https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article Consequences of Emotional Intelligence in Nursing: A Concept Analysis ABSTRACT INTRODUCTION Emotional Intelligence (EI) refers to the competence to manage and regulate the emotions of oneself and others. It is ob- served across several nursing domains, giv- en its nurses’ wellbeing, which successively influences patients and their families [1].There is a general lack of understanding of EI and its overall significance and scope with various competing definitions and models [2]. When integrated in practice, unclear concepts can lead to a significant amount of misapprehension and confusion, since EI is a concept already emerged with confusion. EI is identified through four major aspects, including emotionality, sociability, wellbeing, and self-control [3]. Emotionality is a skill for showing empathy, being concerned about the insights of oth- ers in a situation, and communicating feel- ings [4]. The social competence of individu- als, their competence to explain strong so- cial skills and to influence others is con- cerned within the sociability component. Wellbeing includes a person having the attributes of feeling happy and satisfied with a positive outlook on life and a good level of self-esteem [5]. Lastly, self-control shows the competence of a person to con- trol and regulate his emotional responses and skills for handling stress. Landa et al. [6] showed that emotional intelligence was initially mentioned in the nursing field Background and Objectives: Emotional intelligence refers to a social skill, which enables individu- al to better regulate emotions and cope up with the different demands and environmental pres- sures. This assists in enhancing professional competence enabling better delivery of services. This paper aimed to examine the consequences of emotional intelligence in the nursing profession by presenting its concepts, definitions, models, and implications. Methods: A literature review study was made and articles were searched from various databases including Scopus, EMBASE, ProQuest, PsychINFO, and CINAHL, using key terms “emotional intelli- gence,” “nursing,” and “concept analysis” from 2000 to 2019. Twenty articles were included fol- lowing their compliance with the inclusion and exclusion criteria and removing of the duplica- tions. Results: Social and personal attributes affect emotional intelligence. Self-awareness, relation- ships, self-management, and social awareness are other important components of emotional in- telligence. The nursing professional explains a social and personal aspect that emotional intelli- gence entails and further portrays a meaningful role of emotional intelligence in both the sensi- tivity and moral dimension of clinical practice. Conclusion: The nursing professionals who possess increased emotional intelligence experience few emotional psychosomatic symptoms and emotional exhaustion, greater workshop collabora- tion and teamwork, more satisfaction with their jobs, fewer unidentified patient care needs, and better emotional health. Keywords: Concept analysis; Emotional intelligence; Nurses; Nursing; Psychology Abdulaziz Mohsen Alsufyani; Comprehensive Rehabilitation Center, ministry of labour and social development, Taif, Saudia Arabia )Correspondence: a.aziz987@hotmail.com ) Omar Ghazi Baker; Department of Community and psychiatric nursing, College of Nursing, King Saud University, Ry- iadh, Saudi Arabia Yasir Mohsen Alsufyani; Department of Nursing, College of Nursing, King Khalid University, Abha, Saudi Arabia 82 Erbil Journal of Nursing & Midwifery Received: 29/12/2019 Accepted: 30/3/2020 Published: 30/5/2020 mailto:A.aziz987@hotmail.com https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article after 2000.Ever since then, studies have shown its integration with various nursing competencies, improved practices, educa- tional achievements, compliance with the discipline, enhanced professional behav- iour, and patients’ satisfaction [7,8]. How- ever, Smith, Profetto-McGrath, & Cum- mings [9] have described it as an ambigu- ous term in nursing, given its relatively new development [10]. Various studies confirm that the adequate use of the concept and its clear understanding assists nurses across different disciplines, including edu- cation, research and practice [11-13]. Thereby, this research aims to investigate the emotional intelligence concept for clar- ifying the definition and its implementation in the healthcare setting, primarily by the nurses. A strong and positive link of emo- tional intelligence with staff wellbeing and performance [8-15], further necessitates its assessment. A vivid comprehension of EI and its consequences is incremental in nursing practice, which assists in under- standing the association of emotions with cognition. EI allows nurses to make better decisions, improve relationships, positively affect care quality and their families, and effectively manage their patients. Identify- ing the consequences of EI might enhance its adoption within the nursing profession, especially due to the EI impact on nursing actions. Certainly, this paper aims to exam- ine the consequences of EI in the nursing profession by presenting its concepts, defi- nitions, models, and implications. It is important to clarify concepts such as EI throughout nursing practice, as concepts majorly contribute to the development of awareness. Unclear attributes and defini- tions of concepts significantly prevent the fundamental use of the concept because there might be doubt concerning related or similar concepts. The concept analysis methods are adopted for providing clarity on concepts, its strengths, and limitations so that it can provide an improved contri- bution to its application and knowledge. Several methods have been proposed for concept analysis. However, this paper uses an evolutionary method for concept analy- sis proposed by Rodger in 1989 due to its strong viewpoints in evaluating subject to change. Rodgers [15] assumes that con- cepts are revealed by a cluster of situa- tions, phenomena, or attributes that are experienced concerning similarities. This method refers to the concepts that are constantly enriched and approves that conceptual variations and innovations might be defined over time because con- cepts are discussed and transferred through social interactions and education. Therefore, attributes and consequences related to EI were searched and presented in this paper. Lastly, related concepts were acknowledged, and an exemplifying model case of the concept was developed to pro- vide conceptual clarity. Data source The concept of EI was explored using a com- prehensive literature review, considering the Rodgers evolutionary method concept analysis. This approach provides the best way of examining EI in nursing practice. One of the strengths of using this approach is its viewpoint toward changes that hap- pen over time, rather than defining an ulti- mate truth, which can be used later for developing a general understanding of EI. No particular range or limitations were identified for supporting the dates of publi- cations to support this approach. The arti- cles were searched from databases such as Scopus, EMBASE, ProQuest, PsychINFO, and CINAHL for the key terms “emotional intelligence,” “nursing,” and “concept anal- ysis” from 2000 to 2019.To narrow the re- sults, the Boolean approach was used, such as “Emotional Intelligence” AND “Nursing.” The objective of the literature 83 Erbil Journal of Nursing & Midwifery METHODS https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article Definitions In the area of psychology, several different types of EI are identified, such as the de- velopment of cultural intelligence and its association with social intelligence [17]. Emotional intelligence is interlinked within the theory of multiple intelligences, where the role of emotions and relationships was first considered within the concept of intel- ligence [9,18]. EI is originally defined as based on a set of interlinked competen- cies. Currently, it is defined as a heteroge- neous combination of attributes as com- pared to ability [19]. Goleman [20] defined one of the innovative definitions of EI, which is widespread in the discipline of nursing. According to the definition, EI is defined as competence to identify the feel- ings of a person and emotions interlinked with other relationships. It is essential to focus on the general implications of this EI definition and the contributions of Goleman [20], Mayer and Salovey [21], and Bar-On [22] as they contributed to this realm by developing their models. Attrib- utes Attributes of emotional intelligence are classified into two major categories, including social and personal attributes. Firstly, social attributes are based on social awareness and relationship management. Social awareness refers to the observa- tions and understanding of emotions, con- cerns, and needs of others, the ability to explore things with other people’s insights, and picking up emotional cues [23-25]. Re- lationship management is a competence for managing better relationships, inspiring and influencing others, and communi- cating clearly for managing relationships with others [24, 26, 27]. Self-awareness, in personal attributes, entails understanding and identifying emotions and motivations of a person along with his strengths, weak- nesses, and needs. Self-management is a competence of controlling or redirecting review was to obtain published peer- reviewed articles that were presented in the English language. Articles presented in abstracts were also considered in the inclu- sion criteria. No restrictions were applied in terms of geographical setting to obtain a broader view of definitions, concepts, and consequences of EI in nursing. Articles fo- cusing on the behaviours of adolescence and EI and other specific subjects were ex- cluded from the search process. These were excluded as these are too specific, whereas the focus of the present paper is to provide a general EI understanding. Psy- chology, business and management, edu- cation, and healthcare were several disci- plines in which we were restricted to ex- tract the articles related to EI. The articles that had an emotional intelligence word in their title or abstract were selected. The quality assessment was conducted to en- sure that the selected article meets the points laid out for the study selection. The studies’ methodological quality was ranked using the hierarchy of evidence: nursing resources [16]. 20 articles were included in this concept analysis paper after com- pleting the inclusion and exclusion process and removing the duplications. Figure 1 presents the selection procedure of the number of articles included in this re- search. 84 Erbil Journal of Nursing & Midwifery Figure 1: Study Procedure RESULTS https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article potential for facilitating and strengthening their capacity to provide palliative care that Mr. M might be experiencing substan- tial negative feelings. This evidence might inform the next actions for the APN in sup- port and planning care that is individual- ized to Mr. M, as she will be able to effec- tively work through their emotional state and interpret that into supportive strate- gies towards Mr. M. Contrary outcomes In a contrary case, an example of the lack of emotional support is presented, which helps in exploring the ways that differenti- ate it from the model case. “David is ad- mitted to the local palliative care unit. Over the last few days, his condition has deteriorated, and he cannot move from his bed. The senior nurse evaluates that David will require a bed bath the next morning. So, two nurses have been asked to attend to the personal care of David during their shift. The nurses enter the room of David and inform him that they will be aiding him to wash. Both nurses start communicating with each other discussing their daily rou- tine while carrying out personal care, and communicate with David whenever he needs help”. The feelings of frustration and dismay of a nursing professional can be translated into formulating evaluations. A negative evaluation may have the possi- bility to inhibit the development of a ther- apeutic relationship if the nursing profes- sional shows this reaction to the patient. Consequently, the needs and issues of a patient might not be appropriately ad- dressed and communicated, if a therapeu- tic relationship is not established. The nursing professional will also be troubled by the responses and feelings of a frustrat- ed patient. Identifying the emotions of a patient can either help the nursing profes- sional to understand him/her or may ena- ble the nursing professional to interfere with how she delivers care. Related case In a related case, the concept is associated 85 Erbil Journal of Nursing & Midwifery emotions constructively. It enables a per- son to deny evaluation until sufficient in- formation is collected and to assume be- fore acting [24].Development of Cas- esModel cases and examples The model case presented here is based on clinical experience for representing the concept of emotional support. The patient called Mr. M (names are altered within this section to protect confidentiality and anonymity) was referred by an advanced practice nurse (APN). See the below case: “The nurse was shocked that Mrs. M did not start CPR on her husband. The idea that Mr. M may have had a better consequence regardless of any shortages led to feelings of frustra- tion for the nurse. She might not be cogni- zant of her behaviours if the nurse did not identify her emotions. Inadequate reac- tions can result in negative implications for family care. To be precise, emotional intel- ligence allows persons to be aware of their reactions and emotions and reflects the way they respond to others. The feelings of frustration and disappointment can in- terpret into formulating evaluations of the nurse. In particular, the needs and con- cerns of Mrs. M may not be appropriately communicated and addressed if a thera- peutic relationship is not developed. Awareness of her emotions might either help the nurse to understand Mrs. M or may enable her emotions to lead how she delivers care”. APN is allowed by being in charge of the emotions of Mr. M in emo- tional prediction. Affective prediction fore- casts how people will feel in response to a future event. The APN observed the condi- tions of Mr. M, considering that his unan- ticipated medical emergency and his prog- nosis was deprived under different situa- tions. An emotionally intelligent person is capable of identifying and managing his emotions in a way that would positively affect her relationship with Mr. M. Conse- quently, the competence of APN has the https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 86 Erbil Journal of Nursing & Midwifery with the concept being investigated but does not comprise all the defining charac- teristics. “Sarah is a 45-year old woman who comes to see her husband, Joseph, at the local community hospital. Joseph was diagnosed with a malignant brain cyst 19 months before and received proper treat- ment, resulting in modifications to his mo- bility, personality, and cognitive function. Diagnoses have indicated advanced dis- ease, and he has currently been complain- ing about rapid seizures. Sarah was in- formed that Joseph is working with the physiotherapist, so she has to wait for him to return. The nurse offers Sarah a cup of tea while using the chance to ask how Jo- seph is. The nurse sits beside Sarah and asks her a few simple questions, which al- low her to talk. She tells the nurse about the negative effect of Joseph’s illness on their personal lives”. Motivation indicates having a distinctive focus to gain, and em- pathy is the ability to understand emo- tions, perspectives, and thoughts of anoth- er person. A person would have to be mo- tivated to understand emotions and be clear in accepting the emotions of other individuals. The related case presented above shows an example of the concept of empathy, which refers to actively listening, feelings with sensitivity and accuracy, and feeding back thoughts. The APN explains empathy by making efforts to understand what is happening from the perspective of Jensen. The APN manages to convey her understanding of Jensen’s situation by ac- knowledging her feelings using verbal and non-verbal behavior .Borderline example In a borderline case, an example is pre- sented comprising the defining characteris- tics but varies significantly in one of them. A borderline case is presented below con- cerning emotional intelligence. “Peter is a 58-year-old gentleman who has progres- sive lung cancer, and he has to initiate a course of palliative chemotherapy. Peter has been contacted by the local community nurse at home to arrange her first visit to obtain a pre-chemotherapy blood sample. While obtaining his sample, the nurse talks with Peter about his re- cent scans. The nurse listens to Peter about the negative effect of the news and how he understands what is happening. He becomes quite upset when explaining what the future may hold for him, and he quickly attempts to regain his composure. The nurse portrays what a distressing time it must be for him and his family and reconfirms Peter that the primary health care team is there for helping and sup- porting him”. Being responsible for one’s emotions enables an individual to involve in emotional prediction. Affective predic- tion forecasts how a person will feel in reaction to a future event. Consider an example; if a patient had an unexpected medical emergency and the prognosis of a patient was adverse, the nursing profes- sional should respect the feelings of that patient under different conditions, and therefore, forecast future feelings. A nurs- ing professional is emotionally intelligent who is competent enough for identifying and managing her emotions in a way that positively impacts her working relation- ship with the patient. Consequently, the ability of nursing professionals can facili- tate and strengthen their competence to provide supportive care to the patient, as the nursing professional identifies his/her own emotions. A nursing professional who possesses EI has competence in iden- tifying and understanding that the patient might be facing substantial adverse feel- ings or emotions. This information may assist in inspiring the nursing professional to plan her next actions in caring for and supporting the patient. Furthermore, a nursing professional will be able to effec- tively work through her emotional state and transmit that into supportive actions https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 87 Erbil Journal of Nursing & Midwifery towards the patient, which consequently enriches the antecedents of empathy. An- tecedents of emotional intelligence Self- management and self-awareness are im- portant factors to maintain the well-being of both the nurse and their patients. To be precise, APNs who developed a sense of empathy are motivated to cope with their own emotions, to experience less stress, burnout, and job dissatisfaction. These an- tecedents influence the care of patients, the overall well-being, and the families of nurses. In addition, emotional intelligence is also comprehending the influence of emotions on other individuals and pacify- ing emotions of an individual at times. Consequences of emotional intelligence Consequences are incidents or events that can occur due to the occurrence of a con- cept. Determining consequences through- out the context of a model case enhances the transparency of EI in the nursing prac- tice. The consequences of EI throughout the nursing practice are related to the wellbeing of nurses as working experts. For instance, the evidence is present be- tween nurses and job satisfaction, stress levels, retention, and burnout [28]. A nurs- ing professional possessing EI would be able to comprehend the process to predict future emotional reactions of an individu- al, in terms of patient and family care [29]. A nursing professional can help the devel- opment of positive relationships as they are aware of predicting their feelings, re- actions, and responsiveness to a future interaction or event [30]. Consider a case where inadequate reactions of a nursing professional can result in adverse implica- tions to the patient and family, which might be due to the feelings of frustra- tions. Precisely, EI enables people to be aware of their reactions and emotions and reflect the way they respond to others. This is particularly useful for the nurses in leading positions as they affect as well as influence the practices of the staff nurses and more. Tyczkowski et al. [31] stated that emotional intelligence ena- bles the individuals to become emotion- ally sound, fostering transformational leadership within nursing practice. Given that the concept of EI is not generally recognized in the nursing discipline, it is integral for the nurses to further re- search this area to improve and develop their understanding, which will promote better understanding, information syn- thesizing, as well as generating and as- sisting in improved decision making [32, 33]. Sarrionandia and Garaigordobil [34] also emphasized emotional intelligence development among the nurses as it re- duces the emotional psychosomatic symptoms and burnout, promoting satis- faction towards their job. Emotionally intelligent nurses can employ research- based knowledge and knowledge- transfer techniques for delivering quality -infused results. This understanding is likely to refine the quality as well as de- livery of nursing care. The preliminary focus of this concept analysis was to understand the conse- quences of EI in the nursing practice, specifically on the nursing professional, who can meet the needs of a person, families, communities, and a population. A nursing professional can address her own emotions and feelings for under- standing how they affect her ability and collaboration to explain leadership [11- 13]. Emotions are an important compo- nent of critical decision-making and are a fundamental aspect of the quality of clinical care. A broad foundation of nurs- ing expertise required in decision- making directly affects patients and fam- ily care. Particularly, decisions are more patient and family-focused and DISCUSSION https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 88 Erbil Journal of Nursing & Midwifery empathetic and support and improve the role of the nursing professionals. In this situation, the nursing professional explains a social and personal aspect that EI entails and further portrays a meaningful role of EI in both the sensitivity and moral dimen- sion in clinical practice [23-25]. Self- awareness enables nurses to connect thoughts, actions, and emotions in an in- fluential manner [24], and therefore, is a vital competency in decision-making and creative procedures that might be based on intuitions and feelings. EI supports nurses in using empathy as a resource to understand situations that are based on moral evaluations and professional reflec- tion associated with decision-making [4]. It also enables nurses to ensure the safety of the patients. EI has been associated with stress, emotional wellbeing, and mental health throughout the context of nursing. Patients who are not able to adequately manage their emotions do not seek help or encouragement. The competence of a nursing professional to encourage emo- tional management among patients and their families might assist in facilitating therapeutic associations between nurses and patients if nurses exemplify an emo- tionally intelligent practice. The nursing professionals with high emotional intelli- gence explain less emotional psychoso- matic symptoms and emotional exhaus- tion, greater workshop collaboration and teamwork, more satisfaction with their jobs, fewer unidentified patient care needs, and better emotional health [8, 7, 28]. However, for improving the out- comes, the clinical instructions, and the regulatory system should be established for devising effective decisions. Guidelines can be set for training the employee which not only improves the emotional intelli- gence competence but also helps in in- creasing the satisfaction of nurses as well as patients. Emotional intelligence is an essential as- pect of nursing practice as emotions and sensitivity to mood are prime compo- nents of care and cannot be ignored from how we assume and act like experts. Much work remains to be done, especial- ly for the inconsistency of attributes, whereas a great deal of work is attempt- ed for understanding and exposing EI as a concept. EI facilitates emotional well- being among the nursing professionals and helps in improving the competence to practice abilities that will benefit pa- tients, colleagues, and families as working professionals and as individuals. Emotion- al competence and effectiveness are used interchangeably with emotional intelli- gence and are regarded as surrogate terms. Reflexivity and reflection are terms that are associated with emotional intelligence insofar as they are words that have something common with emotional intelligence but do not have the same attributes. Consequently, EI encourages more than just awareness of emotions; it enables nurses to provide quality care and support to their patients. The ability to identify and understand EI will remain an essential aspect of nursing practice moving forward, despite the misappre- hension and confusion about EI as a con- cept. The author is very thankful to all the as- sociated personnel in any reference that contributed to this research. The author reports no conflicts of inter- est. The study is self-funded. CONCLUSION ACKNOWLEDGEMENT CONFLICT OF INTEREST FUNDING https://doi.org/10.15218/ejnm.2020.10 Erbil j. nurs. midwifery, Vol. 3, No. (1), May, 2020 Original Article 89 Erbil Journal of Nursing & Midwifery [1] Hurley J, Hutchinson M, Kozlowski D. Emo- tional intelligence can help regional nurses maintain their mental wellbeing. Australian Nursing and Midwifery Journal. 2018 May 1;25(10):35 [2] Ackley D. Emotional intelligence: A practical review of models, measures, and applica- tions. 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