Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimension-level exploratory study among public hospitals in Malaysia Devinder Kaur, Murali Sambasivan, Naresh Kumar PII: DOI: Reference:

S0897-1897(15)00044-0 doi: 10.1016/j.apnr.2015.01.006 YAPNR 50622

To appear in:

Applied Nursing Research

Received date: Revised date: Accepted date:

26 July 2014 25 December 2014 7 January 2015

Please cite this article as: Kaur, D., Sambasivan, M. & Kumar, N., Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimension-level exploratory study among public hospitals in Malaysia, Applied Nursing Research (2015), doi: 10.1016/j.apnr.2015.01.006

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Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimension-level

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exploratory study among public hospitals in Malaysia

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Devinder Kaur , Murali Sambasivan , Naresh Kumar

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Asia Pacific University of Technology and Innovation, Bukit Jalil, Malaysia

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Taylor’s Business School, Taylor’s University Lakeside Campus, Subang Jaya, Malaysia

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Global Entrepreneurship Research and Innovation Center, Universiti Malaysia Kelantan

*corresponding author Email: [email protected] Phone: 0060129350065

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Abstract

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Purpose. The purpose of this research is to study the impact of individual factors such as

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emotional intelligence (EI) and spiritual intelligence (SI) on the caring behavior of nurses. Methods. A cross-sectional survey using questionnaire was conducted by sampling 550 nurses

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working in seven major public hospitals in Malaysia. Data were analyzed using structural

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equation modeling (SEM). Results. The main findings are: (1) Critical Existential Thinking and Transcendental Awareness dimensions of SI have significant impacts on Assurance of Human

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Presence dimension of caring behavior; (2) Personal Meaning Production and Conscious State Expansion dimensions of SI have significant impacts on Perception of Emotion and Managing

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Own Emotions dimensions of EI; and (3) Managing Own Emotions dimension of EI has significant impacts on Respectful Deference to Other and Assurance of Human Presence

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dimensions of caring behavior of nurses. Conclusion. The results can be used to recruit and

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educate nurses.

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Keywords: emotional intelligence, spiritual intelligence, caring behavior, nurses, Malaysia

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Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a

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dimension-level exploratory study among public hospitals in Malaysia

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Abstract

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Purpose. The purpose of this research is to study the impact of individual factors such as emotional intelligence (EI) and spiritual intelligence (SI) on the caring behavior of nurses.

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Methods. A cross-sectional survey using questionnaire was conducted by sampling 550 nurses working in seven major public hospitals in Malaysia. Data were analyzed using structural

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equation modeling (SEM). Results. The main findings are: (1) Critical Existential Thinking and Transcendental Awareness dimensions of SI have significant impacts on Assurance of Human

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Presence dimension of caring behavior; (2) Personal Meaning Production and Conscious State

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Expansion dimensions of SI have significant impacts on Perception of Emotion and Managing Own Emotions dimensions of EI; and (3) Managing Own Emotions dimension of EI has

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significant impacts on Respectful Deference to Other and Assurance of Human Presence dimensions of caring behavior of nurses. Conclusion. The results can be used to recruit and educate nurses. Keywords: emotional intelligence, spiritual intelligence, caring behavior, nurses, Malaysia

1.0 Introduction Nurses are among one of the largest groups of health care providers. As pivotal figures in patient care who interact with patients more frequently than other health care providers, nurses have a major caring role (Khademian & Vizeshfar, 2008). Nurses spend more time with hospitalized

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patients than do other groups of health care providers and therefore have a significant impact on patients’ perceptions about their hospital experience. They are present 24 hours a day, seven days

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a week regardless of the physical setting in a hospital (Nussbaum, 2003). Therefore, caring behavior of nurses contributes to the patients’ satisfaction, well-being and subsequently to the

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performance of the healthcare organizations.

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Literature suggests that (1) antecedents of caring behavior have not been identified and investigated extensively (Kaur et al., 2013; Rego et al., 2010) and (2) individual factors have a

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telling effect on the work outcomes (Kaur et al., 2013). This study considers emotional intelligence (EI) and spiritual intelligence (SI) as two important individual factors that affect

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caring behavior of nurses. Greenhalgh et al. (1998) defines caring behaviors as “acts, conduct and mannerisms enacted by professional nurses that convey concern, safety and attention to the

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patient” (p. 928). The dimensions of caring behavior are: (i) respectful deference to other

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(RDO), (ii) assurance of human presence (AHP), (iii) positive connectedness (PC), and (iv) professional skill and knowledge (PSK) (Wu et al., 2006).

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Emotional Intelligence is a key component of competent nursing practice (Akerjordet & Severinsson, 2007; Warelow & Edward, 2007) and it enables a nurse to think and function in a constructive and rational way in the clinical setting (Akerjordet & Severinsson, 2007; Kaur et al., 2013). Sumner and Townsend-Rocchiccioli (2003) have asserted that the ability to effectively manage one’s own and others’ emotions is critical to the provision of excellent patient care. Therefore, EI can have a significant impact on the caring behaviors of nurses. Despite the theoretical support, empirical studies that link the concept of EI and caring behaviors are scarce (Akerjordet & Severinsson, 2007; Kaur et al., 2013; Rego et al., 2010). Spirituality is seen as an inherent aspect of human nature and is considered as the source

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of all thoughts, feelings, values and behaviors of individuals (Hosseini et al., 2010). The concept of spirituality is important and forms the basis of nursing actions (van Leeuwen & Cusveller,

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2004). However, very few empirical studies have provided supporting evidence that spirituality is correlated with the caring behaviors of nurses (Kaur et al., 2013). In this research, SI is defined

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as “as a set of mental capacities which contribute to the awareness, integration, and adaptive application of the nonmaterial and transcendent aspects of one’s existence, leading to such

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outcomes as deep existential reflection, enhancement of meaning, recognition of a transcendent

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self, and mastery of spiritual states” (King & DiCocco, 2009: p. 69). The contributions of this research are twofold. First, this study extends existing research

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about EI and SI and is one of the very few studies that empirically examine the influence of dimensions of SI on the dimensions of EI. The results can enrich the theories related to EI and

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SI. An earlier study by Rego et al. (2010) has studied the impact of dimensions of EI on caring

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behavior of nurses. A recent study by Kaur et al. (2013) has studied the impact of SI, EI, burnout, and psychological ownership on the caring behavior of nurses. However, the authors

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have studied the relationships at the construct level. This research analyzes (1) the impact of the dimensions of EI and SI on the dimensions of caring behavior of nurses and (2) interrelationships between the dimensions of EI and SI. Second, this research has been carried out in a fast developing country in South-east Asia, Malaysia. Specifically, the samples were taken from seven large public hospitals. Studies from this part of the world are a rarity. 2.0 Hypotheses development 2.1 SI and EI Many researchers have argued SI as a core ability that penetrates into and guides other abilities (Ronel & Gan, 2008). Specifically, some authors have asserted that SI influences EI (Hosseini et

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al., 2010; Zohar & Marshall, 2000). The four dimensions of SI (King & DeCicco, 2009) are: (i) critical existential thinking (CET), (ii) personal meaning production (PMP), (iii) transcendental

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awareness (TA), and (iv) conscious state expansion (CSE). The four dimensions of EI (Schutte et al., 1998) are: (i) perception of emotion (PE), (ii) managing one’s own emotions (ME), (iii)

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managing other’s emotions (MOE), and (iv) utilization of emotion (UE). Based on the definitions by King and DeCicco (2009: p. 70), it is argued that CET (capacity to critically

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contemplate meaning, purpose and existential issues), PMP (ability to construct personal

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meaning and purpose in all experiences), TA (capacity to perceive transcendent dimensions of the self, others and of the physical world) and CSE (ability to enter spiritual states of

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consciousness at one’s own discretion) help nurses understand and manage their own and other’s emotions and utilize them in a manner that benefits the patients. Therefore, the hypothesis is as

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follows:

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H1: SI and its dimensions have positive relationships with EI and its dimensions. 2.2 SI and caring behavior of nurses

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According to Kaur et al. (2013), spirituality and nursing “have been linked since the origins of the nursing profession” (p. 3194). The nature of nursing profession is such that the nurses are constantly bombarded by stressors at work and the environment. When stressors are at work it has been shown that the dimensions of SI can help reduce the negative impact of the stressors (King & DiCocco, 2009). This in turn helps nurses provide better care to the patients. Therefore, it is argued that SI and its dimensions have a positive impact on the caring behavior of nurses and the hypothesis is as follows: H2: SI and its dimensions have positive relationships with caring behavior of nurses and its dimensions.

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2.3 EI and caring behavior of nurses According to Rego et al. (2010), researchers have suggested that “EI is crucial for building,

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nourishing, and sustaining the emotionally demanding labor that nurses are required to carry out

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in their interactions with patients” (p. 1421). Therefore, nurses with high levels of EI can provide

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better care to the patients (Akerjordet & Severinsson, 2007). These arguments lead to the

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following hypothesis:

H3: EI and its dimensions have positive relationships with caring behavior of nurses and

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its dimensions. 3.0 Method

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Seven large public hospitals located in and around Kuala Lumpur, capital of Malaysia were chosen for the study. These hospitals have a total capacity of 6194 beds and employed 7446

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nurses in different departments such as general surgical, general medical, pediatrics, obstetrics

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and gynecology, and orthopedics. A questionnaire was designed that captured the demographic characteristics of nurses, three constructs (SI, EI, and caring behavior of nurses) and their

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dimensions. A sample of 550 was selected at random from the seven public hospitals in different departments and the questionnaires were distributed through head nurses. The permission to conduct the study was obtained from the Ethics and Research Committee of Ministry of Health (Malaysia) to conduct the study. The letter from the ministry helped the researchers gain access to the hospitals. The nurses were told that they were under no obligation to participate in the study and they contributed to the study of their own volition. 3.1 Measures The questionnaire designed for the study consisted of four sections to capture the three constructs and the demographic information. The questionnaire items were made available in English and

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Bahasa Malaysia (national language of Malaysia). The back-to-back translations were checked by the experts and subsequently by the Ethics and Research Committee of Ministry of Health.

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Section One captured EI, and the scale with 33 items developed by Schutte et al. (1998) [Schutte Self-Report Emotional Intelligence Test (SSEIT)] was adopted in this study. Section Two

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captured SI, and the scale with 24 items developed by King and DeCicco (2009) [Spiritual Intelligence Self-Report Inventory (SISRI)] was adopted in this study. Section Three captured

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caring behaviors of nurses, and the scale with 24 items developed by Wu et al. (2006) was

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adopted in this research. Section Four captured the demographic data. Besides, this study also captured the patient satisfaction with overall nursing care to validate the findings on the nurses’

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own perception of their caring behaviors. This scale contained three items and was adopted from the study by Otani et al. (2010). Written permissions were obtained from all the authors before

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using their scales.

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3.2 Handling common method bias

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According to Podsakoff et al. (2003), common method bias is the bias that is “attributable to the measurement method rather than to the constructs the measures represent” (p. 879). Our research obtained responses on SI, EI and caring behavior from one source, namely nurses. Seeking responses from one source can potentially introduce error in the form of bias in our results (Conway & Lance, 2010). Therefore, we used Herman one-factor method to assess if common method bias is a cause of concern in our research. We loaded all the items (33 items of EI, 24 items of SI, and 24 items of caring behavior) on a common factor using Exploratory Factor Analysis and observed that the total variance explained was 18.4%. This is less than the maximum 50% suggested by Podsakoff et al. (2003) and therefore, we conclude that the effect

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due to common method bias is not significant. 4.0 Results

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A total of 550 questionnaires were distributed and 487 were received. A total of 448 responses (38 questionnaires were incomplete and one returned without answering) were deemed usable

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and the effective response rate was 81.5%. The reliability test was performed (Cronbach’s Alpha) using SPSS and the validity test (Confirmatory Factor Analysis -- CFA) using Lisrel 9.01

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(student version) and the results are: (1) Cronbach Alpha scores – EI = 0.89, SI = 0.92 and caring

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behavior = 0.92; (2) Fit statistics for CFA – Root mean square error of approximation (RMSEA) = 0.0399 (threshold maximum = 0.08), Chi-square/degrees of freedom = 1.712 (threshold

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maximum = 3), Normed fit index (NFI) = 0.984 (threshold minimum = 0.9), Comparative fit index (CFI) = 0.993 (threshold minimum = 0.9), Goodness of fit index (GFI) = 0.971 (threshold

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minimum = 0.9), and Root mean square residual (RMR) = 0.0287 (threshold maximum = 0.08).

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Based on the results of CFA, convergent and discriminant validity tests were performed as specified by Hair et al. (2010). The results of these tests are given in Table 1 and the results

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indicate that the reliability and validity test results are good. The mean, standard deviation, and the correlation values between the dimensions of SI, EI, and caring behavior are given in Table 2.

Insert Table 1 here Insert Table 2 here The salient features of demographic information are: majority of nurses are women (about 98%), average age of nurses is 34.5 years, and average work experience is 10 years. The salient features of the descriptive statistics are: moderate level of SI dimensions [mean CET (critical existential thinking) = 3.36, mean PMP (personal meaning production) = 3.67, mean TA

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(transcendental awareness) = 3.60, and mean CSE (conscious state expansion) = 3.51], moderate to high level of dimensions of EI [mean PE (perception of emotion) = 3.70, mean ME (managing

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own emotions) = 4.09, mean MOE (managing others emotions) = 3.74, and mean UE (utilizing emotions) = 3.88] and high level of dimensions of caring behavior [mean RDO (respectful

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deference to others) = 4.25, mean AHP (assurance of human presence) = 4.23, mean PC (positive connectedness = 4.04, and mean PSK (professional skill and knowledge) = 4.39]. The data on

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patient satisfaction (data collected from 348 patients) indicate that 90% of the patients are

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satisfied with the care provided by the nurses, 80% are willing to return if needed, and 78% are willing to recommend public hospitals to others (Kaur et al., 2013). This data was collected to

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validate the nurses’ own perception of their caring behavior. The hypotheses were tested using Structural Equation Modeling (SEM) software, Lisrel

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9.1. The final framework with significant relationships and fit statistics are given in Figure 1.

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Many interesting findings have emerged from this analysis. First, hypothesis H1 is supported. Of the four dimensions of SI, three dimensions have significant positive relationships with two

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dimensions of EI. Personal meaning production (PMP) (β = 0.231, p-value = 0.002) and CSE (conscious state expansion) (β = 0.234, p-value = 0.000) of SI are positively correlated with PE (perception of emotion) dimension of EI. Personal meaning production (PMP) (β = 0.430, pvalue = 0.000) and TA (transcendental awareness) (β = - 0.147, p-value = 0.008) are found to be correlated with ME (managing own emotions) dimension of EI. Second, hypothesis H2 is supported. Of the four dimensions of SI, only two dimensions correlate significantly with one dimension of caring behavior. Critical existential thinking (CET) correlates negatively (β = -0.130, p-value = 0.004) and TA (transcendental awareness) correlates

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positively (β = 0.176, p-value = 0.000) with AHP (assurance of human presence) dimension of caring behavior. Third, hypothesis H3 is supported. Of the four dimensions of EI, only one

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dimension has a direct impact on two dimensions of caring behavior. Managing own emotions (ME) has positive correlations with RDO (respectful deference to others) (β = 0.277, p-value =

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0.000) and AHP (assurance of human presence) (β = 0.102, p-value = 0.004).

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Besides testing the hypotheses, the inter-relationships between the dimensions of each construct were tested. These tests have revealed some interesting results. First, among the

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dimensions of EI, (1) PE (perception of emotion) is positively correlated to ME (managing own emotion) (β = 0.446, p-value = 0.000), MOE (managing other’s emotions) (β = 0.256, p-value =

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0.000) and UE (utilizing emotions) (β = 0.174, p-value = 0.000), (2) ME is positively correlated to MOE (β = 0.472, p-value = 0.000) and UE (β = 0.401, p-value = 0.000), and (3) MOE is

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positively correlated with UE (β = 0.221, p-value = 0.000). Second, among the dimensions of

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caring behavior of nurses, (1) RDO (respectful deference to others) is positively correlated to AHP (assurance of human presence) (β = 0.670, p-value = 0.000), PC (positive connectedness)

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(β = 0.442, p-value = 0.000), and PSK (professional skill and knowledge) (β = 0.277, p-value = 0.000) and (2) AHP is positively correlated to PC (β = 0.262, p-value = 0.000) and PSK (β = 0.443, p-value = 0.000). These results indicate that studying the inter-relationships between the dimensions of constructs EI and caring behavior can help the researchers understand these constructs and their dimensions better. The impact of nurse’s duration of experience on the dimensions of EI, SI, and caring behavior was also studied. The age and duration of experience were strongly correlated (β = 0.907, p-value = 0.000). Therefore, duration of experience was chosen to be included in the SEM model. The results indicate that experience has a positive impact on all the dimensions of SI, on two dimensions of EI (managing other’s emotions and utilizing emotions), and one dimension of

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caring behavior (respectful deference to others). Insert Figure 1 here

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5.0 Discussion

This research set out to answer a fundamental question: What are the individual constructs (and

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their dimensions) that influence the work related outcome (caring behavior and its dimensions)

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of nurses? This study has deviated from the earlier studies (Kaur et al., 2013; Rego et al., 2010) by studying (1) the relationships between the dimensions of SI (spiritual intelligence), EI

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(emotional intelligence), and caring behavior and (2) the inter-relationships between the dimensions of each construct. For example, the research by Kaur et al. (2013) considered the

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relationships between SI, EI and the caring behavior at the construct level and found that (i) SI influenced EI and (ii) EI influenced caring behavior of nurses. In order to justify the need for a

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dimension-level study, an analysis of the structural model was made at the construct level and it

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was found that: (1) SI had a positive relationship with EI (β = 0.617, p-value = 0.000), (2) EI had a positive relationship with caring behavior (β = 0.333, p-value = 0.000), and (3) there was no

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significant relationship between SI and caring behavior (β = 0.077, p-value = 0.255). However, the analysis at the dimension level shows that two dimensions of SI [CET (critical existential thinking) and TA (transcendental awareness)] have significant relationship with AHP (assurance of human presence) dimension of caring behavior with CET having a negative relationship and TA having a positive relationship. Therefore, a study at the dimension level is as important as a study at the construct level (Wong, Law, and Huang, 2008) to understand the complete effects. The important findings of this study are given in the following sections. 5.1 Impact of dimensions of SI Critical existential thinking (CET) has a negative influence on the AHP (assurance of human

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presence) dimension of caring behavior. At this point, it is useful to recap the characteristics of CET. It involves the capacity to critically contemplate meaning, purpose and other existential or

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metaphysical issues (e.g. reality, the universe, space, time, death) (Zohar & Marshall, 2000). The critical contemplation may require an individual to be alone (away from the presence of others).

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It is plausible that nurses experiencing this dimension of SI may spend less time with the patients and therefore, a negative relationship between CET and AHP is justified.

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Personal meaning production (PMP) dimension of SI has a strong influence on PE

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(perception of emotion) and ME (managing own emotions) dimensions of EI. The finding suggests that nurses that have the ability to construct a purpose in life and have a sense of

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direction, a sense of order and a reason for existence are in a better position to understand and manage their emotions effectively (Reker, 1997). The inter-relationships between the dimensions

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of EI suggest that nurses who can handle their own emotions are in a better position to handle others emotions and utilize them to their own and patients benefits. According to Akerjordet and

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Severinsson (2007), ability of nurses to identify, handle and manage emotions implies important

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personal and interpersonal skills in nurses’ therapeutic use of self, critical reflection and stimulates the search for a deeper understanding of professional nursing identity. Transcendental awareness (TA) dimension of SI has a negative influence on ME (managing own emotions) dimension of EI and a positive influence on AHP (assurance of human presence) dimension of caring behavior.

It involves the capacity to perceive transcendent

dimensions of the self, of others and of the physical world during normal states of consciousness (Mayer, 2000). This study reveals that this dimension is a “double-edged” sword. TA brings down the nurse’s ability to manage own emotions but helps in talking, appreciating and quickly responding to the patients’ needs. The negative correlation between TA and ME is interesting.

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Transcendental awareness (TA) involves temporarily disconnecting from physicality, and feeling or experiencing a sense of union or oneness with humanity, the universe or a higher power

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(Mayer, 2000). This disconnection may lead to a situation whereby an individual may not be able to manage his/her own emotions effectively.

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Conscious state expansion (CSE) dimension of SI has a positive influence on PE (perception of emotion) dimension of EI. It refers to an individual’s ability to enter into higher or

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spiritual state of consciousness. This state helps an individual’s mind to be in meditative and

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relaxed mode (King & DeCicco, 2009). When the mind is relaxed, the ability of nurses to appraise emotions accurately and discriminate between accurate and inaccurate feelings Therefore, it is logical to observe a positive

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increases significantly (Mayer et al., 2004).

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relationship between CSE and PE.

The ability of the nurses (1) to construct personal meaning and purpose in all physical

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and mental experiences and (2) to enter spiritual states of consciousness (e.g. pure consciousness, cosmic consciousness, unity, oneness) at one’s own discretion (as in deep reflection, meditation,

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prayer, etc.) can help them accurately assess their own emotions, recognize the feelings of others, and manage the emotions effectively. In fact, this capability of nurses is critical to provide effective care to patients (Kaur et al., 2013). 5.2 Impact of dimensions of EI As indicated earlier, of all the dimensions, ME (managing own emotions) plays a major role in influencing RDO (respectful deference to others) and AHP (assurance of human presence) dimensions of caring behavior. Besides, this study indicates that each dimension of EI has a cascading effect on the other dimensions of EI with PE (perception of emotion) being the main driver. Assuming that a nurse has a right “perception of emotion”, how well he/she performs in

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his/her job is dependent on how well he/she manages own emotions. This in turn will have a profound impact on managing other’s emotions and utilizing emotions. This study reveals that a

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nurse’s ability to handle her own emotions plays a crucial role in (1) caring activities such as being honest, showing respect and giving information to the patient to make decisions and (2)

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providing hope to the patients.

How can the results of this study be used to recruit and educate the nurses? According to

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Kaur et al. (2013), “the importance of spirituality in nursing has resulted in the emergence of a body of literature that discusses the role of education in meeting the spiritual needs of first the

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nurses and then their care recipients” (p. 3199). A spiritual care education model for nurses has been developed by Narayanasamy (2006). Therefore, the nursing curricula must include the

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element of spirituality.

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According to Cadman and Brewer (2001), EI is a vital prerequisite for recruitment in nursing. Nursing is considered to be a significant therapeutic interpersonal process and therefore,

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nurses have to be adept at handling their own and others’ emotions. Therefore, nurse educators

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must develop assessment strategies that will identify EI during recruitment because EI cannot be developed quickly enough through interpersonal skills training (Cadman & Brewer, 2001). Once the right candidates for student-nurses are recruited, then proper education to develop their EI and SI can be provided. This study has clearly demonstrated the positive role of experience of nurses (time duration). The experience of nurses guides their SI (all four dimensions), EI (managing other’s emotions and utilizing emotions), and caring behavior of nurses (respectful deference to others). The managers of hospitals can appoint senior nurses as mentors to junior nurses. The mentor-mentee relationship can help junior nurses exhibit the right behavior towards the patients.

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6.0 Limitations and Conclusions

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This study has some limitations. First, the study has been carried out only in a few departments

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in seven public hospitals in Malaysia. Therefore, generalization of results has to be exercised with caution. Second, this study is a cross-sectional study. The causal relationships between the

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variables cannot be empirically validated. Third, ideally, the responses on the caring behavior of

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nurses must be obtained from the patients the nurses are attached to. In this study, the caring behavior of nurses is self-assessed. The caring behavior of nurses was indirectly validated based

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on general level of patients’ satisfaction level.

This research has improved on other studies by analyzing the relationships between EI,

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SI, and caring behavior at the dimension level. The significant findings of this research are: (1) CET (critical existential thinking) and TA (transcendental awareness) dimensions of SI have

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significant impacts on AHP (assurance of human presence) dimension of caring behavior; (2)

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PMP (personal meaning production) and CSE (conscious state expansion) dimensions of SI have significant impacts on PE (perception of emotion) and ME (managing own emotions) dimensions

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of EI; and (3) ME dimension of EI has significant impacts on RDO (respectful deference to others) and AHP dimensions of caring behavior of nurses.

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References Akerjordet, K., & Severinsson, E. (2007). Emotional Intelligence: A review of the literature with

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specific focus on empirical and epistemological perspectives. Journal of Clinical Nursing, 16, 1405-1416.

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Cadman, C., & Brewer, J. (2001). Emotional intelligence: A vital prerequisite for recruitment in nursing. Journal of Nursing Management, 9(6), 321-324.

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Conway, J. M., & Lance, C. E. (2010). What Reviewers Should Expect from Authors Regarding Common Method Bias in Organizational Research. Journal of Business Psychology, 25,

MA

325-334.

Greenhalgh, J., Vanhanen, V., & Kyngas, H. (1998). Nurse caring behaviors. Journal of

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Advanced Nursing, 27(5), 927-932.

Hair, J.F., Black, W.C., Babin, B.J., & Anderson, R.E. (2010). Multivariate Data Analysis: A

PT

Global Perspective. (7th ed.). Upper Saddle River, NJ: Prentice Hall.

CE

Hosseini, M., Elias, H., Krauss, S.E., & Aishah, S. (2010). A Review Study on Spiritual Intelligence, Adolescence and Spiritual Intelligence: Factors that may contribute to

AC

Individual Differences in Spiritual Intelligence and the Related Theories. Journal of Social Sciences, 6(3), 429-438. Kaur, D., Sambasivan, M., & Kumar, N. (2013). Effect of spiritual intelligence, emotional intelligence, psychological ownership and burnout on caring behavior of nurses: a crosssectional study. Journal of Clinical Nursing, 22, 3192-3202. Khademian, Z., & Vizeshfar, V. (2008). Nursing students’ perceptions of the importance of caring behaviors. Journal of Advanced Nursing, 61(4), 456-462. King, D.B., & DeCicco, T.L. (2009). A Viable Model and Self-Report Measure of Spiritual Intelligence. International Journal of Transpersonal Studies, 28, 68-85. Mayer, J.D. (2000). Spiritual intelligence or spiritual consciousness? The International Journal

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for the Psychology of Religion, 10(1), 47-56.

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implications. Psychological Inquiry, 15(3), 197-215.

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Mayer, J.D., Salovey, P., & Caruso, D.R. (2004). Emotional intelligence: Theory, findings, and

Narayanasamy, A. (2006). The impact of empirical studies of spirituality and culture on nurse

SC

education. Journal of Clinical Nursing, 15, 840-851.

Nussbaum, G.B. (2003). Spirituality in Critical Care: Patient Comfort and Satisfaction. Critical

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Care Nursing Quarterly, 26(3), 214-220.

Otani, K., Waterman, B., Faulknew, K.M., Boslaugh, S., & Dunagan, W.C. (2010). How

MA

patient reactions to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend and willingness to return. Journal of Healthcare Management,

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55(1), 25-38.

Podsakoff, P.M., MacKenzie, S.M., Lee, J., and Podsakoff, N.P. (2003). Common method

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variance in behavioral research: A critical review of the literature and recommended

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remedies. Journal of Applied Psychology, 88, 879-903. Rego, A., Godinho, L., McQueen, A., & Cunha, M.P. (2010). Emotional intelligence and caring

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behaviour in nursing. The Service Industries Journal, 30(9), 1419-1437. Reker, G. T. (1997). Personal meaning, optimism, and choice: Existential predictors of depression in community and institutional elderly. The Gerontologist, 37, 709-716. Ronel, N., & Gan, R. (2008). The Experience of Spiritual Intelligence.

The Journal of

Transpersonal Psychology, 40(1), 100-119. Schutte, N.S., Malouff, J.M., Hall, L.E., Haggerty, D.J., Cooper, J.T., Golden, C.J., & Dornheim, L. (1998). Development and validation of a measure of emotional intelligence. Personality and Individual Differences, 25, 167-177. Sumner, J., & Townsend-Rocchiccioli, J. (2003).

Why are nurses leaving?

Nursing

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Administration Quarterly, 27(2), 164-171. Van Leeuwen, R., & Cusveller, B. (2004). Nursing competencies for spiritual care. Journal of

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Warelow, P., & Edward, K.

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Advanced Nursing, 48(3), 234-246.

(2007). Caring as a resilient practice in mental health nursing.

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International Journal of Mental Health Nursing, 16(2), 132-135

Wong, C. S., Law, K. S., & Huang, G. H. (2008). On the Importance of Conducting Construct-

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Level Analysis for Multidimensional Constructs in Theory Development and Testing.

MA

Journal of Management, 34(4), 744-764.

Wu, Y., Larrabee, J.H., & Putman, H.P. (2006). Caring Behaviors Inventory: A reduction of the

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42-item instrument. Nursing Research, 55(1), 18-25. Zohar, D., & Marshall, I. (2000). Spiritual Intelligence: The Ultimate Intelligence. London:

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Bloomsbury Publishing.

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Cronbach

items /

Alpha/CR/A VE (N=448)

33/4

.89/.84/.57

NU

dimensions

MA

Emotional

24/4

.92/.91/.72

AC

Caring Behaviors

24/4

Factor loading: Min – 0.684, Max –0.825 Factor loading: Min – 0.773, Max

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Spiritual Intelligence

PT

ED

Intelligence

Validity (CFA)*

RI P

No. of

SC

Variable

T

Table 1: Results of reliability and CFA (Confirmatory Factor Analysis)

– 0.900 .92/.91/.72

Factor loading: Min – 0.668, Max – 0.860

*CFA (Confirmatory Factor Analysis) was done using LISREL 9.01 student version. Analysis was done at the construct-dimension level; CR -- composite reliability; AVE – Average variance extracted Model Fit Statistics: Chi-sq/df – 1.71 (p-value – 0.87), RMSEA = 0.040, RMR = 0.029, GFI = 0.97, NFI – 0.98, CFI – 0.99 Legend: Chi-sq – Chi-square value, df – degrees of freedom, RMSEA – Root Mean Square Error Approximation (must be < 0.08), RMR – Root Mean Square Residual (must be < 0.08), GFI – Goodness of fit index (must be > 0.9), NFI – Normed fit index (must be > 0.9), CFI – Comparative fit index (must be > 0.9)

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Table 2.Descriptive statistics and correlation values

Mea SD

EI1

ion

n

EI1

3.70

0.38

1.00

EI2

4.09

0.37

0.56

EI2

EI3

EI4

3.36

0.60

1

6

0.51

0.63

0.55

4

5

9

0.33

0.30

3.67

0.55

SI4

CB1

CB2

CB3

3.51

4.25

4.23

4.04

0.46

0.57

0.45

0.50

0.53

CB

1

2

3

4

1.00

1.00

0.36

0.33

1.0

9

0

0.49

0.47

0.42

0.6

5

0

0

47

0.36

0.34

0.38

0.37

0.6

0.75

8

0

9

7

94

1

0.39

0.40

0.43

0.39

0.6

0.76

0.72

8

7

6

4

79

8

7

0.15

0.27

0.22

0.18

0.1

0.20

0.18

0.16

2

7

8

9

55

3

9

9

0.16

0.30

0.21

0.21

0.1

0.24

0.24

0.21

0.71

1.0

8

8

0

9

27

5

7

9

1

0

0.17

0.24

0.20

0.19

0.1

0.18

0.20

0.20

0.62

0.5

0.39

AC

3.60

CB

3

3

SI3

CB

3

CE

SI2

CB

NU

0.61

4

SI4

MA

0.43

0.52

ED

SI1

3.88

0.39

SI3

SC

1.00

PT

EI4

3.73

SI2

1

1 EI3

SI

RI P

Dimens

T

Correlation values

1.00

1.00

1.00

1.00

1.00

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0.48

7

7

84

6

7

2

8

76

0.22

0.31

0.25

0.22

0.1

0.22

0.19

0.17

0.66

0.6

0.53

7

9

1

4

03

1

7

8

5

92

1

T

4.39

7

1.00

RI P

CB4

6

(All correlations are significant at 0.05 significance level)

SC

Legend: EI1 – perception of emotion (PE), EI2 – managing own emotions (ME), EI3 – managing others’ emotions (MOE), EI4 – utilizing emotions (UE), SI1 – critical existential thinking (CET), SI2 – personal meaning production (PMP), SI3 – transcendental awareness (TA), SI4 – conscious state expansion (CSE),

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CB1 – respectful deference to others (RDO), CB2 – assurance of human presence (AHP), CB3 – positive

AC

CE

PT

ED

MA

connectedness (PC), CB4 – professional skill and knowledge (PSK).

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Figure 1. Research Framework (with significant relationships)

0.256 0.472

0.200

0.401

0.221

EI3

EI2

0.105 0.106

EI4

SC

EI1

0.174

RI P

0.446

T

exp

NU

0.277

CB1

0.430

-0.147

0.102 CB2

AC

0.176

0.717

0.262 CB3

PT

SI1

CE

-0.130

0.670

0.234

ED

0.231

MA

0.106

0.442

CB3

SI2

0.443

SI4

SI3

CB4 0.803

0.793

0.798

exp

Legend: EI1 – perception of emotion (PE), EI2 – managing own emotions (ME), EI3 – managing others’ emotions (MOE), EI4 – utilizing emotions (UE), SI1 – critical existential thinking (CET), SI2 – personal meaning production (PMP), SI3 – transcendental awareness (TA), SI4 – conscious state expansion (CSE), CB1 – respectful deference to others (RDO), CB2 – assurance of human presence (AHP), CB3 – positive connectedness (PC), CB4 – professional skill and knowledge (PSK), exp – experience. Model fit statistics: Chi-square/df = 2.39, RMSEA = 0.0556, NFI = 0.976, CFI = 0.986, GFI = 0.972, RMR = 0.0684.

0.277

Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimension-level exploratory study among public hospitals in Malaysia.

The purpose of this research is to study the impact of individual factors such as emotional intelligence (EI) and spiritual intelligence (SI) on the c...
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