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In 2008, The Joint Commission for the Accreditation of Hospital Organizations (JCAHO) released a sentinel event alert titled Behaviors that Undermine a Culture of Safety. In the alert, behaviors defined as intimidating and disruptive included not only overt behavior but also covert behavior. Citing several studies in the alert, JCAHO remarked that safe, high-quality patient care is linked to the communication styles and team interactions of healthcare personnel. These covert behaviors are encompassed under the category of indirect aggression. As a category of behaviors, indirect aggression is defined as a form in which the instigator manipulates others, or by other means, makes use of the social structure in order to inflict harm. To date, this has been found to be more typical in females’ interactions with other females as noted by studies of adult and adolescent human females. Nursing as a profession is 92% female and integrally important in patient care through both direct interventions as well as healthcare team interactions. Therefore, it represents a profession in which the impact of indirect aggression has great negative potential. The overall purpose of the proposed exploratory, descriptive study was to identify global personality traits related to indirect aggression and specific tactics of hierarchy negotiation among females in one predominantly female social context - nursing. The central hypothesis was that some expressions of female indirect aggression correlate with tactics of hierarchy negotiation and clusters of certain personality traits.
Methods:
An exploratory descriptive research approach utilizing an online web-based survey to assess personality, indirect aggression and tactics of hierarchy negotiation across categories of nurses in the United States was employed. Evolutionary Psychology was used as the theoretical framework for the study. Evolutionary Psychology considers the biology of brain function and the resulting behaviors which might be expected as a result of the way the brain has evolved throughout time. The prevalence of these types of behaviors in women and thus in female professions such as nursing could suggest that indirect aggression might have been adaptive in the female evolutionary past. And if so, the tendency to engage in these behaviors could be inherent in brain patterns and functions, making them not only harder to recognize and change, but also more likely to be expressed in a conducive environment. Reliable and valid study instruments were used that are in line with the theory of Evolutionary Psychology. These included the target and aggressor versions of the Indirect Aggression Scales (IAS-T and IAS-A), the Hierarchy Negotiation Questionnaire (HN) and the Neuroticism, Extraversion, Openness Five-Factor Inventory (NEO-FFI).
Results:
Significant findings from this study suggest that higher levels of education, age, years as a nurse, and environment are at least moderately correlated with acts of indirect aggression and tactics of hierarchy negotiation. Findings also show significant correlations across categories of nurses in aggressing through guilt induction behaviors using the tactic of deceptive self-promotion. The personality traits agreeableness, openness and conscientiousness are significant predictors for most acts of indirect aggression and tactics of hierarchy negotiation.
Conclusion:
Results from the study can be used to discuss, define and identify acts of indirect aggression to aid in nursing education and practice as well as to inform policies and procedures to effectively acknowledge and address occurrences. Environment, as evolutionary psychology suggests, seems to play a role in the expression of varying forms of aggression. Awareness of areas which are high-stress, more hierarchical, and more competitive and thus more conducive to expression of indirect aggression might help. Results from this study show that Magnet designation might also have a positive impact on reducing environmental contributors. Research is ongoing to determine if an intervention that promotes self-awareness of personality could also aid in reducing these behaviors.