1. Introduction
The substantial omission of addressing assessment of personality traits and employment of profiling techniques of AHPs, First Responders, and HCPs in vivo; as well as current, and past, research is a significant and concerning issue. In particular, research appraising AHPs and First Responders. Consistent with this theme is the dereliction of duty in lack of identifying perilous personality traits- which invariably render the patient/client as victims of: determinants of pain and suffering; maleficence; malfeasance; and, outright medical negligence.
The classification of health workers maps occupation categories into five broad groupings: health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and other health service providers not elsewhere classified
.
Depending upon the country, the definition of HCPs, AHPs, and First Responders (proposed and full) differs slightly. The terminology utilised in this article is specifically discussed as follows:
1) Healthcare (or Health care) professionals or Health professionals: Doctors; Nurses and Midwives; Dentists; and, Clinical Academic Researchers.
2) Allied Healthcare (or, Allied Health) are considered any other health related professionals who provide diagnostic therapeutic, preventative services of these primary medical professionals. This can include the professions of: art therapy, audiology, chiropractic, dietetics, drama therapy, exercise physiology, medical and laboratory technology; medical technician fields; music therapy, occupational therapy, optometry, orthoptics, orthotics/prosthetics, osteopathy, pharmacy, physiotherapy, podiatry, prosthetics, psychology, radiation therapy, radiography, radiology, social work, sonography, speech therapy, and several other health related professional categories.
3) First Responders or Emergency Services’ personnel (first on scene-) are: Firefighters; Law enforcement: police officers- many local, state & many federal agents; EMTs (Emergency Medical Technicians); EMRs (Emergency Medical Responders).; Paramedics; and, Search & rescue.
The importance of personality traits’ assessment and profiling of HCPs, AHPs, and First Responders primarily involves focus upon psychological wellbeing. The term incorporates psychological, emotional, social, and cognitive, health. The directly associated link between psychological wellbeing, mental health, and- further- personality dysfunction, and Dark Triad personality traits- is spotlighted in this study.
Personality is the product of the dynamic organization (within the) individual of those psychophysical systems that determine individual’s unique characteristics, behaviors, thoughts, and adjustment to the environment
| [2] | Hall, C. S., Lindzey, G., Campbell, J. B. Theories of personality, John Wiley and Sons, New York; 1998. |
[2]
.
Personality is expressed through habits, skills, values and goals, all of which shape our experiences and decisions, including work choices
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
Personality traits notably effect every individual’s perceptions, behaviors and affect, consequently impacting the ways in which each person navigates contexts, settings, and challenges. It is considered predominantly as a fixed part of one’s core identity (non-fluid, untransmutable). Examination of personality traits, especially in each individual working in
Healthcare (and
Allied health) and
First Responders, is imperative to assist in maximizing positive traits; and, significantly addressing the impacts (and potential impacts) of negative ones. Thus, trait theory is an accepted explanation for how personality can manifest in individuals. This theory centres upon the identification, measurement and description of specific traits, subsequently highlighting differences between individuals
.
Furthermore, it is argued that a comprehensive understanding of
Temperament is defined as those components of personality that are heritable, developmentally stable, emotion based and not influenced by sociocultural learning
. Whereas
Character traits demonstrate observational erudition involving pursuit of individual accomplishment.
The term
psychological wellbeing encompasses mental, emotional, and psychological health (excluding physical or spiritual wellbeing)
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
. Furthermore, the important link between
psychological wellbeing and emotional intelligence cannot be understated.
Emotional intelligence represents an assortment of non-cognitive skills and capabilities including empathy, prof 85 sionalism and integrity, and each of these attributes influence an individual’s ability to cope with environmental demands
| [6] | Talarico, J. F., Varon, A. J., Banks, S. E., Berger, J. S., Pivalizza, E. G., Medina-Rivera, G., Rimal, J., Davidson, M., Dai, F., Qin, L., Ball, R. D., Loudd, C., Schoenberg, C., Wetmore, A. L., Metro, D. G. Emotional intelligence and the relationship to resident performances: A multi-institutional study. J. Clin Anesth. 2013, 25(3), 181-7
https://doi.org/10.1016/j.jclinane.2012.10.007 |
[6]
. It is argued that, significant emotional intelligence enhances employment: productivity, effectiveness, and quality, with greater chance of the individual achieving positive career success.
In the next sections (Method, Results, and Discussion), the key assessment tools (for personality traits and profiling assessment) are discussed in detail. They incorporate, for instance, the following themes: identification of personality traits; Emotional Intelligence; Temperament and Character; Neuroticism; Psychoticism; other Mental Health issues; Big Five personality; Evidence Based Practice; Patient safety; Interprofessional collaboration; ‘speaking up’; Burnout; Posttraumatic Stress Disorder (PTSD); and Dark Triad personality traits (Narcissism, Machiavellianism, and Psychopathy); and Risk Assessment of perilous traits. All pertaining to HCPs, AHPs, and First Responders.
Standardized integration of (at the least, a series of) questions or assessment tool [s]. examining HCPs’; AHPs’; and First Responders’ personality traits will promote effective adherence to recruitment policies and procedures and, quality and safety protocols. Discovery of, for instance, Neuroticism; Psychoticism; and, other performance impacting mental health issues (such as, the Dark Triad personality traits of Narcissism, Machiavellianism, and Psychopathy) underpin this approach.
Clinical decision-making based upon over-reliance (and misuse) of the concept
to err is human can (depending upon the state and country) elicit regulatory and medico-legal consequences for specific
HCPs;
AHPs; and/or
First Responders involved in critical incidents and medical error events. Thus, if a
HCP; AHP; or,
First Responder with risk-seeking or professionally dysfunctional personality, or the traits/profile continues to be unidentified and/or their dysfunctionality remains unchecked; it can affect healthcare facility accreditation and funding;
HCPs’,
AHPs’, and
First Responders’ licensing and certification. Ultimately, negative traits compromize stability of healthcare systems. This is, at the core, an issue for realization of true
patient safety. Patient safety and actualization of quality in healthcare is of paramount importance- from individual health related care (including
First Responder involvement) through to healthcare infrastructure. Each person plays their part. This is discussed in a dedicated section later in this article.
Unacceptable standards of care can involve breach of duty resulting in permanent injury or death. Dereliction of duty may include: harmful treatment; diagnostic errors (or clinician compromised administration of medication) and
delayed diagnosis; lack of informed consent; disregard of patients’ (family members’, and carers’, especially in the case of enduring guardianship) wishes; moral and ethical dilemmas (value conflicts); (perverse) payment incentives | [117] | Kairies-Schwarz, N., Souček, C. Performance Pay in Hospitals: An Experiment on Bonus–Malus Incentives. Int J. Environ. PublicHealth. 2020,17,8320. https://doi.org/10.3390/ijerph17228320 |
[117]
in the case of clear and present endangerment of patients. In regards to medical error, and
Patient safety, the
Wilma scenario
| [31] | McKenzie, M. C. The importance of incorporating risk management and assessing for perilous traits during job recruitment interviews, performance appraisals, and post-critical incidents. American Journal of Management. 2025, 25(3), 138-145.
https://doi.org/10.33423/ajm.v25i3.7804 |
[31]
provides a real-time exposé into the risks of trusting healthcare systems when a patient is in crisis.
Moreover, upon consideration of psychological wellbeing of AHPs; HCPs; and, First Responders, inclusion of the following disorders must be indicated in profiling and assessment processes: burnout; PTSD (Posttraumatic Stress Disorder); SVS (Second Victim Syndrome)- as a specific form of STS (Secondary Traumatic Stress) involving caregivers within healthcare.
As an individual’s personality data and predominant traits are unlikely to change significantly over time an individual’s personality report can be used as part of ongoing review, particularly in times of challenge to assist in identifying coping strategies and possible reasons for behaviours and responses
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
.
2. Materials and Methods
A large scoping review remaining compatible with the Johanna Briggs Institute (JBI) approach of 133 published studies was undertaken.
Exclusion criteria included published studies in languages other than English; and, gray papers (unpublished; and, opinion pieces).
A search strategy involved identification of relevant literature via a multitude of established professional journals which research HCPs, AHPs, and First Responders. A committed focus was maintained to determine types of personality traits, and directly associated personality profiles, of these populations. An extensive, full search also utilized research derived from databases: PubMed; CINAHL; Web of Science; and, Scopus.
Key search terms employed were: healthcare professionals; forensic; nurses; physicians; Allied Healthcare professionals; allied health professionals; psychologists; social workers; physiotherapists; First Responders; EMTs; paramedics; police; rescuers; firefighters; personality traits; personality profiling; burnout; risk mitigation; patient safety; medical error; critical incidents; performance appraisal; gaslighting; mental health; psychological wellbeing; and, best practice.
133 highly relevant publications were mapped and were used as a core part of this study, including to identify gaps for consideration in future research. Data was extracted from these studies via the following information: author(s); date published; purpose; design; tools, measurements, and methods; findings; and future research recommendations.
2.1. The Large Scoping Review Included Examination of the Following Tools
Gaslighting Victims’ Questionnaire-GVQ, and
GVQ-Short-form ; assessment of police and firefighter recruits the
NEO-PI-R (Neuroticism, Extraversion, Openness Personality Inventory Revised)
| [87] | Costa, P. T., McCrae, R. R. NEO PI-R. Professional manual, Odessa, FL: Psychological Assessment Resources, Inc; 1992. |
[87]
;
TCI-R-140 (Temperament & Character Inventory Revised) personality measure
| [9] | Cloninger, C. R., Svrakic, D. M. and Przybeck, T. R. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993, 50, 975-90. |
[9]
; self-report questionnaire for
AHPs to determine
PO (Person Oriented) and
TO (Technique Oriented) professions;
EPQ-R (Eysenck Personality Questionnaire- Revised Extraversion/Introversion,
Neuroticism,
Psychoticism)
| [10] | Eysenck, H. J. and Eysenck, S. B. G. The manual of Eysenck Personality Questionnaire. London: Hodder and Stoughton. 1975. |
[10]
and the
MH (Mental Health Checklist) assessment of medical professionals
| [11] | Matthew, P. and Ram, U. Anger in relation to gender, religion and marital status. Indian Journal of Applied Psychology. 1999, 36, 10-13. |
[11]
.;
EBP (Evidence Based Practice) profile for
AHPs | [11] | Matthew, P. and Ram, U. Anger in relation to gender, religion and marital status. Indian Journal of Applied Psychology. 1999, 36, 10-13. |
[11]
.; profiling
HPs and
AHPs non-cognitive traits (EI: Emotional Intelligence)
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
; a semi-structured interview process for
clinical academic AHPs | [65] | King, E., Cordrey, T., Gustafson, O. Exploring individual character traits and behaviours of clinical academic allied health professionals: A qualitative study. BMC Health Services Research. 2023, 23(1025), 1-10. |
[65]
.; a tailored instrument assessing mental health workers’ professional attitudes to
forensic patients/clients
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
.; assessment of
help-seeking behaviors of mental health professionals in relation to their own mental health issues
| [22] | Edwards, J. L., Crisp, D. A. Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology. 2017, 69(3), 218-225. |
[22]
;
Big Five personality traits model application
| [23] | Smith, L., Brown, K.: Psychographic profiling of healthcare professionals. J. Healthc. Manag. 2020, 35(1), 45–60. |
[23]
; focus groups with a semi-structured interview guide for physicians, nurses, and advanced practice providers about
‘speaking up’ behaviors
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
;
16PF (Personality Factor) questionnaire and gathering perceptions of influences upon personality for critical care and emergency care staff (psychological safety and personality influences on psychological safety focused)
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
;
IPC (InterProfessional Collaboration) tool
| [26] | Keba Kebe, N. N. M., Chiocchio, F., Bamvita, J-M., Fleury, M-J. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Medicine. 2019, 7, 1-10.
https://doi.org/10.1177/2050312119841467 |
[26]
; a survey
instrument for medical staff (doctor-patient relationship; physical and mental health; media influence; work environment; and, personal details)
;
MBI (Maslach’s Burnout Inventory)- critical care focus
| [28] | Maslach, C., Jackson, S. E. MBI: Maslach Burnout Inventory: Manual Research Edition. Palo Alto, CA: Consulting Psychologists Press; 1986. |
[28]
; and, exploration of the relationship between
paramedic personality profiles and key factors including
stress, burnout, and
employment retention or
attrition | [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
. In one study, examination of ehealth records and prescribing databases (this is relevant to
DRGs: Diagnosis Related Groups; and,
KPIs: Key Performance Indicators) was connected with
HCPs data along with psychographic profiling of
HCPs | [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
. This is a technique already familiar to most workers in healthcare fields which are typically utilised to comprehend patient behaviors, enhance patient engagement (and is even used, upon occasions, to assess primary carers). A study incorporating construction and development of the
Mindful Healthcare Scale (MHS)- measuring psychological flexibility specific to the the healthcare context
| [30] | Gillanders, D., Fisher, S., Kidney, G., Ferreira, N., Morris, P. G., Harkjaer-Thorgrimsen, L. M. The Mindful Healthcare Scale (MHS): Development and initial validation. Journal of Contextual Behavioral Science. 2024, 33(100817), 1-12.
https://doi.org/10.1016/j.jcbs.2024.100817 |
[30]
; a proposed operational flowchart to help stakeholders identify potential
red flags and recognize dangerous situations
| [81] | Visi, G., Spina, F., Del Duca, F., Maiese, A., Morena, D., Papi, L., Turillazzi, E., Fineschi, V. Forensic aspects of healthcare-related murders: a series of homicides and attempted homicides committed by nurses in Italy. J Forensic Leg Med. 2025 Oct, 115, 102939. https://doi.org/10.1016/j.jflm.2025.102939 Epub 2025 Jul 31. |
[81]
; utilization of the Short
Dark Triad and Short Character Inventory
; personality traits assessment process for
AHPs | [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
; and,
Risk assessment and identification of perilous traits for
job interviews, performance appraisals, and post-adverse events questionnaire (for
HCPs;
AHPs; and,
First Responders)
| [31] | McKenzie, M. C. The importance of incorporating risk management and assessing for perilous traits during job recruitment interviews, performance appraisals, and post-critical incidents. American Journal of Management. 2025, 25(3), 138-145.
https://doi.org/10.33423/ajm.v25i3.7804 |
[31]
were among other students examined.
Patient/client safety assessment tools featured: semi-structured interview, field notes, research memos, and guidance/policies of National Health Service (
NHS) secondary care, primary care, and regional/national bodies regarding
Patient safety and near misses
| [32] | Woodier, N. Burnett, C., Sampson, P., Moppett, I. Patient safety near misses-Still missing opportunities to learn. Journal of Patient safety and Risk Management. 2024, 29(1), 47-53.
https://doi.org/10.1177/25160435231220430 |
[32]
- the ‘
Patient safety’section features further extrapolation.
The integration of results with personality profiling, speaking up behaviors, capacity for both interprofessional collaboration and evidence based practice techniques involving those working in the healthcare field, and
First Responders, is necessitated. Therefore: An Interpretation of model on ‘Speaking up’ behavior in HCPs study was also reviewed
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
2.2. Assessment Techniques and Personality Profiling
Specifically, the following personality based assessment measures and profiling techniques which were identified as key to delineating results, included the following:
Gaslighting Victims’ Questionnaire (
GVQ, and GVQ-Short form)
.
Newly introduced 5 stages of
Gaslighting, are highly relevant to all professionals working in
Healthcare (and.
AHPs), and
First Responder work, alike. They are,
GHFSA stages: Grooming; Hostage to cruelty; Fragmentation; revelationary Shock; and Aftermath .
For instance, employees [and volunteers]. in domestic violence; human resources/occupational departments or outreach from such;
Patient safety, and ethics, professionals; trauma specialists; and, family support workers and, certainly, mainstream employees who are
HCPs,
AHPs, and
First Responders, can use this questionnaire to identify potential or alleged perpetrators of gaslighting, coercive control, bullying, and workplace (and other) abuse
, within healthcare groups’ and first responders’ contexts.
Assessment of police and firefighter recruits via the NEO-PI-R | [87] | Costa, P. T., McCrae, R. R. NEO PI-R. Professional manual, Odessa, FL: Psychological Assessment Resources, Inc; 1992. |
[87]
.
(Neuroticism; Extraversion; Openness-Personality Inventory Revised), plus measurement of heart rate, skin conductance, and eyeblink EMG reactivity) This study examined personality and psychophysiological measures that could shed light on the similarities and differences between police and firefighter recruits that might affect job performance and reactions to job-related stressors. Personality traits of the police and firefighter recruits were assessed using the Revised NEO Personality Inventory (
NEO-PI-R), a 240-item self-report measure of the 5 factor domains of personality:
Neuroticism, Extraversion, openness to experiences, agreeableness, and Conscientiousness
| [87] | Costa, P. T., McCrae, R. R. NEO PI-R. Professional manual, Odessa, FL: Psychological Assessment Resources, Inc; 1992. |
[87]
was employed and psychophysiological responses to a mild stressor were examined by measuring heart rate (
HR), sweat (skin conductance,
SC), and eyeblink electromyogram (
EMG) reactivity to a series of startling loud tones
. The research provided clear delineation of physiological and personality traits.
TCI-R-140 (Temperament & Character Inventory 140 Revised) personality measure
Personality was measured using the TCI R-140
| [9] | Cloninger, C. R., Svrakic, D. M. and Przybeck, T. R. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993, 50, 975-90. |
[9]
. It is comparable with the Big Five traits. It explores the relationship between paramedic personality profiles and key factors including stress, burnout and employment retention or attrition
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
A self-report questionnaire was undertaken to determine whether:
Either
PO (socially dependent, cooperative and relationship focused), or
TO (focused on skills and procedures) were predominant in
AHPs. The study further asks whether there are different levels of certain traits in the individual professions. The usefulness of this information for individuals and organisations to address career satisfaction, recruitment and retention is discussed
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
Study of personality and mental health of medical professional
The
EPQ-R (Eysenck Personality Inventory Revised:
Extraversion/Introversion, Neuroticism,
Psychoticism) and the
MH (Mental Health Checklist) were utilized in this research
| [59] | Bhupender, S. Personality and mental health of medical professionals. Int Res. J. Social Sci. Dec 2014, 3(12), 23-27. ISCA: International Science Community Association| https://isca.in |
[59]
. EPQ-R was developed to measure normal and abnormal dimensions of personality. Eysenck identified three major dimensions of personality:
Psychoticism (P), Extraversion (E) and
Neuroticism (N)
| [10] | Eysenck, H. J. and Eysenck, S. B. G. The manual of Eysenck Personality Questionnaire. London: Hodder and Stoughton. 1975. |
[10]
. Also used, was the Mental Health Checklist (MH) measuring the mental well-being of the respondent through 23 items
| [11] | Matthew, P. and Ram, U. Anger in relation to gender, religion and marital status. Indian Journal of Applied Psychology. 1999, 36, 10-13. |
[11]
.
EBP2 (Evidence Based Practice) profile for AHPs
The Evidence-Based Practice Profile (EBP2) questionnaire was used to assess five domains (Relevance, Terminology, Practice, Confidence, Sympathy) in 918 subjects from five professional disciplines
.
This encompassed
AHPs across a series of allied health professions (5) stages of training, with profession and with age. The Evidence-Based Practice Profile (EBP2) takes 10-12 minutes to complete and consists of a total of 58 items. The categories included: Terminology (17 items) refers to the understanding of common research terms; Confidence (11 items) refers to the perception of an individual’s abilities with EBP skills; Practice (9 items) refers to the use of EBP in clinical situations and Sympathy (7 items) refers to the individual’s perception of the compatibility of EBP with professional work
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
. It is a self-report questionnaire which can facilitate recruitment. All academic staff and students of five allied health professional disciplines including undergraduate students and those enrolled in bachelor degree programs in physiotherapy, occupational therapy, podiatry, medical radiation and human movement were examined
.
Profiling HPs and AHPs non-cognitive traits (EI: Emotional Intelligence)
Information relating to personality traits, behaviour styles and emotional intelligence of qualified health professionals has been gaining interest in the empirical literature. These non-cognitive traits have been explored to determine if they predict characteristics and outcomes of health professionals and their practice
.
Non-cognitive traits have been theorised to predict characteristics, career choice and outcomes of health professionals and could represent a homogenous group. This study aims to profile and compare personality traits, behaviour styles and emotional intelligence of health practitioners across a variety of professions
. Enhancement of EI is directly associated with an individual’s capacity to develop skills and competency across five domains of self-regulation, self-awareness, empathy, motivation and social skills
| [88] | Brewer, J. Emotional intelligence enhancing student effectiveness and patient outcomes. Nurs Educ. 2000, 25(6), 264. |
[88]
.
A semi-structured interview process for clinical academic AHPs
This was developed in regards to: risk themes, and reward, don’t wait to be invited, shifting motivations, research is a team sport, and staying the course
| [65] | King, E., Cordrey, T., Gustafson, O. Exploring individual character traits and behaviours of clinical academic allied health professionals: A qualitative study. BMC Health Services Research. 2023, 23(1025), 1-10. |
[65]
.
A tailored instrument assessing mental health workers’ professional attitudes to forensic patients/clients .
This theme consists of three subthemes: recovery pessimism and dismissal of ambitions, perceived dangerousness and fear, and devaluation through offenses
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
. The theme has two subthemes: ambiguity in detecting stigma, and anticipated stigma. It highlights forensic service users’ difficulty in determining whether they are being stigmatized, as it may be subtly or indirectly, or anticipated
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
. The method employed included a semi-structured interview guide; focus groups for (e.g.) surgical attendants and fellows.
Separate focus groups were introduced to resident physicians, nursing residents, operating room nurses, neonatal intensive care nurses and certified registered nurse (RN) anaesthetists. Result eliciting coding followed
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
.
Assessment of help-seeking behaviors of mental health professionals in relation to their own mental health issues
The prevalence of mental health issues in mental health professionals is problematic on at least three levels: the morbidity and mortality of the individuals; the potentially detrimental effect of untreated illness on the quality of patient care; and the damage done by untreated providers to the general public’s perception of, and confidence in, the mental healthcare industry
. This can extend to clinical depression and anxiety through to suicidality.
However, one area has been largely overlooked is the help seeking behaviour of mental health professionals who experience psychological distress. The aim of this study was to (1) conduct a pilot investigation into attitudes toward seeking help, and barriers to help seeking reported by Australian mental health professionals; (2) investigate differences in barriers reported by experienced and inexperienced mental healthcare professionals (i.e., students)
| [22] | Edwards, J. L., Crisp, D. A. Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology. 2017, 69(3), 218-225. |
[22]
.
The Big Five personality traits model
The Big Five personality traits categorize individuals based on five dimensions:
Openness, Conscientiousness, Extraversion, Agreeableness, and
Neuroticism | [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
. The first trait is openness; it encourages receptiveness to new ideas and treatments; the second conscientiousness, where
HCPs is diligent, organized, and detail-oriented, adhering to clinical guidelines based on evidence practices. Third traits, extraversion, sociability, and assertive influence peer opinions and interaction with pharmaceutical representatives. Fourth trait is agreeableness in concern of
HCPs are cooperative and pharmaceutical representative and cooperative and empathetic patient preference and experiences. Final trait:
Neuroticism is characterized by a high level of stress and anxiety, which creates an impact on the decision-making process and leads to more caution and aversion to risk
| [23] | Smith, L., Brown, K.: Psychographic profiling of healthcare professionals. J. Healthc. Manag. 2020, 35(1), 45–60. |
[23]
.
Focus groups with a semi-structured interview guide for physicians, nurses, and advanced practice providers about ‘speaking up’ behaviors
Focus groups were conducted with nurses, advanced practice providers and physicians at three healthcare facilities were conducted. The healthcare professionals derived from two academic medical centres and one community hospital affiliated with a large academic health system from professional areas of internal medicine, paediatrics, surgery and anaesthesiology
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
In addition, a qualitative descriptive approach was undertaken exploring healthcare professionals’ opinions about and experiences with speaking up with a grounded study design and structured interview questions to (1) answer questions about why, despite training and the knowledge that speaking up saves lives, healthcare professionals do not consistently speak up with legitimate
Patient safety concerns and (2) elicit information which may be useful in enhancing current interventions to increase speaking up behaviours
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
Indeed, the often clear and present sanctification of, and reverence toward, in particular medical professionals, can inevitably block recognition of certain concerning personality traits. Especially, in the case of Dark Triad personality traits which are discussed further in the Results section.
16PF (Personality Factor) questionnaire and gathering perceptions of influences upon personality for critical care and emergency care staff (psychological safety and personality influences on psychological safety focused)
Healthcare teams are expected to deliver high quality and safe clinical care, a goal facilitated by an environment of psychological safety
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
.
The 16PF assessment has been used in healthcare settings (notably with nursing staff and medical student populations) to investigate the impact of personality on measurable outcomes. This is formally referred to as 16PF
| [25] | Cattell, H. E. and Mead, A. D. The Sixteen Personality Factor Questionnaire (16-PF). In G. J. Boyle, G. Matthews, D. H. Saklofske (Eds.). SAGE Publications Ltd; 2008, pp. 135-159. https://doi.org/10.4135/9781849200479.n7 |
[25]
. We hypothesised that the emergency department–an unpredictable and dynamic setting would attract different individuals to those working in the more controlled environment of critical care. Personality was also explored using two methodologies–a more traditional quantitative assessment, combined with individual perceptions of the influence of personality
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
.
The stability of personality traits over the course of a lifetime is widely debated (and, thus)- utilization of a semi-structured qualitative interview. Two quantitative measures of psychological safety and clinical stressors were included within the qualitative interviews
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
. A constant with the current questionnaire is the Edmondson’s validated assessment of psychological safety (and was) also incorporated
.
IPC (InterProfessional Collaboration) tool
This study aims at identifying profiles of mental health professionals based on individual, interactional, structural and professional role characteristics related to interprofessional collaboration
| [26] | Keba Kebe, N. N. M., Chiocchio, F., Bamvita, J-M., Fleury, M-J. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Medicine. 2019, 7, 1-10.
https://doi.org/10.1177/2050312119841467 |
[26]
.
Interprofessional Collaboration amongst mental health professionals is substantially advantageous to patients via enhanced positive outcomes, improved Patient safety and quality care, and patient and staff satisfaction, and healthcare staff morale. It can assist mental health professionals through a reduction in burnout; increased job satisfaction, and reducing potentiality of medical errors whilst also improving system efficiency, reducing errors, and enhancing care quality by integrating diverse expertise for complex patient needs.
A survey instrument for medical staff (doctor-patient relationship; physical and mental health; media influence; work environment; and, personal details)
This study investigates the interplay of work environment, doctor-patient relationships, media influence, and self-reported health among healthcare professionals. Modeling was used to analyze factors impacting well-being, including physical and mental health, work environment, doctor-patient relationship, and media influence. Those involved in the study, were: physicians (also-nurses, lab technicians, pharmacists, and administrators) and departments (internal medicine, surgery, obstetrics and gynaecology, paediatrics, and other departments)
.
The survey instrument
assessed five main domains through 30 item including: personal information domain; physical and mental health; work environment; doctor-patient relationship domain; and, media influence.
Maslach Burnout Inventory (MBI)- critical care focus
BOS (Burnout Syndrome)- is most commonly diagnosed by using the Maslach Burnout Inventory (MBI)
| [28] | Maslach, C., Jackson, S. E. MBI: Maslach Burnout Inventory: Manual Research Edition. Palo Alto, CA: Consulting Psychologists Press; 1986. |
[28]
.
The MBI is a 22-item, self-report questionnaire that asks respondents to indicate on a seven-point Likert scale the frequency with which they experience certain feelings related to their job. The MBI is scored according to the presence and severity of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
.
Exploration of the relationship between paramedic personality profiles and key factors including stress, burnout, and employment retention or attrition
This study was undertaken to address the relative importance of general job- related stressors, ambulance specific stressors and individual characteristics in relation to job satisfaction and health complaints among ambulance personnel
| [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
.
The
Neuroticism scale utilised included characteristics of hostility, depression, impulsiveness, anxiety and vulnerability
| [46] | Treglown L, Zivkov K, Zarola A, Furnham A. Intention to quit and the role of dark personality and perceived organizational support: A moderation and mediation model. PloS One. 2018, 13(3), 1-13: e0195155.
https://doi.org/10.1371/journal.pone.0195155 |
[46]
.
Examination of e-health records and prescribing databases (this is relevant to DRGs: Diagnosis Related Groups; and, KPIs: Key Performance Indicators) was connected with HCPs data along with psychographic profiling of HCPs
Psychographic profiling
comprises examination of personality traits in addition to exploration of attitudes, values, lifestyle factors, and interests. Healthcare sector psychographic profiling is used to understand patient behaviour and improve patient engagement
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
The study was undertaken in order to identify values, attitudes, decision making patterns, and lifestyle preferences of 500 doctors and
HCPs that drive medical decisions. The main aim of this research was to identify a gap by examining the role of psychographic profiles based on reshaping
HCPs prescribing decisions
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
The objectives of this study are threefold:
1) To investigate the impact of psychographic profiles on the prescribing behaviour of HCPs.
2) To explore the potential for integrating psychographic data with traditional profiling methods.
3) To identify the challenges, ethical considerations, and emerging trends associated with psychographic profiling in healthcare. Secondary data were collected from electronic health records and prescribing databases to sustain triangulation of findings and, thereby, enhance validity
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
It is proposed that, psychological predisposition may enhance communication and treatment strategies
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
Construction and development of the Mindful Healthcare Scale (MHS)- measuring psychological flexibility specific to the the healthcare context
The MHS (Mindful Healthcare Scale) is a psychometrically sound measure of psychological flexibility in healthcare contexts. It provides assessment of correlation with measures for burnout, wellbeing, general psychological flexibility, flexibility and self-compassion for healthcare professionals
| [30] | Gillanders, D., Fisher, S., Kidney, G., Ferreira, N., Morris, P. G., Harkjaer-Thorgrimsen, L. M. The Mindful Healthcare Scale (MHS): Development and initial validation. Journal of Contextual Behavioral Science. 2024, 33(100817), 1-12.
https://doi.org/10.1016/j.jcbs.2024.100817 |
[30]
.
Also, the Professional Quality of Life Scale (ProQol-5) was used to measure professional satisfaction, burnout, and secondary traumatic stress
.
Proposed operational flowchart to help stakeholders identify potential red flags and recognize dangerous situations
This operation flowchart would also- assist forensic pathologists in determining the cause of death in suspicious or unexplained fatalities. This flowchart provides a structured framework for investigations, ensuring a systematic and comprehensive approach to identifying potential homicides in healthcare settings
| [81] | Visi, G., Spina, F., Del Duca, F., Maiese, A., Morena, D., Papi, L., Turillazzi, E., Fineschi, V. Forensic aspects of healthcare-related murders: a series of homicides and attempted homicides committed by nurses in Italy. J Forensic Leg Med. 2025 Oct, 115, 102939. https://doi.org/10.1016/j.jflm.2025.102939 Epub 2025 Jul 31. |
[81]
.
Utilization of the Short Dark Triad and the Short Character Inventory (relevant to HCPs; AHPs; and, First Responders)
Dark Triad personality traits embody-
Machiavellianism;
Narcissism; and,
Psychopathy.
Machiavellianism is expressed as a personality characterized as cold, manipulative, and with a cynical worldview and lack of morality
| [103] | Christie, R., Geis, F. L. Studies in Machiavellianism. New York: Academic Press; 1970. |
[103]
.
Narcissism is the tendency to lack empathy, have fantasies of enormous power, beauty and success, and at the same time have problems with criticism and show exploitativeness and exhibitionism
.
Psychopathy is expressed as low empathy, low anxiety, and high impulsive and thrill-seeking behavior
.
The short character inventory is an instrument which was originally designed by C. R. Cloninger for Time Magazine as a short version of the 238-item Temperament and Character Inventory
| [9] | Cloninger, C. R., Svrakic, D. M. and Przybeck, T. R. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993, 50, 975-90. |
[9]
, and was employed for this particular study
.
The short
Dark Triad inventory
was also used. This instrument comprises 27 items, 9 per each dark trait.
Personality traits assessment process for AHPs
PO is an indicator of Person Oriented; and, TO an abbreviation for Technique Oriented. The categories are applied to specific professions within the AHPs field.
PO is signified as socially dependent, cooperative and relationship focused; and, TO focused on skills and procedures
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
Analysis of personality traits of Allied Health Professionals was undertaken- from the perspective of both the TO and PO orientation and the individual professions
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
The traits of concentration were: novelty seeking; harm avoidance; reward dependence; persistence; self-directedness; cooperativeness; and, self-transcendence
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
Risk assessment and identification of perilous traits for job interviews, performance appraisals, and post-adverse events questionnaire (for HCPs; AHPs; and, First Responders)
A new, innovative, and comprehensive, series of questions per the following categories are offered in McKenzie
| [31] | McKenzie, M. C. The importance of incorporating risk management and assessing for perilous traits during job recruitment interviews, performance appraisals, and post-critical incidents. American Journal of Management. 2025, 25(3), 138-145.
https://doi.org/10.33423/ajm.v25i3.7804 |
[31]
.
The personality traits and profiling based categories of focus are:
Compulsive lying (and Confabulation); Coldly Apathetic; Glibness; Inability to Experience Remorse; Extension of Maleficence/Harm; Emotional Emptiness (+ Scenario); Grandiosity; Complete Lack of Acceptance of Responsibility for Own Actions + Scenario; Manipulative/Insidious Opportunism; Impulsivity, Irresponsibility; Unrelenting Need for Simulation/Easily Bored; Anger, Irritability, Poor Concentration, Drug Affected; Poor Behavioral Conduct; Anti-Social/Exploitative Lifestyle Behaviors; Lack of Realistic Long-Term Goals; History of Childhood & Adolescent Behavioral Problems; and, Criminal Adaptability | [31] | McKenzie, M. C. The importance of incorporating risk management and assessing for perilous traits during job recruitment interviews, performance appraisals, and post-critical incidents. American Journal of Management. 2025, 25(3), 138-145.
https://doi.org/10.33423/ajm.v25i3.7804 |
[31]
.
These have been written with
HCPs;
AHPs; and,
First Responders, in mind and continue to have direct applicability to each of these professions. Also, in relation to combatting
maleficence, medical error, medical negligence, the correct handling of critical incidents | [85] | Mitchell, J. When disaster strikes. The critical incident stress debriefing process. Journal of Emergency Medical Service. 1983, 8, 36–39. |
[85]
(pre-, intra-, and post-) as well as excellence in realisation of
Patient safety and quality in healthcare, are at issue which are of equal concentration in this publication.
3. Results
3.1. Positive Personality Traits
The following positive personality traits were detected.
3.1.1. HCPs
In regards to those in the emergency department had higher scores for dominance and emotional stability and significantly lower scores for apprehension
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
. Novelty seeking (orderly and reflective; exploratory and curious) temperament and character traits were identified as higher in: medical students planning to specialise in surgery, emergency medicine or obstetrics/gynaecology compared with those interested in primary care and paediatrics
| [121] | Vaidya, N. A., Sierles, F. S., Raida, M. D., Fakhoury, F. J., Przybeck, T. R., Cloninger, C. R. Relationship between specialty choice and medical student temperament and character assessed with Cloninger Inventory. Teach Learn Med. 2004, 16, 150-6. https://doi.org/10.1207/s15328015tlm1602_6 |
[121]
; and, in nurses than doctors
. Results demonstrated doctors have high personality traits of dominance
| [18] | Buddeberg-Fischer, B., Stamm, M., Buddeberg, C. and Klaghofer, R. (2008). The new generation of family physicians-career motivation, life goals and work-life balance. Swiss Med Wkly, 138(21-22): 305-12
https://doi.org/10.4414/smw.2008.12473 |
[18]
; instrumentality
| [17] | Laurence, C. O., Eley, D. S., Walters, L., Elliot, T., Cloninger, C. R. Personality characteristics and attributes of international medical graduates in general practice training implications for supporting this valued Australian workforce. Aust J Rural Health. 2016, 24(5), 333-9
https://doi.org/10.1111/ajr.12273 |
[17]
; reward-dependence
| [14] | Eley, D. S. and Eley, R. M. Personality traits of Australian nurses and doctors challenging stereotypes? Int J Nurses Pract. 2011, 17(4), 380-7.
https://doi.org/10.1111/j.1440-172X.2011.01952.x |
| [15] | Eley, D., Young, L., Przybeck, T. R. Exploring the temperament and character traits of rural and urban doctors. J Rural Health. 2009, 25(1), 43-9.
https://doi.org/10.1111/j.1748-0361.2009.00197.x |
| [16] | Eley, D. S., Cloninger, C. R., Walters, L., Laurence, C., Synnot, R., Wilkinson, D. The relationship between resilience and personality traits in doctors: implications for enhancing well being. PeerJ. 2013(1), 1-16: e216
https://doi.org/10.7717/peerj.216 |
| [17] | Laurence, C. O., Eley, D. S., Walters, L., Elliot, T., Cloninger, C. R. Personality characteristics and attributes of international medical graduates in general practice training implications for supporting this valued Australian workforce. Aust J Rural Health. 2016, 24(5), 333-9
https://doi.org/10.1111/ajr.12273 |
[14-17]
; shrewdness
| [19] | Reeve, P. E. Personality characteristics of a sample of anaesthetists. Anaesthesia. 1980, 35(6), 559-68. |
[19]
; and anxiety
| [20] | Pajonk, F. G., Cransac, P., Müller, V., Teichmann, A., Meyer, W. Trauma and stress-related disorders in German emergency physicians: The predictive role of personality factors. Int J Emerg Ment Health. 2012, 14(4), 257-68. |
[20]
. Despite medical professionals exhibiting average EI, they perceive that the benefits of emotions are low, suggesting that they do not perceive emotionality in their work context as important and are less likely to utilise it.. Nurses and medical practitioners were found to have higher levels of dominance and lower levels of abstractedness suggesting that they are inclined to be more assertive, forceful and stubborn, and are grounded, practical, solution-orientated individuals
| [13] | Louwen, C., Reidlinger, D., Milne, N. Profiling health professionals’ personality traits, behaviour styles and emotional intelligence: A systematic review. BMC Medical Education. 2023, 23(120), 1-56.
https://doi.org/10.1186/s12909-023-04003-y |
[13]
.
Both medical practitioners and nurses tend to exhibit more control, are not concerned with conflict, and will exhibit traits of assertiveness when presenting their views
| [13] | Louwen, C., Reidlinger, D., Milne, N. Profiling health professionals’ personality traits, behaviour styles and emotional intelligence: A systematic review. BMC Medical Education. 2023, 23(120), 1-56.
https://doi.org/10.1186/s12909-023-04003-y |
[13]
.
Nurses demonstrated very high interpersonal relationships, with emotional stability and commitment to their patients than their medical practitioner colleagues
| [13] | Louwen, C., Reidlinger, D., Milne, N. Profiling health professionals’ personality traits, behaviour styles and emotional intelligence: A systematic review. BMC Medical Education. 2023, 23(120), 1-56.
https://doi.org/10.1186/s12909-023-04003-y |
[13]
. In pursuing a clinical academic career, most participants describe characteristics of tenacity, dedication, and high work ethic. Clinical academic
AHPs possess character traits of high self-efficacy, motivation, and determination in their ambitions to be successful in this field. In summary, inquisitive, intuitive, and instinctive traits seemed to play a fundamental role in generating new opportunities and experiences; seeking permission or approval to engage was rarely considered
| [65] | King, E., Cordrey, T., Gustafson, O. Exploring individual character traits and behaviours of clinical academic allied health professionals: A qualitative study. BMC Health Services Research. 2023, 23(1025), 1-10. |
[65]
. Conversely, this responsibility weighed heavily on some participants in the form of pressure to perform and feelings of guilt where they fell short of their own expectations. A strategic long-game approach was identified, with one respondent notably stating “I approach it all somewhat like a game”
| [65] | King, E., Cordrey, T., Gustafson, O. Exploring individual character traits and behaviours of clinical academic allied health professionals: A qualitative study. BMC Health Services Research. 2023, 23(1025), 1-10. |
[65]
. With regard to rejection or failure, there was general overall acceptance that this is part of clinical work. This notion is supported in ‘a manifesto for failure’, which proposes three concepts important in the management of academic rejection: depersonalising, collectivising, and embracing
. To depersonalise in this context is to divest the research work of personal identity and emotion
.
3.1.2. First Responders
Paramedics play a pivotal role in delivering emergency medical care, contributing to excellence in the prehospital environment and ensuring a seamless continuum of healthcare. In addition, those aged ≥45 years demonstrated lower levels of
spontaneous aggression | [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
.
It has been proposed that emergency personnel choose their careers because they have‘‘very different personalities from the average person”
| [84] | Mitchell, J., Bray, G. Emergency services stress: Guidelines for preserving the health and careers of emergency services personnel. Englewood Cliffs, New Jersey: Prentice Hall; 1990. |
[84]
. This can be ascertained by use of the NEO-PI-R. These personality differences may lead some individuals to seek out dangerous jobs and help them succeed in their chosen vocations
. Emergency personnel in general have a high need for stimulation, are risk takers, are highly dedicated, and have a need to help others. This set of characteristics has been called the ‘‘rescue personality”
| [84] | Mitchell, J., Bray, G. Emergency services stress: Guidelines for preserving the health and careers of emergency services personnel. Englewood Cliffs, New Jersey: Prentice Hall; 1990. |
[84]
. Individuals interested in police work may be expected to have a keen sense of duty and service, whereas those that choose to work in fire rescue services may have
heightened sensation seeking and adventurousness. Police recruits scored higher than firefighters on the gregariousness facet of
Extraversion, on the Conscientiousness domain overall and specifically on the Conscientiousness facets of dutifulness and deliberation. In the loud-tone procedure, firefighters showed greater pre-tone heart rate and skin conductance levels than police, indicating a higher level of baseline autonomic arousal
.
For example, if police training instils heightened vigilance, this might be expected to produce an increased startle response to any sudden, unexpected stimulus. The ‘‘alerting” aspects of startle, (muscular, autonomic and cognitive) could be highly adaptive in preparing an individual for potential danger
.
3.1.3. AHPs
Research involving analysis and determination of specific positive personality traits in
AHPs has been limited to date. Most studies explored personality (medicine, nursing, nursing assistants, dentistry, allied health, paramedics), revealing variation in traits across professions. Behaviour styles were least measured with only ten studies exploring these across four health professions (nursing, medicine, occupational therapy, psychology). profiling qualified health professionals in allied health (physiotherapist, occupational therapist, speech pathologist, dietitian, psychologist, podiatrist, osteopath, chiropractor), medicine, nursing and dentistry
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
(Allied Health Professionals) in the PO (Person oriented) group showed significantly higher levels of traits that emphasise person orientation attributes, such as being sociable, empathic and cooperative, compared with AH professionals in professions with an emphasis on TO (Technique oriented). Professionals in the PO group showed significantly higher levels of traits that emphasise person orientation attributes, such as being sociable, empathic and cooperative, compared with AH professionals in professions with an emphasis on TO
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
Scrutiny of the following studies yielded the following results.
1) Temperament and Character Inventory measurement indicated that allied health clinicians are highly self-motivated, work well in a team, but are less spiritual in nature
.
2) Nurses and psychologists tend to exhibit Type A behaviour styles, including higher levels of competitiveness, time urgency, and with an external locus of control
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
. Type A behaviours studied in psychologists indicated results- demonstrating slightly higher Type A behaviours (10.3 +/- 3.4)
| [72] | Matthews, K. A., Heimreich, R. L., Beane, W. E., Lucker, G. W. Pattern A: achievement, striving, and scientific merit: does pattern A help or hinder? J Pers Soc Psychol. 1980, 39(5), 962-7. https://doi.org/10.1037//0022-3514.39.5.962 |
[72]
.
Medicine and nursing are more dominant
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
in regards to personality trait characteristics. Physiotherapists have a moderate (129.36 +/- 18.314) level of emotional intelligence, that is negatively correlated with occupational stress
| [73] | Nizar Abdul Majeed K, Mohammed Abdulrazzaq J, Kok Chee C. Association of occupational stress and emotional intelligence among physiotherapists in Malaysia: a cross-sectional study. Disabil CBR Inclusive Dev. 2019, 30(4), 77-95 https://doi.org/10.5463/dcid.v30i4.859 |
[73]
. Physiotherapists had significantly higher scores for Relevance compared to all other disciplines except podiatrists.
3) Physiotherapists and pharmacists tend higher level of extroversion
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
.
Podiatrists and occupational therapists scored significantly higher for Relevance compared to medical radiation and human movement subjects
. Occupational therapists are an exception to this, exhibiting higher sensing-perceiving and intuitive-feeling
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
.
It is proposed that utilization of non-cognitive traits (such as emotional intelligence)- might be useful in predicting performance with potential to adapt these to enhance success within their chosen profession
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
.
3.1.4. AHPs and HCPs
Wide spectrum research of
HCPs and
AHPs- was determined to possess the following Person-oriented and/or Technique-oriented personality traits
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
. These were indicated as follows: harm avoidance (worry in anticipation of problems; bold and confident; and, worrying and pessimistic) were higher in: Australian specialist anaesthetists compared with physicians, surgeons and GPs
| [118] | Kluger, M. T., Laidlaw, T. M., Kruger, N., Harrison, M. J. Personality traits of anaesthetists and physicians: An evaluation using the Cloninger Temperament and Character Inventory (TCI-125), Anaesthesia. 1999, 54, 926-35.
https://doi.org/10.1046./j.1365-2044.19999.01112. |
[118]
; reward dependence (dependence on approval of others; not influenced by others; needs to please) were higher in: nurses than doctors
. This may relate to the interplay between extrinsic and intrinsic factors as well as an external or internal locus of control. Furthermore, the categories of, persistence (industriousness of behaviour despite obstacles; quitting and pragmatic; ambitious and industrious) were higher in GPs
; and high in nurses
| [116] | Eley, D., Eley, R., Young, L., Rogers-Clark, C. Exploring temperament and character traits in nurses and nursing students in a large regional area of Australia. J Clin Nurs. 2011, 20, 563-70. https://doi.org/10.1111/j.1365-2702.2009.03122.x |
[116]
; self-directedness (responsibility; goal orientation and self-confidence; purposeless and ineffective; purposeful and reliable) were higher in rural doctors and nurses; and doctors than nurses
; cooperativeness (tolerance; cooperativeness and empathy; critical and unhelpful; empathic and compassionate) were higher in rural-intention medical students
; self-transcendence (view of self in relation to the universe as a whole; materialistic and practical; humble and spiritual) were lower in rural GPs
; in addition to physicians and anaesthetists than in the normal population
| [118] | Kluger, M. T., Laidlaw, T. M., Kruger, N., Harrison, M. J. Personality traits of anaesthetists and physicians: An evaluation using the Cloninger Temperament and Character Inventory (TCI-125), Anaesthesia. 1999, 54, 926-35.
https://doi.org/10.1046./j.1365-2044.19999.01112. |
[118]
.
3.2. Negative Personality Traits (Including Dark Triad, Pathological Traits)
The comorbidity of anxiety and depression is consistent with previous global research. Specifically, 41.6% of individuals with severe depression in a 12-month period also experienced one or more anxiety disorders during the same timeframe
.
An exploration into non-positive personality traits of HCPs, Specialized HCPs, First Responders, and AHPs, is described henceforth.
3.2.1. HCPs
Medical professionals (who) responded to the Revised Eysenck Personality Questionnaire (EPQ-R)
| [10] | Eysenck, H. J. and Eysenck, S. B. G. The manual of Eysenck Personality Questionnaire. London: Hodder and Stoughton. 1975. |
[10]
and Mental Health Checklist (MH)
| [11] | Matthew, P. and Ram, U. Anger in relation to gender, religion and marital status. Indian Journal of Applied Psychology. 1999, 36, 10-13. |
[11]
. The findings were that individuals scoring higher on
Neuroticism and
Psychoticism has poor mental health status and individuals with extraversion maintains good mental health status. Specifically, there was a negative relationship between mental health and
Psychoticism and
Neuroticism with a positive relationship between mental health and extraversion
| [59] | Bhupender, S. Personality and mental health of medical professionals. Int Res. J. Social Sci. Dec 2014, 3(12), 23-27. ISCA: International Science Community Association| https://isca.in |
[59]
. Support for this result comprise the positive relationship between
Neuroticism and
Psychoticism scales, with social maladjustment and poor mental health
.
The study of medical professionals highlighted the need: (1) To investigate the intricate interplay between work environment, doctor-patient relationships, media influence, and self reported mental and physical health among Chinese healthcare professionals; and (2) to identify key leverage points for interventions that can effectively support the health and well-being of medical staff, thereby improving patient care quality and the sustainability of healthcare systems. By adopting a network analysis approach, this study aims to provide a more comprehensive and nuanced understanding of the interconnected factors shaping the well-being of medical staff
.
A study of job stress and working conditions on mental health problems among junior house officers found that job stress is related to mental health problems among young doctors, even when the variables of previous mental health problems and personality traits are controlled. More support during internship is needed
.
3.2.2. Specialised HCPs
A comparison of characteristics involving emergency physicians (including paramedics) and non-emergency physicians which concluded that paramedics had greater control and presented with less nerves than medical students. Although, 30–40% of paramedics questioned were found to have personality traits of emotional instability associated with mental illness such as anxiety and feelings of excessive demand
| [74] | Pajonk, F-G., Andresen, B., Schneider-Axmann, T., Teichmann, A., Gärtner, U., Lubda, J., Moecke, H., von Knobelsdorff, G. Personality traits of emergency physicians and paramedics. Emerg Med J. 2011, 28(2), 141-6.
https://doi.org/10.1136/emj.2009.083311 |
[74]
.
There is evidence to indicate that there is stigma around discussing professionals own mental health concerns within the healthcare settings
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
. However, in the emergency and critical care environment their appears to be some levels of trust as indicated by yielded low scores (<3) for vigilance. This relates to the extent to which people will be wary of and mistrust others
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
.
Nurses in intensive care units, for example, reported feeling distressed when they could not provide optimal care, reflect on difficult incidents, or distance themselves from stressful situations
| [112] | Siffleet, J., Williams, A. M., Rapley, P., Slayter, S. Delivering best care and maintaining emotional wellbeing in the intensive care unit: The perspective of experienced nurses. Appl. Nurs. Res. 2015, 28(4), 305-310
https://doi.org/10.10016/j.apnr.2015.02.008 |
[112]
.
Examination of medical professional’s mental health encompassed anxiety, obsessive–compulsive, and depressive symptoms, physical health in regards to physical fatigue, work environment from hospital level, average daily working hours, night shift frequency, working pressure, job satisfaction, income-efforts relationship, salary system alignment, title evaluation criteria, medical practice environment, to title promotion fairness. The doctor-patient relationship: doctor-patient trust, verbal insult, and physical conflict; and media influence: media shaping positive image, media biasing towards patients
, were concomitantly assessed.
The results indicated that the key category of work environment correlated mental and physical health, doctor-patient relationships, and media influence, components
.
To extrapolate, the three manifesto nodes: anxiety, obsessive–compulsive symptoms, and depressive symptoms yielded significant positive connections
.
Comparably, the PO medical specialties of paediatrics, psychiatry and obstetrics–gynaecology scored more highly on traits of Nurturance, Intimacy and Autonomy than radiology, pathology and ophthalmology, which had high ratings for Dominance, Order and
Narcissism and low ratings for Autonomy and Dependency
.
Healthcare crimes (homicides, and intended homicides) are perpetrated by a wide range of
HCPs, including physicians, nurses, and Allied Healthcare workers. Among the most sinister motivations are the altruistic desire to end the suffering of severely ill patients-concealing narcissistic-omnipotent tendencies or pathological insecurity- or even pursuit of pure sadistic gratification
| [81] | Visi, G., Spina, F., Del Duca, F., Maiese, A., Morena, D., Papi, L., Turillazzi, E., Fineschi, V. Forensic aspects of healthcare-related murders: a series of homicides and attempted homicides committed by nurses in Italy. J Forensic Leg Med. 2025 Oct, 115, 102939. https://doi.org/10.1016/j.jflm.2025.102939 Epub 2025 Jul 31. |
[81]
. It is noted that, in contrast to nurses, physicians may less frequently experience moral distress, most likely because physicians are responsible for making the patient care decisions
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
.
Regarding forensic mental healthcare, participants commented about dismissal of their ambitions (e.g. pursuing academic career), alongside overt expressions that there was no solution for them. Interviewees further reported dismissive behavior from professionals in forensic mental healthcare, showing a lack of engagement, empathy, or responsiveness to their needs, while others (professionals) ignored them entirely. Participants further described instances where professionals perceived or treated them as dangerous. In forensic mental healthcare, this concerned observations of caution and fear shown by new but also experienced professionals. This theme encompasses three subthemes: differential treatment and restrictions, dismissive reactions and avoidance, and intrusive behaviors and threats
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
.
3.2.3. First Responders
Paramedic personality profiles were also seen to have a direct link to mental illness and ability to cope in challenges which are commonly faced in the paramedic profession
| [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
.
Neuroticism was the key finding in paramedic personnel. It was further supported that, paramedics and emergency physicians whom experienced loss or identified mental health problems had an increase in the subscales of
Neuroticism | [74] | Pajonk, F-G., Andresen, B., Schneider-Axmann, T., Teichmann, A., Gärtner, U., Lubda, J., Moecke, H., von Knobelsdorff, G. Personality traits of emergency physicians and paramedics. Emerg Med J. 2011, 28(2), 141-6.
https://doi.org/10.1136/emj.2009.083311 |
[74]
. There is a significant correlation of
Neuroticism as a predictor of poor job satisfaction and increased health complaints and outcomes
| [77] | Sterud T, Hem E, Lau B, Ekeberg Ø. A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel. J Occup Med Toxicol. 2011, 6: 1–9 https://doi.org/10.1186/1745-6673-6-10 |
[77]
.
Additionally, POS (Perceived Organisational Support) was significantly correlated with eight of the 11 dark personality traits
Excitability, Sceptical, Cautious, Reserved, Leisurely, Mischievous, Diligent and Dutiful. It was found that emotionally volatile (excitable), distrusting (sceptical), emotionally aloof (reserved) and passive aggressive (leisurely) personalities were likely to have lower perceptions of organisational support
| [46] | Treglown L, Zivkov K, Zarola A, Furnham A. Intention to quit and the role of dark personality and perceived organizational support: A moderation and mediation model. PloS One. 2018, 13(3), 1-13: e0195155.
https://doi.org/10.1371/journal.pone.0195155 |
[46]
.
Notably, the prevalence of mental illness can also be seen to have relevance in the world of other emergency service workers such as firefighters and law enforcement
| [96] | Adibi, A., Golitaleb, M., Farrahi-Ashtiani, I., Pirani, D., Yousefi, K., Jamshidbeigi, Y., Sahebi, A. The prevalence of generalized anxiety disorder among healthcare workers during COVID-19 pandemic: A systematic review and meta-analysis. Frontiers in Psychiatry. 2021, 12, 658846. |
| [97] | Price, M. Psychiatric disability in law enforcement officers. Behav Sci law. 2017, 35(2), 113–23.
https://doi.org/10.1002/bsl.2278 |
[96, 97]
.
Neuroticism in police had a statistically significant association (p < 0.05) with psychological stress. The trait of
Neuroticism was correlated with distraction, disengagement, denial and blame and illustrates police personnel whom identify as neurotic are more prone to burnout and stress when faced with challenging tasks
| [79] | Kaur, R., Chodagiri, V. K., Reddi, N. K. A psychological study of stress, personality and coping in police personnel. Indian J Psychol Med. 2013, 35(2), 141-7 https://doi.org/10.4103/0253-7176 |
[79]
. It was also recognized that there is a positive correlation within the police force between burnout and
Dark Triad personality traits, namely
Narcissism,
Machiavellianism, and
Psychopathy | [78] | Papazoglou, K., Koskelainen, M. and Stuewe, N. Examining the relationship between personality traits, compassion satisfaction, and compassion fatigue among police officers. Sage Open. 2019, 9(1),
https://doi.org/10.1177/2158244018825190 |
[78]
.
This has a wide range of implications as, it is increasingly popular to combine police and fire departments into one department of public safety, under which employees must perform the duties of both a police officer and a firefighter
| [110] | Aamodt, M., Kimbrough, W. Personality differences between police and fire applicants. Journal of Police and Criminal Psychology. 1985, 1, 10–13.
https://doi.org/10.1007/BF02809195 |
[110]
.
3.2.4. Allied HPs
With reference to PO (Person Oriented) and TO (Technique Oriented)
AHPs, the following was determined. In relation to the PO group were higher in levels of Reward (person oriented health, and allied health, professions) Dependence, Self-Directedness, Cooperativeness and Self-Transcendence compared with the TO group
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
For instance, medical laboratory scientists seemed to have a preference for working alone on highly controlled and predictable tasks
| [102] | Dominelli, A., Wheeler, M. E. The personality traits of medical technologists: Implications for recruitment and retention. J. Allied Health. 2006, 35, e316-42. |
[102]
.
PO (and TO) workers’ mental health concerns; professional confidence; professional capacity; and, cross-referential stigmatization is examined below:
Confidence in research skills, and application of these in general, rated more poorly- when compared to professions such as medical physicists and psychologists
.
A study examined the occurrence of stress, anxiety, depression, and perfectionism amongst graduate students in health science programs and concluded that students in these programs have a higher level of mental illness when compared to populations not enrolled in these programs
| [80] | Bogardus, J., Armstrong, E. S., VanOss, T., Brown, D. J. Stress, anxiety, depression, and perfectionism among graduate students in health sciences programs. J Allied Health. 2022, 51(1), 15E-25E. |
[80]
.
A qualitative study involved exploration of factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries
| [63] | Keeves, J., Braaf, S. C., Ekegren, C. L., Beck, B., Gabbe, B. J. Access to healthcare following serious injury: Perspectives of allied health professionals in urban and regional settings. Int. J. Environ. Res. Public Health. 2021, 18, 1230. |
[63]
. There were a number of challenges in providing optimal care to patients across regional and urban areas
| [64] | Keeves, J., Braaf, S. C., Ekegren, C. L., Beck, B., Gabbe, B. J. Caring for people with serious injuries in urban and regional communities: A qualitative investigation of healthcare providers’ perceptions. Disabil. Rehabil. 2020, 1-9.
https://doi.org/10.1080/09638288.2020.1728787 |
[64]
. It was found that the management of people with serious injuries in the community is complex and often requires a wide variety of allied health professionals (
AHPs) to aid rehabilitation and community reintegration
| [111] | Khan, F., Amatya, B., Hoffman, K. Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. BJS. 2012, 99, 88-96. https://doi.org/10.1002/bjs.7776 |
[111]
. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare
| [63] | Keeves, J., Braaf, S. C., Ekegren, C. L., Beck, B., Gabbe, B. J. Access to healthcare following serious injury: Perspectives of allied health professionals in urban and regional settings. Int. J. Environ. Res. Public Health. 2021, 18, 1230. |
[63]
. Indeed, deleterious affects upon the
AHPs’ own mental health and wellbeing is proposed to occur as a result.
In relation to forensic
AHPs and effects upon consumer stigmatization, perceived dangerousness seemed reflected in instances where professionals labeled forensic service users as “dangerous,” expressed fear, or increased medication dosages to mitigate potential risk
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
.
3.2.5. HCPs, AHPs and First Responders
Dark Triad personality traits are:
Machiavellianism;
Narcissism; and,
Psychopathy. These dark traits seem to have a common core expressed as uncooperativeness upon use of the Short
Dark Triad and the Short Character Inventory to assess a wide range of individuals
.
There appeared to be a clear and unique association between Machiavellian tendencies and low levels of self-acceptance, sense of autonomy and responsibility, self-control, and self-actualization (i.e., low self-directedness), and also low tolerance towards others, unhelpfulness, and low levels of empathy (i.e., low cooperativeness). This suggests that
Narcissism in its pure form is associated with unhelpfulness, low tolerance towards others, and low empathy
.
Those who expressed high levels of
Psychopathy also expressed low self-directedness and low Cooperativeness
.
Thus, an individual who is high in the three dark traits might be goal-directed and unempathic (i.e., high self-directedness and low cooperativeness). At the same time she/he might have a sense of being in connection with something divine or universal (i.e., high self-transcendence).
Machiavellianism or
Psychopathy can be defined as manipulative, individuals who score high on
Machiavellianism are more likely to use strategic planning in their manipulations, whereas individuals high on
Psychopathy crave quick gratification and have problems with impulse control when they manipulate others. Individuals high in
Machiavellianism and
Psychopathy also score low in self-discipline, lack sense of duty, and have difficulties to control, regulate, and direct their impulses (i.e., low levels of the Big Five trait of conscientiousness)
.
In other words, the ``maleficent'' dark profile (i.e., MNP) seems to correspond to a ``fanatical'' light character profile (i.e., ScT) individuals with a ``fanatical'' profile can be characterized as independent and paranoid, and being projective of blame
| [82] | Cloninger, C. R., Bayon, C., Svrakic, D. M. Measurement of temperament and character in mood disorders: a model of fundamental states as personality types. Journal of Affective Disorders. 1998, 51, 21-32. https://doi.org/10.1016/S0165-0327(98).00153-0 |
[82]
.
In fact, everyday sadism has been suggested
as a fourth component, making the triad into a tetrad. It is plausible that future studies might find that enjoyment of cruelty against other human beings and animals is uniquely associated to the inability of transcend the self and feel part of the whole universe
.
Another relevant study proposed an operational flowchart to help stakeholders identify potential red flags and recognize dangerous situations
| [81] | Visi, G., Spina, F., Del Duca, F., Maiese, A., Morena, D., Papi, L., Turillazzi, E., Fineschi, V. Forensic aspects of healthcare-related murders: a series of homicides and attempted homicides committed by nurses in Italy. J Forensic Leg Med. 2025 Oct, 115, 102939. https://doi.org/10.1016/j.jflm.2025.102939 Epub 2025 Jul 31. |
[81]
, and dovetails with a risk management approach to perilous traits in
HCPs,
AHPs, and
First Responders | [31] | McKenzie, M. C. The importance of incorporating risk management and assessing for perilous traits during job recruitment interviews, performance appraisals, and post-critical incidents. American Journal of Management. 2025, 25(3), 138-145.
https://doi.org/10.33423/ajm.v25i3.7804 |
[31]
.
4. Discussion
4.1. Link with Client and Patient Safety
Healthcare professionals play a crucial role in healthcare systems, but their demanding work significantly impacts their mental and physical health, affecting patient care
.
While much of the early drive toward incorporating evidence into clinical practice occurred in medicine (evidence- based medicine approach), this concept now extends to allied health and social care professions
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
.
Healthcare professionals'
psychological well-being is closely linked to the quality of patient care, yet significant challenges remain in defining and addressing these issues. Future research should incorporate patient perspectives and explore interventions to support healthcare workers' mental health. Organizations must foster a culture that prioritizes well-being to improve patient outcomes and workforce sustainability
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
.
Psychological wellbeing is related directly to the concept of psychological safety. Though a homogenized definition has not been determined in research circles, the following definition is proposed. Psychological safety is defined as a shared belief held by members of the team that the team is safe for interpersonal risk taking
. This can manifest in many ways, including speaking up to prevent error or proposing new ideas without fear of negative personal repercussions
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
. In the healthcare environment this can contribute to quality of care (through the development of new care pathways and policies) and
Patient safety (through minimising error and near misses)
| [35] | Nembhard, I. M. and Edmondson, A. C. Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in healthcare teams. Journal of Organizational Behavior. 2006, 27(7), 941-66 https://doi.org/10.1002/job.413 |
[35]
. The absence of a standardized definition makes it challenging to establish a common starting point for research, further complicating efforts to measure
psychological wellbeing-only four measures were specifically designed to assess wellbeing; others targeted related concepts such as work-life balance, job satisfaction, resilience, stress, and anxiety
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
.
Practicing while impaired can have detrimental impacts on patient care, such as resulting in failure to appropriately diagnose or treat individuals under their care; in addition to the detriment to the individuals health, wellbeing, and quality of life that would accompany untreated illness
| [22] | Edwards, J. L., Crisp, D. A. Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology. 2017, 69(3), 218-225. |
[22]
. Accurate and efficient clinical decision-making is effected, and can create conditions where serious medical error, critical incidents, and never events, may occur.
Conflicts between individual values and those of the organization were shown to negatively impact wellbeing. Nurses in one study felt that their organization’s focus on resource management and targets compromised patient-centered care, which they valued
| [75] | Dunning, A., Louch, G., Grange, A., Spilsbury, K., Johnson, J. Exploring nurses’ experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: A qualitative study. J. Res. Nurs. 2021, 26(1-2), 135-146. https://doi.org/10.1177/1744987120976172 |
[75]
. This is particularly pertinent to
KPIs (Key Performance Indicators) and
DRGs (Diagnosis Related Groups- used to determine treatment options) within
Healthcare, Allied Healthcare, and
First Responder, work environments. An intended (but often compromised)
‘do no harm’ approach, indeed.
A study investigated nurses’, doctors’, practice psychologists’, and non-registered healthcare assistants’ in relation to
psychological wellbeing. The findings highlighted five key themes: (1) defining psychological well-being in healthcare professionals, (2) the impact of healthcare work on mental health, (3) organizational influences on well-being, (4) effects of the COVID-19 pandemic, and (5) the relationship between staff well-being and patient care experiences
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
.
Alternatively, high workload was ranked most frequently as being perceived to be the most stressful element of being in a clinical environment, with
‘patient expectation’ most frequently being ranked the least stressful aspect
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
. High workload ranked as most stressful more frequently in critical care staff than by those in the emergency department
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
. Ultimately, it is a question of reasonable expectations of compassion as well as resiliency in clinical (and First Responder) milieux.
Examples of
perceived inappropriate care include: 1) differences in the amount of care given and the expected prognosis (either too much or too little care), 2) caring for patients who are persistently noncompliant, 3) holding the belief that other patients would benefit more from ICU care, 4) delivering inaccurate information to a patient or family, 5) not respecting the expressed wishes of a patient, and 6) delivering medical or nursing care believed to be of inadequate quality
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
. It is vitally important to reduce the negative effects (including near misses through to serious medical errors resulting in permanent disability or death) of haphazard planning and vulnerabilities within healthcare environments. There are two key factors at play: (1) visible leaders who uphold the culture, and (2) longstanding teams with psychological safety
| [89] | Murray JS, Clifford J, Larson S., Lee, J. K., Sculli, G. L. Implementing just culture to improve Patient safety. Mil Med. 2022, 118(7-8) 1596–1599.
https://doi.org/10.1093/milmed/usac115 |
| [90] | van Marum, S., Verhoeven, D., Rooy, D. The barriers and enhancers to trust in a just culture in hospital settings: a systematic review. JPS. 2022, 18, e1067–e1075.
https://doi.org/10.1097/PTS.0000000000001012 |
[89, 90]
. So too, addressing the clear gaps in research involving the patient’s perspective regarding poor quality of care; risk factors sighted within hospital and other healthcare (allied healthcare). environments; dereliction of duty; suboptimal performance; and unprofessional (psychologically or emotionally effected)
Healthcare, Allied Healthcare, and related
First Responders’ behaviors. Two recurring themes were identified (as affecting psychological safety in healthcare environments): (1) The predominantly hierarchical culture of medicine is a barrier to speaking up and (2) Institutional, interpersonal and individual factors can modulate the impact of medicine’s hierarchical culture on speaking up behaviours and inform the strategies employed. Furthermore, an individual’s personality traits can affect their perception of psychological safety
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
In relation to
First Responders, a Tophus case scenario provides extrapolation of
derogation of duty with
life-threatening consequences:
Wilma, a paramedic exhibiting comparable attitudinal characteristics to those in the Shäpé scenario
| [41] | Mary Catherine McKenzie. Advanced thinking on Trauma: Victims of Crime in the Mental Health Context. Peercite J Ment Health. 2024, 2(S): 606-612.
https://doi.org/10.61641/pjmh.2024 |
[41]
, responds to the residence of an 80+ year old female for
emergency hospital transport. The patient exhibits signs of a swiftly escalating
systemic infection. A discussion lasting over thirty minutes occurs with the legally binding caregiver. The caregiver implores for the urgent transfer of the patient to emergency medical facilities. The paramedic subsequently interrogates the now delirious patient, who fervently insists on immediate hospitalization due to infection. The paramedic advises the caregiver that it is
preferable for the patient to pass away in her bed at home. Notwithstanding the aforementioned (the duration since the initial phone contact for an ambulance
exceeds one and a half hours), the paramedic persists in resistance until the caregiver presents
enduring guardianship and associated documentation. Wilma's paramedic partner promptly summons a second ambulance. The patient is conveyed to the nearest hospital. Prior to the ambulance departing from the patient's residential street, the
patient commences complete interaction. Upon her arrival at the hospital emergency room before admission, she
is seated and conversing on the stretcher. The patient receives treatment and
survives | [41] | Mary Catherine McKenzie. Advanced thinking on Trauma: Victims of Crime in the Mental Health Context. Peercite J Ment Health. 2024, 2(S): 606-612.
https://doi.org/10.61641/pjmh.2024 |
[41]
.
Quality healthcare provision and professional standards require AH professionals to be both technically competent and to apply well-developed relationship skills, such as communication, in their specific work context
| [39] | Lin, I. B., Beattie, N., Spitz, S., Ellis, A. Developing competencies for remote and rural senior allied health professionals in Western Australia. Rural Remote Health. 2009, 9(2), 1115. https://doi.org/10.22605/RRH1115 |
[39]
.
Specialization, and
Patient safety, regarding stigma toward Forensic MH Service users requires re-iteration of that, there were three pertinent subthemes discovered: recovery pessimism and dismissal of ambitions, perceived dangerousness and fear, and devaluation through offenses. Furthermore, upon breaking down the category of stigma, two subthemes were determined: ambiguity in detecting stigma, and anticipated stigma. It highlights forensic service users’ difficulty in determining whether they are being stigmatized, as it may be subtly or indirectly, or anticipated. Participants described instances where it was difficult to discern whether professionals’ behaviors or attitudes were stigmatizing, as they could be interpreted as jokes, COVID-19 security measures, or unprofessional behavior
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
.
Thus, professional stigma refers not only to overt discrimination but also to subtle interactions and the meanings attributed to them by service users
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
. Given the negative impact of professional stigma on treatment and rehabilitation, developing a tailored instrument to assess mental healthcare professionals’ attitudes toward forensic service users is essential. This instrument could be used to identify and quantify stigmatizing biases, increase awareness on their relevance, provide insights for the development of targeted interventions to address them and assess their effectiveness
| [21] | Vorstenbosch, E., Escuder-Romeva, G., Haro, J. P., Bulten, E. Conceptualizing professional stigma toward forensic mental health service users: Results of a qualitative inquiry. Int. J. Forensic Mental Health. 2025, 24(4), 324-335. |
[21]
.
The overriding principle of Evidence Based Practice must be explored in order to explain the interdependence with
psychological wellbeing, psychological safety, authentic clinical decision-making,
Patient safety, and quality of healthcare. Failure to adhere to these fundamental principles can readily result in the emergence of a crime victim
| [41] | Mary Catherine McKenzie. Advanced thinking on Trauma: Victims of Crime in the Mental Health Context. Peercite J Ment Health. 2024, 2(S): 606-612.
https://doi.org/10.61641/pjmh.2024 |
[41]
.
Evidence Based Practice (EBP) is understood to involve: ask, acquire, appraise, apply and analyse/adjust, are seen as the key skills required for life-long learning for professional decision-making
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
.
A study prospectively explored the influence on EBP profiles of the primary variables of prior exposure to EBP training, stage of professional training (undergraduate years, post-graduate) and professional allied health disciplines (physiotherapy, occupational therapy, podiatry, medical radiation, human movement) with age and gender explored as secondary variables
. In fact, the attitudes and behaviours of individual staff toward evidence-based practice is likely to be highly variable in terms of empathy, approval and understanding of EBP. This again takes us back to the question: “Is EBP taught or caught?” For Confidence, Practice and Sympathy it appears that both may contribute
.
Interprofessional Collaboration (
IPC) is fundamentally scrutinized as part of an essential, supportive measure for
HCPs,
AHPs,
First Responders, and patients/clients alike. Based on the Bronstein model
| [92] | San Martin Rodriguez, L., Beaulieu, M. D., D’Amour, D., Ferrada-Videla, M. The determinants of successful collaboration: A review of theoretical and empirical studies. J Interprof Care. 2005, 19 (Suppl.1), 132-147
https://doi.org/10.1080/13561820500082677 |
| [93] | Mulvale, G., Embrett, M., Razari, S. D. “Gearing Up” to improve interprofessional collaboration in primary care: A systematic review and conceptual framework. BMC Fam Pract. 2016, 17, 83. https://doi.org/10.1186/s12875-016-0492-1 |
| [94] | Bronstein, L. R. A model for interdisciplinary collaboration. Soc Work. 2003, 48, 297-306
https://doi.org/10.1093/sw/48.3.297 |
[92-94]
independent variables related to IPC may be classified into four conceptual blocks: Individual characteristics (e.g. sociodemographic variables), Interactional variables [related to interpersonal relationships]., Structural variables (related to the organization) and Professional role characteristics (related to professional practice).
As part of IPC- in the mental health (MH) field- interdisciplinary MH teams typically include psychiatrists, nurses, psychologists, social workers, psycho-educators and administrative support professionals
| [99] | Fleury, M. J., Grenier, G. Vallee, C., Aubé, D., Farand, L. Implementation of integrated service networks under the Quebec mental health reform: facilitators and barriers associated with different territorial profiles. Int J Integr Care. 2017, 17(1), 3.
https://doi.org/10.5334/ijic.2482 |
[99]
.
Organizational support, participation in decision-making, knowledge sharing, knowledge integration, mutual trust, affective commitment toward the team, professional diversity and belief in the benefits of interdisciplinary collaboration were features associated with profiles where perceived interprofessional collaboration was higher. These team qualities should be strongly encouraged by mental health managers for improving interprofessional collaboration. Training is also needed to promote improvement in interprofessional collaboration
| [26] | Keba Kebe, N. N. M., Chiocchio, F., Bamvita, J-M., Fleury, M-J. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Medicine. 2019, 7, 1-10.
https://doi.org/10.1177/2050312119841467 |
[26]
. It is argued, that IPC interplays with best practice principles (and human factors) to enhance, monitor, and support, the clinical (and related) workers professional functionality.
Burnout syndrome (
BOS) has become a common worldwide phenomenon, especially among members of high-stress professions: firefighters, police officers, teachers, and all types of healthcare professionals
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
. The decline in the psychological well-being of healthcare workers is evident worldwide
| [119] | Sovold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., Münter, L. Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority. Front. Public health. 2021, 9.
https://doi.org/10.3389/fpubh.2021.679397 |
[119]
, highlighting the gravity of risk to a full range of health systems.
Clinical, and first response, stressors can be multi-fold, and often borne of collegiate
conflict, emotional volatility, harassment and/or
bullying; extremes in workload; and
fear of critical incidents leading to
medical malpractice. Intimidation, harassment (often stealthy in nature), and
workplace bullying in
HCPs,
AHPs, and
First Responder, environments is explicated as- to create a feeling of foreboding, fearfulness, and terror, in a healthcare (or other), worker (which) paralyses, shocks, and overwhelms. When it moves to the physical, compliance is usually the reaction. However, inaction and surrender, usually exacerbates the bully further
.
First described in the 1970s, BOS is a work-related constellation of symptoms and signs that usually occurs in individuals with no history of psychological or psychiatric disorders
| [42] | Maslach, C., Leiter, M. P. (1997). The truth about burnout. San Francisco, CA: Josset-Bass Publishers; 1997. |
[42]
. Eventually, the three classic symptoms of BOS develop: exhaustion, depersonalization, and reduced personal accomplishment
| [28] | Maslach, C., Jackson, S. E. MBI: Maslach Burnout Inventory: Manual Research Edition. Palo Alto, CA: Consulting Psychologists Press; 1986. |
[28]
. Specific personality traits which were associated with BOS are idealism, perfectionism, and overcommitment
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
, along with neurotic personality traits.
BOS is rife within paramedic communities. The demanding nature of the profession underscores the importance of understanding factors influencing their well-being, mental health, resilience, job satisfaction and susceptibility to burnout. The challenging environments faced by paramedics make them vulnerable to factors such as burnout, post-traumatic stress disorder and ongoing mental health challenges
| [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
. Within acceptable limits, stress plays a pivotal role in producing vigilance and determination in the individual however can turn to a state of distress and thus burnout particularly pertinent within the paramedic cohort
. As well as, prolonged sick leave and declining mental health among clinicians
. Three themes emerged relevant to the objective including the correlation of
Neuroticism with stress and burnout, personality types and mental illness with the ability to cope during stressful situations and finally resilience and burnout with the intention to quit
| [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
. Additionally, the association of
Neuroticism with stress and burnout, the influence of personality types on mental illness including the ability to conquer stressful situations and the short/long term implications of this and lastly, the significance of resilience with burnout and the intention to quit
| [46] | Treglown L, Zivkov K, Zarola A, Furnham A. Intention to quit and the role of dark personality and perceived organizational support: A moderation and mediation model. PloS One. 2018, 13(3), 1-13: e0195155.
https://doi.org/10.1371/journal.pone.0195155 |
[46]
.
After a
medical error, physicians may experience significant job-related stress, including anxiety about future errors, loss of confidence, sleeping difficulties, reduced job satisfaction, and perceived harm to their reputation
| [40] | Waterman, A. D., Garbutt, J., Hazel, E., Dunagan, W. C., Levinson, W., Fraser, V. J., Gallagher, T. H. The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf. 2007, 33, 467-476. https://doi.org/10.1016/s1553-7250(07)33050-x |
[40]
. This can easily lead to Burnout (BOS), or in the case of
Secondary Traumatic Stress (STS), or
Second Victim Syndrome (SVS) or
Posttraumatic Stress Disorder (PTSD).
Second Victim Syndrome symptoms are the result of a traumatic patient care event in the healthcare setting. These events can include
near misses, patient adverse events, deaths, or
provider mistakes but really encompass any event that leads to significant mental stress on the part of the provider (otherwise known as the "second victim")
. Issues with alcohol, medications, or substance use
| [123] | Alozai Uu, Sharma S. Drug and Alcohol Use (Archived) (Updated 2023 Jul 21). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK513263/ |
[123]
, among other issues, comprise differential diagnosis of SVS.
BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other healthcare professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care healthcare professionals remained relatively unrecognized
| [128] | Teixeira, C., Ribeiro, O., Fonseca, A. M., Carvalo, A. S. Ethical decision making in intensive care units: A burnout risk factor? Results from a multicentre study conducted with physicians and nurses. J Med Ethics. 2014, 40, 97-103.
https://doi.org/10.1136/medethics-2012-100619 |
[128]
. Burnout syndrome (BOS) occurs in all types of healthcare professionals and is especially common in individuals who care for critically ill patients
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
.
The “Boorman Report” was pivotal in stressing the link between the well-being of healthcare professionals and patient outcomes. It found that NHS Trusts with lower levels of sickness absence, turnover, and agency costs tended to achieve better patient satisfaction, higher quality care, more efficient resource use, and lower infection rates
.
In addition to anxiety and depression in clinicians (and front-line workers) cynicism-depersonalization and emotional exhaustion symptoms typify clinical presentation. Personality characteristics which may be evident, include: tension or apprehension upon complex (and even basic) task completion; disinterest (e.g. in patients); feeling overwhelmed and/or hypercritical; making frequent errors (real and/or imagined); inability to deal with problems; poor resiliency; difficulty in persevering; negligence-based concrete thinking; enduring feelings of failure, minimal self-confidence, and negative self-assessment.
Among physicians, those at the front line of care (family medicine, emergency medicine, and general internal medicine) report the highest rates of BOS (i.e. > 40%)
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
.
It was noted that general practitioners’ burnout was associated with a decrease in their ability to show empathy, listen to patients, and make appropriate referrals, which in turn affected the quality of patient care
| [49] | Hall, L. H., Johnson, J., Heyhoe, J., Watt, I., Anderson, K. and O’Connor, D. B. Exploring the impact of primary care physician burnout and well-being on patient care: A focus group study. J Patient Saf. 2020, 16(4), e278-e283.
https://doi.org/10.1097/PTS.000000000000438 |
[49]
.
The media’s focus on sensationalized stories and worstcase scenarios contributes to fear and anxiety among healthcare workers, who worry about potential public backlash or personal harm. The blurring of personal and professional boundaries through social media creates challenges for healthcare workers, who feel pressure to maintain a certain image online while grappling with the emotional toll of their work. The constant barrage of information and opinion can be overwhelming, making it difficult for healthcare professionals to disconnect from work-related stress and maintain a healthy perspective
.
BOS also results in decreased effectiveness and poor work performance, which have a direct impact on patient care. BOS in nurses is associated with reduced quality of care, lower patient satisfaction, increased number of medical errors, higher rates of healthcare-associated infections, and higher 30-day mortality rates
| [43] | Cimiotti, J. P., Aiken, L. H., Sloane, D. M., Wu, E. S. (2012). Nurse staffing, burnout, and healthcare-associated infection. Am J Infect Control. 2012, 40, 486-490.
https://doi.org/10.1016/j.ajic.2012.02.029 |
| [44] | Poghosyan, L., Clarke, S. P., Finlayson, M., Aiken, L. H. Nurse burnout and quality of care: cross-national investigation in six countries. Res Nurs Health. 2010, 33, 288-298
https://doi.org/10.1002/nur.20383 |
[43, 44]
. In critical care nurses, the most common symptom of BOS is emotional exhaustion (73%), followed by a lack of personal accomplishment (60%), and depersonalization (48%)
| [50] | Mealer, M., Burnham, E. L., Goode, C. J., Rothbaum, B., Moss, M. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety. 2009, 26, 1118-1126. https://doi.org/10.1002/da.20631 |
[50]
.
PTSD (Posttraumatic Stress Disorder) is manifest by intrusion, avoidance, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
. Diagnostic components of PTSD includes exposure to actual or threatened death, serious injury, or sexual violence
. In addition to first-hand experiencing of the event, diagnosis is made by: witnessing, in person, the event[s]. as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend (violent or accidental); (and/or) repeated or extreme exposure to aversive details of the traumatic event(s) (e.g.
First Responders collecting human remains; police officers repeatedly exposed to details of child abuse)
.
The five-factor model of openness to experience, conscientiousness, extraversion, agreeableness, and
Neuroticism | [55] | Vaulerin, J., Colson, S. S., Emile, M., Scoffier-Mérriaux, S. and d’Arripe-Longueville, F. The big five personality traits and French firefighter burnout. J Occup Environ Med. 2016, 58(4), e128-32. https://doi.org/10.1097/JOM.0000000000000679 |
[55]
, is considered comparable in identifying personality traits and their interplay with potential, and actual, development of PTSD symptoms.
A systematic review comparing PTSD symptoms within police, firefighters, ambulance personnel and psychiatric nurses concluded that the prevalence of PTSD amongst these workforces ranged from 8–22%
| [54] | Soravia, K. M., Schwab, S., Walther, S., Müller. T. (2021). Rescuers at risk: Posttraumatic stress symptoms among police officers, fire fighters, ambulance personnel, emergency and psychiatric nurses. Front Psychiatry 2021, 11, 602064.
https://doi.org/10.3389/fpsyt.2020.602064 |
[54]
.
A study explored characteristics of PTSD among emergency medical clinicians and highlights a higher prevalence of PTSD in clinicians who possess perfectionism personality characteristics and those who are deeply affected by stress and guilt
| [51] | Hsiao, Y. Y., Chan, W. H., Ma, I. C., Wu, C-L., Chen, P. S., Yang, Y. K, Lin, C-H. Long-term PTSD risks in emergency medical technicians who responded to the 2016 taiwan earthquake: A six-month observational follow-up study. Int J Environ Res Public Health. 2019, 16(24), 4983.
https://doi.org/10.3390/ijerph16244983 |
[51]
.
Research regarding fire-fighters routinely being exposed to potentially traumatic events was innovated. Their study examining the relationship between trauma exposure with PTSD and other forms of mental illness found an 8% occurrence of PTSD that is increasing in a linear fashion
| [52] | Harvey, S. B., Milligan-Saville, J. S., Paterson, H. M., Harkness, E. I., Marsh, A. M., Dobson, M,. Kemp, R., Bryant, R. A. The mental health of firefighters: An examination of the impact of repeated trauma exposure. Aust NZ J Psychiatry. 2016, 50(7), 649-58.
https://doi.org/10.1177/0004867415615217 |
[52]
. It was further determined that, obsessive perfectionism can cause increased stress and compulsive behaviours in firefighters
| [53] | Oliveira, J., Dias, J. A., Duarte, I. C., Caldeira, S., Marques, A. R., Rodrigues, V., Redondo, J., Castelo-Branco, M. Mental health and post-traumatic stress disorder in firefighters: An integrated analysis from an action research study. Front Psychol. 2023, 14, 1259388. https://doi.org/10.3389/fpsyg.2023.1259388 |
[53]
.
The pressure to maintain clinical competence and stay current with medical advancements can trigger feelings of inadequacy and impostor syndrome, as healthcare workers doubt their abilities in the face of ever-evolving medical knowledge
| [57] | Hu, K. S., Chibnall, J. T., Slavin, S. J. Maladaptive perfectionism, impostorism, and cognitive distortions: Threats to the mental health of pre-clinical medical students. Academic Psychiatry. 2019, 43, 381-385.
https://doi.org/10.1007/s40596-019-01031-z |
[57]
. Furthermore, the weight of making life-and-death decisions can lead to guilt, self-doubt, and moral distress when outcomes are unfavourable
| [56] | White, A. A., Brock, D. M., McCotter, P. L., Hofeldt, R., Edrees, H. H:, Wu, A. W., Shannon, S., Gallagher, T. H. Risk managers’ descriptions of programs to support second victims after adverse events. Journal of Healthcare Risk Management. 2015, 34(4), 30-40. https://doi.org/10.1002/jhrm |
[56]
.
Penultimately, lives will be deleteriously affected (often
permanently) in consideration of both patients and professionals (
HCPs,
AHPs, and
First Responders) unless the concept of
‘Speaking up’ within healthcare, allied health professions, and First Responder networks, is successfully
propagated, normalized, and (where possible)
mandated. Despite training and the recognition that speaking up can mitigate harm to patients and save lives, healthcare professionals do not consistently speak up when they have
Patient safety concerns
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
Within institutions, leaders had a significant impact on speaking up behaviours
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
Individual variations in behaviour were often explained with reference to cultures of origin, professional identity, perceived medical knowledge or experience level. Thus, they described using
Patient safety as rationale to speak up
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
It is acknowledged that ‘Speaking up’ takes courage, decisiveness, realization of one’s own moral compass, and endurance to deal with any resistance from colleagues, or disparagement. It usually requires putting Patient safety first, and not the least as self-recognition of the individual professional’s core reason for practicing in their chosen field. It reduces patient harm and irreversible medical errors. It eventually replenishes a sense of healthy psychological wellbeing, resilience, self-fulfilment, and dissipates the phenomenon of the self-serving ‘young guns’ approach to clinical (and first response) care.
4.1.1. Imperative for Identifying Personality Traits- Foundationals
Due to the extensive nature of this research article, a targeted approach has been employed in order to maximize comprehension of the different contributing factors to personality assessment and profiling of HCP, AHP, and First Responder individuals. Psychological wellbeing and mental health directly correlates with personality assessment and profiling determinants. The outcome of formally identifying personality traits of First Responders, HCPs, and AHPs is indeed an imperative, upon reflection of the results unambiguously explicated below.
Findings related to positive personality traits ascertained that traits such as: (dominance)
| [51] | Hsiao, Y. Y., Chan, W. H., Ma, I. C., Wu, C-L., Chen, P. S., Yang, Y. K, Lin, C-H. Long-term PTSD risks in emergency medical technicians who responded to the 2016 taiwan earthquake: A six-month observational follow-up study. Int J Environ Res Public Health. 2019, 16(24), 4983.
https://doi.org/10.3390/ijerph16244983 |
[51]
; emotional stability; emotional intelligence; dedication (or, a keen sense of duty and service); excellence; empathy, may enhance work functionality and individual coping styles. It does, however, remain person-dependent. Interdisciplinary professional collaboration, best practice principles, and evidence based practice, are inspiring concepts for many related professionals.
Exploration of results regarding negative personality traits indicated that Patient safety has a direct relationship with personality traits which influences psychological wellbeing, mental health, and quality of care (and response), and can eventuate in iatrogenic critical incidents (including medical errors). Neuroticism, Psychoticism, and even in some cases Dark Triad personality traits (Narcissism, Machiavellianism, and Psychopathy), as identified by personality assessment and profiling is significantly present in individuals within HCPs, AHPs, and First Responder, professional fields.
Attitudinal issues, workplace bullying, and burnout (and/or SVS, STS, PTSD and variants) can also destabilize to the point of no return in effective workplace functioning. Systemic avoidance of enacting speaking up behaviors (in many professions within HCPs, First Responders, and AHPs) can further exacerbate such issues.
Fear of stigmatization inversely affects individuals within each of these groups seeking help.
4.1.2. Psychological Wellbeing and Mental Health of HCPs, AHPs, and First Responders
Psychological wellbeing and mental health of Healthcare professionals, Allied Healthcare professionals, and First Responders, is increasingly acknowledged as a primary influence affecting Patient safety, best practice, quality of healthcare provided along with determining effectiveness of healthcare systems.
There is a pressing need to move away from the expectation that healthcare professionals should endure poor psychological health and continue working without proper support. This is, at the least, an occupational safety and health issue. Organizations must recognize and assess the
psychological wellbeing needs of their staff, providing targeted interventions that foster supportive and safe environments. Encouraging staff to explore and address their vulnerabilities is essential for improving both their
psychological wellbeing and the quality of care they deliver to patients
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
.
In ICD-11 (International Classification for Diseases-11), moderate to severe personality dysfunction is diagnosed by existence of psychotic-like beliefs and paranoid ideation- under stress, associated with harm to self or others
| [124] | WHO. ICD-11 clinical descriptions and diagnostic requirements for mental and behavioural disorders. Geneva: World Health Organisation; 2023.
https://icd.who.int/browse 11/l-m/en |
[124]
. The Personality Disorder Severity ICD-11 (PDS-ICD-11) scale
| [8] | Bach B, Simonsen E, Kongerslev MT, Bo S, Hastrup LH, Simonsen S, Sellbom M. ICD-11 personality disorder features in the danish general population: Cut-offs and prevalence rates for severity levels. Psychiatry Res. 2023 Oct, 328, 115484, 1-8.
https://doi.org/10.1016/j.psychres.2023.115484 Epub 2023 Sep 17. |
[8]
can assist in effective measurement.
With reflection upon this definition, findings regarding specific Healthcare, and First Responder, groups are featured below.
Individuals scoring higher on
Neuroticism and
Psychoticism (have) poor mental health status
| [59] | Bhupender, S. Personality and mental health of medical professionals. Int Res. J. Social Sci. Dec 2014, 3(12), 23-27. ISCA: International Science Community Association| https://isca.in |
[59]
. Research
| [58] | Zaninotto, I., Rossi, G., Danieli, A., Frasson, A., Meneghetti, I., Zordan, M., Tito, P., Salvetti, B., Conca, A., Ferranti, R., Salcuni, S., Solmi, M. Exploring the relationships among personality traits, burnout dimensions and stigma in a sample of mental health professionals. Psychiatry Res. 2018, 264, 327-333. https://doi.org/10.1016/j.psychres.2018.03.076 |
[58]
in the
allied health sector, consistently identified
Neuroticism and extraversion as integral predictors of burnout among mental health professionals.
It is argued that- professionally appropriate
medical professionals, and those without disturbing personality traits, mental health disorders, or
Dark Triad personality profiles, feel that they must behave in a dignified, and respectful way. That is, they feel that they- can’t reveal their anger, frustration or any other emotions towards their patients that may indirectly affect their mental health because in some or other way they are suppressing their emotions which leads to poor mental health and
Neuroticism | [59] | Bhupender, S. Personality and mental health of medical professionals. Int Res. J. Social Sci. Dec 2014, 3(12), 23-27. ISCA: International Science Community Association| https://isca.in |
[59]
.
Emphasis on the relationship between the varying levels of
psychological wellbeing needs in healthcare professionals is illustrated in Maslow’s Hierarchy of Needs
. This model demonstrates that healthcare professionals must have their basic needs met before progressing to higher levels of
psychological wellbeing.
For instance, assessment based research is imperative to formulate targeted strategies aimed at improving the health and well-being of
paramedics and
emergency medical technicians globally, with the goal of enhancing employee retention and reducing attrition rates
| [5] | Hatim Gormallah Alzahrani, H. T., Ahmed, R. K., Jowharji, T. W., Alqarni, A. S., Agil, W. M. F., AlDulaijan, W. M., Magadmi, R. K., Malaekah, A. F., Asiri, A. H. A., Elawad, M. E. E., Alharbil, R. R. The psychological well-being of healthcare professionals and it’s impact on patient care: A scoping review. Revista Iberoamericana de Psicologia del Ejercicio y el Deporte. 2025, 20(2), 107-113. |
[5]
. Therefore, furthering the need for realization and enabling of progress toward higher levels of
psychological wellbeing. Additionally, highlighting the necessity for personality and psychological assessment policies and procedures which apply to recruitment, performance assessment, and aim for retention of the individual
First Responders, HCPs, and
AHPs, and installation of sound surveillance techniques to ensure accurate symptom identification, is of vital importance.
Employee Assistance Programs (EAPs)/career counselling is often, equally, as necessary as psychiatric/psychological intervention tailored specifically for interventions regarding psychological and psychiatric disorders.
4.1.3. Attitudinal (Including Ethics, Bullying, and Stigma) and Psychological Intervention (Professionals Seeking Help)
Need for assessment, application of ethical principles, and attitudinal components, are explicated below.
The behavioural tendencies of
HCPs, e.g.,
HCPs with high levels of conscientiousness are more likely to adhere to clinical guidelines. The high level of openness makes people more willing to try new treatments
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
Proposed examples in the context of healthcare and First Responder professions, “is there a prevailing 'get over it' mentality toward patient suffering, diagnosis, treatment, and ongoing care regimens”?
| [125] | McKenzie, M. C. The importance of incorporating risk management and assessing for perilous traits in job recruitment interviews, performance appraisals, and post-critical incidents. Peercite J Ment Health. 2025, 3(S1), 677-683.
https://doi.org/10.33423/ajm.v25i3.7804 |
[125]
. Therefore, the conceptualization of professional stigma should account for the unique forensic context, while focusing on underlying biased attitudes and morally problematic behaviors
| [32] | Woodier, N. Burnett, C., Sampson, P., Moppett, I. Patient safety near misses-Still missing opportunities to learn. Journal of Patient safety and Risk Management. 2024, 29(1), 47-53.
https://doi.org/10.1177/25160435231220430 |
[32]
.
Among critical care physicians and nurses, interdisciplinary discussions that encourage ethical team deliberations may be useful in preventing BOS
| [128] | Teixeira, C., Ribeiro, O., Fonseca, A. M., Carvalo, A. S. Ethical decision making in intensive care units: A burnout risk factor? Results from a multicentre study conducted with physicians and nurses. J Med Ethics. 2014, 40, 97-103.
https://doi.org/10.1136/medethics-2012-100619 |
[128]
.
Conceptually, changing individuals’ attitudes and experiences, logistical barriers can be tackled on a broader, systemic level. Financial barriers could be overcome
| [22] | Edwards, J. L., Crisp, D. A. Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology. 2017, 69(3), 218-225. |
[22]
.
In terms of psychological intervention (professionals seeking help): Reluctance in Healthcare Professional (including AHPs) groups and First Responders to seek psychological intervention is pervasive, fierce, and often punctuated by the gall of assumption. It has significant deleterious effects, from enduring illness and suicidality; extensively damaging impacts on patient care; through to reputational damage of professions, facilities, and healthcare systems.
4.1.4. Awareness of: Limitation in Skills or Compromized Psychological Wellbeing/Risk-oriented Personality Traits
As part of professional ethics, and acknowledging the potential consequences of risk-oriented personality traits, it is argued that AHPs, First Responders, and HCPs, are individually accountable for recognizing (when capable), accepting sound advice, responding to professional recommendations, in relation to mental health concerns and/or concerning personality assessment profiling results. Likewise, when mental health and psychological wellbeing enhancement programs are offered within the workplace, for e.g., that they take full advantage of programs’ availability.
Exemplification of a contrasting approach, is that the majority of medical specialists (anaesthetists) who are practising in Scotland and New Zealand- did not believe personality traits influenced their response to challenging situations, but if presented with the personality traits of potential new recruits that this would influence their hiring decisions
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
.
Interventions targeting awareness of limitation in skills can also help build reasonable resilience and confidence in professional skills, where lacking. For example, professionals who undertake locums or short-term backfill need to be able to step into a workplace, effectively undertake the tasks and leave the results for the next professional to pick up
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
.
Moreover, in terms of professional credence, one can only speculate that confidence levels may mask a lack of awareness of limitations in skills in the early years of training on the one hand, and lack of acknowledgement of advancement in skills in the later years of a program on the other hand, that is, ‘the more you know, the more you realise you don’t know’
.
4.1.5. Profiling and Recruitment
Psychographic profiling emphasizes the psychological factors of individuals, like personality, value structure, orientation, and the way one lives. The process of analysing psychographic pictures covers a lot of information about a certain person, particularly in terms of his or her psychological characteristics, comprising, character, beliefs, behaviours, and ways of living. It is proposed that, demographic and behavioural data provide foundational understanding of HCPs- based on psychographic data provide insight, depth, and nuance
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
. This approach involves hybridization (e.g personality assessment and profiling combined).
In addition, traditional profiling methods combined with psychographic profiling provide a more thorough understanding of
HCPs. Predicting Behaviour- based on psychographic profile is used to predict the behaviours of
HCPs. Furthermore, trust and credibility personalized communication strategies which align
HCPs psychographic profiles enhance trust and credibility
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
Segmented content-based psychographic profiling allows for the segmentation of
HCPs into distinct groups based on their psychological attributes
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
.
In regards to recruitment: personality has long been acknowledged as an important part of candidate selection for professional roles
with the intention of hiring individuals who will be successful, fit in with the existing team and be suited to the role–the latter crucially minimising an individual’s stress and promoting job satisfaction
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
. Further to the scrutinization of use of personality assessment and profiling in specific professions. An important strength in a key study was: the assessment of recruits very early in their careers, i.e., while they were still in training at the police or firefighter academies
. Other research- should be completed into specific personality characteristics, including
Neuroticism, perfectionism, and excitability to facilitate the development of strategies aimed at improving the health and wellbeing of paramedics and EMT workers internationally
| [45] | Betts, C., Stoneley, A., Picker, T. Exploring paramedic personality profiles and the relationship with burnout and employment retention: A scoping review. Australasian Emergency Care. 2024, 27(4), 227-236
https://doi.org/10.1016/j.auec.2024.04.003 |
[45]
.
Whilst the use of personality data in healthcare recruitment may be limited by staff shortages, there may be a role for it in coaching individuals deciding their future clinical specialties and working environments
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
. This may be counter-balanced with the pursuit by researchers to provide likewise emphasis on the vital importance of
assessment and
profiling with particular relevance to
profiling immediately upon employment; after critical incidents; during job promotions; and,
even upon transition to alternative workplace environments. It is
never too early (or the alternative) to gather accurate
risk-mitigation based personality assessment and profiling data of
HCPs,
AHPs, and
First Responders. It can, literally, mean the difference between life and death. Combine faulty identification of perilous traits with poor speaking up behaviors and the effects know no bounds.
4.1.6. Assessment
Empowerment of managers, including in human resources and occupational departments, to undertake personality assessment and profiling of
HCPs,
AHPs, and
First Responders (and acting upon the results, when red flag alerts emerge) will ensure heightened levels of security for patients and colleagues, alike.
Neuroticism,
Psychoticism,
Narcissism,
Machiavellianism,
Psychopathy, and other high risk personality traits do not differentiate between professions via hierarchical status, paternalism, old-boys’ clubs, nor over-compensating or bullied work colleagues. Without clear assessment guidelines and protocols, the implications of this are serious for the healthcare industry, creating a culture of secrecy and denial in the healthcare industry, while leading to a sense of hypocrisy due to the overt denouncing of stigma on one level, yet promoting a lack of acceptance of impairment in mental health professionals on another
| [22] | Edwards, J. L., Crisp, D. A. Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology. 2017, 69(3), 218-225. |
[22]
.
There exists a difference in the strength of certain personality traits present between members of different clinical departments. It is possible to extrapolate from this that selecting for roles within clinical departments may be beneficially assisted using personality assessment tools (both in terms of individual suitability and team cohesiveness). However, given the pressures on the service delivered by the NHS and the continuing staff shortages, departments do not have the luxury of being able to select individuals according to personality type. In addition, performing personality assessments with in-depth candidate feedback requires significant resources including finance, expertise in administering the assessments and time for each participant to undertake the assessment itself. It is also worth considering that heterogeneity of personality within the clinical workforce is likely to be beneficial for clinical outcomes and
Patient safety, given the potential complexity of clinical medicine and positive effects of diversity; individuals with different personalities may react in different ways to organisational challenges, possibly providing an increased opportunity for problem solving and ingenuity. However, whilst this heterogeneity may be useful, the consequences for the individual if they are particularly vulnerable to stress or mismatched in their place or team of work must also be considered. If these ‘at risk’ individuals can be identified it may be possible to provide increased support for them in certain challenging scenarios, with the intention of minimising stress, improving job satisfaction and reducing the risk of burnout
| [36] | Grailey, K., Lound, A., Murray, E., Brett, S. J. The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment. PLoS ONE. 2023, 18(6), 1-20. e0286796.
https://doi.org/10.1371/journal.pone.0286796 |
[36]
.
Future research should aim to include validated psychological scales to better understand healthcare professionals’ psychological well-being
. The MHS (Mindful Healthcare Scale), for e.g., could be used by organisations, alongside evaluations of the contextual drivers of staff wellbeing [such as management style, job demands, job control etc]. to target organisational change efforts at both systemic and individual levels
| [30] | Gillanders, D., Fisher, S., Kidney, G., Ferreira, N., Morris, P. G., Harkjaer-Thorgrimsen, L. M. The Mindful Healthcare Scale (MHS): Development and initial validation. Journal of Contextual Behavioral Science. 2024, 33(100817), 1-12.
https://doi.org/10.1016/j.jcbs.2024.100817 |
[30]
. Furthermore, the triflex structure of the MHS could allow trainers and learners to assess where to target their own efforts in developing their flexibility – enhancing their awareness, their engaged responding or their ability to step back from thinking. Clinical supervisors- development of their supervisees, determining a profile of strengths and areas to be developed, and then targeting experiential methods and homework tasks
| [30] | Gillanders, D., Fisher, S., Kidney, G., Ferreira, N., Morris, P. G., Harkjaer-Thorgrimsen, L. M. The Mindful Healthcare Scale (MHS): Development and initial validation. Journal of Contextual Behavioral Science. 2024, 33(100817), 1-12.
https://doi.org/10.1016/j.jcbs.2024.100817 |
[30]
.
Psychological assessment- could also be useful for the higher education sector when establishing the inherent requirements of their entry level health profession programs
| [12] | Dawes, M., Summershill, W., Glasziou, P., Cantabellotta, A., Martin, J., Hopaylan, K., Porzsalt, F., Burls, A., Osborne, J. Sicily statement on evidence-based practice. BMC Med Educ. 2011, 5(11), 78. https://doi.org/10.1186/1472-6920-11-78 |
[12]
.
Further to consideration of the challenges in
Healthcare and
First Responder based work environments and the emotional and psychological challenges involved. An exemplification of conceptual definitions of how
psychological flexibility or
inflexibility would manifest in healthcare contexts were: (1) present moment awareness of one’s private experiences when working with people, (2) defused from thoughts pertaining to one’s clients, (3) willingness to have unwanted or undesirable internal experiences, (4) responding to oneself and clients as distinct from evaluations or labels about self or clients, (5) clarity around values as a health professional and (6) committing to valued actions in a professional helping context
| [30] | Gillanders, D., Fisher, S., Kidney, G., Ferreira, N., Morris, P. G., Harkjaer-Thorgrimsen, L. M. The Mindful Healthcare Scale (MHS): Development and initial validation. Journal of Contextual Behavioral Science. 2024, 33(100817), 1-12.
https://doi.org/10.1016/j.jcbs.2024.100817 |
[30]
.
4.1.7. ‘Speaking up’
Speaking up behaviors can be compromised by- protective or defensive strategy (perhaps due to previous negative experiences)
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
. For example, timely arrangements for mental health professionals to intervene with healthcare workers experiencing multiple mental health comorbidities within hospitals are comprehensive and evidence-based. Psychological health professionals can provide valuable assistance by consulting and educating healthcare workers through media and multimedia programs, lectures, group and individual counseling, online platforms, and mental health hotlines
| [96] | Adibi, A., Golitaleb, M., Farrahi-Ashtiani, I., Pirani, D., Yousefi, K., Jamshidbeigi, Y., Sahebi, A. The prevalence of generalized anxiety disorder among healthcare workers during COVID-19 pandemic: A systematic review and meta-analysis. Frontiers in Psychiatry. 2021, 12, 658846. |
[96]
.
The data highlighted the importance of moving beyond targeting front-line healthcare professionals for training in the skills of speaking up and engaging institutional leaders and systems to actively promote and reward speaking up behaviours
| [24] | Umoren, R., Kim, S., Gray, M. M., Best, J. A., Robins, L. Interprofessional model on speaking up behaviour in healthcare professionals: A qualitative study. BMJ Leader. 2022, 6, 15-19. https://doi.org/10.1136/leader-2020-000407 |
[24]
.
Thus, there is a convincing argument to be made in relation to promotion of speaking up as a component of Standard Operating Procedures (SOPs).
4.1.8. Burnout (and BOS: Burnout Syndrome)
There exists an universality of psychological disorders and BOS within HCPs, First Responders, and AHPs.
BOS and other psychological disorders which impair the mental and physical health of their members, reduce the quality of care of their patients, and may deter trainees from entering their specific field.
Diagnostic alternatives to BOS or, the generalized term of
‘Burnout’, can be
SVS; ASD; PTSD; or,
CPTSD . That is, respectively, Second Victim Syndrome (SVS, or Secondary Traumatic Stress); Acute Stress Disorder (ASD); Posttraumatic Stress Disorder (PTSD); or, Complex Posttraumatic Stress Disorder (CPTSD).
To particularize, BOS in critical care healthcare professionals may result in posttraumatic stress disorder (PTSD), alcohol abuse, and even suicidal ideation
| [129] | Dyrbye, L. N., Thomas, M. R., Massie, F. S, Power, D. V., Eacker, A., Harper, W., Durning, S., Moutier, C., Szydlo, D. W., Novotny, P. J., Sloan, J. A., Shanafelt, T. E. Burnout and suicidal ideation among U. S. medical students. Ann Intern Med. 2008, 149, 334-341.
https://doi.org/10.7326/0003-4819-149-5-200809020-00008 |
[129]
. Necessary incorporation into forward planning, clinician and First Responder critical incident preventative protocols, are that- multidimensional interventions that address the ICU environmental culture and individual practitioner level are more likely to successfully prevent and treat BOS
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
.
Leaders
| [91] | Edmondson, A. Psychological safety and learning behavior in work teams. Administrative Science Quarterly. 1999, 44(2), 350-83. https://doi.org/10.2307/2666999 |
[91]
(including within the medical and nursing fields) are
professionally obliged to cultivate knowledge, acquire recognition skills, and have effective capacity to access appropriate resources and advice (on behalf of the identified workers). On-ward, in-facility, or on-site programs to reduce stress and tailored
EAPs may assist in their endeavours. Collection of statistical representation of personality profiles’ findings may also help map the extent of the issue.
4.1.9 Patient Safety and Best Practice
Poor decision-making processes have been shown to contribute to the occurrence of critical incidents
.
Upon consideration of best practice, self-report knowledge, attitudes and behaviours vary with exposure, chosen profession, progression through a program and with age but there is no clear indication about which domains may be modified to bring about effective life-long learning in EBP
. Further research into this life and death defining theme is highly recommended. However, it must be acknowledged, that urgency in observance of risk averse
Patient safety and its interconnectedness with evidence based practice- controls that require a human to act, particularly without planning, represent vulnerabilities and more effective controls are needed
| [32] | Woodier, N. Burnett, C., Sampson, P., Moppett, I. Patient safety near misses-Still missing opportunities to learn. Journal of Patient safety and Risk Management. 2024, 29(1), 47-53.
https://doi.org/10.1177/25160435231220430 |
[32]
. Perhaps, by connecting therapies to doctors’ cognitive frameworks, this precision may allow for highly personalized interactions between healthcare professionals, resulting in tailored interventions that optimize patient outcomes
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
. Extending beyond traditional hospital and clinical settings, the limitations of rural mental health services are often
non-risk mitigated. This can adversely affect patients- with
AHPs who are highly inexperienced providing them with psychological intervention for complex clinical presentations. Thus, telehealth services are likely to be beneficial to reduce physical discomfort and financial costs associated with prolonged travel to access healthcare and improve accessibility to limited services, such as mental health supports
| [63] | Keeves, J., Braaf, S. C., Ekegren, C. L., Beck, B., Gabbe, B. J. Access to healthcare following serious injury: Perspectives of allied health professionals in urban and regional settings. Int. J. Environ. Res. Public Health. 2021, 18, 1230. |
[63]
.
One must not understate the importance of patient advocacy (from in-house/directly) accessible ethics advisors to funded programs which advocate for patients, patient carers and families through to professional advice for patients against medical accidents. This differs greatly from sectarian cliques who use the terms patient safety and best practice as rhetoric for their own gain.
4.2. Research
It must be acknowledged that (especially in the case of substance abuse)- reliance on self-report data without biochemical collaboration
| [69] | Sannibale, C., Hurkett, P., Bossche, E. Van Den., O’Connor, D., Zador, D., Capus, C., Gregory, K., McKenzie, M. Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients. Drug and Alcohol Review. 2003, 22(2), 181-190
https://doi.org/10.1080/09595230100100624 |
[69]
it is proposed, that in the population discussed in this study- can limit (or even possibly skew) accurate personality assessment results and one’s overall profile. For example, future studies may include samples from other emergency service professions as well as from police and firefighter populations. It would also be informative to examine emergency-services personnel over the course of their occupational development (e.g., pre-training, early employment, late employment)
.
Moreover, each profession of focus would benefit (preferably) from grandscale application of longitudinal studies which reduce any concerns, about self-report
| [106] | Duschek, S., Haux, S., Garrido, A., Janka, A. Stress in paramedics: Relationships with coping strategies and personality traits. Int J Emerg Serv. 2020, 9(2), 203-16.
https://doi.org/10.1108/IJES-06-2019-0029 |
[106],
based assessment processes in personality traits and profiling spheres.
4.2.1. Performance Duties
Many clinicians, and philosophers, have cogitated upon the concept of the
Hippocratic Oath (HO). However, at its core, it is considered the fundamental of the
medical profession (and associated
healthcare communities, along with related
First Responder networks). With highly current relevance to
HCPs,
AHPs, and
First Responders, alike, Galen said that health resulted from moderation of: air; sleep and wake; diet; passions of the mind; exercise and rest and, retention and evacuation of wastes
. Thus, continuing to confirm that the Hippocratic oath (and in all its adorned forms) a cornerstone for healthcare in the present for ethical, moral, ethico-legal, medico-legal, and professional, domains. It is not an oath to be reduced to an abuse of the concept of ‘to err is human’; selective, perverse-incentivization based conscientious objection; misperceived as justified cherry-picking; or, misappropriated ‘do no harm’. It is a power unto itself (including all of the ramifications and natural consequences which may arise from disregarding the Hippocratic Oath as sacrosanct to the medical profession, and beyond).
Consultation with team leaders, senior management, and corporate leadership and human resources/occupational department personnel would help bring inclusion of assessment of individual workers, and groups- the interrelationship with e.g. best practice and HO principles, to the fore.
4.2.2. Skill Development (and Professional Development: PD) and Curriculum
Core essentials for training- for skill development- comprise:
psychological wellbeing;
mental health; hazardous personality traits and profiles; and rule consciousness.
Competency based, simulation innovated, and
in-vivo enforced training of all undergraduate, post graduate, registered/licensed/certified
Healthcare, Allied Healthcare, and
First Responder participants, is strongly advocated. IPC and EBP education could be used as a supportive adjunct. For e.g., more outreach and training are needed to improve and transfer interprofessional knowledge, IPC competencies and interdisciplinary values and skills among M
HPs | [26] | Keba Kebe, N. N. M., Chiocchio, F., Bamvita, J-M., Fleury, M-J. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Medicine. 2019, 7, 1-10.
https://doi.org/10.1177/2050312119841467 |
[26]
.
Educators knowledge of personal personality profiling assessment results may provide guidance in relation to applicable career options. To elucidate, inappropriate or unsuitable candidates; or, individuals more suited to TO (Technique Oriented) versus PO (Person Oriented) professions within health arenas. For instance- to reiterate, a medical laboratory scientist who manages a large laboratory of junior staff may undertake training in communication and management to enhance his/her role and, in doing so, influence levels of certain character traits, such as Cooperativeness
| [3] | Campbell, N., Eley, D. S., McAllister, L. Investigating personality and conceptualising allied health as person or technique oriented. CSIRO Publishing- Australian Health Review. 2014, 38, 86-92. https://doi.org/10.1071/AH13109 |
[3]
. We recommend that for leaders in high-risk situations to use safety practices, such as procedural safety checklists or code debriefing, as a mechanism to support team members in raising safety concerns in a safe space
| [130] | Smith, K. A., High, K., Collins, S. P., Self, W. H. A preprocedural checklist improves the safety of emergency department intubation of trauma patients. Acad Emerg Med. 2015, 22, 989-92. https://doi.org/10.1111/acem.12717 |
[130]
.
Mock training involving replicating real-life situations may be beneficial to enhance understanding and enactment of
speaking up skills.
Particular strategies and interventions to enhance workers’ functionality and maximize their personality traits’ attributes include: Work Environment as a Primary Intervention Target; Integrated and Tailored Health Programs for Physical and Mental Well-being; Develop a Plan to Reduce Doctor-patient Conflicts; Strategic Media Engagement for Building Trust in Healthcare- Healthcare professionals can also serve as Key Opinion Leaders on social media, using their platforms to clarify misconceptions and build public trust; Systems Thinking Approach in Policy and Practice- collaborative approach among stakeholders- such as healthcare management, policymakers, media representatives, and educators
is essential.
4.2.3. Teamwork and Environment
For teams to function optimally within a stressful environment, the presence of psychological safety is increasingly regarded as paramount
| [26] | Keba Kebe, N. N. M., Chiocchio, F., Bamvita, J-M., Fleury, M-J. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Medicine. 2019, 7, 1-10.
https://doi.org/10.1177/2050312119841467 |
[26]
.
Based on a report from the American Association of Critical-Care Nurses, six standards are needed to establish and sustain a healthy work environment: 1) skilled communication, 2) true collaboration, 3) effective decision making, 4) appropriate staffing, 5) meaningful recognition, and 6) authentic leadership
| [127] | American Association of Critical-Care Nurses: AACN standards for establishing and sustaining healthy work environments: A journey to excellence. 2nd ed., Aliso Viejo, CA: American Association of Critical Care Nurses. 2016. |
[127]
. To illustrate, a pertinent study highlights the relevance of focusing on participation in decision-making, knowledge sharing, mutual trust, team conflict, belief in benefits of interdisciplinary collaboration and knowledge integration for improving IPC in MH teams and for future service planning. Findings also confirm the value of team commitment, organizational support and professional diversity for strengthening IPC in the MH sector, while arguing for a biopsychosocial approach to mental healthcare
| [26] | Keba Kebe, N. N. M., Chiocchio, F., Bamvita, J-M., Fleury, M-J. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Medicine. 2019, 7, 1-10.
https://doi.org/10.1177/2050312119841467 |
[26]
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Forbye, addressing workplace stressors, fostering positive doctor-patient relationships, and mitigating negative media portrayals can contribute to a healthier environment for healthcare professionals. Comprehensive programs addressing both mental and physical health needs, including mental health screenings, stress management techniques, and promoting physical activity, are crucial
.
4.2.4. Policy
Execution of: human rights’ fundamentals; ethics;as well as, standardization of principles; protocols, standards and procedures, whereby professionals are expected to formally adhere to personality assessment, profiling, and intervention/other consistent with results of their assessment is necessary to ensure sound professional application and service to patients/clients. In fact, this could easily be incorporated into preparation for internal and external audits, and in application for accreditation.
Healthcare accreditation is a formal process where an independent body evaluates if an organization meets specific quality and safety standards. Accreditation is awarded after an unannounced, on-site survey assessing compliance with established standards. Surveyors review patient records, observe care, and interview staff and patients. Accreditation typically lasts three years (two for laboratories), and accredited organizations may display
The Gold Seal of Approval as a mark of quality and
patient safety . External evaluation provides assurances that healthcare facilities have adequate quality systems in place. It also contributes to quality improvement,
risk mitigation,
patient safety, improved efficiency and accountability, and sustainability of the healthcare system
| [132] | ISQua EEA: International Society for Quality in Health Care External Evaluation. FAQs: Frequently Asked Questions: What are the benefits for a healthcare user of choosing care from an accredited provider? Dublin, Ireland: ISQua EEA; 2026. https://ieea.ch/faqs/ |
[132]
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Reference to specific populations, and traits, are provided. The personality characteristics and stress responses of rescuers have clinical as well as administrative policy implications
.
Over and above, participants highlighted the need for personalized interactions receptive to their own professional goals and ethical conscience
| [29] | Pervaiz, K. and Bawa, S. S. Psychographic profiles of healthcare professionals and their impact on prescribing behaviour. Springer Nature. A. Mirzazadeh et al. (Eds.). 2025, pp. 69–90. https://doi.org/10.1007/978-3-031-93601-2_5 |
[29]
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Further research highlights
HCPs with a high level of conscientiousness to adhere to clinical guidelines and a high level of openness to be inclined to try new treatments
| [23] | Smith, L., Brown, K.: Psychographic profiling of healthcare professionals. J. Healthc. Manag. 2020, 35(1), 45–60. |
[23]
.
Due to the deleterious impact of BOS on the job satisfaction of critical care healthcare professionals, healthcare costs, and quality of care, international and national policy makers should work with a variety of stakeholders to shape the laws and regulations that will reduce BOS in critical care healthcare professionals, improve the quality of patient care, and decrease healthcare costs (e.g. those associated with turnover)
| [37] | Moss, M., Good, V. S., Gozal, D., Kleinpell, R., Sessler, C. N. Special article: An official critical care societies collaborative statement: Burnout Syndrome in critical care healthcare professionals: A call for action. Society of Critical Care Medicine and Wolters Kluwer Health. July 2016, 44(7), 1414-1421. https://doi.org/10.1016/j.chest.2016.02.649 |
[37]
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Ultimately there is necessity for, education encapsulating the importance of applying personality assessment and profiling during
job recruitment | [62] | Mokaya, S. M. Effect of personality tests on recruitment. United States International University-Africa; 2012 |
[62]
and,
post-adverse events; as well as for inclusion in
occupational safety and health programs in order to maximize secure, reliable, and risk averse teamwork and systems’ collegial compatibility, and for coaching purposes.
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