Running Head: COMMUNICATION IN CONFLICT
Communication in Conflict Resolution: A Research Analysis
Alexandra Becker RN, BSN
University of Texas Arlington College of Nursing
In partial fulfillment of the requirements of
NUR5311 Nursing Management in Healthcare
Sharon Judkins PhD, RN, NEA-BC
October 25, 2012
Communication in Conflict Resolution: A Research Analysis
Introduction
In the nursing profession and healthcare organizations as a whole, communication has always been key in patient care, employee relationships, job satisfaction, and organizational structure. Conflict tends to arise when there are disagreements in care, hierarchal issues, culture issues, and communication issues. This paper will focus on communication skills for conflict resolution with a review of five studies and communication applicability to the nursing field. Communication and conflict resolution are important to nursing practice because nurse leaders need to be able to intervene when conflict arises and successfully mediate the conflict with regards to individual needs of each person involved. Effective communication is important whether it be speaking, listening, body language or silent communication in the form of kind gestures. The results of these studies will help me develop the skills necessary to pursue a career in nursing administration.
Literature Review
An issue surrounding healthcare organizations around the world is conflict among healthcare personnel. The most common causes of conflict are personal differences, lack of clear job descriptions and responsibilities, role incompatibility, resource scarcity, and job uncertainty (Pavlakis, Kaitelidou, Theodorou, Galanis, Sourtzi, and Siskou, 2011).
The researchers conducted a study to assess factors leading to conflict among staff. They found that a major factor of conflict was inter-personal communication gaps. The study also found that differences in education levels lead to communication problems. Ultimately, nurse leaders showed a lack of knowledge on how to handle conflict and emphasized that communication pathways were not being taught to staff and leaders in the healthcare organizations (Pavlakis, Kaitelidou, Theodorou, Galanis, Sourtzi, and Siskou, 2011).
According to the researchers, hospital information flows in all directions and organizational goals should be clearly understood by each individual. Efforts should be made by managers to improve teamwork by adopting open door policies with open lines of communication. The limitations of the study were that the questionnaire used to collect on factors associated with conflict was self-reported and reliability was assumed, not proven. The results, however, do stimulate more research on successful conflict management strategies (Pavlakis, Kaitelidou, Theodorou, Galanis, Sourtzi, and Siskou, 2011).
Conflict amongst nurses is also very common, sometimes described in terms of role conflict, burnout, horizontal violence, and intergenerational conflict (Brinkert, 2011).
Brinkert (2011) conducted a study with senior nursing managers to determine if the implementation of the Comprehensive Conflict Coaching Model (CCCM) is effective in training nurse managers to become conflict coaches for staff. The study found that the CCCM effectively addressed the topic of conflict communication in nursing and nurse managers exposed to the program exhibited the skills necessary to mediate conflict amongst staff through communication (Brinkert, 2011).
The main limitation of this study was that the researcher was the one implementing the model and training the staff. On occasion, according to Brinkert (2011), the training and research intertwined with use of pre- and post intervention interviews to provide information for future research. The fact that self-reported manager ratings dropped at the 3 month mark and peaked again at the 6 month mark made it difficult to interpret data given the small number of participants. However despite the limitations, the CCCM was reported to be useful, successful, and effective way of supporting nurse manager conflict intervention. This study suggests more research to help nurses communicate through conflict better.
Conflict can be created when there are insufficient nurse leaders or when the nurse leaders are without appropriate competencies to respond to the changing environment (Eddy et al., 2009).
A study was conducted to gather information from practicing nurse leaders to identify strategies related to highly competent nursing leadership (Eddy et al., 2009).
This study concluded that the most essential leadership competencies were communication skills and conflict resolution skills. These two categories are similar and overlap in the fact that one cannot exist without the other (Eddy et al., 2009).
The study also concluded that communication skills did not only encompass speaking with employees, but listening and body language as well when speaking with clients or physicians.
The limitations of this study were that many of the leaders interviewed knew each other and concerns of conflict of interest arose. Furthermore, the sample of nurse leaders was small and lacked in ethnic diversity (Eddy et al., 2009).
This study is applicable to the nursing management field because it sheds light on what skills are necessary for leaders to prosper and be seen as successful by their subordinates. Educating nurse leaders in communication and conflict resolution skills is crucial to success of the leader.
Communication between team members can be very difficult when these members are of different race, religion, culture and socio-economic background. In the constantly changing world of healthcare, nurses need to adapt to different cultures because the world is becoming more diverse every day. Not only are patients becoming more diverse but this diversity also causes nursing and healthcare professional staff to become more diverse, which has the potential to lead to conflict.
Jager and Raich (2011) conducted a study to determine what characteristics, if any, impeded communication amongst staff members in a healthcare setting. Previous research shows that high levels of communication and commitment in groups stems from groups exhibiting factors such as trust, respect, cooperation, collaboration, willingness to work together, and likeness among group members. The researchers hypothesized that teams of increased diversity may have lower levels of communication and higher levels of conflict than those teams with a small amount of diversity (Jager and Raich, 2011).
Employees were given a survey that measures team cohesion, commitment, communication, process conflict, discrimination, and trust. The results showed that increased team diversity yielded increased communication misunderstanding and decreased communication effectiveness. Results also showed that poor communication did not necessarily occur because of diversity differences such as age, sex, or race. Communication problems were caused by deep rooted issues such as values and attitudes (Jager and Raich, 2011).
The researchers commented that with only 69 responses to their questionnaire, adequate portrayal of the entire unit or even nursing profession was impossible. The inconsistency between the hypotheses and results could be based on the small degree of representation that the sample population had over the entire nursing population (Jager and Raich, 2011).
There was also no mention of the reliability and validity of the survey tool used in this study, which makes generalizing this study very premature. However, this is applicable to nursing administration because these nurse managers need to be able to effectively intervene in diversity related conflict and understand how to communicate effectively with both parties to reach a common ground.
Tschannen et al. (2011) agree along with many other healthcare professionals, researchers, and authors that the most common conflicts in healthcare are a result of poor communication. Studies have shown that miscommunication happens because of organizational culture; differences in status and discipline (Tschannen, et al., 2011).
As primary caregivers, nurses need to ensure all patient-related information is accurately passed to various other professions in a timely manner. The researchers tested a communication intervention that allotted more opportunities for nurses and physicians to engage in mutual communication and problem-solving techniques to resolve communication conflict in both entities. Reliability of this intervention had been previously tested through analysis of interdisciplinary teams of nurses, doctors, and nutritionists. Pearson correlation coefficients were computed for nurses (r=.99) and physicians (r=.98) (Tschannen, 2011).
It was initially hypothesized that nurse and physician communication would be improved through the implementation of a communication intervention that sought to improve inter-group dynamics. Although analysis failed to show significant changes in all aspects of communication, the results did support slight improvement in communication and collaboration. This research has also shown that open communication between nurses and physicians results in improved patient outcomes and less fragmentation of care (Tschannen, 2011).
It is recommended that hospitals initiate processes to educate and train current nurses and physicians in the skills of effective communication techniques, allowing them to work harmoniously together. Nurse managers can use this study as a framework to work towards improving the nurse-physician relationship, which can be very difficult to change.
Literature Critique
The aforementioned studies collectively had an underlying theme; communication is very important for conflict resolution. Whether the conflicts stem from employee relationships, nurse-physician relationships, or even client-nurse relationships, nurse managers and administrators must be able to discern the root issue in conflict and use communication skills to mediate the conflict. Although communication seems like the obvious solution to conflict, serious examination of ways to communicate and barriers to communication are rarely addressed.
There are many major factors that contribute to conflict in a healthcare organization. Conflict often stems from organizational power struggles, as seen in nurse-physician relationships or from interpersonal struggles as seen in nurse-nurse relationships. Communication amongst team members can help understand where the conflict is arising from and then foster ideas for ways to resolve the conflict. Utilizing communication does not always mean using verbal communication. There are also types of nonverbal communication that can be used in conflict resolution, but the nurse manager must determine which styles of communication are suitable and appropriate for which type of conflict situation.
Nonverbal communication plays an important role in conflict management. Paying attention to both sides of an argument demands conscious effort and is essential in establishing relationships (Shipley, 2010).
The literature shows that employees prefer leaders who exhibit not only exemplary skills in verbal communication, but also exhibit nonverbal skills when necessary. The literature also shows that it is the role of nursing managers, administrators, and educators to provide staff and other leaders with the opportunities for education and training in conflict management (Brinkert, 2001).
Implementing tools such as the Comprehensive Conflict Coaching Model gives nursing educators and managers the tools to train their staff using evidence-based and reliable data. Successful implementation studies need to be constantly reviews by healthcare leaders to keep training and education up to date in this field of conflict resolution skills.
Diversity in the workplace is becoming more apparent and needed as the client population changes. Although diversifying the workforce has its advantages for patients, it can also become a source of conflict among employees. Culture, gender, attitudes, beliefs, and race are all underlying factors that can contribute to conflict in the workplace. These factors can create issues with trust, respect, cooperation, collaboration, willingness to work together, and likeness among group members. It is the role of the nurse manager to be able to discover the underlying cause of conflict and be prepared to address it with each party, in a culturally correct way without offending someone (Jager and Raich, 2011).
Lastly, a large source of conflict stems from the nurse-physician relationship. This is a conflict that has been raging on for years without much research being done on ways to combat this conflict. There has always been a power struggle between physicians and nurses, when the ultimate goal of both teams is to deliver quality patient care in a safe environment. It is the role of the nurse manager to facilitate the growth of this relationship and mediate when necessary. The literature shows that communication is one of the easiest ways to mediate this problem (Tschannen et al., 2011).
The nurse manager or administrator needs to help the relationship grow by encouraging collaboration instead of avoidance of the issue (Leever, et al., 2010).
Allotting for adequate time for these two teams to communicate patient needs and plans can facilitate assertive and helpful communication instead of hostile and aggressive communication (Tschannen et al., 2011).
When working together in a harmonious relationship, nurses and physicians can deliver adequate and safe care to patients, ultimately making patient experience successful.
Conclusion
Nursing managers, administrators, and educators play a crucial role in conflict resolution, specifically through the use of communication skills. Understanding cultural differences both individual and organizational can help nurse managers address the underlying causes of conflict and determine which communication skills will be necessary to successfully solve the issue at hand. Determining which communication skills would be most effective in each situation can be taught through conflict management model implementations. Nursing educators should remain up to date with studies and research related to conflict resolution and communication skills, ultimately brining that knowledge back to nurse administrators and staff. Knowledge of conflict management can help me grow in my practice even when confronted with small issues with coworkers or patients. This knowledge of communication and conflict resolution can also help when leading peer groups and coworkers. Knowing where to find more information on this topic will also help in my future role as a nurse leader.
References
Brinkert, R. (2011).
Conflict coaching training for nurse managers: A case study of a two-hospital health system. Journal of Nursing Management, 19(1), 80-91. Doi: 10.1111/j.1365-2834.2010.01133.x
Eddy, L.L. et al. (2009).
Relevant nursing leadership: An evidence-based pragmatic response. International Journal of Education Scholarship, 6(1), 1-17. Doi: 10.2202/1548-923X.1792
Jager, M., Raich, M. (2011).
The management of multi-cultural teams: Opportunities and challenges in retirement homes. Journal of Management and Marketing in Healthcare, 4(4), 234-241. Doi: 10.1179/1753304X11Y.0000000010
Leever, A.M. et al. (2010).
Conflicts and conflict management in the collaboration between nurses and physicians: A qualitative study. Journal of Interprofessional Care, 24(6), 612-624. Doi: 10.3109/13561820903550762
Pavlakis, A., Kaitelidou, D., Theodorou, M., Galanis, P., Sourtzi, P., Siskou, O. (2011).
Conflict management in public hospitals: The Cyprus case. International Nursing Review, 58(2), 242-248. Doi: 10.1111/j.1466-7657.2011.00880.x
Shipley, S. (2010).
Listening: A concept analysis. Nursing Forum, 45(2), 125-134. Doi: 10.1111/j.1744-6198.2010.00174.x
Tschannen, D. et al. (2011).
Implications of nurse-physician relations: Report of a successful intervention. Nursing Economic$, 29(3), 127-135. Retrieved from