A literature review of conflict communication causes, costs, benefits and interventions in nursing

Conflict Competence Among Resident Physicians: Knowledge and Perception

BACKGROUND

The hospital environment is a complex and unpredictable workplace where different providers share the responsibility of patient care. Differences in opinions, values, and experiences between resident physicians and other care team members may trigger conflicts that affect the safety and quality of patient care. Thus, developing conflict competencies may help to negotiate the complexities of different conflict situations and resolve these conflicts. However, the extent of the knowledge and perception of conflict competence among resident physicians remains to be determined.

METHODS

A survey and qualitative semi-structured interviews of resident physicians were conducted. Participants were recruited voluntarily. Survey results were analyzed using SPSS 21, and MAXQDA 24 was used to evaluate the interview transcripts with thematic analysis.

RESULTS

Sixty-five resident physicians completed the survey, and 15 resident physicians were interviewed. 61.5% of the survey respondents identified as female, 76.9% were Caucasian, 35.4% of the respondents were from surgical specialties, and 43.1% of the residents were in their second year of training. 53.8% of the participants reported witnessing or experiencing conflicts weekly, with 44.6% reporting resident physician-nurse conflicts. 63.1% of the conflicts were reported as unresolved, with 16.9% reporting that the conflict affected future working relationships, 25.5% of the conflicts were due to failure of communication, 75.4%residents did not have any form of prior training on conflict management, and 83.1% of them reported interest in conflict competence training. Conflicts mainly affected the quality of care (87.3%) compared to patient safety concerns (12.3%). Participants with prior training in conflict competence were more likely to resolve their reported conflict (p = 0.047). The interviews highlighted 5 main themes: sources of conflict, awareness of conflict resolution styles, addressing conflict and outcomes, and the effect on patient care. Sources of conflict included hierarchy and different priorities. 52.2% of the respondents did not know any style of conflict resolution. Addressing conflict included collaboration, avoidance, competition, and prevention. Avoidance was the most common style used by interviewees, followed by collaboration. While most felt that the conflicts affected the quality of patient care, 1 interviewee reported severe adverse events on the patient.

CONCLUSION

Conflicts are rife in the hospital environment and can affect patient care when unresolved. Resident physicians' knowledge of conflict competence is low and does not reflect the complexity of their working environment. Future training in conflict competence and resolution is warranted.

Sequential Mediation Effects of Organizational Support and Collaboration on Missed Nursing Care

BACKGROUND

It is necessary to find ways to mediate the relationship between role overload and missed nursing care in settings where nursing staffing is inadequate. This study aimed to identify the single and multiple sequential mediation effects of organizational support, nurse-physician collaboration, and nurse-nurse collaboration on the relationship between role overload and missed nursing care.

METHODS

Data were collected from 237 registered Korean nurses working in general wards in October 2022. The measures used were the modified role overload scale, nurse-physician collaboration scale, nurse-nurse collaboration scale, a short version of the Perceived Organizational Support Scale, and the modified Missed Nursing Care Scale. Data were analyzed using PROCESS macro in SPSS. A hypothesis test was performed using Model 81, proposed by Hayes, which includes serial multiple mediators.

RESULTS

Organizational support, nurse-physician collaboration, and nurse-nurse collaboration showed a mediation effect on missed nursing care. Organizational support, nurse-physician collaboration, and nurse-nurse collaboration showed significant multiple sequential mediation effects on the relationship between role overload and missed nursing care. When the indirect effect sizes of nurse-physician collaboration were compared with those of nurse-nurse collaboration in both single and multiple sequential mediation paths, the indirect effect of nurse-physician collaboration was greater than that of nurse-nurse collaboration on the relationship between role overload and missed nursing care.

CONCLUSIONS

As an alternative strategy to reduce missed nursing care in situations with insufficient nursing staffing, organizational support should precede nurse-physician and nurse-nurse collaboration. In particular, improving nurse-physician collaboration shows promise in mitigating missed nursing care.

Key aspects of the Saudi healthcare system reform and the potential impact on the main stakeholders: A qualitative study

Objectives

To explore and understand KSA's fundamental healthcare system reform, the potential changes and challenges, and their impacts on major stakeholders.

Methodology

To gain in-depth insights into healthcare leaders' perspectives regarding healthcare system reform in KSA, a qualitative research approach was used. Ten participants from diverse backgrounds were selected, representing various sectors in KSA: private, public, executive, consulting, and regulatory. This study was conducted between august 2022 and June 2023.

Findings

The findings revealed four key themes that shed light on healthcare system transformation in KSA and its effects: healthcare system reform, the impact of corporatization/privatization on healthcare providers, the impact of corporatization/privatization on health insurance, and the impact of corporatization/privatization on the workforce. Furthermore, the findings indicated that the ongoing transformation of the public sector toward privatization in KSA faces various challenges that affect most, if not all, stakeholders in the sector. However, the private sector possesses several strengths that can aid in addressing the challenges associated with the rapid transformation of the system. These strengths include familiarity with the market, robust financial management, extensive experience in coding and billing payers and insurance companies, efficient decision-making processes, flexibility, and maturity.

Conclusion

The study facilitated comprehensive insights into the transformation of KSA's healthcare system and the public sector's shift toward corporatization/privatization. The sector must enhance its capabilities by establishing specialized units and recruiting talent. Further studies are also needed to gain a deeper understanding of the obstacles hindering the transformation.

"Two Years Later I'm Still Just as Angry": A Focus Group Study of Emergency and Internal Medicine Physicians on Disrespectful Communication

Phenomenon: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. Approach: In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center. Findings: We organized focus group results into four overarching categories related to disrespectful communication: characteristics and context (including specific phrasing that members from each department interpreted as disrespectful, effects of listener engagement/disengagement, and the tendency for communication that is not in-person to result in misunderstanding and conflict); differences across training levels (with disrespectful communication more likely when participants were at different training levels); the individual correspondent's tendency toward perceived rudeness; and negative/long-term impacts of disrespectful communication on the individual and environment (including avoidance and effects on patient care). Insights: In the context of predominantly positive descriptions of interdepartmental communication, participants described episodes of perceived disrespectful behavior that often had long-lasting, negative impacts on the quality of the learning environment and clinical work. We created a conceptual model illustrating the process and outcomes of these interactions. We make several recommendations to reduce disrespectful communication that can be applied throughout the hospital to potentially improve patient care, interdepartmental collaboration, and trainee and faculty quality of life.

Evaluation of a Theory-Based Virtual Counseling Application in Nursing Education

Effective communication skills in nursing are necessary for high-quality nursing care, but given the decline in nursing students' attitudes and their low self-confidence in effective communication with patients, a participatory and experiential training method is needed. Therefore, a virtual counseling application was developed using artificial intelligence and a three-dimensional avatar to facilitate learning of communication skills. This study aimed to evaluate the effectiveness of this theory-based virtual intervention on nursing students' learning attitudes, communication self-efficacy, and clinical performance. A longitudinal quasi-experimental study was conducted. Ninety-three undergraduate nursing students received virtual patient trainings with four clinical scenarios over 2 years. Data were analyzed using McNemar test and analysis of variance. Virtual patient training improved students' learning attitudes toward communication skills for scenarios involving the pregnant woman (20.4%, P = .03) and depressed patient (17.1%, P = .01) and enhanced perceived self-efficacy for scenarios involving the pregnant woman (22.6%, P = .002) and stressed nursing student (18.3%, P = .002). Students received lower clinical communication scores for pediatric, obstetric, and medical practicums compared with a previous cohort who received no training. Overall, this virtual counseling application can provide a valuable and cost-effective communication learning resource for the nursing curriculum.

Work-Family Balance and Managing Spillover Effects Communicatively during COVID-19: Nurses' Perspectives

Work-family balance has received meaningful attention from researchers and practitioners alike. Work and family are usually seen as two separate domains that are interdependent, with boundaries that have some level of permeability. Crisis situations can alter permeability of these boundaries, enhancing integration of the two domains due to exchange of ideas and spillover of concerns between these domains. This study looks at how these boundaries are impacted for nurses working directly with COVID-19 patients. The study conducted 24 semi-structured interviews with nurses. Through a thematic analysis the study found that the work-family boundaries have blurred due to concerns around the contagiousness and anxiety associated with the virus. In order to cope with these spillover and possible crossover effects, nurses use prosocial distortion and avoidance and create sub-boundaries at home.

Failure to Rescue Deteriorating Patients: A Systematic Review of Root Causes and Improvement Strategies

OBJECTIVES

"Failure to rescue" (FTR) is the failure to prevent a death resulting from a complication of medical care or from a complication of underlying illness or surgery. There is a growing body of evidence that identifies causes and interventions that may improve institutional FTR rates. Why do patients "fail to rescue" after complications in hospital? What clinically relevant interventions have been shown to improve organizational fail to rescue rates? Can successful rescue methods be classified into a simple strategy?

METHODS

A systematic review was performed and the following electronic databases searched between January 1, 2006, to February 12, 2018: MEDLINE, PsycINFO, Cochrane Library, CINAHL, and BNI databases. All studies that explored an intervention to improve failure to rescue in the adult population were considered.

RESULTS

The search returned 1486 articles. Eight hundred forty-two abstracts were reviewed leaving 52 articles for full assessment. Articles were classified into 3 strategic arms (recognize, relay, and react) incorporating 6 areas of intervention with specific recommendations.

CONCLUSIONS

Complications occur consistently within healthcare organizations. They represent a huge burden on patients, clinicians, and healthcare systems. Organizations vary in their ability to manage such events. Failure to rescue is a measure of institutional competence in this context. We propose "The 3 Rs of Failure to Rescue" of recognize, relay, and react and hope that this serves as a valuable framework for understanding the phases where failure of patient salvage may occur. Future efforts at mitigating the differences in outcome from complication management between units may benefit from incorporating this proposed framework into institutional quality improvement.

Role of Socio-Demographic and Environmental Determinants on Performance of Community Health Workers in Western Kenya

Background: The performance of community health workers remains an area of significant global focus. The role of community health workers in sub-Saharan Africa has evolved over time in response to changing health priorities, disease burdens, and workforce demands. Recently, Kenya revised its community health strategy in response to challenges faced with the implementation of grassroots primary health care initiative. Implementation of community health programs is often inconsistent, and they vary widely in many attributes. The purpose of this study was to explore factors influencing performance of community health workers in Vihiga County, Western Kenya in light of the political devolution. Methods: The study was a cross-sectional study design that involved a quantitative method of data collection. A sample of 309 participants was selected through cluster and simple random sampling. A self-administered and -structured questionnaire was used to gather data, s, and those who were not able to respond individually were guided by the research assistants. Results: The community health workers were 75.2% females and 24.8% males. Performance was significantly associated with not being employed, (OR = 2.4; 95% CI, 1.4–4.4), secondary education (OR = 0.7; 95% CI, 0.5–1.1), lack of conflict resolution mechanism (OR = 2.2; p = 0.017), lack of support (OR = 1.5; p = 0.03), and community health work not seen as important (OR = 1.5; p = 0.041). Poor communication skills were also more likely to influence performance of community health workers (OR = 0.5; p = 0.050) and poor road network (OR = 0.361; p = 0.000). Conclusions: These findings offer a deeper understanding of the interaction between CHWs contextual situations, structural challenges, and performance. Addressing influential factors of CHWs performance in multi-task settings is important in preventing overtaxing their work capacity and to maintain quality performance as countries move towards universal health coverage. Strategies for incentivizing, attracting, and sustaining men in CHWs is important to broaden perspectives about this critical role in society.

Managing conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play

AIM

To describe and illuminate conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play.

BACKGROUND

Conflicts are common in healthcare settings and affect patient care and the wellbeing of nurses. To be able to manage complex practice situations, conflict management is an essential competence for nurses and should be highlighted during education. The aim of the study was to describe and illuminate conflict situations nursing students encounter during their clinical practice, narrated and performed through Forum Play.

DESIGN

The study was designed as a summative qualitative analysis of written group assignments related to nursing students' participation in a drama workshop.

METHOD

A summative qualitative content analysis of written group assignments related to nursing students' participation in a drama workshop, focusing on conflict management. During the workshop the students explored conflict situations they had encountered during clinical practice, through Forum Play. After the workshop, the students handed in a mandatory written group assignment where they described one of the conflict situations.

RESULTS

The findings are presented in three categories; Parties; Arenas; Situations, one main theme; "Who knows best" and two subthemes; Difficulties to adapt to the new and Difficulties reaching a mutual understanding.

CONCLUSION

Conflict situations that nursing students encounter during their clinical practice often stem from the health care staff's difficulties in adapting to the new and difficulty reaching a mutual understanding. Conflict management can be implemented as a powerful learning strategy in nursing education.

An Ethics Early Action Protocol to Promote Teamwork and Ethics Efficacy

BACKGROUND

Moral dilemmas and ethical conflicts occur in critical care. Negative consequences include misunderstandings, mistrust, patient and family suffering, clinician moral distress, and patient safety concerns. Providing an opportunity for team-based ethics assessments and planning could improve communication and reduce moral distress.

OBJECTIVES

The aims of this study were to explore whether an early action ethics intervention affects intensive care unit (ICU) clinicians' moral distress, ethics self-efficacy, and perceptions of hospital climate and to compare nurses' and physicians' scores on moral distress, ethics self-efficacy, and ethical climate at 3 time points.

METHODS

Intensive care unit nurses and physicians were asked to complete surveys on moral distress, ethics self-efficacy, and ethical climate before implementing the ethics protocol in 6 ICUs. We measured responses to the same 3 surveys at 3 and 6 months after the protocol was used.

RESULTS

At baseline, nurses scored significantly higher than physicians in moral distress and significantly lower in ethics self-efficacy. Plot graphs revealed that nurses' and physicians' outcome scores trended toward one another. At 3 and 6 months post intervention, nurse and physician scores changed differently in moral distress and ethics self-efficacy. When examining nurse and physician scores separately over time, we found nurses' scores in moral distress and moral distress frequency decreased significantly over time and ethics self-efficacy and ethics climate increased significantly over time. Physicians' scores did not change significantly.

DISCUSSION

This study indicates that routine, team-based ethics assessment and planning opens a space for sharing information, which could decrease nurses' moral distress and increase their ethics self-efficacy. This, in turn, can potentially promote teamwork and reduce burnout.

Transforming training into practice with the conflict management framework: a mixed methods study

OBJECTIVE

To implement and evaluate the use of the conflict management framework (CMF) in four tertiary UK paediatric services.

DESIGN

Mixed methods multisite evaluation including prospective pre and post intervention collection of conflict data alongside semistructured interviews.

SETTING

Eight inpatient or day care wards across four tertiary UK paediatric services.

INTERVENTIONS

The two-stage CMF was used in daily huddles to prompt the recognition and management of conflict.

RESULTS

Conflicts were recorded for a total of 67 weeks before and 141 weeks after implementation of the CMF across the four sites. 1000 episodes of conflict involving 324 patients/families across the four sites were recorded. After implementation of the CMF, time spent managing episodes of conflict around the care of a patient was decreased by 24% (p<0.001) (from 73 min to 55 min) and the estimated cost of this staff time decreased by 20% (p<0.02) (from £26 to £21 sterling per episode of conflict). This reduction occurred despite conflict episodes after implementation of the CMF having similar severity to those before implementation. Semistructured interviews highlighted the importance of broad multidisciplinary leadership and training to embed a culture of proactive and collaborative conflict management.

CONCLUSIONS

The CMF offers an effective adjunct to conflict management training, reducing time spent managing conflict and the associated staff costs.

Accountability issues in an English emergency department: A nursing perspective

INTRODUCTION

Nurses confront doubts about their accountability and how it affects their clinical practice daily in the complex environment of an emergency department. Therefore, nurses' experiences can provide vital information about the decisions and dilemmas in clinical practice that affect both healthcare professionals and patients alike.

AIM

The aim of this study was to explore the perceptions of nursing staff in an English emergency department in relation to their ethical, legal and professional accountability.

METHODS

Ethnographic content analysis was used to analyse 34 semi-structured interviews from registered nurses working in an emergency department.

RESULTS

There were five categories found during the coding process: nursing care, staff interactions, legal and professional accountability, decision-making process and ethics and values.

CONCLUSION

Several issues related to nursing accountability were found, including the effects of nursing shortages and the reasoning behind multidiscipinary team conflicts. Different approaches of individual and institutional accountability, the evolution of Benner's nursing model and nursing value progression was also identified as key issues. All these phenomena affect nursing accountability in different ways, so their comprehension is paramount to understand and influence them to benefit both patients and nurses.

Nurse Practitioners’ Work Values and Their Conflict Management Approaches in a Stressful Workplace: A Taiwan Study

Globalization has created an urgent need to understand management practices in different cultures. This study examines Confucianism-based work values of nurse practitioners in Taiwan and explores their impact on conflict management approaches in order to help health practitioners maintain sustainable work relationships and improve organizational effectiveness in an increasingly stressful workplace. Based on the data from 259 nurse practitioners in Taiwan, this study shows that nurse practitioners in Taiwan consider holistic rewards, self-fulfillment and personal growth, challenge and responsibility, autonomy, and meaningfulness as important work values. Hierarchical regression results further indicate that nurse practitioners with strong group-centered needs, such as needs for holistic rewards, preferred collaborative methods to manage conflicts in the workplace, and individuals with strong self-centered needs, such as needs for personal growth and self-fulfillment and needs for autonomy, preferred competitive methods to manage conflicts. Interestingly, this study also finds that self-centered needs such as needs for self-fulfillment and personal growth, and needs for challenge and responsibility are also related to collaborative approaches. Managerial implications are then discussed for conflict management training for nurse practitioners under stressful work conditions.

Conflict and conflict management in hospitals

PURPOSE

Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.

DESIGN/METHODOLOGY/APPROACH

This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.

FINDINGS

Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers' personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager's age, work experience and management experience.

PRACTICAL IMPLICATIONS

The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.

ORIGINALITY/VALUE

This is the first study conducted in Iran examining the level of conflict, its types and identifying managers' dominant conflict resolution strategies at front line, middle and top management levels.

A Virtual Counseling Application Using Artificial Intelligence for Communication Skills Training in Nursing Education: Development Study

BACKGROUND

The ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings.

OBJECTIVE

The aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings.

METHODS

The stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud's Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D.

RESULTS

The VPs included four case scenarios that were congruent with the nursing undergraduates' semesters' learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training.

CONCLUSIONS

The creation of VPs to assist in nursing students' communication skills training may provide authentic learning environments that enhance students' perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation.

Reducing healthcare conflict: outcomes from using the conflict management framework

OBJECTIVE

To test a new conflict management framework (CMF) to help staff identify and de-escalate conflict between staff and patients/families.

DESIGN

Before/after study that reports staff quality of life, frequency/severity of conflicts and qualitative interviews on using the framework. Data were collected from May 2017 to September 2017.

SETTING

A paediatric oncology department day-patient and 23-bed inpatient ward.

INTERVENTION

A two-stage CMF used by staff during daily handovers to identify and then manage conflict cases with families.

RESULTS

Staff found the CMFto be helpful in identifying and de-escalating conflicts. The number of conflicts reported decreased by 64% from baseline to follow-up. Communication regarding conflict identification improved. Reports of staff burn-out decreased between the two time-points (n=55 at baseline, n=31 at follow-up; p=0.001). Scores on compassion and secondary traumatic stress did not change.

CONCLUSIONS

The CMF substantially reduces the incidence of conflicts and is an acceptable approach for staff. Continued use of the framework would require it to be fully integrated into the working of the ward, which would need to include senior medical buy-in. Further refinements to the framework have been made and will be tested in four UK sites in 2018/2019.

Perceptions on nurse-nurse collaboration among registered nurses in Finland and Norway

BACKGROUND

Intraprofessional collaboration necessitates understanding and knowledge on how nurses perceive each other and what factors promote good collaboration. The relationship between nurse-nurse collaboration has been explored relatively little, though intraprofessional collaboration is an essential factor for a healthy work environment.

AIM

This study explores the Finnish and the Norwegian nurses' perceptions of nurse-nurse collaboration in nursing care and factors associated with those perceptions.

DESIGN

A cross-sectional quantitative study design.

METHODS

In 2015, data were collected from 406 Finnish and Norwegian RNs in two acute-care hospitals, by employing the Dougherty and Larson's Nurse-Nurse Collaboration Scale (NNCS). Descriptive statistics, cross-tabulations, Pearson's chi-Square tests and multivariate anova were used for analysis. Ethical approval for this study was obtained from ethics committees in both countries.

RESULTS

Findings indicated that the perception of nurse-nurse collaboration was good in both countries. However, significant inter-country differences were found in the collaboration subscales. Compared with their Finnish counterparts, Norwegian nurses awarded higher scores to conflict management, communication, shared process, coordination and professionalism. The results suggest that nurse characteristics, such as main working time and total work experience, were related to the perception of collaboration.

CONCLUSION

The subscales with the highest scores in both countries were professionalism, shared process and communication. Factors such as conflict management and coordination are areas which should be emphasised to achieve good collaboration between nurses. Here, nurse leaders play an important part in assessing and improving RN-RN collaboration.

Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis

AIMS AND OBJECTIVES

To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance.

BACKGROUND

Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated.

DESIGN

A cross-sectional secondary data analysis.

METHODS

Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline.

RESULTS

Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = -4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = -9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01).

CONCLUSIONS

To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders.

RELEVANCE TO CLINICAL PRACTICE

To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.

Learning About Conflict and Conflict Management Through Drama in Nursing Education

BACKGROUND

In the health care settings in which nurses work, involvement in some form of conflict is inevitable. The ability to manage conflicts is therefore necessary for nursing students to learn during their education.

METHOD

A qualitative analysis of 43 written group assignments was undertaken using a content analysis approach.

RESULTS

Three main categories emerged in the analysis-to approach and integrate with the theoretical content, to step back and get an overview, and to concretize and practice-together with the overall theme, to learn by oscillating between closeness and distance.

CONCLUSION

Learning about conflict and conflict management through drama enables nursing students to form new knowledge by oscillating between closeness and distance, to engage in both the fictional world and the real world at the same time. This helps students to form a personal understanding of theoretical concepts and a readiness about how to manage future conflicts. [J Nurs Educ. 2018;57(4):209-216.].

An integrative review on conflict management styles among nursing professionals: implications for nursing management

AIM

To critically appraise and synthesize empirical studies that examined conflict-management styles used by nursing professionals when dealing with conflict.

BACKGROUND

Conflict is an organisational issue not new to the nursing profession. Despite the increasing research interest on this topic, no studies had been conducted to appraise and summarize evidence that examined conflict-management styles in nursing professionals.

METHOD

An integrative review method was used to analyse the findings. The primary databases used to access articles published from 2000 onwards were CINAHL, Medline, Psych Info, ERIC, Embase and SCOPUS. The search words and MeSH terms included: conflict, management, nursing, nurse manager, nurse, style, and strategy.

RESULTS

Twenty-five studies met the inclusion criteria. Integration was the most frequent style employed by nursing professionals when dealing and managing conflict, followed by accommodation. Avoiding and competing were found to be the least frequently used styles. Mixed and conflicting results were obtained when nurses' demographic variables were considered. Studies are needed to examine how organisational and interpersonal factors influence nurses' choice of style for handling conflicts.

CONCLUSION

Findings demonstrated that nursing professionals used constructive/positive conflict management approaches rather than destructive/negative conflict management approaches.

IMPLICATIONS FOR NURSING MANAGEMENT

This integrative review provided up-to-date evidence that is useful when formulating interventions to equip nurses with positive conflict-management styles necessary to mitigate and manage conflict. Such interventions may include: structured training on conflict management, team building, and conflict coaching activities, continuing professional development, reflective exercises, simulation, and role playing.

Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork

OBJECTIVE

The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units.

BACKGROUND

Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup.

METHODS

Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables.

RESULTS

Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup.

CONCLUSION

Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.

Collaboration in a competitive healthcare system: negotiation 101 for clinicians

Purpose The purpose of this paper is to evaluate the effectiveness of negotiation training delivered to senior clinicians, managers and executives, by exploring whether staff members implemented negotiation skills in their workplace following the training, and if so, how and when. Design/methodology/approach This is a qualitative study involving face-to-face interviews with 18 senior clinicians, managers and executives who completed a two-day intensive negotiation skills training course. Interviews were transcribed verbatim, and inductive interpretive analysis techniques were used to identify common themes. Research setting was a large tertiary care hospital and health service in regional Australia. Findings Participants generally reported positive affective and utility reactions to the training, and attempted to implement at least some of the skills in the workplace. The main enabler was provision of a Negotiation Toolkit to assist in preparing and conducting negotiations. The main barrier was lack of time to reflect on the principles and prepare for upcoming negotiations. Participants reported that ongoing skill development and retention were not adequately addressed; suggestions for improving sustainability included provision of refresher training and mentoring. Research limitations/implications Limitations include self-reported data, and interview questions positively elicited examples of training translation. Practical implications The training was well matched to participant needs, with negotiation a common and daily activity for most healthcare professionals. Implementation of the skills showed potential for improving collaboration and problem solving in the workplace. Practical examples of how the skills were used in the workplace are provided. Originality/value To the authors' knowledge, this is the first international study aimed at evaluating the effectiveness of an integrative bargaining negotiation training program targeting executives, senior clinicians and management staff in a large healthcare organization.

Preventing and managing challenging behaviour

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes.

Blended learning pedagogy designed for communication module among undergraduate nursing students: A quasi-experimental study

BACKGROUND

Effective communication is important for nurse and patient outcomes. Nursing students often feel unprepared to communicate effectively with patients and other healthcare workers within the clinical environment. Blended learning pedagogy-based communication skills training can provide an alternative to traditional methods of teaching to enhance students' satisfaction and self-efficacy levels in communicating with others.

OBJECTIVES

To examine the effectiveness of blended learning pedagogy in a redesigned communication module among nursing undergraduates in enhancing their satisfaction levels and attitudes towards learning communication module as well as self-efficacy in communication.

DESIGN

A single group pre-test and post-test quasi-experimental design was adopted.

SETTINGS AND PARTICIPANTS

Data were collected from August 2016 to November 2016 from 124 nursing undergraduates from a leading nursing school.

METHODS

Blended learning pedagogy was adopted to redesign a communication module that offered a wide array of learning opportunities via face-to-face classroom and online sessions. Validated and reliable instruments were used to measure satisfaction levels with blended learning pedagogy, attitudes towards learning communication, and communication self-efficacy. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Participants had enhanced satisfaction levels with blended learning pedagogy, better attitudes in learning communication skills, and improved communication self-efficacies at posttest (week 13 of the semester) when compared with their pre-test scores (week one of the semester). Participants scored higher in the Blended Learning Satisfaction Scale, the Communication Skills Attitude Scale, and the communication skills subscale of the Nursing Students Self-Efficacy Scale.

CONCLUSIONS

Blended learning pedagogy can be effectively used in facilitating communication modules and enhancing student outcomes among nursing undergraduates. The long-term effectiveness of using blended learning pedagogy in facilitating communication modules should be evaluated from students' and patients' perspectives. Additionally, the technology should be constantly improved by incorporating more interactive functions and should be tested to accommodate the learners' needs.

Evolution of Intensive Care Unit Nursing

The specialties of critical care medicine and critical care nursing arose to provide special treatment and care to the most severely ill hospital patients. However, critical care medicine does not seem to have made any major therapeutic progress in the past 30 years. The reduction of mortality in intensive care units (ICUs) is due essentially to improvements in both supportive care and the relevant technologies. In future, increases in the number of ICU beds relative to bed numbers in other hospital wards will probably be contemplated, even in a scenario of decreasing costs; clinical protocols will be computerized and/or nurse-driven; more multicenter and international trials will be performed; and organizational strategies will concentrate ICU personnel in a few large units, to promote the flexible management of these healthcare workers. Moreover, extracorporeal organ support technologies will be improved; technology informatics will cover all the bureaucratic aspects of healthcare work, aiding the staff in workload assessment; and critical care multidisciplinary rounds and follow-up services for post-ICU patients will be implemented. Lastly, a better continuum of care between the pre-hospital phase, the emergency care phase, the ICU phase, and the post-ICU phase should be achieved.

Also, policies should be drafted to manage sudden large demands for critical care beds in mega-emergencies.

The main lines of discussion in critical care nursing research should include nursing research priorities in critical care patients, holistic approaches to the patient, the humanization of care, special populations of ICU patients, and challenges related to critical care nursing during emerging outbreaks of infectious diseases.

An integrative review on conflict management styles among nursing students: Implications for nurse education

OBJECTIVES

Nurse education plays a critical role in the achievement of conflict management skills in nursing students. However, a wider perspective on this concept has not been explored. This paper is a report of a review appraising and synthesizing existing empirical studies describing conflict management styles among nursing students.

DESIGN

An integrative review method guided this review.

DATA SOURCES

Five (5) bibliographic databases (CINAHL, Medline, Psych Info, Embase and SCOPUS) were searched to locate relevant articles.

REVIEW METHODS

An electronic database search was performed in December 2016 to locate studies published from 2007 onwards. The search words included: 'conflict', 'management resolution', 'management style', 'management strategy', 'nursing', 'student'. Thirteen (13) articles met the inclusion criteria.

RESULTS

Nursing students preferred 'constructive/positive conflict management styles' when handling conflicts. However, more studies are needed to identify factors that may affect their choice of styles. Further, this review emphasizes the need for empirical studies to identify appropriate interventions that would effectively enhance nursing students' skills in managing conflicts using rigorous methods.

CONCLUSIONS

Nursing faculty play a critical role in teaching, training, and modeling constructive conflict resolution styles in nursing students. Simulation scenarios, reflective exercises, and role playing may be useful to facilitate such learning in choosing constructive conflict management styles. Structured training programme on conflict management will assist nursing students develop positive conflict management styles.

[Patients, physicians and nursing personnel in intensive care units: Psychological and psychotherapeutic interventions]

During intensive care treatment patients suffer from various forms of stress. Certain psychological and psychotherapeutic interventions (e. g. cognitive behavior therapy, hypnotherapy and psychoeducation) can provide relief. Even patients with a severely reduced ability to communicate can benefit from an early psychological intervention as supportive treatment. The aim of these interventions is to reduce psychological impairments and burdens, provide strategies for coping with physical handicaps or necessary treatment and avoid long-term negative psychological impacts. Organizational and institutional constraints as well as emotional stress are a specific challenge for intensive care personnel. In order to guarantee an efficient collaboration within an interdisciplinary team it is vital to follow clearly defined methods of communication exchange, such as daily ward rounds, regular multidisciplinary meetings and team or case-focused supervision. Properly functioning teamwork increases job satisfaction and is the key to an optimal therapy for the patients.

Lateral hostilities among nurses employed in intensive care units, emergency departments, operating rooms, and emergency medical services. A national survey in Italy

BACKGROUND

Lateral hostilities (LHs) are "nasty, unkind, aggressive behavior between colleagues working at comparable organizational levels." When LHs occur "at least once a week for a period of not less than 6 months," they become "bullying." The frequency of lateral violence in health care literature varies from 5.7% to 65%.

OBJECTIVES

The aim of this study was to explore the extent of LH and the effects on the quality of lives of Italian nurses working in prehospital emergency medical system, emergency department, intensive care unit, and operating rooms.

METHODS

A descriptive study was conducted through an online survey in the Web site of the National Italian Association of Critical Care Nurses (ANIARTI).

RESULTS

A total of 1504 nurses filled up the questionnaire, with 1202 valid data entries (79.9%). Of this group, 739 (61.5%) were women and 951 (79.1%) had experienced some form of LH at least once in the last 12 months, whereas 269 (22.4%) felt to be victims of bullying. The number of transfers to other departments/services due to LH was 43 cases (3.6%), and 829 (69%) experienced psychophysical disorders attributed to LH experienced in the span of the year.

DISCUSSION

Lateral hostility is a frequent occurrence that calls for implementation of management policies to achieving an overall improvement of the work environment climate.

Nurses' Perceptions of Horizontal Violence

In this article, I describe a study exploring horizontal violence and nurses’ perceptions of the phenomenon within the context of two 28-bed inpatient hospital units. The purpose of the study was to develop a clearer understanding of horizontal violence, incorporating observation and inquiry to identify the language nurses use to describe their experiences and factors in the nursing work environment that may perpetuate the phenomenon. Observation, review and analysis of policies, and interviews with staff were completed between June and November 2012. Thematic analysis resulted in five themes: (a) behaviors are minimized and not recognized, (b) fear inhibits all reporting, (c) avoidance and isolation are coping strategies, (d) lack of respect and support, and (e) organizational chaos. The findings suggest future interventions must address a range of factors that perpetuate horizontal violence within the nursing work environment with consideration for the embeddedness and complexity of the phenomenon.

"Drop dead … I need your job": An exploratory study of intra-professional conflict amongst nurses in two Ontario cities

Past studies have focused on inter-professional conflict and its implication for professional status and work. However, there is a dearth of research on intra-professional conflict and its implications for professions. This study explores intra-professional conflicts among nurses in Ontario, using a qualitative research design, drawing on in-depth interviews with 66 nurses. The study identifies conflicts along race and age: Visible minority and younger nurses report more conflict, with visible minority nurses particularly vulnerable and racially marginalized. Members of Visible minorities and young nurses responded to workplace conflict by demonstrating competence, seeking support from colleagues, and either ignoring the abuse or standing up for themselves. These strategies do nothing to challenge professional unity. Nonetheless, intra-professional conflict has negative consequences for professionals and their work.

THE OCCURRENCE OF THE CARE 'OF US' IN THE MOVEMENTS AND FLUCTUATIONS OF THE INTERACTIVE PROCESSES IN THE HOSPITAL ENVIRONMENT

This study's objective was to understand how nursing and health professionals experience and signify the relationships in the care "of us" process, using Grounded Theory as its method. A total of 25 nursing and health workers from a university hospital, distributed into four sample groups, participated in the study. Data were collected through semi-structured interviews in March-July 2011. The contextualization of the institution and management form the context. The movements of human relations/interactions and the professionals' health are causal conditions, while the advance of technology and decline of human care and social life are intervenient conditions. The processed human relations/interactions of care are the strategies that cause the care "of us" to take place in the procedural circularity of care and being-cared-for. The professionals construct the care "of us" in their practice, understood as relational and procedural, in the movements and fluctuations of processes of human interactions.

'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

Background and Objectives

This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital.

Methodology

The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings.

Ethics Statement

Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned.

Results

Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients.

Conclusion

To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers and health workers on conflict management should be put in place. Additionally promoting communication and interaction among health workers can foster team spirit. Also resolving conflicts using the collaborating response may help to create a conducive work environment that will promote healthy work relations, which can facilitate the delivery of quality maternal and neonatal health care. However, such an approach requires that unequal power relations, which is a root cause of the conflicts is addressed.

Avenues of action in ethically complex situations: a critical incident study

OBJECTIVES

The aims of this study were to explore nurse leaders' experiences with ethically difficult situations, perceptions about risk factors, and specific actions for ethical conflicts.

BACKGROUND

Research indicates that nurses are reluctant to bring ethical concerns to nurse leaders for fear of creating trouble, and yet, nurse leaders are key figures in supporting ethics-minded clinicians and cultures.

METHODS

The critical incident technique was used to collect descriptions from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and counted.

RESULTS

End-of-life situations accounted for the majority of incidents. Most situations had 3 to 4 ethical issues. Healthcare provider and system-level factors were perceived to increase the likelihood of ethical conflicts more often than family and patient factors. Respondents were more likely to identify leader actions that address specific situations rather than specify system-level actions addressing root causes of conflicts.

CONCLUSIONS

Findings can be used to help leaders create ethics competencies, policies, and education.

Conflict escalation in paediatric services: findings from a qualitative study

OBJECTIVE

To explore clinician and family experiences of conflict in paediatric services, in order to map the trajectory of conflict escalation.

DESIGN

Qualitative interview study, employing extreme-case sampling. Interviews were analysed using an iterative thematic approach to identify common themes regarding the experience and escalation of conflict.

PARTICIPANTS

Thirty-eight health professionals and eight parents. All participants had direct experience of conflict, including physical assault and court proceedings, at the interface of acute and palliative care.

SETTING

Two teaching hospitals, one district general hospital and two paediatric hospices in England, in 2011.

RESULTS

Conflicts escalate in a predictable manner. Clearly identifiable behaviours by both clinicians and parents are defined as mild, moderate and severe. Mild describes features like the insensitive use of language and a history of unresolved conflict. Moderate involves a deterioration of trust, and a breakdown of communication and relationships. Severe marks disintegration of working relationships, characterised by behavioural changes including aggression, and a shift in focus from the child's best interests to the conflict itself. Though conflicts may remain at one level, those which escalated tended to move sequentially from one level to the next.

CONCLUSIONS

Understanding how conflicts escalate provides clinicians with a practical, evidence-based framework to identify the warning signs of conflict in paediatrics.

Conflict management style of Jordanian nurse managers and its relationship to staff nurses' intent to stay

AIM

To explore the relationship between conflict management styles used by nurse managers and intent to stay of staff nurses.

BACKGROUND

Nursing shortages require managers to focus on the retention of staff nurses. Understanding the relationship between conflict management styles of nurse managers and intent to stay of staff nurses is one strategy to retain nurses in the workforce.

METHODS

A cross-sectional descriptive quantitative study was carried out in Jordan. The Rahim organization conflict inventory II (ROCI II) was completed by 42 nurse managers and the intent to stay scale was completed by 320 staff nurses from four hospitals in Jordan. The anova analysis was carried out.

RESULTS

An integrative style was the first choice for nurse managers and the last choice was a dominating style. The overall level of intent to stay for nurses was moderate. Nurses tend to keep their current job for 2-3 years. There was a negative relationship between the dominating style as a conflict management style and the intent to stay for nurses.

CONCLUSION

The findings of the present study support the claim that leadership practices affect the staff nurses' intent to stay and the quality of care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can improve the intent to stay for staff nurses if they use the appropriate conflict management styles.

Enhancing resilience, empowerment, and conflict management among baccalaureate students: outcomes of a pilot study

To manage interpersonal conflict, nursing students need evidence-based interventions to strengthen stress resiliency, psychological empowerment, and conflict management skills. A pilot 1-group, pre-post-design, 2-semester intervention used simulated experiences to enhance these skills with 60 undergraduate nursing students. Findings suggest that integration of conflict resolution skills throughout the curriculum, with repeated opportunities to practice using a variety of styles of conflict management in relation to situational factors, may be beneficial to prepare students for the challenges of today's healthcare environment.