Conflict-Handling Styles Demonstrated by Nursing Students in Response to Microethical Dilemmas

Undergraduate nursing students have reported feeling ill-prepared to handle the conflict that accompanies the routine exposure to microethical dilemmas. Microethical dilemmas, as first defined by Worthley (1997), are routine questionable practices that have the potential to compromise quality patient care, negatively impact workplace culture, and initiate moral distress. Nurse educators employ a variety of strategies to support students' ability to effectively manage conflict; however, little is known about how students authentically respond to ethical dilemmas. The purpose of this pilot study was to describe the frequency of conflict-handling styles demonstrated by undergraduate nursing students who encountered microethical dilemmas embedded within high-fidelity simulation (HFS) scenarios in the academic laboratory.LITERATURE REVIEWThe literature review was conducted to understand what is currently known about conflict handling via empirical studies conducted among nursing students and postlicensure nurses. The Cumulative Index for Nursing and Allied Health, PubMed, Wiley Online Library, Communication Source, and Google Scholar were searched using the following keywords: conflict, handling, management, styles, strategies, nursing, student, healthcare, prevalence, and research.Thomas and Kilmann, classical researchers and conflict management experts, define conflict as a process involving both subjective and objective differences between individuals who perceive incompatibilities between goals (Folger, Polle, & Stutman, 2013; Jones & Brinkert, 2008; Thomas & Kilmann, 1978). For example, conflict arises during microethical nursing practice dilemmas when a student must decide between two choices: speak up and advocate or remain silent and permit substandard care. Although nursing students are educated about professional advocacy responsibilities, they may experience difficulty in speaking up during conflict due to the higher value placed on preserving the student-staff nurse relationship (Krautscheid & Brown, 2014).Gilligan (1982) theorizes that relationships, not responsibilities, are a core variable influencing decision-making. Gilligan's theory accentuates that how a moral agent should respond is based on the contextual details of a situation, emphasizing extra consideration for those individuals who are particularly vulnerable to the actions of another. How nursing students respond during microethical conflicts reveals a convergence among hierarchical relationships, ethical decision-making, and conflict communication styles.According to Thomas and Kilmann (1978), five conflict-handling styles exist: competing, collaborating, compromising, avoiding, and accommodating. (Operational definitions are presented in Table 1.) Noteworthy here is the understanding that each style may be appropriately used, depending on the situational context of conflict. With specific attention on advocacy for quality patient care while also sustaining a civil workplace culture, desirable conflict-handling styles are collaborating and compromising. Ineffective conflict-handling styles, on the other hand, include avoiding, competing, and accommodating.Al-Hamdan, Norrie, and Anthony (2014) and Valentine (2001) utilized the Thomas-Kilmann Conflict Mode Instrument to measure selfreported conflict-handling styles among postlicensure nurses. Two studies that evaluated conflict-handling styles among nursing students also utilized the Thomas-Kilmann Conflict Mode Instrument. Pines et al. (2014) and Sportman and Hamilton (2007) revealed compromising, accommodating, and avoiding as the most frequent styles. Each of these studies derived results based on participant recall and self-report rather than observational methods. No research could be found documenting observed conflict-handling styles demonstrated by undergraduate nursing students.METHODA descriptive, cross-sectional, post hoc analysis was used to quantify the frequency of conflict-handling styles demonstrated by senior-level students in a baccalaureate (BSN) program at a private, faith-based institution in the Pacific Northwest region of the United States. …