ICU Care Improved with Conflict Management Education

Bobbie Ann A. White, EdD, MA

Stressful by nature, the intensive care unit (ICU) inevitably faces conflicts due to immediate and cohesive action from physicians, nurses, respiratory therapists, and advanced practitioners.

In an effort to help improve the ICU’s taxing environment, a team of investigators has created a conflict management education intervention, which was released at the 2018 CHEST Annual Meeting in San Antonio, TX. Specifically, the team focused on 4 main objectives that included “diagnosing” the conflict type and cause, recognizing internal dialogue, introducing conflict management modes used in conflict situations, and developing self and other awareness.

“The conflict management educational intervention improved the participants’ knowledge and had an effect on perceptions,” lead investigator, Bobbie Ann A. White, EdD, MA, shared in a comment. “Qualitative data suggest ICU participants were interested in concrete information that will help with conflict resolution, and some participants understood that mindfulness and awareness would improve professional interactions or reduce conflict.”

In order to evaluate pre and post-knowledge perceptions of conflict, descriptive statistics on the participants’ chosen conflict management modes, and qualitative analysis assessing 3 open-ended questions on the post-test, and quantitative analyses evaluating 3 open-ended questions on the post-test, quantitative analyses were used.

From 56 participants, these 3 data points were collected, which resulted in varying samples sizes for each analysis. Forty-five participants were included in the pre-posttest analysis, and 49 participants were included in the Thomas-Kilmann descriptive statistics.

Knowledge post-tests had a higher average of 6.42 (sd=1.232) in the pre-posttest experimental group (n=31) compared to 3.61 (sd=1.407). This metric represented an increase following the conflict management intervention (t(30= -3/145, p=.0040).

Avoiding conflict management mode was the first choice of action by the most participants (31.6%), which was followed by compromising (29.8%), accommodating (24.6%), collaborating (8.8%), and competing (5.3%).

The Thomas-Kilmann conflict management modes and better awareness of others were reported by participants to be aspects of the intervention that would stay with them. “Being more mindful of different perspectives was the session’s main takeaway as reported by 1 participant.

Additionally, the degree of enrichment in the perception and perspective dialogues during the sessions were reported to strongly correlate with the diversity of the group; the more diverse the group, the more enriching the interactions.

From the data, study authors concluded that participants’ knowledge was improved with the conflict management educational intervention, which was also observed to have an effect on participants’ perceptions. The qualitative data also suggests participants’ interest in concrete information that can assist with conflict resolution in the ICU. A portion of participants also recognized that mindfulness and awareness would minimize conflict and improve professional interactions.

Several clinical implications were also made with the study. Primarily, rehashing the importance of conflict management should not be included in the educational contact time. Instead, medical professionals should focus on team perceptions and practice resolution skills.

The most common conflict management modes, which included avoiding and compromising, were 1 specific clinical implication found. Investigators noted that best outcomes in conflict are yielded by neither of these modes.

Coaching ICU staff on how to compete in a healthy way as the competing mode may also be advisable since the competing mode was the least preferred by participants. Given that competing mode can be necessary for certain situations, such as fighting for a specific treatment for an acutely ill patient, encouraging it in a healthy expression may be beneficial.

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