Danielle Artis, MSN, RN, CPN; Keisha A.

Robinson, PhD, CNM, C-EFM; & Stacey

Wood, DNP, RN, CNM

Resilience and Emotional Intelligence Interventions for

Empowering Nursing Students: A Review

Abstract Nursing students are the future of healthcare

and comprise the largest portion of the health
Background: Students must cultivate resilience professions in the workforce (American Association
and emotional intelligence to thrive in nursing of Colleges of Nursing [AACN], 2024). Among all
school. Resilience enables one to endure and other health-related disciplines, nursing students have
function normally amid tough situations, and been identified as experiencing higher stress levels
emotional intelligence heightens empathy,
than other non-nursing university students (Lavoie-
understanding, and regard for others. Research
Tremblay et al., 2022). Students pursuing a degree in
indicates that nursing students are better equipped
to successfully navigate academic and clinical nursing or health sciences often face stress. Those
rigor when both traits are present. Therefore, this pursuing a nursing or health sciences degree
review aims to identify interventions in the commonly experience stress stemming from
literature that enhance resilience and emotional academic and clinical environments and external
intelligence in nursing students. factors like financial and familial pressures (Diffley
& Duddle, 2022).
Method: Using PRISMA guidelines, a search was According to recent research findings, a
conducted to explore research on resilience and
correlation exists between nursing students who
emotional intelligence in nursing and health
exhibit difficulties in adjusting and coping with stress
science students in the United States within the
past five years. in academic and clinical environments and their
classification as high-risk candidates for burnout
Results: Levels of resilience and emotional upon entry into the workforce (Hughes et al., 2021).
intelligence increase most when interventions are A study by Hurley (2020) showed that resilience and
employed. Increases in resilience and emotional emotional intelligence can positively impact student
intelligence did not occur naturally; instead, in performance and decrease burnout. These two traits
some cases, both characteristics decreased. are well-documented protective factors that can be
learned, practiced, and modeled (Cooper, 2021). By
Conclusion: Non-optional environmental changes
and mindfulness interventions embedded in consistently improving resilience and emotional
nursing curriculums enhance resilience and intelligence, students can develop better coping and
emotional intelligence. adaptive abilities, leading to overall well-being and
success in confronting the common stressors of
Keywords: Index Words: Resilience, Emotional academic and clinical training.
Intelligence, Nursing Students Resilience is defined and perceived in various
ways. Stephens (2013) conducted an extensive
literature review and created an operational definition
of nurse student resilience, defined as when an
individual uses personal protective factors to
navigate perceived stress and adversities.

The ABNFF Journal 10 Volume 1 (2024), Number 2

 However, emotional intelligence is a set of key skills Emotional Intelligence
for nursing students to develop as it enables them to At the core of resilience is individuals' need
cultivate important qualities such as compassion, to be self-aware and understand their strengths and
empathy, awareness, and respect for patients and challenges (Landry, 2019; Lebow, 2021). This
their families. These qualities are crucial for meeting includes skills to regulate personal and interpersonal
the demands of nursing and providing high-quality relationships and empathy for others, commonly
care to patients and their families. called emotional intelligence (Landry, 2019; Lebow,
Faculty in higher education are well 2021). Emotional intelligence has been described as
positioned to take the lead in modeling and teaching a personal development journey and a crucial aspect
resilience-building skills and guiding students' self- of nursing education (Napolitano et al., 2023).
assessment of emotional intelligence. Strategies for Emotional intelligence is categorized by four
building resilience and emotional intelligence among competencies:1) self-awareness, 2) self-
nursing students in the academic setting have been management,3) social awareness, and 4) social or
reported to be beneficial to student success (Meyer, relationship management (Landry, 2023; Napolitano et
2023; Strout, 2023). However, few studies have al., 2023). Self-awareness is a reflective process that
identified which specific strategies are most assists the individual with identifying and
effective. It is crucial to pinpoint effective strategies understanding their own emotions
to help students develop these fundamental skills. (Napolitano et al., 2023). Self-management is
Therefore, the purpose of this systemic review, in managing personal emotions under stressful situations
accordance with the Preferred Reporting Items for and remaining positive when setbacks occur (Landry,
Systematic Reviews and Meta-Analyses (PRISMA) 2023). Social awareness is the ability of the individual
guidelines, was to identify resilience and emotional to recognize others’ emotions and empathize with
intelligence-enhancing strategies for nursing and others (Landry, 2023). Social or relationship
health science students in the United States. The management is the ability of the individual to
review’s findings will have future implications for influence others using therapeutic communication
the nursing curriculum's design. skills to resolve conflicts (Landry, 2023). The ability
of individuals to regulate and interpret these concepts
Resilience can determine their emotional intelligence. Emotional
Despite not having a universal conceptual intelligence is categorized as either higher or lower
definition, resilience is a well-documented (Lebow, 2021).
protective factor that can be learned and modeled Individuals with higher emotional intelligence
(Auburn et al., 2016). The concept of resilience has can regulate emotional impulses that, if inappropriate,
been under development since the 1800s and may impede healthy relationships and hinder
continues to evolve successful academic or professional progress
(Flach, 1980). Resilience is described as a personal (Napolitano et al., 2023). As future healthcare
attribute, trait, or even a process or cycle that can be providers, nursing students will need higher emotional
developed or enhanced to improve a person's intelligence to meet the needs of those in their care.
positive coping mechanisms using specific strategies High emotional intelligence enables nurses to approach
(Prosser et al., 2017; Stephens et al., 2017). Other stressful situations more thoughtfully
critical attributes of resilience, especially when (Napolitano et al., 2023). However, for some students,
referring to healthcare professionals, include rising high emotional intelligence may not be innate; instead,
above, adaptation and adjustment, dynamic it may be necessary to learn emotional intelligence
processes, and ‘ordinary magic.’ (Napolitano et al., 2023).

The ABNFF Journal Volume 1 (2024), Number 2

11
 Faculty can provide activities to strengthen intelligence were measured or enhanced.
resilience and emotional intelligence and role-model Additionally, articles such as opinions, editorials, and
behaviors to benefit students and patients. Emotional commentaries were excluded due to their lack of peer
intelligence in nursing education is not just review and potential introduction of bias.
beneficial; it is necessary for students to provide Furthermore, selected articles were required to have a
empathetic, compassionate, and patient-centered care sample population of nursing or health science
(Napolitano et al., 2023). When combined with students, as this was our population of interest.
resilience, emotional intelligence can significantly
improve and support academic success and, more Study Selection
importantly, patient care quality. We conducted an extensive literature search
for this research to identify relevant studies. We
Methods retrieved 506 studies from various databases,
including 147 from CINAHL Ultimate, 173 from
Search Strategy PubMed, and 186 from ERIC. We then meticulously
We conducted a thorough systematic review screened each study against strict inclusion and
in accordance with PRISMA guidelines. Our search exclusion criteria and removed any duplicates. After
for relevant studies was conducted on April 9th, this process, 25 full-text articles were selected for
2024, using reputable databases, including CINAHL final analysis. Our systematic approach ensured the
Ultimate, PubMed, and ERIC. We paired keywords selected articles' quality and reliability. Figure 1.
such as resilience, adaptability, and emotional presents the study selection process and the reasons
intelligence with "AND" nursing students to locate for excluding certain studies.
the most applicable literature. In addition, the
reference list of each included source was carefully Results
examined to identify additional studies.
Characteristics of Included Studies
Eligibility Criteria Our systematic analysis of 25 studies
The inclusion criteria mandated that research encompassed a diverse range of research types, with
be conducted solely in academic institutions based in 19 studies centering on resilience or resilience-related
the United States. This allowed us to moderately concepts while the remaining five studies focused on
control international variations in the confounding emotional intelligence. Notably, one study measured
influence of the COVID-19 pandemic and its both resilience and emotional intelligence. Most of
management in the academic setting. Inclusion the studies (40%) utilized quantitative methods with
criteria also included full articles published in sample sizes ranging from 28-933 nursing student
English from 2019 to 2024. Our preference was for participants, while 24% of the reviewed studies were
articles that used both qualitative and quantitative qualitative, with sample sizes ranging from 24 to 52
research methods, as well as systematic reviews and student nurse participants. An identical percentage
meta-analyses. This approach allowed us to (24%) of literature review articles were identified,
understand the topics being studied comprehensively. followed by a small fraction (12%) of studies
Abstracts were excluded from consideration employing a mixed methods approach with student
due to their potential lack of detailed methodology nurse sample sizes ranging from 36-97.
descriptions, which could impede the precise The studies presented within this PRISMA-
identification of how resilience and emotional guided systematized review focused solely on

The ABNFF Journal Volume 1 (2024), Number 2

12
academic institutions in the United States. All measure an individual's ability to cope with adversity
reviewed studies comprised sample populations of (Huehn et al., 2023; Krautscheid et al., 2020). This
nursing students with diverse levels of academic 24-item inventory demonstrated excellent internal
experience, ranging from those in their first year of a consistency (Cronbach's alpha = 0.95) (Labelle et al.,
four-year bachelor's program to those pursuing 2015).
doctoral degrees in nursing. Although various The 14-item Resilience scale, which measures
research designs were employed, sampling strategies an individual's ability to adapt to change,
were identified as either convenient or purposive. demonstrated a relatively good internal consistency
Excluding the literature reviews, most studies were with a Cronbach's α of 0.85 (Windle et al., 2011).
single-site (84%), multi-site (11%), and 5 % were However, this review noted it as the least frequently
online national studies. used measure of resilience (Precin et al., 2019). Most
importantly, despite the use of varied inventories to
Measures measure resilience in nursing students, all the
Resilience was operationalized using a range reviewed studies indicate moderate levels of resilience
of well-established and validated scales. Among in their respective samples of nursing students.
these, the Connon Davidson Resilience Scale (CD- Emotional intelligence was operationalized
RISC) emerged as the most widely utilized tool for solely by the Mayer-Salovey-Caruso Emotional
measuring resilience. The CD-RISC tool is designed Intelligence Test (MSCEIT) (Chrisshire et al., 2019;
to measure adult psychological resilience. Construct Meryer,2023). The mean MSCEIT scores identified
validation of the CD-RISC during testing using in this review ranged from 88 to 103.3 (Chrisshire et
factor analysis identified five sub-scale variables al., 2019; Meryer,2023). The 141-item MSCEIT is a
(eigenvalues >1) that characterized the concept of widely accepted tool for assessing adult emotional
resilience (personal competence, strength in intelligence and predicting student academic
adversity, acceptance, control, and belief in mystical performance (Mayer et al., 2000). The full-scale
influences) and demonstrated an internal consistency MSCEIT demonstrates good reliability (Cronbach's
with a Cronbach alpha of 0.89 (Davidson, alpha = .86) (Mayer et al., 2000). MSCEIT scores are
2018). The CD-RISC is available as a 25-item (CD- calculated within four subscales: Perceiving
RISC-25) and 10-item (CD-RISC-10) questionnaire, Emotions, Using Emotions, Understanding Emotions,
sharing nearly identical psychometrics (Davidson, and Managing Emotions. According to the developers
2018). Our review showed that the twenty-five-item Meyer et al. (2000), the average MSCEIT emotional
version of the CD-RISC was used an equal number intelligence score is 100 with a standard deviation of
of times as its short-form ten-item version (Fowlers 115. This systemic review identified that some
et al., 2020; Macintosh, 2022; Olson et al., 2024; nursing students had below-average emotional
Wilson et al., 2021). intelligence scores while others scored above average
Other commonly used resilience scales (Chrisshire et al., 2019; Meyer, 2023).
identified in this PRISMA-guided review included
the six-item Brief Resilience scale (McDermott et al., Observational Non-Intervention Studies
2020; Munn et al., 2022), which measures an During the systematic review, it was
individual's ability to bounce back from stress and discovered that 28% of the studies were non-
demonstrates internal consistency (Cronbach alpha interventional observational studies (Percin et al.,
=.77). The Scale of Protective Factors was another 2019; Cheshire et al., 2020; Fowlers et al., 2020;
measure identified in this review and is designed to McDermott et al., 2020; Krautscheid et al; 2020;
Munn et al., 2022; Meyer, 2023). Of these studies,

The ABNFF Journal 13 Volume 1 (2024), Number 2

cross-sectional design was more frequently An unconventional intervention involved
implemented, with most measuring the students' regularly exposing nursing students to small
resilience and/or emotional intelligence scores at a challenges to help them become more resilient
single point in time (Percin et al., 2019; Munn et al., (Koharchik, 2019). According to Koharchik (2019),
2022; McDermott et al., 2020; Krautscheid et al., exposing students to difficult work experiences may
2020; Meyer, 2023). However, two non- lead to the ability to recover more quickly from the
interventional observational studies followed the exposure and assist them with developing a sense of
students through the nursing program, conducting a toughness or being up to the next challenge. Overall,
series of resilience and emotional intelligence no specific intervention appeared to be more
assessments (Cheshire et al., 2020; Fowlers et al., effective than others. Nevertheless, when compared
2020) to non-interventional studies, implementing an
Cheshire et al. (2020) and Fowlers et al. intervention consistently led to increased resilience
(2020) longitudinally assessed resilience and and emotional intelligence, although not always with
emotional intelligence among nursing students. The statistical significance (Bouchard et al., 2024; Carter
findings revealed a marginal increase in resilience as et al., 2023; Precin et al., 2019; Strout et al., 2023;
students progressed through the program, with mean Vick et al., 2024).
scores moving from 77.2 (SD= 10.5) to 77.51 (SD= All qualitative or mixed-method studies
11.25), although this change did not reach statistical utilizing a qualitative approach involved the
significance (p=>.05) (Cheshire et al., 2020; Fowlers implementation of an intervention (Bouchard et al.,
et al.; 2020). Conversely, Cheshire et al. (2020) 2024; Carter et al., 2023; Debrew, 2023; Higgins et
reported a natural decline in emotional intelligence al., 2023; Huehn et al., 2023; Matthes et al., 2022;
scores as students advanced in the nursing program, Munn et al., 2022; Vick et al., 2024). The
from a mean of 94 (SD=17) to 88 (SD=19). predominant methodological approach in most
qualitative studies involved surveys or a combination
Intervention Studies of surveys and interviews (Bouchard et al., 2024;
The systematic review revealed that 44% of Matthes et al., 2022; Munn et al., 2022; Vick et al.,
the studies included were intervention-based. Among 2024), while narratives and journaling constituted the
the intervention studies, the predominant techniques second most prevalent qualitative methodological
utilized included mindfulness and meditation (Carter approach (Carter et al., 2023; Debrew, 2023; Higgins
et al., 2023; Strout et al., 2023; Vick et al., 2024). et al., 2023). Notably, focused groups were the least
Some studies concentrated on modifying the utilized method for qualitative data collection
academic environment to enhance student resiliency, (Huehn et al., 2023).
such as by altering the scenery or conducting Among the reviewed studies, recurring
morale-boosting sessions during designated times themes such as the significance of physical activity,
(Huehn et al., 2023; Matthes et al., 2022; Napolitano mindfulness, and self-care practices emerged as
et al., 2023). Other researchers integrated resilience pivotal in fostering resilience (Carter et al., 2023;
or emotional intelligence-building assignments into Munn et al., 2022; Higgins et al., 2023).
the curriculum to enhance students’ resilience or Furthermore, the sense of connectedness derived
emotional intelligence (Bouchard et al., 2024; from social support surfaced as a critical factor in
Debrew, 2023). Student surveys and interview aiding students to adapt during challenging periods
findings identified common themes of “feeling (Bouchard et al., 2024; Huehn et al., 2023).
connected” and “feelings of empathy” (Bouchard et al.,
2024; Debrew, 2023).

The ABNFF Journal 14 Volume 1 (2024), Number 2

Regarding emotional intelligence, no qualitative and clinical environment. Meyer (2023) suggests that
themes were identified. However, it was observed students' capacity to manage their emotions and
that students who reflected on their patient care empathize with others prepares them to deliver safe,
experiences demonstrated an enhancement in compassionate patient care. Thus, nursing curricula
empathy (Debrew, 2023). should include strategies for enhancing emotional
intelligence as a fundamental skill to improve
Conclusion students' ability to function and engage in critical
The review of the literature has demonstrated thinking during stressful situations (Napolitano,
the promising potential of self-care practices in 2023).
enhancing resilience among nursing students. The It is crucial to incorporate the identified
specific self-care practices, such as exercise, strategies into nursing curricula to develop resilience
maintaining a healthy diet, adequate sleep, and emotional intelligence in nursing students. These
meditation, mindfulness, and deep breathing, have traits are essential for supporting their success and
shown to be particularly effective (Huges et al., equipping them with the necessary skills to excel
2021; Matthes et al., 2022; Strout et al., 2023). These academically and professionally. Nursing faculty
techniques not only assist students in managing stress play a key role in preparing students for the
but also improve their overall well-being (Strout et workforce by teaching techniques to improve
al., 2023). Other strategies, such as peer support emotional intelligence and strengthen resilience.
groups and student mentoring, have also proven This, in turn, will help students adapt to the
beneficial, providing students with a platform to constantly changing demands of healthcare while
share their concerns and experiences while receiving providing safe and compassionate patient care.
reassurance from others who are also experiencing
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Wilson, J. L., Hampton, D., Hensley, A., Culp-
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Figure Legend

Figure 1. Prisma flow diagram of search outcomes.

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