Introduction

The COVID-19 pandemic has created a stressful environment for the world, and healthcare workers, including nursing professionals, are affected the most. The work demands, job responsibilities, and risks for nurses increased due to the nature of working during this pandemic. Individuals are all struggling with situations and difficulties that are troubling to different degrees. EI among nurses works as a protective factor in these situations. The solution is to be logical, rational, and good common sense. However, it remains in theory, and practical situations are different for different individuals. Instincts, feelings, and personal values take over and become a major part of the dilemmas facing and the decisions that the individual chooses. There is a conflict between a man’s thinking and feelings, which makes decision-making more complicated. In the real world, both feelings and instincts are major influences on the behavior. Even though an individual has higher thinking power or intelligence, they come to poor decision-making or choice. In this situation, people will be by EI.^[1]

The aim of the review is to analyze the implications of EI on nursing practice, nursing research, nursing education, and nursing administration.

Analysis on the Importance of EI

EI is a valuable set of ideas that can be used in the workplace and in the home as a parent, teacher, or manager. It’s about being aware of feelings in us and in others, understanding them, and managing their impact. It’s about being in control, interpreting body language, coping with negativity, working with others, and building psychological well-being. EI is an assortment of mental abilities and skills that can help you to successfully manage both yourself and the demands of working with others.^[2] EI is the ability to manage one’s emotions as well as other people’s emotions. EI is a combination of three essential skills: emotional awareness, emotional management, and emotional application.^[2] Mayer, Salovey, and Daniel Goleman are the major pioneers in EI, and they presented that the ability to understand emotions and manage them is important for creating success. This idea took off and improved the way people tackle their emotions. Corporate organizations began to pay attention to the EI of their talents. If an individual wants to react to a situation quickly, he/she should be able to read the emotions involved in such situations and manage them masterfully. This will bring the most appropriate emotional sequence for the occasion.

According to WHO, health professionals play a central and critical role in improving access to and providing quality health care for the population. Mechanisms for optimizing the strengths and skills of health professionals will be essential to achieving the aims of health care. The working environment of health care professionals provides stress, adjustment problems, and mental health issues both in the professional and personal life and can directly or indirectly influence the quality of care provided to the consumers or clients.^[3]

Indian Medical Association reported (2018) that doctors, nurses, and other health care workers are having more stress from many factors like long working hours and medical training, violence against health workers, the stress of saving lives, seeing trauma at such close quarters, and constantly and suicide among health care workers is a public health crisis and should be tackled before it’s too late.^[4] According to Sara Hedderwick, a consultant in infectious diseases at Belfast, “There is no limit for what one wants to do to help patients get better, but to do that, health care professionals must ensure that they remain healthy too. Trying to achieve this fine balance between personal and professional commitments is very difficult, particularly for those who have families and dependents. This struggle often leads to stress in the employee’s life.”^[5]

Nurses are required to work long hours and night shifts, and this causes a conflict between their personal and professional roles. This has a toll on the employee’s ability to take care of his own health; the employee is constantly juggling to ensure a balance between the care he gives to his patients and the care he gives to himself and his family. Nearly 8,000 women participated in a study conducted by the Studer Group in 2008, including nurses (23%), administrators (22%), physicians (2%), and other healthcare professionals such as therapists and lab personnel (53%). It was reported that only 9% of women who work in the healthcare industry are very satisfied with their work-life balance, and 46% of the women reported that they attended to their own needs only a few times per year.^[6] A retrospective analysis was done to estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals. The study found that the probability of being ever divorced (or divorce prevalence) among physicians was 24.3%; dentists, 25.2%; pharmacists, 22.9%; nurses, 33.0%; healthcare executives, 30.9%; lawyers, 26.9%; and other non-healthcare professionals, 35.0% (34.9% to 35.1%). The statistics show that divorce prevalence is higher among nurses, which concludes that the personal and professional life is not balanced and EI to adapt to different situations is lacking.^[7] The statistics and findings from research studies suggest that healthcare professionals are at high risk of having psychological problems and burnout syndromes, and the job culture also provides a stressful environment, as explained in many studies. While the emotional aspects of clients are cared for, it is necessary that the health professionals themselves should be mentally and emotionally healthy to ensure better quality client care. The problems faced by nursing professionals are to be handled with immediate concern where interventions can be planned or training can be provided to help them adapt to their situations and handle themselves well in every crisis, whether personal or professional. This requires active, evidence-based strategies that help them have professional and personal satisfaction, which indirectly reflects in providing quality patient care. The incorporation of these interventions will enable nursing professionals to become active members of the health teams by improving work-life balance, EI, and quality of life, thus reducing burnout and psychological problems.

Nurturing EI will help to improve adaptability and maintain positive relationships and attitudes. EI also contributes to providing patient-centric care in today’s health profession, where healthcare demands are higher. EQ will also help healthcare professionals develop control over their emotions and those of their patients and develop the ability to exhibit quality care.

EQ has been shown to positively contribute to the physician-patient relationship, increased empathy, teamwork, communication, stress management, organizational commitment, physician and nurse career satisfaction, and effective leadership. Several dozen nursing research studies demonstrate a correlation between EQ and nurse performance, retention, stress adaptation, organizational citizenship, and selected positive patient clinical outcomes.

Implication of EI on Professional Nursing Practice

Many organizations, including the healthcare industry, have identified the importance of EQ for their leaders, managers, and employees to provide quality service to customers. Developing EI among nurses is very important as they are more concerned with a holistic care approach to the client and family. So, emotions, emotional behavior, and emotional literacy play a very important role in the nursing field.

A concept review conducted by Raghubhir AE on EI in professional nursing practice using Rodgers's evolutionary analysis approach analyzed 23 articles from different sources, including CINAHL, PyschINFO, Scopus, EMBASE, and ProQuest, from 1990 to 2017. The review reported four common attributes of EI-self-awareness, self-management, social awareness, and social/relationship management. The study concludes that these attributes facilitate the emotional well-being among advanced practice nurses and enhance the ability to practice in a way that will benefit patients, families, colleagues, and advanced practice nurses as working professionals and as individuals. The study also suggested the integration of EI within nursing as EI is a concept that may be central to nursing practice as it has the potential to impact the quality of patient care and outcomes, decision-making, critical thinking, and overall, the well-being of practicing nurses.^[8]

A concept paper written by Cadman C and Brewer J explores 'EI' in relation to recruitment to preregistration nurse education programs. They have cited many studies that demonstrated that EI is the common factor that marks individuals as leaders, innovators, and effective managers. The role of qualified Nurses needs key qualities and skills that are demanded by the health care system to provide quality patient care and to improve the standards of the organization. The skills that a nurse should show apart from their academic performance include the ability to work effectively in teams, the ability to recognize and respond appropriately to one's own and other's feelings, and the ability to motivate oneself and others, which are the key components of EQ. The authors suggested that selection processes that determine levels of EI in prospective candidates will act as reliable predictors of success in both clinical nursing practice and academic study. They also recommend that nurse educators create assessment strategies that will also give importance to EI at recruitment.^[9]

A descriptive study was conducted to find the relationships between the EI of nurses and the service quality rendered to patients and families. The researcher also identified the relationship between EI, communication skills, and job satisfaction. The study was conducted in 3 different hospitals in Iran, and 4 assessment tools were used. The study found that there is a direct relationship between EI and service quality. Communication skills and job satisfaction are playing a mediator role in improving service quality through EI. The researchers concluded that developing EI will help in delivering high-quality services that are aimed at many managerial initiatives in the health sector. Many research studies have proved that behavior and mood can be modified, so the health sector should implement strategies to improve EQ among nurses for better quality care.^[10]

An article written by Vitello-Cicciu J on exploring EI briefly describes EI and various underlying concepts. The author also clarifies the implications of EI for nurse leaders and in the workplace for nurses, and how it contributes to the quality of care based on the four-branch model of Mayer and Salovey.^[11]

Michelangelo L. did a meta-analysis in 2014, which included 395 EI studies of approximately 65,300 participants. This study was done to evaluate whether EI training for nurses improves critical thinking and emotional competence enough to justify including EI in nursing curricula. The study included various aspects of EI-related nursing abilities and traits such as leadership, health, reflection, ethical behavior, nursing performance, and job retention/satisfaction. The study result shows that the average effect size for all studies is r = 0.3022, which is moderate. All the studies reported a positive correlation with EI ranging from weak to strong, with a moderate cumulative effect size of r = 0.3022 across all studies. So, the study concluded that enhancing EI will contribute to a positive change among nurses, which will improve the quality of care.^[12]

The implications of EI for nurses are applied in clinical practice, research, administration, and education.

Implications in Nursing Practice

Implications in Nursing Education

Interventions to advance EI in nursing should continue to focus on integrating the development of EI within the nursing curriculum.

Nurse Educators have the potential to impact and encourage this integration by using knowledge-transfer techniques to put research-based knowledge regarding EI into practice.

Nurse Educators should develop assessment strategies to measure EI of the nurse students who joins the basic nursing education programs and meanwhile implement strategies to develop the EQ among the student nurses.

There is a positive correlation between EI and the traits and abilities tested, i.e., leadership, health, reflection, ethical behavior, nursing student performance, and job retention/satisfaction. This suggests that Nurse Educators should take the initiative in EI training and instruction and should be considered for inclusion in the nursing school curriculum.

Implications in Nursing Research

Nurses will engage in research and education to further advance this concept and its importance to nursing practice, as generating, synthesizing, and using research evidence is central to advanced nursing practice.

A continued effort in research regarding EI and its conceptual clarity within nursing practice is necessary and will ultimately help refine the quality and delivery of nursing care.

Organizational researchers can examine how workplace emotions are managed by employees to improve work outcomes.

Implications in Nursing Administration

Nurse leaders are a resource to other team members. So, they should demonstrate behaviors of EI will contribute to the growth of this concept within nursing practice as they may influence others to become emotionally intelligent as well therefore supporting transformational leadership within nursing practice.

As valued leaders within nursing and in health care, nurses who engage in emotionally intelligent behaviors within their leadership roles demonstrate less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration, and teamwork, more satisfaction with their jobs, and fewer unmet patient care needs.

Nurse leader/Manger has the potential to make a significant contribution to health care by empowering themselves, their patients and families, and colleagues through EI.

To create a climate for satisfied staff, patients, and their loved ones and diminish the degree of emotional labor that may cause burnout in nursing staff.

Nursing leaders will be expected to achieve desired organizational outcomes and expressions such as a caring and a supportive environment. They will be expected to set the tone for their nursing units and foster an esprit de corps that facilitates cooperation and positive teamwork. Minimizing or dealing with potential conflict among healthcare providers in a particular nursing unit will also be crucial if the team is to be effective and avoid burnout. This expectation requires these leaders to possess a high degree of EI to recognize and use emotional information in social interactions with their nursing staff and patients.

Nursing leaders who possess EI will demonstrate the ability to perceive emotions, to express emotions accurately, and differentiate authentic from false emotional expressions.

Nursing leaders will be able to use emotions to redirect their nursing staff to important patient care issues like prevention of medication errors. They will also be able to generate emotions that facilitate decision-making, to use mood swings as a means of considering multiple perspectives among their staff and to use varied range of emotions in different patient care situations.

Discussion

The article suggests that EI should be practiced by Nurse to the full extent where they will be able to effectively interact with patients, team members and health care stake holders for effective nursing practice and enhance quality of care. This will ensure that the nurse leads the care planning of clients and the health team when the Indian scenario develops independent practice by nurses as nurse practitioners and community health officers to give an equal and valid influence at all levels of healthcare.^[13]

Goleman has focused on the importance of self-awareness in his theory. Nurses should be able to explore this concept and understand the negative attitudes, irrational thoughts, and relationship issues among themselves and their clients in the hospital and community. EI is an element that is very crucial when dealing with different people and different situations in clinical settings, along with a strong knowledge base and scientific evidence. If a nurse is able to apply EQ skills in their work, they will be able to understand the effect of reactions they have on others and develop healthy teamwork, which indirectly improves the quality of patient care.^[14]

Conclusion

Today, most people are surrounded by more stress, apprehensiveness, and fear for the future. Every organization is suffering at some level from emotional hijacks, and thus, their organization may be operating in a dumbed-down fashion. Emotions are contagious, so if one person is emotionally hijacked in the team or organization, most likely, others will catch it, like the flu. So quickly, the team IQ can lose points, jeopardize executive decisions, and deteriorate teamwork and collaboration. The leaders’ ability to manage their emotions then is paramount as they are the “emotional thermostat” for their team and can influence their team’s mood and productivity.^[15] This situation can be overcome by improving emotional literacy and EI, which will make the team members and the administrators handle various situations tactfully. The higher the EI, the more able a person is to understand, identify, and subdue an emotional hijacking situation.

Source of Funding

None.

Conflict of Interest

None.