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Emotional intelligence among nursing students

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Štiglic, G, Cilar, L, Novak, Ž, Vrbnjak, D, Stenhouse, R, Snowden, A & Pajnkihar, M 2018, 'Emotional
intelligence among nursing students: Findings from a cross-sectional study', Nurse Education Today, vol.
66, pp. 33-38. https://doi.org/10.1016/j.nedt.2018.03.028

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10.1016/j.nedt.2018.03.028

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Title: EMOTIONAL INTELLIGENCE AMONG NURSING STUDENTS: FINDINGS FROM A
CROSS-SECTIONAL STUDY

Authors: Gregor Štiglic1,2*, Leona Cilar1, Žiga Novak1, Dominika Vrbnjak1, Rosie Stenhouse3,
Austyn Snowden4, Majda Pajnkihar1

Author’s addresses:
1
Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000 Maribor, Slovenia
2
Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46,
2000 Maribor, Slovenia
3
School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
4
School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, Sighthill Court,
Edinburgh, EH11 4BN, UK

*Corresponding author at: Faculty of Health Sciences, University of Maribor, Žitna ulica 15, 2000
Maribor, Slovenia. Tel: +386 2 3004731, Fax: +386 2 3004747, E-mail: [email protected].

E-mail addresses:
[email protected] (G. Štiglic),
[email protected] (L. Cilar),
[email protected] (Ž. Novak),
[email protected] (D. Vrbnjak),
[email protected] (R. Stenhouse),
[email protected] (A. Snowden),
[email protected] (M. Pajnkihar).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or
not-for-profit sectors.

Acknowledgment
Authors would like to acknowledge Slavko Cvetek for his help in translation of the questionnaires.

Conflict of interest
No conflict of interest has been declared for this study by the authors.

Word count: 4465 words.

1
Emotional intelligence among nursing students: Findings from a cross-sectional study

Abstract
Background: Emotional intelligence in nursing is of global interest. International studies
identify that emotional intelligence influences nurses’ work and relationships with patients. It
is associated with compassion and care. Nursing students scored higher on measures of
emotional intelligence compared to students of other study programmes. The level of emotional
intelligence increases with age and tends to be higher in women.
Objectives: This study aims to measure the differences in emotional intelligence between
nursing students with previous caring experience and those without; to examine the effects of
gender on emotional intelligence scores; and to test whether nursing students score higher than
engineering colleagues on emotional intelligence measures.
Design: A cross-sectional descriptive study design was used.
Settings and participants: The study included 113 nursing and 104 engineering students at the
beginning of their first year of study at a university in Slovenia.
Data: Emotional intelligence was measured using the Trait Emotional Intelligence
Questionnaire (TEIQue) and Schutte Self Report Emotional Intelligence Test (SSEIT).
Methods: Shapiro-Wilk’s test of normality was used to test the sample distribution, while the
differences in mean values were tested using Student t-test of independent samples.
Results: Emotional intelligence was higher in nursing students (n = 113) than engineering
students (n = 104) in both measures [TEIQue t = 3.972; p < 0.001; SSEIT t = 8.288; p < 0.001].
Although nursing female students achieved higher emotional intelligence scores than male
students on both measures, the difference was not statistically significant [TEIQue t = -0.839;
p = 0.403; SSEIT t = -1.159; p = 0.249]. EI scores in nursing students with previous caring
experience were not higher compared to students without such experience for any measure
[TEIQue t = -1.633; p = 0.105; SSEIT t = -0.595; p = 0.553].
Conclusions: Emotional intelligence was higher in nursing than engineering students, and
slightly higher in women than men. It was not associated with previous caring experience.

Keywords: emotional intelligence, caring, recruitment, retention, psychometrics, nursing.

1. Background

Emotional intelligence (EI) was originally described by Salovey and Mayer (1990, p. 189) as
"the ability to monitor one’s own and others’ emotions, to discriminate among them, and to use
the information to guide one’s thinking and actions". There is no unified theory of EI; EI is
theorised as either a trait (e.g. Petrides & Furnham, 2000) or an ability (Salovey and Mayer,
1990). As a trait, like personality, EI is understood to be relatively fixed, whereas theorised as
an ability – and Mayor, Caruso and Salovey (1999) argue that EI is an ability like general
intelligence (IQ) – then it should be possible to improve an individual’s EI through educational
intervention.

2
EI is proposed as important for nursing practice (Bulmer-Smith et al., 2009; Cadman & Brewer,
2001) and there is a growing international literature examining relationships between EI and a
range of nursing attributes, including leadership (Duygulu et al., 2011; Benson et al., 2010;
Erkutlu & Chafra, 2012; Chan et al., 2014), stress management (Gorgens-Ekermans & Brand,
2012; Zhang et al., 2016), nursing student mental well-being (Montes Borges & Augusto, 2007)
and caring behaviours (Rego et al., 2010). If EI is important for nursing, then it might be argued
that nurse educators should ensure that nursing students have high EI at the point of graduation
from nursing programmes. However, given the conceptual debates and the empirical evidence
that supports the trait argument (Van der Linden et al., 2012) as well as the ability argument
(Benson et al., 2010; Foster et al., 2017) then it would be foolhardy for nurse education
establishments to rely on being able to develop enough EI in their students during the process
of their education to make them excellent nurses. There is therefore an argument for selecting
nursing students for EI as either a basis from which to further develop such skills (i.e. as an
ability) or in light of the argument that the level of EI that an individual possesses might be set
prior to education (i.e. as a trait), in which case selection for high levels of EI on entry to
education might be necessary.
A longitudinal study of nursing and midwifery students (n=867) in the United Kingdom (UK)
(Snowden et al., 2015; Stenhouse et al., 2016) aimed to understand the relationship between
student EI on entering nurse education and their retention and successful completion of nursing
programmes in an attempt to understand whether EI would be a useful criterion for student
nurse selection. They (Snowden et al., 2017) found that trait emotional intelligence had a small
significant relationship to successful programme completion. The generalisability of these
findings to other countries and cultures is not known. This paper presents a cross sectional
analysis of data from the first stage of a replication of the Snowden et al. (2015) study in a
cohort of nursing students in Slovenia.

Emotional intelligence in nursing

There is a growing international body of empirical work examining student nurse EI. Cerit and
Beser (2014) found gender differences in their study of EI in nursing students in Turkey. Whilst
female students achieved higher average scores on global scores, empathy and social skills
dimensions, male students achieved higher scores on emotional awareness, control of emotions
and motivation (Cerit & Beser, 2014). Additionally, Snowden et al. (2015) found that global EI
scores on both trait and ability measures were higher for women than men and that EI increased

3
with age. Students of nursing and midwifery demonstrated higher EI than students of other
study programmes (Snowden et al., 2015). In an Australian study, EI increased over the course
of a pre-registration nursing programme (Foster et al., 2017).
International studies of EI in nursing students have generally focused on its relationship to
student health and coping. Aradilla-Herrero et al. (2014) in a Spanish study found that nursing
students who experienced depression and scored highly on the ‘attention to emotion’ factor of
the Trait Meta Mood Scale (Salovey et al., 1995) had an increasing likelihood of suicidal
ideation. This builds on Augusto-Landa & Montes-Berges’ (2009) findings that scores on this
factor were negatively related to self-esteem in nursing students. In Korea, Jeong (2015) found
a negative relationship between EI and emotional labour, while Kim and Han (2015) and
Moradi et al. (2011) found relationships between EI and coping strategies in nursing students.
Thus, much of the EI research is focused on the impact on the student rather than the
relationship with retention and the development of the required competence and knowledge for
nursing.
While EI was found to correlate positively with nursing students’ clinical performance (Zysberg
et al., 2011; Beauvais et al., 2011), successful completion of nursing programmes (Jones-
Schenk & Harper 2014; Snowden et al., 2017) and motivation and academic performance
(Leskovic, 2016), research otherwise does not always confirm that the level of EI among first-
year undergraduate nursing students is necessarily predictive of their subsequent performance.
Even students with a lower level of EI have the potential to successfully complete their
programme (Snowden et al., 2017). This is why the relationship between EI and performance
needs further research.
The relationship between EI and performance is not straightforward. For example, although it
has been suggested that low level of EI among nurses was associated with failings in care for
patients, particularly in relation to issues such as understanding and compassion (Francis,
2013), the mechanism of these relationships are not understood. Francis (2013) suggested that
more research is needed to better understand the relationship between these attributes.
There is a lack of research in the field of EI in Slovenia in relation to health care, although many
studies show that the connection between EI and adequate health care is one of the strongest in
the whole field of patient care (Cerit & Beser, 2014). There is evidence that EI is associated
with successful completion of nursing studies, but again the relationship is not altogether clear
(Jones-Shenk & Harper, 2014).
In the UK previous caring experience is promoted as a selection criterion for student nurses
(Francis, 2013). However, Snowden et al. (2017) found no correlation with performance or

4
retention on programmes. The context for many recruits onto nursing programmes in Slovenia
differs from that in the UK in that in Slovenia there is a secondary school system that provides
education for Health Care Technicians (HCT).

Slovenian Secondary Schools for Health Care Technicians

Slovenia has a system of secondary schools, which prepare HCT for their work in health and
social care environments. Pupils enter these schools at age 15 following nine years of primary
education. The first two years are characterized by a basic secondary education and the last two
years are focused on health care knowledge and competences. Theoretical professional and
practical education within schools is complemented by practical training in a range of health
care facilities under the supervision of a school and clinical mentor. The distribution of time
spent acquiring practical versus theoretical skills is set at 1018 versus 1496 hours, respectively.
Following secondary school, HCTs can enter the nursing colleges and faculties to undertake a
3-year Diploma degree in nursing at European Qualifications Framework (EQF) level 6.
However, not only HCTs can enter diploma undergraduate nursing study programmes, students
from general (gymnasium) and other technical secondary educational schools can enter as well.
Thus, many entrants to Diploma degree nurse education in Slovenia have experience of clinical
practice settings in line with Francis’ (2013) recommendation that students undertake a period
of clinical practice before applying for a nursing course as a means of improving the caring and
compassion of nurses who enter training (and perhaps arguably their EI).

Aim

The aim of this study was to determine if the findings of similar studies were replicable in
Slovenia.

Objectives

To establish whether there were statistically significant differences in emotional intelligence

between nursing students with previous caring experience and those without; to examine the
effects of gender on EI scores; and to test whether nursing students score higher than their
engineering colleagues on EI measures.

5
Hypotheses

Three hypotheses were tested in the scope of this study:

1. Students with previous caring experience will show higher EI than those without.
2. Men will have lower EI than women.
3. Nursing students will have higher EI than non-nursing students.

2. Methods

2.1 Design

The study followed a cross-sectional descriptive design.

2.2 Participants

The study included 113 first year diploma undergraduate nursing students and 104 first year
undergraduate computing students at two faculties in Slovenia. All first year students were
invited to participate. Out of 220 applicable students, three did not complete the questionnaire
and were excluded from the study. The survey was conducted between 16th November 2016
and 30th January 2017.

2.3 Data Collection

All 217 students completed a questionnaire that contained the Trait Emotional Intelligence
Questionnaire (TEIQue Short Form) (SF) (Petrides, 2009) and Schutte’s Self Report Emotional
Intelligence Test (SSEIT) (Schutte et al., 1998) in the Slovenian language using an online
questionnaire in both cases. Healthcare and language experts translated both instruments into
Slovene using the back-translation technique in order to guarantee the equivalence between
both languages.

2.4 Data analysis

Data were analysed using the statistical program IBM SPSS version 22. Distributions were
tested for normality to select the appropriate statistical test. All hypotheses were tested using

6
non-parametric or parametric tests based on the distribution of the data for specific variables.
Results are shown in the form of graphs and tables.

2.5 Ethical Considerations

The permission to perform the research from the institutional ethics commission was obtained
in November 2016. Before carrying out the research participants were introduced to the purpose
of the research, their rights and obligations. They were also informed about their voluntary
participation, anonymity and ability to leave the study at any time.

3. Results

The study involved 217 participants of which 113 (52%) were male and 104 (48%) female. The
majority of nursing students were female (n=104, 92%) while the majority of engineering
students were male (n=88, 85%). The study included 113 first-year nursing students (52%) and
104 first-year engineering students (48%). The age of the respondents ranged from 18 to 43
years. Of these, 69% (n=150) were 19 years old, which is the age when most of the students
start their study at university level in Slovenia.
Distributions of all responses to both measures were tested for assumptions of normality. Fig.
1 shows the distribution for the TEIQue and Fig. 2 for the SSEIT measure.

Fig. 1. TEIQue total distribution

7
Fig. 2. SSEIT total distribution

1. Students with previous caring experience will show higher EI than those without.
There were 86 (40%) participants with previous caring experience and 131 (60%) without
previous caring experience. A total of 81 nursing students (72%) and only five (5%) engineering
students had previous caring experience. Of these, 58% (n = 52) gained their experience in
hospital, 21% (n = 19) in other facilities, 14% (n = 12) in nursing homes and 7% (n = 6) in their
home. As the focus of this study was on nursing students, the data from engineering students
was not used in this comparison due to an extremely low number of participants with previous
caring experience. The distribution of both measures was Gaussian, which allowed us to use a
parametric statistical test (i.e. t-test presented in Table 1).

Table 1
Mean EI scores by previous caring experience for nursing students.
Mean value ± standard deviation p-value
With caring experience 93.95 ± 11.92
SSEIT 0.553
Without caring experience 95.53 ± 14.57
With caring experience 152.93 ± 20.85
TEIQue 0.105
Without caring experience 160.44 ± 24.82

8
Although the trend was to lower scores on both measures in those with previous caring
experience, the differences were not significant.

2. Men will have lower EI than women.

Despite the small number of men in nursing and small number of women in the engineering
group, the sample was split by study programme and the differences in both groups analysed
separately. Distribution of responses for both measures was normal in both comparisons.
Independent-Samples t-test did not show statistically significant differences between male and
female scores, except in the case of the SSEIT score in engineering students (Table 3).

Table 2
Mean EI scores by gender and study programme.

Nursing Engineering
Mean value ± standard p- Mean value ± standard p-
deviation value deviation value
SSEIT Male 91.12 ± 13.30 78.81 ± 13.09
0.249 0.025
Female 94.98 ± 12.55 89.88 ± 15.20
TEIQue Male 150.88 ± 22.28 142.89 ± 21.33
0.403 0.355
Female 155.79 ± 22.22 150.00 ± 11.02

It has to be noted that the SSEIS result was significant, but it was based on relatively small
subgroups, especially in the case of engineering students with only 8 (8%) female students.

3. Nursing students will have higher EI than non-nursing students.

There is a statistically significant difference in EI among students of different study
programmes measured with both scales. Table 3 shows the results by study program with
nursing students achieving higher EI scores than non-nursing students.

Table 3
Mean EI scores by study program.

SSEIT TEIQue
Mean value ± standard p-value Mean value ± standard p-value
deviation deviation
Nursing 94.40 ± 12.68 155.05 ± 22.20
< 0.001 < 0.001
Engineering 79.66 ± 13.51 143.43 ± 20.78

9
In summary, EI is significantly different between nursing and engineering students. This result
confirms the trends that could be seen in the previous two hypotheses and were not always
statistically significant, i.e. higher scores are related to previous caring experience and female
students.

4. Discussion
This study examined the differences in emotional intelligence between nursing students with
previous caring experience and those without, the effects of gender on emotional intelligence
scores, and comparison of the EI scores of nursing students with those of the engineering
students. The main limitation of the study was in sampling of the population where it was not
possible to match the sample size of male and female between nursing and engineering students
limiting the exploration of the impact of gender on the EI of the cohorts.
No significant differences in emotional intelligence between nursing students with previous
caring experience and those without were found; this is congruent with the findings of Snowden
et al (2015). A difference in EI scores related to gender and programme of study was detected.
However, given the limitations of the sampling identified above, it is possible that this
difference in EI scores between engineering and nursing students might partly be explained by
the fact that females, who made up the majority of the nursing sample, generally score more
highly on EI than males (Snowden et al 2015), who made up the majority of the engineering
sample.
Researchers from the field of nursing have focused their research on the EI of future nurses, i.e.
nursing students. Such studies have been conducted in a range of international contexts
including the United Kingdom (eg Snowden et al 2015, 2017), USA (eg Jones-Schenk & Harper
2014), Spain (eg Aradilla-Herrero et al 2014), Korea (eg Jeong 2015) and Turkey (eg Cerit &
Beser 2014). This study focused on the level of EI among diploma undergraduate nursing
students in Slovenia. The level of EI of nursing students in relation to previous caring
experience was observed and compared with engineering students, at the beginning of both
diploma undergraduate study programmes. Based on the review of the literature, the following
hypotheses were set up: students with previous caring experience will show higher EI than those
without; men will have lower EI than women; and nursing students will have higher EI than
non-nursing students.
Previous caring experience might enable students to self-select on the basis of a realistic
understanding of nursing (Health Education England, 2014). However, despite being proposed
as an important selection criterion for developing ‘caring’ nurses, previous caring experience

10
has not been found to correlate with EI or completion of nursing education (Snowden et al.,
2015; Snowden et al., 2017). In fact, Stenhouse et al. (2016) found that previous caring
experience was associated with poorer performance at the end of students’ first year. Similarly,
the results in this study found that previous caring experience was not associated with a higher
level of EI. There is a question of whether students with previous caring experience might be
more successful in their later work but this requires further longitudinal study beyond
graduation.
The level of EI was also compared between male and female participants. In this context,
previous qualifications were not taken into account as only the level of EI among both genders
in both study programmes was observed and compared. Snowden et al. (2015) stated that the
level of EI is higher among female students. Similar results were expected in this study, based
on cultural similarities between both countries. The hypothesis was only partially confirmed in
a group of engineering students. The result was not statistically significant, but the mean values
clearly showed higher values in both scales and both study programmes for female students.
The Turkish study showed that EI is significantly higher among female students of nursing
(Cerit & Beser, 2014). Another study, dealing with EI by gender was previously performed in
Spain, where the results were similar to those in Turkey, Slovenia and the United Kingdom
(Fernandez- Berrocal et al., 2012).
The interpretation of the results shows that the level of EI among nursing students is noticeably
higher than the level of EI among engineering students. The hypothesis can be confirmed on
both SSEIT scale and the TEIQue scale. These findings supported those of Snowden et al.
(2015), and might also be expected due to the nature of nursing work and the strong association
of compassion, empathy, understanding and EI found in other studies. The fact is that studying
nursing requires an adequate level of EI because of students’ participation in clinical practice
and in the clinical environment (Zysberg et al., 2011). Future nursing students are aware of
what it means to study nursing, even if they have previously not attended a secondary school
for HCT. They also know that working successfully as a nurse is highly connected with one’s
personal characteristics and values. Future nursing students will care for healthy, sick, dying,
injured or elderly people during their study because the mere decision to study nursing means
that the future students already have a certain level of compassion and empathy, as otherwise
they would not have decided to study nursing in the first place. This does not mean that
engineering students have no compassion or that they are not emotionally intelligent. It only
shows that they have a lower level of EI in comparison with nursing students. It would also be
very interesting to investigate the level of EI among students from other professional fields that

11
are more related to importance of being emotionally intelligent, for example, students of
psychology, medicine or physiotherapy, and later compare them with nursing students.

5. Conclusion

EI as a topic is strongly associated with care, compassion and empathy. Nurses spend much
time with patients as well as their relatives, hence it is important for them to have a high level
of EI. During education it is necessary to teach nursing students about the importance of EI
within nursing. A review of the literature showed that nursing students have a higher level of
EI than students of some other courses. For this reason, statistical importance in difference
between nursing and engineering students' EI was calculated to show that hypothesis can be
confirmed. However, it was not possible to confirm a difference in EI between the group of
nursing students with previous caring experience compared to those without. It has not yet been
proved that students with previous caring experience are better in their job than those who did
not have previous experience. This requires further longitudinal follow-up to examine the
relationship between previous caring experience and performance in nursing over time. The
Slovenian educational context, with its secondary education providing a standardised practice
experience, provides a particularly good opportunity to understand the relationship between
previous caring, EI and nursing performance. Studies also show that EI differs depending on
students’ gender with the same trend observed in student cohort of this study. Again the
difference was not statistically significant in all subgroups, but the trend can be seen. Further
studies with equal numbers of male and female nurses would facilitate a greater understanding
of the gendered nature of EI in the nursing population and its impact on performance and
retention. It is notable that the EI of students who had attended Slovenian secondary schools
for HCT was not greater than those who had not, which raises the question of whether it is not
simply ‘doing’ and learning about nursing that is important for EI development, but that perhaps
there are specific educational interventions required to increase students’ EI. This requires
further exploration. As the study is designed as longitudinal, it will be possible to follow the
students until the end of their programme and conduct different longitudinal analyses in the
coming two years to confirm the initial findings reported in this paper.

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