Title: Factors related to clinical performance of baccalaureate nursing students
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Title: Factors related to clinical performance of baccalaureate nursing students
Physical Description: viii, 86 leaves : ; 28 cm.
Language: English
Creator: Gregory, Shirley Joan
Copyright Date: 1977
 Subjects
Subject: Nursing students -- Psychology -- Florida   ( lcsh )
Personality and occupation   ( lcsh )
Curriculum and Instruction thesis Ph. D
Dissertations, Academic -- Curriculum and Instruction -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
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Statement of Responsibility: by Shirley Joan Gregory.
Thesis: Thesis--University of Florida.
Bibliography: Bibliography: leaves 81-85.
General Note: Typescript.
General Note: Vita.
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Bibliographic ID: UF00098918
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000210061
oclc - 04168779
notis - AAX6880

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FACTORS RELATED TO CLINICAL PERFORMANCE
OF BACCALAUREATE NURSING STUDENTS














BY

SHIRLEY JOAN GREGORY


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY




UNIVERSITY OF FLORIDA


1977

































Copyright by
Shirley Joan Gregory
1977

































To

my parents

Lunelle and Henry S. Gassner, Jr.














ACKNOWLEDGMENTS


The author gratefully acknowledges the support and

assistance of her advisory committee, Dr. James W. Hensel,

chairman; Dr. William Alexander; Dr. Blance I. Urey;

Dr. Wilson Guertin; Dr. Margaret K. Morgan; and Dr. Amanda

Baker.

To Dr. Hensel and Dr. Morgan I pledge that their very

special contribution to my future will be perpetuated

through my efforts in behalf of others.

Sincere appreciation is extended to Dr. Rose Mary

Ammons, George Mayer, Shirley Lyons, and Pauline Hill for

their kind and expert assistance in organizing the data.

Gratitude is expressed to Barbara Bradford and

Bobbie Moskot for their help with the hand scoring.

I am deeply indebted to each student from Florida State

University, the University of Florida, the University of

South Florida, and Barry College who so graciously and

professionally participated in this research.

To Sue Kirkpatrick I am sincerely appreciative of

her infinite patience in the typing of this study.

For their continued interest and support in all of

my endeavors, I am most grateful to my parents, sisters,

and brothers.

















TABLE OF CONTENTS


Page


ACKNOWLEDGMENTS . . . . . . . . . .

ABSTRACT . . . . . . . . . . ..


CHAPTER 1.


CHAPTER 2.




CHAPTER 3.


INTRODUCTION . . . .

Statement of the Problem .
Assumptions . . . .
Delimitations . . . .
Limitations . . . .
Operational Definitions .

REVIEW OF RELATED LITERATURE


. . . .

. . . 3
. . . 4
. . . 4
. . . 4
. . . 5


. 7


Summary . . . . . . . ..


PROCEDURES . . . . .


. 14


Phase One: Instrumentation . . .
Development of the Instrument .
Pilot Test of the Selected Items .
Q Sort Items: Profile of Perceived
Performance . . . . . .
Sixteen Personality Factor Question-
naire . . . . . . . .
Comprehensive Ability Battery .
Phase Two: Collection of Data . .
Sample . . . . . . . .
Collection of Data . . . . .
Phase Three: Production of Shape
Factors . . . . . . . .
Phase Four: Computation of Coefficients
of Correlation for All Variables .

CHAPTER 4. ANALYSIS AND INTERPRETATION OF DATA .

The Shape Factors . . . . .
Identifying the Types . . . .
Pattern Descriptions . . . . .
Type 1 . . . . . . .
Type 2 . . . . . . .











Page


Type 3 . . . . . . .
Type 4 . . . . . . .
Type 5 . . . . . . .
Correlation of Shape Factors and
Personal Variables . . . .

CHAPTER 5. SUMMARY, CONCLUSIONS, AND RECOMMENDA-
TIONS . . . . . . . .

Conclusions . . . . . .
Recommendations . . . . .

APPENDIX A. LETTER TO THE DEANS . . . . .

APPENDIX B. BIOGRAPHIC DATA . . . . . .

APPENDIX C. LOADINGS ON SHAPE PATTERN FACTORS .

REFERENCES . . . . . . . . . .

BIOGRAPHICAL SKETCH . . . . . . . .









Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

FACTORS RELATED TO CLINICAL PERFORMANCE
OF BACCALAUREATE NURSING STUDENTS

By

Shirley Joan Gregory

August, 1977

Chairman: James W. Hensel
Major Department: Curriculum and Instruction

The research was designed to identify patterns of

behavior in clinical performance of baccalaureate nursing

students and to determine their relation to certain per-

sonal variables in the cognitive, affective, and psycho-

motor domains. A total sample of 96 senior level nursing

students from three major universities in Florida partici-

pated in the project.

A self-report technique was used to collect data over

a wide spectrum of clinical performance behaviors. The

questions were presented in a Q Sort format for the

purpose of compensating for bias due to social desirability

of some items. The instrument was given the title "Profile

of Perceived Performance." Q factor analysis produced

five patterns which accounted for only a small amount of

total variance (26%). However, the qualitative descriptions

of those patterns seemed to have credibility when com-

pared with personal observations of practicing nurses.









Continuous variables from the shape factors were

produced by using each subject's factor loadings on all

rotated factors that had qualified as pattern factors

(i.e., three or more subjects loading at .50 or above).

Pearson product moment correlations were calculated be-

tween these variables and the subjects' scores on three

subtests of the Comprehensive Ability Battery (CAB) and

the 16 scores from the Sixteen Personality Factor

Questionnaire (16 PF) Significant relationships were

revealed between three of the five shape variables and

several of the variables from the 16 PF and the CAB.

An important by-product of the research was the

potential usefulness of the Profile of Perceived Perfor-

mance. It has potential input as a clinical teaching

tool and as a source of data for program evaluation in a

variety of health-related professions.


viii















CHAPTER 1

INTRODUCTION



Within memory of the present generation of practi-

tioners, the almost extinct role stereotype of the nurse

was fairly accurate. Duties and expectations, within

limited parameters, clearly defined the nurse's role. The

scope of that role has now changed. Alterations in health

care, as well as in the agencies providing it, have

challenged conventional role expectations (Kelly, 1966;

Lysaught, 1970; Henderson, 1973). Today there is no

single type, role, set of duties, nor one level of expec-

tation as far as career advancement is concerned. In

short, nursing has become such an expansive field in and

of itself that there is room for a wide variety of

persons, each with his own pattern of individual differences.

With the increasing rate of change in role structure,

more types of persons will find outlets for their talents

in this field.

The study was designed to identify patterns of be-

havior in clinical performance and to determine their

relation to personal variables in the cognitive, affective,

and psychomotor domains.










The Procrustean method in which students' individual

differences were subdued, transforming them into the

stereotype image of the dedicated nurse, is no longer

appropriate. Today's nursing educators face a mandate

to devise ways of identifying and nurturing individual

differences of students in order to provide the varied

types of nurses needed by the profession.

The ever-changing status of practice imposes a major

responsibility on nursing educators to discover what con-

stellations of personal characteristics exist in students

currently enrolled in nursing programs and how they relate

to performance characteristics.

Many educators, including those in nursing, become

uncomfortable with the thought of accommodating the myriad

individual differences that have been identified by be-

havioral scientists. The problem is confounded because

not only are there many roles, but each individual brings

his own style of behavior to the role he occupies. That

is to say, several similar roles, held by different

persons, will be implemented in as many different ways

as there are persons (Cronbach, 1970; Cattell, 1973).

However, research has shown that such differences tend to

fall into patterns or types (Guertin, 1966; McCaulley, 1974).

Nowhere in nursing education is the problem of manag-

ing individual differences more apparent than in the










clinical setting. Performance in this area is a unique

tripartite aspect of education, residing as it does in

three domains. Although once considered to be primarily

psychomotor in nature, clinical performance is now

recognized as also containing cognitive and affective

components (Kelly, 1966). Clinical performance is a

synthesis of knowledge gained, cognitive skills acquired,

and the attitudes developed, in addition to the purely

psychomotor tasks that also remain high in importance.

Since 1965 there has been a significant increase in

the development of techniques designed to break large

groups into clusterings or subgroups of individuals who

share similar characteristics (Hartigan, 1975). These

techniques are becoming more widely known and are being

adapted to an ever-enlarging range of applications.


Statement of the Problem

In order to nurture those individual differences of

nursing students which may contribute to the different

styles of clinical performance needed in the health care

delivery system, it is necessary to determine first

whether such styles can be identified empirically. Only

then can the relationship of personal variables to

clinical performance styles be studied in a scientific

manner.










The objectives identified to achieve the purpose of

the study were

1. To identify and isolate style or patterns of

nursing performance behaviors; and

2. To determine whether a relation exists between

patterns of nursing performance behaviors and

personal variables of nursing students.


Assumptions

For the purpose of this research it was assumed that

1. The Sixteen Personality Factor Questionnaire was

a valid and reliable instrument for measuring

primary source traits of personality;

2. The Comprehensive Ability Battery was a valid

and reliable instrument for measuring primary

ability factors of personal variables;

3. The sample population had been exposed to

curricula similar in overall criteria as defined

by the National League for Nursing (1972) and

the Florida Nurse Practice Act (1976);

4. Individuals in the sample would respond in a

sincere manner;

5. Volunteer participants were representative of

the population of nursing students in Florida;

and

6. Error would be random.










Delimitations

A recognized delimitation of the research was that

1. Only three baccalaureate nursing programs, having

upper division status, were considered.


Limitations

The research is further limited in that

1. Ninety-six senior level nursing students partici-

pated in the sample through volunteering; and

2. The Profile of Perceived Performance Instrument

required self-perception only.


Operational Definitions

For the purposes of this study the following defini-

tions will be used:

Baccalaureate nursing student--one who is currently

enrolled in a program of nursing leading to a

four-year degree.

Clinical performance--those experiences which will

allow nursing students to apply their knowledge

to a client-related situation, real or simulated.

Perceived clinical performance--a self-report by which

a nursing student perceives his own level of per-

formance, developed by the researcher for this study.

Personal characteristics--those characteristics or

features which distinguish one person from

another, such as biographic data.






6



Personal variables--those entities in the cognitive,

affective, and psychomotor domain which dis-

tinguish one person from another.

Profile--refers to a set of scores obtained by an

individual on a given set of measuring devices.

Pattern--refers to the profile of mean scores of a

group of individuals who have been found to have

similar profiles.

Holistic--refers to the "wholeness" of an individual.















CHAPTER 2

REVIEW OF RELATED LITERATURE



The chapter is organized around discussions of

nursing literature that relate to registered nurses'

performance, registered nurses' personality, nursing

students' performance, nursing students' personality.

Considering the relatively large amount of research

that has been generated by, for, and about nurses in the

last twenty years, it is noteworthy that so little has

been concerned with clinical performance. Probably the most

extensive amount of nursing research involves predicting

scores on state licensure examinations, a topic which,

according to Smeltzer (1965), has been investigated "up,

down, and sideways." This is not to imply that such

studies were not needed, since every graduate from a state

accredited program of nursing must pass a licensure

examination in order to practice as a registered nurse.

One of the more recent studies (Williams, 1975) investi-

gated the relationship of personality to the National State

Board of Nursing Test Pool Examination scores. Williams

determined the existence of relationships between

performance on the total National State Board of Nursing










Test Pool Examination (NSBTPE) score and type, as

measured by the Myers-Briggs Type Indicator (MBTI), as

well as between scores on four of the five subscales of

the NSBTPE and type.

However, research also shows that success on the

NSBTPE does not necessarily forecast success in nursing

practice. Dubs (1975) demonstrated this by comparing

on-the-job performance of 30 graduates from a diploma

nursing program and their achievement while students in

the school to their NSBTPE scores. The study revealed

that students' cumulative grade point averages and their

nursing theory grades were the best predictors of success

on the NSBTPE. However, clinical performance grades were

clearly the best predictors of their performances as

registered nurses.

Since clinical performance can be considered analo-

gous to the nurses' performance in the "real world," much

interest has centered in this area. Two studies of

national importance (Knopf, 1972; Schwirian, in press) have

addressed this facet of nursing. In 1961, the National

League for Nursing initiated a longitudinal study of

nursing students, their occupational goals, and demographic

characteristics. Significance of the study, as pointed

out by Knopf (1972), lay in the broad data base provided

by a sample of 45,000 nursing students from three types










of programs: hospital diploma, associate degree, and

baccalaureate. Conclusive data about baccalaureate

students is not yet available. In another extensive

project funded by the Division of Nursing, United States

Public Health Service, Schwirian (in press) undertook, among

other tasks, the collection of all extant information

concerning prediction of nursing students' later perfor-

mance as registered nurses. The project, now in the third

of its four phases, has made extensive use of question-

naires directed to randomly selected basic schools of

nursing throughout the United States. Several unpublished

tentative conclusions were shared by the project director.

A comparison of performance ratings by nursing supervisors

and self-reported ratings by graduate nurses indicated

notable differences in the areas of interpersonal rela-

tions, critical care, and leadership. Supervisors rated

graduates' performance in critical care higher than the

graduates had rated themselves and lower in the areas

of interpersonal relations and leadership than the gradu-

ates had rated themselves. Baccalaureate graduates were

rated significantly higher on teaching and planning

nursing care than were graduates from associate degree and

hospital diploma programs.

Recent literature addressing the problem of a broad

spectrum of personal variables as they relate to clinical










performance of nursing students is limited (Morgan, 1974;

Koehne-Kaplan and Tilden, 1976; French and Rezler, 1976).

Most research that seems to have some bearing on the

problem can be considered to fall into one of several

categories: performance of registered nurses, personality

of registered nurses, performance of nursing students, and

personality of nursing students.

The primary reason for existence of any professional

program is to prepare persons for performance in that

profession. Knowledge of existing activities and be-

haviors in a profession is essential to those who educa-

tionally prepare future performers. Urey (1968) explored

a method of identifying and classifying activities and

behaviors of nurses through task analysis. Each nursing

procedure, selected on the basis of its frequent implemen-

tation, was performed by a registered nurse and observed

by two observers. The method was determined by the

researcher to be reliable and could be easily adopted for

use by nursing educators. Prompted by interest in

efficient and effective analysis of nurses' performance

in the clinical setting, Dunn (1970) examined the

relationship between a cognitive test of scientific

principles and observed performance of selected registered

nurses. Significant differences were observed and reported

by the investigator. Five nurses who scored highest on










the cognitive test performed least well in the clinical

area, while the five who scored least well on the cognitive

test received better scores for actual performance. Both

Urey and Dunn supported the necessity for examining a

broad spectrum of personal variables as well as further

exploration in the area of clinical performance.

Kelly (1974), Gilbert (1975), and Beck (1976) ex-

amined the degree of congruence between leadership poten-

tial and personality traits. Kelly (1974) compared the

scores of registered nurses on the Minnesota Multiphasic

Personality Interview, Sixteen Personality Factors

Questionnaire, California Psychological Inventory, and

Edwards Personal Preference Schedule, with promotion as

the criterion. Analysis revealed only one of the derived

multiple correlation coefficients as statistically

significant. Of those nurses who were promoted, decisive

traits were found to be capacity for status, femininity,

and poise. Gilbert (1975) compared personality scores

with managerial (leadership) scores of 70 graduate

students in two specialities: medical-surgical and

psychiatric nursing. Although no significant differences

in leadership potential were observed between the two

groups, distinctions in personality did exist. A related

study by Beck (1976) compared registered nurses' scores

on the Myers-Briggs Type Indicator with their scores on










the Management Style Diagnosis Test. Beck reported a

significant difference between nurses in staff positions

and nurses in supervisory positions on the task orienta-

tion dimension. Executive style differences existed

in that nursing supervisors who scored high on the

executive dimension were of the sensing type, while staff

nurses on that same dimension were intuitive types.

These findings generally support the earlier determinations

of Lukens (1965) and Miller (1965).

While studies dealing with demographic and personality

characteristics of nursing students have been widespread

(Singh, 1971), most have been concerned with a constricted

number of variables and, more specifically, have related

to the theory portion of nursing education rather than

the clinical portion. An exception is the study by

Koehne-Kaplan and Tilden (1976), in which they explored a

concern about the relationship of personality to the

process of clinical judgment in a clinical setting. Test

scores from the Jungian Type Survey were used to examine

the degree of relationship to Final Examination scores of

99 baccalaureate nursing students. A combination of pen,

pencil, and simulated nurse-patient situations were used

as the Final Examination Score. Although the analysis

revealed no significant relationships, observation of the

gross data distinguished personality types. A related






13


study by Johnson and Leonard (1970) pointed out that

noncognitive measures of interest and personality have

failed to contribute significantly to the prediction of

clinical performance. An earlier observation by Taylor

et al. (1966) supports these findings.


Summary

In summary, the review of related literature pointed

out the following:

1. Although personality characteristics of

registered nurses and nursing students have been

the subject of extensive research, most studies are

directed toward success in theoretical aspects.

2. Predictors of success in clinical performance

are few in number.

3. Few educators have used research models which

permit use of a holistic approach to predict

successful clinical performance.















CHAPTER 3

PROCEDURES



This chapter includes four phases: Phase One

describes the development of the Q Sort instrument and

a pilot test of that instrument; Phase Two describes the

sample and data collection; Phase Three describes the

production of shape (Q analysis) factors; Phase Four

describes relationships between shape factors and scores

from two other instruments, the Sixteen Personality

Factor Questionnaire, and the Comprehensive Ability

Battery.

The major question to be answered involved one of

analyzing relationships between clinical-performance type

variables and personal variables in the cognitive,

affective, and psychomotor domains.

Although the available literature provided a wealth

of information concerning personal variables and their

hypothesized relation to nursing education, it did not

provide an instrument for collecting data about students'

clinical performance that would be suitable for this

study. While instruments have been developed, such as those










by Palmer (1960, 1962) and Tate (1964), none focused on a

holistic approach to obtain performance criteria. Also,

either they required a huge expenditure of person power

and time or were so contaminated with possible error

variance as to be relatively useless. Therefore, it was

necessary to develop an instrument that encompassed

performance in the cognitive, affective, and psychomotor

domains, while not requiring the mammoth amount of time

usually required for observation in all of these areas.

Rather than focusing on a few specified nursing

procedures, it was decided that the project should sample

broadly from the total spectrum of clinical experiences

encountered in a baccalaureate nursing program. This

included sampling from attitudes, knowledge, and

psychomotor behaviors in order to provide a holistic frame

of reference for the patterns.

After the development of the clinical performance

data-gathering instrument, a method was selected for

isolating patterns of types from the information to be

collected. A major criterion in selection of the pattern-

isolation method was that it must lend itself to creating

continuous variables from the patterns.

In addition to collecting the data concerning

clinical performance, commercial tests of personal vari-

ables in the cognitive, affective, and psychomotor domains










were administered to all students in the sample. Pearson

product moment correlation coefficients were calculated

between scores on those tests and the clinical perfor-

mance pattern variables.


Phase One: Instrumentation

In order to develop an appropriate technique to

collect a broad spectrum of clinical performance data, it

was first necessary to ask and respond to two questions:

1. What content should be included to collect a

broad spectrum of data on each student's clini-

cal performance?

2. What type of instrument could be utilized to

provide a total picture of each student's

clinical performance within a reasonable span

of time?


Development of the Instrument

Based on statements found in the literature, inten-

sive review of baccalaureate curricula,discussions with

nursing educators and practitioners, as well as the inves-

tigator's 15 years of personal observation in the clinical

setting, 20 seemingly appropriate constructs were

reviewed by selected faculty from the University of

Florida College of Nursing for the purpose of establishing

their suitableness to baccalaureate nursing education.










The selected constructs with references are listed

as follows:

1. Adaptability (Fischbach, 1977)

2. Breadth of categorization (Urey, 1968)

3. Communications (Raven, 1972; Ryden, 1977;

Tetreault, 1976)

4. Confidence (Raven, 1972)

5. Decision-making quality (Schwirian, in press)

6. Flexibility of cognitive closure (Koehne-Kaplan

and Tilden, 1976)

7. Initiative (VanDenby, 1976)

8. Mode of perception (Koehne-Kaplan and Tilden,

1976)

9. Persons, data, and things orientation (Moody,

1973)

10. Reality orientation (Henderson, 1973)

11. Responsibility (Ventura, 1976; Richards, 1972)

12. Tolerance for complexity (Schwirian, in press)

13. Assessment (Lewis, 1973)

14. Intervention (Lewis, 1973)

15. Safety (Dunn, 1970)

16. Evaluation (Lewis, 1973)

17. Leadership (Ventura, 1976; Gilbert, 1975)

18. Professional roles and relationships (Ventura,

1976)










19. Research (Lewis, 1973)

20. Teaching (Schweer, 1972).

A total of 193 items were then generated to sample

behaviors that seemed to typify the constructs.

The most obvious solution to the problem of obtain-

ing data in many performance areas within a short time

span was the use of a self-report technique. Self-report

has been validated for a variety of purposes, including

clinical performance. Among those, Peterson et al. (1975,

p. 13) reported that of a total sample of 164 nursing

students, 47 rated themselves exactly as their instructors

rated them; 48 rated themselves within 1 point of their

instructor's rating; 41 rated themselves within 2 points

of their instructor's rating; while 28 rated themselves

within 3 or more points of their instructor's rating. Similar

results have been reported by Palmer (1962) and Schwirian (in

press). Cronbach (1970, p. 493) offered that "self-

report can be treated as a record of typical behaviors,

which the subject is in a uniquely excellent position to

observe." However, self-report posed certain other

problems, chiefly that of social desirability biasing the

responses. Experts (Cronbach, 1970; Guertin, 1966; Cattell,

1973; Lemon, 1973) recommended that this problem is best

handled by an instrument based on a forced-choice format.










Therefore, the instrument that was developed, as described

later in this chapter, involved a ranking, or ipsatizing

procedure.

Because the selected methodology allowed the ranking

of a limited number of items, the investigator could at

best only sample behaviors. Further consultation with

selected faculty from the University of Florida College

of Nursing aided in the final decision of which behaviors

to retain. Of the original 193 items, 96 were selected

as those most appropriate for describing the selected

constructs and most suitable for baccalaureate education.


Pilot Test of the Selected Items

A 5-point Likert scale was developed for use with

the 96 items so they could be subjected to a pilot

testing procedure.

Twenty senior nursing students from Barry College in

Miami, Florida, volunteered to test the selected items.

Senior students were requested for the pilot testing

since they were essentially at the same academic level

and had had clinical experiences similar to those of

the sample identified for the total project.

Student comments were solicited by the investigator

following the testing procedure in order to determine










readability and clarity of the items. Based on their

suggestions and comments, several statements were reworded.

Means and standard deviations were computed and examined.

The distribution of a large number of items provided

evidence of bias due to social desirability of the content.

This justified use of a forced-choice format such as the

Q Sort.


Q Sort Items: Profile of Perceived Performance

Each of the 96 items was printed on a 2-x-3 card

(Figure 1).








It is easiest for me to
learn a procedure by watch-
ing someone else do it first.






Figure 1. Sample Q Sort card.



The items were separated into two Q Sorts, each

having 48 items, to permit ease in the procedure of sort-

ing. The list of items making up both Q Sorts can be

found in Figure 2. The first 48 items refer to










motivational concerns subsumed under the identified

constructs, while items 49 through 96 refer to actual

performance.


I offer assistance to
colleagues who need help


The more challenging
client care is, the better
I perform.


Frequently used procedures
rarely become automatic with
me.


Information presented in
broad terms is more under-
standable to me than when
it is presented in minute
detail.

No matter how I feel, I
assume responsibility for
care of the total client.


Above all else, I am a good
listener.


I carry out my clinical
responsibilities no matter
what.

My decisions are usually
effective.


I remain in the clinical
area during assigned hours
without thinking about
frequent breaks.


Setting priorities in
client care is easy
for me.

It is easiest for me to
learn a procedure by
watching someone else
demonstrate it first.

I am unaware of using one
of my senses more than
another during client
assessment.

I take appropriate action
on unusual symptoms.




I enjoy working with complex
information that is neces-
sary for planning effective
care.

I perform as well in
situations around many
persons as when left alone.

It is easy for me to work
within the confines of a
hospital routine.

Legal aspects related to
client care usually in-
fluence my nursing practice.

My instructor and I agree
on my level of achievement
in the clinical area.


Figure 2. Q Sort items










I enjoy working with clients
who have complex equipment
helping them.

It is unusually disturbing
to me to be corrected.


I develop nursing plans that
are highly detailed.


My performance is best when
I am left alone.


Using terms that clients
understand is typical of me.


It is important to me to
communicate in such a way as
to let others know precisely
what I mean.

I find it difficult to see
where I am wrong, even when
it is pointed out to me.

I enjoy working with clients
who need reassurance and
support.

Clinical assignments involv-
ing many details are
difficult for me to handle.

Once I have made a decision,
I seldom change my mind.



Once I have started a pro-
cedure, although complicated,
I will not stop until it is
completed.


It gives me confidence to
know that my instructor is
near by.

It is typical for me to
seek out additional learn-
ing experiences.

Performing adequate "follow-
through" on all procedures
is typical of me.

I use all of my senses in
picking up cues from clients
during assessment.

If time permits, I do
additional work that seems
to be needed.

Useful information is
usually obtained by me
through a client's history.


I prefer to listen to a
lecture on a new procedure
rather than read about it.

The nursing plans I develop
are actually workable.


I enjoy developing nursing
plans for all clients
assigned to me.

I hate to interrupt working
on something because I have
to go and work on something
else.

Interruptions to my routine
do not bother me.


Figure 2--(continued)










It is unlikely that my
decisions contain errors.


My clinical assignments are
completed without being
urged by my instructor.

New symptoms are interpreted
by me without automatically
attributing them to an
original diagnosis.

Although not pointed out to
me, I recognize my limita-
tions.


Last minute changes in a
clinical assignment are
usually acceptable to me.

It is usual for me to
clearly describe a client's
reactions.

Routine tasks bore me.




When I complete a task, I
think of other ways it
might have been done better.


Rate your ability to:


use counseling as a means of
helping clients identify and
solve their own problems.

initiate assessments of
current nursing practices in
client care.

reassess situations and plan
new approaches for client-
related problems.

instruct clients post-
operatively, using scien-
tific rationale in terms
they understand.

maintain a scholastic effort
for development of a knowl-
edge base for safe practice.

formulate and test hypotheses
for client care.


proceed safely with a
nursing plan before check-
ing with instructor.


make accurate judgments
based on scientific knowl-
edge and client data.

accurately interpret physio-
logical data, such as
vital signs, lab reports.

protect client from danger,
injury or risk.


promote group consensus of
solutions to client-related
problems.


use library resources in
search of a knowledge base.


insure appropriate range of
motion exercises for the
immobilized client.

establish priorities of
client care.


Figure 2--(continued)










predict client's potential for
wellness.


use correct body mechanics.


compare anticipated and
actual results of nursing
action.


solve client care problems
that involve others.


use concepts of change theory
to analyze information.


Meaningfully organize
information about a client.


give consideration to scienti-
fic principles as a way to
insure safe practice.



pursue reading for personal
growth.




work well with others.


systematically investigate
a problem through use of
library resources.

develop a workable plan of
care.

utilize scientific refer-
ences while completing
assignments.


insure appropriate skin
care to the immobilized
client.

accurately interpret
results of medication.

precisely monitor a client's
fluid and electrolytes,
vital signs, tubes, post-
operatively.

substantiate decisions
with appropriate documenta-
tion.

instruct clients, using
information in accord with
their changing daily needs.

adhere to a moral and
ethical code of nursing
practice.

prepare clients for dis-
charge through imparting
knowledge, assessing their
understanding of current
state of health.

provide clients with
sufficient explanations
about their care so that
they can assist in monitor-
ing their own progress.

handle self as professional
in client care.

utilize group teaching
techniques.


establish rapport with other
members of the health team.

obtain useful information
from a client.


Figure 2--(continued)










consider risk of consequences
to the client.

give direction to nursing
assistants.

assess nursing action in
light of its possible risk
to self and agency.


give of self while providing
direction for the client.

prepare client pre-
operatively, including
psychological support.


make judgments free of
personal biases.

perform manual skills.


make decisions based on
consideration of the
probability of conse-
quences.

create a climate for free
interaction with others.

utilize principles of
asepsis when administering
intramuscular injections.


Figure 2--(continued)





Sixteen Personality Factor Questionnaire

The Sixteen Personality Factor Questionnaire is a

multidimensional set of 16 questionnaire scales (Cattell

et al., 1970). The test was used in the research since it

measures a number of personality variables that have been

considered important by nursing educators. Each factor

was measured on a bipolar scale, although the test was

comprised of 187 items (Figure 3).

The Sixteen Personality Factors Questionnaire (16 PF)

was untimed, although Form B took approximately 50 minutes,

when used in the study. The dependability

coefficient for Form A is .86 (tast-retest). The stability










coefficient for males is .49 and females.62 (test-retest).

The validity of the test is construct validity: Direct

concept validity is equal to.79 while the indirect

validity is equal to.96.


Factor A

Reserved (detached, critical,
cool)


Factor B

Less intelligent (concrete-
thinking)

Factor C

Affected by feelings (less
stable)


Factor E

Humble (mild, accommodating)

Factor F

Sober (prudent)



Factor G

Expedient (evades rules)

Factor H

Shy (timid)

Factor I

Tough-minded (self-reliant)


Outgoing (warmhearted,
easy-going,
participating)



More intelligent (abstract-
thinking)



Emotionally stable (faces
re-
ality)



Assertive (independent,
aggressive)


Happy-go lucky (impul-
sively
lively)



Conscientious (rule-bound)



Venturesome (socially bold)



Tender-minded (dependent)


Figure 3. Sixteen factors for Sixteen Personality
Factor Questionnaire.










Factor L

Trusting (adaptable, easy to Suspicious (self-
get on with) opinionated)

Factor M

Practical (careful, regulated Imaginative (wrapped up
by external re- in inner
alities) energies)

Factor N

Forthright (sentimental) Shrewd (calculating)

Factor 0

Placid (self-assured, confi- Apprehensive (troubled)
dent)

Factor Q1

Conservative (respecting Experimenting (critical,
established analytical)
ideas)

Factor Q2

Group-dependent (a joiner) Self-sufficient (resource-
ful)

Factor Q3

Undisciplined Self-Conflict Controlled (socially
precise)

Factor Q4

Relaxed (unfrustrated) Tense (frustrated)


Figure 3--(continued)










Comprehensive Ability Battery

The comprehensive Ability Battery, developed by

Hakstian and Cattell (1975), consists of 20 primary mental

abilities. Of those, three were selected for use in this

study since they offered assessment in areas not usually

measured by commercial tests, spontaneous flexibility,

ideational fluency, and aiming.

Spontaneous flexibility (Fs) reflects the ability

to break traditional sets and use of flexible ideas to

generate a large amount of information. It is a timed

test of 6 minutes of working time. The reliability

(1975) for males is .74, for females, .87. The direct

concept validity is .72.

Ideational fluency (F.) is concerned with generating

ideas about a given topic rapidly, thus measuring the

ability to quickly retrieve learned material. It is a

timed test of 4 1/2 minutes of working time. The relia-

bility (1975) for males is .84, for females, .78. The

direct concept validity is .88.

Aiming refers to the ability to carry out precise

movements, requiring eye-hand coordination under high

speed conditions. It was timed with 5 minutes working

time. The reliability (1975) for males is .81, for

females, .75. The direct concept validity is .94.










Each of these tests was administered by the investi-

gator according to the designated directions accompanying

the test.


Phase Two: Collection of Data

Sample

Ninety-six senior level nursing students from three

upper division baccalaureate nursing programs in Florida

volunteered to participate in the study. In order to

prevent bias that might occur because of any possible

dissimilarities in the curricula, an equal number of

subjects was chosen from each university. Although 102

students volunteered to participate, they were not equally

distributed among the universities. Therefore, 6 excess

subjects were randomly eliminated.

Students of senior level status were selected for

the project since they were relatively at the same

academic level, already had a significant amount of

clinical experience, and, therefore, were much closer to

"real world" nursing practice. Only students who volun-

teered to participate were used in the project.

Prior to identifying the sample, criteria were

specified by the investigator:

1. Only nursing students having senior level status

would be considered.










2. Students must be enrolled in an upper division

baccalaureate nursing program in Florida.

3. Students would be volunteers.

The three nursing programs that most matched these

criteria were Florida State University, the University of

Florida, and the University of South Florida.


Collection of Data

The data for the study were collected during

February and March, 1977, by the investigator.

A letter (Appendix A) sent to the Dean of Nursing

in each of the three universities selected for the study

explained the underlying nature of the study, including

a brief description of the instruments that would be used.

It was requested that students be allowed the opportunity

of participating in the study. A follow-up telephone

call to each dean resulted in permission to meet with

those students who indicated a willingness to participate.

At this time, there was agreement between the dean and

the investigator as to a specific time and place for the

meeting with the students.

During each testing session with various groups

ranging in numbers from 2 to 36, the investigator informed

the students of the purpose of the study.

Concern for the protection of human subjects was

assured in several ways. First, participation was on a










voluntary basis only., Second, students were assured of

the confidentiality of any data that they had contributed.

Third, students were assured that the data would not be

released by name to anyone other than the investigator.

Fourth, confidentiality was maintained by removing

identifiable data and substituting a code number.

Subjects who volunteered to participate in the

project completed a Biographic Data Form (Appendix B) at

the time of test administration. Of the 96 respondents

there was a total of 87 females and 9 males; of those,

66 were between the ages of 20-23, 27 between the ages

of 24-26, 6 between the ages of 27-29, and 9 were over

30 years of age with the oldest 47. All had

been employed at some time, with the exception of 16. Of

those that had been employed, 67 had been employed in a

health-related area (Table 1).

The investigator was physically present during each

testing session. Each student was required to sort

two decks of cards (Q Sorts), complete a timed three-

part commercial test and one standardized test having

183 items.

Each Q Sort consisted of 48 statements each printed

on a separate card as described earlier. In addition to

these cards, each student received seven additional cards

with numbers printed on them indicating the number of


















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statements that must be placed in the pile. Those

numbers, 1, 3, 11, 18, 11, 3, 1, were addressed on a

continuum from MOST LIKE ME to LEAST LIKE ME. The sub-

jects were allowed to move the cards around if they so

chose. Following completion of each Q Sort, cards were

labeled by students with their name and student number.

The Comprehensive Ability Battery was administered

as a timed test. A stop watch was used so that standardi-

zation could be achieved for all persons. Directions were

read aloud as indicated in the manual accompanying the

test.

The Sixteen Personality Factor Questionnaire was

given last. Since it was not a timed test, students were

free to leave the testing area as soon as they were

finished.

The total testing time for each group was approximately

2 1/2 hours.


Phase Three: Production of Shape Factors

The data from each subject's Q Sort were keypunched

onto computer cards, shown graphically in Figure 4.

It was necessary to hand score the three subtests of the

Comprehensive Ability Battery, but a computer program

was available to score the Sixteen Personality Factor

Questionnaire (16 PF). The latter test had been







35





















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administered on sheets designed for optical scanning,

which was the method used to transfer the responses to

computer cards prior to scoring.

Scores of the Comprehensive Ability Battery and the

16 PF were transferred to computer cards and later used

in a correlation procedure with the variables derived

from shape pattern variables.

There are a variety of techniques that may be used to

produce types or patterns from sets of data collected on,

from, or about individuals. Those data sets are usually

called profiles. Types are groups of individuals with

similar profiles called patterns.

One of the common misconceptions about types is that

they consist only of categories. Eysenck (1973, p. 19)

pointed out that

There is no reason to believe that the
notion of a typology presupposes a categori-
cal system; both Jung and Kretschmer, who
were possibly the best known typologists
of the inter-war period, postulated a dimen-
sional rather than the categorical scale.

Since it is more informative to know the degree to which

a person fits a type rather than simply knowing what he

is or is not, types that could be expressed as a

continuum seemed more desirable than those that merely

represented a classification. That is to say, it is

helpful to know not only with which type one's profile










is most congruent, but to know exactly how congruent it is

with that type, and with the other types isolated from

the same kinds of data.

The nature of the instrument for collecting clinical

performance data placed some restriction on the selection

of a pattern analysis technique. Because Q Sort is, in

essence, a shaping technique (i.e., students' placement

of items actually results in an ordinal positioning of

all items), it seemed appropriate to use the analysis

Stephenson (1953) recommended for use with Q Sort. First

developed by Stephenson in 1936, the technique is a factor

analytic procedure involving the correlation of persons

rather than of tests. The method was called Q technique

by Cattell (1952). It differs from ordinary factor

analysis (R analysis) in that the matrix of test scores

(or other data) is transposed so that the resultant

correlation matrix represents the similarity of each

person's profile to the profile of each person in the

group. Factor analysis of this correlation matrix then

proceeds in the usual way. Factors isolated through

this technique are called shape factors. A computer

program for this procedure is available in the Education

Evaluation Library (Guertin and Bailey, 1970) housed in

the Northeast Regional Data Center, Gainesville, Florida,

under the title EEL 504.









The use of Q analysis as the method for isolating

clinical performance types was particularly desirable be-

cause it provided information in the form of factor load-

ings that give evidence of the relative congruence of

each profile with each pattern. An additional incentive

was the successful use by Ammons (1972) of shape factor

loadings as continuous variables in multivariate analysis.

Accordingly, items of the Q Sorts for each student

were submitted to analysis with EEL 504. One item was

dropped from each Q Sort to prevent each subject from hav-

ing any given score predictable from a knowledge of all the

others. The principal axes matrix from EEL 504 was produced

on computer cards as a by-product of that program, and was

submitted to processing with EEL 511, the factor rotation

program of the Education Evaluation Library (Guertin and

Bailey, 1970), to produce computer cards containing a factor

matrix rotated to the Varimax criterion. Output from EEL

511, loadings for each subject on each shape factor,

became the pattern variables required by this study.


Phase Four: Computation of Coefficients of
Correlation for All Variables

In order to investigate relationships between the type

variables and the personal variables from the Sixteen

Personality Factor Questionnaire (16 PF) and the Compre-

hensive Ability Battery (CAB), Pearson product moment

correlations were computed.















CHAPTER 4

ANALYSIS AND INTERPRETATION OF DATA



This chapter discusses shape factors, type identifi-

cation, type descriptions, and correlation of shape

factors and personal variables.


The Shape Factors

Shape (Q) analysis, with the 96 subjects as

variables, involved 94 of the Q Sort items. The resulting

principal axes matrix consisted of 71 factors, which

accounted for 88.35 percent of the common variance. That

was 92.03 percent of the total variance. Rotation to

the Varimax criterion produced a 17-factor solution

accounting for 64.48 percent of total variance, which

was 70.08 percent of the common variance. This sum of

squares loading for each of the rotated factors appears

in Table 2.


Identifying the Types

In order to determine which, if any, of the shape

factors might have usefulness as type variables, each

factor was inspected visually for the strength of its









TABLE 2

The Sum of Squared Loadings of Rotated Shape Factors



Factor Sum of Squared Loadings


8.16
5.67
2.42
2. 80
4.33
2.65
2.01
2.34
3.85
3.49
2.27
5.10
3.56
4.23
2.37
2.42
2.27


loadings. By use of the criterion of having no less than

three subjects loading at a minimal level of .50 (Guertin

and Bailey, 1970), factors one, two, three, four, and

nine were identified. Loadings of all subjects on those

factors are shown in Appendix C. Those five factors ac-

counted for only 23.8 percent of the total variance, which

was 26 percent of the common variance. Table 3 presents the

number of subjects whose loadings were at the criterion

level for each factor that qualified as a type. That

table also shows the percentage of common variance









accounted for by each of those factors, defined as the

radio of the sum of squared loadings on the factor

to the total common variance extracted by the principal

axes matrix.



TABLE 3

Factors Selected as Type Variables



Number of
Subjects % of
Loading Common
Pattern Factor at .50 Variance


1 1 8 9.2
2 2 4 6.4
3 3 4 2.7
4 4 3 3.2
5 9 4 4.4




Comparison of data in Table 3 with the sum of squared

loadings in Table 2 reveals that those factors which

qualified as patterns were not always those accounting for

the largest amount of variance. Indeed, patterns three

and four were representative of the weaker factors of the

rotated solution, respectively explaining only 2.7 percent

and 3.2 percent of the variance. The factor loadings

were not much different from those expected by chance.










Pattern Descriptions

Development of patterns from the shape factors

separately for each of the five factors meeting the cri-

terion was accomplished by identifying the students having

loadings of at least .50 on the factor and then determin-

ing the means and standard deviations of each Q Sort item

for those students. Those data are shown for each of the

five type factors, as well as those for the total group,

in Table 4.

Qualitative descriptions of each pattern are the

result of selecting those items whose mean was particularly

high or particularly low. Since the Q Sort items were

weighted on a scale 1 through 7, high was defined as a

mean of 5.25 or above, while low was defined as a mean of

2.75 of less. These values represented the extreme values

for the 7-point scale. Since the weighting scheme for

the Q Sort allowed a student to place only 8 percent of

the items in each of these extreme categories,it would

seem that items with means at the respective levels would

reflect meaningful characteristics of the patterns.

Inspection of Tables 5 through 9, showing the content

of meaningful items for each pattern, provided an over-

view for describing salient characteristics of the

types.












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Type 1

Students in Pattern 1 (Table 5) seem to be coopera-

tive, outgoing individuals who are interested in the client

as a person. Low means for "formulating hypotheses ."

and "use library . ." suggest a lack of interest in the

scientific aspect of client care. An important perfor-

mance characteristic of these students is their effort to

promote client independence where appropriate.


Type 2

Students in Pattern 2 (Table 6) seem to be conscien-

tious and very task- and procedure-oriented. They may be

less concerned about the client's psyche and more con-

cerned with his physical needs. The client may be

regarded more as a patient than as a person.


Type 3

Students in Pattern 3 (Table 7) seem to be conscientious,

cooperative, and have little difficulty in handling many

details. There does not seem to be any concern with the

ability to establish priority in client care. The un-

usually high means for ". . working with clients who

need . support," and ". . give of self . ." are

indicative of a warm, nurturing type. Again, in this

pattern there is evidence of a lack of interest in the

scientific basis of nursing procedures.










TABLE 5

Content of Pattern 1



Item Standard
No. Content Mean Deviation

1 I offer assistance to colleagues 5.63 .70
who need help.

11 Above all else, I am a good 6.50 .71
listerner.

22 It is typical for me to seek 5.38 .86
out additional learning
experiences

48 use counseling as a means of 5.50 .50
helping clients identify and
solve their own problems.

77 provide clients with sufficient 5.50 .87
explanations about their care
so that they can assist in
monitoring their own progress.

78 work well with others. 6.00 .87

91 give of self while providing 5.50 .87
direction for the client.

36 Once I have made a decision, 2.50 1.22
I seldom change my mind.

57 use library resources in 2.75 .83
search of a knowledge base.

58 formulate and test hypotheses 2.75 .83
for client care.

80 systematically investigate a 2.00 .87
problem through use of library
resources.









TABLE 6

Content of Pattern 2



Item Standard
No. Content Mean Deviation

4 It is easiest for me to learn 5.50 1.12
a procedure by watching some-
one else demonstrate it first.

11 Above all else, I am a good 5.75 .43
listener.

9 No matter how I feel, I assume 5.25 .83
responsibility for care of
the total client.

32 I enjoy working with clients 6.50 .87
who need reassurance and
support.

42 My clinical assignments are 5.25 .43
completed without being urged
by my instructor.

48 use counselor as a means of 5.50 1.12
helping clients identify and
solve their own problems.

53 protect client from danger, 5.25 .43
injury, or risk.

72 meaningfully organize 5.25 .83
information about a client.

93 prepare client pre-operatively, 5.25 1.09
including psychological support.

94 utilize principles of asepsis 5.25 .43
when administering intra-
muscular injections.

58 formulate and test hypotheses 2.50 .87
for client care.

2 Setting priorities in client 2.75 .83
care is easy for me.











TABLE 6--(continued)


Content


Standard
Mean Deviation


6 I am unaware of using one of 2.75 1.09
my senses more than another
during client assessment.

19 I enjoy working with clients 2.25 .83
who have complex equipment
helping them.

36 Once I have made a decision, 2.50 .50
I seldon change my mind.

64 use correct body mechanics. 2.25 .83


Item
No.










TABLE 7

Content of Pattern 3



Item Standard
No. Content Mean Deviation

1 I offer assistance to 5.75 .43
colleagues who need help.

22 It is typical for me to seek 5.25 .83
out additional learning
experiences.

32 I enjoy working with clients 6.50 .87
who need reassurance and
support.

53 protect client from danger, 5.25 .83
injury or risk.

61 establish priorities of 5.25 .43
client care.

73 adhere to a moral and ethical 5.50 .50
code of nursing practice.

91 give of self while providing 6.50 .87
direction for the client.

34 Clinical assignments involving 1.75 .83
many details are difficult
for me to handle.

35 I enjoy developing nursing 2.75 .83
plans for all clients
assigned to me.

57 use library resources in 2.75 .43
search of a knowledge base.

58 formulate and test hypotheses 2.75 1.09
for client care.


64 use correct body mechanics.


1.50 .50










Type 4

Students in Pattern 4 (Table 8) are destined to be

stars in any critical care nursing unit. They are able

to handle routine tasks without boredom but also seem

alert to the unusual. They work well with teams, but do

not seem to be outgoing, person-oriented individuals. They

differ from the preceding three patterns in a seeming

disinterest in interpersonal involvement with clients.


Type 5

Students in Pattern 5 (Table 9) appear to be loners

who lack self-assurance and seem to be more comfortable

with clients than with peers. They prefer information

presented in an uncomplicated fashion. Another character-

istic of these students is to promote client independence

where appropriate. They are probably more adequate than

they feel themselves to be.


Correlation of Shape Factors
and Personal Variables

Pearson product moment correlation coefficients were

computed between the five type variables, the 16 personal

variables from the Sixteen Personality Factor Question-

naire (16 PF), the two cognitive variables from the

Comprehensive Ability Battery (CAB), and the single










TABLE 8

Content of Pattern 4



Item Standard
No. Content Mean Deviation

8 I take appropriate action on 5.33 .47
unusual symptoms.

53 protect client from danger, 5.67 .94
injury,or risk.

78 work well with others. 5.67 .47

79 handle self as professional 5.33 1.25
in client care.

81 develop a workable plan of 5.33 .94
care.

85 consider risk of consequences 5.33 1.25
to the client.

38 Clinical assignments involving 2.33 .47
many details are difficult for
me to handle.

45 Routine tasks bore me. 2.67 .47

68 solve client care problems 2.33 .94
that involve others.

18 systematically investigate a 2.33 .94
problem through use of library
resources.










TABLE 9

Content of Pattern 5



Item Standard
No. Content Mean Deviation

22 It is typical for me to seek 5.50 1.12
out additional learning
experiences.

32 I enjoy working with clients 5.25 1.30
who need reassurance and
support.

46 Although not pointed out to 5.25 1.09
me, I recognize my limitations.

48 use counseling as a means of 5.75 1.09
helping clients identify and
solve their own problems.

77 provide clients with sufficient 5.75 .83
explanations about their care
so that they can assist in
monitoring their own progress.

91 give of self while providing 6.00 1.22
direction for the client.

5 Frequently used procedures 2.50 .50
rarely become automatic with me.

7 Information presented in broad 2.50 1.12
terms is more understandable to
me than when it is presented in
minute detail.

55 promote group consensus of 2.75 .43
solutions to client-related
problems.

87 give direction to nursing 2.75 .83
assistants.

89 assess nursing action in 2.75 .43
light of its possible risk
to self and agency.






58



TABLE 9--(continued)



Item Standard
No. Content Mean Deviation

92 create a climate for free 2.75 .83
interaction with others.










psychomotor variable from the latter instrument. These

coefficients are shown in Table 10.

Using the procedure described by Guilford (1965,

p. 162), each correlation coefficient was tested to

determine whether or not it represented a significant

departure from 0. Stated in a null form, the hypothesis

was



-H : r = 0.
o xy
a .01


The procedure involved calculation of z, or deviation

units, for each correlation coefficient with the

formula



r
xy
r=0


where








The significance of z is determined by relating

that statistic to the area under the normal distribution.

A correlation coefficient of .26 was required to reject

the hypothesis of zero correlation for the data pre-

sented in Table 10.










TABLE 10

Correlations Between Type Variables and
Personal Variables



Item Type
No.
1 2 3 4 5

1 0.22 0.07 -0.12 -0.08 -0.15

2 0.14 -0.02 -0.03 0.15 0.10

3 0.10 -0.12 -0.17 -0.06 -0.07

4 -0.13 -0.08 0.07 0.07 -0.15

5 -.25 -0.04 0.12 0.04 -0.05

6 0.21 -0.00 -0.19 0.08 -0.01

7 0.27* -0.20 -0.13 -0.17 -0.10

8 0.06 0.18 0.26* 0.16 0.21

9 -0.20 0.12 0.15 -0.10 0.11

10 -0.24 -0.01 0.14 0.09 0.01

11 0.09 0.02 -0.01 0.01 0.08

12 -0.11 0.09 0.29 0.07 -0.03

13 -0.26* -0.02 -0.10 0.02 -0.10

14 -0.35* 0.05 0.04 0.07 0.09

15 0.12 -0.08 -0.28* -0.09 0.01

16 -0.20 0.13 0.15 -0.05 0.12

17 -0.04 -0.05 0.08 0.01 -0.28*

18 0.13 0.13 -0.16 -0.04 0.01

19 -0.05 0.03 -0.01 0.05 0.08

20 1.00 0.05 -0.01 -0.20 -0.08










TABLE 10--(continued)


Item Type
No.
1 2 3 4 5


21
0.06
22
-0.01
23
-0.18
24
-0.07


*p < .01.


1.00

-0.04

-0.13

0.10


-0.04

1.00

0.04

-0.02


-0.12

0.04

1.00

0.01


0.10

-0.12

0.01

1.00


Variables Labels


16 PF (bipolar)

1. Reserved--Outgoing

2. Less intelligent--More
intelligent

3. Affected by feelings--
Emotionally unstable

4. Humble--Assertive

5. Sober--Happy-go-lucky

6. Expedient--Conscien-
tious

7. Shy--Venturesome

8. Tough-minded--Tender-
minded

9. Trusting--Suspicious

10. Practical--Imagina-
tive

11. Forthright--
Astute


12. Self-assured--Apprenhen-
sive

13. Conservative--Experimenting

14. Group dependent--Self-
sufficient

15. Undisciplined--Controlled

16. Relaxed--Tense

17. Spontaneous Flexibility

18. Ideational fluency

19. Aiming

20. Type 1

21. Type 2

22. Type 3

23. Type 4

24. Type 5










Inspection of Table 10 reveals that three out of

the five shape variables correlated (p<.01) with one or

more of the personal variables.

The Type One variable (shape factor loadings)

correlated positively with the 16 PF bipolar variable

"shy versus venturesome" and negatively with the 16 PF

bipolar variables "conservative versus experimenting"

and "group-dependency versus self-sufficient." Since the

higher scores on the bipolar variables represent, as in

the usual format, behaviors more typical of that connoted

by the second named (or right-hand) descriptor, Type One's

positive correlation with "venturesome" and negative

correlation with "experimenting" and with "self-

sufficient" seems contradictory. However, considering

the description of the Type One students as "cooperative

. outgoing . interested in the client as a person

. ." it is possible to visualize them as socially

venturesome in the extraverted sense, and group-oriented

in that they are comfortable with and are stimulated by

others. Such persons might well be conservative in

areas not related to personal interaction.

The Type Three variable showed positive correlation

with the 16 PF variable "tough-minded versus tender-

minded" and negative correlation with the instrument's

variable called "undisciplined self-conflict versus










controlled." The type description was suggestive of a

warm nurturing personality, quite consistent with the

positive correlation with the 16 PF "tender-minded"

variable. The type's high mean on the Profile of

Perceived Performance item concerning ". . give of self

. ." is not inconsistent with the negative correlation

with the 16 PF "controlled" variable, which is further

described (Cattell, 1973) as "socially precise,

compulsive." In order to give freely of self, it may be

necessary on occasion to be something less than precise

in regard to social considerations. A high degree of

self-control, in fact, probably inhibits the giving of

self by many persons whose inner wishes may be in the

direction of showing concern and caring for others but

who are prevented from doing so by fear of revealing

their inner selves.

The Type Five variable correlated negatively with

the cognitive spontaneous flexibility from the

Comprehensive Ability Battery (CAB). This variable, as

indicated in Chapter 3 involves the breaking of sets and

the generation of a large amount of new semantic informa-

tion in a short time. As measured in the CAB, it is

similar to what is commonly termed verbal fluency. This

relationship may explain to some degree the poor self-

concept that seems embedded in the Type Five description.





64



These persons feel themselves to be in a poor light in

modern society, where the ability to verbalize is often

mistaken for intelligence. However, it is a highly

desired characteristic in a social context, as it is in

an educational context.

Neither type variables Two nor Four correlated

highly with any of the personal variables.

In light of the correlations described for Types

One, Three, and Five, it can be concluded that there might

be some personal variables that are significantly related

to patterns of perceived clinical performance.















CHAPTER 5

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS



This chapter summarizes the earlier chapters. Con-

clusions of the statistical analyses and recommendations

for further investigations are discussed.

The research was designed to identify patterns of

behavior in clinical performance of baccalaureate

nursing students and to determine their relation to certain

personal variables in the cognitive, affective, and psycho-

motor domains. A total sample of 96 senior level nursing

students from three major universities in Florida partici-

pated in the project.

In order to nurture those individual differences of

nursing students which may contribute to the different

styles of clinical performance needed in the health care

delivery system, it was necessary to determine first

whether such styles could be identified empirically. The

objectives identified to achieve this purpose were

1. To isolate and identify styles or patterns of

nursing performance behaviors, and

2. To determine whether a relation exists between

patterns of nursing performance behaviors and

personal variables of nursing students.

65









Because available instruments required a huge expendi-

ture of person power and time or were considerably con-

taminated with possible error variance, it was necessary

to develop an instrument that encompassed performance in

the cognitive, affective, and psychomotor domains.

Rather than focusing on a few specified nursing pro-

cedures, it was decided that the project should sample

broadly from the total spectrum of clinical experiences

encountered in a baccalaureate nursing program. This

spectrum included sampling from attitudes, knowledge, and

psychomotor behaviors in order to provide a holistic frame

of reference for the patterns.

A self-report technique was used to collect data over

a wide spectrum of clinical performance behaviors. The

items were presented in a Q Sort format for the purpose

of compensating for bias due to social desirability of

some items. The instrument was given the title "Profile

of Perceived Performance."

After development of the clinical performance data-

gathering instrument, a method was selected for isolating

patterns or types from the information that was to be

collected. A major criterion in selection of the pattern-

isolation method was that it lend itself to creating

continuous variables from the patterns.

The use of Q factor analysis as the method for isolating

clinical performance types was particularly desirable









because it provided information in the form of factor

loadings that gave evidence of the relative congruence

of each profile with each pattern. Q factor analysis, a

factor analytic procedure involving the correlation of

persons rather than tests, produced five patterns which

accounted for only a small amount of total variance (26%).

However, the qualitative descriptions of those patterns

seemed to have credibility when compared with personal

observations of practicing nurses.

Continuous variables from the shape factors were

produced by using each subject's factor loadings on all

rotated factors that had qualified as pattern factors

(i.e., three or more subjects loading at .50 or above).

In addition to collecting the data concerning clinical

performance, commercial tests of personal variables in the

cognitive, affective, and psychomotor domains were ad-

ministered to all subjects in the sample.

Pearson product moment correlation coefficients were

computed between the five type variables, the 16 personal

variables from the Sixteen Personality Factor Questionnaire,

and the two cognitive variables from the Comprehensive

Ability Battery, and the single psychomotor variable from

the latter instrument.


Conclusions

Although five types were identified by applying the

previously specified criteria, the Q factors from which









they were derived did not account for the major portion

of variance associated with the "person" intercorrelation

matrix. Thus, over half of the variance was associated

with those factors on which fewer than three persons loaded

at .50 or higher. For that reason, caution should be used

in making inferences concerning the type variables.

There are several possibilities that might explain

the limited success of the instrument (Profile of Perceived

Performance) in identifying patterns of nursing perfor-

mance behaviors. One possibility involves the processes

by which students were selected by the various upper

division nursing programs. A dual screening process,

encompassing academic success and persistence through two

years of lower division course work as well as a formal

screening procedure prior to being admitted to the nursing

program, had been utilized. Such processes tend to bring

about a truncated range of cognitive talent and may well

result in a similar truncation in affective areas.

Also contributing to the limited success of the instru-

ment to identify patterns may have been the wording of the

items. The relative lack of student sophistication, in

so far as the terminology of nursing education is concerned,

may have contributed to a variety of item interpretations.

A relationship between clinical performance and some

measurable personal characteristics was tentatively con-

firmed, since three out of the five shape variables









correlated (p<.01) with one or more of the personal

variables. The Type One variable (shape factor loadings)

correlated positively with the Sixteen Personality Factor

Questionnaire (16 PF) bipolar variable "shy versus venture-

some" and negatively with the 16 PF bipolar variables

"conservative versus experimenting" and "group-dependency

versus self-sufficient." The Type Three variable correlated

positively with the 16 PF bipolar variable "tough-minded

versus tender-minded" and negatively with the variable

"undisciplined self-conflict versus controlled." The

Type Five variable correlated negatively with the cognitive

"spontaneous flexibility" from the Comprehensive Ability

Battery (CAB).

Neither variables Type Two nor Type Four correlated

highly with any of the personal variables.

In light of the correlations described for Types

One, Three, and Five, it was concluded that there might

be some personal variables that are significantly related

to patterns of perceived clinical performance.


Recommendations

The instrument developed for this study has potential

usefulness in a variety of situations. With some adaptation

its self-report format makes it an excellent tool for

helping nursing students to acquire insight into their

clinical skill. Instructors' ratings of the students'









skills could be compared to the students' own self-report

ratings, and both instructors and students might well be

enlightened in the process.

Another potential use is in program evaluation. Data

on students' perceived strengths and weaknesses, coupled

with the faculty's own observations in that regard, might

point out areas for curricular or methodological adjustments.

Conversely, it could point out the students' need for

greater skills in reality testing. Further recommendations

are that the Profile of Perceived Performance (POPP) be

developed into a forced-choice format that is less time

consuming in scoring so that a larger sampling could be

made. Also, criterion measures in clinical performance,

such as clinical grades and faculty estimates of students'

performance, should be obtained and examined for relation-

ships with student profiles on the POPP, with type

variables derived from the POPP, and, possibly, with the

individual items from that instrument, as well as with

Q and R factors in relation to those external clinical

performance criteria.

An additional utilization of the study might be to

develop a questionnaire using the 20 selected constructs

which faculty members could place in order of priority

according to their relative importance for students in

baccalaureate nursing programs. Additionally, faculty

might be given the opportunity of suggesting other basic









constructs whose values had not been previously recognized.

Items could then be developed, assigning weights relative

to the information obtained from the questionnaire.

With some adaptation, the POPP might also be adminis-

tered to junior level nursing students. A combination of

items identified from junior and senior level nursing

students could be used to assist administrators of nursing

programs in identifying the actual performance level of

their students. Such information might not correspond to

the level purported to be that of a particular nursing

program. However, the results might assist a faculty in

differentiating between the idealized and actual perfor-

mance level at which they are preparing students for

practice.

By use of faculty and student input, discrepancies

between the idealized and actual levels of performance

might be detected.

Further exploration with other personal variables,

such as needs, locus of control, cognitive closure, and

related cognitive variables should be undertaken with the

POPP to determine whether relationships exist between

performance type and a larger number of personal variables.

The method used to identify patterns of nursing per-

formance behaviors could be easily adapted for use with

practicing nurses. By sampling nurses who are successful

in "real world" settings, the value and suitableness of









the patterns for particular roles in a variety of clinical

specialties might be determined (i.e., leaders and

followers in intensive care nursing, surgical nursing,

and psychiatric nursing). A comparison could then be made

between patterns or styles of students and practicing

nurses to determine the degree to which nursing programs

are preparing nurses who can function successfully in

various "real world" settings.

The potential usefulness of the method and the

instrument is not limited to nursing education and nursing

practice. Other health care professions should find

adaptation of both the method and instrument beneficial

in studying these disciplines.









APPENDIX A


LETTER TO THE DEANS

S. Joan Gregory
10575 125th Street, North
Largo, Florida 33540

February 1, 1977


Gwendoline R. MacDonald, Ed.D.
Dean, College of Nursing
University of South Florida
4202 Fowler Avenue

Dear Dean MacDonald,

Over the past several years I have been interested in
personal variables as they affect clinical performance in
nursing. As you know, authorities at the national level
consider this question to be one of great significance.
Therefore, I am utilizing my doctoral research as an
opportunity to increase the small body of knowledge that
exists in this area.

The purpose of this study is to investigate cognitive,
affective, and psychomotor factors related to clinical
performance of baccalaureate nursing students. This will
be accomplished through the use of four short standard-
ized tests and a Q Sort that has been especially designed
for the baccalaureate level student. The total time re-
quired to complete these instruments is approximately two
hours per student.

I have selected senior level nursing students in three
State upper division nursing programs for study. A sample
of 33 such students from each of the three programs will
be necessary for a successful study.

I am hereby requesting your permission to include the
University of South Florida in the sample. You may be
assured that I will supply you with complete results of
the study. Also, I would be pleased to provide test
interpretation to each participating student.

I will contact you next week by phone for your response.
At that time, I would also like to discuss specific dates
for administration of the tests, selection of students
who will participate in the study, and other related
details.





74




Sincerely yours,



S. Joan Gregory










APPENDIX B

BIOGRAPHIC DATA




First Name Middle Name Social
Sec. No.


Permanent Address--Street No. City,


County, State Zip
Code


Mailing Address--Street No. City, County, State Zip
Code


Birth Date

No. Day Yr.


Number of:

Brothers
Sisters
Children


Have you ever
attended a junior
college?
Yes How long?
No


How do you describe yourself? (Please check ONE.)

1. Am. Indian 2. Black, non-Hispanic origin

3. -Asian or Pacific Islander 4. Hispanic

5. White, non-Hispanic origin 6. Foreign student,
non-immigrant

Previous work experience (Please check where applicable to
you.)

1. Hospital 2. _Nursing home 3. _Doctor's
office


4. Other


5. None


Why did you choose nursing? (Please check only ONE.)

1. Economic 2. Service to others 3. Career
oppor-
tunities


4. Medical school
not available


5. Other


Last Name


Sex

Male
Female













APPENDIX C

LOADINGS ON SHAPE PATTERN FACTORS


Item Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5


0.4809

0.1082

0.0566

0.5537

0.2016

0.0288

0.0943

0.0587

0.2766

0.0703

0.1]360

0.5222

-0.0157

0.1268

0.3162

0.3868

0.1842

0.5039

0.1959

0.1069


0.2711

0.1745

0.2336

0.1843

0.2944

0.4423

0.0066

0.0669

0.6399

0.0285

0.1158

0.1653

0.0564

0.1672

0.5522

0.1869

0.2494

0.1167

0.2920

0.0373


0.0215

-0.0477

0.0715

0.0716

-0.1763

0.0311

-0.0657

-0.1414

-0.0072

-0.0209

-0.0197

0.1925

0.0642

-0.1599

0.1606

-0.1734

0.2292

-0.0227

0.1423

0.0321


-0.0010

0.1528

0.2246

0.1333

0.2914

0.0488

0.1330

0.3000

0.0847

0.7894

0.2055

-0.0009

-0.0070

0.0167

-0.0360

0.0327

0.1384

0.3481

0.0729

-0.0496


0.0270

0.0273

0.1923

0.3127

-0.0127

0.4539

0.1083

0.1190

0.1190

0.0347

0.0456

0.0924

0.0515

0.2345

-0.0263

0.2725

0.1887

0.0900

0.1183

0.0703










APPENDIX C, continued


Item Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5


21 0.0149

22 0.1081

23 0.3550

24 0.2401

25 0.4244

26 0.1929

27 0.4153

28 0.4791

29 0.0423

30 0.0876

31 -0.0413

32 0.2747

33 0.2877

34 0.1055

35 0.1795

36 0.1904

37 0.3800

38 0.0631

39 0.3479

40 0.4859

41 0.4925

42 0.1989


0.0945

0.3557

0.1658

0.3483

0.4083

0.3701

0.2647

0.4466

0.0362

0.3359

0.1293

0.2533

0.2431

-0.0807

0.4390

0.0594

0.0862

0.0699

0.1020

0.3221

0.1156


0.2403

0.1113

-0.0950

0.1350

0.1326

0.1134

0.2506

-0.0349

0.7323

-0.0510

-0.0505

-0.0661

0.0561

0.0812

-0.2566

-0.2768

0.0132

-0.1109

0.2010

-0.2783

-0.0473


0.4265

0.2181

0.2050

0.0122

-0.0561

0.0267

0.1171

0.2314

0.0251

-0.1025

0.0606

-0.0470

0.0666

0.0811

0.1152

0.0080

0.0273

0.2109

0.0504

0.1336

0.0239


0.2904

0.1029

0.0686

0.1787

0.0877

0.1309

0.0877

0.1569

0.0898

0.2464

0.0203

0.2960

-0.0786

0.0257

-0.0370

0.0842

0.1733

-0.1111

-0.1017

0.0838

-0.0464


-0.0355 0.1642


0.1118 -0.0972










APPENDIX C, continued


Item Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5


0.2729

0.1787

0.4792

0.4252

0.1221

0.3028

0.3257

0.2358

0.2890

0.4960

0.7576

0.4322

0.2225

0.1541

-0.0380

-0.0552

0.1404

-0.0103

0.3887

0.1400

0.2081

0.5642


-0.3349

0.1681

0.2536

0.2564

0.1917

0.0189

0.1166

0.0841

-0.0921

0.0121

0.1263

0.0905

0.1166

0.1554

0.2849

0.1530

-0.0705

0.1966

0.2078

0.0288

0.0318

0.1746


0.1469

-0.0316

-0.0607

0.0896

0.0041

0.0716

-0.2000

0.0955

-0.3340

0.0612

-0.1080

-0.0355

0.0440

-0.0990

-0.1991

-0.0822

0.1412

0.3526

0.0230

-0.0227

0.0544

0.1029


-0.0610

-0.0145

0.0062

0.0211

0.0644

0.1109

0.1128

0.0976

0.0642

0.2148

-0.0206

0.0027

0.0455

0.0286

-0.0652

0.0802

0.3390

0.0272

0.3539

0.1317

-0.1140

0.0533


0.1022

0.1247

0.2278

0.0834

-0.0099

0.1831

0.0838

0.1227

0.2145

0.0278

-0.0007

-0.0252

0.0156

0.4074

0.0753

0.3421

0.0826

-0.0101

0.1915

-0.0548

-0.0545

0.1716










APPENDIX C, continued


Item Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5


0.2981

0.3275

0.5261

0.2527

0.2652

-0.0054

0.3650

0.0981

0.5325

0.2288

0.0778

0.3363

0.4489

0.1734

0.3448

0.2819

0.1266

0.1965

0.4440

0.1611

0.2236


0.2253

0.1013

0.0609

0.1898

0.4045

0.2492

0.1281

0.1414

0.2518

-0.0298

-0.0219

0.1857

0.0619

0.3546

0.0865

0.3345

0.2434

0.4997

0.1479

0.0736

0.1882


0.0264

0.0949

-0.2531

0.2244

0.0016

-0.0425

-0.0078

0.0230

-0.0197

-0.0453

0.2328

0.1431

0.2957

-0.0297

-0.0693

-0.0677

-0.1977

0.0134

0.0486

0.0723

-0.0654


-0.0864

0.0335

-0.0347

-0.1323

0.1920

0.2765

-0.0175

0.4191

-0.0039

0.1047

0.3797

0.1060

0.1701

0.0649

0.0934

-0.1154

0.1633

-0.1182

0.2001

0.1035

0.1436


0.1885

0.0857

0.2344

0.1876

0.1499

0.3245

0.1913

0.1931

0.1769

0.2457

0.3529

0.1264

0.0910

0.3146

0.1241

0.2268

0.5920

0.3996

0.3660

0.6244

-0.0686


-0.2818 -0.0918 0.1958


86 0.0595 0.0651










APPENDIX C, continued


Item Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5


0.1633

0.0990

0.1931

0.1540

0.1864

-0.0690

0.1842

0.1739

0.1250

0.2058


0.1459

0.6244

0.2273

0.0948

0.4475

-0.0473

0.0127

0.1335

0.4313

0.3781


-0.1254

0.0356

-0.2843

0.0400

-0.0346

-0.1599

-0.1101

0.2540

-0.2150

0.0486


0.3139

0.0106

0.0239

0.1989

0.1476

-0.1204

0.1382

-0.0339

0.0658

0.0423


0.1168

0.0926

0.2900

0.2134

0.1595

-0.1100

0.1146

0.4693

0.1022

0.0160














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BIOGRAPHICAL SKETCH


Shirley Joan Gregory was born and reared in

Brunswick, Georgia. After graduation from Glynn Academy

she attended St. Joseph's Infirmary School of Nursing.

She received a Bachelor of Science in Nursing degree from

Mount St. Agnes College in Baltimore, Maryland.

In 1973, Miss Gregory received a Master of Science

degree in Counseling and Guidance from Barry College in

Miami, Florida, while employed at Miami-Dade Community

College.

She has worked as a staff nurse, supervisor, instructor,

and more recently, was Chairman of Nursing at Miami-Dade

Community College.

Miss Gregory is a member of the National League for

Nursing, the American Nurses' Association, The Association

for Supervision and Curriculum Development, The American

Educational Research Association, Pi Lambda Theta, and

Kappa Delta Pi.











I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.




James W. lensel, Chairman
Professor of Curriculum and Instruction



I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.




William/Alexander
Professor of Curriculum and Instruction



I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.




Blanche I. Urey /
Professor of Nursing



I certify that I have read this study and that in my
opinion it conforms to acceptable -standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.




Wilson H. Guertin
Professor of Foundations











I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.




MargareQ K. Morgan
Associate Professor of Curriculum and
Instruction



This dissertation was submitted to the Graduate
Faculty of the Division of Curriculum and Instruction in
the College of Education and to the Graduate Council, and
was accpeted as partial fulfillment of the requirements
for the degree of Doctor of Philosophy.

August, 1977




Dean, Graduate School




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