great deal more education
in conflict resolution.(Vivar, 2006)

A study was conducted by Ceyda Bas¸ ogul to analyzes the emotional intelligence levels and
conflict management strategies of nurses and the association between them. This cross-sectional,
descriptive study was conducted with 277 nurses in a stratified random sample. The data were
collected from nurses who gave their informed consent to participate using a personal
information form. Data were assessed by descriptive statistics, t tests, and Pearson correlation
analyses, using SPSS software. The nurses' methods were categorized as follows: low for
compromise (M ¼ 1.99) and low for integration (M ¼ 1.96). The nurses' techniques were
avoiding (M ¼ 2.98), dominating (M ¼ 2.76), and obliging (M ¼ 2.71). On a 5-point rating
scale, the emotional intelligence of nurses was rated as medium (mean ¼ 2.75). Emotional
intelligence scores were positively correlated with integration (r ¼.168), obliging (r ¼.25),
dominating (r ¼.18), and compromising (r ¼.33) conflict management strategies; scores were
negatively correlated (p <.05) with avoiding (r ¼.225). Conflict resolution techniques are
impacted by nurses' emotional intelligence, according to the study. In order to apply conflict
management techniques that work, nurses need to become emotionally intelligent. To increase
the effectiveness of conflict management in healthcare facilities, training programmes on
emotional intelligence and conflict management are required.(Başoğul & Özgür, 2016)

A study was conducted by Leodoro J. and his colleagues to critically appraise and synthesize
empirical studies that examined conflict management styles used by nursing professionals when
dealing with conflict. An organizational problem that is not new to the nursing field is conflict.
To analyze the results, an integrative review method was applied. The inclusion criteria were met
by twenty-five studies. When handling and managing conflict, nursing professionals most often
used the integration style, which was followed by accommodation. The least popular styles were
found to be competing and avoiding. When the demographic characteristics of nurses were taken
into account, inconsistent and mixed findings were found. Research is required to determine how
interpersonal and organizational elements affect nurses' conflict resolution styles. Results
showed that rather than using destructive or negative conflict management techniques, nursing
professionals employed constructive or positive approaches. In order to empower nurses with the
positive conflict-management skills they need to effectively manage and minimize conflict, this
integrative review offered current evidence. These interventions could be in the form of role-
playing, simulation, ongoing professional development, structured training on conflict
management, team-building, and conflict coaching activities, and continuing education.
(Labrague et al., 2018)

A study was conducted by Nigar Erdenk and her colleagues to determine whether personality
traits of nurses have an effect on conflict management strategies. The personality traits of the
nurses are expected to be one of the causes. This study design is cross-sectional, descriptive, and
correlational. Participating in the study were 237 nurses employed by three distinct hospitals.
Researchers used the "Personal Information Form" to gather research data. Frequency and
percentage distributions, descriptive statistics, t-tests, Cronbach's alpha coefficient, Pearson
product-moment correlation analysis, and basic linear regression analysis tests were used to
analyze the gathered data. Most nurses experienced disagreements, particularly with patients'
families, on many occasions per month. It was discovered that nurses' primary personality traits
were "conscientiousness" and "openness," and that they frequently employed the "integration"
method in times of conflict. It was also shown that several of the conflict resolution techniques
used by nurses were influenced by their personality types. It was discovered that several of the
dispute resolution techniques used by nurses were influenced by their personality types. It is
recommended that nurse managers provide support to nurses who implement suitable conflict
management techniques. Additionally, conflict management education courses that impart
suitable skills to other nurses should be established.(Erdenk & Altuntaş, 2017)

A study was conducted by Dr Fatma Rushdy to determine emotional intelligence and conflict
management styles used by nurse managers, Every nurse manager who was employed by a
separate department at the time of the study was included in this one. Three sections make up the
self-administered questionnaire sheet: The first section asks about personal factors such the
hospital name, age, gender, marital status, years of experience, and educational attainment. The
second section is called the Emotional Intelligence Questionnaire and has seventeen items. The
third section is called the Conflict Management Questionnaire and has twenty-one items. The
results showed that the primary hospital's smoothing style had the greatest mean scores among
the conflict management techniques employed by nurse managers. Conversely, the forceful style
at Women Health Hospital outperformed the confrontational style at Pediatric Hospital. At
Assiut University Hospitals, almost half of the nurse managers exhibited a mild emotional
intelligence level. Emotional intelligence and the avoidance of confrontation style have a
negative association (-0.080). According to the study's findings, nurse managers most frequently
employed pushing and smoothing conflict management techniques when resolving disputes with
their staff members. The nurse managers under study have a low level of emotional intelligence.
The conflict resolution techniques employed by nurse managers—forcing and smoothing—were
positively correlated with emotional intelligence. The study suggested using conflict
management training programmes to educate individuals to take a step back and evaluate results
in light of team goals.(Mohamed & Yousef, 2014)

A study was conducted by Deborah Weider-Hatfield and his partner to assess the relationships
between conflict management style and levels of intrapersonal, intragroup, and intergroup
conflict experienced by managers, for three organizational relationships: immediate manager,
peers, and subordinates. Relationships among (a) conflict management styles, (b) levels of
conflict, (c) two general reactions to work, and (d) four types of individual outcomes experienced
by employees in the United States were assessed in two studies. In Research I, there was a
significant increase in intragroup conflict reported by low-dominating supervisors, more
intrapersonal conflict was reported by supervisors who used a high-integrating style with
subordinates, and more intrapersonal conflict was experienced by subordinates who used a high-
obliging style with their supervisors. In Study 2, there was less intrapersonal, intragroup, and
intergroup conflict among high-integrating subordinates compared to low-integrating
subordinates. The analysis' findings also showed a substantial correlation between integration
and each of the six organizational outcomes. A high-dominating approach was linked to lower
interpersonal rewards and lower job satisfaction. Interpersonal results were positively correlated
with both integrating and compromising, and adversely correlated with dominating and avoiding.
Lastly, people's results and job satisfaction decreased with the amount of conflict they
encountered at work.(Weider-Hatfield & Hatfield, 1995)
CHAPTER 3

MATERIAL AND METHODS

3.1 Study Population

The study will be conducted among the registered nurses working in Hospitals of Lahore.

3.2 Study Design

Cross Sectional study design.

Cross-sectional studies are observational studies that analyze data from a population at a single
point in time.

3.3 Setting

The study will be conducted at New Advance College of Nursing and Allied Health Scinces,
Lahore.

3.4 Study Duration

Four month after approval of synopsis.

3.5 Sample Size

Using Slovin’s Formula

Sample Size = n = N / (1 + Ne2)
N= Population Size= 250
e= Margin of Error =0.05
n= 250/1+250(0.05)2
 n=154

3.6 Sampling Technique

Convenience Sampling Technique will be used.

3.7 Sample Selection

3.7.1 Inclusion Criteria

 Registered Nursing working in major hospitals of Lahore.

3.7.2 Exclusion Criteria

 Unwillingness of nurses to participate in the study.

 Undergarduate nursing students

3.8 Procedure

Participants fulfilling inclusion criteria will be included in this research. A modified self-reported
questionnaire will be used to assess knowledge, attitude and practice level among study
population. The questionnaire contains two sections labelled as A (demographics) and B
(Knowledge, Attitude and Practice) Questions. After the approval and written consent from
professionals the data will be used for analysis.

3.9 Statistical Analysis

The data will be entered and analyzed using IBM-SPSS V-23. Findings will be presented in form
of tables, bar charts or percentages.
2.10 Ethical Considerations

Ethical clearance will be obtained from Institutional Review and Research Advisory Board
(IRRAB) of New Advance College of Nursing and Allied Health Sciences, Lahore.
Confidentiality will be maintained at each level of the response in this study.
 REFERENCES

Başoğul, C., & Özgür, G. (2016). Role of Emotional Intelligence in Conflict Management
Strategies of Nurses. Asian Nursing Research, 10(3), 228–233.
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Beckman, B. P. (2019). The Power of Magnet: Changing Nurses, Changing Nursing. Journal of
Nursing Administration, 49(9), 400–401. https://doi.org/10.1097/NNA.0000000000000775

Erdenk, N., & Altuntaş, S. (2017). Do personality traits of nurses have an effect on conflict
management strategies? Journal of Nursing Management, 25(5), 366–374.
https://doi.org/10.1111/jonm.12474

Johansen, M. L. (2012). Keeping the peace: Conflict management strategies for nurse managers.
Nursing Management, 43(2), 50–54.
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conflict management styles among nursing professionals: implications for nursing
management. Journal of Nursing Management, 26(8), 902–917.
https://doi.org/10.1111/jonm.12626

Labrague, L. J., & McEnroe – Petitte, D. M. (2017). An integrative review on conflict

management styles among nursing students: Implications for nurse education. Nurse
Education Today, 59, 45–52. https://doi.org/10.1016/j.nedt.2017.09.001

Mohamed, F. R., & Yousef, H. R. (2014). Emotional intelligence and conflict among nurse
managers at Assiut University Hospital. Journal of Education and Practice, 5(5), 160–165.
https://www.iiste.org/Journals/index.php/JEP/article/view/10967

Saif, N., Shahzadi, A., Shahzadi, A., Aish, A., Shahzadi, S., Arif, S., Basharat, I., Qasim, N., &
Tahira, S. (2023). Assessment of knowledge , attitude and practice regarding conflict
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levels of conflict, and reactions to work. Journal of Social Psychology, 135(6), 687–698.
https://doi.org/10.1080/00224545.1995.9713972
 ANNEXURES

ANNEXURE I

QUESTIONNAIRE

Knowledge, Attitude and Practice regarding Conflict Management Among

Nurses of Tertiary Care Hospital
Section A: Demographics
Name------------------------------

1. Sex-----------------------------

2. Age a)22-34years b)>35years

3. Work Experience a)0-6years b) >6years

4. Exposed to conflicts while working? a) Yes b) No

Section B: Knowledge, Attitude and Practice of Nurses about Conflict management

Sr. Knowledge, Attitude and Practice Questions Agree Strongly Disagree Strongly
No. Agree Disagree

1 Does conflict is the consequence of real or perceived

differences in mutually exclusive goals?

2 Are nurses often have conflict with other health care

professionals due to working in high stress job?

3 Does conflict arise due to poor communication?

4 Do you accept that confronting is the most effective

means for resolving conflict in a time-constrained
situation?

5 Are you believe kill your oppose with cooperation?

6 Do you choose the technique of disappear when mess

arise?
7 Do you meet the expectations of others regarding
conflict management in work place environment?

8 Do you prefer compromise when solving conflict and

just move on?

9 Do you accept that forcing leaves cause of conflict

unresolved?

10 Do you try to negotiate and adopt a “give and- take”

approach to problem situation?

11 Do you avoid hard feelings by keeping your

disagreements with others to yourself?

12 Do you explore issues with others to find solutions that

meet everyone’s needs?

13 Do you generally argue your case and insist on the

merits of your point of view?

14 Do you think collaborating implies mutual attention to

the problem?

15 Do you think resistance may be an effective approach

to handling power differences?

16 Do you think competing is used in situations in which

time does not allow for more cooperative techniques?

17 Do you think accommodating is used when individuals

neglect their own concerns in favor of others’
concerns?

18 Do you think suppressing is used in situations where

conflict is discouraged?

19 Do you think conflict not as an obstacle, but as an

opportunity for problem- solving?

20 Do you know smoothing is accomplished by

complimenting one’s opponent?