Evaluation of the Relationship between the Levels of Patience and Tranquillity and Conflict Resolution Styles of Executive Nurses

Aims . Tis study examined nurse managers’ confict resolution styles, tranquillity and patience levels, and their relationships. Background. Managers are supposed to know how to manage confict to reduce the destructive efects of confict and create constructive efects. Methods . Te study was a descriptive cross-sectional study and in a city centre in Karadeniz region, in May 2022. It was aimed to reach all executive nurses but was completed with 41 executive nurses. Te data were collected face to face using a Sociodemographic Questionnaire, the Rahim Organizational Confict Inventory, the Patience Scale


Introduction
Confict is a disagreement or incompatibility between two or more people or groups, a clash of interest, power, and status [1] and occurs when conficting activities happen [2].Confict is a contestation of interests, power, and status between two or more individuals or groups and occurs when conficting activities occur.Te diferences in values, ideas, and attitudes, communication and coordination disorders, uncertainties about the management feld, and sometimes the poor functioning of the management process can be considered the root causes of confict in hospitals [1,3,4].Confict is not always positive or negative; it can signify danger or a harbinger of new opportunities.Whether confict outcomes are positive or negative is related to how it is managed [1].Constructively worked confict is said to bring about healthy competition, strengthen team participation, and bridge the communication gap [5].Terefore, confict management is one of the skills managers require [6].
Confict resolution is the method used to resolve conficts in social situations [7].Diferent strategies such as integration, obliging, dominating, compromising, and avoiding are used in confict management.Te "integration" strategy adds up to a high interest for self and others, plus involves preciseness, information exchange, and questioning.As for the strategy of "compromising," the individual neglects his self-interest to satisfy the other party's anxiety, resulting in the situation's characterisation as obedience and compliance with the requests of the opposite party.In addition, it is used when the protection of relations with the other party is more important than the satisfaction of needs.Contrary to the strategy of "integration," "domination" adds up to a high interest for oneself and a low interest for others.Te dominant person will do anything to win, resulting in their ignorance of the other party's needs and expectations.Confict is viable unless it is between the superior and the subordinate, but it can lead to a stalemate when both sides are on equal footing.Te "avoiding" strategy involves low interest, both for oneself and others.In other words, an avoidant cannot satisfy both his anxiety and others.Instead of resolving the confict, postponement can be used to gain time for one of the parties.Te "obliging" strategy involves both parties giving up on something to reconcile mutually.Terefore, it is unsuitable for dealing with complex problems requiring a problem-solving approach.However, it is useful when building a consensus is impossible and both parties need a temporary solution to a complex issue [1,8,9].
Nurse managers experience confict daily and are central to confict management [10].A study revealed that 61.4% of the nurses in charge of the service had conficts with the nurses they worked with, most of which were caused by organisational reasons (61.5%) [11].Te leading causes of confict between physicians and nurses are ambiguity in job descriptions, communication problems, rude and destructive behaviours of physicians, perception of the profession [12], and diferences in doctors' demand for power and nurses' demand for infuence [13].In addition, other studies have found moderate to high levels of stress [14][15][16], job burnout [17], low job satisfaction [15,[18][19][20][21], and occupational fatigue [22] in nurses.Factors afecting stress and job satisfaction, such as high workload, shift work and overtime, staf shortage, job uncertainty, workplace violence, and managers' attitude [15,16,[22][23][24] can also be considered as factors that cause confict.
Te reasons for the confict among the executive nurses were afected by variables such as the hospital, age, and professional experience.In addition, the job description and workload caused the confict [25].Regarding confict management, it was determined that the service managers used the integration strategy the most and avoidance the least [11].Accordingly, nursing students mostly used the strategy of obliging and least domination [26]; in addition, the confict strategies of university students did not difer according to gender [27].Diferent strategies were used to resolve the confict between doctors and nurses; the most used strategies were integration, compromising, and avoidance, whereas the least used one was dominating [12].While determining the appropriate strategy in a confict, considering its contribution to organisational efectiveness, satisfying social needs, and meeting members' ethical and moral needs are crucial.However, excessive integration and obliging strategies help solve strategic problems [1].
Patience, which is among the characteristics expected in managers [28,29], is defned as a person's tendency to stand calmly in the face of disappointment, distress, or sufering [30].Te concept of patience gives the manager purpose, tolerance, openness to change, and empathy.It is expected by employees to be more compassionate, open-minded, and willing to manage any situation [29].Patience has long been recognised as a human strength and a critical component of moral excellence [31].Its structure saves the individual from negative emotions and increases life satisfaction [32].Te demonstration of true patience depends on both behavioural and emotional components [30].Patience is positively related to subjective well-being, positive coping, and success [31].It also includes powerful virtues, such as balance and justice.Patients have less negative afect, lower depression, fewer health problems, and increased life satisfaction [32].Nurses' patience levels were above the average [33], and it was determined to be a component that afects nurses' resilience in Iran [34].
On the other hand, tranquillity refects feelings such as comfort, calmness, and serenity, expressed by the characteristics of [35] individuals, such as harmony, balance, comfort, confdence, and inner peace [36].When there is no threat in daily life, feelings of satisfaction, tranquillity, and well-being emerge, and people generally express their expectations from life in two diferent ways: tranquillity and happiness [35].Although studies on patience and tranquillity in the healthcare feld are limited, tranquillity and employee performance are positively associated [37].In this respect, it is thought to be a pioneering study.
Conficts can frequently emerge due to the complex structure of health services, which are also areas where different disciplines work together.Tey can happen between health personnel, resulting in medical errors with severe consequences if they are not resolved [38,39].Since all conficts in health institutions will afect cooperation and the delivery of quality health services, managing the confict with a positive outcome is crucial.Terefore, it is necessary to determine the use of confict resolution strategies by executive nurses.In addition, nurses work in extraordinary situations such as pandemics.Also, these processes cause nurses to experience depression, stress, and anxiety [40].Tese negative emotions can afect the level of patience and peace of mind of nurses.Patience and peace levels of nurse managers will be refected on the working environment and nurses and will afect the quality of service.Te level of patience and peace afected may also infuence the choice of confict resolution strategy.Terefore, this study aims to determine executive nurses' confict resolution strategies, tranquillity, and patience levels and examine their relationship.
Research Questions.
(1) Which confict resolution strategies is the most used by nurse managers in confict resolution?(2) Which levels of tranquillity and patience the nurse managers need?(3) Is there a relationship among confict resolution strategies, tranquillity, and patience levels?
Te hypotheses of this study are formulated as follows.
Hypothesis 1. Tere is a relationship between the patience levels of nurse managers and their confict resolution styles.A high score from any subdimension indicates that that specifc confict management strategy is used more than others.In contrast, a low score from any subdimension shows that that particular strategy is used less than diferent strategies [8,41].Cronbach's α of the scale subscales was calculated as 0.81 [41].In this study, Cronbach's α values of the scale were found in the range of 0.66-0.89.

Patience Scale. Te Patience Scale was developed by
Schnitker, and its validation study in Turkish was conducted by Dogan and Gulmez.Tere are three subdimensions on the scale, namely, interpersonal patience: 1, 4, 7 (r), 9, 11; long-term patience (patience in life hardships) 2, 5, 8; and short-term patience (patience in daily life) 3, 6, 10 (r).It was designed in a 5-point Likert type with 11 items and covered the options between "strongly agree" and "strongly disagree."Also, it contains nine positive and two opposing statements.Items 7 and 10 are reverse scored.Te highest score on the scale is 55, and the lowest is 11 points.Te highest and lowest score ranges that can be obtained from the subdimensions of the scale are interpersonal patience "5-25," long-term patience "3-15," and short-term patience "3-15."A high score obtained from the scale indicates that the patience levels of the individuals are high, whereas a lower score shows a lower level of patience [30,42].Cronbach's α of the scale was found to be 0.78 [42].Te Cronbach's α value was found to be 0.68 in the study.1.
When we group the themes as per the literature, 8 (44.4%) of the conficts are happening due to individual reasons (lack of love and respect, not taking responsibility, lack of empathy, and personal problems), 10 (55.6%) of them due to organisational reasons (working conditions and health policies).
Observations revealed that executive nurses always used the integration strategy, mostly the obliging and compromising strategies and, occasionally, the avoidance and domination strategies.Te average score of the Patience Scale is considered moderate with a value of 39.15 ± 6.09, and its subdimension scores were determined as 9.88 ± 2.42 for short-term patience, 18.02 ± 2.98 for interpersonal patience, and 11.24 ± 2.35 for long-term patience, respectively.Participants' level of tranquillity is considered moderate, with a score of 3.70 ± 0.70.In addition, their average scores from the scales are shown in Table 1.
Accordingly, executive nurses' long-term, short-term, and total patience levels were signifcantly lower in case of confict with the nurses (p � 0.002, p � 0.007, and p � 0.001).Teir interpersonal patience levels were also substantially lower in case of confict with other employees (p � 0.037).Tere was no signifcant diference in the Patience Scale according to gender, marital status, educational status, and being patient and peaceful.No signifcant difference was found in the Tranquillity Scale by the independent variables.(Table 2).
According to the analysis in Table 3, there was a signifcant diference in terms of using the strategies of integration and obliging as confict resolution methods as to the educational status of the executive nurses (p � 0.040, p � 0.049).While this diference was observed between postgraduates and high school and undergraduates regarding the integration strategy, it was only seen between postgraduates and undergraduates in the obliging strategy.Te table also reveals that postgraduates use the integration and obliging strategies less often.Tere was no signifcant diference between confict resolution strategies by gender, marital status, confict with nurses and other employees, and state of being patient and peaceful variables.(Table 3).
Te corelation analaysis revealed that a weak negative correlation was determined between the variable of working time in the institution and both compromising (r = −0.34)and obliging (r = −0.37).Tere was a weak negative (r = −0.37)correlation between the working time as Journal of Nursing Management 6 Journal of Nursing Management a manager variable and the obliging strategy.A weak positive (r = 0.35) correlation was determined between short-term patience and the level of tranquillity.Ten again, a moderate positive correlation was found between the strategies of integration and compromising (r � 0.66), a strong correlation with obliging (r � 0.77), and a weak positive correlation with the level of tranquillity (r � 0.31).Te correlation analysis is shown in Table 4.

Discussion
Tis study, which investigated the strategies of nurses working in managerial positions in two diferent hospitals in confict management and their levels of patience and tranquillity, revealed that 51.2% of the participants had confict with their colleagues and 46.3% with other employees.In similar studies, 61.4% of the nurses in charge of the service stated that they had conficts with the other nurses [11], and confict was experienced by all critical care nurses, with 42.5% of the studied nurses having had moderate confict [44].Tis can be explained by the fact that diferent professional members work together in the health sector, working conditions are complex, and the workload is high.As per the study, the participants mostly used the "integration" strategy in confict management, the second most "obliging," and the least "dominating."Similar to this study, in other relevant studies, it was stated that the strategies of integration and compromising [11,12,25,[45][46][47][48] were used the most, and the domination [12,25] strategy was used the least.In addition, some studies indicate the least used strategy was avoidance [11,45,46].Te fact that the nursing students mainly used the compromising strategy and least the domination strategy shows similarity with our results [26].According to the literature, strategic solutions can be solved by integrating and obliging [1].Consistent with this information, executive nurses use the strategies desired in confict resolution more.Although administrative nurses and nursing students use the compromising strategy more often in confict resolution, the data show that confict continues at high rates in hospitals.Terefore, it is crucial to attempt to solve the individual and organisational factors that are considered to be the cause of this situation.In a study, it was shown that by using telenursing application, it can improve the delivery of health services by increasing access to specialised services where mutual communication and interaction are well established [49].Similarly, tele-nursing application can be tried in confict resolution.
According to our study, postgraduate executive nurses used "integration" and "obliging" strategies less than high school and undergraduate nurses.While it was similar in one study that undergraduates used the compromising strategy less than other strategies [46], the educational status variable did not make a signifcant diference in confict resolution strategies in other studies [11,45,47].Tis difference may be due to the diferent grouping of the educational status variable.Te fact that postgraduates are positioned in senior management is not unexpected.On the other hand, executives are more likely to resolve strategic conficts involving diferences in planning and objectives, and the literature suggests using the strategies of integration and obliging in strategic confict resolution.Integration and compromise styles allow all employees to adopt the organisation's goals and objectives.So, the reason for the decrease in integration and generous strategies, which were widely used by students and postgraduates, should be investigated in other studies.
As the duration of work in the profession and the hospital increases, the usage of the strategies of compromising and obliging decreases.Similarly, one study found that the compromising strategy decreased as the experience and seniority increased, which supports our study results [46].Tis study has also revealed that the compromising strategy decreased as the working time as a manager increased.According to another study, while the generous strategy was used more in those who worked as a manager for 20 years or more, avoidance was used more in those who worked for 6-10 years [45].Working as a long-term manager can increase organisational commitment and the use of a compromising strategy.Te diference in this study may be that nurses have less managerial experience.Besides, there are studies in which these variables do not make a diference [47].
In this study, the age average was 37, and no signifcant relationship was found between age and confict resolution strategies.Tere are other supporting studies with the same results [47].However, as a result of this study, the compromising strategy was used signifcantly more by employees over 45 [45].Te majority of the young population in this study, which showed a positive correlation between age and experience, may explain the diference from the other research.
In the study, similar to the literature, the gender [27] and marital status [45] variables did not make a signifcant diference in confict management strategies.Unlike this study, there are studies where males prefer to use the generous [46] or avoidance [47] strategies more, while females prefer to use the integration strategy more [47].
92.7% of the participants think that they are patient.When we look at the scale scores, their patience levels are above average in total and subdimensions, similar to a study [33].Also, it was observed that although executive nurses' long-term, short-term, and total patience levels decreased during a confict with the nurses, their interpersonal patience levels did not change.Tese results suggest that executive nurses maintain communication with nurses by looking at events situationally to ensure the continuity of their work.Teir interpersonal patience levels decrease during a confict with other employees.Tis may suggest that they individualise the events more.Te literature shows a positive relationship between patience and decisionmaking skills [50].Terefore, the decrease in the interpersonal patience levels of executive nurses may afect their problem-solving skills and create new clash environments.In this case, it may lead to communication loss with other employees.Te study found no relationship between patience level and confict resolution.In this case, hypothesis 1 is rejected.

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Journal of Nursing Management 70.7% of the participants in the study stated that they were peaceful, and their tranquillity levels were found to be moderate according to the scale.Also, there was a positive correlation between their tranquillity and short-term patience levels.Tis fnding supports hypothesis 3.During a confict with nurses whose short-term patience levels are low, there is expected to be a decrease in the tranquillity levels of executive nurses.Te fact that their tranquillity level could have been higher in this study may be the fact that they always use the integration strategy.Considering this study, a positive correlation was found between the integration strategy and the level of tranquillity.Tis relationship supports hypothesis 2.

Limitations and Strengths.
Including only public institutions in the study and the small number of managers may be a limitation.However, it is a strength that the issues of patience and peace of mind are addressed together.What makes this work powerful is that no studies have been found in the healthcare feld in which confict management strategies are being studied together with tranquillity and patience.In addition, the fact that studies on patience and tranquillity in nurses are limited in general makes this study vital.

Conclusion and Recommendations
Accordingly, the participants used all confict management strategies, mostly "integration" and frequently "obliging" and "compromising."Also, their educational status was infuential in their confict management strategy preferences.In addition, the patience and tranquillity levels of the participants were moderate.While their long-and shortterm patience levels decrease in case of a confict with nurses, their interpersonal patience levels decrease in a confict with other employees in the hospital.Tis study has also revealed that the level of tranquillity increases as the integration strategy is used in confict resolution.On the other hand, no relationship was found between patience and confict management strategies.Tis fnding indicates that executive nurses maintain professionalism and exhibit the same attitude in the face of events.
Due to its nature, health services have a complex structure, and it is an area where diferent disciplines work together, so conficts are inevitable.Tey need to be managed in a way that will result in a positive outcome as it will afect cooperation and quality of health service delivery.For tranquillity, activities such as in-service training are recommended to increase the use of "integration" by all managers.It is crucial to draw attention to this issue, especially in the postgraduate education process.A unit can be established within the organisation for staf only, where nurses can receive support when they feel that their level of patience and peace of mind has decreased.It is recommended that similar issues be studied with nurses and other health professionals in future studies.In addition, qualitative research methods can be used to examine the issues in depth.
(1)lusion criteria were as follows: Working as an executive nurse Volunteering to participate in the study 2.2.Sampling Strategy.Te questionnaires were distributed to the executive nurse and collected after they were flled out.2.3.Data Collection Tools.Te data were collected face to face using the Sociodemographic Questionnaire, the Rahim Organizational Confict Inventory Scale, the Patience Scale, and the Tranquillity Scale.2.3.1.SociodemographicQuestionnaire.Te questionnaire developed by the researcher consists of 11 questions, including age, gender, marital status, educational status, working time in the profession, working time in the current institution, working time as a manager, condition of a confict with nurses, condition of a confict with other employees, and state of fnding oneself patient and peaceful.2.3.2.Rahim Organizational Confict Inventory (ROCI-II).Tis scale was developed by Rahim in 1983 to identify fve diferent confict management strategies.It was adapted into Turkish by Gumuseli and Taymaz and consisted of three forms.FormA includes confict management strategies used by subordinates in conficts with superiors.Unlike form A, form B holds strategies superiors use in conficts with subordinates.Form C consists of strategies organisation members use in conficts with their peers.In this study, form B, also called ROCI II, was used.Te scale, which was designed in a 5-point Likert type, consists of 28 items and has options such as always(5), often (4), sometimes (3), rarely(2), and very rarely(1).It reveals individuals' use of fve confict management strategies to what extent.Also, it has the following fve subdimensions: integration, compromising, dominating, avoiding, and obliging.Items "1, 5, 12, 22, 23, and 28" are related to the "integration" strategy, items "2, 11, 13, 19, and 24" to "compromising," "8, 9, 18, 21, and 25" to "dominating," "

Table 2 :
Te analysis of the Patience Scale and the Tranquillity Scale with certain variables.

Table 3 :
Te analysis of confict resolution strategies with certain variables.

Table 4 :
Te correlation between independent variables, the Patience Scale, the Tranquillity Scale, and the Rahim Organisational Confict Inventory Scale.