The influence of personal qualities on performance and progression in a pre-registration nursing programme

Article (PDF Available)inNurse education today 34(5) · October 2013with182 Reads
DOI: 10.1016/j.nedt.2013.10.011 · Source: PubMed
Abstract
Research conducted primarily with psychology and medical students has highlighted that personal qualities play an important role in students' academic performance. In nursing there has been limited investigation of the relationship between personal qualities and performance. Yet, reports of student incivility and a lack of compassion have prompted appeals to integrate the assessment of personal qualities into pre-registration nursing student selection. Before this can be done research is needed to explore the influence of students' personal qualities on programme performance and progression.

Figures

The inuence of personal qualities on performance and progression in a
pre-registration nursing programme
,
☆☆
Victoria Pitt
a,
, David Powis
b
, Tracy Levett-Jones
a
, Sharyn Hunter
a
a
School of Nursing and Midwifery, University of Newcastle, Australia
b
School of Psychology, University of Newcastle, Australia
summaryarticle info
Article history:
Accepted 21 October 2013
Available online xxxx
Keywords:
Nursing students
Personal qualities
Attrition
Academic performance
Clinical performance
Background: Research conducted primarily with psychology and medical students has highlighted that personal
qualities play an important role in students' academic performance. In nursing there has been limited investiga-
tion of the relationship between personal qualities and performance. Yet, reports of student incivility and a lack of
compassion have prompted appeals to integrate the assessment of personal qualities into pre-registration nurs-
ing student selection. Before this can be done research is needed to explore the inuence of students' personal
qualities on programme performance and progression.
Aim: This study explores the relationships between students' personal qualities and their academic and clinical
performance, behaviours and progression through a pre-registration nursing programme in Australia.
Method: This longitudinal descriptive correlational study was undertaken with a sample of Australian pre-
registration nursing students (n = 138). Students' personal qualities were assessed using three personal quali-
ties assessment (PQA) instruments. Outcome measures included grades in nursing theory and clinical courses,
yearly grade point average, nal clinical competency, progression (completion), class attendance and levels of
life event stress.
Results: Signicant correlations were found between academic performance and PQA scores for self-control,
resilience and traits of aloofness, condence and involvement. Final clinical competence was predicted by con-
dence and self-control scores. Students with higher empathy had higher levels of life event stress in their rst
year and class attendance had a positive correlation with self-control. Completing the programme in three
years was weakly predicted by the measure of resilience. No difference was noted between extreme or non-
extreme scorers on the PQA scales with respect to performance or progression.
Conclusion: This sample of students' personal qualities was found to inuence their academic and clinical perfor-
mance and their ability to complete a pre-registration programme in three years. However, further research is
required with larger cohorts to conrm the use of personal qualities assessment during selection.
© 2013 Elsevier Ltd. All rights reserved.
Introduction
Many preregistration nursing education programmes select students
solely on prior academic performance (Schmidt and MacWilliams,
2011). However, increasing reports of incivility (Altmiller, 2012), unsafe
clinical practice (Luhanga et al., 2008) and a lack of compassion have
generated interest in the assessment of personal qualities at admission
to pre-registration nursing programmes (Baguley et al., 2012; Francis,
2013; Schmidt and MacWilliams, 2011). It is further suggested that
extremes in students' personal qualities contribute to students' poorer
adjustment to life changes (Warbah et al., 2007), uncivil behaviours
(Robertson, 2012) and lower resilience to stress (Munro et al., 2008).
In order to make decisions concerning the inclusion of personal qualities
into selection criteria, an understanding of how students' personal qual-
ities impact upon programme performance and progression is required.
Personal Qualities
The terms personal qualities, personal attributes, non-cognitive
qualities, personal characteristics and non-academic factors are often
used interchangeably in the literature (Ahmad and Safadi, 2009;
Johnson and Cowin, 2013; Schmidt and MacWilliams, 2011). No clear
and agreed denition exists of the personal qualities desired of a prac-
ticing registered nurse (Johnson and Cowin, 2013; Pitt et al., in press).
However, four sets of attributes have been identied that illustrate the
qualities desired in the practicing nurse: (1) personality traits; (2) con-
scientiousness/motivation; (3) cognitive skills; and (4) professional/
personal values (Pitt et al., in press). These attributes are consistent
with the international professional standards (American Nurses Associ-
ation, 2001; Nursing and Midwifery Board of Australia, 2008; Nursing
Nurse Education Today xxx (2013) xxxxxx
Conict of interest: No conict of interest has been declared by the authors.
☆☆
Funding: This research received no specic grant from any funding agency in the
public, commercial, or not-for-protsectors.
Corresponding author. Tel.: +61 2 4921 6645; fax: +61 2 4921 6301.
E-mail address: Victoria.Pitt@newcastle.edu.au (V. Pitt).
YNEDT-02629; No of Pages 6
0260-6917/$ see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nedt.2013.10.011
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Please cite this article as: Pitt, V., et al., The inuence of personal qualities on performance and progression in a pre-registration nursing
programme, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.10.011
and Midwifery Council, 2010; Scottish Government Health Directorates,
2010). Yet there has been limited exploration of these attributes or
qualities in relation to selection and their inuence on nursing students'
pre-registration programme performance and progression.
(1) Personality traits The interest in exploring personality in rela-
tion to performance is driven by the belief that personality direct-
ly impacts an individual's behaviour, which in turn inuences a
student's success in a programme (Rothstein et al., 1994). A
study of 350 UK nursing students found that higher extraversion
scores predicted lower nal programme grades (McLaughlin
et al., 2008). This outcome may relate to examination or essay as-
sessments as students with higher extraversion scores tend to be
more sociable rather than studious (Chamorro-Premuzic et al.,
2005). Accordingly they may have differing results if classroom
participation or clinical placements are assessed. McLaughlin
et al. (2008) noted that psychoticism scores were signicantly
higher in nursing students who withdrew from their programme.
Higher levels of psychoticism are believed to impact on students'
levels of interest and motivation and may contrast with conscien-
tiousnessscores(Chamorro- Premu zic and Furnham, 2003).
(2) Conscientiousness/motivation The t rait of conscientiousn ess
remains one of the strongest predictors of academic perfor-
mance as measured by grade point averag e (GPA) in both
medical and psychology students (Chamorro-Premuzic and
Furnham, 2008; Conard, 2006; de Koning et al., 2012; Dohe rty
and Nugent, 2011). In an Australia pre-registration nursing pro-
gramme lower conscientiousness and agreeableness scores were
found to predict (65% and 67% respectively) student attrition in
the rst year of a programme (Deary et al., 2003). Wilson-
Soga's (2009) doctoral study of 197 associate degree nursing stu-
dents in the United States of America (US) also noted that scores
of conscientiousness positively correlated to GPA. A limitation of
Wilson-Soga's study is that conscientiousness measures were
conducted at the end of the degree which would have only cap-
tured those students who were more conscientious and had not
withdrawn from the programme.
The link between conscientiousness and academic performance
is considered to be directly related to the motivation of the stu-
dent. Self-efcacy and the motivation to apply effort have been
explored in nursing students in relation to the areas of mathe-
matics (Andrew, 1998), nursing occupation (McLaughlin et al.,
2008), expectations (Silvestri, 2010) and general self-efcacy
(Taylor and Reyes, 2012). Each of these studies used distinct
tools, and reported self-efcacy as a signicant predictor of stu-
dents' academic performance as measured by nal course marks
(McLaughlin et al., 2008), science course marks (Andrew, 1998),
exam marks (Taylor and Reyes, 2012
) and the National Council Li-
censure Examinati on for Registered Nurses (NCLEX-RN) (Silvestri,
2010).
(3) Cognitive skills Cognitive qualities are usually evaluated sepa-
rately from personal qualities. A student's ability to problem
solve, think critically and apply knowledge is the focus of a number
of studies. Critical thinking skills have been found to have a posi-
tive relationship with both the GPA (Bowles, 2000)andthe
NCLEX-RN success (Giddens and Gloeckner, 2005).
(4) Professional/personal values These values are customarily ex-
plored during face to face selection interviews; focusing on percep-
tions of the professional and personal qualities required in nursing,
their motivation to nurse and their communication skills (Ahmad
and Safadi, 2009; Baguley et al., 2012; Ehrenfeld and Tabak, 2000;
Roberts et al., 2010; Wilson et al., 2009). The intention of inter-
views is to recruit individuals who are best suited to the profession
(Rodgers et al., 2013). In many cases interview processes lack rig-
our and are limited in the ability to predict retention or academic
performance (Ahmad and Safadi, 2009; Rodgers et al., 2013;
Wilson et al., 2009). Ehrenfeld and Tabak (2000) noted only a
slight decrease in rst year attrition with the inclusion of inter-
views examining students' familiarity and motivation to nurse,
yet no statistical analysis was reported. Others have reported
that a student's desire to nurse had no relationship with academic
performance during a programme (Ahmad and Safadi, 2009;
Wilson et al., 2009). These mixed results may be related to the
lack of valid instruments for measuring the range of personal qual-
ities required by nursing students.
Personal Qualities Assessment (PQA) (www.pqa.net.au)
A tool designed to explore a broad range of personal qualities in
health care professionals is the PQA (Powis et al., 2005). Although de-
signed primarily for medical students, research has shown that the
PQA also reects those qualities desired in the practicing nurse (Pitt
et al., 2013). The PQA consists of a battery of three tests:
Narcissism, aloofness, condence, empathy (NACE) scale consists of
100 multiple choice statements; providing a total personality mea-
sure of INVOLVEMENT on the continuum of involvement versus de-
tachment, and four subscale scores providing measures of the traits
narcissism, aloofness, condence, empathy which are considered nec-
essary in the development of productive relationships (Munro et al.,
2005). The NACE has a reported high Cronbach's alpha of 0.9 and re-
ported construct validity (Munro et al., 2005).
Interpersonal Values Questionnaire (IVQ) consists of four hypothet-
ical moral dilemmas with 49 multiple choice responses; providing a
measure of moral orientation, which may predict a student's deci-
sion making when confronted with a moral dilemma (Bore et al.,
2005). The IVQ produces a Lib-Com score on the continuum of liber-
tarian (favouring the individual's needs) versus communitarian
(favouring the rules of society). The IVQ has reported Cronbach's co-
ef
cients of 0.830.92 and demonstrated construct validity (Bore
et al., 2005).
Self-Apprai sal Inventory (SAI) consists of 100 statements that re-
quire multiple choice responses. It provides two scores (self)
CONTROL (reecting conscientiousness) calculated from scores
on traits orderly,industrious, self-controlled, (not) permissive
and (not) anti-social and RESILIENCE (reecti ng emotional sta-
bility) calculated from scores on traits volatility, withdrawn,
moody, anxious and unreality (having stra nge or tr oublesome
thoughts) (Bore et al., 2005). The SAI has good internal consistencies
(Munro et al., 2008).
When app lied to selection of medical students, it is suggested
that those students with extreme PQA scores, that is ±2 standard
dev iations from the mean, are less likely to succeed in a programme
and therefore should be excluded from admission (Bore et al., 2009).
Extreme scoring stud ents may exhibit behaviours such as being too
involved with patients or too alo of to allow for the formation of ther-
apeutic relationsh ips; additionally they may not va lue the needs of
others or possess the interpersonal skills and values required in a
health profession (Powis et al., 2005). Although the research of extreme
versus non-extreme scorers' academic performance is limited, social
work has reported that students with low empathy scores, communitarian
(decision making) and high narcissism scores failed their pre-practicum
interpersonal skills assessment hurdle (Gibbons et al., 2007). A study
of medical students has also noted a signicant correlation between
high narcissism and high aloofness scores and poor performance in
group interactions and examinations (Adam et al., 2012). Further inves-
tigation of extreme scores and programme performance is required in
nursing students.
2 V. Pitt et al. / Nurse Education Today xxx (2013) xxxxxx
Please cite this article as: Pitt, V., et al., The inuence of personal qualities on performance and progression in a pre-registration nursing
programme, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.10.011
This paper outlines a study with a sample of Australian pre-
registration nursing students (n = 139) who completed the PQA on
entry to a three year bachelor programme. During the subsequent
three years students' progress and performance data were systematical-
ly collected. Correlations were made between students' academic and
clinical performance, life event stress, class attendance and programme
progression.
Method
Using a longitudinal descriptive correlational design this study re-
ports on the personal qualities, programme performance, behaviours
and progression of a sample of nursing students over three years. Ethical
approval for the study was obtained from the university's human re-
search ethics committee. All students (n = 517) enrolling in the rst
year of a three year Bachelor of Nursing (BN) programme at a large
multi-campus university in Australia in 2009 were invited to partici-
pate. Of these 139 students consented to participate; a 26.8% response
rate. On entry they completed the PQA and over the next three years
the following data on progress and progression were collected:
Academic performance was measured during the three years of the
study using GPA and course aggregate marks. GPA was calculated
using total grade points (high distinction = 7, distinction 6, credit = 5,
pass = 4, ungraded pass = 4 and fail = 0) awarded for a semester, di-
vided by the total number of course units taken; providing a result on a
scale of 07. The GPA was calculated at the end of semester one, year
one (2009) and each following year. Course aggregate marks were pro-
vided for nursing theory, clinical nursing and bioscience courses. Marks
were reported for each year's requisite courses: rst year, second year
and third year.
Clinical performance was a dichotomous measure of competent/not
competent based on students' nal clinical performance appraisal. This
appraisal was conducted by a university employed facilitator as part of a
third year course during clinical placement using a Structured Observa-
tion and Assessment of Practice (SOAP) (Levett-Jones et al., 2011).
Student behaviour measures taken throughout the three years of the
study included:
(a) The Life Events Scale for Students (LESS), adapted from Clements
and Turpin's (1996) scale to suit the Australian context. It provides
a measure of life event stress experienced over a 12 month period.
A list of 34 items is allocated a score based on stress rating. Stu-
dents selected items they had been exposed to in the preceding
12 months, example failing a course (53 points) and breakup
with boyfriend/girlfriend (65); providing a total LESS score.
Details of reliability and validity of the original LESS have been re-
ported (Clements and Turpin, 1996).
(b) Attendance was reported for one second year clinical course.
Attendance included lectures and tutorials; a percentage of atten-
dance was provided for each student.
Progression was measured as a three group variable identifying
whether students completed the programme in the 3 years, withdrew
or continued their enrolment after 3 years.
Data an alysis was conducted using IBM SPSS version 20 (SPSS,
Inc., Chicago, IL, USA). Preliminary analy sis noted that the following
data were normally distributed: condence, empathy, Lib-Com,
CONTROL, s econd and third year theory course sco res, all clinical
course scores and life event stress scores for nal year. All other var-
iables had skewed distributions. All raw scores were transferred to
Z-s cores to allow an exploration of extreme values for PQA scor es.
Correlational analysis (Pearson's and Spearman) was performe d be-
tween the PQA scores and st udents' academ ic performance, life
event stress and attendance. Logistic regression was conducted on
PQA scores and clinical performance. Multinominal regression was
performed on PQA and programme progression. The alpha was s et
at 0.05 for all statistical analysis.
Results
Of the 139 students who consented to participate, 138 completed
the PQA surveys in 2009. The majority of these participants were female
(86%), with a mean age of 27 years of age. Detailed demographic data
and their relationship to PQA data are reported separately. The descrip-
tive statistics for the PQA surveys are provided in Table 1.
Academic Performance
The number of students undertaking second and third year theory
and clinical courses decreased during the study (see Table 2). This re-
ects a delay in student progression based on a leave of absence, part-
time enrolment and course failure. The decreasing GPA data was related
to student withdrawal and leave of absence (see Table 2).
Signicant correlations were identied between PQA scores for
NACE and SAI and academic performance, except for bioscience course
performance (see Table 3). The IVQ had no signicant correlation with
students' academic performance.
NACE
Scores for aloofness and condence signicantly correlated with aca-
demic performance. Aloofness scores negatively correlated (p b 0.05 to
p b 0.01) with GPA across 2009 and 2010; rst and second year nursing
theory courses and rst year clinical course performance. In contrast
higher scores of condence (p b 0.05) positively correlated with third
year theory courses. Students' score of INVOLVEMENT weakly correlat-
ed (p b 0.05 to p b 0.01) with GPA in 2009 and 2010 as well as with rst
and second year nursing theory course marks. There was no correlation
between empathy and narcissism scores and academic performance.
SAI
The measure of (self) CONTROL (p b 0.05 to p b 0.01) positively cor-
related with GPA in the rst two years but not in the third year, whereas
RESILIENCE (p b 0.05 to p b 0.01) positively correlated with GPA only in
the rst year. Scores of CONTROL correlated with second year theory
course marks and RESILIENCE correlated with third year clinical nursing
course marks, but with no other theory or clinical courses.
Clinical Performance
In 2011, 51 students who had progressed to third year completed
a compulsory clinical competence assessment (SOAP). Of these 41
(80%) were assessed as competent and 1 0 (20%) were not competent
and required reassessment. Logistic regression was performed to de-
scribe the relationship betwee n PQA scores and c linical competence
using the categories of competent (n = 41) and not competent
(n = 10). The Wald test was used to determine if scores possessed
signicant predictive value (Pallant, 2009). The NACE condence
score and SAI measure of CONTROL were the only signicant predic-
tors of c linical competenc e. The strongest predictor of clinical com-
petence was (self) condence; recording an odds ratio of 0.803
Table 1
Means and standard deviations for the personal qualities assessment.
PQA Mean SD
Narcissism (NACE)
a
52.6 8.1
Aloofness (NACE)
a
51.2 7.2
Condence (NACE)
a
61.8 9.2
Empathy (NACE)
a
71.5 6.9
INVOLVEMENT vs DETACHED (NACE)
a
269.4 20.2
Lib-Com (IVQ)
a
121.7 16.8
SELF CONTROL (SAI)
b
104.2 12.2
RESILIENCE (SAI)
b
104.4 17.0
a
n =133.
b
n =135.
3V. Pitt et al. / Nurse Education Today xxx (2013) xxxxxx
Please cite this article as: Pitt, V., et al., The inuence of personal qualities on performance and progression in a pre-registration nursing
programme, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.10.011
(Wald x
2
(1) = 8.152, p = 0.004). This indicates that as these scores
increased by 1 the chance of b eing assessed as competent in the nal
clinical assessment increased by 20%. The score of CONTROL record-
ed an odds ratio of 0.943 (Wald x
2
(1) = 3.858, p = 0.042); indicat-
ing that as st udents' score increased by 1 thei r cha nce o f bein g
assessed as competent in their nal assessment increased by 6%.
Behaviours
TheresponserateforthecompletionoftheLESSwaspoor;35
students completed the scale in 2009 (mean = 267.71); 19 stu-
dents in 2010 (mean = 232.42) and only 16 completed in 2011
(mean = 156.31). The NACE score for empathy was the only score to
correlate with students' life event stress. Higher empathy scores had sig-
nicant positive correlation (r
s
= 0.396, n =34, p = 0.021) with
higher levels of life event stress during students' rst year of study.
The average attendance at the second year clinical course (n = 75)
was 88.6%. For attendance only CONTROL (SAI) positively correlated
(r
s
=0.29,n =75,p =0.013)withattendance.
Progression
At the conclusion of the study, over one third (n = 49; 35.5%) of the
sample had withdrawn from the programme, one third had completed
(n = 46; 33.3%) and approximately one third remained enrolled in the
programme (n = 43; 31.2%) because of part-time enrolment, leave of
absence or the need to repeat a course. Multinomial regression was
used to assess the impact of the PQA on progression (completed, con-
tinues, withdrawn) using the reference group completed.RESILIENCE
was the only signicant predictor (Wald x
2
(1) = 5.089, p =0.024)of
students' likelihood of completing the programme over 3 years, record-
ing an odds ratio of 0.970. This indicates that as students' RESILIENCE
score increased by 1, their chance of completing the programme rather
than continuing on after 3 years of study increased by 3%. RESILIENCE
had no signicant impact of on withdrawal in relation to completion.
Progress of Students with Extreme Scores
Of the 138 students who undertook the PQA, 32 (24%) students had
extreme PQA scores. Using Z scores the sample was split into extreme
(beyond ±2 standard deviations of the mean) (n = 32) and non-
extreme scorers (n = 106). Analysis was repeated on the split sample
for academic and clinical performance and progression measures to de-
termine whether differences existed between the groups. No signicant
differences were noted between groups in regard to performance, be-
haviours or progression.
On examination of individ ual data of the extre me scoring stu-
dents, it was noted that nine students had extreme scores in more
than one PQA scale: Eight stu dents had two extreme scores and
one student had four extreme scores. The one student with four ex-
treme scores (high narcissism, low IVQ, low CONTROL, low RESIL-
IENCE) academically passed the programme but failed the nal
clinical assessment (SOAP). Of the eight students with two extrem e
PQA scores one withdrew, three complete d the programme and
four remained enrolled after thr ee years. Of the 23 students with
only one extreme PQA score, eight withdrew, nine remained en-
rolled and seven passed the programme (six were competent with
remediation in the nal assessment).
Discussion
This study found signicant relationships between students' person-
al qualities and academic and clinical performance, behaviours and pro-
gression. Better academic performance was found to be related to the
personal qualities of lower aloofness, higher (self) CONTROL (reecting
conscientiousness) and higher RESILIENCE (reecting emotional stabil-
ity). Although the correlations are weak (range 0.179 to 0.259), such
low correlations between academic performance and personality attri-
butes are common and can potentially provide insight into future suc-
cess (Kuncel et al., 2010). The positive correlation between measures
of conscientiousness and academic performance is well supported in
other studies (Poropat, 2009; Wilson et al., 2009).
The most consistent relationship with academic performance across
the programme was the personality trait of aloofness, that is an avoid-
ance of involvement with others and being detached (Munro et al.,
2005). The nding that higher aloofness scores correlated to poorer ac-
ademic performance is supported by a recent study conducted with UK
Table 2
Descriptive data for academic performance.
Academic performance n Mean
Grade point average (GPA) (07)
GPA_2009 semester 1 136 4.22
GPA_2009 137 4.15
GPA_2010 122 4.08
GPA_2011 93 4.26
Theory focused courses %
First year 128 70.17
Second year 97 67.22
Third year 70 71.19
Clinical focused courses %
First year 128 66.28
Second year 91 66.10
Third year 63 68.29
Bioscience courses % 121 64.23
Table 3
Signicant correlations between PQA and academic performance.
PQA Academic performance
GPA Theory Clinical
2009 sem1 2009 2010 2011 First Second Third First Second Third
NACE INVOLVEMENT r
s
.151 .179
a
.226
a
.142 .209
a
.231
a
.040 .119 .108 .040
n 130 131 117 91 123 94 68 123 87 62
Aloofness r
p
-.225
b
.243
b
.253
b
.196 .202
a
.211
a
.043 .220
a
.158 .155
n 130 131 117 91 123 94 68 123 87 62
Condence r
p
.072 .057 .109 .172 .040 .162 .246
a
.085 .070 .161
n 130 131 117 91 123 94 68 123 87 62
SAI SELF CONTROL r
s
.225
b
.259
b
.216
a
.185 .171 .206
a
.065 .126 .083 .063
n 132 133 119 92 125 94 68 125 88 62
RESILIENCE r
p
.214
a
.214
b
.163 .129 .156 .136 .113 .090 .131 .252
a
n 132 133 119 92 125 94 68 125 88 62
The IVQ correlated with no academic performance measures. n/s non-signicant.
a
Correlation is signicant at the 0.05 level (2 tailed).
b
Correlation is signicant at the 0.01 level (2-tailed).
4 V. Pitt et al. / Nurse Education Today xxx (2013) xxxxxx
Please cite this article as: Pitt, V., et al., The inuence of personal qualities on performance and progression in a pre-registration nursing
programme, Nurse Educ. Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.10.011
medical students (n = 146) with aloofness scores consistently demon-
strating a negative relationship with exam performance (Adam et al.,
2012). These results highlight a more pressing problem for pre-
registration education programmes, in that more detached students
may not possess the high level interpersonal skills required of a practic-
ing nurse. Further investigation is required concerning the role the trait
of aloofness plays not only in examination performance, but also in
group work situations and during clinical placement.
Academic performance was signicantly related to scores of person-
al qualities in the rst two years, but less evident in the nal year of
study. Similar ndings were noted in undergraduate psychology stu-
dents, which found a strong correlation between conscientiousness
and academic performance in year one, moderate in year two and no
correlation in year three (de Koning et al., 2012). This was also support-
ed by Adam et al. (2012), who noted a consistent positive association
between measures of CONTROL and RESILIENCE and academic perfor-
mance (GPA) in medical students, in their rst two years of study. The
reasons for this are at least two fold. Firstly, students with lower levels
of CONTROL or conscientious and RESILIENCE may not progress to the
nal years and, secondly, students in the nal year of their programme
may develop learning or supportive strategies that contribute to their
academic performance more than their personal qualities (de Koning
et al., 2012). Therefore it is important that support strategies are inte-
grated in the early years of nursing programmes to assist with the de-
velopment of skills such as hardiness that may potentially assist
students to develop resilience, which may assist not only their academic
performance but also their career longevity and success (Jackson et al.,
2007; Kuncel et al., 2010).
The relationship between measures of personal qualities and clinical
performance has attracted limited attention in nursing. Most research
has been qualitative in nature and explored qualities that are perceived
as benecial to being prepared and learning in the clinical setting
(Killam and Carter, 2010). The present study found that students who
entered the programme with higher condence scores had a greater
chance of being graded as competent in their nal clinical assessment.
This nding is supported by Adam et al. (2012) who identied a positive
correlation with condence scores and assessment of medical students'
practice skills. These ndings highlight the need for the continual explo-
ration of personal qualities and clinical performance, especially in stu-
dents who lack self-condence.
In relation to behaviours and personal qualities the results were
mixed. The low response rate to the life event scale surveys makes it dif-
cult to discuss the results with any condence. However, the strongest
correlation within the study was between empathy and the life event
scale for students. It is hard to disregard the
nding that students with
higher measures of empathy on entry experience higher levels of life
event stress in the rst year of the programme. Nursing has been iden-
tied as a highly stressful course (Beck et al., 1997)andasempathy is
identied as a desired personal quality for professional nurses to act
competently (Nursing and Midwifery Board of Australia, 2006)the
need to provide students with resources and skills to maintain empathy
without over-involvement and managing life event stress may be bene-
cial for both the student and the profession. This study also found that
students with higher CONTROL scores (reective of conscientiousness),
had better attendance rates than others. This nding was not surprising
as it would be expected that a more conscientious student would attend
all available learning opportunities.
With regard to progression, RESILIENCE (reective of emotional sta-
bility) was noted to be a weak predictor of completion. It is logical that
students who are less impulsive and more emotionally stable may be
more focused and able to apply effort and complete a programme. The
limited ability of personal qualities to predict a student's progression
has been reported by Deary et al. (2003) who also noted a lack of signif-
icant associations between student attrition and personal qualities.
No correlation was noted between IVQ (moral orientation) scores
and performance or progression. Moral orientation identies the student
disposition when faced with an ethical decision, whether they place
greater value on the individual or on societies' rules (Bore et al., 2005).
A student's moral orientation or ethical perspective is the underpinning
reasoning in their decision making. Moral conict and distress is experi-
enced by undergraduate students both in the clinical experience and in
written assessments (Caldwell et al., 2010). Taking this into consider-
ation, future explorations of moral orientation should use outcome mea-
sures that explore written assessments that reect ethical dilemmas
(Neville, 2004) or observations in clinical placements or simulation
experiences.
A foundation for the instigation of this research was the possible use
of PQA in student selection. This was based on the idea that students
with extreme PQA scores should be ltered from selection. However,
the results of this study do not support the exclusion of students with
extreme PQA scores at this time. This is supported by Gibbons et al.
(2007) whose study with social work students also noted no signicant
difference in an assessment item's pass/fail rate between those with and
without extreme PQA scores. Further large sample, longitudinal studies
are required with outcome measures that reect students' ethical deci-
sion making and observations in clinical placement as well as academic
performance and progression.
Limitations
A limitation of the study was the large attrition rate of the sample.
Over three years 35% of the sample withdrew, although the programme
did note an increased attrition rate in 2010 (17.4%) reective of the uni-
versity attrition rate (17.9%); this sample's attrition was extreme. Expla-
nations behind this high attrition rate remain unknown, yet other
longitudinal studies have reported similar high rates of attrition (Deary
et al., 2003). Further limitations of this study include the small number
of participants who completed the life event survey; this necessitates
caution with the interpretation of the results associated with ndings,
and the use of convenience sampling which may have ensured that stu-
dents who elected to participate were more conscientious.
Conclusion
Using a battery of personal qualities measures, it was demonstrated
that students with lower aloofness and higher scores for (self) condenc e,
INVOLVEMENT, (self) CONTROL and RESILIENCE had better academic
performance. Students with higher scores in CONTROL were also noted
to have better attendance. While condence was noted to be a strong pre-
dictor of students' clinical performance. RESILIENCE was a predictor of
programme completion, yet only accounted for a 3% increase in chance
of completion over continuing enrolment after 3 years. Life event stress
in students' rst year of study was found to correlate positively with em-
pathy scores. In contrast students who entered the programme with ex-
treme personality scores did not differ signicantly in progression and
performance to those with no extreme scores. These results highlight
the importance of considering personal qualities as potential selection
criteria as well as highlighting opportunities to provide support to
those who may be at risk of poorer academic performance.
Future research should perhaps focus on larger student cohorts rath-
er than convenience sampling and should use outcome measures that
evaluate behaviours that may be inuenced by personal qualities,
such as tutorial behavioural observations, reports of academic or profes-
sional misconduct, clinical simulation observations, and clinical place-
ment observations. The addition of these measures would strengthen
conclusions regarding the benets of introducing PQA into selection
procedures for nursing pre-registration education programmes.
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    • "In the current integrative review, resilience was conceptualized as either a trait or a process. Although resilience was described as a trait in some studies, resilience was not demonstrated as a static trait or characteristic but as a phenomenon that changed over time (Beauvais et al., 2014; Pitt et al., 2014; Stephens, 2012; Taylor & Reyes, 2012). Resilience as a process was more evident in qualitative studies (Carroll, 2011; Knight et al., 2012 ). "
    [Show abstract] [Hide abstract] ABSTRACT: Resilience is a phenomenon known to buffer the negative effects of stress. Resilience is important in the lives of nursing students and nurse educators. An integrative literature review was conducted to explore the current state of knowledge of resilience in the context of nursing education. Implications from the review findings were deduced for nursing education practice and research. Three theoretical papers and 16 empirical reports were included in the review. Three themes emerged from the analysis: (a) Resilience Is Important in Nursing Education, (b) Resilience Is Conceptualized as Either a Trait or a Process, and (c) Resilience Is Related to Protective Factors. The findings provide data to support interventions to enhance the resilience of nursing students and nurse educators and offer a foundation for further research of resilience in nursing education. [J Nurs Educ. 2015;54(8):438-444.]. Copyright 2015, SLACK Incorporated.
    Article · Aug 2015
    • "Along with this, literature continues to identify the presence of nursing students who demonstrate unprofessional attitudes and behaviours (Duffy, 2003; Luhanga et al., 2008). Many consider that selection criteria could be modified so as to recruit students who possess the personal qualities desired in a registered nurse and improve students' academic and clinical performance (Perkins et al., 2013; Pitt et al., 2014; Wolf, 2012). "
    [Show abstract] [Hide abstract] ABSTRACT: Reports of a lack of compassionate care from nurses have resulted in calls to integrate the assessment of personal qualities into nursing student selection, with the intent to recruit individuals whose attributes reflect those desired in the practising nurse. Whilst nursing programmes are able to determine students' academic abilities on enrolment limited attention has been given to other qualities. Although there is an understanding of the qualities desired in the practising nurse, to date there has been limited exploration of nursing students' personal qualities as they enter nursing programmes and whether these change over time.
    Full-text · Article · May 2014
  • Full-text · Technical Report · Jan 2014 · Nurse Education Today
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