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Arménio Rego Universidade de Aveiro, Campus de Santiago, 3810-193 Aveiro- Portugal firstname.lastname@example.org Lucinda Godinho Universidade de Aveiro, Campus de Santiago, 3810-193 Aveiro- Portugal email@example.com Anne McQueen The University of Edinburgh, Nursing Studies, School of Health in Social Science Teviot Place, Edinburgh, EH8 9AG A.McQueen@ed.ac.uk Miguel Pina e Cunha Faculdade de Economia, Universidade Nova de Lisboa Rua Marquês de Fronteira, 20, 1099-038 Lisboa – Portugal firstname.lastname@example.org ABSTRACT We relate nurses’ emotional intelligence (understanding one’s emotions; self-control against criticism; self-encouragement; emotional self-control; empathy and emotional contagion; understanding of other people’s emotions) with their caring behaviors (respectful/trustful treatment; giving explanations). One hundred and twenty nurses self-reported their emotional intelligence, and three patients of each one (n=360) described their caring behaviors. Variance, correlation and regression analyses were conducted to study how nurses’ emotional intelligence explains caring behaviors. The findings show the following: (a) EI explains a significant but low unique variance of caring behaviors; (b) complex combinations between EI dimensions appear to be required for nurses to act as good caregivers. Keywords: Nursing; Emotional intelligence; Caring behaviors; Quality health care INTRODUCTION Quality health care and service excellence are of critical and fundamental importance and are major differentiating features between health care providers (Anthony, Brennan, O’Brien, & Suwannaroop, 2004; Ford, Sivo, Fottler, Dickson, Bradley & Johnson, 2006; Rowell, 2004). Patient satisfaction is a widely recognized measure of medical care quality and a predictor of several positive consequences for organizations and patients (e.g., patient adherence to treatment regimens, malpractice suits, hospital employees’ satisfaction, and financial performance; Gesell & Wolosin, 2004). However, as Khatri (2006: 45) argued, “health care organizations are not factories” and, in comparison with industrial model of management, they require a different set of human resources practices and systems to support a particular kind of
We are grateful to all nurses, patients and hospital administrators who contributed to the data collection.
service. Considering their emotional, psychological and/or physical fragilities, patients are not “normal” customers. They need both instrumental and expressive care. Although both contribute to excellence in health care, the expressive caring is increasingly overshadowed by instrumental caring with a focus on technical skills and knowledge. The compassionate behavior is thus being threatened by technological concerns and economic constraints (Godkin & Godkin, 2004). The increasing emphasis on the instrumental elements threatens the integrity of the whole (Freswater & Stickley, 2004; Woodward, 1997). As Kerfoot (1996: 62) argued, “[c]continually, we experience situations where patients received excellent technical care but, when the emotional side of their care was not met, they believed that their care was inadequate”. Patient-centered quality care requires not just excellent technical actions and good management/coordination efforts, it also demands care that (a) is respectful of and responsive to individual patient preferences, needs, and values; (b) assures that patient values guide the clinical decisions and (c) provides patients with emotional support (Gesell & Wolosin, 2004; Institute of Medicine, 2001). As pivotal figures in patient care who interact with patients more frequently than other health care providers, nurses have a major caring role (McQueen, 2000; Williams, 1997). Several authors have considered it as part of a therapeutic interpersonal relationship and even a moral imperative (Issel & Kahn, 1998). Huch (2003) stressed that nursing is a caring science, and Freswater and Stickley (2004: 94) asked emphatically: “What is nursing if it is not the provision of one human being caring for another?” Caring “is the act of conveying individualized or person-to-person concern or regard through a specific set of behaviors” (Issel & Kahn, 1998: 44). Patients report that they feel cared for when they feel treated as individuals, receive help dealing with their illness, and when they believe that nurses anticipate their needs, are available to them and appear confident in their work (Godkin, 2001; Godkin & Godkin, 2004; Hines, 1992). The caring nurse is perceptive, supportive of patient concerns and physically present/available (Godkin, 2001; Riemen, 1986). By paying attention to the idiosyncratic physiological and emotional needs of their patients, nurses can improve patients’ satisfaction, well-being and health (Al-Mailan, 2005; Dingman, Williams, Fosbinder, & Warnick, 1999; Godkin, 2001; Godkin & Godkin, 2004; Issel & Kahn, 1998; Mahon, 1996; Meyer, Cecka & Turkovich, 2006; Williams, 1997; Wolf, Colahan, Costello, Warwick, Ambrose, & Giardino, 1998). Financial, economic and legal benefits have been reported as well in literature (Issel & Kahn, 1998; WeechMaldonado, Neff & Mor, 2003; Wolf et al., 1998). Considering these benefits, promoting expressive caring is a worthy and even an imperative aim (Godkin & Godkin, 2004). This requires that researchers identify the factors affecting caring behaviors and the study reported here contributes to this body of knowledge by linking caring with emotional intelligence (EI). The paper is structured as follows. After discussing the relevance of EI for a number of aspects of individual and organizational life and for nursing, we theoretically show how nurses’ EI may relate with their caring behaviors. Then we present the method, results, discussion and conclusions. Some implications for health care organizations’ management will be presented.
2002): (1) perceive one’s own and others’ emotions and accurately express one’s own emotions. This is an “ability model”. Pettijohn & Parker.. 1997. Fosbinder & Warnick 1999). Mayer & Salovey. 2005) and that EI is associated to salesperson’s customer orientation (Rozell. Theoretical perspectives and empirical studies on what abilities comprise EI differ somewhat. These skills can improve the patients’ well-being (Dingman. and demonstrate empathy in their care (McQueen. considering that nursing is mainly relational in nature and impregnated with intense emotional meaning and labor (Cadman & Brewer. but for their own self-protection and health as well. they are empathetic and adaptable. 2004. This is an astonishing observation. It is more and more recognized that interpersonal and intrapersonal skills are required to cope with the complex demands of modern health care systems. Empirical and theoretical evidence suggest that EI is relevant for a number of aspects of individual and organizational life (e. Freshwater & Stickley. In spite of this emerging theoretical literature. (2) facilitate thought and problem solving through use of emotion. 2001).g. 2004. in dealing with their own and others’ emotions is axiomatic”. 2004). are more likely to ‘connect’ easily with patients and to meet their emotional needs immediately. . to discriminate among them. (3) understand the causes of emotion and relationships between emotional experiences. combining abilities with a broad range of personality traits. Kerfoot. They also need to understand and manage their own emotions.g.. (4) manage one’s own and others’ emotions. 2000). Cadman & Brewer. and the respective references for a synthesis). but other perspectives (e. For example. 2004). health and well-being. 1998) reflect “mixed models”. empirical studies are scarce. 2002.. MacCulloch. see Van Roy & Viswesvaran. not just for high quality care. nourishing and sustaining the emotional labor that nurses are required to carry out in their interactions with patients. Cadman and Brewer (2001: 322) argued that the competence of nursing practitioners “. 2003). satisfaction with life. 2002. EI is also making an appearance in nursing journals (e. Mayer & Caruso. McQueen. 2004. 1996. 1998) and help nurses to cope with the stress of clinical nursing practice (Cadman & Brewer. Salovey & Caruso. Freshwater and Stickley (2004: 93) stressed that “every nursing is affected by the master aptitude of emotional intelligence” and that “it is not enough to attend merely to the practical procedure without considering the human recipient of the process”. and to use this information to guide one's thinking and action”. although one of the most widely reported models includes four dimensions (Salovey. Mayer. McQueen. Nurses need to interpret and understand how patients feel. Several authors have suggested that EI is crucial for building. 2001. Goleman. 2004).EMOTIONAL INTELLIGENCE Salovey and Mayer (1990: 189) defined EI as “the ability to monitor one's own and others' feelings. Williams. . Vitello-Cicciu. Studies also have shown that EI of service providers’ predicts customer satisfaction (Kernbach & Schutte. Both the ability and the mixed models have strengths and limitations (Caruso. to ascertain their motives and concerns. they are able to see the patients’ perspectives and thus are more apt to understand and satisfy 3 . Literature suggests that nurses with higher EI display strong self-awareness and high levels of interpersonal skills. have positive economic consequences (Issel & Kahn. productivity/performance. 1998. effective leadership. 2001.g.
(2) self-control against criticism. more persistent in giving emotional support to patients and more optimistic in the middle of a crisis. 2004). regardless of the situation. a patient raises a complaint with a nurse or is threatening towards him/her in some way. Boyatzis & McKee. 1996). (5) empathy and emotional contagion. 2005a. 2005b. An EI model previously developed and validated by one of the authors (Rego & Fernandes. thus disseminating their competencies. 2005c) was used. We hypothesize that the above six dimensions also impact on nurses’ caring behaviors and present arguments supporting this position. 2005a. However. nurses are well-advised to keep their emotions in check and balance. satisfaction with life and students’ academic achievement (Rego & Fernandes. Goleman. This six-factor model fits the data well. irritated. if nurses do not really understand that they are frustrated. each EI dimension is discussed separately. Self-control against criticism Emotionally intelligent nurses can choose how to respond to different interactive situations without being emotionally overwhelmed by them (Vitello-Cicciu. EMOTIONAL INTELLIGENCE AND CARING BEHAVIORS Understanding one’s emotions Nurses capable of a self-reflective process become aware of their own emotions (McQueen. Following. 1998). they are less likely to control the expression of these emotions. Wright & Cropanzano. and become less available to listen to and care for such a patient (Bushell. and this emotional awareness component of the EI dimension can provide that ability (Rozell. the reliabilities are satisfactory and it can predict individual health. with potentially negative effects on the patient (McQueen. 2006. they can demonstrate a more judicious manner when they interact with patients and they are more likely to behave and communicate in an “appropriate” and respectful way. a factor-structure embracing six dimensions emerged: (1) understanding one’s emotions. and rationale is given for possible interactions between them. This paper reports on an empirical study assessing how six dimensions of EI relate to nurses’ caring behaviors. 2004). (4) emotional self-control. Pettijohn & Parker. 2003). for example. It is also likely that such nurses would view adverse situations in a more positive light and would be willing to try new approaches and solutions without fear of failure (Rozell et al. angered or very sad regarding a patient situation. 2005b. Through several exploratory and confirmatory factor analyses. 2005c). As a result. This can be an important competency when. (3) self-encouragement. A nurse with low selfcontrol against criticisms is more likely to take some comments or questions as personal attacks on him/her. 2002). In short. 1998.. 4 . In short. they are more likely to manage them.their needs (Kerfoot. When nurses recognize their feelings. For example. strengths and positive emotions to patients (Goleman. 2006). (6) understanding of other people’s emotions. disgusted. Use of emotions (self-encouragement) Self-encouraged nurses tend to be more persevering when facing difficulties. they may exercise self-constraint against negative emotions they are experiencing. 2004). provided that nursing is mostly relational in nature. obstacles and crises. it is likely that more self-encouraged nurses adopt more expressive caring behaviors in dealing with patients.
1996) and respond appropriately (Vitello-Cicciu. For example. anger. understand and satisfy patients’ needs (Kerfoot. to foster trust and a sense of security. 5 . Emotional labor can be defined as the effort. 2005. a nurse with accurate understanding of her own (negative) emotion (for example. planning and control needed to express organizationally desired emotions and suppress undesirable ones during interpersonal transactions (VitelloCicciu. mental work to manage feelings. Nurses are also expected to demonstrate a nonjudgmental manner with patients. contributing to excellence in the practice of nursing. although the exploratory state of the field does not afford clear expectations yet. that is. Von Dietze and Orb (2000) propose that compassion affects nurses’ decisions and actions. Gesell & Wolosin. a convenience sample comprising 120 nurses and 360 patients (three for each nurse) provided the data. the idiosyncrasies of nursing require some complex combinations of EI aspects so that nurses can be truly positive caregivers.Emotional self-control Nurses face extremes in emotion everyday. We suppose that other interactions between EI dimensions can occur. Behaving more empathetically. Caring requires emotional labor. confusion. physical and psychological fragility (Al-Mailam. 2003). nurses are more able to understand the values. Nurses with low self-control against criticisms can reduce their caring behaviors towards patients who questioned them or complain about their treatments unless they compensate for this reactive sensitivity with a stronger selfencouragement that motivates them to persevere in adopting caring behaviors. they may not be able to remain calm during “crises”. After analyzing the factorial structure and reliabilities of both constructs. 2003). they can show higher concern for their patients and generate better emotional and psychological reactions in them. variance. 2004). Empathy and understanding of other people’s emotions By understanding the patients’ emotions. Patients exhibit unhappiness. after noticing the failure of the treatments applied to a “special” patient) may be very anxious about communicating openly with the patient if (s)he has insufficient self-encouragement to persevere and demonstrate appropriate behaviors and feelings. and being more empathetic. However. correlation and regression analyses were carried out to test how nurses’ EI explain caring behaviors. expressing empathy for patients and showing an understanding for patients experiencing pain or emotional. appreciate the patients’ perspectives. A loss of emotional control can have negative effects for both nurse and patient. sadness and feelings of aversion. Thus. METHOD Having secured ethical approval for the study. understand the impact of their actions. desired emotions consist of displaying a genuine caring demeanor. worries and fears of patients. Nurses self-reported their own EI and patients reported their caring behaviors. To achieve this. They are more apt to automatically connect with patients. nurses may require suppressing any negative feelings towards patients. 2004). it is suggested that they correlate positively with nurses’ caring behaviors. Henderson (2001) also claims that emotional involvement by nurses may improve the quality of care and is a requirement of excellence in nursing practice (McQueen. Having identified the nature of the six EI dimensions. If nurses are not proficient in managing their own emotions. nurses can be more compassionate as well. In nursing.
…. Moreover. regarding two categories: nurses’ communication. It comprises 41 seven-point Likert-type scales. 1999. “form the basis for estimating the economic value of caring”. connect with their own experiences. Nurses were asked for cooperation and consent. and attitudes and behaviors. 56 had 12 years and 53 had at least a baccalaureate.6 years. 60% were “enfermeiro graduado” (“graduate nurse”.The subjects and instruments for data collection The subjects included both nurses and patients. Items were worded and/or adapted from two mains sources: (1) the six caring dimensions of nursing presence (Doona. The mean age of the sample was 49. The instrument comprised 15 five-point Likert scales. They were asked to participate immediately before leaving the hospital. behave in a sensitive way and are present. it is the patients’ interpretation of the nurses’ caring behaviors that lead to psychological consequences for patients and. Patients can accurately realize if nurses are available. 144 had six years. 7: “the statement applies to me completely”). Their positions were the following: 34% were “enfermeiro” (“nurse”. Regarding schooling. 2005b. Godkin. It is appropriate for patients to report nurses’ caring behaviors because they are the recipients and direct beneficiaries of them (Godkin & Godkin. 6 . Consent was accepted as a willingness to complete the questionnaire. level 3). as Issel and Kahn (1998: 44) suggested. level 2) and 6% were “enfermeiro especialista” (“specialist nurse”. Anonymity was assured and the completed questionnaire was enclosed in an envelope by the patient before returning to the researcher. 5: “the statement applies to me completely”). Written permission for carrying out the study was obtained by the hospitals’ administration. (2) the customers’ expectations list proposed by Millar (1996). Mean age was 32 years (range: 21-68 years). 2005a. devised from the literature and on the basis of the authors’ experience and expertise. Although supervisors can report accurately the technical performance of nurses. 34 patients had four schooling years. 2004). Chase & Haggerty. The subjects were invited to report their own EI through the previously developed and validated instrument by the first author (Rego & Fernandes.5. 2004). treat them as unique persons. 2001. many caring behaviors towards patients escape their careful observation. Each patient was asked to indicate on the scales the degree to which each statement applied to the nurse with whom they were in contact. level 1). Seventy-nine percent were female. The subjects were asked to assert the degree to which each statement applied to them (1: “the statement does not apply to me at all”. 57% were male. through face-to-face contact accomplished by one author. Three patients who had been nursed by each of the nurses interviewed (with at least three days of contact with the nurse) were invited to complete a questionnaire reporting on the nurses’ behaviors. working in surgical and orthopedic services in seven Portuguese public hospitals. (1: “the statement does not apply to me at all”. 2005c). Godkin & Godkin. are attentive and good listeners. The average number of days of contact between patients and nurses was 5. The sample of nurses comprised 120 nurses. 73 had nine years. …. We were parsimonious with the number of questions to minimize time and effort for the patients.
I understand the reasons.75 0. representing the degree in which the patient feels that the nurse treats him/her with dignity. (r) I become angry when others criticize me – even if I feel that they are right.88 (0.57 (0.56 0.72) 0.90 0. I really know what I am feeling. Comparative Fit Index (CFI) and Incremental Fit Index (IFI). (r) Use of emotions (self-encouragement) Usually. The first factor comprises six items. 1998). All Lambdas except one (0.88 -0. Ricard 7 .90 0. 2005b. Understanding of one’s emotions I understand the causes of my emotions. I give as well as I can to achieve my goals. 18 items were removed.75) 0. When I feel sad. A two-factor solution was extracted (Table 2).80) 0. (r) It is difficult for me to accept a critique. Rarely do I stay furious. I lose control. the resulting model fits the data adequately (Table 1). 2005c). Understanding of other people’s emotions I do as well as I can to understand the others’ point of view. Because fit indices were not satisfactory.44) are higher than 0. four items were removed according to the modification indices and standardized residuals (Byrne.78 0.62) 0. Fit indices Chi-square/Degrees of freedom Root mean square error of approximation Goodness of fit index Adjusted goodness of fit index Comparative fit index Incremental fit index Relative fit index * Completely standardized solution (r) reverse-coded items In brackets: Cronbach Alphas (0.50.77) 0.68 (0. I am used to setting my own aims. (r) It is difficult for me to talk with people who do not share my points of view. Thus.73 Data about caring behaviors were also submitted to a principal component analysis. I can calm down whenever I am furious.Data analysis A principal component analysis was carried out upon the data about nurses’ EI. Cara. (r) I feel the problems that my friends face as they were my own. Due to cross loadings. The 23 remaining items gave rise to a sixfactor structure very similar to the one previously devised by the Rego and Fernandes (2005a.76). (r) The others’ suffering doesn’t affect me.80 0.60 0. Emotional self-control (regulation of emotions) I can stay calm even when the others are angry. Due to cross loadings.70 level.72 0.62) are above the 0.79 (0.07 0.66 0. It incorporates the meaning of several dimensions proposed by Cossette. Empathy and emotional contagion I am indifferent to the others’ happiness. Considering Root Mean Square Error of Approximation (RMSEA). I really understand the feelings of the people I am related with. respect and trust (Alpha: 0. a confirmatory factor analysis was conducted.44 (0.59 0.6 0.62 0. I encourage myself to give as well as I can.83) 0. six items were removed. TABLE 1 Emotional intelligence – Confirmatory factor analysis (completely standardized solution) Self-control against criticism When I am defeated in a game.72 0.88 0.84 0.78 0. I understand the emotions and feelings of my friends by seeing their behavior. and all Cronbach Alphas except one (0.89 0. Usually.82 1.
21 (S)he came up to me in a respectful and courteous manner.1% Cronbach Alpha 0. 2001): uniqueness.70 0. which is consistent with studies showing high patient satisfaction with nursing care (e. connecting with the patient’s experience.83). both factors incorporate items representing five of the six dimensions of “nursing presence” (Doona et al. (s)he answered me. “within groups”). for example).31 (S)he demonstrated availability when I came up to him/her. nurses described themselves as moderately/highly emotionally intelligent.9% 24. 0.15 (S)he explained me the treatments and the expected results.84 Bartlett’s test of sphericity: 1312..86 (S)he spent enough time for giving me explanations and talk with 0. thus suggesting that variance between nurses is higher than variance for each nurse (i.0 in self-encouragement. namely humanism.83 0. They also to a great extent represent the meaning of the seven items that Bulfin (2005) used to measure the patient satisfaction in his model of nursing as caring theory. For both caring behaviors. sensitivity. Thus. correlation and regression analyses were conducted to examine how EI relates with caring behaviors.000) RESULTS Table 3 depicts the means. except regarding emotional self-control. Considering the seven-point scale. sensing.71 0.29 0.31 0.001. Although most correlations between EI dimensions are positive.g. (S)he explained to me the pain that I will feel when treatments will 0. my intimacy and my spiritual beliefs. respect the patients and trust Whenever I asked him/her. It appears that nurses who are more self- 8 . On the whole.e.15 When I talked with him/her. 0. 0.12 (S)he was worthy of the trust I entrusted to him/her. Godkin. against 6. 0. 0.and Pepin (2005).69 0. at the nurse level of analysis. 0. TABLE 2 Nurse’ behaviors towards the client – Principal component analysis# Factor 1 Factor 2 Nurse treat Nurse give patients with explanations to dignity... Patients described the caring behaviors of their nurses very positively. 2005). The second factor contains three items reflecting the degree in which the patient feels that the nurse provided him/her with courteous explanations about the treatments and their consequences (Alpha: 0. 1999.76 0. helping relationship and spirituality. It incorporates the meaning of the teaching dimension proposed by Cossette and associates (2005). self-control against criticism relates negatively with self-encouragement and empathy.83 #KMO: 0.80 0. and emotional selfcontrol relates negatively with empathy. (s)he paid regard to me. going beyond the scientific data and being with the patient.75 me. Explained variance 36.60 0. standard deviations and correlations between variables.54 (p=0.31 (S)he respected my dignity. 0. with a mean score that can be described as low (3.9. an ANOVA was run with nurse as independent variable.75 be applied. F values are significant for p<0. Variance. the caring behaviors of each nurse were scored through the mean of the scores that the three patients imputed to them.08 0. Before aggregating the scores of caring behaviors imputed to each nurse (as described by three patients). Al-Mailam.
14 0.31 *** 0.6 32. trustful and explicative. Vakola.09 2 -0.0 0.05 0.02 0.0 0.01 ***p<0.2 4. 2003. these variables were entered in the first step as control variables.2 0. Nurse age 10.04 -0. (b) EI dimensions with higher predictive power were shown to be self-control against criticism and self-encouragement. Understanding of one’s emotions 7. Older nurses denote longer time in contact with patients. Use of emotions (selfencouragement) 3. Empathy and emotional contagion 6. Considering that the nurses’ age and contact time between patient and nurse relate with some EI dimensions and caring behaviors. Self-control against criticism 2.7 5.53 *** -0. In short. Nurse age correlates positively with the understanding of other people’s emotions and the understanding of their own emotions.29 *** -0. and that different individuals may be characterized according to different combinations of EI dimensions scores.41 *** 0.8 0.18 * 0.9 0. Hierarchical regression analyses were carried out to study how nurses’ EI explains caring behaviors. and the more emotionally selfcontrolled nurses tend to be described as less respectful and trustful by patients.22 * 0.8 4.8 1. Next.01 0.16 0.06 -0. on the whole. standard deviations and correlations 1. One can speculate that this is due to the nurses’ personality idiosyncrasies.5 SD 1. (c) more selfencouraged nurses were described by their patients as adopting more respectful and explanatory caring behaviors.15 0.31 *** -0.09 0.25 ** 3 4 5 6 7 8 9 *p<0.09 0. Dignity and respect 8.5 1 -0. but are less empathetic. Contact time between patient and nurse Means 5.05 -0. (b) the nurses who scored higher in self-control against criticism were described by their patients as adopting more explanatory behaviors. Tsaousis & Nikolaou. Explanations 9.22 * -0.08 -0.64 *** -0.7 3.16 0. EI dimensions tend to correlate positively (Dulewicz.22 * 0.25 ** 0.7 0. and the finding steadily recommends that EI must be seen as a multidimensional construct. older nurses tend to describe themselves as more capable of understanding their own emotions and those of others.11 0.3 5. These are surprising findings. Emotional self-control 4.05 0.02 0. EI dimensions were entered.08 0.24 ** 0. 2004).16 -0. On the contrary. Understanding of other people’s emotions 5.05 **p<0.01 -0.9 5.0 3.00 Nurses’ self-encouragement relates positively with both caring behaviors. TABLE 3 Means. considering that previous empirical evidence shows that.controlled against criticisms are less self-encouraged and less empathetic.27 ** 0.4 8.38 *** 0. more self-encouraged nurses are described by patients as more respectful. nurses’ emotional self-control relates negatively with the nurses’ dignity/respect behavior. and negatively with empathy and emotional contagion.45 *** 0.0 5.21 * 0.06 0.31 *** -0.19 * 0.22 ** 0.11 -0.20 * -0. 9 .01 0. Higgs & Slaski.1 6. More emotionally self-controlled nurses are also less empathetic. The findings (Table 4) suggest the following: (a) nurses’ EI explained unique variance of both nurse caring behaviors. That is to say.16 0.
04 0.25* 0.00 -0.03 -0.06 Use of emotions (self-encouragement) 0.52* R2 1% Self-control against criticism 0.9 4.06 F 1.01 ***p<0.07 0.09 -0.5 4.83** 11% 11% Although emotional self-control correlates significantly with one caring dimension (Table 3).8 4.6 4.17 -0.15 Understanding of other people’s emotions 0.05 **p<0.86* R2 5% R2 change 4% *p<0.02 Empathy and emotional contagion 0.24* Emotional self-control -0.4 4.TABLE 4 Hierarchical regression analyses: How nurses’ EI explain their caring behaviors Respect.10 Contact time between patient and nurse -0. FIGURE 1 How emotional self-control interact with self-encouragement to predict the explanatory behaviors 5 4. In other words: (a) the nurses provide fewer explanations to patients when they are less emotionally self-controlled and less self-encouraged (maybe they fear revealing their negative emotions to the patients when providing the explanations).04 Understanding of one’s emotions -0.41*** -0.08 0. dignity and trust 1st step 2nd step Nurse age -0. (b) the nurses provide more explanations when they are less emotionally self-controlled and more self-encouraged.20 F 1.6 4.8 Explanations 4.14 0.00 Explanations 1st step 0.3 Self-encouragem _low ent Self-encouragem _m ent iddle Self-encouragem _high ent 4 Low Middle Em ional self-cont ot rol H igh 10 . we found an interaction effect between this EI dimension and self-encouragement (Figure 1): the effect of self-encouragement in the explicative behavior is stronger when nurses are weakly emotionally self-controlled.05 0. Exploring the data.18 2. the respective Beta is not significant (Table 4).13 0% 2nd step 0.
2 4.6 Self-encouragem _low ent Self-encouragem _m ent iddle Self-encouragem _high ent 4.7 4.7 Explanations 4. but not when they are more self-controlled.6 4 Low Middle Self-cont against crit rol icism s H igh To explore data.8 4. Putting it differently: less self-encouraged nurses decrease significantly their explicative behaviors when they are less self-controlled against criticisms. We found an interaction effect between this dimension and self-encouragement. considering that this dimension does not correlate significantly with those behaviors (Table 3). (c) however. (b) they overtake this discomfort if they are more self-encouraged.2 4. 11 .8 4. thus avoiding to explain some treatments and consequences to patients. Nurses with low self-control against criticism tend to decrease significantly their explicative behaviors when they are less self-encouraged. This pattern is depicted in Figure 2. we tested other interactions and found that the understanding of one’s emotions can impel the nurses to reduce explicative behaviors if they are less self-encouraged (Figure 3). One possible explanation for this finding is the following: (a) the nurses who understand their own negative emotions feel discomfort in giving explanations to patients about negative events and treatments. FIGURE 2 How self-control against criticism interact with self-encouragement to predict the explanatory behaviors 5 4. This suggests that this dimension interacts with other dimensions to predict nurses’ behaviors. they “lose” if they are less self-encouraged. but not when they are more selfencouraged.The predictive power of self-control against criticism for caring explanatory behaviors is surprising.
9 4.8 4.4 4.2 4 Low Middle Em hy pat H igh 4. there are some plausible arguments supporting the 12 .FIGURE 3 How the understanding of one’s emotions interact with self-encouragement to predict the explanatory behaviors 5 4.8 4.5 4.8 4.4 Explanations 4.6 4.8 Findings show that empathy and emotional contagion do not explain caring behaviors.8 4.4 4 Self-encouragem _low ent 3.7 4.4 4.7 4.6 Self-encouragem _m ent iddle Self-encouragem _high ent 3 Low Middle Underst anding of one’s em ions ot H igh FIGURE 4 How empathy interact with self-encouragement to predict the explanatory behaviors 5.6 4.7 4. Although this seems surprising.5 Self-encouragem _low ent Self-encouragem _m ent iddle 5 Explanations Self-encouragem _high ent 4.
thus becoming more susceptible of emotional apprehension.6 5 4 Low Middle Underst anding of ot people em ions her ot H igh The finding that the understanding of other people’s emotions does not predict caring behaviors is also surprising. (b) less self-encouraged nurses decrease their explicative caring behaviors when they are less empathetic. and they advised nurses to use strategies that promote empathetic concern and avoid emotional contagion. 2001).8 4.finding. stress and burnout (McQueen.6 4. The question is that nurses with high emotional contagion can be easily affected by the emotions experienced by patients. but not when they are more empathetic. Omdahl and O’Donnell (1999) differentiated empathetic concern and emotional contagion. It shows that: (a) when nurses combine high understanding of the other people dimensions with low emotional self- 13 .5 Em ional self-cont _low ot rol Em ional self-cont _m ot rol iddle 5 Explanations Em ional self-cont _high ot rol 4. which is not the case of our measurement instrument. The interaction pattern depicted in Figure 5 is also useful in explaining our findings. to understand the impact of their actions on them and to understand and satisfy their needs. the finding make sense if we consider that nurses with this EI skill are more sensitive to stress (Humpel.5 4. 2004) and less capable to exert their role without emotional strain and with emotional discernment. our findings suggest that the empathy and emotional contagion dimension is not unimportant. to see the world from the perspective of patients. One could expect that nurses with good capabilities in this EI aspect might be more apt to connect with patients. rather it interacts with self-encouragement in predicting caring behaviors. but not when it is higher. However. Caputi & Martin. this negatively affecting their caring roles. nurses reduce their explicative caring behaviors when they are less empathetic and less self-encouraged.4 4. However. Figure 4 depicts this interaction pattern: (a) less empathetic nurses decrease their explicative caring behaviors when their self-encouragement is lower. FIGURE 5 How the understanding of other people emotions interact with emotional selfcontrol to predict the explanatory behaviors 5. This suggests differentiating both aspects of “empathy”. In other words.6 4.7 4.
it is likely that patients will express their feelings honestly and disclose personal information when they feel they can trust the nurse. allowing a more precise diagnosis and consequently better treatment plans. which can have negative effects in the cardiovascular and endocrine systems. (b) when they combine low understanding of the other people dimensions with high emotional self-control. thus improving the satisfaction and job commitment of personnel. 1998. 2004. reducing medication errors. In contrast. have the opportunity to make informed choices and to maintain control. A better patient-centered organizational climate can also emerge. Wolf et al.control. must be interpreted with caution. Rathert & May. DISCUSSION AND CONCLUSIONS Making sense of the main findings The increasing demands of health care consumers and the shift from the caring for paradigm to the caring about paradigm (McQueen. This can lead to more favorable word-of-mouth recommendations of the health organization. the quality of the psychological closeness tends to be enhanced. a better reputation in the community. fewer lawsuits and better economic and financial results of health care organizations (AlMailan. and in fewer illness complications. for a synthesis). when disrespecting and communicating poorly with patients. Weech-Maldonado. 2000) require that nurses adopt caring behaviors contributing to the patients’ well-being and the performance of the health organizations. 2000). Patients may reciprocate with self-disclosure. perhaps reducing turnover (Gesell & Wolosin. 2004. For example (see Issel & Kahn. In such a secure relationship. 1998). 1988). Both self-care and compliance can result in decreased need for medications and procedures. Our empirical research suggests that EI is one of these relevant abilities. The results show that the ability to manage emotions can lead nurses to be more 14 . nurses’ perceptions of patients tend to be more accurate. we dealt with two categories of caring behaviors that likely meet both aims. Ware & Hays. This demands good intra and interpersonal skills and abilities to form a healthy therapeutic relationship with patients. 2005. some reciprocal advantages can emerge. When nurses explain treatments and their likely consequences. 2003. by showing respect for patients. The findings. and do communicate effectively with patients. they adopt more explicative caring behaviors. 2004. It is also likely that patients comply more with the nurses’ clinical and medication orientations (Gesell & Wolosin. an increasing demand of services. however. Lee. nurses contribute to increasing the patients’ stress. blood pressure. This can be important for self-care and compliance with treatment regimens. and a mutually acceptable level of intimacy and emotional involvement are more likely to be achieved (McQueen. nurses improve the level of patient satisfaction. 1998.. In short. they adopt less explicative caring behaviors. patients do increase their self-esteem and self-worth. and levels of stress-related hormones. Issel & Kahn. such as an increase in heart rate. In this paper. Neff & Mor. since the differences between nurses’ scores are small. The nurse is a pivotal figure in patient care and is best placed to provide much of the psychological and emotional care (McQueen. providing nurses with important clinical information. When patients are treated with dignity and respect. 2007). 2000). The positive impact of nurses’ caring behaviors impels researchers to study their antecedents.
A high understanding of one’s emotions can be detrimental of caring behaviors if nurses are also less self-encouraged. Selfencouragement is the better predictor. promotes the nurses’ caring behaviors. Self-encouragement also reinforces or mitigates the effects of other EI dimensions on the explicative caring behaviors. at least. Third: less empathic nurses tend do adopt less explicative caring behaviors if they are less self-encouraged. Lower empathy can result in less caring behaviors if nurses are less self-encouraged. in itself and/or combined with other EI dimensions. “it is now considered acceptable for nurses to show their emotions as they empathize with patients and show their humanity (Staden. because findings suggest that some less emotionally self-controlled nurses tend to adopt more explicative caring behaviors. our sample is very homogenous.5 in the other EI dimensions) seems to imply that many low emotionally self-controlled people elect nursing as a profession. nurses being more/less caregivers when they describe themselves as more/less self-encouraged. considering that the ratio between the number of variables and the number of subjects must be. First: less emotionally self-controlled nurses tend to adopt fewer explicative caring behaviors when they are less self-encouraged. 1998)”. but not if they are more self-encouraged (Figure 3). as it is shown by the high means scores and the low standard deviations (Table 3). This can be problematic for performing the factor analysis. as McQueen (2000) argued. alternatively. but not if they are more self-encouraged. Limitations and future studies Our sample size is small. This may contribute to the low predictive power of EI for caring behaviors. because. nurses adopt more caring behaviors when they are less emotionally self-controlled and more self-encouraged as well (Figure 1). The fact that the sample’ mean score in this EI dimension is the lowest (3. The question is to know whether the explicative behaviors adopted by the less emotionally self-controlled nurses are really addressing the patients’ needs. attentive and trustful towards patients. mainly the explicative ones. Selfencouragement. The case of emotional self-control is especially worthy of mention. Future studies must collect a larger and more diversified sample. Thus. A higher understanding of other people’s emotions is more conducive to caring behaviors if nurses are less emotionally self-controlled. It depends on how different aspects of the nurses’ EI profiles combine. future studies must also improve the 15 . the positive effect of a low emotional self-control. One might therefore speculate about the extent to which a low emotional self-control is a positive attribute of nurses. Regarding caring behaviors.9 against an average of 5. Some examples can be presented.respectful. Indeed. not all EI dimensions lead automatically to more caring behaviors. or just a tendency to disclose emotions and explanations without considering their full consequences on patients. but more of these behaviors when they are more self-encouraged (Figure 1).70. Second: nurses who understand their own emotions decrease their explicative caring behaviors if they are less self-encouraged. Considering that the reliability of an EI dimension is lower than 0. 1:3. The finding suggests the likely negative effect of a high emotional self-control over caring behaviors or. On the whole. and to provide them with more explanations regarding treatments and their respective consequences. but not if they are more self-encouraged (Figure 4). the findings stress the relevance of several EI dimensions. A low self-control against criticism is detrimental to caring behaviors if nurses are low self-encouraged as well.
Stress. For example. Future studies can also include mediating variables. Future studies are required to show (a) how nurses combine their scores in different dimensions and (b) how these configurations relate with caring behaviors in different therapeutic. 2003). such as factors within the working environment (Bardzil & Slaski. Only two dimensions of caring behaviors were studied. Osborne & Ambrose. One can hypothesize that higher individual EI is positively correlated with frequent caring behaviors when the working climate is positive and facilitates the emergence of those behaviors. McQueen. satisfaction. Mayer. 1994) and examine whether the relevance of both dimensions studied here are not cross-culturally contingent (Lee-Hsieh. Future studies can also investigate moderating variables.psychometric properties of the EI measurement instrument. It will be interesting to measure EI through other methods (ability and informant approaches. cancer and psychiatric patients require different caring approaches and their diseases can incur different emotional meaning and intensity. The above discussion suggests other interesting avenues for future research. Future studies must take into account other dimensions (e. Caruso & Salovey. psychologically deny their own situation and/or verbally attack them. Kuo. it is likely that more emotionally intelligent nurses adapt their behaviors to these different circumstances. 2005). Patients’ characteristics can also moderate the relationship between nurses EI and caring behaviors (Henderson. low emotionally self-controlled nurses could negatively affect the wellbeing of patients if they do not manage the expression of their own emotions and are not aware of their impact on the patients.g. nurses with higher EI might avoid giving some explanations to patients who experience a strong psychological distress. 2001. it is possible that a negative working climate inhibits the nurses with higher EI to adopt more caring behaviors. In contrast. The questions that arise then are: (1) In which conditions are the low emotionally self-controlled nurses more positive caregivers? (2) What other individual features do these nurses possess to channel the expression of their emotions to patients in a careful and positive way? (3) How do both caring behaviors studied here relate with patients’ health and well-being? This study has brought to light the complexity of EI with respect to caring behaviors and shows the relevance of the expression of different EI dimensions in individual nurses’ EI profile. 1984. such as the “mechanisms” that make the translation between EI and caring behaviors. Implications and final comments Our findings support the argument that measurement of EI can form part of the selection process and that the topic needs be incorporated into performance 16 . Thus. Tseng & Turton. occupational commitment and emotional states are likely candidates to mediate the relationships. Giardino. 2000). For example. Different kinds of health care services can also act as moderators. Bardzil and Slaski (2003: 102) stressed the argument when they argued that “there is little point in developing emotionally intelligent individuals in order to return them to an environment that fails to support their new positive attitudes and behaviors”. interpersonal and organizational situations. Wolf. 2004).. burnout. Larson. For example.
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