Emotional intelligence is defined as the ability of people to recognise, understand and control their own emotions and recognise, understand and influence the emotions of others (Hogeveen et al, 2016). It is an essential skill in leadership and includes four dimensions (Law et al, 2004; Ishii and Horikawa, 2019; Al-Hamdan et al, 2020):
- The appraisal of a person's own emotions (‘self-emotion appraisal’): a person's capability of understanding and expressing their own personal emotions
- The appraisal of the emotions of others: the ability of a person to recognise and interpret the emotions of other people
- The use of emotions: the ability of a person to use their own emotions in effective ways in practice
- The regulation of emotions: the ability of a person to control and manage their own emotions.
Many studies have indicated the positive impact of emotional intelligence on increasing nurses' wellbeing, job satisfaction, engagement, teamwork, conflict resolution and caring behaviours; and decreasing burnout and turnover, job stress and chronic fatigue (Başoğul and Özgür, 2016; Hong and Lee, 2016; Lee et al, 2018; Nightingale et al, 2018; Yan et al, 2018; Al-Hamdan et al, 2020; Huang et al, 2019). These positive impacts of emotional intelligence result from its role in increasing nurses' ability to nurture relationships, recognise their limitations and strengths, display empathy, use personal influence, act as change agents, create a shared vision and work collaboratively (Kooker et al, 2007; Carragher and Gormley, 2017; Ayaad et al, 2018; Raghubir, 2018; White and Grason, 2019). Thus emotional intelligence may be considered a key to enhancing nurses' ability to make a professional practice model (PPM) more effective.
A PPM describes how nurses practice, interact and collaborate to provide optimal and high-quality nursing care. The effective implementation of a PPM is considered an essential strategy to achieve nursing excellence, as indicated in the 2019 Magnet Application Manual (American Nurses Credentialing Center (ANCC), 2017). Based on many studies, enhancing a positive professional practice environment could be accomplished by ensuring staff leadership, autonomy, and control over practice, effective interdisciplinary relationships and teamwork, effective communication about patients, using constructive techniques to solve disagreements and conflict, delivering culturally sensitive and competent care to patients, and improving internal work motivation (Basol et al, 2015; Ives Erickson et al, 2017; O'Hara et al, 2019; Al-Ruzzieh and Ayaad, 2020).
The successful implementation of an effective PPM would enhance the professional practice environment, including teamwork, communication with and about patients, cultural sensitivity and conflict management, and ensure sufficient resources, work motivation, staff relationships, autonomy and supportive leadership (Ng'ang'a and Byrne, 2015; Qu et al, 2019).
Many studies have indicated that the effective implementation of a PPM has a significant role in improving an organisation's outcomes, nurses' satisfaction and patients' outcomes (Bieber and Joachim, 2016; Slatyer et al, 2016; Olender et al, 2020). These impacts may be found in complex settings, such as oncology, where there is a need for a high level of co-ordination among nurses and between nurses and other health professionals. Well-developed models and frameworks are essential to guide nurses to provide high-quality care and improve patient outcomes (Jacobs and Shulman, 2017; Philip et al, 2018; Selby et al, 2019).
Many factors influence the implementation of a PPM; they can be related to the nurses' ability to nurture relationships, recognise their limitations and strengths, display empathy, use personal influence, act as change agents, create a shared vision and work collaboratively (Ayaad et al, 2018; Raghubir, 2018; White and Grason, 2019). Thus the level of emotional intelligence may be considered a key to enhance the nurses' capability to make the PPM more effective.
To the best of the authors' knowledge, there are no studies in the literature discussing the impact of emotional intelligence on the effective implementation of a PPM, especially in a specialised cancer centre, which this study aimed to examine.
The results of this study will increase the awareness of nurse leaders in oncology settings regarding the importance of emotional intelligence in the implementation of a PPM and encourage them to develop strategies to enhance emotional intelligence among nurses and nurse leaders in order to achieve nursing excellence.
Methods
Research design
The study used a cross-sectional design. A cross-sectional study is generally used to investigate certain phenomena and relationships between study variables (Setia, 2016).
Setting
This study was conducted at King Hussein Cancer Center (KHCC) in Jordan. KHCC has 352 beds and is a not-for-profit comprehensive cancer centre. Around 1200 nurses work at KHCC. In 2019, it became the first hospital in Jordan to earn a Magnet designation (ANCC, 2017). A nursing PPM was developed during the centre's journey to achieving this designation and was revised in 2018 based on the ‘quality compass’ and Donabedian theories (Al-Ruzzieh and Ayaad, 2020). The KHCC PPM involves several dimensions, including professional development, a positive working environment, interdisciplinary collaboration, recognition and rewards, shared governance and best practices, including research and evidence-based projects (Al-Ruzzieh and Ayaad, 2020).
Sample
A convenience sampling technique was used to select the 580 frontline registered nurses who had at least 1 year's experience at KHCC and who agreed to participate in the study. This technique was used to capture the highest number of participants in a short time (Cooper and Schindler, 2014).
Ethical approval
Institutional review board approval (no. 20 KHCC 88) was obtained from the KHCC research department. This approval confirmed the availability of a consent form before data collection, the right of refusal or withdrawal from the study and confidentiality of the participants' information. Questionnaires were kept anonymous and did not include any unique identifiers such as name and/or employee numbers.
Instrument
Data were collected using a self-administered questionnaire in three parts. The first part inquired about demographics: sex, date of employment, marital status, membership of the shared governance council, educational level, and working unit type. Some units include more than one type of care provision. For example, the medical surgical unit comprises five separate units.
The second section included statements measuring emotional intelligence, using the validated Wong and Law Emotional Intelligence Scale (WLEIS) (Law et al, 2004). The questionnaire had 16 statements covering four domains:
- Self-emotions appraisal (statements 1-4)
- Total regulation of emotions (statements 5-8)
- Use of emotion (statements 9-12)
- Others' emotion appraisal (statements 13-16).
This questionnaire used a 7-point Likert scale where 1=strongly disagree and 7=strongly agree. The reliability of the scale was tested using Cronbach's coefficient, ranging from 0.83 to 0.92, which indicated that the scale is reliable since all values were more than 0.60 (acceptable level). The loading factor analyses of the WLEIS were more than 0.30 (Law et al, 2004).
The third section included statements measuring the effective implementation of the PPM, as it leads to achieving high levels of professional practice (Ng'ang'a and Byrne, 2015; Qu et al, 2019). The Professional Practice Work Environment Inventory (PPWEI) was used (Ives Erickson et al, 2017). This inventory included 61 items scored on a 6-point scale (strongly disagree, moderately disagree, disagree, agree, moderately agree, and strongly agree). It covered nine components: teamwork; communication about patients; cultural sensitivity; handling disagreement and conflict; sufficient staff, time and resources for quality patient care; work motivation; staff relationships with physicians, staff and hospital groups; autonomy and control over practice; and supportive leadership. The reliability for the scale was tested using Cronbach's coefficient—the results showed that the scale is reliable since the value of the Cronbach alpha for PPWEI was 0.93, which was higher than 0.60 (the acceptable level). The loading factor analyses were more than 0.50, which indicated the validity of the scale (Ives Erickson et al, 2017). The questionnaire was uploaded to SurveyMonkey (SurveyMonkey Inc, California, USA) and a link sent to eligible nurses by email.
Data collection
The potential participants were identified in collaboration with the human resources department at KHCC through reviewing the staffing database against the eligibility criteria. The questionnaire was uploaded as a web-based form through SurveyMonkey to make the data collection process easy. The questionnaire was combined with a covering letter and was sent to all 950 potential participants via email. The data collection was conducted during August 2020.
Data analyses
SPSS (IBM SPSS Statistics for Windows, Version 20.0) was used to analyse the data. Descriptive analysis including frequency, percentage, mean and standard deviation were used to describe the demographic of participants, mean and standard deviation (SD) of used scales. The Pearson correlation coefficient test was used to measure the relationship between emotional intelligence and the effective implementation of the PPM. The covariate regression coefficient test was utilised to measure the impact of nurses' emotional intelligence on the effective implementation of a PPM. This test was adjusted to demographic characteristics to estimate the effect of each independent variable after holding all other variables constant. P-values were considered significant at 0.05.
Results
Participants' demographics
As Table 1 indicates, 580 frontline registered nurses responded, with a mean age of 28.57 years (SD=5.80) and a mean experience of 6.21 years (SD= 6.17). Most of them were female (339; 58%), married (288; 50%), and had a bachelor's degree (524; 90%). Most of the participants were working in medical-surgical units (171; 29%).
Table 1. Participants' demographics
| Demographic characteristic | Results |
|---|---|
| Gender (n) (%) | |
| Male | 241 (42%) |
| Female | 339 (58%) |
| Educational level (n) (%) | |
| ▪ Bachelor | 524 (90%)) |
| ▪ Postgraduate | 56 (10%) |
| Marital status (n) (%) | |
| Single | 279 (48%) |
| Married | 288 (50%) |
| Divorced, or widowed | 13 (2%) |
| Age (mean) (SD) | 28.57 (5.80) |
| Years of experience (mean) (SD) | 6.21 (6.17) |
| Working unit type (n) (%) | |
| ▪ Emergency rooms | 54 (9%) |
| ▪ Intermediate and intensive care units | 88 (15%) |
| ▪ Outpatient units | 70 (12%) |
| ▪ Bone marrow transplantation units | 63 (11%) |
| ▪ Medical surgical units | 171 (29%) |
| ▪ Operating room and post-anaesthesia care units | 45 (10%) |
| ▪ Ambulatory and working groups | 89 (15%) |
| Total (n) (%) | 580 (100%) |
Mean values of study parameters
Table 2 presents the mean values for the study scales. The overall mean value for the domain of emotional intelligence was 5.60 (SD=0.78), with the use of emotions domain having the highest mean (5.88, SD=0.87). The overall mean value for implementing the PPM was 4.76 (SD=0.59), with the communication about patients domain having the highest mean (4.96, SD=0.72).
Table 2. Mean values of study parameters
| Scale | Mean (SD) |
|---|---|
| Emotional intelligence: (6-point Likert scale) | |
| ▪ Self-emotions appraisal | 5.59 (0.06) |
| ▪ Total regulation of emotions | 5.54 (0.90) |
| ▪ Use of emotion | 5.88 (0.87) |
| ▪ Others-emotion appraisal | 5.38 (1.02) |
| Overall mean | 5.60 (0.78) |
| Implementation of PPM (5-point Likert scale) | |
| ▪ Teamwork | 4.92 (0.78) |
| ▪ Communication about patients | 4.96 (0.72) |
| ▪ Cultural sensitivity | 4.92 (0.73) |
| ▪ Handling disagreement and conflict | 4.40 (0.72) |
| ▪ Sufficient staff, time, and resources for quality patient care | 4.40 (1.08) |
| ▪ Work motivation | 4.92 (0.84) |
| ▪ Staff relationships with physicians, staff, and hospital groups | 4.19 (0.78) |
| ▪ Autonomy and control over practice | 4.44 (0.83) |
| ▪ Supportive leadership | 4.63 (0.97) |
| Overall mean | 4.76 (0.59) |
Correlation between emotional intelligence and implementation of the PPM
Table 3 presents the correlation of emotional intelligence with the effective implementation of the PPM. The results show that the overall mean value of emotional intelligence had a significant positive correlation with the effective implementation of the PPM (r=0.580, P<0.001). Moreover, the results showed that emotional intelligence and its related domains had a positive correlation with the implementation of the PPM and its related subscales (P<0.001), except the correlation between self-emotions appraisal and use of emotion with staff relationships, which was significant at P<0.05. These results indicate a relationship between a high score of emotional intelligence and the effective implementation of the PPM.
Table 3. Correlation between emotional intelligence scale and professional practice work environment
| Professional practice work environment inventory | Emotional intelligence scale: r value | ||||
|---|---|---|---|---|---|
| Self-emotions appraisal | Total regulation of emotions | Use of emotions | Others-emotion appraisal | Overall mean | |
| Teamwork | 0.374 ** | 0.347 ** | 0.366 ** | 0.332 ** | 0.428 ** |
| Communication about patients | 0.453 ** | 0.293 ** | 0.397 ** | 0.359 ** | 0.455 ** |
| Cultural sensitivity | 0.366 ** | 0.342 ** | 0.338 ** | 0.316 ** | 0.418 ** |
| Handling disagreement and conflict | 0.21 ** | 0.217 ** | 0.157 ** | 0.300 ** | 0.297 ** |
| Sufficient staff, time, and resources for quality patient care | 0.297 ** | 0.215 ** | 0.218 ** | 0.313 ** | 0.335 ** |
| Work motivation | 0.370 ** | 0.260 ** | 0.362 ** | 0.330 ** | 0.403 ** |
| Staff relationships with physicians, staff, and hospital groups | 0.08 | 0.147 * | 0.069 | 0.155 * | 0.157 ** |
| Autonomy and control over practice | 0.293 ** | 0.279 ** | 0.289 ** | 0.335 ** | 0.362 ** |
| Supportive leadership | 0.354 ** | 0.319 ** | 0.337 ** | 0.373 ** | 0.431 ** |
| Overall mean | 0.481 ** | 0.417 ** | 0.414 ** | 0.505 ** | 0.580 ** |
Significant at P<0.001;
*Significant at P<0.05 (in bold)
The impact of emotional intelligence on the PPM implementation
Table 4 presents the impact of emotional intelligence on the implementation of the PPM adjusted to the participants' demographics. The results show that there was a significant positive impact of emotional intelligence and its domains on the implementation of the PPM (P<0.001). Moreover, the results show that there was a positive impact of emotional intelligence on teamwork and communication about patients' related domains (P<0.05 and P<0.001, respectively).
Table 4. The impact of emotional intelligence scale on the professional practice work environment adjusted to participants' demographics
| Professional practice work environment inventory | Emotional Intelligence Scale: r value (P-value*) | ||||
|---|---|---|---|---|---|
| Self-emotions appraisal | Total regulation of emotions | Use of emotions | Others-emotion appraisal | Total mean | |
| Teamwork | 0.0230.79 | 0.28680.001** | 0.17530.05* | 0.0460.617 | 0.133<0.05* |
| Communication about patients | 0.47720.001** | 0.13020.11 | 0.29570.001** | 0.1870.05* | 0.2730.001** |
| Cultural sensitivity | -0.08970.4069 | -0.00150.9876 | -0.03020.7482 | -0.1180.288 | -0.060.449 |
| Handling disagreement and conflict | -0.03960.6511 | -0.01130.8833 | -0.09880.1963 | 0.1670.063 | 0.0040.946 |
| Sufficient staff, time, and resources for quality patient care | 0.10420.05 | -0.01530.74 | -0.00460.92 | 0.1150.05* | 0.050.206 |
| Work motivation | 0.09020.27 | -0.07130.31 | 0.12550.07 | 0.0990.23 | 0.0610.30 |
| Staff relationships with physicians, staff, and hospital groups | -0.06830.30 | 0.02140.71 | -0.04820.40 | -0.0190.78 | -0.0280.56 |
| Autonomy and control over practice | 0.08510.25 | 0.05300.41 | 0.04020.53 | 0.1170.12 | 0.0740.17 |
| Supportive leadership | 0.00840.89 | 0.07020.20 | 0.06490.23 | 0.1140.07 | 0.0640.15 |
| Overall mean | 0.7700.001** | 0.5670.001** | 0.6750.001** | 0.8990.001** | 0.7280.001** |
Significant at P<0.001;
*Significant at P<0.05 (in bold)
The results show the significant impact of self-emotions appraisal on communication about patients, total regulation of emotions on teamwork and use of emotion on communication about patients and sufficient staff, time and resources for quality patient care (P<0.001).
Discussion
The study provides empirical support for the importance of the level of emotional intelligence and its role in nursing. The results on the emotional intelligence level were higher than the results of other previous studies (Nespereira-Campuzano and Vázquez-Campo, 2017; Taylan et al, 2021). This may be due to the differences in nursing excellence and professional development status between the settings where the studies were conducted.
The results showed that a high score in the professional practice environment is an indicator for effective implementation of the PPM. The authors expected a high professional practice environment, due to the KHCC's Magnet designation. This designation has a role in improving the work-life balance, teamwork and collaboration, quality of care, nursing autonomy, and availability of resources and equipment (Ayaad et al, 2018; Al-Ruzzieh and Ayaad, 2020; McCaughey et al, 2020; Olender et al, 2020).
The results showed a positive correlation of emotional intelligence and its domains with the implementation of the PPM (P<0.001). This is also confirmed when adjusted to the participants' demographics (P<0.001). This result may be explained by the fact that high levels of emotional intelligence enhance nurses' ability to implement the PPM through improving nurses' leadership and autonomy, professional development and competencies, teamwork, coping and stress management, and nurse engagement.
These results are supported by the literature, which showed a positive correlation between emotional intelligence and many factors that are expected to enhance the implementation of a PPM through improving the professional practice environment, such as introducing and improving conflict management strategies, physical and emotional caring, organisation relations and co-operation, problem-focused coping, the adequacy of resources and reducing occupational stress (Ng'ang'a and Byrne, 2015; Başoğul and Özgür, 2016; Jain and Duggal, 2018; Mazzella Ebstein et al, 2019; Al-Ruzzieh and Ayaad, 2020).
Moreover, the results demonstrated the positive impact of emotional intelligence on teamwork and on communication about patient-related domains of the professional practice environment (P<0.05 and P<0.001, respectively). In other words, emotional intelligence, through the proper understanding, using and controlling of emotions, and the understanding of others' emotions, is considered a predictor for effective teamwork and communication about patients.
The literature supports these results, indicating the impact of emotional intelligence on team and interdisciplinary working relationships' effectiveness, quality of team interactions, effective communication skills, conflict management, caring behaviour and moral sensitivity. These factors are expected to enhance the implementation of a PPM (Duffy, 2016; Ives Erickson et al, 2017; Nightingale et al, 2018; Taylan et al, 2021).
The results show the impact of the self-emotions appraisal domain on communication about patients (P<0.001). Nurses with high self-emotion appraisal and use of emotion can successfully manage and cope with their emotions, and are able to understand and express their own emotions and apply their emotions in effective ways (Law et al, 2004; Aslan and Inan, 2014; Ishii and Horikawa, 2019; Al-Hamdan et al, 2020). Having an awareness of a nurse's own emotions may improve his or her ability to engage in patients' care effectively, advocate for patients and communicate about patients with other health professionals.
The results show the impact of the use of the emotion domain on communication about patients and availability of staff, time, and resources for quality patient care (P<0.001). People with a high ability to manage their emotions effectively may also have the ability to utilise their time, advocate for others and themselves, and negotiate to achieve the required resources to perform the work effectively (Libbrecht et al, 2010; Aslan and Inan, 2014; Nightingale et al, 2018). For this reason, a high ability to use emotions may play an important role in perceiving time and utilising resources effectively to improve the quality of care.
The results show the impact of the total regulation of emotions domain on teamwork (P<0.001). A person with a high score in the regulation of emotion has a greater ability to engage, communicate, interact, and collaborate with others, and is more able to cope and mitigate occupational stress (McTiernan and McDonald, 2015; Chen et al, 2019; Mazzella Ebstein et al, 2019).
Limitations
There were many unavoidable limitations, such as the lack of sufficient studies that discuss the impact of emotional intelligence on implementation of a PPM and the lack of feasibility to control external variables, which can be considered as a barrier to achieving and interpreting more valid results. Moreover, the study was conducted in an oncology setting, so the generalisation of data may be restricted to similar settings. Accordingly, more studies are recommended to discuss the impact of emotional intelligence on the implementation of a PPM in a different setting. Other aspects that influence the performance of a PPM to be considered in future studies are leadership styles and organisational culture.
Conclusion
This study evaluated the impact of emotional intelligence on the implementation of a PPM. A cross-sectional design was conducted on an appropriate sample size despite the lack of previous studies discussing this issue in a comprehensive manner. This result is an initial step for nurse leaders to consider the importance of emotional intelligence in implementing a PPM in a specialised cancer centre. Although the study objectives confirmed the impact of emotional intelligence on the implementation of a PPM, the results should be interpreted with caution since many external variables would affect the results, such as the study setting and the hospital's excellence status.
KEY POINTS
- Emotional intelligence plays important role in nursing wellbeing and practice in the oncology setting
- There was a positive correlation of emotional intelligence with the effective implementation of the professional practice model in the oncology setting
- The emotional intelligence can be considered a predictor for the effective implementation of a professional practice model in the oncology setting
CPD reflective questions
- How can we improve the effectiveness of a professional practice model in a healthcare organisation?
- Can emotional intelligence be considered a predictor for the effective implementation of a professional practice model?
- How can emotional intelligence affect the implementation of a professional practice model?