Association between nurses' personality characteristics and their attitude toward the older adults.

BACKGROUND: Administration of quality care in the aged people requires having a positive attitude toward them. Numerous factors including nurses' personality characteristics may play a role in their attitude toward the aged people. Therefore, the present study investigated the association between nurses' personality characteristics and their attitude toward the aged people.
MATERIALS AND METHODS: This is a cross-sectional study conducted on 261 nurses selected through random stratified sampling. Kogan's Attitudes toward Older People Scale (KAOPS) was adopted to measure nurses' attitude toward the aged people, and five-factor personality inventory was used to detect their personality dimensions. The data were analyzed by descriptive and inferential statistical tests (Pearson correlation coefficient and multiple linear regression). P < 0.05 was considered significant.
RESULTS: Results showed that the predictive model of nurses' attitude toward aged people based on their five-factor personality dimensions was significant (P = 0.001). Overall, the variables, entered in the model, predicted 13% of variance of nurses' attitude toward aged people. Among the predicting variables, two dimensions of personality, including agreeableness (P = 0.046) and neuroticism (P = 0.003), significantly predicted nurses' attitude toward aged people.
CONCLUSIONS: The results showed that nurses with higher agreeableness and lower neuroticism can be an appropriate option in caring for the aged people. Therefore, nurse managers are suggested to take steps toward creating a more positive attitude toward the aged people among nurses, in addition to holding educational programs for them with the goal of agreeableness empowerment.

INTRODUCTION

Based on the general census of population and housing in Iran in 2006, aged people over 65 years comprise about 5.19% of the total population of Iran (70 million).[1] Old age is a period during which changes occur in shape and function of internal and external organs and they impair individuals’ adaptation with the environment.[2] Various studies also emphasized on an increase in burden of diseases and disability in the elderly. It comprises a noteworthy portion of health care and treatment service receivers in geriatric health system.[3] High prevalence of diseases and disability among aged people creates a higher demand for the care given to this group by experienced and professional staff,[4] which is mostly provided by nurses.[5] Experts have stated that the best way to fulfill aged people's needs is through promotion of nurses’ knowledge concerning the needs of geriatric group. If less experienced and untrained nurses are hired to take care of the aged people, the quality of care becomes less.[6] Some evidences show that the attitude toward aged people is among the elements determining the quality of care they are given such that individuals’ more positive and emotional attitude toward the aged people brings about a more satisfactory life for them.[7] Therefore, some researchers tried to investigate nurses’ attitude toward the aged people and its association with various factors. For instance, Hosseini Seresht showed that the first year nursing students had negative, third year students had neutral, and working nurses had a positive attitude toward aged people.[8] Mellor, in a study on nurses’ attitude toward the aged people, reported a significant difference between education level and the attitude toward the aged people.[9] Various factors, mentioned in some of the aforementioned studies, seem to explain the differences in individuals’ attitudes toward the aged people. If we refer to psychological background of individuals’ behavior and attitudes, the role of their personality characteristics in prediction of their specific behavior and attitudes toward various phenomena is highlighted.[10] Based on definition, personality is a pattern of thoughts, feelings, and behavior, resulting from personal characteristics, accompanied with hidden and observable strategies that are masked by that pattern. Nowadays, the Big Five Personality Dimensions, introduced by Goldberg, have been widely accepted and adopted to define most of the personality aspects of individuals.

Its five dimensions include extroversion, agreeableness, conscientiousness, neuroticism, and openness.[1213] Selection of the appropriate personality can improve a better occupational function for the organization and affect the staff's attitude toward their own work.[14] In fact, individuals’ personality plays a key role in their occupational function as it frames their motivation and attitude toward their occupation and the way they respond to occupational demands.[12] Although the determining role of individuals’ personality characteristics in their behaviors and attitudes has been emphasized, this important issue has not been mentioned in nursing texts. On the other hand, despite the warnings about the existence of a negative attitude toward the aged people, even among the health system staff, this issue has not been taken seriously and their determinants have not been detected yet. Finally, despite discovering the important role of individuals’ personality in prediction of their specific behaviors and attitudes, no study has been conducted on the predictive role of nurses’ personality characteristics in determination of their attitude and, consequently, their function in provision of health services to the aged people. Therefore, the present study aimed to investigate the association between nurses’ personality characteristics and their attitude toward the aged people.

MATERIALS AND METHODS

This is a cross-sectional study conducted in 2014. Subjects comprised 261 nurses working in selected university hospitals in Isfahan, who were selected through random stratified sampling. After calculation of sample size, the number of subjects in each hospital, as well as their number in each ward (according to the number of hospitalized aged people in that center and its wards) was determined. Researcher's access to the subject was made possible after obtaining respective official permission and by coordinating with the head nurses of the wards. Nurses with a bachelor's degree or above were selected, and after receiving necessary information about the goals of the study and its process, they signed an informed consent form. Researcher referred to the wards in different shifts and collected the data by a questionnaire. Goren questionnaire with 34 items was adopted to evaluate nurses’ attitude. Big Five Personality Dimension of John et al. (1991) was adopted to measure personality dimensions. This questionnaire contains 44 items scored in a five-point Likert's scale (absolutely disagree = 1 to absolutely agree = 5), divided into five sub-scales (representing the five dimensions of personality), including extroversion (8 items); agreeableness (9 items), consciousness (9 items), neuroticism (8 items), and openness (10 items). The scoring was done by adding up the scores of the items in each sub-scale. Validity and reliability of the Persian version of Kogan's Attitudes toward Older People Scale (KAOPS) were confirmed by Karshki and Garavand. Its content validity was reported to be 0.88 (by experts’ indications), and its internal consistency was established by Cronbach alpha (α = 0.81).[15] Validity and reliability of Five Personality Dimension model questionnaire were established by Fossati et al. among Italian subjects.[1] Nasseh et al. reported Cronbach alpha of over 0.75 for all its dimensions and reliability of over 0.70 (r = 0.70) for this questionnaire.[12] To investigate the demographic characteristics of the study population, a demographic and occupational questionnaire including age, sex, work experience, type of employment, educational degree, marriage, history of living with an older adult, and the nurses’ related ward of hospital was adopted.

Collected data were analyzed by descriptive and inferential statistical tests (correlation coefficient, multiple linear regression analysis) through SPSS 17. In regression analysis, personality dimensions and personal and occupational characteristics as predictive variables and nurses’ attitude as criterion variable were entered in the model.

Ethical considerations

The present study was approved by the ethics committee of Isfahan University of Medical Sciences and all ethical considerations including subjects’ volunteer participation and confidentiality of their data were respected.

RESULTS

Results showed that out of 261 nurses, 193 (73.9%) and 68 (26.1%) were female and male, respectively. Subjects’ mean [standard deviation (SD)] age and work experience were 34.92 (7.19) and 10.86 (7.33) years, respectively. About 62.1% of the subjects were married, 0.8% were widowed, 0.4% were divorced, and 36.8% were single. Most of the subjects were either a permanent staff (35.6%) or a casual staff (35.6%) and had the history of living with an older adult (53.3%), while most of them had no history of professional care of an older adult (67%). Mean (SD) of subjects’ attitude scores are presented in Table 1, and mean (SD) of five personality dimensions scores are presented in Table 2. For multiple regression analysis assumptions provision, the data were evaluated and skewness and kurtosis values were proved in an appropriate range of ±2, revealing the normal distribution. Tolerance and volume of inflation (VIF) values were also in appropriate range, revealing absence of linearity of predictive variables. Results showed that predictive model of nurses’ attitude, based on their five personality dimensions, was significant (P = 0.001, F12,243 = 2.992). The entered predictive variables explained 13% of variations related to attitude in the model (R2=0.13). The obtained results of multiple regression analysis evaluating the association of predictive variable with attitude are briefly presented in Table 3. Results showed that none of the subjects’ personal or occupational characteristics were correlated with nurses’ attitude toward the aged people. Among the variables of personality, two variables of agreeableness and neuroticism significantly predicted nurses’ attitude toward the aged people.

Table 1

Mean and standard deviation (SD) scores of nurses’ attitude toward the aged people (N=261)

Table 2

Mean (SD) scores of five dimensions of nurses’ personality (N=261)

Table 3

Multiple regression analysis results to evaluate the predicting variables of attitude

DISCUSSION

The present study was conducted with the goal of defining the association between nurses’ personality characteristics and their attitude toward aged people in the university hospitals of Isfahan. In general, the results showed that among the variables associated with personality characteristics, two variables of agreeableness and neuroticism could significantly predict nurses’ attitude toward aged people. Existence of a positive and significant association between agreeableness in nurses and their attitudes toward aged people showed that nurses with the personality characteristic of agreeableness were more appropriate to work with the clients. In addition to having a more positive attitude toward aged people, they have more desire to work with them and are able to make a more efficient communication with the old patients, which is in line with other studies. For instance, Atari et al.[16] believe that individuals with more agreeableness have a spirit of cooperation, are more reliable, have a more positive approach toward their function, and even understand the negative aspects of working environment. They also believe that a person with agreeableness has more philanthropy and likes to have empathy, cooperation, and supportiveness in his/her interpersonal communications. Daff,[17] Singh and Singh,[18] and Van Emmerlik and Euwema[19] showed that agreeableness is positively and significantly associated with citizens’ organizational behavior. It seems that existence of such specifications in people with agreeableness can reveal their positive attitude toward the aged people, which is consistent with the present study. However, further studies are needed to clarify the nature of such an association.

Results also showed that neuroticism had a significant negative association with nurses’ attitude toward aged people, which is in line with some other studies.

Nasseh et al. believe that individuals with neuroticism experience signs such as anxiety, insecurity, anger, and negative attitude toward others, which leads to their reduced personal success and, consequently, results in negative effects on their treating the clients.[12] Some evidences show that high scores of neuroticism are accompanied with lack of emotional stability and negative emotions such as fear, sadness, confusion, anger, guilt, and hatred, and people with neuroticism are more prone to impulsiveness, aggression, and vulnerability.[16] Therefore, existence of such characteristics in nurses with neuroticism can result in their negative attitude toward the specific and vulnerable clients, including the aged people. Although the present study did not focus on investigation of psychological and behavioral outcomes of neuroticism in nurses, some other existing studies investigated the psychological and behavioral outcomes of neuroticism in nurses and reported miserable outcomes among these people. For instance, Van Emmerik and Euwema reported a significant negative association between neuroticism and citizens’ organizational behavior dimensions.[19] Ghanei et al. emphasized on the association between neuroticism and occupational stress.[20] Regression analysis carried out in the study of Alizadeh Goradel showed that neuroticism is a significant predictor of occupational burnout.[21] All these evidences support the conclusion that nurses with neuroticism are not an appropriate choice to be hired to work with the aged people, as these clients have more complicated needs, compared to others. In the present study, three variables of extroversion, conscientiousness, and openness were not significantly associated with nurses’ attitude toward the aged people, which is not in line with the findings of other studies. Nasseh et al.[12] reported a significant negative association between extroversion and emotional burnout. As the positive emotions of extrovert people can make them hopeful about their future occupational function, they are expected to have lower levels of emotional burnout and, consequently, more appropriate function and attitude toward the aged people. They also reported a significant negative association between conscientiousness and all dimensions of occupational burnout. As people with conscientiousness are conscious and accountable with a positive occupational motivation, they are expected to have a more positive attitude and desire to play a role in different situations, including working with the aged people.

One the other hand, in the study of Nasseh et al., a significant negative association was reported between openness and a diminished personal accomplishment. In fact, people with a high level of openness are more curious and creative toward their environment and, consequently, they have fewer levels of the anxiety and confusion. Therefore, they are expected to have a more appropriate approach toward the aged people.

This result is also inferred from other studies including Swider,[22] Shimizutani,[23] and Azeem.[24] Meanwhile, the results of the present study showed no significant association between the three variables of extroversion, conscientiousness, and openness. The difference in results might have originated from the different socio-cultural factors of the study populations. However, further studies are suggested in this context to obtain more clear results. It should be noted that some limitations could have affected the results, including the fact that five-factor personality measurement does not contain all personality characteristics affecting the attitude toward the aged people. Moreover, the multiple regression model, ignore measurement error and, consequently, cannot clarify all factors and specifications associated with nurses’ attitude toward the aged people.

CONCLUSION

The results showed that the variable of agreeableness was significantly and positively associated with nurses’ attitude toward the aged people, and neuroticism had a negative significant association with their attitude toward the aged people. Thus, nurses with higher agreeableness and lower neuroticism can be an appropriate option for the aged people. Therefore, nurse managers are suggested to take steps toward creating a more positive attitude toward the aged people among nurses, in addition to holding educational programs for them with the goal of agreeableness empowerment.