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Capital we must develop: emotional competence educating pre-licensure nursing students.

Abstract

Emotional competency is a skill commonly overlooked within the nursing curriculum. However, with the complexity of the health care environment and increased emphasis on team collaboration, nurse educators who focus on health promotion and technical, medical, and organizational competencies need to consider adding a focus on soft skills, such as emotional competency. This pilot study engaged 14 pre-licensure nursing students who were involved in an 18-month leadership program. Pre-post scores of the Emotional and Social Competency Inventory are described. Statistical significance was found with three core areas: emotional self-awareness, emotional self-control, and inspirational leadership.

KEY WORDS Emotional Competency--Pre-Licensure Nursing Students--Leadership Development

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Pre-licensure nursing students are entering health care at a time of great turbulence. It is also a time of many opportunities for improving health and health outcomes for diverse populations. Given changes in the health care environment, nurses need more than skills in health promotion and medical, technical, and organizational competencies. They must also develop soft skills encompassing emotional competence, that is, the ability to distinguish, manage, and harness one's own feelings and better understand the feelings of others, and to use this information to respond effectively (Codier, Freitas, & Muneno, 2013). Salovey and Mayer (1990) coined the term emotional competence (EC), which gauges the aptitude to get along with oneself and others. EC is rooted in the theory of social competence (Hsu, Wan-Yu, Wang, &Yen-Yu, 2010).

EC has surfaced as an important skill that influences nursing performance in a variety of ways, for example, in augmented negotiation skills, improved relationship building, reduced burnout, adaptive response to organizational change, better physical and emotional wellness, enhanced team performance with open communication, increased safety, and increased customer satisfaction and improved nurse retention (Codier et al., 2013). Ultimately, EC can reveal whether a nurse's efforts are ordinary or extraordinary.

Pre-licensure nursing students need to recognize and understand EC and its value and assess their current personal EC abilities. Individuals enter the profession with varied life experiences and have different capabilities and academic preparation (Wilson & Carryer, 2008). What has been required in the past, for example, book knowledge or professional experience in another field, does not necessarily translate into high levels of EC (Shipley, Jackson, & Segrest, 2010).

Nursing requires interpersonal and team interactions with diverse "individuals, families, and groups in multiple relationships" whose values and beliefs may differ from one's own; nevertheless, being able to manage one's emotions and responses appropriately and to communicate effectively with others is necessary (Wilson & Carryer, 2008, para. 27). These factors, linked with our profession's demands and stressors, necessitate cultivation of EC to mitigate high levels of emotional distress, disengagement, burnout, and untimely departure from the profession (Por, Barriball, Fitzpatrick, & Roberts, 2011).

As leaders in today's health care system, professional nurses need to be able to motivate employees and respond well to subordinates' individual developmental needs, collaborate effectively with interprofessional team members, and properly manage relationships with others (Hsu et al., 2010). Essentially, they need to increase their leadership effectiveness. This article describes pre-post scores of the Emotional and Social Competency Inventory among a cohort of pre-licensure nursing students who participated in an 18-month leadership program.

LEADERSHIP PROGRAM FRAMEWORK AND CONTENT

Kouzes and Posner's (2012) exemplary leadership theory served as a guide for the leadership program. Behaviors, practices, and/or actions that use Kouzes and Posner's five exemplary practices of leadership include: modeling the way (demonstrating actions that model one's values and help earn the respect of followers); challenging the process (purposefully challenging customary practice); inspiring a shared vision (helping others imagine what they might anticipate for the future); enabling others to act (establishing behaviors and practices that support individuals to be both effective followers and leaders); and encouraging the heart (providing opportunities to embolden and stimulate leaders to make a positive difference and contribution to the many individuals and communities they affect).

The leadership courses used student-centered action learning and experiential approaches, including small- and large-group discussion, debates, roundtable discussions, individual/group projects with multiperson feedback, short reflective prompts, debriefing exercises, journaling, interprofessional team simulations, and development and implementation of an individualized professional development plan. These learning experiences provided opportunities to develop new skills and try different ways of thinking and alternate styles of behavior.

Kouzes and Posner wrote that "any skill can be strengthened, honed, and enhanced, given the motivation and desire, along with practice and feedback, role model, and coaching'' (p. 10). Therefore, once students learn the value of cultivating EC through deliberate developmental experiences, the skills and abilities linked with EC can be formed and shaped (Lee, 2010). Every leadership style invariably encompasses aspects of EC, including self-awareness/self-management as well as social awareness/social skills (Hsu et al., 2010).

METHOD

Sample

Approval was obtained from the university's institutional review board for a nonexperimental pre-post survey in January 2012 and May 2013, respectively. The convenience, nonrandom sample included 14 undergraduate, pre-licensure, female nursing students who attended an academic institution located in the northern part of the United States and participated in a voluntary leadership program. The program encompassed six one-credit courses (Waite, McKinney, Smith-Glasgow, & Meloy, 2014) that students took concurrently with required academic courses. Participation in the leadership program was expected to increase students' EC.

Instrument

The Emotional and Social Competency Inventory, University Edition (ESCI-U), was used to assess participants' skills in recognizing, managing, and motivating their own emotions as well as their social ability to be cognizant and respectful of others' feelings (ESCI-U, n.d.). Boyatzis (2011) described the ESCI-U as a 72-item self-report assessment that focuses on 12 competencies: emotional self-awareness, emotional self-control, adaptability, achievement orientation, positive outlook, empathy, organizational awareness, coach and mentor, inspirational leadership, influence, conflict management, and teamwork. Competencies are organized within four categories (self-awareness, self-management, social awareness, and relationship management) and two cognitive dimensions (systems thinking and pattern recognition).

The ESCI-U, available in five languages, has high reliability (.83) and Cronbach's alpha (.74 to .93) and has good divergent validity (Sharma, 2012). It is scored on a five-point Likert scale, with scores ranging from 1 (never) to 5 (consistently) for the use of particular thoughts and actions in relation to self and others.

Students completed the first assessment at the outset of their first class as juniors and the second assessment at the end of the last class as seniors. The authors hand-scored the ESCI-U following guidelines in the instruction manual. Data, coded numerically using the Statistical Package of Social Sciences version 20.0 database, were reported in the aggregate to preserve participants' confidentiality.

RESULTS

Of the 14 students, one had earned a previous degree; the others were first-degree students. The authors implemented a paired sample f-test to determine statistical significance. Summary results for pre-assessment and post-assessment surveys (means, standard deviations, and paired samples correlation significance) are displayed in Table 1.

Participant scores affirmed implementation "sometimes" or "often," demonstrating a minimal shift between test results. There was no statistical significance at the p < .05 level (two-tailed) within the outcome data. Paired sample correlations indicated statistical significance at the p < .05 level for emotional self-awareness (.001), emotional self-control (.008), and inspirational leadership (.027).

DISCUSSION

Pre-post scores on the ESCI-U for this cohort of pre-licensure nursing students indicated positive findings for the following variables: emotional self-awareness, emotional self-control, and inspirational leadership. Harrison and Fopma-Loy (2010) recognized that nurse educators tend to overlook the relevance of emotions as critical motivators in decisions and actions of future nurses. They further identified that each "nursing intervention is affected by the master aptitude of emotional" competence (p. 644).

Emotional self-awareness, a core variable of significance from our findings, is key to improved understanding of behavior, as the quintessence of self-awareness is viewing yourself as others see you (identification of thoughts and feelings; Harrison & Fopma-Loy, 2010). Also, to effectively model the way as a leader, students must gain both self-awareness and confidence in recognizing others' needs (Hsu et al., 2010). Self-awareness is essential to team-based work and in assessing subordinates' needs effectively, especially with delegation decisions (Hsu et al., 2010).

Within the context of the classroom experience, students were able to focus on emotional and social self-awareness when engaged in short reflective prompts, roundtable debates, and debriefing exercises. These activities allowed students to write about and discuss their own and others' perspectives, thereby promoting empathy. This compassion enabled others to act, specifically demonstrating courage by speaking to classmates' emotional responses when discussing contrasting views and sensitive and challenging issues.

Emotional self-control, the capacity to hold one's unsettling emotions and impulses under control, is an essential underpinning of both self-management and social awareness (Harrison & Fopma-Loy, 2010). Students developed skills in these areas, particularly with group-oriented projects where instances arose when students experienced frustration and annoyance toward other group members.

Inspirational leadership focuses on being able to both inspire a shared vision and inspire individuals to collaborate together for a common goal, which is integral to relationship management (Harrison & Fopma-Loy, 2010). Interprofessional simulation provided opportunities to engage with others in working toward a common goal regarding patient care.

Taken together, intellectual understanding and technical skills about EC are needed, yet they lack sufficiency in a profession as complex and demanding as nursing (For et al., 2011). Self-awareness and emotional regulation are necessary abilities that can be beneficial to individuals in the nursing profession in order to challenge the process of present-day practices. These characteristics, as captured in EC, allow individuals to manage stress more effectively, thereby promoting a process of restoration of self and others (encourage the heart), health maintenance, and career development.

Por and colleagues (2011) indicated that there is little explicit discussion about EC and its related components included in the nursing curricula, limiting students' opportunities for guidance that could improve their emotional and social skills. Findings from our study offer preliminary insight into pedagogical strategies that nurse educators can use to cultivate some foundational insights about EC among pre-licensure nursing students, specifically ways to enhance emotional self-awareness, emotional self-control, and inspirational leadership.

When nursing students develop skills to process their own emotions, engaging other individuals with their emotions is made possible (Wilson & Carryer, 2008). Future research should examine how nurse educators evaluate aspects of EC in nursing education and practice and explore how individual variables connect with preferred methods of developing EC (Codier et al., 2013).

This study had limitations that are worth noting. We used a small, nonrandomized sample from one nursing program located in a specific geographic region and no comparison group, limiting conclusions about a relationship between the course and EC.

CONCLUSION

When students are able to recognize and model the way by regulating their own EC and emotional distress, they can better relate to another person's emotional distress (Codier et al., 2013). An appeal to nurse educators is therefore needed to incorporate approaches to teaching and evaluating EC within the curriculum (classroom/clinical) using, for example, Kouzes and Posner's (2012) five core practices, which are essential for those entering the nursing profession. Future studies that provide comparative data among student groups would also be useful.

REFERENCES

Boyatzis, R. E. (2011). Managerial and leadership competencies. Vision: Journal of Business Perspective, 75(2), 91-100.

Codier, E., Freitas, B., & Muneno, L. (2013). Developing emotional intelligence ability in oncology nurses: A clinical rounds approach. Oncology Nursing Forum, 40(1), 22-29. doi:10.1188/130NF.22-29

Emotional and Social Competency Inventory, (n.d.). Retrieved from http://www. haygroup.com/leadershipandtalentondemand/ourproducts/item_details.aspx? itemid=43&type=1 &t=1

Harrison, P. A., & Fopma-Loy, J. (2010). Reflective journal prompts: A vehicle for stimulating emotional competence in nursing. Journal of Nursing Education, 49(11), 644-652. doi:10.3928/01484834-20100730-07

Hsu, B., Wan-Yu, C., Wang, M., & Yen-Yu, L. (2010). Explaining supervisory support to work-family conflict. Journal of Technology Management in China, 5(1), 40-54.

Kouzes, J. M., & Posner, B. (2012). The leadership challenge: How to make extraordinary things happen in organizations (5th ed.). San Francisco, CA: Jossey-Bass.

Lee, A. (2010). Examining the socially responsible leadership development outcomes of study abroad experiences for college seniors [Unpublished master's thesis]. University of Maryland, College Park.

Por, J., Barriball, L., Fitzpatrick, J., & Roberts, J. (2011). Emotional Intelligence. Nurse Education Today, 37(8), 855-860.

Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9,185-211.

Sharma, R. (2012). Measuring social and emotional intelligence competencies in the Indian context. Cross Cultural Management, 79(1), 30-47.

Shipley, N., Jackson, M., & Segrest, S. (2010). The effects of emotional intelligence, age, work experience, and academic performance. Research in Higher Education Journal, 9, 1-19.

Wilson, S., & Carryer, J. (2008). Emotional competence and nursing education: A New Zealand study. Nursing Praxis in New Zealand, 24(1), 36-47.

Waite, R., McKinney, N, S., Smith-Glasgow, M. E., & Meloy, F. A. (2014). The embodiment of authentic leadership. Journal of Professional Nursing, 30(4), 282-291. doi:10.1016/j.profnurs.2013.11.004

Roberta Waite, EdD, PMHCNS-BC, FAAN, ANEF, is assistant dean of academic integration and evaluation of community programs, Drexel University Doctoral Nursing Department, Philadelphia, Pennsylvania. Nicole S. McKinney, MA, is a doctoral candidate at Drexel University in the Couple and Family Therapy Department. The activities reported in this article were supported (in part) by the Josiah Macy Jr. Foundation. For more information, contact Dr. Waite at MterhaaWjhu.edu.

doi: 10.5480/14-1343
Table 1: ESCI-U, Pre-Post Assessment Summary
Results (N = 14)

                                            Standard
                              Means         Deviation     Significance

                           Pre     Post    Pre    Post

SELF-AWARENESS

Emotional Self-Awareness   4.37    4.44    .47    .46     .001 *

SELF-MANAGEMENT

Achievement Orientation    4.49    4.53    .41    .52     .108

Adaptability               4.21    4.40    .72    .46     .064

Emotional Self-Control     4.11    3.99    .62    .62     .008 *

Positive Outlook           4.30    4.37    .41    .41     .351

SOCIAL AWARENESS

Empathy                    4.20    4.11    .65    .56     .621

Organizational Awareness   4.46    4.33    .57    .49     .139

RELATIONSHIP MANAGEMENT

Conflict Management        4.13    4.1     .68    .52     .255

Coach & Mentor             3.96    3.97    .71    .66     .633

Influence                  4.05    4.14    .65    .41     .741

Inspirational Leadership   4.14    4.16    .57    .61     .027 *

Teamwork                   4.51    4.50    .53    .49     .127

COGNITIVE

Systems Thinking           3.76    4.04    .36    .55     .616

Pattern Recognition        3.72    3.92    .42    .82     .161

Note. Ukert scale scores are 1 = never, 2 = rarely, 3 = sometimes,
4 = often, 5 = consistently

 *Correlation is significant at the p < 0.05 level (two-tailed) for all
pre-post measures.

Capital We Must Develop
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Title Annotation:Research Brief
Author:Waite, Roberta; McKinney, Nicole S.
Publication:Nursing Education Perspectives
Article Type:Report
Date:Mar 1, 2016
Words:2374
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