Personality Tiait Profile of Nurse Practitioners By Barbara L. Waples, RN, BSN Submitted in Partial Fulfillment of the Requirements for the Master of Science in Nursing Degree Edinboro University of Pennsylvania Approved by: __ /0f Judith Schilling, CRNP, Ph.D Committee Chairperson Date Cindy Rouse, RN, MSN, CCRN Committee Member Saint Vincent Health Center Date Deborah Hess, RN, MSN Committee Member Saint Vincent Health Center Date oO Abstract Personality Trait Profile of Nurse Practitioners Little is known about personality traits of nurse practitioners (NPs). This inf01 mation would be useful to the individual NP, the profession as a whole, and to foster educational offerings to mentor these traits in future NPs. The purpose of this study was to identify the personality traits of a sample of student nurse practitioners (SNPs) and NPs using the Guilford Zimmerman Temperament Survey (GZTS). The Model of Nursing Knowledge developed by Chinn & Jacobs-Kramer (1988) was used as the conceptual framework for this study. This Model defines the specifics of self and other as they relate in a conversation. The GZTS was self administered by Internet access to the forty-four volunteer participants of 11 SNPs and 34 graduate NPs from a community in northwestern Pennsylvania. A comparison was made between these two groups and between the two groups and the Guilford data bank base population of 619 nursing student applicants (Guilford 1976). Trained staff from Career Assessment Concepts, Inc. of Erie, PA analyzed each individual's results. Grouped data was then forwarded to the researcher. No significant differences were found among the study participant group as compared to the normative base population of nursing student applicants. Of the ten personality traits according to Guilford, the study participants had mean scores higher in the areas of general activity, restraint, assertiveness, and masculinity (Guilford, Zimmerman, & Guilford, 1976). Additional research within a larger nurse practitioner population is recommended. This will up date the data base population to include specific personality trait information for the nurse practitioner. This study was supported in part by a grant from Sigma Thetu Tau, International, Nu Theta Chapter. Table of Contents Contents Page 1. Introduction 1 Background of the Problem- 1 Origin of Personality 3 Definitions of Personality 3 The Big 5 Factor Taxonomy 5 Statement of the Problem 6 Theoretical Framework 7 Research Purpose 9 Research Question 11 Assumptions Limitatioiis 11 Definition of Terms 12 Summary2. Review of Literature Studies of Nurse Practitioners Studies of Other Nurses Studies of Other Professionals Summary iii 3. Methodology 25 Research Design 25 Sample, Setting, and Informed Consent 26 Instrumentation 27 Validity 29 Reliability 31 Operational Definitions Data Analysis- 36 Summary 37 4. Data Analysis Presentation and Analysis of Data- 38 Demographic Data Analysis of Study Participants- 40 Scoring of the GZTS Summary 5. Conclusions- Summary of Findings Discussion of Results Conclusions Recommendations for Additional Research References iv 52 Appendixes 57 A. Mailing to Potential Study Participants- 57 B. Return Post Card 60 C. Study Participant Letter 61 D. Temperament Graph 64 v List of Table Table Page 1. Model of Nursing Knowledge: Summary of Key Points-—10 vi List of Figures Figure — Page 1. Schematic diagram of the identified characteristics of personality according to the Guilford Zimmerman Temperament Survey 33 2. Sex of participants 40 3. Ages of participants 41 4. Educational level of participants- 41 5. Employment status of NP participants- •42 6. Mean temperament summary results of study participants and the GZTS norm group -43 7. Mean temperament summary results of the SNPs 44 and the NPs group vii 1 Chapter 1 Introduction This chapter provides an overview of the value of personality trait (PT) identification and its usefulness for nurse practitioners (NPs). The purpose of this study was to identify the personality traits of a sample of NPs using the Guilford Zimmerman Temperame:mt Survey (GZTS). The Model of Nursing Knowledge served as the theoretical framework for this study (Chinn & Jacobs-Kramer, 1988). The research purpose, research questions, assumptions, limitations, and definition of the terms used in this study are also provided. Background of the Problem Advanced practice nurses are experts at health promotion and disease prevention and have proven themselves to be competent primary care providers in diagnosing and managing illness (Mundinger, 1999). Mundinger added that advanced practice nurses make up approximately 4% of the professional nursing workforce and can provide 80% to 90% of the services that primary care physicians provide. According to Neubauer (1998), one grows into full potential as a person over time. One acquires professional knowledge and skill from work and life experiences. Neubauer saw the development of self as an integration of who one is and what one does. Bradham, Dalme, and Thompson (1990) found that desirable behaviors for all professional nurses include confidence, advocacy, 2 and interdependence. They further explored the notion that certain personality traits would promote these behaviors to a greater degree than others. Feldman & Crook (1984) found that participants iin a graduate health science program had certain personality characteristics that could be influenced or changed by the program. Inner directedness with the internalizing of principles and motivations, an increased flexibility in applying values to their lives, and the accepting of themselves and their weaknesses, were the characteristics changed or influenced by the program. Other characteristics studied were manifestation of personality which included areas of poise, ascendancy, self-assurance, and interpersonal integrity; social norms and values; academic potential; intellectual efficiency; and the attitude and beliefs related to team functioning and interpersonal relationships. The researchers suggested that personal characteristics deemed important by program planners might be more appropriate as criteria for admission lather than as objectives of the program. According to Dr. Stephen Barrett (1999), the president and founder of Career Assessment Center, Inc., the personality of an individual is 80% genetically determined at birth and approximately 20% learned from life experiences. He explained that people come to a career with a set of personality traits in place. Each person needs to identify these personality 3 traits as strengths or weaknesses and adapt socially appropriate responses to these traits. Origin of Personality. According to Allport (1937), there are over 50 different meanings of the term personality. The word personality comes originally from the Latin persona which is associated with the ancient Greek theater (Guilford, 1959). In ancient times, a Greek player commonly held a mask in front of his face. This mask was a "persona" because the player talked through it. Over time, the word "persona" was applied to the actors in the theater. Definitions of Personality. Guilford (1959) explained the multiple meanings of personality. "One's personality is something that enables a person to put himself over" (Guilford, 1959, p. 3). A unique pattern of ten traits, or characteristics of that person, is the key to one's personality. These ten traits are general activity, restraint, ascendance, sociability, emotional stability, objectivity, friendliness, thoughtfulness, personal relations, and masculinity. Guilford (1959) defined a trait as any distinguishable, relatively enduring way in which one individual differs from another. Allport defined trait as the primary unit of the personality (Allport, 1954). His definition of personality has become a classic. Allport defined personality as the dynamic organization within the individual, the psychophysical systems that determine the individual's unique adjustments to 4 the environment. His definition involves five major concepts. These concepts are the dynamic organization, the psychophysical systems, the determination, the uniqueness of the personality, and the adjustments to the environment. Allport developed the Personological Trait Theory (Allport, 1954). He taught the first personality course in the United States and formulated the groundwork for issues that are still debated today (Pervin, 1990). His dynamic organization of personality stresses the need for active organization within the self (Cloninger, 1993). His theme centers on the unity of the self that is influenced from hereditary, temperament, and intelligence. Allport (1954) reviewed personality traits as real and useful predictors that "determine" the unique self. The public self establishes security and comfort between the inner self and the environment. In 1938, one year after Allport's theory was published, H. A. Murray (1938) published his work. Murray emphasized the emotional and motivational processes of the individual. He defined the individual as a whole organism with its parts mutually related. He differentiated needs from traits. Needs have complex relationships with behavior. They are hypothetical concepts expressing the organism's potential readmess to respond in a certain way under certain conditions. Needs are internal processes that may or may not be apparent in one's behavior, whereas traits are observed consistencies or patterns in behavior. Allport and Murray 5 shared important points in their separate theories, while differing in their terminology and explanations of traits versus needs (Pervin 1990). The Big 5 Factor Taxonomy. According to John (1990), Allport and Odbert developed the original personality taxonomy list in 1936 by categorizing all words found in the dictionary that described one's personality. The final list contained 18,000 words, sometimes referred to as the "18,000 trait descriptors" (John, 1990). This list was divided into four categories of attributes. Although this categorization of attributes was helpful, the need for a more refined taxonomy was recognized. By using factor analysis, the list was revised and categorized into 12 primary personality factors (Cloninger, 1993). According to John (1990), in 1961, Tupes and Christal did further analysis and correlation with the factor list and found five strong and recurrent factors. This is the "Big Five" Factor Taxonomy used today. The Big 5 Factor Taxonomy represents a broad level of personality descriptors (John, 1990). In the study of personality, the taxonomy enables the researcher to study specific domains of personality characteristics instead of examining separately the thousands of individual attributes that make human beings individual and unique. 6 The "Big Five" factors are broad and summarize a large number of distinct and specific personality characteristics (John, 1990). The five factors are: 1. Factoi I surgency (talkative, assertive, and energetic), 2. Factor II agreeableness (good-natured, cooperative, and trustful), 3. Factor III dependability (conscientious, responsible, and orderly), 4. Factor IV emotional stability (calm, not neurotic, not easily upset), 5. Factor V culture (intellectual, cultured, polished, and independentminded). Factors I and II primarily summarize traits of an interpersonal nature and tend to account for the largest percentage of variance in personality ratings. Factor III describes task behavior and social impulse control. Factor IV involves the contrast of a calm and relaxed confidence with nervous tension, temper, and the potential for anxiety and sadness. Factor V describes the depth, complexity, and quality of ones mental and physical life. This fivefactor structure has been replicated and adjusted by many researchers, and serves as the basis for many personality profile instruments (John, 1990). Statement of the Problem Little is known about the personality traits of NPs. The identification of this information would be useful to the individual NT and the profession as a whole. It may help to foster educational offerings that mentor these traits in 7 future NPs. It may help the individual NP to identify his or her strengths and weaknesses that can benefit the communication process between the nurse practitioner and the patient. If a specific personality trait profile is identified, a comparison can be made between the student population and the graduate NPs. Theoretical Framework The theoretical framework for this study is the Model of Nursing Knowledge (Chinn & Jacobs-Kramer, 1988). Chinn & Jacobs-Kramer defined four knowledge patterns originally named by Carper (1978) as empirical, ethical, personal, and aesthetic knowledge. Empirical knowledge, for example the science of nursing, is the pattern most closely associated with traditional science. Empirical knowledge is expressed as principles, laws, and theories. Ethical knowledge relates to matters of duty, rights, obligations, and moral imperatives. Ethical knowledge involves judgmental decisions of right or wrong, ethical or unethical decisions, and noble, honorable, or good actions. Personal knowledge is awareness of self and other in a relationship. It involves encountering and actualizing the self. Personal knowledge transforms objective reality and stereotypes, and is not dictated by the symbols of language. The knowledge of self and other can be explored without written words. One comes to know self and other by actually living the experience. The art of nursing is an example of aesthetic knowledge. It is 8 gamed by subjective observation. This knowledge requires the development of what is individual, particular, and unique. Chinn & Jacobs-Kramer (1988) further explained the four knowledge patterns by considering how they are created, expressed, and assessed. Table 1 illustrates these dimensional concepts (Chinn & Jacobs-Kramer, 1988). The personal knowledge pattern and how it relates to NPs is the focus of this research. Chinn & Jacobs-Kramer (1988) expressed this knowledge in terms of the created, expressed, and assessed dimensions. The created dimension involves expressing the self by encountering and focusing on self while realizing the surrounding realities and the environmental potentialities. It captures how knowledge is encountered and focused in a conversation. The expressive dimension encompasses authenticity and disclosure. It captures how knowledge is disclosed. Self can be explained further as the authentic self that is known only privately and the disclosed self as being the public self that is revealed to others. Finally, the assessed dimension requires us to focus on both sides of self and its expression to other. This assessment is an internal process that creates awareness of both the authentic and disclosed self. It provides for examination and reflection of knowledge by asking critical questions about form and context. Assessment involves examining the expressed form of self. Critical questions address the credibility of the congruity of self. Asking to 9 what extent we "know what we do" and "do what we know" creates awareness of both the authentic and the disclosed self. This enables personal development toward inner strength, genuineness, and authenticity that characterizes congruity of self. Reflection and response is the process associated with the self as a pattern of knowing. Patterns of knowing, believing, and perceiving from the inner self are processed and expressed to others for interpretation (Chinn & Jacobs-Kramer, 1988). The communication between the NP and the patient is the basis of knowledge about self and how it relates to others. One discloses oneself to the patient in conversation. One is sharing self in this encounter. This becomes a basis of knowledge about the authenticity of self and other. As the patient and the nurse focus on the patient's situation, heightened awareness of what each person feels or "knows" and how they act or do emerges in this conversation. The ten traits of ones personality is how persons express themselves in conversation. One is aware of their reactions in the exchange. One can examine the communication exchange and identify the specific distinguishable ways in which one individual differs from another. Research Purpose The purpose of this research was to provide a profile of the personality traits of NPs. The identification of the personality traits may benefit 10 Table 1 Model of Nursing Knowledge: Summary of Key Points Knowledge Patterns Empirical Ethical Personal Aesthetic Describing Valuing Encountering Engaging Explaining Clarifying Focusing Interpreting Predicting Advocating Realizing Envisioning Facts Codes Self: authenticity & disclosure Art-act Theories Standards Models Normativeethical theories Descriptions to impact understanding Descriptions of ethical decision making What does this represent? Is this right? Do I know what Ido? What does this mean? How is it representative? Is this just? Do I do what I know? Process/ Context Replication Dialogue Response & reflection Criticism Credibility Index Validity Justness Congruity Consensual meaning Created Dimension Expressed Dimension Assessed Dimension Critical Question Note. P- 293' 11 individual NPs in their communication exchange with patients. This identification may also help the NP population foster educational offerings that mentor such traits in future NPs. Research Question The following research questions were posed for the purpose of this study: 1. Are there similarities in the personality trait profiles of graduate NPs in this research study? 2. Are there similarities or differences in the personality trait profiles of student NPs, graduate NPs, or the GZTS data bank profile of nursing student applicants? Assumptions For the purpose of this study, the following assumptions were made: 1. The Guilford Zimmerman Temperament Survey was filled out independently by the research subjects without influence from others. 2. The research subjects were able to read and understand directions for completing the research tool. 3. The research subjects answered the questions honestly. Limitations For the purpose of this study, the following limitations were identified 12 1 ■ The participant population was limited to a small convenience sample of student nurse practitioners and nurse practitioners in northwestern Pennsylvania. This affected the generalizability of the study. 2. The participant population was generalized to all NPs and did not take into account their specific type of practice setting. 3. Desirable or undesirable life event changes can cause physical and/ or mental health problems and attitude changes that may affect the research subjects responses (Dolan, 1987). 4. Demographic information collected was limited to age, sex, ethnic background, highest grade completed, and status of employment. Definition of Terms The following terms are defined as they were used in this study: 1. Nurse Practitioner is a primary health care provider whose care is continuous and comprehensive, and includes collaboration among, and referral to, other health professionals (American Nurses Association, 1987). 2. Primary Care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing an ongoing partnership with patients, and practicing in the context of family and community (Donaldson, Yordy, Lohr, & Vanselow, 1996). 13 3. Personality Traits are how a person demonstrates the effects of past and present life experiences through the vantage points of "self" and "other" (Handler & Meyer, 1998). 4. Assessment of Personality is a three dimensional view of self. It determines an in depth understanding of strengths and weaknesses people do not readily show in ordinary conversation (Handler & Meyer, 1998). Summary The concept of personality traits dates back to the 1930s (Allport, 1937). The identification of ones personality traits show us the unique individual pattern of that person, the true colors of the inner self (Cloninger, 1993). The identification of a personality trait profile for NTs may provide valuable information that can influence future practice and the delivery of educational offerings. The Model of Nursing Knowledge was the conceptual framework utilized for this study (Chinn & Jacobs-Kramer, 1988). This framework defines personal knowledge as the awareness of self and other in a relationship. The purpose of this study was to identify a profile of the personality traits of the NPs practicing in a community in northwestern Pennsylvania. With the identification of a specific personality trait profile for NPs, individual NP practice, educational offerings, and possibly curriculum adjustments can 14 be made to foster and support these traits in the future. Assumptions, limitations, and definition of the terms used in this study have been presented. 15 Chapter 2 Review of Literature The purpose of this study was to identify the specific personality traits of a sample of nurse practitioners (NTs) in northwestern Pennsylvania. This review of the literature addresses various personality studies done with NPs, nurses, and other professionals. This chapter also provides the reader with a selective overview of personality tool testing. Studies of Nurse Practitioners Many studies have been done concerning personality traits. Several studies support the usefulness of personality trait identification. Burns, Lapine, & Andrews (1978) studied the personality traits of students in a pediatric NP program before and after training was completed. They used the Edwards Personal Preference Schedule to evaluate seven consecutive groups for a total of 125 students measured. An analysis of variance for repeated measures was performed on the pretraining scores and posttraining scores at the p<0.05 level of significance. They found significant increases in autonomy, heterosexuality, and exhibition, and significant decreases in endurance, order, dominance, abasement, intraception, and nurturance in these students after completion of the course work. They proposed that the increases could be explained by the possible co:mfort level of knowledge acquired after completion of the course of study. They hypothesized that the decrease in 16 both order and endurance may have been related to the balancing of the demanding academic and clinical requirements of the program and/or recognition that the new role required considerable flexibility. They continued to explain the decrease of nurturance and abasement as being represented by an increase of confidence as the student acquired the new skills of the pediatric NP. Dominance decreasing after the program may have resulted from the program's emphasis on counseling. Intraception was thought to be in conflict with assertiveness required to initiate the new role. Another study looking at the pediatric NP found that the educational program did not change the personality characteristics of the students (Bruhn, Floyd, & Bunce, 1978). Three psychological tools were used to measure personality characteristics of 43 class participants. The Rotter's Internal- External Locus of Control Scale, the Budner's Intolerance of Ambiguity Scale, and the Myers-Briggs Type Indicator (MBTI)-Form F were given upon entry into the program, at graduation, and at 1 year post graduation. The researchers chose these instruments because they had been used in a variety of other studies of nurses to assess attitude, adjustment, and vocational preference. These tools were felt to capture the understanding of nurses' attitudes and adjustments to a new role, namely that of the NP. This new role involved changing the identity of the nurse from one who performs delegated nursing tasks to one who assumes more responsibility for direct care of 17 patients in ambulatory settings. The Rotter's Internal-External Locus of Control Scale and the Budner's Intolerance of Ambiguity Scale showed no significant differences in scores upon entry into the program, at graduation, or at 1 yeai post graduation. Significant differences were found with respect to the characteristics on the MBTI-Form F at the 0.05 level of statistical significance. The MBTI-Form F is a 166-item instrument containing four separate indices that represent the four basic preferences, which according to Jung, form each individual's personality. The four indices are extroversion­ introversion (El), sensing-intuition (SI), thinking-feeling (TF), and judging- perception (JP). Each of the four indices is divided into two separate scales, thus scores indicate a person's basic preference on one of each of the four scales. Bruhn, Floyd, & Bunce found that students were more introverted and perceptive at the completion of the program than upon entry into the program. The researchers concluded that the personality characteristics of the students changed somewhat during the learning of their new role. However, these changes did not persist 1 year after the nurses entered their first job in this new role. The implications of this study would seem to be that nursing and medical educators should be realistic regarding the re-socialization of nurses for new roles. Sullivan (1978) compared 127 NP graduate students and 31 physician colleagues. She used the Edwards Personal Preference Schedule to measure 18 differences in their personality characteristics. The nurses ranked high in heterosexuality, dominance, intraception, change, and achievement as compared to the physicians. Sullivan described the nurses as having a high degree of self-acceptance and confidence in performance of their role as care provider. In the review of current literature, the researcher was unable to locate personality trait studies done within the general NP population. Studies of Other Nurses Bruegel-Richards (1972) studied the characteristic differences among all graduates from 13 schools of nursing in the western United States. One hundred and twenty graduates from a baccalaureate program, 134 from associate degree programs, and 107 from diploma programs constituted the convenience sample of 361 subjects. The Gordon Personal Profile, the Professionalization Scale, and a general intelligence test were used in this research. Bruegel-Richards found no significant difference among the three groups of students in intelligence, leadership potential, responsibility, emotional stability, or sociability. Although the scores did not reach statistical significance, diploma students showed the highest levels of leadership d associate degree students demonstrated the potential and sociability an highest levels of responsibility and emotional stability. All of the groups appeared more responsible and emotionally stable than the average female 19 college student of the norm group, but much less sociable. According to Bruegel-Richards a more complex picture developed from the results of the professionalism scale. In describing their ideal of nursing practice, graduating baccalauieate students had a significantly more professional orientation than did diploma and associate degree students. Baccalaureate students also saw their instructors as having a more professional ideal of nursing practice. However, in the perception of physicians' ideal of nursing, head nurses' ideal of nursing, patients' ideal of nursing, and perception of the real situation, no significant differences were found among the three groups of students. Goldstein (1980) used the Personal Orientation Inventory to compare self-actualization scores of students in five baccalaureate and five associate degree nursing programs in the state of Illinois. The student groups were tested in their final month of study. The Personal Orientation Inventory was subdivided into categories of self-actualization, spontaneity, self-regard, self­ acceptance, and the capacity for intimate contact. A t-test was used to compare the scores of the two groups of students. A total of 204 baccalaureate students had mean scores significantly higher (E<0.05) than the 159 associate degree students in all areas. The author concluded that the baccalaureate students had greater potential as leaders, but noted that it was unclear whether the baccalaureate-prepared students had higher expectations or goals 20 when entering their educational program than did the associate degree students. Bradham, Dalame, & Thompson (1990) published a study measuring the desirable personality traits in nursing students that were valued by practicing nurses. A sample of 178 nurses from nine institutions in four different states was surveyed. The nurses surveyed indicated the level of personality traits desirable for nurses, based on the Personality Research Form (PRF) definitions. Each of the PRF personality trait definitions were measured on a scale of high, moderate, or low. The PRF traits are abasement, achievement, affiliation, aggression, autonomy, change, cognitive structure, defendence, dominance, endurance, exhibition, harm avoidance, impulsivity, nurturance, order, play sentience, social recognition, succorance, and understanding. These traits were compared with results obtained from 67 associate degree nursing students and 23 baccalaureate degree nursing students. These student volunteers came from two different nursing programs. The level of personality traits deemed to be desirable by the practicing nurses were congruent with the students' scores. The scores of the associate degree nursing students and the baccalaureate degree nursing students al the point of entry, and on completion of their schooling, did not significantly (p<0.05) differ for the majority of the traits measured. The baccalaureate degree-nursing students, however, did score higher than the 21 associate degree-nursing students at the completion of their program in the areas of autonomy, dominance, and understanding. Tarno (1980) published a descriptive study of the personality types of successful nurses. Tarno defined the successful nurse as one who had completed schooling and was working full-time in an acute care facility. She investigated the possibility that successful nurses have a common psychological type or types. She surveyed 41 female registered nurses, which had been working less than 3 years, using the Myers-Briggs Type Indicator (MBTI)-Form F. There was no single common psychological type for the successful nurse found by analysis of variance, although some similarities were found in the areas of sensing and feeling. According to Tarno, the subtypes of sensing and feeling were felt to be strong descriptors of a successful nurse. Personality types amd preferences of certified registered nurse anesthetists (CRNA), student registered nurse anesthetists (SRNA), and other registered nurses (RN) were researched by Carrara (1992). Her purpose was to compare and contrast the personality preference of 47 CRNAs and SRNAs with 28 RNs who did not have the career goal of becoming a CRNA. Carrara used the MBTI-Form G for data collection. The MBTt-ta G is an abbreviated version with only 50 items and is used for quick screening purposes. These data were statistically significant for the CRNA/SRNA 22 group showing introversion over extroversion, sensing over intuition, thinking over feeling, and judging over perception, Carrara concluded that the nurse anesthetists were more likely to be impersonal, introverted thinkers and the RNs working in acute bedside patient care units were more likely to be people-oriented feelers. According to this researcher, these characteristics fit the type of nursing needed in each of these fields of practice. Beaver (1955) studied 108 student nurses from two colleges. She compared student nurses to a control group of 91 female students in a liberal arts college working toward their education certification. The groups were matched for race, sex, and age. The mean age for the student nurses was 19 years, 3.5 months; for the education majors, 19 years, 8 months. The purpose of this study was to determine the degree to which the GZTS could differentiate a group of student nurses from a group of education majors. Using the GZTS for trait identification, the researcher found the student nurses to have a statistically greater amount of emotional stability, objectivity, friendliness, and sociability as compared to the education majors. The education majors were found to have higher scores in personal relations and masculinity. The researcher concluded that the GZTS did a good job in differentiating the student nurses from the otherwise similar group of student education majors. 23 Studies of Other Professionals Guilford (1952) studied temperament traits in 208 executives and compared them with 143 foreme:;n, at a large chain grocery. The tests administered to these two groups were the Guilford series of personality inventories: Inventory of Factors STDCR, Guilford-Martin Inventory of Factors GAMIN, and the Guilford-Martin Personal Inventory. The traits represented in these tests are social introversion-extroversion, thinking introversion-extroversion, depression, emotional stability, impulsiveness, general activity, ascendance or social boldness, inferiority feelings, masculinity of attitudes and interests, nervousness, objectivity, agreeableness, and cooperativeness. The executives scored significantly higher (p<0.01) in the areas of social extroversion, freedom from depression, emotional stability, impulsiveness, general activity, social boldness, self-confidence, calmness, objectivity, agreeableness, and the ability to be coopeiative. Herzberg (1954) tested college students and noncollege controls using the Guilford Zimmerman Temperament Survey (GZTS). He found that the college students ranked higher in the personality traits of social boldness, sociability, emotional stability, objectivity, personal relations, and masculinity; and lower in the areas of friendliness, thoughtfulness, general activity, and restraint. 24 Another study looked at the personality traits of 60 occupational therapy students and 22 practicing occupational therapy clinicians (Brown, 1989). The Personality Research Form E was used to collect the data. Analysis of vaiiance indicated statistically significant differences between students and clinicians on certain personality variables. Students scored higher on abasement, affiliation, change, nuturance, play, and social recognition scales. The clinician group scored higher for endurance and harm avoidance. Summary This chapter has provided a review of the literature concerning personality trait profile identification. As the literature indicates, certain personality traits are more specific in certain types of professions. This current study was designed to identify the personality traits of NPs using the Guilford Zimmerman Temperament Survey. Information obtained from this study could be used to identify the potentially more successful NP student applicant and to enhance the current communication practices between NPs and patients. 25 Chapter 3 Methodology This chapter describes the methodology that was utilized to determine the personality traits in a sample of nurse practitioners (NPs) in northwestern Pennsylvania. The Guilford Zimmerman Temperament Survey (GZTS) was used to study this sample. Included in this chapter are the research design, sample, setting, informed consent, instrumentation, validity, reliability, operational definitions, and data analysis. Research Design This study utilized a descriptive research design. The goal of this research was to gather information regarding a personality trait profile of the nurse as a NP, both as a student NP and a graduate NP in northwestern Pennsylvania. Another goal included the identification of any differences between these two groups. The GZTS identifies temperament characteristics as they are related to leadership style, interpersonal skills, analytical style, the ability to juggle multiple tasks, the ability to handle stressful situations, and the ability to learn new concepts and ideas. The GZTS was administered to voluntary participants through the Internet site of Career Assessment Center, Inc. (CAC). Trained staff members from CAC interpreted the Survey results. Volunteer participants had the opportunity to attend a seminar held at Saint Vincent Health Center, Erie, PA, approximately 2 weeks after they had 26 completed the Survey. This seminar provided individual participants with their Survey results. A staff counselor from CAC led the seminar. Sample, Informed Consent and Setting A convenience sample of student NPs and graduate NPs was selected. The selection process included a mailing to all student NPs from the univeisities in the Elie County, PA area and to the members of the Northwest Pennsylvania Nurse Practitioner Association (Appendix A). This mailing included a self-addressed stamped return postcard (Appendix B). Return of the postcard constituted the consent to be a study participant. These participants were contacted again by mail with the specific information needed to access the GZTS via the Internet on the CAC, Inc web site page (Appendix C). Included in this mailing were specific instructions for signing on to the CAC, Inc. web site, filling in the candidate information sheet, and accessing the GZTS. The researcher's phone number was included should any questions or concerns arise. Demographic information obtained and included in this study was gender, age, ethnic background, the highest grade completed in education, and the current employment status of the participants. An authorized user identification number and password was provided. A specified stop date and time when the Survey would no longer be available was also included. 27 According to CAC guidelines, the information related to this testing was confidentially protected by law. ReguUtions limit anyone's right to mahe any further disclosure of this information without written consent of the person to whom it pertains. To preserve anonymity of the participants, no individual results or scores were identified. Only the overall group profiles of the NP population were reported. A follow-up review of individual participant results was scheduled at Saint Vincent Health Center on May 30, 2000 at 7:00pm. Study participants were also given the opportunity to review the results of the research project following its completion. Instrumentation The main objective of the Guilford inventories is to provide scores for the separate primary traits of one's personality (Guilford, 1959). The first analysis inventory is based on introversion-extroversion dimensions that actually represent more than one primary trait. Later analysis testing showed that other areas of temperament exist. Thus, this 300-item survey was developed. The GZTS involves those items that have been found by factor analysis to indicate primary traits. This Trait Survey was the fourth inventory developed by Guilford and has been in existence since 1949 when it was first published (Guilford. Zimmerman, & Guilford, 1976). The goal was to develop a single inventory that would cover all of the traits idendfied in the three original inventories and to decrease the intercorrelations found in the 28 previous inventories. Thus the GZTS was utilized as the research tool in this study The GZTS is a commercial instrument that the researcher purchased through CAC. This standardized self-administered Survey requires approximately 60 minutes to complete. It is designed to yield a set of scores that identify the ten characteristics of personality according to Guilford and Zimmerman. These ten characteristics are general activity, restraint, ascendance, sociability, emotional stability, objectivity, friendliness, thoughtfulness, personal relations, and masculinity. The Survey statements consist of 300 situational items with thirty statement items representing each of the ten characteristics profile traits (Guilford et. al., 1976). The participant must read each item carefully and mark a "YES" as the answer if they agree or feel the statement is true. If the statement is more false than true, or if the participant disagrees with it, a "NO" mark is given for that statement. There are no right or wrong answers. The score weight of +1 or -1 is assigned to the "YES" or "NO" responses, respectively. The CAC web site incorporated the hand held scoring stencils to tally the ten individual trait scores for each of the study participants- involved. The purpose of this Survey was best served if the participants described themselves and stated their opinions as accurately as possible. Many statements may seem similar, but no two are exactly dike. 29 The GZTS is represented as a bipolar trait tool (Guilford, 1959). Bipolar traits extend from one pole to an opposite pole through a zero or neutral point. This neutral or adaptive zone is corresponding with the middle range C scores of 4, 5, or 6 on the result page. For example, the trait of general activity has the inactive person at one pole and the energetic person on the opposite pole. The zero point comes at a place at which the two named qualities are equally balanced, where a person could be described as having neither the one nor the other quality predominating. This persons score for general activity would fall into the adaptive range of 4, 5, or 6. Validity. Evidence concerning validity of the GZTS scales was drawn from a large number of factor-analytic studies done by Guilford, Zimmerman, and Guilford (1976). Analyses of total GZTS scale scores, by themselves or along with scores from other test instruments, have repeatedly pointed toward the same four second-order traits. These traits are identified as: Social Activity (based upon the first-order traits Ascendance, Sociability, and General Activity; Introversion-Extroversion (based upon Restraint and Thoughtfulness); Emotional Stability (based upon Emotional Stability and Objectivity); and Paranoid Disposition (based upon Objectivity, Friendliness, and Personal Relations). These combinations also suggested a third-order trait of Emotional Health, based upon Emotional Stability and Paranoid Disposition. This leveled hierarchy design is the foundation of the GZTS. 30 Another indirect source of validity information comes from the comparisons of vocational groups in terms of the patterns of scores they obtained from the GZTS (Guilford, 1959). There is some reasonableness in patterns of scores found for librarians, male and female; for nurses in training; for reseai ch and development engineers as compared with sales and service engineers, and for teachers as compared with college students. Librarians tend to be low in confidence, ascendance, and general energy drive. Nursing students tend to be more sociable, emotionally stable, friendly, and masculine in their attitudes and interests than the education majors. Research and development engineers tend to be lower on scores for ascendance, sociability, and friendliness. Teachers tend to be more restrained, emotionally stable, objective, friendly, and tolerant than the college students, but lower in general energy level and ascendance. There is also information concerning predictive validity of some of the scores, which comes from the academic setting. The highest correlation with college grade point averages were for R (restraint) scores, T (thoughtfulness) scores, and F (friendliness) scores. of achievement among the Also, there is some evidence for prediction student nurse population. In the academic setting, there were promising predictions of teaching performance and of leadership among freshman women (Guilford, 1959). 31 Eeliabllitv. The reliability coefficient of each of the ten characteristic scores from the GZTS range from 0.75 to 0.87 and the standard errors range from 2.2 to 2.6 (Guilford, Zimmerman, & Guilford, 1976). From these values it would follow that the odds are two to one that an obtained score lies within approximately 2.5 points from the "true" score for that individual. Using twice the standard error as a basis, it can be said that any obtained score does not differ by more than 5 points from the corresponding true score, and the odds are only about 1 in 20 of this being incorrect. Internal consistency and test-retest reliability coefficients are satisfactory as determined by Jackson (1961). He reported the stability of the GZTS scores over a period of 18 months. His subjects were 72 women service representatives and 24 women supervisors in a telephone company. The 49 subjects who completed the post-test were the study participants. They had a test-retest correlation of the following scores G-0.77, R-0.75, A-0.71, S-0.92, E0.69, 0-0.71, F-0.68, T-0.82, P-0.68, and M-0.52. The relatively low figure for M reflects a restricted range due to the sampling of all women working at the same company. Jackson pointed out that major life changes had occurred in several of his subjects that may have contributed to the changes in some of the scores. The senior author of the GZTS computed the retest reliabilities of GZTS scales based on the retesting of 43 civil-service employees most of whom were 32 either firemen or police officers in a small west coast community (Guilford et al., 1976). The mean age of these males was 37 at retest and they had been employed for an average of 2.7 years. Retest reliabilities were G-0.64, R-0.63, A-0.66, S-0.61, E-0.70, F-0.77, T-0.69, P-0.62, and M-0.55. Operational Definitions For the purpose of this study, the graduate NP is a primary health care provider who has completed a NP program and has practiced in a variety of settings including but not limited to pediatrics, geriatrics, family practice, obstetrics, gynecology, neurology, oncology, emergency medicine, or acute care medicine. Ones personality is made up of various traits (Guilford et al., 1976). These characteristics are an integrated part of the whole person. The schematic in Figure 1 identifies these characteristics. They include ten specific characteristics that are scored on a scale ranging from zero to ten. The trait score that corresponds to the highest average performance is not at the top of the scale but at some point between the middle and the top (Guilford, 1959). Each of these temperament characteristics is defined as follows: 1. The G scale is General Activity. It is the measure of motivation, the menial and physical drive of the person (Guilford et al., 1976). If a person's G scale is high, they do everything harder: they socialize more, work harder, and play harder. If the G score is very high, at a score of rbne or ten, the energy 33 level may be of a compulsive type. On the other hand, if they have a low G score this person may be described as a lethargic person: one that can only do one project at a time. An example may be procrastinators who have low output of continuous energy unless they are under an emergency situation. They are slow to anger and find it hard to initiate new projects (Guilford et al.). Thoughfulness . T Friendliness Personal Relations p Masculinity M F General Activity Objectivity o G Restraint Emotional Stability E R /Sociability s AscendanceX A . r. ,. m nf the identified characteristics of personality according Figure 1. Schematic diagram t Survey (Guilford et al., 1976). to the Guilford Zimmerman Tempeiai 34 2. The R scale measures Restraint. It is a measure of overall emotional maturity (Guilford et al.. 1976). The person with a hrgh R scale tends to be rigid, structured, and methodical about everything. They are serious people and take control of situations and preplan all tasks. On the opposite end is the low R person with a carefree impulsive attitude. 3. The A scale is Assertiveness versus Submission (Guilford et al., 1976). On the one end are the domineering, assertive, leader types and on the opposite end are the timid, passive, helpless followers who let others make decisions for them. 4. The S scale measures Sociability (Guilford et al., 1976). On one end you have a person who cannot work by him or herself, who needs people contact to get the job done. They define themselves by others around them. On the opposite end of this scale is a person who avoids social contacts. They are shy and enjoy one-on-one interaction more than a large party atmosphere. 5. The E scale is Emotional Stability. This scale has nothing to do with stability as it refers to judging good or bad, healthy or unhealthy behaviors (Guilford et al., 1976). It is the measure of mood stability. A person with a high scoring E reacts in the same predictable way almost every time. On the opposite end of this scale, is the person who has varying reactions to change and does not react wel! to emohonai stressors. It is said that they are on an emotional roller coaster. 35 6. The O scale is Objectivity. The high scoring O person is the social cold fish (Guilford et al., 1976). Their expressions are external and nonfeeling. They have thick skin. On the opposite end is the hypersensitive person who has subjective reactions to peoples' comments. Their feelings are hurt easily and they fear everyone is talking about them to a point of possible paranoia. 7. The F scale refers to Friendliness. The high scoring F person is everyone's friend (Guilford et al., 1976). They find it hard to discipline people as a supervisor. They are people pleasers. On the opposite end is the low F scored a person, who is the untrusting doubting type. They are suspicious of everyone's motives and may become violent in the right circumstance. 8. The T scale is Thoughtfulness. On one end you have a person who has the need to know why (Guilford et al., 1976). They may be obsessed to find out the why in any situation. They can even become consumed with worrying about the unknown. On the opposite end is the person who works for the here and now, the doers, who work best when specific directions are given. 9. The P scale represents Personal Relations. The high scoring P person is cooperative and has positive relationships with others (Guilford et al.. 1976). They accept people as they are. Everyone is equai in his or her eyes. On the opposite side is rigid planners, wherein if you are not like them you are 36 inferior and unacceptable. They are intolerant of others. They believe their way is the right way and have difficulty accepting others' ideas. 10. The M scale is Masculinity. This scale involves the acceptance of the traditional social-cultural male-female attitudes towards masculinity and femininity (Guilford et al., 1976). Even thou this terminology is out dated the tiaditional social and cultural attitudes can be applied. On one end is the typical tough person that is less sensitive, a bully-type that sees things as either a male role or a female role. On the opposite side is the person who is sensitive, tender-minded, emotional, and typically thought of as soft and feminine. If a man's score is low in this category it does not mean that he is feminine or homosexual. It indicates that this man has feelings and is sensitive to them. He has gone beyond the stereotypical role of male as the tough, nonfeeling, macho man and is able to respond to his emotional sensitive side. An example of the profile chart can be found in Appendix D. Data Analysis The GZTS contains 300 items that include 30 items per trait (Guilford et al., 1976). Items representing the first five temperament trails of G, R, A, S, and B are in the first one-half of the Survey statement items. Items representing the second five temperament traits of O, F, T, P. and M are included in the second half of the Survey statement items. This format mates hand scoring of the Survey easier, although computer anaiysis „as utilized m 37 this study. The results are displayed in graphs according to each of the ten temperament traits identified by the Survey results. If a specific profile for the NP population is identified, a review of this type is included. A comparison of the NP profile was also made to the SNP profile and to the GZTS data bank for nursing student applicants. Summary The goal of this study was to identify the personality traits of the NP population in a convenience sample of NPs from northwestern Pennsylvania. The use of the GZTS was utilized for the collection of these data. This Survey identifies ten characteristics of personality according to Guilford et al. (1976). Volunteer participants accessed the GZTS online from the CAC, Inc. web site. Survey results were collected and analyzed by the CAC, Inc of Erie, PA. Research design, sample, informed consent, setting, instrumentation, validity, reliability, operational definitions, and data analysis were included in this chapter. 38 Chapter 4 Data Analysis This chapter presents the analysis of data, the scoring of the GZTS, and demographic data for study participants. The purpose of this research study was to identify the personality traits of a sample of NPs using the Guilford Zimmerman Temperament Survey (GZTS). Figures were used to present the results in an understandable fashion. Presentation and Analysis of Data This study was done to determine if a personality trait profile could be identified for a sample of nurse practitioners (NPs) in northwestern Pennsylvania. This study compared the sample personality trait profile of NPs to the student nurse practitioners (SNPs) and to the GZTS data bank of 619 nursing student applicants' scores (Guilford 1976). A total of 207 mailings to potential study participants were sent out. These mailing contained a request for volunteer participation and were sent to the 168 members of the Northwest Pennsylvania Nurse Practitioner Association (NPNPA) and to 39 SNPs at two universities in Erie County, PA. A total of W6 (51%) of the self addressed and stamped post cards were returned. Of the 106 returns, 28 (26%) npooIe who indicated their inability to be were people 39 study participants and one was returned without a name and onutted from the study. The remaining 77 (73%) subjects were the research participants. A second mailing was sent to the 77 study participants giving them the directions for accessing the GZTS on the web site of Career Assessment Center, Inc. (CAC). This mailing also included the information needed to properly fill out the demographic information sheet online. This mailing included a time limit of 2 weeks for completion of the Survey with a stop date and time of May 26, 2000 at 11:59 p.m. A list of study participants who completed the Survey appeared on the CAC Website upon signing in. With 5 days remaining to take the Survey, an E-mail message or a telephone reminder was made to participants who had not yet completed the Survey. Please note that the SNP participants were unable to be contacted unless they were members of the NPNPA because it was against the university policy for the researcher to contact the SNPs individually. The study participant letter was distributed in class to SNPs at both of the area universities. Forty-eight (62%) participants went to the web site and registered but only 45 (58 X>) completed the Survey for analysis. The Survey was sent to CAC of Brie, PA to be analyzed. The personality trait profiles were displayed on GZTS Assessment Result Sheets. For comparison and significance, the base popmation of (n=619) nursing 40 school applicants from the Guilford data bank was used for a normative comparison population of nurses. This data bank population was used as a comparison to the sample of SNPs and NPs in this research. A comparison was also made of the study participant SNPs to the study participant graduate NPs. Demographic Data Analysis of Study Participants The study participants included a total of 34 (76%) graduate NPs and 11 (24%) SNPs. The gender distribution includes 29 (65%) female graduate NPs, 5 (11 %) male graduate NPs, and 11 (24%) SNPs, with one student being male. Figure 2 illustrates the gender distribution of study participants. ■ 11% □ 24% □ 65% Figure 2. Sex of participants. 41 Members of the study sample had a mean age of 46 years. The age range for SNPs was 31 to 56 with a mean age of 44 years, • For the graduate NP group the range was 36 to 69 with a mean age of 47 years. Figure 3 illustrates the age distribution of study participants. 12 10 8 6 4 2 0 r~i I—| 30 35 40 45 50 55 60 65 Figure 3. Ages of participants. The study sample had an ethnic background mix of 42 (93%) Caucasian, 1 (3%) Hispanic, and 2 (6%) listed as other. The educational status of the study participants included 34 (73%) with masters' level education, 5 □ 11% ■ 2% ^4- El 7% □ 7% □ Doctorate ■ Masters □ Bachelors □ Some College 1• ■?> ■ High Schoo1 W73% Figure 4. Educational level of participants. 42 (11%) senior college, 3 (7%) doctorate, 3 (7%) baccalaureate degree, and 1 (2%) at the twelfth grade level. Figure 4 illustrates the educational distribution of study participants. Of the 34 graduate NPs in the study sample, 31 (91%) were employed, 2 (6%) retired, and 1 (3%) was unemployed seeking work. Figure 5 illustrates the employment status of the study participants. Retired 3% Unemployed seeking work 6% / / \ / □ Employed □ Unemployed seeking work I ■ Retired I \ Employed 91% Figure 5. Employment status of NP participants. 43 Scoring of the GZTS After each study participant completed the Survey online, it was sent to the CAC, Inc. office in Erie, PA for analysis. The computer software has replaced hand scoring answer sheet stencils for Survey scoring. The scores for each of the ten personality characteristics were given for each of the participants. Mean scores were calculated for temperament summaries. No significant differences were found among the study participant group as compared to the normative base population of student nurse applicants. Figure 6 displays these results. No significant differences were found among General Activity Restraint Assertiveness Sociability _____ _______;—— Motional Stability Objectivity ■ Study Participants Norm Group Friendliness Th°ughtfulness Personal Relations Masculinity 8 0 10 qrv results of study participants and Norm group. Figure 6. Mean temperament summ y 44 the study graduate NPs as compared to the study participant SNPs. Results were computed separately for the SNPs and the graduate NP participants. Figure 7 displays these results. General Activity Restraint Assertiveness Sociability Emotional Stability ■ Students □ NP Graduates Objectivity friendliness Thoughtfulness Personal Relations Masculinity Figure 7. Mean temperament summary results of SNP group and graduate NPs. Surnmar Thrs chapter induded the presentation and andysis of study resufts, cup GZTS. Results are demographic information, and scoring leview displayed as figures for ease of understanding and interpr 45 significant differences were found among the study participant group as compared to the Guilford nor:■mative base population of student nurse applicants. In relationship to the GZTS norm population of student nurse applicants, the study participants had mean scores that were higher in the areas of general activity, restraint, assertiveness, and masculinity. Figure 6 displays these results. 46 Chapter 5 Conclusion The theory of personality trait identification has been developing for almost 50 years (Allport, 1954). Guilford identifies ten identifiable traits in each individual (Guilford, 1954). A unique pattern is a part of every one of us but certain traits can be seen to cluster in certain professions and occupations. The purpose of this study was to identify the personality traits of a sample of student nurse practitioners (SNPs) and nurse practitioners (NPs) using the Guilford Zimmerman Temperament Survey (GZTS). The Guilford data bank provided a normative base population of student nurse applicants for comparison. This chapter includes a summary of the study findings, discussion of results, conclusions, and recommendations for further research. Summary of Findings Figure 6 and Figure 7 presents the Temperament Survey results. There was no significant differences found among the study participants and the normative base population of student nurse applicants. The SNPs mean scores were higher in general activity and thoughtfulness as compared to the graduate NP population. Although the higher scores were not significant, these trait scores can be analyzed according to Guilford's definitions of the ten characteristics. The higher general activity score can be explained by the role 47 identification of a student verses a graduate NP. The SNP may feel acutely motivated or driven as an adult student pursuing a new career as compared to graduate NPs who are working at their jobs with identified boundaries and role functions. In the area of thoughtfulness, SNPs may feel emotionally chai ged in their new role. They need to know the rationale behind what they are doing in this new role as SNP. When analyzing the results according to the median scores, similarities to the mean scores were found except in the personality trait scores of assertiveness and thoughtfulness. The median SNPs group score was 9 as compared to the median score of the NPs group score of 6. This can be explained by the fact that SNPs need to be more assertive and determined to learn their new role. The thoughtfulness scores of the study SNPs group were 5 as compared to the graduate NP group score of 8. The median thoughtfulness score shows that the graduate NP has to be able to rationalize their clinical decisions to a higher level. The graduate NP scored higher in the areas of restraint, assertiveness, sociability, emotional stability, objectivity, friendliness, personal relations, and masculinity as compared with the study participant SNPs. There was no significant differences seen among any of these scores, although the greatest difference was seen in the area of sociability with the NPs scoring 5.6 and the SNPs scoring 4.0. A person with a low-ended scale is one that avoids social contacts, is shy, and works alone for the most part. The SNP works alone, is 48 learning a new role as SNP, and has one-on-one interactions with their preceptor and the patients. Comparing the GZTS data bank norm of 619 student nurse applicants with the study participants as a whole revealed some differences as well. The data bank norm group had higher scores in the areas of sociability, emotional stability, objectivity, friendliness, thoughtfulness, and personal relations than did the study participants. The study participant group had a higher score for general activity, restraint, assertiveness, and masculinity. Although, the values are not significantly different the greatest degree of differences lay within the areas of sociability, personal relations, and masculinity. The mean score for the GZTS norm group for sociability was 6.0 and was 4.8 for the study participant. The mean score for the GZTS norm group of student nurse applicants for personal relations was 6.0 and the mean score for the study participants was 4.8. The GZTS norm group score for masculinity was 4.0 with the study participant scoring 6.0. All results can be seen in the adaptive or middle range scores of 4-5-6 but some analogies can be made. The sociability score for the study participant group was lower. This could be explained by the nature of the work that the NP group does as compared to that of the student nurse applicant groups work ethic. The NP group needs to function rather independently with one-to-one encounters. 49 The NP will feel satisfied with his/her job by how well the patient understands their disease and treatment plans. This is a partnership of ongoing evaluations and revisions that requires continued communication and follow-up by both parties involved. The personal relations score was lower for the study participants. This may be explained by the fact that the NP group has to follow given guidelines for health maintenance and disease prevention that could be viewed by the patient as unacceptable or unnecessary. The NP group may see the patient in view of what they can improve or do better for their health and well being. The masculinity score was higher for the study participant group. This may show the need for the predominantly female population of NPs to be on the tougher side, holding back feelings and being less sensitive to get the job done in a predominantly male medical society. Discussion of Results The personality traits identified for the sample of graduate NPs in this study can be explained in the following manner. This NP group has a high level of productivity to get the job done. They are mature, serious, and objective in their role. They are able to take charge and lead others when necessary. They view others as individuals that can improve their state of health status and well-being. The NP is tolerant and accepting of others but 50 sees the need to question and contemplate a better plan. This information is useful for the NP population as a whole. NPs can reflect upon this information and use it to enhance their communication skills with patients and other professionals. This role is one of a health care provider whose care is continuous and comprehensive with defined attributes and skills to ensure care delivery. As Chinn & Jacobs-Kramer (1988) defined the four knowledge patterns as useful parts of the Model of Nursing Knowledge, we can see how this relates to the graduate NP population in this study. The personal knowledge pattern is expressed to others through communication, be it consciously or subconsciously. We express ourselves by the way we "handle" ourselves around others. When NPs are aware of their individual traits, they can identify specific distinguishable ways in which they differ from another person. In the literature reviewed, nursing attracts the confidant, interdependent, patient advocate (Bradham, Dalme, and Thompson 1990). According to Beaver (1955), nursing attracts the emotionally stable, objective, friendly, and sociable person. Burns, Lapine, and Andrews (1978) found that the pediatric nurse practitioners had the desirable traits of interdependence, autonomy, exhibition, and heterosexuality. Introversion and perceptiveness 51 were traits identified by Bruhn, Floyd, and Bruce (1978) for the pediatric NP. Sullivan (1978) found the NP graduate students having a high degree of self­ acceptance and confidence in performance of their role as care providers. This current research shows a similar distribution of traits for the nurse as a NP. Conclusions The conclusions of this study were: 1. The GZTS did not identify any significant differences among the groups studied. 2. The GZTS did not identify any similarities in personality trait profiles of the graduate NPs studied. 3. The study participants scored higher in the areas of general activity, restraint, assertiveness, and masculinity as compared to the GZTS data bank of student nursing applicants. 4. The SNPs mean scores were higher in the areas of general activity and thoughtfulness as compared to the graduate NPs in this study. 5. The study graduate NP group had mean scores higher in the areas of restraint, sociability, emotional stability, assertiveness, objectivity, friendliness, personal relations, and masculinity than did the study SNP group. 52 Recommendations for Additional Research Recommendations based on this study were: 1. Additional research should be done using the GZTS within a larger sample size population of NPs. This will develop a data base population of NP specific personality trait information. 2. Additional research should be done to determine if personality traits change during the schooling process in becoming a graduate NP. 3. This study could be used in a wider geographical area in order to allow a more general application of the findings. 4. Additional research should be done focusing on a specific area of practice of the NP population. Can specific personality traits be identified for a specific type of practicing NP? 53 References Allport, G. W. (1937). Personality: A psychological interpretation. New York: Holt, Rinehart & Winston. Allport, G. W. (1954). Becoming: Basic considerations for a psychology of personality. New Haven, CT: Yale University Press. American Nurses' Association (1987). Standards of practice for the primary health care nurse practitioner. Kansas City, MO: Author. Barrett, S. P. (1999, October). Guilford Zimmerman Temperament Survey presentation. Lecture presented at Saint Vincent Health Center, Erie, PA. Beaver, A. P. (1955). Temperament and nursing. Psychological Reports, 1, 339-344. Bradham, C. U., Dalme, F. C., & Thompson, P. J. (1990). Personality traits valued by practicing nurses and measured in nursing students. Journal of Nursing Education, 25, 225-232. Brown, G. T. (1989). Personality characteristics of occupational therapy students and clinicians. 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Murray, H. A. (1938). Explorations in personality. New York: Oxford University Press. Neubauer, J. (1998). Personal development: A lifelong journey. Advanced Practice Nurse Quarterly, 3(4) 1 -9. Pervin, L. A. (1990). A brief history of modern personality theory. In L. A. Pervin (Ed.), Handbook of personality theory and research. New York: The Guilford Press. Sullivan, J. A. (1978). Comparison of manifest needs of nurses and physicians in primary care practice. Nursing Research, 27, 255-259. Tarno, P. S. (1980). A descriptive study of the personality types of successful nurses. Unpublished master's thesis, Edinboro University of Pennsylvania, Edinboro, PA. / 57 Appendix A Mailing to Potential Study Participants Dear Nurse Practitioner or Student Nurse Practitioner: I am requesting your participation in a research study that will contribute to the Nurse Practitioner field. The study involves no cost, only a short amount of your time, and can possibly be completed in your home. I'm a family nurse practitioner graduate student at Edinboro University, working on completing my thesis for a Masters of Science in Nursing degree. My thesis involves the identification of the personality traits of the nurse practitioner (NP) population, including student nurse practitioners and graduate nurse practitioners. I am attempting to determine whether there are personality traits unique to the nurse practitioner population. This information will be useful to those considering a career as a NP, to those already working as a NP, and to those involved in program development for NPs. The testing instrument I am using for this study is the Guilford Zimmerman Temperament Survey (GZTS). This Survey identifies temperament characteristics as they are related to leadership style, interpersonal skills, analytical style, the ability to juggle multiple tasks, the ability to handle stressful situations, and the ability to learn new concepts and ideas. All information will be presented as grouped data in my thesis. It will 58 be anonymous and used for purposes of data analysis only. Completion of the Survey constitutes your consent to participate in this study. The Survey involves approximately 60 minutes of your time and must be completed in one seating. The testing process involves computer Internet access from your home, office, or another site of your choice. This online assessment is found on the Career Assessment Center, Inc. web site. A stamped and addressed postcard is enclosed with this letter. Please indicate on the postcard your willingness to participate in this study and return it to me on or before May 8, 2000. I will then send you a user identification number and password to access the GZTS tool from a computer. The results of your individual Survey will be professionally analyzed at the Career Assessment Center, Inc. office in Erie. An explanation and review of the Survey results will be held at Saint Vincent Health Center at a later date and time. More information about this meeting will follow in a future mailing to study participants. If you have any questions or concerns related to this researcher study, please free to call me at my home, 474-9084. If you are unable to be a researcher participant, I thank you for your interest and time in reading this information. Please mark the postcard appropriately and return it to me. 59 Sincerely, Barbara L. Waples, SFNP Edinboro University 60 Appendix B Return Post Card YES, I'm interested in being a research participant in your thesis study. Please forward the necessary information for accessing the GZTS online. NO, I'm sorry, I can not participate in your thesis study. Print your name 61 Appendix C Study Participant Letter Dear Study Participant, First let me thank you for your willingness to participate in this study. Your time commitment is greatly appreciated. With your completion of this Survey, I hope to identify a personality trait profile of nurse practitioners in northwest Pennsylvania using the Guilford Zimmerman Temperament Survey (GZTS). It is important for the accuracy of the results that you answer all statements to the best of your ability, and to do this independently of others. Please follow the enclosed instructions to access the Survey. The Survey will be available online until May 26, 2000 at 11:59pm. The results of your Survey will be professionally analyzed at the Career Assessment Center, Inc. of Erie. Trained Career Assessment Center staff will explain and review Survey results at Saint Vincent Health Center on May 30, 2000 at 7pm in the McGarvey Learning Center. The discussion will last one hour, with a question and answer time to follow. If you have any questions about my thesis, please feel free to call me at home (814) 474-9084. If you have any questions or difficulty signing onto the Survey itself, please call the Career Assessment Center for help at (814) 453-7681. To access the Guilford Zimmerman Temperament Survey: 62 1. Go to Career Assessment Center website @ www.careerassessment.com 2. Click onto Secure on-line Attitude & intelligence Testing 3. Go to bottom of this page and click on enter the online testing area 4. Enter user identification — edinboro 5. Enter password — waples 6. Click on area to register new student 7. Fill out Candidate Information page: a. You must fill in all sections on this page to advance to the Survey b. Some item selections are given for you on the enclosed example sheet c. If you are a student NP, please indicate "student" under the status section 8. Click on Enter Test Area a. Your name will appear with others; click on your name b. Click Enter the testing area; Survey will appear next 9. Complete Survey: a. Follow the instructions given b. Each page contains 30 situational items c You must answer all items on each page to advance to next page 63 d. Thank you again Sincerely, Barbara L. Waples, SFNP Edinboro University 64 Appendix D Temperament Graph I General Activity Restraint Assertiveness Sociability Emotional Stability Objectivity Friendliness .. I Thoughtfulness Personal Relations - Masculinity - 0 • ■ ■ 2 4 6 8 10