Introduction

Conflict is inevitable in any work environment due to inherent differences in goals, needs, desires, responsibilities, perceptions, and ideas. According to Danna & Griffin (1999), persistent conflict at work is detrimental to the work climate and negatively affects individual’s physical and psychological well-being, resulting in increased turnover and absenteeism, reduced co-ordination and collaboration, and lower efficiency. However, the most common triggers of situations of conflict are: communication problems, organizational structure, role disputes, lack of resources, misunderstandings, and lack of professional commitment among others (Santiago et al. 2009).

Conflict is commonly perceived as being a negative issue. However, the experience of dealing with conflict can lead to positive outcomes for nurses, their colleagues and patients. Conflict that is managed effectively by nurses can lead to personal and organizational growth. Therefore, well-managed conflict resolution, which may include the use of strategies such as clinical supervision and individual reflection, can be used to stimulate creativity and innovation in the team, in the medium to long term, which can positively impact on patient care (Hocking, 2006). Team members who are able to learn to resolve their differences and turn conflict into such a learning experience are helping to build a learning culture in their workplace. Success, in turn, further strengthens relationships and individuality (Tjosvold, 1997).

Stages of conflict

Conflict occurs across a temporal sequence of stages or phases. Pondy (1967) described five stages of conflict which are:
• Latent conflict – where conditions for conflict are present, but not recognized;
• Perceived conflict – where people become aware of a conflict;
• Felt conflict – where conflict becomes personalized and the people may feel anxious or even hostile; tension built, but the conflict still not in the open;
• Manifest conflict – where the conflict is enacted through behaviours, the existence of the conflict becomes obvious to other people not involves;
• Conflict after-math – where conflict is stopped by some method and new methods are established.

Awareness leads to a variety of thoughts and emotions about the episode and the development of potential responses. These responses, which are related to trying to cope with the conflict situation, result in some type of observable behaviour. There is a reaction from the other person that results in an interaction that may be prolonged because each person’s behaviour stimulates the other’s responses. As the interaction progresses, thoughts and feelings about the conflict issue may change, which affects the behaviour accordingly. When the interaction stops, outcomes are produced. The outcomes have consequences for both people, such as mutual agreement, mutual avoidance, and control by one person or no resolution.

Types of conflict

There are several types of conflict. For instance, the concept of relationship, affective, and emotional conflict are difficult to distinguish, as are the concepts of task, debate, substantive, and cognitive conflict. Relationship conflict exists when there are interpersonal incompatibilities, including personality clashes, tension, animosity, and annoyance. This type of conflict is usually very counterproductive, taking the focus away from the issues that need to be resolved and replacing it with personal antagonism. Another type is Task conflict, where awareness of differences in viewpoints and opinions pertaining to a team task, includes ideas and differences of opinion about the chore. Task conflict can lead to dissatisfaction, but it can also have positive effects on productivity and team performance (Baron, 1990). Process conflict is another type of conflict, which occurs when determining how task accomplishment should proceed, who is responsible for what, and how things should be delegated. Process conflict focuses on how tasks would be accomplished. For example, when nurses disagree about whose responsibility it is to complete a specific duty, they are experiencing process conflict.

Why manage conflict?

When a team or individuals within a team are in conflict, the care of patients will be jeopardised. Conflict breeds poor communication and poor communication breeds poor care. The reason for managing conflict is that conflict affects morale. When the morale in a team is low, staff leaves and new staff does not join. This creates recruitment and negative impact on patient care.

In addition, conflicts need to be managed because conflict is just not nice. Well-managed conflict can increase the understanding of those involved of each other and of themselves. This improves the ability of those involved in conflict resolution to better manage their interpersonal relationships in the future. Groups that resolve conflict together generate an increased cohesiveness and better understanding of each other and work more productively. However, well-managed conflict resolution, which may include the use of strategies such as clinical supervision and individual reflection, can be used to stimulate creativity and innovation in the team (Hocking, 2006).

Team member preparation

Teams are powerful force in organization. They are assembled to tackle complex and strategic issues within a company. Often the membership is a select group of people from different departments, each with special skills or talent to solve a particular problem. In order for a team to be successful, it is essential for members to know the basics of conflict resolution, delegation, and consensus building. Without these skills, each team must rely on whatever they have learned on their own, or the facilitator’s skills in moving the team through these struggles. This is not an ideal way to manage teams, and reduces the synergistic benefits of team-based activities.

Preventative strategies

The first step in conflict management is learning how to prevent or minimize it. A team leader has several ways to do that. Ground rules can be useful because as conflict arises, the leader can refer the team back to them for guidance. These tend to be good objective guidelines that remove the leader from the role of enforcer.

Ellis and Abbott (2011) listed the seven Cs of ground rules, which include:

• Commanding: try to avoid being commanding. Such as; telling people how to behave they will make them resist
• Comparing: do not compare persons or situations to something that has happened before that did not involve them or to the behaviours of someone else
• Condemning: do not condemn an individual or their emotions. The purpose of conflict resolution is to solve the problem, not the person
• Challenging: do not lay down a challenge, because if people will rebel and test your resolve, to do whatever it is you threatened to do
• Condescending: avoid being condescending and explaining how you understand someone’s motivations better that they do, even if you believe you do. However, being condescending creates more bad feeling and will not help resolve the issue
• Contradicting: try not to contradict the people involved. Contradiction often takes the form of interruption and may demonstrate lack of respect
• Confusing: do not confuse the resolution of an episode of conflict by bringing up old conflicts or new problems because the process is not going how you want it to.

After establishing the rules by which conflict resolution will proceed,
Thomas and Kilmann (1974) identified five approaches to conflict resolution that may prove useful which are:

• Collaboration – creates an environment in which a win-win solution is possible if both sides are willing to be creative. It is useful in creating partnership where enmity previously existed. The problem with collaboration as a conflict resolution method is, that is time-consuming and either party could decide not to keep their agreement.
• Compromising- means that both sides in a dispute have to give some ground. This approach is useful where the individuals involved are equally committed to their points of view or where they are of similar status. Compromise can speed up resolution of a dispute. However, the problem is that if one side is right, then compromise is wrong.
• Accommodating – giving in to one view of a conflict is useful when one side realizes the issue is more important to the other side, or that they are wrong. It helps maintain a relationship which may prove to be more important than the cause of the disagreement. The problem with accommodating is that it can be misconstrued as weakness.
• Competing – when the point of conflict is correct it is important not to give in easily. Competing can heighten conflict and may not be a good idea when the conflict may become physical in nature.
• Dodging – is the best short-term strategy when the conflict is not important, or too busy to deal with an issue. Therefore, you need to cool off or there is no chance of winning. Dodging can make matters worse in the long run and may allow a transgressor to win.

As members of the health care team, nurses must be able to work in corporation with colleagues to deliver safe, effective and ethical patient care. Unresolved conflict among colleagues may hinder communication, collaboration and teamwork, which negatively affects patient care. In addition, nurses are less likely to be abused by patients if they do not tolerate abuse among colleagues.

Nurses can employ consistent strategies to help prevent conflict among colleagues from escalating, which can:

a) promote a respectful work environment by modelling professional behaviour;
b) mentor, support and integrate new staff members into the practice setting;
c) reflect on personal attitudes, motivators, values and beliefs that affect relationships with colleagues, identify personal areas need of improvement and strive to alter own behaviour in situations that have previously ended in conflict; and
d) recognize that personal stress may affect professional relationship and take steps to manage that stress

Macaulay and Cook (2011) listed the seven steps of how to handle conflict:

1) Understand how you typically respond to conflict. Practise being flexible and putting yourself on the other person’s shoes.
2) Listen carefully to words and feelings.
3) Reflect back what has been said to build greater respect and shared understanding.
4) Be clear on your case but don’t become so fixated by point of view that you get tunnel vision on other perspectives.
5) Be prepared to negotiate where necessary to reach an agreement which is acceptable to both parties in the long term as well as immediately.
6) Review the implications of major decisions on the other people and your own behaviour. Ask for feedback on how you handle conflict and set yourself some improvement goals.
7) Communicate regularly and build relationships, even or especially when damage has been caused

A more thorough understanding of the sources of conflict within nursing work environments would enable a shift from conflict management to conflict prevention. To change a work environment, managers and nurses need a common understanding of what conflict is constituted of. Its consequences, in terms of the impact on individual nurses and the team, should be acknowledged. Primary prevention begins with education of staff in all areas of nursing, including the clinical workplace, curriculum development of undergraduate programmes and development of orientation schemes supporting new graduates in the first year of practice (McKenna et al. 2003).

Conclusion

Overall, it is clear that conflict is a natural part of group work. It can be a tremendous source of creativity, and at the same time it can sidetrack a team. What makes the difference is, having group members and a group leader that understands and manage conflict effectively.

Nurses must learn how to eliminate its destructive effects, while enhancing the constructive results. Reducing the amount of conflict in everyday work environment depends on the understanding of the sources and effects of conflict among nurses. Therefore, priority must be given to preventing conflict before it affects the well-being of nurses, and ultimately the care of patients.