This assignment is a Critical Appraisal of an Article for Nursing.

GUIDE FOR APPRAISING QUANTITATIVE RESEARCH ARTICLES Sections of the research article Address these points: Title Explain how the title represents what the research is about. List the words in the title that indicate the population studied, the topic under investigation and the method used. Author/s List what research expertise can be ascertained from the author/s qualifications and affiliations. Abstract Demonstrate how, in the abstract, there is an outline of: x the research aims, problem or hypothesis; x the methodology and methods employed; x include population and data collection; x the results; x the conclusion; x recommendations. Introduction/ literature review Outline how the literature is reviewed to identify a gap in previous research. Identify whether primary or secondary sources are used and provide examples to demonstrate why this is relevant. Explain how the introduction and/or literature review provides a context for the research problem. State the significance of the research problem, aims or hypothesis. Discuss to what extent the literature is critically appraised. Methodology and methods. Outline the aim of the research and explain how this relates to the research problem. Describe how the methodology allows the researchers to answer the aims or address the aim/s of the study or hypothesis. Explain why the sampling method is suitable. Discuss how well the researchers explain the procedure for collecting data. Outline the data analysis method and discuss whether the data analysis is rigorous. Explain whether ethical issues are considered. Results Provide examples to illustrate how results are achieved using analysis methods described previously; Describe the importance of results being clearly stated and supported with raw figures and/or percentages. Discussion Limitations Explain how well the author/s discuss the study findings in relation to the research question or aim/s of the study. Summarise how the authors have linked the results of this study to similar research studies. Explain how the study’s limitations are addressed. Conclusion Outline how well the conclusion follows logically from the results of the study. Explain how the author/s argue for the relevance of their results to clinical practice and make recommendations for further research. If the author/s do not argue this, explain how the results might inform clinical practice and contribute to further research.. Table 1 – adapted from Ingham-Broomfield (2008) and Solutions for Public Health (2010). These resources will help you develop your critiquing skills by leading you through the process. Ingham-Broomfield, R. (2008). A nurses’ guide to the critical reading of research. Australian Journal of Advanced Nursing, 26(1), 102-109. Solutions for Public Health. (2010). Critical skills appraisal program. Retrieved February 12, 2013, from http://www.casp-uk.net/

Australasian Emergency Nursing Journal (2014) 17, 139—145 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/aenj RESEARCH PAPER The personality of emergency nurses: Is it unique? Belinda Kennedy, RN, Grad Cert Emergency a,b,∗ Kate Curtis, RN, GDip Crit Care, MN (Hons), PhDa,b,c Donna Waters, RN, MPH, PhDb a Trauma Service, St George Hospital, Gray St, Kogarah, NSW, Australia b Sydney Nursing School, University of Sydney, 88 Mallet St, Camperdown, Australia c St George Clinical School, Kogarah, Faculty of Medicine, University of NSW, Australia Received 4 March 2014; received in revised form 27 May 2014; accepted 15 July 2014 KEYWORDS Personality characteristics; Emergency nurse; Recruitment; Occupational choice Summary Background: With everincreasing demands on emergency services itis necessary to consider how to enhance the recruitment and retention of emergency nurses in public hospitals. Personality is known to influence occupational choice, yet there is a lack of research exploring how personality may influence the workforce decisions of emergency nurses. Methods: A standardised personality test instrument, the NEOTM-PI-3, was used in a survey design inclusive of demographic questions to measure personality characteristics. Data were collected from 72 emergency nurses working at an Australian Emergency Department between July and October 2012. The personality scores of emergency nurses were compared against general population norms in each of five personality domains and their 30 associated facets. Results: Participants scored higher than population norms in the domains of Extraversion (p < .001), Openness to experience (p < .001) and Agreeableness (p = .001), and in twelve facets, including excitement-seeking (p < .001) and competence (p = .003). Conclusion: The personality profile of this sample of emergency nurses is different to the population norm. Assessment of personality and knowledge of its influence on specialty selection may assist in improving retention and recruitment in emergency nursing. Crown Copyright © 2014 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia Ltd. All rights reserved. ∗ Corresponding author at: Trauma Service, St George Hospital, Gray St, Kogarah, Sydney 2217, Australia. Tel.: +61 2 9113 2936; fax: +61 2 9113 3974. E-mail address: belinda.kennedy@sesiahs.health.nsw.gov.au (B. Kennedy). Introduction There is a global nursing shortage that is predicted to worsen in coming years. This is secondary to increased service demands as a result of the ageing population, an ageing nursing workforce and a diverse range of professional http://dx.doi.org/10.1016/j.aenj.2014.07.002 1574-6267/Crown Copyright © 2014 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia Ltd. All rights reserved. 140 B. Kennedy et al. What is known Personality influences occupational choice, as individuals seek a profession that provides personal satisfaction and meets their own personal needs. Personality characteristics have been linked to stress and burnout, similarly some have been shown to improve an individual’s ability to cope in stressful circumstances. The majority of the research undertaken in nursing does not involve defined specialty areas. What this paper adds? This paper provides a personality profile of a group of emergency nurses from the emergency department of a large tertiary referral hospital in Sydney. It is demonstrated that the profile of emergency nurses in this study is different to the general population. opportunities for nurses that take them away from clinical nursing roles.1,2 The emergency department (ED) is the entry point for approximately 40% of all hospital admissions and the demands for emergency care within Australia are growing at rate exceeding population growth.3 Compounding the nursing shortage, vacancies in critical care areas such as emergency are amongst the most difficult to fill.3 In the past, a range of strategies including educational programmes, models of care, workplace leadership and flexible rosters have been considered to enhance recruitment and retention.4—6 While some of these strategies have demonstrated favourable results, it is recognised that no single approach will improve retention. Retaining experienced nurses within the hospital setting requires a combination of approaches to have a sustained impact.1 The retention of emergency nurses not only has potential economic advantages, but also a likely positive impact on patient care and outcomes, as well as improved morale among the nursing workforce.7 The personality of an individual is one factor that has the potential to influence both their recruitment and retention in a role. Yet in nursing, there has been minimal consideration of the influence of personality on these choices. This is despite evidence to suggest that personality will influence career choice.8 Personality is the inner characteristics of an individual that influences their thoughts, feelings and behaviour.9 Occupational choice has been considered an expression of an individual’s personality, as they will seek a profession or role that will provide personal satisfaction and meet their personal needs.8,10 Certain personality characteristics may place individuals at higher risk of burnout, while others may improve their ability to cope under stressful situations.11—13 It is recognised that the ED is a highly stressful environment and staff employed within this area experience high levels of stress and emotional exhaustion.7,14 There has been a considerable amount of research on personality types attracted to a nursing career in general, but there is limited research that explores personality within defined specialty areas.15 That which exists has been carried out a long time ago, using a wide variety of personality instruments, and not consistently measuring the same personality characteristics. While the research is limited, findings have demonstrated differences in the personality characteristics of nurses working within different specialty areas.16,17 Personality testing enables the identifi- cation of individual personality characteristics, permitting a comparison of differences and similarities among and between people.18 Testing can provide information on how an individual is likely to respond or cope when exposed to different situations.19,20 Knowledge ofthe personality profile of emergency nurses not only has the potential to improve recruitment and retention, but also the ability to appropriately meet psychosocial needs addressing issues such as stress and burnout in the workplace. There is some controversy around the use of personality testing in recruitment, however it is currently used in up to 20% of US companies.21 There exists a wide range of theories of personality and an even wider range of instruments to test personality characteristics and domains.18,22 The Five Factor Model (FFM) of personality adopts the basic principles of the trait theory of personality. This model has gained wide acceptance among those involved in personality psychology and is supported by an extensive body of research.18,20,23 The FFM provides a structure consisting of five broad domains of personality: Neuroticism, Extraversion, Openness to experience, Agreeableness and Conscientiousness. For each domain there are six associated facets.24 The FFM provides a comprehensive description of personality norms as well as the possibility of distinguishing personality differences between individuals.24,25 The NEOTM Inventories were specifically developed to test personality according to the FFM, and as such are one of the most widely accepted tools for this purpose.26 Given the information available from previous studies, it is reasonable to hypothesise that one would find different personality profiles among nurses working within different specialties. The present study aimed to use the NEOTMPI-3 to develop a profile of emergency nurse personality characteristics to establish whether clusters of common personality characteristics can be identified among
this specialty nursing group. Methods Site and sample The ED of a large tertiary referral trauma hospital in Sydney, Australia was the sole site for data collection. In 2012 this ED managed 66,507 presentations, approximately 20% of which were paediatric. The study used a convenience sample of registered nurses employed on a permanent basis within the ED between July and October 2012. Instruments Two questionnaires were combined to collect demographic, workplace and personality data. The first questionnaire collected participant demographics and information around personal and work related factors considered to influence Personality profile of emergency nurses 141 Table 1 Personality domains and facets of the NEOTM-PI-3 according to five factor model of personality.26 Personality domain Facets N: Neuroticism N1: Anxiety N2: Angry Hostility N3: Depression N4: Self-consciousness N5: Impulsiveness N6: Vulnerability E: Extraversion E1: Warmth E2: Gregariousness E3: Assertiveness E4: Activity E5: Excitement-seeking E6: Positive emotions O: Openness to experience O1: Fantasy O2: Aesthetics O3: Feelings O4: Actions O5: Ideas O6: Values A: Agreeableness A1: Trust A2: Straightforwardness A3: Altruism A4: Compliance A5: Modesty A6: Tender-mindedness C: Conscientiousness C1: Competence C2: Order C3: Dutifulness C4: Achievement striving C5: Self-discipline C6: Deliberation retention in nursing such as autonomy, educational opportunities, job satisfaction and flexible rostering.27 The NEOTM-PI-3 is the most recent version of the NEOTM Personality Inventories26 and was selected to collect and test personality data from the ED nurses according to the FFM of personality.28 The NEOTM-PI-3 assesses the five personality domains and 30 associated facets as shown in Table 1 with their associated codes. The NEOTM-PI-3 is widely used in both research and clinical settings and has undergone robust evaluation demonstrating its reliability and validity.26,28,29 The NEOTM-PI-3 Form S is a 240 item self-report questionnaire with response options ranging from strongly agree to strongly disagree which takes approximately 30—40 min to complete. Participants respond to statements such as ‘I ignore a lot of silly little rules’ and ‘I wouldn’t enjoy vacationing in Las Vegas’.30 Responses are weighted from zero to four, with participants blinded to the weighting applied. Data collection Following ethics approval, all 95 registered nurses employed on a permanent basis within the ED at the time of the study were invited to participate. An email from the study investigator was forwarded to eligible nurses by the emergency nurse educator. The email explained the aims of the study and included an invitation to participate. Attached were a participant information sheet and the contact details for the study investigator, available via email or phone to discuss any questions regarding the study. Also included in the email was assurance that participation was voluntary, participants were under no obligation to complete the questionnaire, and that data collected were not identifiable. Staff were also informed about the study at regular departmental meetings by the clinical nurse consultant. Interested participants could elect to complete questionnaires either in their own time, or in allocated work time. They were directed to contact the emergency nurse educators who facilitated distribution of the questionnaires and/or allocation of work time to complete. The clinical nurse consultant and the nurse educator’s were not directly involved in the study. Data were collected over a three month period from July 2012—October 2012. All data were entered into an electronic spreadsheet and data entry quality checked by each study investigator. Data were then imported into SPSS v.2131 for analysis. Data analysis Descriptive statistics were used to summarise responses to the demographic and NEOTM-PI-3 questionnaires. Participant mean scores on the NEOTM-PI-3 were compared with established population norms using a one sample t-test. Due to the expected small number of males in the sample, a gender comparison was not feasible and combined (male and female) population norms were used for the comparison. The alpha level for statistical significance was set at 0.01. Results Demographic profile A total of 72 emergency nurses employed either full time (77.8%) or part time (22.2%) completed the study (76% response rate). Their mean age was 32.4 years (SD 9.0, range 20—58 years) and 80.6% were female. Compared to the general Australian nursing and midwifery workforce, participants in this study were slightly younger (32.4 years vs 38.4 years) and there was a slightly higher proportion of males (19.4% vs 14.1%). This pattern is similar to the demographics of the specialty critical care and emergency nurse workforce across Australia.32 Respondents had an average 10 years (SD 8.6) experience as registered nurses, with 6.9 years (SD 6.3) in emergency nursing. The majority of participants (87.5%) held a Bachelor of Nursing degree and just over half (51.4%) had some form of postgraduate nursing qualifi- cation. Of those with postgraduate qualifications, 30 (81.1%) held a specialty qualification in emergency nursing. Other postgraduate specialty qualifications were in critical care (13.5%), midwifery (8.1%) and nursing management (5.4%). 142 B. Kennedy et al. Table 2 NEO-PI-3 scores for extraversion of emergency nurses compared to population norms. Personality domain and facets Combined population norms mean score (SD) Emergency nurses mean score (SD) Extraversion 110.4 (19.3) 121.8 (19.9) p < .001a E1: Warmth 22.3 (4.4) 23.9 (4.5) p = .003a E2: Gregariousness 17.1 (5.1) 18.4 (5.0) p = 039a E3: Assertiveness 16.1 (4.9) 16.1 (5.5) p = .962a E4: Activity 17.7 (4.3) 19.4 (4.3) p = .002a E5: Excitement-Seeking 17.2 (5.1) 20.7 (4.8) p < .001a E6: Positive Emotions 20.2 (4.9) 23.4 (4.6) p < .001a a One sample t test with combined population norms, alpha set at p ≤ 0.01. Figure 1 Emergency nurses mean NEOTM-PI-3 scores compared with population norms. Personality profile — NEOTM-PI-3 Participants in this study scored significantly higher than combined population norms for the personality domains of Extraversion (p < .001), Openness to experience (p < .001) and Agreeableness (p = .001) (Fig. 1). Participants also scored higher than NEOTM-PI-3 population norms on four out of six facets within the Extraversion domain: warmth (p = .003); activity (p = .002); excitement seeking (p < .001) and; positive emotions (p < .001) (Table 2). The personality domain of Extraversion is related to the way in which one approaches and deals with individuals and the world around them. High scores on the Extraversion facet of the NEOTM-PI-3 are associated with friendly individuals, who tend to lead fast paced lives and who possess the ability to engage in conversation easily with strangers and are comfortable in noisy environments.18,26 Analysis of facets within the personality domain of Openness to experience found that the emergency nurses scored higher than population norms on three of the six facets: feelings (p < .001); actions (p < .001) and; values (p < .001) (Table 3). The Openness to experience domain relates to how and individual responds to various types of experience.26 High scores on facets within the Openness to experience domain in the NEOTM-PI-3 are associated with individuals who are broad minded, tolerant of others lifestyle choices, aware of their own feelings and willing to challenge social, political and religious values. High scores on the Openness to experience domain and facets describes individuals who like variety and the opportunity to experience new and different activities as opposed to leading a predictable and routine lifestyle (Table 4).18,26 Within the personality domain of Agreeableness, emergency nurses in this sample scored higher than population norms on two facets: altruism (p < .001) and modesty (p = .002). High scores on these facets of the NEOTM-PI-3 are associated with individuals who are thoughtful and considerate, and who will do whatever
is necessary to assist others. The Agreeableness domain describes individuals who are modest and humble and who prefer not to be put in the spotlight, preferring to highlight the achievements of others rather than their own.18,26 While there was no difference found between emergency nurses in this sample and NEOTM-PI-3 population norms for the domains of Neuroticism (p = .397) and Conscientiousness (p = .153), analysis of the facets within these two domains (Table 1) showed that participants in this study scored significantly higher on impulsiveness (p = .002) and competence (p = .003), and lower on vulnerability (p < .001). Lower vulnerability scores are associated with an ability to function Table 3 NEO-PI-3 scores for openness to experience of emergency nurses compared to population norms. Personality domain and facets Combined population norms mean score (SD) Emergency nurses mean score (SD) Openness to experience 107.7 (18.6) 119.9 (19.2) p < .001a O1: Fantasy 17.1 (4.6) 18.4 (5.6) p = .045a O2: Aesthetics 16.4 (5.7) 17.0 (5.7) p = .398a O3: Feelings 20.4 (4.1) 22.3 (3.8) p < .001a O4: Actions 15.9 (3.6) 19.5 (3.4) p < .001a O5: Ideas 17.8 (5.4) 18.9 (6.0) p = .135a O6: Values 20.1 (4.2) 23.8 (3.7) p < .001a a One sample t test with combined population norms, alpha set at p ≤ 0.01. Personality profile of emergency nurses 143 Table 4 NEO-PI-3 scores for agreeableness of emergency nurses compared to population norms. Personality domain and Facets Combined population norms mean score (SD) Emergency nurses mean score (SD) Agreeableness 119.1 (18.2) 125.9 (17.5) p = .001a A1: Trust 19.5 (4.5) 19.0 (5.2) p = .441a A2: Straightforwardness 20.3 (4.7) 21.5 (4.5) p = .030a A3: Altruism 23.4 (3.9) 25.4 (3.6) p < .001a A4: Compliance 16.4 (4.5) 17.6 (5.0) p = .061a A5: Modesty 19.1 (4.4) 21.4 (4.4) p = .002a A6: Tender-mindedness 20.4 (3.9) 21.8 (4.1) p = .026a a One sample t test with combined population norms, alpha set at p ≤ 0.01. well in emergency or stressful situations and to continue to make effective decisions in such circumstances. Higher scores on the conscientiousness facet reflect the personality of an individual who is proactive in keeping themselves informed and who possess good decision making skills and commonsense. Higher scores on impulsiveness are associated with individuals who at times may take impulsive action.18,26 Discussion This study generates a profile of the personality of Australian emergency nurses working in the ED of a large hospital in Sydney. These nurses demonstrated significantly higher scores than combined population norms on three of five personality domains measured by the standardised NEOTM-PI-3 personality assessment instrument which is based on the Five Factor Model of personality. These were the personality domains of Extraversion, Openness to experience and Agreeableness. The emergency nurses participating in this study were a relatively experienced group, with more than half (68.1%) having worked in the ED for more than three years. This suggests that their results may be consistent with nurses who have been retained within the emergency nursing specialty. Since the inception of specialist emergency nursing, there has been considerable evolution and change in the professional role of emergency nurses.33 There has only been one other study exploring personality in emergency nurses.34 This study was undertaken more than twenty years ago and used a different instrument to measure personality. It was considered that the results of this study would not be an accurate reflection of today’s emergency nurse workforce. In addition, use of a different personality instrument would make it difficult to accurately compare results of the studies. Emergency nursing is a unique and specialised area of practice functioning within a distinct health delivery environment.35 The ED is a busy, noisy work environment, with a high patient turnover. The frequency and type of presentations is unpredictable and emergency nurses must have the capacity to care for the full spectrum of physical, psychological and social health problems within their community.35 Emergency nurses are required to work within a time pressured environment. With the introduction of National Emergency Access Targets (NEAT) in New South Wales in 2012, it is intended that by 2015, 90% of patients must be triaged, treated and discharged from the ED within four hours.36 The unpredictability, along with time pressures, adds to the stress of the work environment. This practice environment is likely to offer experiences appreciated by nurses who score higher than the general population in the personality domains of extraversion and openness, such as shown by the emergency nurses participating in this study. Emergency nurses must also be able to develop a rapport with individuals from all age groups, socioeconomic and cultural backgrounds, in time-critical situations, and often at a time when these individuals are most vulnerable.35 To gather the information necessary for effective treatment of patients within their care, it is vital that emergency nurses have sufficient skill and the type of (extraverted) personality that allows them to develop relationships and engage in conversation with patients while conducting an assessment.37 Emergency nurses also need to possess the characteristics associated with the personality domain of Openness to experience, to facilitate confidence when treating patients from diverse backgrounds in an unpredictable and hectic work environment. Participants in this study also had high scores in the personality domain of Agreeableness, and particularly, the facets of modesty and altruism. These characteristics may be common to many individuals who choose nursing as a career, however, there is no evidence to support this notion and further research across all nursing specialties using the NEOTM-PI-3 is required. The personality profile of this sample of Australian emergency nurses suggests that nurses who demonstrate the personality characteristics of Extraversion, Openness to experience and Agreeableness are likely to be suited to emergency nursing work and have the ability to function in the (at times) stressful and fast paced work environment. This study has some limitations. Due to the relatively small sample size it was not possible to examine potential differences in the personality profiles of sub groups such as males and females; part time or fulltime workers, and length of time employed in the ED. The study was conducted at a single site. Larger, multicentre studies across a range of emergency nursing practice contexts are required to determine if our results are generalisable to the broader emergency nursing workforce. Personality testing is used by a variety of professions to compliment recruitment processes.21 As a consequence of advances in technology and health care, it takes significant resources to train nurses to function as experts in their specialty.38 For example, it can take up to two years 144 B. Kennedy et al. for an emergency nurse to attain the requisite knowledge base and skills to progress to triage training, for oncology nurses to perform plasmapheresis or for intensive care nurses to perform extracorporeal membrane oxygenation. Personality testing has the potential to play a role in the recruitment of nursing staff suited to a particular specialty, just as it has been considered in some medical fields such as anaesthesia.39,40 While personality testing should not be used to prevent people working in a particular specialty area of their choice, testing may have a role in targeting those nurses more suited to a clinical area and therefore, improve retention within their field. There have been three studies that investigate nursing personality profiles in other specialties such as critical care41 and oncology.42,43 A further two studies have investigated and compared the personality profiles of specialist medical and surgical nurses,17 and medical- surgical and intensive care nurses.16 However each of these studies have limitations, including small sample sizes, lack of comparison
to population norms. All of these studies were undertaken over an expansive timeframe and none in the last ten years making them unlikely to be an accurate reflection of today’s workforce. A broader, more robust personality profile of nurses successfully employed within defined specialty areas is needed. Conclusion Emergency nurses in this study demonstrated higher levels of Openness to experience, Agreeableness and Extraversion in their personalities than established population norms. Further research in emergency nursing and other specialty areas will more accurately establish personality profiles and determine whether these are unique to nurses working within these specialties. The investment required to train nurses to function as a ‘‘specialist’’ implies that a benefit exists in targeting individuals potentially suited to working within specialty nursing areas to optimise their retention within the specialty workforce. Authorship BK and KC conceived, BK, KC and DW designed the study and developed the study protocol. BK conducted data collection and entry, KC and DW supervised data collection and quality. BK and KC analysed the data. BK, KC and DW prepared and approved the manuscript. Provenance and conflict of interest We declare this is original work and there are no conflicts of interest. This paper was not commissioned. Funding The study received no funding and was undertaken as a Masters of Philosophy research degree. Research ethics statement This paper reports the findings of a research study that adhered to the National Statement on the Conduct of Human Research by the Australian National Health and Medical Research Council, and has been approved by the South East Sydney Central Network Human Research Ethics Committee (HREC approval: LNR11/STG/223). References 1. Hirschkorn CA, West TB, Hill KS, Cleary BL, Hewlett PO. 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