A STUDY INFLUENCE
NURSING EDUCATION ON DEVELOPMENT OF EMOTIONAL INTELLIGENCE LINDA SHANTA, PHD, RN⁎
LESLIE GARGIULO, PHD†
The Future of Nursing, Leading Change, Advancing Health (Institute of Medicine 2011) challenged the profession of nursing to assume leadership of interdisciplinary health care teams. Leading these teams requires cognitive ability to manage highly charged and emotional work. Emotional intelligence (EI) is a characteristic necessary to process emotional information for creative problem solving. In addition, emerging evidence indicates there may be an association of nurses' EI and quality patient care (K. Adams et al., 2011). The foundation for development of competencies essential for nursing practice begins with nursing education. This quasi-experimental study investigated if baccalaureate-level nursing education increased the level of EI as operationalized by J. D. Mayer and P. Salovey's (2004) four-branch abilities model. Findings indicated that senior nursing students scored higher on the ability to understand and reason about emotions over pre-nursing students (P b .05); however, pre-nursing students scored higher than senior nursing students on the ability to accurately perceive emotions (P b .05). Regression analysis found that self-estimated grade point average was the only significant predictor of overall EI. Although the senior nursing students demonstrated strength in the ability to reason about emotion, the ability to perceive emotion seemed to have declined. This problem requires further research and action through transformed nursing education. (Index words: Nursing education; Emotional intelligence; MSCEIT; Abilities model emotional intelligence) J Prof Nurs 30:511–520, 2014. © 2014 Elsevier Inc. All rights reserved.
HE INSTITUTE OF Medicine (IOM) and Robert Wood Johnson Foundation 2011 study made a clear call for nursing to become central to the overhaul in health care. Recommendations from this study include increasing the influence of nursing in three important ways: (a) in health care decisions of the individual patient, (b) in improving the health of communities, and (c) in developing health care policy. In the end, individual nurses must possess competencies specific in these three areas to have such an influence and to meet the demands for affordable health care. The manner in which nurses care for their patients and work with their colleagues relates to their own ability to perceive emotions. This ability includes not only
⁎Faculty Chair Chamberlain College of Nursing, Phoenix, AZ 85021. †Vice President of Education, Ashworth College. Address correspondence to Dr. Shanta: 1018 N. Martingale Road, Gilbert, AZ 85234. E-mail: [email protected]
accurately interpreting emotions of clients and colleagues but also perceiving one's own emotional responses to the environment (Shanta & Connolly, 2013). It is important that nurses are able to establish effective ways to communicate with others, and to do this, nurses must use their own emotions to facilitate thinking about a problem and to understand the implications of emotions in themselves and others to offer possible solutions to complex health care problems. Negotiation within a complex health care environment increases the number and types of interactions; thus, nurses must not only be able to manage their own emotional responses but also be able to manage the emotional responses of others (Freshwater & Stickley, 2003). The importance of nurses possessing the competence to function within the complex health care environment is clear (Shanta & Connolly, 2013); however, it is less clear how nurses are prepared to develop this capability. Having this capacity will help them to cope with inevitable emotional
Journal of Professional Nursing, Vol 30, No. 6 (November/December), 2014: pp 511–520 © 2014 Elsevier Inc. All rights reserved.
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reactions that emerge during complex interactions and communications in the chaos that permeates today's health care (Shanta & Connolly, 2013). Emotional intelligence (EI) may be one mechanism that will facilitate improved practice through integration of the science of nursing with reflective and ethical care of patients, families, and communities. The way an individual reacts to emotional information has been termed emotional intelligence. Mayer, Salovey, Caruso, and Sitarenios (2001) defined EI as the “ability to recognize the meaning of emotions and their relationships and to use them as a basis for reasoning and problem solving” (p. 234). These researchers believed that EI is related to cognitive intellect through the ability to use reasoning by way of information to find meaning. Mayer and Cobb (2004) argued that EI contributes to the foundation for such desirable characteristics as caring and empathy because it is through learning from the affective dimension that individuals develop skills that are linked to caring behavior (Benner, 2001; Goleman, 1995; Mayer & Cobb, 2004).
Background and Literature Review Emerging evidence may illuminate an important association of nurses' EI and quality patient care. This vital connection is only beginning to be studied, and a recent pilot study explored the impact of nurses' EI on patient outcomes and found that the collective level of nurses' total EI score and the area score of experiencing emotion were significant predictors of quality patient care (Adams et al., 2010). Although other authors have conceptually linked EI to improved patient care, this study quantified this outcome. Although this study focused on nurses in the field practicing skills with competence requirements shaped by the professional organizations' standards, it is important to explore how nurses gain EI in the first place. Obviously, the foundation for development of all skills and competencies essential for nursing practice begins with nursing education. Baccalaureate nursing education is designed to facilitate the development of caring as translated into affective characteristics of professional values, such as altruism, autonomy, human dignity, integrity, and social justice (American Association of Colleges of Nursing [AACN], 2008) and human flourishing, nursing judgment, professional identify, and a spirit of inquiry (National League for Nursing, 2011). However, Benner, Sutphen, Leonard, and Day (2010) contend that there is a significant gap between the competencies needed for contemporary nursing practice and the way that nurses are currently educated. Taskoriented education no longer adequately prepares nurses to meet the complex demands of practice and changing health care industry. Therefore, it is essential that every facet of nursing education be examined to determine how it contributes or hinders development of explicit characteristics that will reinforce the competencies necessary to meet the new challenges put forth by the IOM (2011) report. Effective response to these challenges will require that an individual outcome of nursing education include the capacity to perceive, facilitate,
understand, and manage the interactivity of human systems, and this is particularly true for successfully caring for the emotional responses of patients and families facing changes in their health. These abilities, integral to EI, are important to the achievement of the broader goals presented by IOM (2011), but there is no more important goal than to provide a foundation to achieve the goal for nurses to lead interdisciplinary teams in creating lasting change in the health care system (Shanta & Connolly, 2013). Although Mayer and Cobb (2004) contended that one may be able to accelerate or enhance innate EI abilities through education, it is unclear if the current manner that nurses are educated influences the level or relates to EI at all. Unfortunately, the concept of EI has been discussed through different models (discussed in the theoretic discussion), which clouds evidence of defining the importance of EI in nursing. In general, the literature has described the value of EI in relationship to understanding the link between one's own emotion, personal coping, and resulting judgment. Mayer and Cobb (2004) argued that EI contributed to the development of desirable characteristics such as caring and empathy, because it is through learning from the affective dimension that individuals develop skills linked to caring behavior (Benner, 2001; Goleman, 1995; Mayer & Cobb, 2004). Nevertheless, the work of nursing requires highly developed cognitive abilities for effective clinical judgment (Benner et al., 2010). As an example of how a nurse with a high level of EI might improve care can be illustrated by the following scenario, which demonstrates the combination of the first two abilities of EI. In this instance, the nurse accurately perceives a patient's emotional expression of anger and irritability in reaction to a poor prognosis as resulting from true emotions of sadness, fear, and grief that underpin the emotion experienced by the patient. The nurse uses this knowledge to stimulate his or her own creative thinking to generate an empathetic response. These abilities of EI are not empathy by themselves; however, they are important to an empathetic response because the combination of these abilities supports the ability of one to recognize and recreate another's experience within oneself. This ability may be a central quality of an emotionally intelligent individual. It is clear that nurses must possess an integration of the ability to use cognition to reason about the emotional needs of patients while also using highly technical knowledge toward providing care in an ethical manner (Benner et al., 2010). Over the past decade, nursing literature has provided varied levels of evidence in support of the importance of individual nurses possessing the ability to understand the information behind personal emotions and emotions conveyed by others. The evidence has been in the form of expert opinion and variable research findings. Themes found in the current nursing research included findings of nurses with high EI having an enhanced capacity to meet the multifaceted demands of practice (Beddoe &
THE IMPACT OF NURSING EDUCATION ON DEVELOPMENT OF EMOTIONAL INTELLIGENCE
Murphy, 2004; Doherty, 2009; Lucas, Laschinger & Wong, 2008; Morrison, 2008; McQueen, 2004; Patterson & Begley, 2011; Smith, Profetto-McGrath, & Cummings, 2009; Vitello-Cicciu, 2003; Young-Ritchie, Laschinger, & Wong, 2009), and this higher level of EI in the nurses may result in improved patient outcomes (Adams et al., 2010; Bailey, Murphy, & Porock, 2011; Codier, Muneno, & Franey, 2011; Codier, Muneno, Franey, & Matsuura, 2010; Davies, Jenkins, & Mabett, 2010; Kooker, Shoultz, & Codier, 2007). In spite of these findings and conclusions, current nursing research related to EI still presents an unclear picture of the relationship of EI and nursing practice because studies have used inconsistent models of EI, thereby making critical analysis between studies difficult. The upcoming theoretical section will discuss the variation in models of EI in detail.
Theoretical and Conceptual Discussion The literature related to EI as an area of research has spanned the past 20 years. The first decade of research was dedicated to conceptual and theoretic testing of the EI models. Two distinct models emerged from this early work, and researchers have labeled the mixed model and the abilities model. The mixed model merges social proficiency, behavior, and personality traits with emotional competencies (Matthews, Roberts, & Zeidner, 2003). An example of this model was Goleman's efforts to popularize the concept of EI in his bestselling book Emotional Intelligence (1995). His conceptual definition involved self-control, zeal, persistence, and motivation. Bar-On (2000) also used the mixed model for EI, although he defined EI as noncognitive abilities that influence one's ability to handle demands and pressure. Salovey and Mayer (1990) pioneered the abilities model of EI. These researchers constructed this model from the premise that most of life's tasks and challenges are loaded with affective information, which are different than purely cognitive information. This model of EI is composed of four distinct branches of abilities. The four abilities include (a) perceiving, (b) using emotion for effective thinking, (c) cognitively understanding emotional information, and (d) managing emotional responses within oneself and others. The abilities model of EI has undergone rigorous testing and refinement that have substantiated validity through a variety of disciplines (Budnik, 2003; Farmer, 2004; Pellitteri, 2002, Poon Teng Fatt, 2002, Salovey, Stroug, Woolery, & Epel, 2002; Vitello-Cicciu, 2003). Researchers developed and tested a tool to measure EI based on the abilities presented in this model, the Mayer– Salovey–Caruso Emotional Intelligence Test (MSCEIT; Mayer, Salovey, Caruso, & Sitarenios, 2003). The MSCEIT produces several levels of scores used to determine the level and area of an individual's EI. The most valid levels of the MSCEIT results are (a) global EI score that is contingent on the score of all other level scores, (b) two area scores (experiential and strategic) that are each dependent on the combination of two branch scores, and (c) four branch scores (perceiving
emotions, using emotions, understanding emotions, and managing emotions) that represent each of the four abilities making up the model. Similar to other disciplines, nursing research and literature have not demonstrated use of a consistent model of EI. These differences in the models used for research pose challenges when making theoretic connections between studies. Nonetheless, nursing literature has argued the conceptual importance of EI to nursing practice from a variety of established EI frameworks (Beddoe & Murphy, 2004; Doherty, 2009; McQueen, 2004; Olsen, 2001; Patterson & Begley, 2011; Shanta & Connolly, 2013; Smith et al., 2009). Admittedly, the use of inconsistent models of EI in nursing research presents a challenge to making consistent conclusions; still, there is evolving evidence in the nursing literature to support the conceptual discussion. Studies linking nursing and EI have found a positive relationship toward outcomes of nursing practice (Lucas et al., 2008; Vitello-Cicciu, 2003; Young-Ritchie et al., 2009.) Other work explored the relationship between EI and conflict, stress, and burnout in staff nurses (Budnik, 2003; Farmer, 2004; Morrison, 2008). Additional studies are beginning to identify EI as an essential component for nursing care of patients (Bailey et al., 2011; Codier et al., 2010; Codier et al., 2011; Davies et al., 2010; Kooker et al., 2007). Although there is agreement that EI is important for nurses to possess, it is less obvious in the nursing literature as to how nurses develop EI or how nursing education might influence development of it prior to nurses working in the field. Four studies investigated nursing education to EI (Augusto Landa, Lopez-Zafra, Aguilar-Luzon, & Salguero de Ugarte, 2009; Faralli, 2009; Jenkins, 2006; Suliman, 2010). These studies approached the concept with varied purposes, models, and methods and without any consistent findings. Studies about nursing education and EI that were structured by the abilities model and which used the MSCEIT in the data collection focused on validating the tool in cross cultural nursing students (Ma, Tsai, Chang, & Lane, 2010), and faculty EI and empowerment of students (Jenkins, 2006). A search of the literature found only one study that investigates the influence of baccalaureate nursing education on scores of EI. Benson, Ploeg, and Brown (2010) used a self-report questionnaire based on the mixed model of EI to study if there was a difference among students across the program (Years 1 and 4). Although all students scored at a level indicating effective social functioning, Year 4 students scored significantly higher in the interpersonal and stress management subscales. The literature did not provide insight into the influence of nursing education and the development or improvement of the nursing student's ability to perceive, use, understand, or manage emotions. In the previous review of literature that relates nursing, EI is thought provoking, and yet there are more questions than answers. Not only does it remain unclear how nurses develop or increase the level of EI, but the inconsistency of
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models (mixed vs. abilities) used in the research has increased the difficulty in comparing results between studies. Nursing practice requires a blend of strong intellectual and relational skills that will support clinical judgment and ethical comportment (Benner et al., 2010), and these skills are purported to be part of the abilities model of EI. Because of the essential need for this integration of cognitive knowledge, relational communication, and ethical comportment, this study design was based on the abilities model and used the MSCEIT to collect data relative to the participants level of EI.
Methodology Research Question The theoretical proposition that EI increases with education served as the underpinning for the following research question. Specifically, this study examined the impact of extended nursing education as the “dosage” on the rate of raising EI in nursing students. The definition of dosage was exposure to a curriculum directed specifically toward professional values and caring of the patient. The implication is that a higher dosage of curriculum within a baccalaureate nursing program ought to have a positive effect on change in a student's EI level. This article focuses on the following research question from the greater study: • Does baccalaureate level nursing education predicated upon The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998) increase an individual's level of EI at a higher rate than general education as operationalized by abilities defined by Mayer and Salovey's (2004) four-branch abilities model? Research Design. The research design utilized a quasiexperimental between-groups comparison research design that functioned as a quasi-longitudinal study to examine the hypothesis and research question. Quasiexperimental research design uses control and experimental groups that are available to a researcher (Creswell, 2003). Two academic majors (education and nursing) were divided into four groups to represent a premajor group and a senior major group in each discipline. The experimental group was composed of a group of seniorlevel college students completing a nursing major. The educational major was chosen as a comparison college program because of similar demographic and social characteristics between those studying education and nursing. Nursing education served as the treatment applied to the experimental group. The dependent variable was the level of EI as measured by the most current version of the MSCEIT (Mayer et al., 2003). Figure 1 depicts the theoretical relationships of the variables. Three Midwestern universities (two public and one private) were included as sites for research subjects. All three universities supported programs within their organizational structures that included colleges or departments of nursing and teacher education. Institutional review
board (IRB) from each of the universities approved the study prior to recruitment. North Central Association Commissions on Institutions of Higher Education accredited all three universities. The Commission Collegiate Nursing Education accredited all three nursing programs, and the National Council for Accreditation of Teacher Education accredited the education major programs. It is noteworthy to mention that there was a possibility that characteristics between the two professional majors might differ based on admission tests and course preadmission criteria differences. The grade point average (GPA) admission criteria of the three institutions ranged from 2.50 to 3.0 out of a 4.0 system. In reality, all of these programs had more applicants than available slots for student admissions, which may have served to inflate the average GPA of the senior nursing.
Subject Recruitment and Protection Following IRB approval from each institution involved, a third party at each university and within each department recruited subjects by e-mail. This method was utilized because it was assumed that a familiar person might increase student response to the invitation to participate. Informed consent was provided in the invitation e-mail that was sent by the contact person, and again, consent was assumed when an individual participated by submitting data. Recruitment and data collection occurred over two semesters to obtain a sufficient sample size. Unfortunately, because of the third-party recruitment method, the researcher was unable to determine response rate.
Study Design The study design used convenience sampling of college students representing both genders from one of the three previously described universities. The design divided the sample, and four groups were formed based on the level of college study at which each participant claimed to be. • Control group 1 included students with a declared interest in an education major, but without being officially admitted to the major (n = 37). • Control group II was composed of college-level senior students completing a bachelor's degree in education (n = 28). • Control group 3 was incoming with a declared interest in a nursing major, but without official admission to the major (n = 119). Neither Group 1 nor Group 3 had any professional courses beyond a brief career exploratory course. • Group 4 was designated as the experimental group and was composed of students who were completing a bachelor's degree in nursing (n = 67). The contact person e-mailed an invitation to participate to students within the specific institution and program. The e-mail contained links to the demographic questionnaire. The participants received a 16-digit identifier to link the demographic data and MSCEIT scores of each individual.
THE IMPACT OF NURSING EDUCATION ON DEVELOPMENT OF EMOTIONAL INTELLIGENCE
Figure 1. Theoretical relationship of variables.
Demographic data collection included level of college, discipline of study or intended study, selfreported GPA, age, gender, prior knowledge of EI, and previous health care experience. GPA was an important variable to explore because cognitive processing of emotional information has been shown to be related to general intelligence (Mayer & Salovey, 2004). Likewise, the potential influence of age was important to control for because EI has been found to increase with age (Mayer, Caruso, & Salovey (1999). By using GPA, age, and gender, as well as level in college and choice of major, the design attempted to identify and predict the strongest relationships between these independent variables with the dependent variable of EI and provide for control of potential of differences between the groups. The level of EI was measured through the current version of the MSCEIT, which is a 141-item scale that is designed to measure eight task scores, four distinct branches, two areas, and total scores of EI (Mayer et al., 2003). The MSCEIT developers recommended test interpretation at the full-scale, area, and branch labels for the highest level of reliability and validity (Mayer et al., 2003). Various studies have demonstrated that the MSCEIT has demonstrated reliability and validity particularly at the total EI score level (r = .93), the experiencing area level (r = .90), and strategic area level (r = .88). The branch level, although some demonstrated slightly lower reliabilities, is sufficient: (a) perceiving emotions (r = .91), (b) facilitating thought with emotion (r = .79), (c) understanding emotions, and (d) managing emotions (r = .83; Mayer et al., 2003).
Analysis and Results Demographic Results. Data were available for 251 cases, for which data were available for analysis. Frequency and percentages for gender, age, and self-reported composition of the groups are displayed in Tables 1 and 2. There were several expected findings. Typical of nursing and education, most of the participants were female (85%). As expected, the age variable was significantly skewed because most of the participants were traditional college age, and only 12 respondents (5%) were 40 years or older. The data were not transformed because age was a theoretically significant variable in relationship to developing EI (Mayer et al., 1999). The senior nursing students demonstrated a higher self -reported GPA than any of the other groups (Table 2). Table 3 presents additional demographic data from the sample as a whole related to the variables of health care experience and selfestimated knowledge of EI. Comparison of Demographics Among the Four Groups. Age presented as a significant, although not unexpected, difference between groups of increasing progression in a college program, F(3, 247) = 10.63, P b . 001. The post hoc means comparison test indicated that prenursing (M = 20.49) differed from the senior education (M = 23.07) and senior nursing (M = 24.04) groups and the pre-education (M = 20.84) group differed from the senior nursing students. Self-estimated GPA also differed significantly, F(3, 234) = 4.98, P b .01. Post hoc means comparison tests indicated that the senior nursing
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Table 1. Frequencies and Percentages for the Gender and Education Group Variable Gender Female Male Education group Pre-education Pre-nursing Education senior Nursing senior
37 119 28 67
14.7 47.4 11.2 26.7
students had higher estimated GPAs (M = 3.52) than prenursing students (M = 3.30) and pre-education students (M = 3.23), which was significant at P b .05. This result was also not surprising because although the pre-nursing and pre-education students have declared their intended major, they have not been admitted to the desired major. In fact, a low GPA often prevents acceptance into the desired major. A Kruskal–Wallace test was performed to assess differences between the groups related to experience in health care and knowledge of EI. A significant difference in health care experience between the four groups was detected (P b .001; Table 4). No significant differences emerged between the groups in terms of knowledge of EI. The comparison analysis explored the influence of nursing education on the level of EI of the student participants in this study. Table 5 displays means and standard deviation for the entire sample on all measures of EI. One-way analysis of variance (ANOVA) along with post hoc means comparison tests (Bonferroni adjusted) were performed to examine the mean differences in these test scores based on the education group, specifically whether senior nursing students scored higher or lower than students in the pre-nursing, pre-education, or education seniors group did on overall EI, the area scores, and/or the four branch emotion scales. ANOVA results revealed that there are no significant differences between the mean scores of the senior nursing students and students in any of the other education groups for overall EI, experiential area, and branches of perceiving, using, and managing emotions. However, a significant mean difference on the reasoning area score, F(3, 246) = 2.97, P b .05, was identified. Post hoc means comparison tests revealed that senior nursing students scored an average of 6.23 points higher on this measure (M = 98.74) than did pre-nursing students (M = 92.51), which was significant at P b .05. Likewise, a significant mean Table 2. Descriptive Statistics Groups
Age, M (SD)
Pre-education Pre-nursing Education senior Nursing senior Total sample
20.84 (5.24) 20.49 (4.19) 23.07 (2.93) 24.04 (4.78) 21.78 (4.65)
Self-reported GPA (SD) 3.23 (.59) 3.30 (.44) 3.41 (.38) 3.52 (.31)
Table 3. Frequency and Percentage for Experience in Health Care and Knowledge of EI Variable Experience in health care None b 1 year 1–2 years N 2 to b 5 years N 5 years Knowledge of EI None Little Moderate Much Extensive
87 65 45 31 23
34.7 25.9 17.9 12.4 9.2
33 100 92 23 3
13.1 39.8 36.7 9.2 1.2
difference on the understanding emotion branch emerged. Post hoc means comparison tests revealed that senior nursing students scored 6.56 points higher on this measure (M = 98.01) than did the pre-nursing students (M = 91.45), which was significant at P b .01. These same statistically significant differences were not detected on this measure between senior nursing students and pre-education students and between senior nursing students and education seniors. Although there was not a significant difference detected in the branches of the EI model during the ANOVA comparing the senior nursing students with the other groups, an analysis that regrouped the students as preprofessional and senior professional detected significance in the branches of perceiving and understanding. Therefore, as a final exploratory analysis to determine possible differences between pre-nursing students and nursing seniors, a t test was completed to examine differences between the means of the perceiving emotion of pre-nursing students (M = 102.16) and senior nursing students (M = 97.46). Significance was identified, (184) = 2.04, P = .045. The same significance was not found comparing means for the perceiving branch of the pre-education students (M = 100.31) to the education seniors (M = 96.55). These analyses indicated three significant differences between pre-nursing students and nursing seniors. However, there were no significant findings of differences in any area between senior nursing students and any level of education student on the ANOVA. Correlational Analysis of Possible Influencing Factors. Linear regression analysis assessed the extent to which education group, age, gender, self-estimated GPA, experience in health care, and knowledge of EI contributed to variance in overall EI (Table 6). The total percentage of variance explained in overall EI with this model was .04, which is rather low and suggests that some of the predictors were unsuccessful in accounting for the variance explained in overall EI. The single-best predictor of overall EI was self-estimated GPA, which, when added to the model at Step 4, significantly increased
THE IMPACT OF NURSING EDUCATION ON DEVELOPMENT OF EMOTIONAL INTELLIGENCE
Table 4. Pairwise Comparison of Group Experience in Health Care Pre-nursing
Pre-nursing Pre-education Education senior
P = .005 ns
P b .001 P b .001
P = .005 P b .001
the percentage of variance explained to .041 (R 2change), with Fchange significant at .002. R 2change provides the percentage by which R 2 increases from step to step. The addition of experience in health care at Step 5 increased the percentage of variance explained by .014, although the Fchange statistic did not quite reach statistical significance (P b .10). The linear regression analyses assessed the extent to which gender and education group contributed to the variance explained in each of experiential area (1) and reasoning area (2) scores. Table 7 displays the results of this analysis. The education group was a successful predictor of variance when added as Step 2. The education group variable increased the percentage of variance explained to .33 (R 2change, with Fchange significant at .004. In this model, β = .18 for education group, with t significant at P b .01. Since education group was coded 1, 2, 3, and 4, and β is positive, this signifies that as education group increases (as the numeric codes for education group change from 1 to 4), there will be an increase of .18 in Area 2 score. That is, as the level of student changes from pre-nursing to senior nursing, the reasoning area (2) score will increase by a rate of .18.
Discussion and Implications The purpose of this article was to report specific results about the influence of nursing education on the development or increase of EI. This article presents findings of a study that explored how general undergraduate education and specifically nursing education would influence EI (Shanta, 2007). The results of this study failed to reveal significant differences in the abilities of senior nursing students compared to the three control groups in the scores for overall EI, the experiential area, and using and managing emotions. In fact, there were no significant differences found between senior nursing students and any level of the education student and thus did not
Table 5. Means and Standard Deviation for MSCIET Scores Variable
Overall EI Area score experiencing Area score reasoning Perceiving emotions Using emotions Understanding emotions Managing emotions
96.53 100.39 94.82 100.00 100.87 93.84 99.43
15.15 16.19 13.85 15.58 16.40 12.92 16.17
Table 6. Summary of Regression Analysis on Overall EI Variable Overall EI (total R 2 = .04) Step 1 Education Group Step 2 Age Step 3 Gender Step 4 GPA Step 5 Health care Experience Step 6 EI Knowledge *
Fchange Significance R 2change
.21 3.28 *
P b .01.
provide any evidence that nursing education increased EI over the level of other undergraduate education. The exact mechanism that increased the level of understanding and reasoning about emotions was not part of the aims for this study. The design of the study was not sufficient to determine the cause of lowered scores on perceiving emotion. However, the study examined other possible influencing factors: (a) GPA, (b) health care experience, (c) knowledge of EI theory, (d) gender, and (e) age. Regression analysis found that GPA predicted the greatest variance in the overall level of EI. In effect, as the GPA raised, so did the overall score of EI by 0.21. Nursing seniors also had significantly higher GPA reports than pre-nursing or pre-education. This finding supports the theoretical construct that cognitive strength is an underpinning of the abilities model. It may also provide some level of reassurance to those who expressed concern about the lack of emphasis on the intellectual demands for effective nursing practice (Benner et al., 2010). In addition, the findings have practical significance in that, as policy makers become more concerned with the nationwide and global nursing shortage, nursing education programs may be pressured to accept students with lower GPAs. The danger with a trend such as that is not only that students with less cognitive ability will graduate, but also with lower levels of EI. Further research is necessary to explore the relationship of requirements for minimum average GPA for admission to a professional nursing program and the ultimate successful transition to practice. Moreover, perhaps the level of EI should also be a component to be considered along with the GPA when faculty and administration of nursing programs make admission decisions. The purpose of this study focused on the possible relationship of nursing education on the development of abilities to perceive emotion, use emotion for thinking, understand emotional information, and to manage emotions. These abilities are components of the abilities
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Table 7. Summary of Regression Analysis on Area 1 and Area 2 Scores Variable
Area 1 score * Area 2 score Step 1 Gender – Step 2 Education group .18 2.93 **
* Neither gender nor education group predicted variability in Area 1 score. ** P b .01.
model of EI (Mayer & Salovey, 2004). Essentially, this study sought to test if nursing education predicated upon The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) increased the abilities related to EI. Three significant results did emerge between senior nursing student scores and those of prenursing students. Specifically, senior nursing students scored significantly higher on the reasoning area and understanding emotion branch, whereas the pre-nursing students scored significantly higher on the perceiving emotion branch compared to senior nursing students. Nursing seniors, when studied as a group, had a higher level of reasoning about emotion. This was particularly the case when it came to understanding emotion. This finding is not an unexpected result of nursing education because understanding and reasoning about complex emotions are crucial for nurses to develop during their education for effective management of interpersonal relationship (Benner et al., 2010; King, 1981). Nevertheless, the finding that pre-nursing students scored significantly higher on the perceiving emotion branch compared to senior nursing students may have even greater implication and meaning for nursing education. This finding is troubling because nursing education is designed to prepare the individual for effective nursing practice. Perception was one of two vital skills necessary for management of highly emotional situations and believed to allow the nurse to focus on patients' needs (King, 1981) and nurses need to be able to realize how a patient's response to health changes influences delivery of effective patient care (Benner et al., 2010). The perception of these needs should then generate empathy (Holm, 1997; Jackson, 2004; Olsen, 2001). Beddoe and Murphy (2004) declared that nurses use empathy in health care to recognize and respond to patients' emotions during illness. Unfortunately, aligned with the findings from this study showing a decline in the senior nursing student's ability for accurately perceiving emotion, other research has identified decreased empathy associated with progression in nursing education programs (Holm, 1997; Ward, Cody, Schaal, & Hojat, 2012). In addition, Benner et al. (2010) asserted that it is through relational interaction that nurses become effective members of the interdisciplinary teams. The ability to accurately perceive and evaluate emotions within oneself and within others in the health care team is
essential if nurses are to become influential and lead the transformation of health care, as is called for by the IOM, (2011) report. Nurses are called to lead collaborative teams to expand redesign of health systems and practice environments (IOM, 2011). The literature review completed for this study did not identify nursing research that provided evidence of how to help nursing students develop or improve the abilities of EI within a professional nursing program. Although there is insufficient research on ways to improve EI in students, it is an area that is important for nurse researchers and nurse educators to partner with a goal to find effective ways to improve emotional competence in nursing students to contribute to the solution for health care. Furthermore, it is imperative that the curricular structure of nursing education provide opportunities for students to use their emotional knowledge in learning how to induce empathy and promote therapeutic relationships with patients (Yorks & Sharoff, 2001) and to build their ability to interact effectively with their colleagues (Benner et al., 2010; King, 1981). Ultimately, the position of nurse as leader of the health care team will require that nurses possess highly developed abilities of dealing with emotional information. EI provides the foundation for a nurse to develop interpersonal skills that will allow the nurse to develop effective relationships with the patient, the family, and other members of the health care team.
Limitations This study was limited primarily by the convenience sampling that was conducted over two semesters through third-party contact, which diluted research control of sampling procedure. In addition, differences in the size of groups also presented limitations for this study. The size difference between the education and gender groups made statistical analysis difficult, and, in several instances, inconsistency in the group sizes could have resulted in the findings that neared significance.
Recommendations for Future Research It remains unclear how baccalaureate nursing education contributes or hinders the development of EI. However, given the prospect that improved patient outcomes occur when nurses possess higher levels of EI, it is appropriate to extend the understanding of the influence that nursing education has on the development of this characteristic. Further, future studies are needed to add knowledge about the relationship of baccalaureate nursing education and EI. Specifically future research is needed to explore if nursing education can assist those entering with lower levels of EI to improve their ability to accurately perceive and use emotion for improved creative thinking and to understand and manage emotions. A longitudinal study would address the limitations inherent in a crosssectional research design, as the pretest/posttest would more clearly identify the impact of nursing education on the changes of individual levels of EI.
THE IMPACT OF NURSING EDUCATION ON DEVELOPMENT OF EMOTIONAL INTELLIGENCE
Finally, this article focused on the impact of nursing education and the development of EI. The study did not explore gender differences in the context of group comparisons. However, other exploratory work found gender differences where females scored significantly higher in managing emotions than males (Shanta, 2007). Therefore, given the increased number of males entering nursing, it will be important to study gender differences in the development of EI through nursing education. By clearly identifying the influence nursing education currently yields on the development of EI, it may be possible to develop interventional studies to support innovative models of nursing education that will increase EI and, ultimately, the integration of the affective and cognitive abilities necessary for modern health care.
Conclusions The picture of a relationship between EI and nursing practice is only beginning to emerge; nevertheless, current literature provides a compelling reason to pursue this area further. If we are to address the call for transformation of nursing education (Benner et al., 2010) with the ultimate goal to meet the recommendations of the IOM for the advancement of nursing profession, we must explore all facets of the way nurses are prepared for practice. More questions emerged from the findings of this study than were answered. The current nursing environment is one in which the technical knowledge required of nurses presents barriers to connection with the holistic curricula that has been embraced by nursing literature (Espeland & Shanta, 2001). Specific skills that translate to caring must be attained for an individual to generate empathy (Mathews, Zeidner, & Roberts, 2002). Benner (2004) argued that skills necessary for emotional engagement must be developed over time and with experience. Clearly, development of competencies necessary for nursing practice must begin in the way nurses are educated. Given the findings from this study, in which senior nursing students' demonstrated strength in their ability to reason, and their decline in the ability to perceive emotion, nursing educators will need to return to the foundations of nursing to reinvest in specific components necessary for empathetic care by the professional nurse. However, it is not sufficient to concentrate on the caring aspect of nursing without addressing the fundamental cognitive element necessary for clinical reasoning and ethical comportment essential for transformed nursing practice (Benner et al., 2010). Nursing education must be designed through the integration of emotional competence and rigorous cognitive engagement. The abilities model of EI may provide a framework by which nursing education will be a pivotal process where nursing students can more fully acquire competencies needed for both essential aspects of nursing practice.
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