Conflict Man JCN[1]

CHARACTERISTICS OF THE NURSING WORKFORCE

Conflict management styles used by nurse managers in the Sultanate of

Oman

Zaid Al-Hamdan, Raghda Shukri and Denis Anthony

Aim. The study aimed at investigating the conflict management styles used by nurse managers in the Sultanate of Oman.

Background. Conflict is inevitable in daily nursing work. Several styles are used to manage conflict situations. In previous

studies conducted in Western countries, avoiding and compromising conflict management styles appear to be the first choices for

the nurses. In Arab countries, no study to date has examined the conflict management styles used by nurse managers to compare

with the results from studies conducted in Western countries.

Design. Survey.

Method. A questionnaire was distributed to all nurse managers working in the three-management levels from nine referral

hospitals in Sultanate of Oman, 271 were returned, a response rate of 86%. The results were analysed using SPSSSPSS version 16.

Results. Nurse managers in Oman used all five conflict management styles, with integrating style as the first choice followed in

order by compromising, obliging, dominating and avoiding. These results differ from the results of the studies conducted on

nurses in other countries.

Conclusion. The results of this study have implications for people who work in the hospitals, whether practitioners or policy

makers. Recommendations are offered to improve nurse managers work environment.

Relevance to clinical practice. Conflict can affect patient care if handled badly. Poorly handled conflict results in lower staff

morale and poorer retention, both adversely affect patient care.

Key words: management, nurse manager, nurses, nursing, organisational behaviour

Accepted for publication: 17 August 2010

Introduction

Conflict is inevitable in everyday social, organisational and

professional nursing life. Conflict management styles of nurse

managers can influence the quality of care delivered to

patients. Nurses comprise the largest health care professional

group and are daily confronted with complex problems

involving conflicts among staff.

For the purpose of this research, Pondys (1967) definition

of conflict was used conflict is typically described as a

dynamic process underlying a wide variety of organisational

behaviour and occurs whenever interdependent parties pur-

sue incompatible goals or incompatible relationships develop

between two or more individuals in an organisation.

Conflict may occur between two individuals, in small

groups and work teams, or between groups (De Dreu & Van

De Vliert 1997) such as physiciannurse, nursepatient,

nursenurse and nurseother personnel. Because nurse man-

agers deal with internal and external conflicts on a regular

Authors: Zaid Al-Hamdan, PhD, RN, Assistant Professor and Head,

Clinical Nursing Department, Faculty of Nursing, Applied Science

University, Amman, Jordan; Raghda Shukri, PhD, RN, Expert,

College of Nursing, Sultan Qaboos University, Muscat, Oman;Denis

Anthony, PhD, RN, Professor of Nursing, School of Nursing and

Midwifery, De Montfort University, Leicester, UK

Correspondence: Denis Anthony, Professor of Nursing, School of

Nursing and Midwifery, De Montfort University, Leicester, UK.

Telephone: +44 116 201 3909.

E-mail: [email protected]

2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580 571doi: 10.1111/j.1365-2702.2010.03557.x

basis, they must understand the importance of and become

skilled in, conflict management. Nurse managers are respon-

sible for managing conflict created by changes external to the

organisation and for managing intra-organisational inter-

personal conflict. In so doing, they control or influence the

total climate of a patient care unit.

Conflict is not an easy matter to contend with, especially in

a hospital, where many different personalities may be

involved. The management of conflict tends to be even more

complicated when the parties have different assumptions,

rules and styles that reflect their unique personalities and

cultural values. This requires the manager to have knowledge

and skill in the application of conflict management styles.

Conflict management is an administrative process that

becomes an integral and essential aspect of organisational

activity (Valentine 1995). Conflict is often not the issue itself

but the differences in conflict management styles create the

greatest tension in a conflict situation (Ting-Toomey et al.

2000).

Literature review

Management of conflict is extremely important for the

effective functioning of organisations and for the personal,

cultural and social development of human beings. Construc-

tive and creative conflict management is a real challenge and

a goal for any professional who is genuinely interested in

assisting others and the organisation as a whole, in changing

unfavourable conflict situations into positive, cooperative

and relatively peaceful directions. Effective conflict manage-

ment promotes motivation, enhances morale and promotes

individual and organisational growth (Rahim 1986).

Types of conflict management

Research into conflict management is focused primarily on

the conflict situation and on the personsituation interaction

(Knapp et al. 1988). There is no single way of managing a

conflict; it is therefore the responsibility of the person or

group to be conscious of the problem, to select the most

suitable strategies depending on the context in which the

problem has emerged and to identify and confront conflict at

an early stage. The five ways of handling conflict can be

defined (with synonyms in brackets as authors name them

differently) as avoiding (denial, withdrawal), compromising

(negotiating), integrating (collaborating), obliging (accom-

modating) and dominating (forcing, competing) (Blake &

Mouton 1964, Thomas & Kilmann 1974, Rahim 1983).

Avoiding results from low concern for self and others,

which involves reducing the importance of the issues and

attempting to suppress thought about issues (Keenan et al.

1998). Avoiding simply refuses to address the conflict; it is an

unassertive and uncooperative response. This approach is

appropriate when the other party is more powerful (McElha-

ney 1996).

Compromising results from moderate concern both for

oneself and others. It involves intermediate levels of both

assertiveness and cooperation. This approach focuses on

quick, mutually agreeable decisions that partially satisfy both

parties (Rahim 1983). Compromising emerges when there is

negotiation and interchange. Each person gains something

but gives up something else in the process.

Integrating involves one party working with the other to

find a solution that satisfies both the parties. It confronts

issues and arises from high concern for self and others.

Collaboration is both assertive and cooperative and involves

an attempt to work with the other person to find a solution

that fully satisfies the concerns of both the parties. This

approach leads to mutually satisfying decision-making (Mar-

riner 1982). It involves an exchange of information about

priorities and preferences, shows insights and makes trade-

offs between important and unimportant issues, which mean

each person or group tackles the problem with equal

consideration.

Obliging comes from low concern for oneself and high

concern for others, which is orientated towards accepting and

incorporating the other partys will. It involves unilateral

concessions, unconditional promises and offers of help.

Accommodating is characterised by cooperative but unasser-

tive behaviour. The accommodating individual exhibits self-

sacrificial behaviour by neglecting his or her own concerns to

satisfy those of the other person. Accommodation promotes

harmony and gains credits that can be used at a later date

(Marriner 1982, McElhaney 1996).

Dominating focuses on imposing ones will on others and

involves threats and bluffs, persuasive arguments and posi-

tional commitment. Competing is an aggressive, uncompro-

mising approach to conflict that is power-driven. The

individual pursues his or her own personal goals without

regard for others. This approach is appropriate to use when a

quick or unpopular decision must be made or to protect

oneself or someone else from an aggressor (McElhaney 1996,

Vivar 2006) or in an emergency situation.

Conflict management and nurse managers

The changing and turbulent environment in which nurse

managers now operate demands from them skills and abilities

to guide conflict situations towards constructive outcomes

(Hendel et al. 2005). Managing conflict well is one of the

Z Al-Hamdan et al.

572 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580

challenges nurses frequently face. Resolving conflict in an

effective manner promotes an environment that stimulates

personal growth and assists in providing quality patient care

(Barton 1991).

All nurses, regardless of their position, must effectively

manage conflict to provide an environment that stimulates

personal growth and ensures quality patient care (Forte

1997). The challenge for the leader then is not so much the

mere presence of conflict but, when it is recognised in the

course of communication, to deal with it effectively and to

achieve resolutions (Vivar 2006). Keenan et al. (1998) notice

that both literature and research studies over the last few

decades relating to conflict management in nursing are

limited. We found no studies on conflict management styles

used by nurses in any Arab countries and in particular not in

the Sultanate of Oman.

Gender

Largely female nurse managers (of 182 only three were men)

(Marriner 1982) were slightly less competitive and collabo-

rative, as accommodating, slightly more avoiding than their

male counterparts (339 practicing male managers at middle

and upper levels in American business and government

organisations).

Seniority

Avoidance in managing conflict is related to the sense of

powerlessness associated with staff nurses and nurse man-

agers roles in their relationships with physicians and upper-

level administrators (Valentine 2001). An avoiding style is

used by nurses because they behave according to the

traditional paradigm of doctor dominance and nurse defer-

ence, because they are frequently busy and because they have

little knowledge of conflict management (Vivar 2006). Using

a conflict instrument [MODE, (Thomas & Kilmann 1974)],

junior staff (staff nurses) used avoiding as a most common

style (Cavanagh 1988). However, more senior staff (deans,

nurse managers) used compromising and collaborating before

avoiding (Woodtli 1987, Hendel et al. 2005).

Student nurses in Turkey were found (using ROC II) to use

integrating and obliging the most and dominating the least in

conflict with faculty members. Students who employed

integrating and obliging evaluated their conflict management

skills higher than those who used avoiding and compromising

(Kantek & Gezer 2009). Staff nurses may be using avoiding

more than students because of cultural differences between

countries, but it could equally be because of different cultures

in academic and clinical areas.

Demographic variables

Using an adapted version of MODE, Hendel et al. (2005)

examined the conflict management styles of 60 head nurses

from five general teaching hospitals in Israel. There was no

relationship between most of the demographic characteristics

and the style of conflict management used, but the longer

tenure the head nurse had in his or her position, the more

frequently they used collaborating as their preferred conflict

management style.

Conclusion

There may be differences in management styles of nurses

dependent on gender, seniority and length of service, some

examples using the same tool (MODE) are seen in Table 1.

However, no research has been located that examined the

conflict management styles used by Arab nurses, and it is

possible that the cultural identity of either Arab nurses or

nurses from other cultures working in an Arab country might

have an effect on management styles.

The study

Aim

This paper, based on a doctoral study (Al-Hamden 2008),

explores the styles of conflict management used by nurse

managers in the Sultanate of Oman.

Design

Cross-sectional survey.

Sample

All nurse managers working in the Ministry of Health referral

hospitals nine hospitals.

Questionnaire

The Rahim Organisation Conflict Inventory II (ROCI II) was

employed (Rahim 1983). ROCI II consists of 28 items and is

used internationally including in the Middle East (Kozan

1989). The five subscales of conflict style have been tested for

retest reliability and internal consistency and found to be

both reliable and valid (Rahim 2004). ROCI II has also been

tested for build, convergent and distinguishable validity and

found to be valid (Rahim et al. 2000). It consists of a series of

items with a five-point Likert scale (5 = strongly agree

Characteristics of the nursing workforce Conflict management styles

2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 571580 573

1 = strongly disagree) that reflects conflict management

styles. The five conflict management styles reflect different

combinations of concern for self and concern for others

(dual-concern model). With the authors permission, the

researcher adapted the instrument by adding demographic

variables: age, gender, job position, qualifications and years

of experience.

Ethical approval

This research was approved by De Montfort University

Ethics Committee and the Ethical Committee at the Ministry

of Health, Oman. All ethical guidelines set by the Ministry

of Health were followed. The participants signed consent

forms.

Data collection procedure

The study was introduced to the head of nursing departments

at the nine participating hospitals. In each hospital, the head

of nursing distributed questionnaires to their staff and when

completed, they were collected from the nursing office.

Section one of the questionnaire collected age, gender, years

of experience, management level and nursing qualification.

Section two of the questionnaire consisted of 28 scaled items

on conflict management styles measured with a Likert scale.

IBM SPSS STATISTICSIBM SPSS STATISTICS version 16 (IBM Corporation, New York,

NY, USA) was used to analyse the data.

Finding

Two hundred and seventy-five nurse managers from nine

hospitals participated in this study, which represented 86%

of the total nurse managers in these hospitals; four were

excluded because of missing data. The demographics are

shown in Table 2. The preference of styles used by the

participants is shown in Fig. 1, in descending order integra-

tive, compromising, obliging, dominating and avoiding.

Nationality showed significant differences for both com-

promising (p = 004) and dominating (p < 0001) with

KruskallWallis. However, after the Bonferonni correction

(division of the standard alpha level of 005 by the number of

pairwise tests, here five), only dominating remained signifi-

cant with Omanis and Jordanians scoring higher and Indians

and Filipinos lower (Fig. 2). Management level showed

significant differences for obliging and integrating (p =

0001 and 0003, respectively, with KruskallWallis), both

remained significant after applying the Bonferonni correction.

More senior positions tended to have higher integrating style

and lower obliging (Fig. 3).Table1Conflictmanagem

entstylesusedbynurses

indescendingorder

offrequency

(allstudiesusedMODE)

Woodtli

(1987)

Cavanagh

(1988,1991)

Cavanagh

(1991)Staff

Cavanagh

(1991)

Managers

Barton

(1991)

Eason

(1999)

Kunaviktikul

etal.(2000)

Hendel

etal.(2005)

1Compromising

Avoiding

Avoiding

Avoiding

Compromising

Avoiding

Accommodating

Compromising

2Collaborating

Compromising

Accommodating

Compromising

Collaborating

Accommodating

Compromising

Collaborating

3Avoiding

Accommodating

Compromising

Accommodating

Avoiding

Compromising

Avoiding

Competing

4Accommodating

Collaborating

Collaborating

Collaborating

Accommodating

Collaborating

Collaborating

Avoiding

5Competing

Competing

Competing

Competing

Competing

Competing

Competing

Accommodating

Sample

167deans

64femalenurse

145staffnurse

82managers

69differentlevels

217registerednurse

354registerednurse

60nursemanagers

Z Al-Hamdan et al.


Educational level was significant for all except avoiding

style, but after the Bonferonni correction, compromising and

integrating failed to reach significance (p = 019 and 0033,

respectively, with KruskallWallis), while dominating and

obliging remained significant (p = 0006 and 0003, respec-

tively, with KruskallWallis). Those with a bachelor degree

scored lower for dominating and bachelor andmasters degrees

scoring lower for obliging (Fig. 4). The only significant differ-

ence between the genders was for compromising with men

scoring higher (MannWhitney, p = 0009) and this remained

significant after applying the Bonferonni correction (Fig. 5).

A linear regression analysis was conducted with each

management style as dependent variable and independent

CompromisingObligingDominatingAvoidingIntegrant

5

4

3

2

1

264

256

146

69139256181

145

236

Figure 1 Management styles.

NationalityJordanianFilipinoIndianOmani

5

4

3

2

1

2564370

11058

178

58

145

181

69139

10107

146

181

256


Figure 2 Nationality and management style.

Table 2 Sample demographics

Variables Frequency Percentage

Gender

Male 52 192Female 219 808

Marital statues

Single 42 155Married 215 793Divorced 9 33Widowed 5 18

Management level

First level 185 683Middle level 78 288Top level 8 30

Nursing qualifications

General nursing diploma 147 542Bachelor of science in nursing 37 137General and specialised diploma 65 240Bachelor in nursing and

specialised diploma

11 41

Masters in nursing 11 41Nationality

Omani 157 579Indian 61 225Filipino 14 52Jordanian 25 92Other nationalities 14 52

Current positionTop levelMiddle levelFirst level nurse managers

5

4

3

2

1

43181

216 245219

102110 70

256

145

236

10

50

146

69

181

107139

256


Figure 3 Level and management style.



variables age, years qualified as a nurse, years in manage-

ment, years in post, management level (first, middle and top

level) and education level (diploma, degree or masters). The

stepwise method was employed with input criterion of

p < 005 and output criterion p > 01, and gender, whether

married and the four common nationalities (Omani, Jorda-

nian, Indian or Pilipino) were entered in dummy variable

format as additional independent variables.

Integrative: Higher position and years qualified had

positive b values (i.e. position and longer years had higher

values for integrative), and Indian nationality and years in

post had negative values (i.e. longer in post or being Indian

nationality had lower values) R2 = 011.

Avoiding: Indian nationality was positive and years qual-

ified negative, R2 = 003.

Dominating: Omani or Jordanian nationality were posi-

tive, R2 = 020.

Obliging: Position, education and years qualified were all

negative, R2 = 011.

Compromising: Only male gender was kept in the regres-

sion equation (positively), R2 = 003.

Discussion

Conflict management styles

Demographic variables affected all management styles to

some extent. More senior and more experienced staff tended

to use integrative more and use obliging or avoiding less.

More highly educated nurse managers tended also to use

obliging less. Managers who had longer time in their current

post tended to use integrative less. Men used compromising

more than women. Omani and Jordanian managers were

more likely to use dominating and Indian managers more

likely to use avoiding and less likely to use integrative styles.

However, these differences between nationalities, manage-

ment and education levels and genders, while significant,

show similar patterns (Figs 25). Specifically, integrating is

first and compromising second regardless of nationality,

position, education or gender. The highest R2 figure was 02

(dominating), which means 20% of the variance is explained

by the variables (nationality in this case) which further

implies 80% is not. For compromising, only 3% is explained

(by gender), so virtually all of the variance in compromising is

because of other (unknown) factors.

Men are more likely to use compromising than women. All

nationalities tend to use integrative but Indian managers less

so. Gender, nationality, seniority, experience and education

all have an effect on management styles, but these effects are

too small to change the rank order of the conflict manage-

ment styles. The similarities are more striking than the

differences. All management styles are used and after

integrative (which with a mean of 43 is by far the highest);

the other four are similar (ranging from 28 for avoiding to

34 for compromising).

In contrast to the USA (where no study has shown

integrative to be the most employed style), in Oman nurse

managers score most highly in this area and this is true for

EducationMastersDegreeDiploma

5

4

3

2

1

256

145

236

256

181


Figure 4 Management style by education level.

Gender MaleFemale

5

4

3

2

1

264

221

256

145

1050

107146

69139

181

256


Figure 5 Management style by gender.

Z Al-Hamdan et al.


both genders, all four main nationalities and each manage-

ment level. The results are similar to Tabak and Orit (2007)

study of Israeli nurses (who also found integrative was

associated with less stress), Qatans (2001) findings in the

Oman but in the education field and Ozkalp et al. (2009) in

the commercial sector in Turkey. Personality type (extravert

versus introvert) did not significantly correlate to any of the

conflict management styles in a sample of US nurses

(Whitworth 2008), but collaboration (integration) is associ-

ated with higher values of emotional intelligence in nurses in

the United States (Morrison 2008). Emotional intelligence

moderated conflict management styles, those with high

emotional intelligence could more effectively employ even

forcing and withdrawing techniques (Salami 2009).

Rahim (1986) suggests that all styles of conflict manage-

ment are appropriate in one situation or another. In

addition, Vivar (2006) suggests that there is no appropriate

or inappropriate strategy to deal with conflict. The time

available, context, culture and type of personality should be

taken into account. Barton (1991) mentions that each of

the conflict handling strategies can be used effectively

depending on the process and on structural factors that

come into play. However, integrating is considered one of

the more effective ways of handling conflict to achieve

long-term benefit (Thomas 1976, Marriner 1982, 1995,

Rahim 1986).

Integrating or collaborating is a preferred style, because it

is one in which both parties win and concerns are explored in

an environment of openness and equality. In nursing studies,

integrating is found to be the second most frequently used in

three studies conducted on managers either on the clinical

side or on the academic side; Woodtli (1987) in her study

regarding conflict management styles used by deans of

nursing, Barton (1991) in her study regarding the nurse

managers in different levels in USA and Hendel et al. (2005)

in their study regarding the conflict management styles used

by nurse managers in five general hospitals in Israel.

Integrating was also found to be the fourth most frequently

used by nurse managers in the USA in Cavanaghs (1988)

study.

Compromising is the second most preferred style used by

nurse managers. This style is in a lose-lose mode. For

compromising, both parties must be willing to give up

something of equal value. In previous research regarding

nursing, compromising is the first choice for the partici-

pants (Woodtli 1987, Barton 1991, Hendel et al. 2005) or

second choice (Cavanagh 1988, 1991, Kunaviktikul et al.

2000). Compromising is a quick fix for the temporary

settlement of complex issues, for inconsequential issues,

when goals are important but not worth major disruption

and for backup when collaboration and competition fail

(Valentine 2001). This approach focuses on quick, mutually

agreeable decisions that partially satisfy both parties (Ra-

him 1983).

Obliging is the third most frequent style used by nurses in

Oman. In this style, one party neglects their own concern to

satisfy those of the other. This style is used in routine work

and when the issue is important to the other party (Valentine

2001). Obliging is the first choice for staff nurses in

Kunaviktikul et al.s (2000) study, the second for the staff

nurse sample in Cavanaghs (1991) study and the nurse

managers in Easons (1999) study, the third for nurse

managers in Cavanaghs (1988, 1991) study, the fourth for

the dean of nursing schools in Woodtlis (1987) study and the

last for nurse managers in Hendel et al.s (2005) study.

Dominating is the fourth style used by nurse managers in

Oman. In this style, one party neglects the others concerns.

This style is appropriate to protect the patients life and to

avoid putting someone else in danger (McElhaney 1996,

Vivar 2006). In previous nursing research, dominating was

reported to be the third most preferred style by Hendel et al.s

(2005) participants and the last used by those of Woodtlis

(1987), Cavanaghs (1988, 1991), Bartons (1991), Easons

(1999) and Kunaviktikul et al.s (2000).

Avoiding was the least favourite style used by nurse

managers in Oman. Avoiding results from low self-esteem

and high concern for others. Previous nursing research shows

that avoiding is the first choice for Cavanaghs (1988, 1991)

and Easons (1999) subjects and the third for Woodtlis

(1987), Bartons (1991) and Kunaviktikul et al.s (2000) and

the fourth for Hendel et al.s (2005).

There are specific aspects of nursing in Oman that might

explain the differences compared to Western countries. The

Omanification process, whereby Omani nationals are encour-

aged to take nurse management roles, may be relevant. Most

of the nurse managers are Omani, but most of the medical

staff (72%) are expatriates. Thus, the traditional professional

power of medical over nursing staff may be moderated by a

national power of Omanis over expatriates.

Kozan (1989) found that employees were more accommo-

dating to ward supervisors, more avoiding towards peers and

more forcing towards subordinates. Omani culture maintains

a relatively wide distance in power between various levels

and this could explain why they (and Jordanians) are more

inclined to use dominating (presumably to more junior staff)

than other nationalities. Most of the nurse managers in

Oman are relatively junior (68% are in first-level manage-

ment) and thus compromising and obliging are also likely

strategies as these managers will often be dealing with peers

or more senior staff.



Consequences of different conflict management styles

A recent review of conflict communication (Brinkert 2010)

shows conflict in nursing is costly, with burnout, absenteeism

and turnover worse where conflict is not well addressed.

Alternatively, where it is positive, outcomes are seen, for

example nurses working in shifts in Australia showed fewer

physical symptoms where conflict was reduced (Pisarski et al.

2008). In community hospitals in Canada, conflict manage-

ment was associated with nurses perceptions of their units

effectiveness, with constructive conflict management giving

greater effectiveness (Siu et al. 2008). Effective conflict

management is associated with positive outcomes in other

professions. For example, clergy in the New York area of the

USA who used collaborative conflict management styles were

found (using MODE) to suffer less from burnout than other

styles (Beebe 2007). Teams of teachers in Israel showed

(using ROC II) integrative conflict management was associ-

ated with good team performance and dominating with poor

performance (Somech 2008).

Organisational citizenship behaviour is that which is above

the call of duty and not given formal reward, but associated

with efficiency and group performance (Salami 2009). In

Nigeria, using the conflict resolution strategies scale (Howart

& London 1980), employees using confronting, compromis-

ing and smoothing techniques were more likely to produce

organisational citizenship behaviour than forcing and with-

drawing (Salami 2009).

Developing the requisite skills does not only or necessarily

involve specific training on conflict management. Conflict

resolution skills were higher in nursing students taught using

a problem-based learning compared with conventional teach-

ing in Turkey (Seren & Ustun 2008); therefore, innovative

educational methods may be associated with improved skills

in handling conflict. Thus, good conflict management can be

formally taught or indirectly improved by problem-based

learning (for example) and results in better staff relations and

reduced costs.

Recommendations

The results of the present study have implications for

people who work in the hospitals, whether practitioners

or policy makers. Some recommendations based on the

findings can be used to improve nurse managers work

environment:

For the nurse managers to help staff nurses resolve conflicteffectively, they first must learn how to resolve their own

conflicts productively.

The establishment of criteria for selection of nurse man-agers depends not only on years of experience but also on

personality and management skills.

Training programmes in personal and conflict manage-ment are needed for nurse managers in Oman. These

programmes should be prerequisites for work as a nurse

manager.

Prior training focused on cultural factors must be given tonon-national nurse managers before they arrive in Oman.

Clear policies and job descriptions for all health workersin hospitals and for nurse managers particularly need to

be developed and implemented to reduce conflict situa-

tions in the work place.

Summary

In Oman, nurse managers report an integrative management

style to be the most favoured. This is unlike all other studies

in Western countries where integrative is never the highest

scoring, even in senior management. It may be that the

specific cultural conditions of Oman are more conducive to

integrative management. While there are differences between

the various demographic groups (gender, nationality, senior-

ity and education), what is more striking is the similarity of

them. Males and females, managers of all four main

nationalities and at each management level all reported

integrative management style as the most preferred.

Limitations

Self-reports

The quantitative method used in this study rely on self-

reports, the objectivity of which can be affected by the

attitudes of the respondents. Their responses may simply

reflect their own self-image and their views of others, as

individuals and according to their hierarchical positions. Such

factors may distort the accuracy of their self-reporting

regarding their own behaviour and that of others.

Control of variables

When assessing conflict management styles, complete control

of all factors which could affect such styles is not possible.

The characteristics of the organisational structure, for one,

were not examined, nor were relationships with colleagues

at the same and different hierarchical levels, the features of

the various levels of authority, the models of care delivery

and the opportunities for continuous professional develop-

ment.

Z Al-Hamdan et al.


Relevance to clinical practice

Inappropriate conflict management can adversely affect

patient care. For example, if dominating conflict management

style is employed in (say) operating rooms, then junior staff

may feel unable to inform a surgeon that they are about to

amputate the wrong leg. Conversely, in a cardiac arrest in

intensive care, someone senior needs to take charge and

dominating is entirely correct. More generally, we have seen

poor conflict management affects staff retention and morale,

and this will in turn adversely affect patient care.

Acknowledgements

We thank all nurses who participated in this study and the

ministry of Health in Oman for the facility and cooperation.

We also thank the Applied Science University in Jordan who

partly funded this research.

Contributions

Study design: DA, RS, ZA; data collection and analysis: ZA,

DA, RS and manuscript preparation: DA, ZA, RS.

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