introdution

IntroductionIntensive care units (ICUs) have multidisciplinary and interprofessional specialty dedicated to the comprehensive and continuous management of patients having acute, life-threatening and organ dysfunction (1). Intensive care unit nursing staff is competent registered nurses poses specialized skills and knowledge to provide comprehensive high quality care for acutely ill patients. They plan, coordinate and implement care with the health care team to meet physical, psychological, and spiritual needs of the patient and family (2). Although, critical care professionals, nurses, physicians and others involved in intensive care form an integrated team to work together in harmony, those team possess different background, values, and goals which make it a good media for conflict to arise (3, 4). Conflict is a disagreement, or difference of opinion related to the management of patients in an ICU, involving more than one person and requiring decision-making or action. It may emerge from variety of sources including interpersonal differences in values, opinions and scarce of resources. Lack of clarity about one’s tasks, lack of guidance by superiors, lack of work justice, lack of respect, unclear decision-making processes, inadequate communication, disparity of power between nurses and physicians, ambiguity in authority and leadership style can be also additional sources of conflict (5, 6). Conflict is undeniable part of everyday work in ICUs; it has positive as well as harmful consequences. Experiencing little amounts of conflict stimulates discussion and develops human capabilities to handle interpersonal differences (7). While, unmanaged conflict will establish confusion in interpersonal relations, widen the chasm of misunderstanding, increase staff burnout, time wasting, turnover and hostility (8). Conflict handling is the practice of recognizing and dealing with disputes in a rational, balanced and effective way to achieve constructive rather than destructive results (9). Waithaka et al. (2015) (10) differentiated between five conflict handling styles by using two dimensions, cooperativeness (the degree to which one party satisfy the others party’s concerns) and assertiveness (the degree to which one party satisfy his or her own concern). The five different conflict handling styles are avoiding, competing, accommodating, collaborating and compromising style. Avoiding style characterized by unassertiveness and uncooperativeness, the individual parties that use this style do not confront one another to try and come up with a resolution to the conflict. Competing style known by assertiveness and uncooperativeness, it’s a desire to satisfy one’s interest, regardless of the impact on the other party. Accommodating style known by unassertiveness and cooperativeness, the willingness of one party to place the opponent’s interest above his or her own. Collaborating style characterized by assertiveness and cooperativeness, each person respect the ideas and value of the other to find solution that satisfies both of them. Compromising style known by moderate level of assertiveness and cooperativeness, and both persons have to give up a significant part of their interests (10). Conflict handling aims to place conflicting parties in situations where they can choose alternative positive decisions to resolve differences and helping nursing staff to develop communication and problem-solving skills (11). Therefore, ICU nursing staff requires effective communication with everyone in order to ensure competent and safe practice (12). Assertiveness skill is one of the communication skills that enables ICU nursing staff to build an effective team relationships and deal with conflict (13). It is the ability to express one’s feelings, opinions, beliefs, and needs directly, openly and honestly, while not violating the personal rights of others (14). Ability to communicate effectively in assertive manner aims to resolve conflict by openly communication, encouraging discussion and promoting harmonious work environment for provisions of quality patient care (15). While, non-assertive ICU nursing staff has difficultly in refusing the requests of others and fear of upsetting others which leads to avoidance and poor relationships of all kinds (16). On the other hand, there are certain factors that influence ICU nursing staff to be assertive including personal factors, administrative factors and human relationship factors. Personal factors include fear of being hated or neglected, administrative factors include s lack of motivation and over workloads while, human relationship factors include avoid conflict (17). Learning how to behave and communicate assertively can be a powerful tool in helping to resolve conflicts and turn a difficult situation into an advantage (18). Therefore, assertiveness educational program is expected to help ICU nurses to handle workplace conflicts.

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