Differences in attitudes as measured by the California F scale in a group of psychiatric nurses

The problem: The general purpose of this study was to test certain inferred relationships between the authoritarian and nonauthoritarian personalities, as defined by Adorno and his colleagues, and age, years since graduation, length of general nursing and psychiatric nursing experience, and the type of nursing education background of a group of psychiatric nurses. A number of predictions were made about the relationships between The Authoritarian Personality F Scale and these items of sociological data. The basis for constructing these hypotheses resulted from descriptions of authoritian and nonauthoritarian people by Adorno and numerous other investigators. Comparisons of these descriptions led to the following hypotheses: A direct relationship would be found between F Seale scores and age, years since graduation, length of experience in general nursing and length of experience in psychiatric nursing. A relationship would be found between F scores and the type of educational background, thus the graduates of hospital schools of nursing would score higher. No relationship would be found between F scores and the type of position held in psychiatric nursing. Methods and procedures: In order to test the hypotheses, the F Scale was administered to a group of 244 registered nurses employed in both public and private hospitals and general hospital psychiatric wards in twelve Western states. The psychiatric nurse sample was characterized by a wide range of age, graduation dates, lengths of experience in both general nursing and psychiatric nursing, and they represented six levels of nursing educational background. In order to test the hypotheses concerning the relationships between F Scale scores and each of the variables, a product-moment correlation coefficient was computed between F scores and age, years since graduation, length of general nursing experience and psychiatric nursing experience for the entire group, and for various subgroups within the sample. As a further means of analyzing the data, a t-ratio test of the difference between mean scores was made between the mean scores of the groups representing each of the six levels of educational background. Statistical comparisons were also made between nurses in staff nurse, supervisory, administrative and educational positions in psychiatric nursing. The sample was further compared by testing differences between mean scores of a random sample of nurses working in private hospitals, general hospital psychiatric wards and public hospitals. Similar comparisons were made on a random sample of nurses working in each of the twelve states represented in the sample. The resultsf: In testing the predictions made in this study the following results were obtained: 1. A significant positive correlation existed between the F Scale scores and age. The hypothesis was upheld for the entire sample and for the two main subgroups within the sample, the hospital graduate nurses and nurses with college degrees. 2. A significant positive relationship existed between F Scale scores and years since graduation. This hypothesis was upheld for the entire sample and for the two main subgroups. 3. A significant positive relationship existed between the length of experience in general nursing and F Scale scores. This hypothesis was upheld for both main subgroups as well as the entire sample. 4. No significant relationship existed between F Scale scores and the length of experience in psychiatric nursing. However, a significant relationship existed between F scores and years of psychiatric nursing experience when the influence of age on F scores was nullified. 5. A significant difference existed between the mean F scores of hospital graduate nurses and nurses with college degrees. The hypothesis predicting a relationship between the type of nursing educational background and F Scale scores was upheld. 6. No significant difference existed between mean F scores of nurses in different positions in psychiatric nursing. This hypothesis was upheld. 7. Mean F scores for this sample were lower than those found by Adorno and his collaborators in their California studies. 8. No significant difference existed between the mean F scores of nurses working in different types of psychiatric hospitals. 9. No significant difference existed between the mean F scores of nurses working in different states. 1. Assuming that the F Scale is a valid measure of authoritarian tendencies in the personality structure, it would seem that descriptions made by Adorno and many others, of the authoritarian and nonauthoritarian person are applicable to this sample of psychiatric nurses. 2. The variables Adorno postulated as making up the authoritarian personality are not as prominent among the sample group of psychiatric nurses as they were among the population on which the F Scale was validated, since the psychiatric nurse sample had lower mean F scores than the validation group. 3. Important factors which influence scores on the California F Scale include age and educational background.

DIFFERENCES IN ATTITUDES AS M~ASURED BY THE CALIFORNIA F SCALE IN A GROUP OF PSYCHIATRIC NURSES A Thesis Submitted to the Faculty of the Graduate School University of Utah In Partial Fulfillment of the Requirements for the Pegree Master of Science by Edna' Lee Bishop Neumann April 1962 LIBRARY UNIVERSITY OF UTAH ACKNOWLEDGMENT The au~hor wishes to express her sincere appreciation to Mrs. Mildred Do Quinn, Dean of the College of Nursing of the University of Utah for her nelpful suggestions anq aS$i~tance. She also wishes to expresS thanks to Miss.Sumiko Fqjik!. College of Nursing and Dr. Norman Wallen. Department of Educational Psychology for their corrections and suggestions. Sincere appreciation is also expressed to Mrs. Jo-Anne Jedlicka for her helpful suggestions. to Mro Blaine P. Parkinson, for his assistance in statistical analyses, and to the authorts husband for his constant encouragement. ~88906 This Thesis for the Mast~r of Science Degree by Edna Lee Bishop Neumann has been approved by TABLE OF CONTENTS LIST OF TABLES 0 0 000 o 0 o 0 • 0 o • 0 .0. o • • . .. LIST OF FIGURES o o 0 o 0 0 0 o 0 6 0 o • 0 0 o • 000 o • CHAPTER I. II. III. IV. Vo INTRODUCTION 0 0 o 0 00.0. • 00. 0 0 0 .0. The problem 0 0 • 0 0 0 0 0 0 • 0 0 0 .. • 0 0 .. 0 Importance of the study. • 0 0 0 0 0 • 0 • • 0 0 Definition of terms. 0 • 0 0 0 0 0 • • 0 0 • 0 0 The authoritarian personality •• 0 0 0 0 0 0 • Psychiatric nurse. 0 0 0 • 0 0 0 0 • 0 • • 0 0 Private hospital 0 0 0 0 0 0 0 0 • 0 0 0 0 0 • General hospital psychiatric ward. 0 • 0 0 0 0 Public hospital. 0 0 • 0 0 0 0 0 0 0 • 0 • • 0 Delimitations 0 0 • 0 • 0 • 0 • 0 0 0 0 0 0 0 0 0 REVIEW OF RELATED LI.TERATURE.. 0 o • • 0 o • o • 0 The Authoritarian personality. 0 0 ••• 0 • 0 • ~e nature of the problem. 0 0 • 0 • • 0 0 • • Measurement of antidemocratic trends • • • 0 0 Studies related to The Authoritarian Personalit¥. 0 0 • 0 0 • 0 0 0 •• 0 0 0 6 • 0 Related studles in nursing • 0 • 0 0 0 0 0 0 0 0 Summary 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 0 • • • • • THE METHOD 000 000 o • o 0 00. o 0 00. Selection of subjects. 0 0 • • • • 0 • 0 0 • 0 0 The measuring instrument • 0 • • • 0 0 0 0 • • • Administration of tests. • 0 • • • • • 0 • 0 • • Statistical analyses of the data 0 0 0 0 • 0 • 0 THE SAMPLE 0 • 0 0 0 0 0 6 0 0 0 0 0 • • 0 0 0 0 0 The entire sample. 0 • Q • 0 0 • 0 0 0 0 0 0 0 0 Hospital graduate nurses 0 0 0 0 c • 0 ., • 0 • 0 Nurses with college degreeso 0 0 0 0 0 0 0 0 0 • THE RESULTS o 0 0 0 0 e 0 0 • 0 0 0 0 0 0 0 • 0 0 0 The relationship of F scores to the four variables within the entire sample • 0 0 0 • • The relationship of F scores and variables for ho~pital graduate n~rses • 0 6 0 0 • 0 • 0 The relationship of F scores and variables for nurses with college degreese • eo ••• 0 PAGE vi vii 1 2 4 6 6 7 7 7 7 7 9 9 9 10 10 12 19 20 20 21 22 23 26 26 31 32 35 35 36 36 CHAPTER VIo Vllo A comparison of relationships, between F scores and the variables in subgroups within the group of nurses with college degrees 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other _comparison,s within the sampleo 0 0 0 o 0 o 0 ANALYSIS OF RESULTS o o 0 000 000 0 o 0 o 0 0 A consideration of the obtained correlations 0 SUMMARY~CONCLUSIONS AND RECOMMENDAT~ONSJO o '0 0 The problemo 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Methods and procedures 0 0 0 0 0 0 0 0 0 0 0 0 The resultso 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Conclusions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Recommendations 0 0 0 0 0 0 0 0 0 0 0 0 0 ~ 0 0 BIBLIOGRAPHY 0 000 o 0 o 0 000 000 0 o 0 000 0 o 0 APPENDIX 0 0 0 0 000 000 0 0 0 0 000 000 o 0 000 v PAGE 39 39 47 47 54 54 54 55 57 57 61 64 FIGURE Io 110 LIST OF FIGURES Age Distribution 0 a 0 0 coo 0 0 0 0 a c 000 Distribution of Years Since Graduation a o 0 o 0 1110 Distribution of Psychiatric and General IVa Vo Vlo VIlo Nursing Experience a 0 000 000 000 o 0 () 0 Distribution by Stateo 000 000 000 o 0 o 0 Distribution of Various Positionso 0 00(1 0(10 Distribution of Types of Hospitals 0 C 0 () 0 o 0 Distribution of Educational Levels 0 o 0 o 0 o 0 PAGE 26 27 28 29 30 31 32 LIST OF TABLES Product=Moment Correlations Between F Scores for the Entire Samplee- Ior Hospital_Graduate Nurses and for Nurses with College Degrees 0 110 Product=Moment Correlations Between F Scores and the Four Variables for the Subgroups Within the Group of Nurses with College PAGE o 0 I) 0 37 Degrees 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 I) 0 0 I) I) 40 1110 IVo A Comparison of the F Scale Mean Scores and Standard Deviations for Various Groups Within the Sample I) 0 0 0 0 0 0 0 0 0 I) 0 I) 0 0 0 0 I) I) I) 0 A Comparison of Mean Age 9 Years Since Graduation 0 and Length of General and Psychia·tric Nursing Experience for Various Groups Within the Sampleo 0 0 Mean Scores of a Random Sample of Nurses in Different Positions o 0 0 0 0 0 0 0 0 0 0 0 0 o I) 0 0 41 43 44 CHAPTER I INTRODUCTION Many psychiatric hospitals have a particular authoritarian structure 0 with a great deal of authority over the patient invested in the personnelo This authority is necessary to a large extent~ it is a practical outgrowth of the type of care necessary for patients in the psychiatric hospitalo The patientUs illness is frequently attended by such poor judgment that he may be in danger of harming himself or others g indeed 9 he may even be unable to care for himself. or to supply his most fundamental needso Therefore~ authority over the patient has to b~ given to the hospital staff to provide adequate careo This authority~ however® should be cautiously and rationally used and dele= gated 0 Mo Jo Myers substantiates this view i and states that the primary aim of the hospital and all its personnel should be to "encourage the emotional growth of the patient 9 [and] to utilize only that authority which is necessary for the patientUs welfareoooo ul The question is raised that a person with authoritarian person-ality tendencies may not be the best person in whom to invest a high degree of authority over the patiento ,Studies in authoritarian per= sonality tendencies in psychiatric nursing personnel:,.are neededo Authors ,of !!!! Authoritarian' PersQnality2 have conducted extensive investigations into the aspect of authoritarianism in the personalitYe , !~: 10 Margin J 0 Myers 9 Jr 0 9 VI Authori ty·g Handle with Care i q, Hospitals~ 31~41~ JanuarY9 1951 0 20 To Wo Adorno~ and others~ The Authoritarian PersonalitY0 (New Yorkg Harper and Brothers't 1950).' 2 and have come to focus on the relationship between personality structure and ideologyo Evidence has been combined by these investigators from a wide variety of social=psychological measuring techniques and clinical proceduresJ) which have suggested some high and consistent relationships between certain aspects of the personality and authoritarianismo Io THE PROBLEM The general purpose of the study was to compare certain inferred relationships between the authoritarian and nonauthoritarian personalities, as defined by Adorno and his colleagues~ and certain sociological infor..., mation in a group of psychiatric nurses o A review of literature and preliminary observations in various psychiatric settings have indicated the nature of the expected relation­ships between scores on ~ Authoritarian Personality Fascist Scale, hereinafter called the F Scale~ and specific items of sociological data o The specific purpose of the study was .to investigate t in a sample of psychiatric nurses. the relationship between scores on the F Scale and such factors as age i type of nursing educational backgro~ndt recency of graduation~ length of experience in general nursing, length ,of experience ,in psychiatric nursing l) ,. and the type of position .presently held in psychiatric nursing o In the past t methods of teaching and the philosophies of many hospital schools of nursing tended to be rigid t traditional and authori­, tariano. "Nursing has long been' imbued with a hierarchal structure 3 which has fostered and reinforced the attitude of authoritarianismo u3 It would seem to follow then i that nurses trained in such programs could be expected to have similar attitudes and to use these authoritarian methods in giving nursing care o Considerable attention has been given to this area within the last ten years~ however g and many school of nursing have attempted to change some of these methodso The history of collegiate~ or baccalaureate degree programs in nursing, while relatively short® has shown these schools to be typically more flexible~ democratic and progressive~ Nurses trained in these programs could be expected to be more liberal in their attitudes and in giving nursing careo The F Scale has as its purpose to yield a valid estimate of antidemocratic tendencies at the personality level o The Scale does not attempt to imply that the features of this personality pattern are touched upon in the Scale j but only that the Scale embraces a fair sample of the ways in which this pattern characteristically expresses itself 0 In view of the above~ and because of the results of studies which will be reported in detail in Chapter IIg the following hypotheses were madeg Hypothesis Io A direct relationship .would be found, ,between age and F Scale scores t thus the olde.v', subj ect would score' higher fI Hypothesis ~o A direct relation$hip would be found between 30 Beatrice Brooks. t1IStuqent Attl..tudesg· How They Differ9 " ,NursingWorld Sl 134 28=30!l June~ 1960 0 . . years since gr1aduation from any school of nursing and F Scale scores 0 thus the subject who graduated earlier would score highero ~=-===== lIlo A direct relationship would be found between length of experience in general nursing and F Scale scores 0 thus the subject with longer experience would score highero =======-=-== lVo An inverse relationship would be found between length of experience in psychiatric nursing and F Scale scores'z although this relationship would be smallo Thus~ the subject with longer experience in psychiatric nursing would score slightly lowero Hypoth~~ Vo The type of nursing educational background would have a significant relationship to F Scale scores o It was anticipated that graduates f~om hospital s:chools of nursing would score significantly higher than graduates from collegiate programs in nursingo It was further anticipated that the more education a subject had~ the lower she would score on the F' Scalao Hypothesis VI,o There would be.no significant difference between the scores of subjects in the four types of positions in psychiatric nursinge IIo IMPORTANCE OF THE STUDY The importance of providing an environment for the psychiatric patient which favor,ably influences his mental health through meeting his immediate needs and contributing to~is.comfort and security is generally recognized and acceptedo When the treatment of the .patient takes place within the hospital 5 unit i the job of creating and maintaining this therapeutic milieu is primarily the function of the nursi?g service personnelo 4 One factor that influences the nurseQs ability to create and maintain a therapeutic environment is her personality structure o "In a field in which human interactions are the focus of consideration 9 there can be little doubt that the personality patterns of the people involved may be of the deepest consequenceso n5 There are implications to be drawn from a study of attitudes and the bases for them which may lead to change in the education of nursing students for psychiatric nursing o Authorities in the field of psychiatric nursing describe certain qualities and personality attributes that the psychiatric nurse should possess 0 As a member of the therapeutic team. she should apply know-ledge of dynamic psychiatry to the interpersonal and group relations she develops, create a therapeutic ward atmosphere; and competently assist the therapist with treatmentG6 Further 0 she should have a non-critical attitude~ and be flexible, sympathetic, understanding and free from an air of superiority0 7 wIThe nurse must. in short, be prepared 46 MarIan Kalkmani) UWhat the Psychiatric Nurse Should be ,£aucated to Dotu Psychiatric Q:uarterly. Supplement, 1993. 1952 0 56 Francis Me Canter and Ruth ShoemakerS) "The Relationship Between Authoritarian Attitudes and Attitudes Toward Mental Patients," Nursing Research~ 9 39~419 Winter 9 1960 0 60 Committee on Psychiatric Nursing of the Group for the Advancement of PsychiatrYil The Psychiatric Nurse in the Mental Hospital. Report Number 22~ MaY9 1952:-- ~-- .. 76 Helen Fo Hansen~ A Review of Nursing?) (Philadelphiag We Bo Saunders CompanYiJ 1956)~ p& 1"970 -- 6 to see naked emotions and must be able to meet them with warmth, under­standing and relaxation. n8 To be able to meet these criteria, it might be helpful: for the nurse to have a particular type of personality structure. This study was justified in that it investigated one aspect of the per.sonality structure of the psychiatric nurse. the aspect of authoritar~ani_m. ~ , , , " , 1110 DEFINITION OF TERMS ~ authoritari~ personality. Adorno and his collaborators derived and defined nine variables as component parts of the authori-tarian personalityo These variables, with a brief description of each. are listed belowg a. b. c. d. e. f. Conv,er:-tionalismoRigid adherence to conventional, miadle=class values. Authoritarian submission. Submissive. uncritical att(iude, toward ,idealIzed moral authorities of the ina~f>up. Autl'l9ritarian aggressiono Tendency to be on the lookout for g and to condemn. reject, and punish people who'violate conventional'values. Anti-intraception. Opposition to the subjective. ~imaginative, thei tender·-mindec1., , Supers;ition ~"ste:eo~y~y. ,Th',helie~/ in ~ystical determl.nants of the, l.ndl.vl.dual,t s.fate'; ''t~e dl.spo-sition to think in rigid categbr~'s~ Power and "toughness." Preoccupation',with the domina'iiC'e-suhmlssion. strong-weak, leader~follower dimensions; identification'with ,power' figures; over ..... emphasis ,upon the' conventionalized· .attributes of' the ego'; ,exaggerated assertion of'strength and toughness 0 Destructiveness and cynacism •. Generalized ~ostility. viiification of the 'human. s. OlgaH. Weiss'. ,Attitudes ,in Psychiatric "Nursing .2!!:!., (New York': G~ P. PUtnamts Sons, i§m~ p. 93. ho ProjectivitY6 The di~position to believe that w11d ana dangerous things go on in the world, the projection outwards of unconscious emotional impulse!; 0 i. Sexo, Exagg,er~'ted concern with sexual "goings~ onon9 These variables are thought of as forming a constellation of personality factors e of going together to form a single syndrome, which is a relatively enduring structure in the person • making him receptive to antidemocratic propaganda. Psychiatric nurse. In this study the term psychiatric nurse refers to a registered nurse who is assigned to the psychiatric units of the hospital the full time that she is on d\lty. regardless' of her position. title. or educational background. Private hospitalo The term private hospital refers to a privately supported hospital which devotes its entire facilities to the care of p~ychiatric patients6 General hospital psychiatric ward. This term refers to a unit within.a general hospital which is devoted to the.careof psychiatric patients. Public hospitalo The term public hospital refers to a tax suppor.ted hospital which elevotes ~it's. entire facilities to the care of psychiatric patientso IV.> DELIMITATIONS 1. The compr.ehensive clinical ratings. evaluations and 7 8 descriptions made by the California investigators of authoritarians and nonauthoritarians were based on the records of those who scored' in the upper quarters and lower quarters of the F Scale, the Ethnocentrism Scale and the Political=Economic-Conse~vatism Scale~ In this study. only the F Scale was used to appraise authoritarianism. The sizeable intercorrelations of the tnree scales were thought to make the use of one fcale justifiableo10 20 This study was concerned with the relationship between all scores on the F Scale and the sociological data, rather than attempting to divide the sample into high authoritarians and low authoritarians. This was done because of the generally accepted belief that authori-tarian traits within the personality form a continuum. rather than absolute categorieso 3. The sample was drawn from twelve Western states, and consists of psychiatric nurses employed in four private' hospitals •. eight general hospital psychiatric wards and ten public hospitalsc 10. Correlations.between the.F'and.theEthnocentrismJ scales are ~75 on the average in Forms 40 and 45 of the' F Scale··(Adorno.,~e cit •• p.262). The' average correlation' between the ,FScale and Politl.car­Economic~ Conservatism Seale is 0.57 (Ibid. p. 265) 6 CHAPTER II REVIEW OF RELATEn~," LITERATURE, A great deal has been written regarding authoritarianism, and The Authoritarian Personality has served as a research tool for a decade 0 A brief summary of the work of experimenters on some problems related to authoritarianism in nursing and nursing education will be given 0 10 uTHE AUTHORITARIAN PERSONALITY" ~ nature ~~ problemo Using certain ideas from Fromm. Reik. Erikson, Maslowe Chisholm and others, the California investigators began a study which resulted in ~ Authoritarian Personalityo This study, which began as an investigation of anti-Semitism. broadened its scope to explore the relation between personality t social discriminat'ion and political ideologyo Its fundamental hypothesis is that the political. social and economic convictions of a person often form a pattern which is an expression of deep-lying personality trendso l The major' concern of the California investigators was with the "potentially fascistic" person. whose structure made him particularly susceptible to anti­democratic propagandao This book is basically a descriptive account of the progressive formulation and refinement of attitude scales and supporting clinical data which indicate that persons who are prejudiced ,and authoritarian differ in personality from those who are democratic and equalitariano Using psychoanalytic theory as a basis 9 it was 10 hypothesized that this personality structure was the product of early family experienceso The authors of the book developed a research design to test this theorYt and present a massive array of data to support it6 Measurement of anti-democratic trendso In the course of the five year investigation 9 four separate scales were developed 0 including various forms of eacho The F Scale was the last to be developed. and was designed as a measure of prejudice without appearing to have this as its aim~ and without mentioning the name of any minority groupo Its major purpose, however 9 was to yield a valid estimate of anti-democratic tendencies at the personality levelo This instrument was called the F Scale to signify its concern with implicit prefascist tendencieso Items were chosen to tap each of the variables listed on pages six and seven of this studyo After considerable revision~ the final form of the Scale had an average reliability coefficient of 090' (N=lSI8)o2 IIo STUDIES RELATED TO "THE AUTHORITARIAN PERSONALITY" The general thesis of ~ Authoritarian Personality is that the authOritarian person can be described as being basically rigid i insecure, fearful of his own sexual and aggressive tendencies, repressive. extremely status conscious and having a tendency to regard the world as a menacing and ego=alien place where safety/may be found only.in rigid discipline of self and others e and in suppression of ideas or- bebaYiar' which might allow expression of inner disturbing impulseso The 11 authoritarian indi~idual cannot tolerate ambiguitY9 and his perceptions of others are restricted because of his selective inattention to uncon-ventional behavior, his approach to others is conventional Q nonpersona-lized and essentially lacking ininsignto The nonauthoritarian 9 on the other hand g is reported to have greater creativitY9 imagination and ability for empathy~ and a concep-tion of equality in human relationshipso "The nonauthoritarian per= sonalityooohas less need to perceive similarity between his own and others g values and attitudes o His reactions to others will be more highly individualized and his evaluations more objectiveo Therefore, he will be better equipped to use subtle personality cues and make more personalized, insightful assessments of the attitudes and values of others 0,,3 There has been considerable criticism of the F Scaleo For example i Thomas Cohn finds that the Scale is to some degree a measure of ability in role=taking~ which he points out is largely a functio~ of intelligenceo4 Hyman and Sheatsley have argued that validation pro­cedures were seriously deficiento 5 Even with these limitations in mind, the F Scale. in a variety 30 Ao~codel and Po Mussen 9 "Social Perceptions of Authoritarians and Nonauthoritarians,n Journal of Abnormal and Social Psychology, 48: 181, April, 19530 40 Thomas So Cohn9 Upactors Related to Scores on the F (Predis­position to Fascism) Sca1e t" unpublished Pho.Do dissertation!) 'University of M~chig~n0 1953 0 50 Richard' Christie' and' .Marie Jahoda l .Studies in the Scope and Method of "The Authoritarian .Personality," (Glencoeg Tna'Fee Press;- 1954)0PP() ~~-..... ,c.,.",- 12 of studies~ has consistently types of authoritarians e Various have established that the authoritarian personality syndrome particularly evident among the less educated~ the aged, the rural~ the isolate~ members of disadvantaged minorities g members of the more dogmatic religious organizations~ those in lower socio= economic strata 9 and those reared in an authoritarian family environ= mento nOne can conclude g on the basis of results of this wide variety of studies~ that the basic limitation of the F Scale its failure to identify all types of authoritarians o Though the F Scale may be a rough measure of intelligence and role=taking there is no proof that it is not also a measure of author! tarianism 0 gg6 1110 RELATED STUDIES IN NURSING In an investigation of democratic and autocratic beliefs and practices among graduate nurses~ Helen Nahm said that for a long period of years s nursing leaders have written about and emphasized the impor= tance of in hospitals and schools of nursing which are based on a democratic philosophy~ but hospitals are predominately operated on authoritarian principles~ and nursing service tends to be highly authoritarian 0 Yet~ she Uooonurse educators and administrators have relatively less insight into how tight and restrictive'the psycho-logical environment still than almost any other problem of and Thomas Hault~ If'A Social=Psychological theory of the Authoritarian Personality~li Journal of -="' .. ===~~ 65g279 9 November~ 19590 13 nursing education 0 U'iJ7 Perhaps it is this lack of insight into the problem that is reflected in the fact that there have been few studies done in nursing on the problems of authoritarianism g and those reported have been done in relatively recent yearso Helen Nahm~ using an authoritarianism scale other than the F Scale g found that of nursing students enrolled in twelve schools of nursing (N~424)9 the more democratic student groups were enrolled in schools whose practices seemed related to a more liberal or democratic philosophy 0 Students who had had preonursing work in liberal colleges were also more democratic than other stud~rtts .nrolled in collegiate nursing programso As was true of the students g she found that graduate nurses had beliefs and practi~es more related to authoritarian than to democratic philosophyo There was no si.gnificant difference in authori-tarianism between recent graduates and those who graduated a number of years agoo However~ nurses who had had one or more years of college work were significantly less authoritarian than nurses with only high school backgroundo8 Beatrice Brooks conducted a study to determine the validity of the assumption that students who select different types of nursing education are basically different in their attitudeso 9 Using the Nahml) IJtlAutocratic versus Democratic Belief and Practices of Graduate Nurses~ii ;1ourn~ 2! Social PsYChOl.0il.0 33g271~ May, 19510 80 Ibido 9 ~ Brooks,s" ~o cit 0 California F Scale and other measures of attitudes~ she tested 833 students entering diploma® associate degree and baccalaureate schools of nursingo The mean scores of each of the three program samples fell within the authoritarian range of the Scale 0 which indicated that the majority of students entering the selected basic nurse education programs were authoritarian in attitude g even at the time of entrance o 'There was no significant difference in scoring between the three program groups at the time of entrance o Miss Brooks is presently conducting a longitudinal study to ascertain what direction the attitudes will take as a result of 14 experience in the particular program the student enteredo In summarizing her findings 0 she said 0 Il fiSpecific factors which contribute to this high level of authoritarianism at the time of entrance can only be speculated upon at the presento Attitudes~ in general~ are a reflection of con= ditioning o [On an attitude scale measuring social dominance=submission. the]oooscoring of these students indicated that 0 as a group9 they came from a submissive portion of the general population o It may be relevant to speculate that this submissive group tends to reflect more rigid attitudes than do those from a more liberal backgroundo u10 Leonard Eron studied the effect of nursing education on authori~ tarian attitudeso11 He administered the F and Political-Economic- Conservatism scales" plus others j ,to five groups of nursing students at 10 0 Ibid t ppo 29=30 0 110 Leonard Do Eron0' l1IThe Effect of Nursing Education on Attitudesi'nu N~rsing Research® 4g24=21!i June)) 1955 0 15 different stages of their education in two schools of nursing t Yale and the University of Washington Q and to a group of general duty graduate nurses in Washington (N~134)o He found a definite trend for groups to have lower mean scores as age and level of education increased o This was true both between and within the two schools of nursingo The general duty nurses scored significantly lower than all except the third year nursing students at Yale o Because the results parallel within both schools, this study provides evidence of the effect of nursing education and experience on the variableso He found that anxious subjects were also significantly more authoritariano Eron felt that age might account for the changes in F scores, since he found a consistent trend for authoritarian scores to go down as age increasedo It is interesting to note that most other studies have found the opposite result8 in relation to age and F scores. that is the F scores tend to go up with increased ageo Eron 9s sample. however e was restricted to two schools of nursing 0 and the rang~ in age was small. about seven years g since his subjects we~e between about twenty-three and thirty years of age o Nancy Jordison investigated a similar problem'o12 Controlling intelligence and marital status 0 she administered the F Scale to paired groups of nursing students o In genera1 9 ,her hypothesis ,was confirmed that a nursing curriculum leads to desirable changes in attitudes of sensitivity in interpersonal relations o Her results were also 120 Nancy So Jordison~ t1A Nursing Curriculum and Attitude Change 9 It NursingR_E!search t 9 g 19 ~ Spring t 1960 0 16 consistent with the hypothesis that greater changes in the measured attitudes occur in the latter~ clinical portion of the nursing curriculume Georgia Hudson found that the F Scale might have predictive value 0 since her data showed that students with the most democratic attitudes were most apt to have a high grade point averageo13 Most investigators believe~ however 0 that attitude tests are best used in placement and counselinS g rather than in predictiono In the area of psychiatric nursing 0 two studies only very recently reported are of interesto Canter and Shoemaker hypothesized that an individual with an authoritarian personality tendency might be particularly threatened by people g mental patients for example. who were giving evidence of inablity to control themselves~ and might attempt to increase psychological distance between themselves and these threat=inducing peopleo14 These investigators found a significant relationship between authoritarian personality tendencies~ as measured by the F Scale in a group of student nurses (N=47)t and a negative o,r fearful attitude toward mental patientso The authoritarian group was less susceptible to change in this stereotype following instruction and contact with mental patientso- Thus their hypothesis'was supportedo In a study along similar lines 8 Gelfand' and Ullmann'test,ed: a group of nursing students o This group (N:36) decreased very 130 GErc)rgia Bo Hudson~ nEffectiveness of Selected Psychological Tests in Predicting Academic Standing and Persistence for Student Nurses," Nursing ,Research 0 7gl36' October i 1958 0 140 Canter and Shoemakeri\ 2.E"o =l!o significantly in authoritarian attitudes toward mental illness after instruction and contact with psychiatric patientso They also found "very significant evidence" that the less authoritarian student'$ made higher theory grades!) although clinical practice grades were not sig ..... nificantly relatedo15 17 It is difficult to make any generalizations from either'of these studies 0 The reader is urged to note the small sample size 0 and the fact that Gelfand and Ullmann did not indicate whether the group of students who decreased in authoritarian attitudes scored within the authoritarian range of the Scale when they w_re tested before the in-struction and contact with patientso Pre~ious studies cited indicate some relationship between education and experience and decreased F scores, and also tend to support Gelfand and Ullmann~s results regarding grades 0 That nurses tend to have authoritarian tendencies in their personalities is hard to deny in the light of available literature o Various authors have speculated on the causes for this authoritarianism, and some of the hypotheses include the suggestion that the authoritarian atmosphere in many hospitals leads to the development of authoritarian traits in nurEJEuJQ16 Others contend that' such traits are developed long befor$ women pave completed their educational preparation for 15 0 Sidney Gelfand and Leonard Po Ullmann. "Attitude Changes Associated with Psychiatric Affiliation," Nursing Research. 10g200- 204, Fall i 19610 18 nursing, and suggest instead that the highly authoritarian atmosphere in schools of nursing conditions and strengthens the authoritarian trends in personalities, rather than weakens such trends. The tenstons and pressures to conform that are characteristic of schools of nursing reinforce existing trends in individuals who would otherwise remain democratic.17 Still others suggest that the enforced attitude of subservience, the limited opportunity given the nurse to do any indepepdent thi~king and to express her conclusions and the ~~bordinate role the nurse usually plays--ttall representing what some people refer to as good discipline"~-are responsible for the notorously inarticulate nurse who is the product of the authoritarian atmosphere which characterizes many nursing schools today.IS IV. SUMMARY In this review of literature consideration was given to studies related to the F Scale. a measure of authoritarianism, and the use of this Scale in nursingo It was pointed out that the F Scale was constructed, in part, as a measure of prejudice without appearing to have this' as its aim. It was suggested from the literature that the person .with an 1'. Robert Mo Frumkin, "Nursing S,tudents' Attitudes Toward Civil Liberties'," Nur.ing()Q~109k. 4:162-163, March, 1956. 18. DorothY'Mer.ness~ t'Pteparatiop of' the Nurse .for the Psychiatric' Tean1', tlAmeri<:.~ JO~!'fJ;al' !t Nursing, 51:320-32·2 • May. 1951. .~thorit.rian personality axt.~nllli.d his value" was intolerant of ambiluity, lass 1maainativ., .nd baa leaa capacity for empathy .nd inaiaht. Some of the criticisms of the F Scale were reviewed. The use of the F Scale in nursing was found to be relatively limited and fairly recent. These nursina studies tended to support the hypothesis that authoritarianism is related to educational back~ ground, and that the concept of authoritarianism has important impli­cations for nursing service and nursing education. Some suggested reasons for th~ level of authoritarianism in Duraina were also commented upon. 19 CHAPTER III THE METHOD Selection ~ subjectso A list of public hospitals for mental disease, private hospitals for mental disease, and general hospitals which admit patients for the screening and/or treatment of mental disorders in the United States was obtained from the Mental Health Consultant in Region VIII of the United States Public Health Servioe o From these lists. the first hospital in each category named for each of the thirteen Western states was chosen for the study sample. The general hospital psychiatric ward sample was limited to those hospitals which had a regular ward for the screening and treatment of psychiatric patients.. The states included in the study were Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah. Washington and Wyoming. A letter (see Appendix I) was sent to the Director of Nursing in each of the hospitals chosen, explaining the general purpose of the study, and requesting permission to have the F Scale administered to the psychiatric nurses in that hospital. A sample copy of the questionnaire, which was designated Research Survey, was enclosed along with a self-addressed postal card ,(see' Appendix II) on which the Director could check pertinent information essential to administering the.questionnaires. When the postal card was returned, if the Director had agreed to participate in the study', the specified number of questionnaires were sent, along with a stamped.self .. addressed manila .envelope and a letter 21 of instructions (see Appendix III)o If there was no reply from the hospital within one calendar month, a follow-up letter was sent (see Appendix IV)e If the hospital did not reply to the follow-up letter, the next hospital listed for that state and category was contacted in the same manner. If a hospital replied to either of the letters, but did not wish to participate in the study, it was decided that no other hospital of that type for that state would be oontactedo This was done in order to complete the study within a reasonable length of timeo This procedure was repeated until one hos­pital of each of the three kinds. for each state, had been established as a participant or nonparticipant. Through the cooperation of various Directors of Nursing, a total of 272 nurses in twelve Western states, representing four private hospitals, eight general hospital psychiatric wards and ten public hospitals were tested o A total of ninety-six letters were sent to various hospitals, including first letters, instruction letters and follow-up letters. Of the forty~eight hospitals contacted, twenty-three or forty-eight percent agreed to participate in the study. Only one participating hospital did not return the questionnaires~ A total of 348 questionnaires were sent'to participating hospitals. 272 or .. sev.enty~eight percent were returnedo Ten percent, or twenty-eight of those questionnaires were not .completed andcouldt not be used. The.total sample reported was 24~. !.!!!,measul'ing instrumento The .Authoritarian Personality F 22 Scale, used in the stud.y, is found in Appendix'Vo Details may be found elsewhere;l but briefly. the Scale is composed of twenty-eight items which are found in Forms 40 and 45. the third and last revision of the F Scale.2 except for the omission of one itemo This item. "It'is best to keep some postwar authorities in Germany to keep order and prevent chaos," was excluded because it is outdated. The subject was asked to check appropriate spaces in ~elation to educational background and position in nursing, and to fill in blanks with age, date of graduation, age at time of graduation, length of experience in nursing and length of experience in psychiatric nursing, The subjects were not asked to sign their names to the questionnaire. The subject may indicate various degrees of agreement or dis-agreement with each item of the Scale, with no middle or neutral category. The respon,es are converted into positive scores in the following manner: -3 = 1 point =2 = 2 points -1 = 3 points +1 = 5 points +2 = 6 points +3 = 7 points A subject9s scale score is the sum of his'scores on the single items. In this study. the subjects were grouped in.various ways, and the scale scores totaled and divided by the number of subjects' within the group to obtain the mean score per subject 0 Administration of the tests. The author of this study personally administered the questionnaires· to the psychiatric nurses' in' one' public 10 Adorno, -££0 .=.!!o ppo 222-2620 2. Ibid t po 256 0 23 hospital in Washington i and one public and one general hospital psychia-tric ward in Utaho The other questionnaires were mailed to the Director of Nursing in the participating hospital. along with instructions for their administratioD o In all cases. the subjects were to be instructed that they would remain anonymous, and that the testing was part of nursing research being carried out at the University of Utah o Statistical analyses ~~~o It was anticipated that a relationship would be found between the educational background of this sample and authoritarianism as measured by the F Scaleo For the purpose of noting the influence of educational background on the relationships which were predicted. the sample was divided into subgroups according to educational backgroundo In an attempt to determine the relationships between F score and the four variables of age. years since graduation. years of experience in general nursing and years of experience in psychiatric nursing, a product-moment c.orrelation coefficient3 was calculated separately on each of the subgroupso In this way. the variable of educational background was held constant o On the basis of the educational background 9 the subgroups were designated hospital graduate nurses and-nurses' with college.degreese The nurses with college degrees were further subgrouped' into hospital 30 Jo Po Guilford. Fundamental Statistics in Psychology and ,Education g (New York: McGraw-Hill Book Company, ~~. 1956). po-r!8o 24 graduates who had earned a baccalaureate degree in nursing; collesiate graduate nurses; nurses with master or doctoral degrees in'nursing. hospital graduates with a baccalaureate degree in a field other than nursing, s~ch as education or psychology; and associate degree nurs •• o In order to test the predictions concerning the relat~onships between F Scale scores and each item of sociological data, • product-moment correlation coefficient was computed between F scores and each of these variables o Correlations were determined for the entire sample of 244, as well as separate correlations for the sample of 180 hospital graduate nurses t and the sixty=four nurses with college degrees. Further. correlations were computed separately for each of the smaller subgroups within the group of nurses with college degreeso As a further means "of . analyzing , the ,.data.: a· t-r,tio test4 was t S2p(f.'+ ~< nl n2 \ computed to determine the difference between'mean scores' of nurses working in private hospitals, general hospital psychiatric wards and public hospitalso To test .the.~e.d.ic:t.ion .concerning relationships betweenF' scores ~nd ~he type of position presently held in psychiatric nursing', ,. simple analysis of vari,.ncewas'computed ,on a random sample of staff nurses, supervisors, admini~trators and educatorso A similar computation was 40 JIi'Sme Co Rc. Li, I~ir.oductioni to' Statist~e_+' l,nf,rence,. (Ann Arbor, Michigang Edward ... !fathers. rrs9j. po ![!1o performed on a random sample of nurses from each of the twelve states represented in the sampleo 25 CHAPTER IV THE SAMPLE Because there are different levels of nursing education. and the diffePences between these levels of education are an important considera-tion in this study, this chapter will be devoted to a detailed analysis of».:tba-composition of the eritire sc;unple. according to educational background~ and other variables o The entire sampleo The sample~ consisting of 2~4 subjects, was first considered as a who16c Within the entire sample. there was an age range of forty~four years 0 with the youngest subject nineteen an~ FIGURE I Age In Yedrs AGE DISTRIBUTION 27 a half, and the oldest subject sixty=threeo The above Figure I indicates the composition of the entire sample according to agee The numbers at the bottom of the graph represent the lower limits of each intervalo There was a forty=six year range in years since graduation within the sample as a whole0 with the earliest graduation in 1915 0 and the most-recent in 19610 Figure II illustrates the distribution of years. since graduation within the sample Q Numbers at the bottom of this graph indicate the upper and lower limits of each intervalo FIGURE II Yea.rs Since G-raduation DISTRIBUTION OF YEARS SINCE GRADUATION 28 There was_ a fO'flty year range, .within th.e sample in years of general nursing experience~ from less than one year to forty years of experience 0 Experience in psychiatric nursing follows a similar. though shorter range~ with the longest length of psychiatric experience being thirty-six years o Figure III indicates the group composition· regarding these two variables o Numbers at the bottom of this graph indicate the upper and lower limits of each intervalo One notes that s'lightly over fifty-six percent of the nUJri'ses :in this sample had less than five .y ears FIGURE III Years Of Exper-/ence DISTRIBUTION OF PSYCHIATRIC AND GENERAL NURSING EXJ?ERIENCE 29 exp.rience in psychiatric nursing o Figure I indicates that the nurses within this sample are fairly equally distributed according to age. so one can assume that nurses of all ages are entering psychiatric nursing for the first time~ Seventy=one subjects, or slightly over twenty-nine percent of the entire sample have had all their nursing experience in a psychiatric settingo The twelve states represented in the sample are Alaska 9 Arizona, California, Colorado~ Hawaii, Idaho g Montans e Nevada e New Mexico, Utah, Washington and Wyomingo The distribution of subjects within the sample by states is shown in Figure IVa FIGURE IV S ta tes DISTRIBUTION BY STATE 30 Four types of positions in psychiatric n~rsing are represented in the sample l these are staff nurses, supervisors, administrators and ed~catorso The adm~nistrator group includes head nurses as well as d,irectbrf$ of nursing servic,eo The educator group includes those nurses who instruct student nurses~ practical nurses and psychiatric attendents, as well as in=service education instructQrs and directors of nursing education 0 Figure V indicates the distribution of nurses holding different positions within psychiatric nursing o Staff nurses, Sup.'r­visors "dm~ni­strator Educa­tors FIGURE V TOTAL SAMPLE N = 244 NUMBER OF SUBJECTS DISTRIBUTION OF VARIOUS POSITIONS The 244 subjects within the sample are employed in three differenttypes'ofhospitals for the ,care of psychiatric patients. These'includeprivate hospitalsw> general hospital psychiatric wards, and public hospitalso This distribution is pictured in Figure VIo FIGURE VI TOTAL SAMPLE N ~ 244 NUMBER OF SUBJECTS DISTRIBUTION OF TYPES OF HOSPITALS There are six levels of nursing education represented in this 31 sample 0 These levels~ which will be described brieflYi are pictured in Figure VIIi) on page thi.rty=twoo Hospital graduate nurses o The largest group within the total sample is 180 nurses who graduated from hospital schools of nursing, often called diploma schools of nursing o Some hospital schools are affiliated with a college or university for a portion of the nursing curriculum~ but the nurse does not receive a college degree upon com-pletion of the nursing programo Instead i she receives a diploma which entitles her to take the State Board Test Pool Test for licensure. and upon receiving a passing grade on this examination e she becomes a registered nurse~ The~ nursing curriculum in a hospital school of nursing is usually three years in length o Hospital graduate Hospital grad= uate. degree Collegiate graduate Ho~pital grad= uate, non=nur degree Hospital grad­uate, graduate degree Associate degree graduate o 5 ... , )0 FIGURE VII TOTAL SAMPLE N = 244 NUMBER OF SUBJECTS DISTRIBUTION OF EDUCATIONAL LEVELS 32 180 ItS ISO Nurses with college degrees o The second major group within the sample was sixty=four nurses with college degreeso These subjects were further divided according to the type of college background· they had o The largest of these subgroups' includes thirty nurses who had graduated from a hospital school of nursinS i and later obtained a 33 ba~ealaureate degree in nursing from a college or universityo Generally some college credit is given for the hospital nursing curriculum, although this varies considerablyo The nurse is required to take courses which will bring her to the level of a collegiate graduate in nursingo The second largest subgroup wes sixteen graduates of collegiate, or baccalaureate degree nursing programso These nurses spend four or five years~ depending on the particular program in which they are enrolled. in a college or university nursing curriculum, and upon graduation obtain a baccalaureate degree in nursing o The collegiate graduate also takes the State Board Test Pool Test for licensure and upon receiving a passing grade in this examination becomes a registered nursee Five nurses within the group of nurses with college degrees were graduates of hospital schools of nursi~gt who had later obtained a baccalaureate degree from a college or university in a field other than nursing, such as education or psychologyo Since these nurses were working in a psychiatric hospital. it was assumed that nursing was their major field of interest e and the college work had been completed as a supplement to nursingo A fifth subgroup within the sample c'ODs.isted of eight nurses who were graduates of hospital schools of nursing o However. in addition to this preparation, they had also obtained a baccalaureate degree and a graduate degree in some field of nursingo The subjects were not asked to designate whether this graduate degree was on the master or doctoral,level~ There were no collegiate graduate nurses 34 who had e~rned a graduate degree in nursing in this sample 0 The last subgroup within the sample was five nurses who were graduates from associate degree programs in nursingo These programs, which originated in 1952~ are usually within a juniore or community, college, and are generally two years in lengtho Upon completion of the nursing curriculume the student receives an associate degree in nursing, and is entitled to take the State Board Test Pool Test for l~censureo Upon receiving a passing grade on this examination, she becomes a registered nurse o In most associate degree programs, there is no psychiatric nursing curriculum o Instead, there is often a short period of time, usually two to four weeks t when the student observes in a psychiatric setting 0 She may not participate in nursing care given to psychiatric patients 0 Perhaps this lack of instruction and guided contact with psychiatric patients is one reason for the small number of nurses with this type of background in the sample. One might raise the question that few nurses from associate degree programs work in psychiatric settings without further preparation o In summary~ the entire sample was viewed from the standpoint of its composition according to different variables, and a brief descrip­tion was given of the various levels of education in nursing o CHAPTER V THE RESULTS A statistical analysis of the following relationships will be reported in this chapter: (1) the relationship between scores on the F Scale to age, years since graduation, years of general nursing experience, and years of psychiatric nursing experience for the entire sample; (2) the relationship of scores on the F Scale to the above variables for hospital graduate nurses; (3) the relationship of F scores to these variables for nurses with college degrees; (4) a comparison of relationships between F scores and the above variables among subgroups within the sample; and (5) other comparisons within the sample. The relationship~! scores ~~~ variables within the entire sample. The product-moment coefficient of correlation between F Scale scores and age in the entire sample is moderate, showing a definite relationship, and is significant at the .01 level of confi­dence.. Ooefficient of correlations are significant at the .01 level of confidence for years since graduation and length of general nursing experience (see Table 1)0 This indicates that as age increased, F. scores also increased, as the number of years since graduation increased. F scores increased, and as years of experience in nursing increased, the F score increasedo The correlation coefficient for years of psychiatric nursing experience was very slightly negative, and did not reach statistical significance. This finding was essentially repeated in all subgroups of the sample. 36 ~ relationship ~I scores ~ variables ~ hospital graduate nurses. In the sample of 180 hospital graduate nurses, the findings were consistent with results obtained for the entire sampleo Correla­tions were significant at the 001 level of confidence between F scores and age, years since graduation, and years of experience in general nursing, with a small negative correlation between years of psychiatric experience and F scores (see Table I)o As in the entire sample, increased age, earlier date of gradua­tion and longer years of general nursing experience accompany a higher F score in this sample of hospital graduate nurses, with length of psychiatric nursing experience having no significant relationship. ~ relationship ~I scores ~ variables for' nurses ~ college degrees o Consistent with results from the entire sample and the hospital graduate nurses, are the results obtained in the group of sixty-four nurses with college degrees. The coefficient of correlation between F scores and age is significant at the 005 level of confidence, while correlations between F scores and years since graduation, and length of experience in general nursing are significant at the .01 level of confidence. There is a very small negative correlation between length of psychiatric nursing experience and F scores for this sample group (see Table 1)0 These results indicate that a higher F score among nurses with college degrees in this sample is found in older nurses, who graduated earlier and have had longer years of experience in general nursing, with length of psychiatric nursing experience apparently unrelated. TABLE I PRODUCT~MOMENT CORRELATIONS BETWEEN F SCORES AND FOUR VARIABLES FOR THE ENTIRE SAMPLE, FOR THE HOSPITAL GRADUATE NURSES AND NURSES WITH COLLEGE DEGREES AGE YEARS S'INCE GENERAL PSYCHIATRIC GRADUATION EXPERIENCE EXPERIENCE t- ENTIRE SAMPLE N = 244 025a 028a 020a '=002 HOSPITAL GRADUATE tl = .).80 029a 030a 020a "'0003 COLLEGE. DEGREE N = 64 027b 034a 032a -0036 aCo~elation is significantly different from zero at the 001 level of confidencec bCorrelation is significantly different from zero at the 005 level of confidence o On the basis of significant correlations cited in Table I. it is concluded that Hypothesis I. that a direct relationship would be found between F scores and age. is upheld. and that older nurses in this sample tend to score higher on the F Scalee The re~ationships 37 fall beyond the cOl level oft eonfidence.with the exception of age and F scores in' ,nurses with college degreese which is significant at the 39 005 level of confidence o It is also concluded ,that, ,Hypothesis II, predicting a direct relationsh~p,betweenyears since graduat~on from any school of nijl'sing and F scores, ,is upheld, and that nurses',~nthis sample who graduated earlier ,tend to ,score higher on the' ,F 'Seal, than nurses who graduated more recently, regardless of the type ot,nursing education program attended 0 The r.elationships are significant beyond the 001 level of confidence 0 ,S~gnificant' ,correlations.;between ,F sco~es and the length of experience ,in ,general nursing cited in Table I also uphold Hypothesis III, which ,pnedicted,a ,direct, relationship between length of experience in general nursing and,r Scale scor..s. Thus, ,the nurses in this sample with longer years of gen'eral nu.rsing elCperienpe te~d. tQ have higher sco~es on the FScale. Thes'erelat,ionships are significant beyond the 001 level of confidence. CorrelationswerenQt· significant between' F scores and length of experience ,in ,psychiatric' nursing" Hypothesis ,lV, which predicted an invel'se .relationship .would be ,found'between' length of ,experience <in psychiatric nursing andF Scale sco!'.'., was .not upl1e+Q, and in fact. the direction of the "obtained correlat~ons,' .was appoai te to that predicted. In an' ,attempt to inv.st·igate ,this finding further, the author believed ,that the affects of age,.might be a distorting factor~ To testt~is assumption', a iproduct-momentcor.~elation ,coefficient was calculated between~age' and length ,of experience in psychiatric' nursingo 39 A first=order partial coefficient of correlation was computed to hold the variable of age constanta With the influences of age upon F scores ruled. out or nullified 9 the correlation between F scores and length of I psychiatric experience is 0163 0 This correlation is significant at the 001 level of confidenceo This computation was performed on the entire sample of 2449 since results on this variable were similar for all subgroups within the sampleo In this sample t decreased F scores do accompany longer years of psychiatric experience if the influences of age are nullifiedo This further computation upholds Hypothesis IVo ! comparison ~ relationships between F scores ~~ variables in subgroups within ~ group £!: nurses ~ college degrees 0 The coefficients of correlation between F scores and age 0 years since graduation 9 length of experience in general nursing and length of experience in psychiatric nursinS 9 while not reaching levels of signi-ficance. tend to be in the same direction as correlations obtained in the larger groups within the sampleo These subgroups are small, how-ever. and this is offered as one reason for lack of statistical signifi-canceo The correlations for the various subgroups within the group of nurses with college degrees are cited in Table 110 Even though these correlations fail to reach significance, they do, in general 9 tend to support previous findings cited above c Other comparisons within ~ sampleo A comparison of mean scores and standard deviations for the various subgroups within the sample i indicate that t in general i nurses with more education tend to have lower F scores (see- Table 111)0 TABLE II PRODUCT-MOMENT CORRELATIONS BETWEEN F SCORES AND FOUR VARIABLES FOR THE SUBGROUPS WITHIN THE GROUP OF NURSES. WITH, COLLEGE DEGREES .... AGE YEARS SINCE GENERAL PSYCHIATRIC Hospital graduates with nursing degrees N = 30 033 Collegiate graduates N = 16 021 Hospital graduates with graduate degrees in nursing N = 8 025 Hospital graduates with non=nursing degrees N = 5 -0016 Associate degree graduates N = 5 041 GRADUATION EXPERIENCE EXPERIENCE 032 018 0015 031 009 061 .60 002 024 014 40 TABLE III A COMPARISON OF THE F SCALE MEAN SCORES AND STANDARD DEVIATIONS FOR VARIOUS GROUPS WITHIN THE SAMPLE SUBGROUP Entire sample N = 244 Hospital graduates N = 180 Nurses with college degrees N = 64 Hospital graduates with baccalaur~te degrees N = 30 Collegiate graduates N = 16 Hospital graduates with baccalaureat~ arid graduate d~grees in.nursing N = 8 Hospital graduates with non-nursing baccalaureate degrees N = 5 Associate degree graduates N = 5 MEAN r SCORE 88 0 7c 78.0 STANDARD DEVIATION 25.2 28.7 19.0 41 cT-ratio test indicates difference between mean scores signifi­cantly different from zero at the .01 level of confidence. 42 To test the significance of the difference of the mean scores on the F Scale between hospital graduate nurses and nurses with college 'degrees~ a sample of sixty=four hospital graduate nurses was chosen. using a random sample tabl60 No attempt was made to match the two groups of sixty=four except for number of cases o A t=ratio test was computed 9 which demonstrated a difference in the mean scores of these two groupso This difference was highly significant at the 001 level of confidence (a t=ratio of ! 20 61 was necessary to be significant at the 001 level i and a t=ratio of ! 40 91 was obtained)o To further establish the finding that education does have a relationship as predicted to F scores, the subgroups were further compared 0 Table IV gives the mean age for the various groups. as well as the mean years since graduation i mean length of general nursing experience and mean length of psychiatric nursing experienceo Although Table IV reveals that there are some small'differences in the mean age, years since graduation and years of experience in both general nursing and psychiatric nursing. these differences are not statistically significant a and not large enough to account' for the very significant difference between the mean scores on the F Scale of hospital graduate nurses and the mean F scores of nurses with any type of college backgroundo In an attempt to identify further differences inF scores within the entire samples the 244 subjects were divided into the type of position presently held in psychiatric nursingo A random sample of seventeen cases was selected. again using the random sample tables. for TABLE IV A COMPARISON OF MEAN AGE, YEARS SINCE GRADUATION AND LENGTH OF GENERAL AND PSYCHIATRIC NURSING EXPERIENCE FOR VARIOUS GROUPS WITHIN THE SAMPLE MEAN MEAN ,YEARS MEAN MEAN SUBGROUP AGE SINCE GENERAL PSYCHIATRIC GRADUATION EXPERIENCE EXPERIENCE Entire sample N = 244 33 0 5 15 1106 years 506 years (1946) Hospital graduates N = 180 3101 14 11 eS 505 (1947) Nurses with college degrees N = 64 3704 15 12 0 0 600 (1946) Hospital graduate. baccalaureate degree N = 30 41 0 5 19 15 04 705 (1942) Collegiate graduate N = 16 28 0 2 6 60 4 304 (1955) Hospital graduates bacca1aureate t graduate degree in nursing N = B 42 0 6 18 15 0 6 70 6 (1943) Hospi~a1 graduate 0 non-nursing degree N = 5 4204 17 13 0 2 5 6 8 (1944) Associate degree graduate N = 5 29 0 2 4 20 8 204 (1957 ) 43 44 each of the four types of position j staff nurse i supervisor9 administra-tor and educatoro The mean scores for each of these groups are compared in Table Vo TABLE V MEAN SCORES OF A RANDOM SAMPLE OF TYPE OF POSITION Staff nurses Supervisors Administrators Educators NURSES. IN. DIFFERE.NT . POSITIONS MEAN F SCORES FOR A RANDOM SAMPLE OF SEVENTEEN SUBJECTS 88 0 30 91 0 00 68 0 35 Although there is a definite trend for educators to score lower than the other three groups0 and supervisors to score higher than the other groupsj an analysis of variance did not demonstrate a significant difference in mean scores (the obtained F reached about the ten percent level of significance)o On the basis of the fact that no significant differences were found between mean scores of a random sample of nurses in .various positions ,in psychiatric nursing 9 Hypothesis VI9 ,pr,edicting that there would be no significant differences between these groups~ is upheldo As noted above@ however~ there was a trend in the mean scores for supervisors to score highest~ with staff nurses~ administrators and educators following~ in that ordaro . 45 No significant difference between mean F scores was found for a random sample of nurses working in different types of hosp'italso One can conclude that~ in general~ high ·scorers and low scorers are ran= domly distributed in the sample of nurses employed in the private hospitals i general hospital psychiatric wards and public hospitals in this sample o In similar computations 0 no significant differences in mean F scores were found between a random sample of nurses working in the twelve states represented in this sampleo Again~ one might conclude that high and low scorers are randomly distributed in the sample of nurses tested in the various states o In summary~ it was found that (1) the older nurses in the sample tested tend to have higher F Scale scores, (2) the nurses in this sample who graduated from any type of nursing education program several years ago tend to have higher F scores than recent graduates from any type of nursing program; (3) nurses in this sample with more years of general nursing experience tend to have higher F scores; (4) in this sample longer years of psychiatric nursing experience are related to decreased F Scale scores if the affects' of age on F scores are nullified; (5) these results are comparable between hospital graduate nurses 9 nurses with college degrees and for the entire sample, (7) there is no 46 apparent relationship between F Scale scores and the type of position held in psychiatric nursing; (8) there is no relationship betweep F scores and the type of hospital in which the subject works in this sample; (9) there is no relationship in this sample be~ween F scores and the state in which the subject is employed, and (10) there is a significant difference in the scores of hospital graduate nurses and nurses with college backgrounds 9 with hospital graduates scoring signi­ficantly higher on the F Scale than nurses with college degrees. CHAPTER VI ANALYSIS OF RESULTS A consideration of the obtained correlations o In this study of the interrelationships of the F Scale scores and the variables of age, years since graduation 9 length of experience in both general nursing and psychiatric nursinS i and educational background, with the one exception of psychiatric nursing experience t high and consistent corre= lations were founde Significant correlations between length of psychia-tric nursing experience and F scores were found when the influence of age on F scores was nullified o Even with these correlations~ however. one must be cautious in making broad generalizations about the descriptions of persons with authoritarian and nonauthoritarian personality tendencies o Considera-tion must be made of the fact that the Scale is not exclusive in its measurement of traits e As has already been considered in the review of literature~ these measures are not independento Apparently no factor a~alysis was done on the items to see if there were clusters of items which did not conform to the variables listed on pages six and seven of this studye The Scale was not 0 therefore. a "pure" measure of authoritarianisrne The findings cited in this study do conform, however, with results from many previous studies. and in general. it is concluded that the F Scale is a valid and reliable measure of authoritarian tendencies in the sample tested o Consideration was given to the high level of authoritarian traits 48 and practices within the nursing profession in the review of litera-ture o Isabel Menzies states that nurses e~perience a good deal of stress in their worko1 When one considers Eronvs finding that anxious subjects were significantly more authoritarian.2 substantiated by Pressey and Kuhlen in the statement that "oooanxious subjects or sub-jects under stress appear to be more rigid i perhaps achieving a certain security by inflexible behavior~uv3 one might expect a higher mean score in this sample o The group on which the Scale was validated (N = 449) had a mean score of 113 0 90, which is higher than the 8402 mean sco~e for the entire sample tested in this studyo Perhaps one reason for this comparatively lower mean score is the increased awareness among the general public of the authoritarian-nonauthoritarian descriptionso Thus, the nurses in this sample might have made an effort toward marking the "right" answerso It would not have been possible to control ~his factor& if it did i in fact, enter into the reported attitudes of the subjectso Adorno discusses the low scorer and describes various "syndromes" that .explain this scoring patterno4 It is possible that part or all of these syndrome factors entered into the resultso Ie Isabel Eo Po Menzies i) ItNurses Under Stress 't" Internat iona1 Nursing Review9 7g9 9 December i 1960 0 3 0 Sidney Lo Pressey and Raymond Go Kuhlen e . Psychological .Dev.elopment Thr.ough ~~ Spane (New York~ Harper and Brothers, 1957), po 358 0 49 High and consistent correlations between F scores and age show the same trend as the results of many previous studies o Many surveys and polls have reported more conservative attitudes among older peopleo Adorno closely correlates conservatism and F Scale scores.S so one might raise the question that growing older simultaneously affects the F Scale and conservatismc However g it might be that the increased awareness of authori­tarian characteristics, and the intellectual acceptance of the deleterous affect of these characteristics on psychiatric patients might have affected the younger members of this sample in the same way that it might have affected the lower-than=expected mean scores o It should be noted that these results regarding increased F scores accompanying increased age are in opposition to Eron's findings, since he found a consistent trend for authoritarian scores to go down with increased ageo6 The age range of the present study, however. was forty=four years, compared to about seven years in Eron~s samplee It is concluded that the present results are more reliable. both because of the greater age range l the larger number of subjects in the sample. and the greater geographical and educational representationo The high correlations obtained between F scores and years since graduation follow closely the findings associated with age o Since older nurses would have graduated earlier g and younger nurses would 50 Ibid 0 pp~ 262-2650 60 Eron 9 ~e cito 50 have graduated more recently~ this finding seems reasonable o Helen Nahm found opposite results regarding years since graduation~ since she found no significant difference in authoritarianism between recent graduates and those who graduated a number of years ago07 She did not report on the range of years since graduation in her study, however 0 She also used a measurement of authoritarianism other than the F Scale, and this may account for lack of agreement in this area o One might raise the question that the increased concern among nurse educators about authoritarian practices and methods of teaching in schools of nursing in recent years might be a factor in the lower mean F scores found in more recent graduates o A further question might be raised that there has been an increased concern about authoritarian practices among nursing service personnel~ and that this factor might have influenced the lower mean scores found among nurses with shorter lengths of experience in general nursing o In the studies cited in Chapter II by Canter and ShoemakerS and Gelfand and Ullmann9 some relationships were found between a psychiatric nursing affiliation and F scores o Although the results of these two studies seem conflicting~ they both indicate that there were some changes in students i attitudes after instruction and contact with psychiatric patients o On the basis of these studies s it was predicted 70 Helen Nahm~ ~o ~o 8 0 Canter and Shoemaker, ~o =!!o 90 Gelfand and Ullmann® ~o =!!o 51 that there would be a decrease in authoritarian attitudes as the le,ngth of experience in a psychiatric hospital increased o This prediction was not borne out~ instead there was a slightly negative correlation 9 in general 0 When the influence of age on F scores was nullified 9 however 0 there was a significant relationship between r scores and years of experience in a psychiatric settingo One might assume that age has a greater influence on F Scale scores than does psychiatric experience o The significant differences in this study between mean F scores of hospital graduate nurses and the scores of nurses with any type of college background tends to support the work of numerous other investi­gatorso Helen Nahm also found that nurses with one or more years of college had lowe~ mean scores than nurses with only a high school back­groundo lO The mean scores of the group of sixty=four nurses with college degrees was compared with mean scores of a random sample of sixty=four hospital graduate nurses o No attempt was made to statistically compare other subgroups within the group of nurses with college degrees because of the small size of these subgroupso However. a gross comparison reveals that the sixteen collegiate graduates had the lowest mean F seore t 6202 or 26 0 5 points below the mean score of hospital graduate nurses (see Table IlIon page fort y=one) 0 Hospital graduates with a baccalaureate degree in a field other than nursing had an almost equally low mean score of 6205~ Associate degree graduates had the 52 highest mean score within this group0 but at 78 0 0 they still scored 10 07 points below hospital graduates o Since associate degree graduates usually spend a year less than hospital graduates in a nursing curri~ culum 0 an important question is raisedo Perhaps the length of nursing education may not be of particular importance in regard to changes in authoritarian attitudes 9 as long as the nursing education is in a college or university settingo Since age has been shown to have a relationship to F scores in this sample® one might expect that subgroups which were older on the average would tend to score highero Three subgroups hav~ an average age over forty=one years i these are hospital graduates with nursing degrees at the baccalaureate level i at the graduate level 0 and at the baccalaureate level in a field other than nursing o The first two subgroups do tend to score somewhat higher than other subgroupse but hospital graduates with non=nursing degrees had the second lowest mean F score o This finding would lead one to question whether some factor in a non-nursing curriculum at the collegiate level counteracts to a greater degree than the, collegiate nursing curriculum those factors in the hospital nursing program that foster and encourage authoritarian attitudes 0 Adorno generally discusses the F Scale as measuring a deep=lying and relatively enduring aspect of personality structureo Yet, it would seem that the environmental experience of college work g in general. tends to influence F scores by lowering them~ Critics of this assump= tion believe that people with different types of personality tendencies 53 enter different types of programso Beatrice Brooks tested this hypo­thesis 9 and found that nursing students tend to have authoritarian atti­tides regardless of the type of nursing program they entered oll The results of the present studYi and other studies 9 introduce a question as to the durablity of authoritarian traits o There are important implications in this question for the educators of nursing students for psychi~tric nursing~ and for other areas of nursing in which the personality of the nurse is of importanceo These implica= tions will be discussed in the last chapter of this studyo Although there was no significant difference in the mean F scores of nurses in different positions in psychiatric nursing 9 there was a trend in the sample for supervisors to score higher than other groups and educators to score lowero In order to match the four groups for size 0 a random sample of seventeen subjects was chosen for each groupo It may be that 'this sample was too small to show any signifi­cance b$yon~ a trendo CHAPTER VII SUMMARY0 CONCLUSIONS AND RECOMMENDATIONS ~ problemo The general purpose of this study was to test certain inferred relationships between the authoritarian and nonauthori= tarian personalitiesf) as defined by Adorno and his colleagues. and ages years since graduation 0 length of general nursing and psychiatric nursing experience 8 and the type of nursing education background of a group of psychiatric nurses 0 A of wer'e made about the relationships between Jhe Authoritarian r Scale and these items of sociological datao The basis for constructing these hypotheses resulted from of authoritian and nonauthoritarian people by Adorno1 and numerous other investigators o Comparisons of these descriptions led to the following hypothesesg A direct relationship would be found between r Scale scores and age, years since graduation 0 length of experience in general nursing and length of experience in psychiatric nursing o A relationship would be found between F scores and the type of educational background 0 thus the graduates of hospital schools of nursing would score highero No relationship would be found between F scores and the type of position held in psychiatric nursingo Methods and 0 In order to test the hypotheses 0 the F Scale was administered to a group' of 244 registered nurses employed in both public and private hospitals and general hospital psychiatric AlH:lY\lTlIO 9 2.£0 cit 0 55 wards in twelve Western stateso The psychiatric nurse sample was characterized by a wide range of age g graduation dates 0 lengths of experience in both general nursing and psychiatricnursing~ and they represented six levels of nursing educational backgroundo In order to test the hypotheses concerning ~he relationships between F Scale scores and each of the variables~ a product-moment correlation coefficient was computed between F scores and age, years since graduation 9 length of general nursing experience and psychiatric nursing experience for the entire group0 and for various subgroups within the sampleo Asa further means of analyzing the data e a t=ratio test of the difference between mean scores was made between the mean scores of the groups representing each of the six levels of educational backgroundo Statistical comparisons were also made between nurses in staff nurse. supervisorY9 administrative and educational positions in psychiatric nursingo The sample was further compared by testing differences between mean scores of a random sample of nurses working in private hospitals~ general hospital psychiatric wards and public hospitalso Similar comparisons were made on a random sample of nurses work~ng in each of the twelve states represented in .the sampleo The results6 In testing the predictions made in this study the following results were obtainedg 10 A significant positive correlation existed .between the F Scale scores and age o The hypothesis was upheld for the entire sample 56 and for the two main subgroups within the ~ample® the hospital graduate nurses and nurses with college degrees o 20 A significant positive relationship existed between F Scale scores and years since graduation o This hypothesis was upheld for the entire sample and for the two main subgroupso 30 A significant positive relationship existed between the length of experience in general nursing and F Scale scores o This hypo= thesis was upheld for both main subgroups as well as the entire sample o 40 No significant relationship existed between F Scale scores and the length of experience in psychiatric nursing o However® a signi­ficant relationship existed between F scores and y,ars of psychiatric nursing experience when the influence of age on F ,cores was nullified o 50 A significant difference existed between the mean F scores of hospital graduate nurses and nurses with college degreeso The hypothesis predicting a relationship between the type of nursing educa= tional background and F Scale scores was upheldo 60 No significant difference existed between mean F sco~es of nurses in different positions in psychiatric nursing o This hypothesis was upheldo 70 Mean F scores for this sample were lower than .those found by Adorno and his collaborators in their California studies 6 8 0 No significant difference existed between the mean F scores of nurses wqrking in different types of psychiatric hQspitalso 90 No significant difference existed between the mean F scores of nurses working in different states o 57 CONCLUSIONS 10 Assuming that the F Scale is a valid measure of authoritarian tendencies in the personality structure g it would seem that descriptions made by Adorno and many others Q of the authoritarian and nonauthoritarian person are applicable to this sample of psychiatric nurses o 20 The variables Adorno postulated as making up the authori­tarian personality are not as prominent among the sample group of psych­iatric nurses as they were among the population on which the r Scale was validated~ since the psychiatric nurse sample had lower mean F scores than the validation groupo 30 Important factors which influence scores on the California F Scale include age and educational backgroundo RECOMMENDATIONS In order to better understand the nature of authoritarianism in this psychiatric nurse subculture 9 it would be of great interest and utility to conduct an analysis of the items of The Authoritarian Per= sonality F Scale o A study of this kind would provide information and understanding of the unique characteristics of this population and would afford further comparison of this group with other samples from the general populationo Studies are needed to investigate the affect of authoritarian personality tendencies in the psychiatric nurse on the nursing care she gives the psychiatric patient 0 Further studies on the attitudes of men and women entering 58 nursing would help to clarify research on the attitudes among graduate nurses 0 Definitive studies to ascertain tne affect of a psychiatric nursing curriculum on attitudes of nursing students are needed o Studies of this type would help to determine what changes could be expected, and what changes might be encouraged in students during their experience in this area of the nursing curriculumo Certain implications for nursing education and nursing service result from this studyo Among these implications are changes which might be instituted in all types of nursing education. but in particular in the hospital school of nursingo More emphasis could b~ given to attitudes of nursing students l and attention directed toward encour.a g- ~ ~ ins the nursing student toward the use of scientific and problem solving techniques in nursing problems, and discouraging the use of stereotyped solutions with no opportunity for the student to do critical, evaluative thinkingo In the nursing service area, certain changes are implied from this studyo It would be helpful for the nurse to have more opportunity to make decisions about nursing problems~ which would increase the emphasis on personal initiative o It would be helpful to clearly define responsibilities so that the nurse could rely more on critical, evalua-tivethinking in giving nursing care than on rigid. stereotyped methods and .procedures which help to reduce her anxiety~ This study implies,that it would be helpful to encourage graduates of.hospital schools of nursing to return to college for 59 additional preparation in nursing or allied fields o The results of the study also imply certain changes that might be made in selection and placement of nurses in the psychiatric settingo Younger nurses, with some college or university work in their educational background might be selected to work closely with psychiatric patients; while older nurses who graduated from a hospital school of nursing might be placed in positions where there was not so much direct contact with patients. BIBLIOGRAPHY BIBLIOGRAPHY Adorno, To WOi) and others!) The Authoritarian Personality. New Yorkg Harper and Brothers~ 19~ Allporte Gordon W0 8 The Nature of Prejudice. Cambridgeg Addison=Wesley Publishing Company; 1954 9 537 ppo Block i Jack and Jeanne Block g v'An Investigation of the Relationshi.p Between Intolerance .to Ambiguity and Ethnocentrism t " Journal of Personality. 199303=311i March, 19510 Brooks. Beatrice 0 VYStudent AttitudeS8 How They Differ," Nursing World. 134~28=30~ June i 1960 0 Browne Amy Frances® Research in Nursing g Philadelphiag Wo Bo Saunders CompanY0 1958. 316 ppa == Canter g Francis MO i and Ruth Shoemakerg "The Relationship Between Authoritarian Attitudes and Attitudes Toward Mental patients." Nursing Research 9 9~39=41® Winter 0 1960 0 Christie 9 Richard g liThe Effects of Frustration Upon Rigidity in Problem Solution~>,' !!!!: American Psychologist t Sg296=297. July, 1950 0 Christie g Richard and Marie Jahoda. Studies in the Scope and Method of "The Author! tarian Personality 0 it Glencoe =-.ni'e Free' Press, 1954;- 2'19ppo Cohne Thomas 809 'UFactors Related to Scores on the F (Predisposition to Fascism) Scale 9 Wf unpublished PhoDo dissertation, University' of Mich­igang 1953 0 Committee on Psychiatric Nursing of the Group for the Advancement of Psychiatry, The Psychiatric Nurse in the Mental Hospital. Report Number 229 MaY9 1952 0 =--= ====- Copeland. Mary and others 0 "A Projective Technique for Investigating How Nurses Feel About the Use of AuthoritYt" Nursing' Research. 4:79, Octoberg 1955 0 Cronback g Lee JOt Essentials of Psychological Testing. New York: Harper and Brothers 9 1960 9 60~pP: . Edwards g Allen Log Statistical Methods for the Behavioral Sciences. New York~ Rinehart and COmpanYt 19~~ ppo - Edwards gAllen .L 0 0 ifUnlabled Fascist Attitudes 9 tV· Journal of Abnormal and Social Psycholo 9 36gS75=582 g October, 19410 -- 62 Erona Leonard~ "The Effect of Nursing Education on Attitudese":Nursing Research l 4g24=27® June® 1955 0 Frenkel~Brunswik® Else® Yflntolerance of Ambiguity as an Emotional and Perceptual Personality Variable ~.. Journal 2L Personali tr t 1,8: 108. +43. January® 1949 0 Fromm. Eric. Escape From Fr~edomi) New Yorkg Farrar and Rinehart, Ine., 1941 9 299 ppo ==== Frumkin. Robert Mo 9 ~'Nursing StudentsO Attitudes Toward Civil .. ,Liberties," Nursing Outlook 0 4g162=163& March s 1956 0 Gelfand I) Sidney and Leonard Po Ullmann 9 911Attitude Changes Associated with Psychiatric Affiliation t l1i Nursing Research t 10 g 200.204. fall, 19610 Gregg, Dorothy Eo~ nThe Psychiatric Nurse~s Role l n AlDeric.an,_Journal ~ . Nursing 0 54g848=451~ JulY8 1954 0 Guilford t Jo PO& Fundamental Statistics in Psychology and Education, New Yorkg McGraw=Hill Book Company®:Inco t 19569 565 pp. Hansen j Helen Fo, A Review of Nursing~ Philadelphia: Wo Be Saunders Company. 19560~58 ppo == - Hudson. Georgia B0 8 9¥Effectiveness of Selected Psychological Tests in Predicting Academic Standing and Persistence for Student Nurses." Nursing Resea~chi 19l36 t Octoberi 19580 Jones i Me B0 0 UAuthoritarianism and Intolerance of Fluctuation,". Journal of Abnormal and Social Psychologyi 50gl25-126. 1955. Jordison. Nancy Sittins® ViA Nursing Curriculum and Attitude Changes," Nursing Research 0 9g79, Spring~ 1960 c l<alkman. Marian!) nWhat the Psychiatric Nurse Should be Educated to Do," ~sychiatric QuarterlY0 Supplement0 1993. 19520 Li, Jerome Co Rot Introduction to Statistical Inference. Ann Arbor, Michigan~ Edwards Brothers~959i 553 ppo Maslow, Ao Hot nThe Authoritarian Character Structure," Journal of Social Psychology~ l8g401=411~ November i 19430 Menzies. Isabel E() P0 0 uNurses Under Stressi)Vf International Nursing Review~ 7g9=16 0 December~ 1960 0 Mereness. Dorothy!) "Preparation of the Nurse for the Psychiatric Team,lt American Journal~ Nursingt 51g320=322 0 MaYi 19516 MY.1'8. Marain J •• Jro l "Authority a Handle with Care," Hospitals, 311 ~l. January, 1957 0 63 Nahm. Helen, "Autocratic veraus Democratic BeUefa and Practice. ot Graduate Nurses," Journal !!Soc.!al PsychololY. 331271-278. May, 1951. Narvan. Leslie" and James Co Stauffacher~ "The Personality Structure of Ps~chiatric Nurses." Nursing _.search, 5gl09=114e February, 1951. Pearline Lo 10e "A Research Report on Some Valu~s and Behaviors on Nursing.Stations~n unpublished research grant report, Division of' Nursing Resources e Public Health Service, July, 1957 0 Pollack 9 Otto and others. t'Pennsylvania Pilot Study of Nursing Functions,it HursingResearcb" 2821=22. June. 1953 0 Pressey. Sidney Lo. and Raymond Go Kuhlen, Psychological Development Through the ~ Spang New Yorkg Harper and Brothers t 1951. 654pp. Rokeach~ Milton, .!1!!:. Open ~ Closed ~9 New York: Basic Books. Inco, 1960$ 410 ppo Sanford 9 Nevitt. "Recent Developm$nts in Connection with the Investi­gation of the Authoritarian Personality." Sociological Review, (New Series). 2g11-33. July, 1954 0 Scodel. Alvin and Paul Mussen, "Social Perceptions of Authoritarians and Nonauthoritariansj)1J8 Journal of Abnormal and Social Psychology. 48:181-184. Aprile 1953 0 -- --- . Stewart. Don and Thomas Hault. uA Social~Psychological Theory of The Authoritarian Personality," American Journa,l· of Soc!oloiY. 652274- 279. November, 1959 0 -.. Stott, Sterling Stewart, "A Comperison of th_ Authoritarian PePSODelity F ... Scale .with the Allport ... Vernon-L!ndzfly$tudy'of Values." unpu.b­lished masterOs thesis. Uni:versity of Utah, 195""0 Titus, Edwin HOi) and Eo Po Holl,nder, nThe California F Scale in . Psycbology8 Research 19500 1955," Psychological Bulletin. 54:1. January~ 1957 0 , .. Tudor, Gwen £·01 "Sociopsychiatric Nursing ApPl"oach' .to Intervention in a Problem of Mutual Witbdrawal· on's Mental:Hospital·Ward,tt :Psychiatry, ,15:2, May. 19520 Weisl t O.l.la' ~M'6t' ,~ttitude.ill' ,Pstcbl:atric': N~.r.s.l~I .. C.r,. New York1 G. P • . , , ~tnalD"a Sona, !§S4't: itt ppo : APPENDIX APPENDIX I FIRST LETTER TO THE DIRECTOR OF NURSING Director of Nursing --========= Hospital -==~~======0 Arizona Dear Madame t - In an attempt to improve nursing education. I am studying some opinions held by psychiatric nurseso The sample chosen for this study includes various types of hospitals for the care of psychiatric patients in the thirteen Western states in the United States Public Health Service Region VIIlo Your participation in this study is requestedo Your participation in the study would involve the administra­tion of a simple queltionnaire to the nurses who are regularly employed in the psychiatric w.rds of your hospitalo A sample questionnaire is enclosed 0 The instructions are complete on the questionnaire itself. and it takes less than fifteen minutes to complete~ Other hospitals participating in the study have used p,rt of an in=service meeting with success i since the questionnaire can be completed and handed in at one time o The questionnaire can also be given to individual nurses to complete o In my studYQ a psychiatric nurse- is defined as a registered nurse who is assigned the full time that she is on duty in the hospital to the psychiatric wards o This includes part time nurses as well as full time; supervisors." admin.istrators"andeducat.orsas ... well as staff nurses 0 A postal card is enclosed for your .. replYa On receiving your replYe I will send the specified. number. of questionnaires, along with instructions for their administration and a stamped. self=addressed envelope for their return to me o I will be happy to send you a copy of the research results when the study i. completed~ and I will appreciate your participation in the research o Yours sincerely. APPENDIX I.I POSTAL CARD ENCLOSED WITH FIRST LETTER I will participate in this research study Yes No ~~~==~~~~~--- Total number of Ro Novs.employed in the hospital. Number of questionnaires needed __ ~~~==~==~~~a- Hospital bed capacity Average patient census Signed ~~~~==~--~~=~==-=~=-===-=-=~=~=-==~H~o~~~.qi~t-a91~~--~- ~-====~=====. Arizona APPENDIX III LETTER OF INSTRUCTION Jane Doe i Ro No Director of Nursing ==---====== Hospital -==========9 Arizona Dear Miss Doe~ I received your postal card reply today® and want to thank you for your interest and participation in this research studyo Ten questionnaires j along with a stamped 9 self=addressed manila envelope are enclosedo The questionnaire is simple to administer, the instructions are complete on the form itself. and it should take less than fifteen minutes to completeo Many hospitals have used part of an in-service meeting to administer the questionnaires Q since they can be completed and collected at one timeo It might be more convenient i how­ever 0 to give the questionnaire to each individual nurse to complete 9 ' with instructions to turn the form in at some specified time and placeo Usually the less time allowed~ one shift or one day at the most e the better the returns will bec Regardless of the way in which .you choose to administer the questionnaires 9 a quieti unhurried and uninterrupted atmosphere is most conducive to filling out the form carefullyo Please inform the nurses that they should fill 'out the form completely, that they are not to sign their names to the forms 9 and that they are parti­cipating in this research as ,part of nursing research being carried out at the University of ... Uta.h o In my studY8 a psychiatric nurse is defined as a registered'nurse who is assigned the full time that she is on duty in the hospital to the psychiatric ,wardso The questionnaire will then be given to the part time as well as the full time nurses; supervisors, administrators and educators as well as staff nurseso It would'not be given to ttfloat" nurses or those who might be assigned to the psychiatric wards only in some emergency staffing situation t or only ocassionallyo I trust it will be possible for you to return the completed forms to me within five days of receiving themo I will be happy to send you a copy of the research, results when the study is completed~ and I appreciate your participationo Yours sincerelYj Director of Nursing ==-~====== Hospital ===-======~ Arizona Dear Madame!) APPENDIX IV FOLLOW UP LETTER You may recall that I wrote you early in July regarding participation in, a research study. designed to. improve nur.s.ing educa= tion g and ultimately nursing.careo. A sample questionnaire!) to be given to the registered nurses at the ========= Hospital was enclosed in the letter t along with a postal card on which you could indicate your desire.to participate.in.the study. or noto Since I have not 9 as yet, received the postal card~ I wondered if there was some question on the research study that I might answer for you to help you reach a decision on participation in this studyo Since summer is traditionally a busy timel) with vacations for the staff~ I realize that it is sometimes difficult to find time for extra work Q In view of the facts that the questionnaire takes less than fifteen minutes to completet that it i,s quite simple to admini­ster and that it would be meaningful to have a ======== hospital for psychiatric patients represent the State of Arizona® I hope that you will be able to participate in this studyo It is not possible to answer all the questions that one might have about participation in a research study in a first lettera so if you have any questions about the study, I will be happy to answer them for YOUe I will enclose a postal card for your convenience in replying·, and trust you will send it back to me at your earliest possible con­venience. Yours sincerely, APPENDIX V RESEARCH SURVEY Your participation in this research survey will help to improve nursing care for psychiatric patientso Your protectedg, you will remain anonymous~ so you may feel free to answer fully and accord­ing to your real feelings o Mark the appropriate blankg Graduate of g _ Associate degree. school .. of nursing Hospital school of nursing ================~== Collegiate s basic degree .program Degree .. progr.am .for registered Graduate program leading to a master or doctoral degree in nursing Other Type of position in psychiatric. nurseg staff "''II~iJ'''(c>C;. educator supervisor ~~~~~==~~= Fill in the blanks& Year graduated Age when ~~~========~~========~====~~==~ Age now Years ~~==~====~============~==========~~~~== ... Years active This is a study of what the general public thinks about a number of questions 0 The best answer to each statement below is your own personal opinioDo We have tried to cover many points of view o You may find that yo~ agree strongly with some statements 9 disagree strongly with others~ and pe.rhaps ... be unce.rtain about other-so Whether you agree or disagree with any statement~ you can be sure that many other' people feel the same way you doo Directions Read each statement carefully and mark it according to your first reaction o Mark the corresponding. numbers on the blank line after each statement in the following.wayg If you agr~e very much with a statements mark the space +3 0 If you agree pretty much with a statement 0 mark the space +20 If you agree a little with a statement; mark the space +10 If you disagree very much with a statement g mark the space =30 If you disagree pretty much with a statement~ mark the space -2Q If you disagree a little with a statement 0 mark the space =10 10 Human nature being what it conflict 0 ~ there will always be war and 1 70 2. Obedience and respect for authority are the most important virtues children should learn 0 2 --""""" 30 No weakness or difficulty can hold us back if we have enough .wi1l powero 3 -",==........, 4. Science has its place but there are many important things that can never possibly be understood by the human minda 4 ~~= 50 Every person should have complete faith in some super~ natural power whose decision he obeys without question. 5 ~=~ 60 When a person has a problem or worry 'V it is bes·t for him not to think about it\) but to keep busy with more cheerful things 0 6 10 A person who has bad manners'V habits and breeding can hardly expect to get along with decent peopleo 7 ~~~ 8. What the youth need most is strict discipline\) rugged deter= mination'V and the will to work and fight for family and country 0 8 -~== 90 Some people are born with the urge to jump from high placeso 9 10 0 Nowadays with so many different kinds of people moving around and mixing together so much~ a person has to protect himself especially carefully. against catching an inf'.ection ===~= or disease from them 0 10 . ==~- 11~ An insult to our honor should always be punishedo 11 --==- 120 Young J people sometimes get rebellious ideas il but as they grow up they ought to get over them and settle doWD o 12 ---- 13 0 What this country needs most e more than laws and political programs a is a few courageous® tireless s devoted leaders in whom the people can put their faitho 13 140 Sex crimes 9 such as rape and attacks on children 0 deserve more than mere imprisonment, such criminals ought to be ---=- publically whipped~ or worse. 14 ~~-- 15 0 People can be divided into two distinct classes. the weak and the strongo 15 ---- 16" There is hardly anything lower than a person who does not feel a great lovell gratitude i and respect for his parents. 16 ==="== 71 170 Some day it will probably be shown that astrology can explain a lot of thingso 17 ~==-=== 18 0 Nowaday~ more and more people are prying into matters that should,. remain personal and privateo 18 =~-= 19 0 Wars and social troubles may some day be ended by an earth= quake or flood that will destroy the whole wo.rld o 19 20 0 Most of our social problems would be solved if we could somehow get rid of the immora1 0 crooked and feebleminded ~~~== people 0 20 ===~~""'" 210 The wild sex life of the old and Romans was tame compared to some of the goings=on in this country~ even in places where people might least expect ito 21 _=-=-_000:> 220 If people would talk less and work more~ everybody would be better offo 22 ....:;ao~-..,., 23 0 Most people donQt realize how much our lives are controlled by plots hatched in secret places o 23 """"'*"'-~- 240 Homosexuals .are hardly better than criminals and ought. to be severely punished \) 24 ' ~~~ .... 25 0 No sane!) normalg) decent person could ever think of hurting a close friend or relative o 25 ~--~ 26 0 Familiarity breeds contempto 26 270 The business man and the manufacturer are much more impor-tant to society than the artist and the professovG 27 ---= 28 0 Nobody ever learned anything really important except through suffering o 28-' -_.. .. APPEND.IX VI PARTICIPATING HOSPITALS STATE TYPE OF HOSPITAL QUESTIONNAIRES Arizona General .hospita~ psychi.atric ward 5 Public l:\aspital 23 California General hospital psychiatric ward 10 Private hospital 4 Colorado General hospital psychiatric ward 9 Private hospital 11 Public hospital 39 Idal10 General hospital psychiatric ward 6 Public hospital 11 Montana General hospital psychiatric ward 8 Public hospital 12 Nevada Generalhospita~ psychiatric_ward 5 Public hospital 20 New Mexico Private hospital 9 Utah General hospital psychiatric ward 8 Public hospital 10 Washington General hospital psychiatric ward 1 Private hospital 3 Public hospital 28 Wyoming Public hospital 6 Alaska Public hospital 10 Hawaii Public hospital 26