The development of the skills and competencies essential for nursing practice begins with nursing education. Along with technical and critical thinking skills, nurse graduates must be equipped to manage the emotions of patients, caregivers, and other professionals to ensure optimal patient outcomes (Senyuva, Kaya, Isik, & Bodur, 2014; Shanta & Gargiulo, 2014). Emotional intelligence (EI) is an important characteristic of nurses that can affect the quality of their work, including clinical decision-making, critical thinking, and the use of evidence and knowledge in practice (Kaya, Senyuva, & Bodur, 2017).
EI is defined as "the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth" (Mayer & Salovey, 1997, p. 5). Nurses with high EI abilities have been found to provide a more holistic approach in caring for patients; they take into account such factors as financial restrictions, social issues, and the health care beliefs of the patient and caregiver (Codier & Codier, 2015). The purpose of the study was to determine if measured EI of nursing students changes over time. Mayer and Salovey's (1997) ability model of EI served as the theoretical framework. The model divides the abilities and skills of EI into four areas: perception, facilitation, understanding, and management of emotions.
METHOD
A quantitative, longitudinal, correlational design was used to measure the EI scores of baccalaureate nursing students over time. Students had completed program prerequisites and were in the first semester of a professional nursing program. Approval from the university's institutional review board was obtained, and participants were informed they could drop out of the study at any time.
Sample
The study involved 112 nursing students at a public university in the United States. All participants were 19 years or older; 83 percent identified as female. Eighty-eight percent identified as Caucasian; 5 percent identified as African American; 1 percent identified as Hispanic or Latino; and 6 percent did not identify.
Instrument
The instrument used to measure EI for this study was the online Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), which is an ability measure. The reliability and validity of the instrument for the total EI score is r = .93. Reliability of the four ability branches are perceiving emotions (r = .91), facilitating emotions (r = .79), understanding emotions (r = .80), and managing emotions (r = .83; Mayer et al., 2003). Students completed the MSCEIT at two separate time points: in the first month of the program and one month prior to graduation.
The 141-item MSCEIT is administered online by Multi-Health Systems, Inc., and takes approximately 45 minutes to complete. Scoring includes an overall EI score, two area scores, and four ability scores. Scores utilized for this study included the overall EI score as well as each of the four ability subscores (perception, facilitation, understanding, and management of emotions). A MSCEIT score of greater than 106 indicates high EI, scores between 94 and 106 reflect middle EI, and a score of less than 94 indicates low EI. There are currently no data that establish a "typical" score specifically for nursing students.
Data were collected at two separate time points during this longitudinal study. Eighty-five participants completed the MSCEIT at Time Point 1 (first month of first semester). At Time Point 2 (one month prior to graduation), 29 did not complete the MSCEIT, resulting in a final sample of 56. Five students did not complete the MSCEIT due to academic progress; the others chose not to participate or did not fully complete the MSCEIT. Completed scored datasets were accessed electronically via the secure Multi-Health Systems, Inc., server and analyzed using paired t-tests.
RESULTS
A paired samples t-test was conducted to evaluate the impact of the upper division nursing courses on students' scores on the MSCEIT. There was a statistically significant decrease of total EI scores from Time Point 1 (M = 94, SD = 17.20) to Time Point 2 (M = 88.42, SD = 19.30), t(55) = 3.32, p < .01. The mean decrease in the total score was 6.32, with a 95 percent confidence interval ranging from 2.50 to 10.14. The eta-squared statistic (.17) indicated a large effect size.
Paired samples t-tests also evaluated changes in MSCEIT subscales. For the Ability 1 subscale (perceiving emotions), there was a statistically significant decrease in scores from Time 1 (M = 100.75, SD = 15.41) to Time 2 (M = 94.87, SD = 18.93), t(55) = 2.92, p < .01. The mean decrease in Ability 1 scores was 5.87, with a 95 percent confidence interval ranging from 1.84 to 9.91. The eta-squared statistic (.13) indicated a moderate effect size.
For the Ability 4 subscale (managing emotions), there was a statistically significant decrease in scores from Time 1 (M = 95.09, SD = 17.51) to Time Point 2 (M = 87.48, SD = 15.59), t(55) = 3.29, p < 01. The mean decrease in Ability 4 scores was 7.62, with a 95 percent confidence interval ranging from 2.97 to 12.26. The eta-squared statistic (.16) indicated a large effect size.
Results of Ability 2 (facilitating emotions) and Ability 3 (understanding emotions) subscales were not statistically significant. For the Ability 2 subscale, there was a decrease in scores from Time 1 (M = 98.96, SD = 19.7) to Time 2 (M = 94.13, SD = 18.11), t(55) =1.86, p = .068. For the Ability 3 subscale, there was a slight decrease in scores from Time 1 (M = 92.89, SD = 11.4) to Time 2 (M = 91.92, SD = 15.47), t(55) = 0.503, p = .617.
DISCUSSION
A statistically significant decrease in participants' total measured EI over the course of the program was found in this study. Although this finding is disturbing, previous studies support a decrease in EI for students enrolled in high-stakes professional programs (Gribble, Ladyshewsky, & Parsons, 2017; Lewis, McNulty, White, Lane, & Mackay, 2017). One of the most concerning findings from this study was a significant decrease over time in the students' ability to perceive emotions. Fundamentally, this involves the ability to recognize emotion, such as nonverbal perception and expression of emotion in the face and voice. An example would be a nurse's ability to recognize a facial expression that masks the real emotion, such as the patient in extreme pain who smiles for the benefit of family. Nurse educators agree that the ability to perceive emotions should be a minimal competency for nurse graduates and is crucial to be a successful nurse (Codier, Kofoed, & Peters, 2015).
A statistical decrease in managing emotions was also noted. The ability to manage emotions is vital in providing care to patients and family members. For example, a nurse whose patient has died must manage self-emotions to understand that, although it is normal to mourn with the family, caring for the family's emotions is an initial priority. The nurse's goals, self-knowledge, and social awareness are all based on the capacity to manage emotions.
Two of the four EI abilities - facilitation and understanding emotions - did not show a statistically significant decrease in this study. Facilitation of emotions relates to a person's ability to use emotions in thought. This includes the capacity of emotions to assist thinking and the ability to recall an emotion clearly. This ability is needed to recognize that the angry emotions of a patient are masking the underlying fear of a new medical diagnosis. Understanding and analyzing emotions entails the ability to recognize relationships between emotions and differentiate them from one another. This ability reflects one's capacity to understand the outcomes of emotions. For example, a nurse must be able to recognize when a patient feels unlovable and thus rejects the nursing care being provided. Although these two abilities did not show a significant decrease in this longitudinal study, both ability mean scores decreased over time.
It is important to investigate the reasons why EI decreased in this study. Nursing students enter a BSN program because of a desire to help people and provide care to patients in medical crisis. One reason for the decrease in emotional ability is the increased cognitive load students are faced with during a rigorous course of study (Kaylor, 2014). Often within weeks students become overwhelmed by the volume of content in the curriculum. They find themselves in a competitive educational environment where the primary form of evaluation is high-stakes testing.
Stress can also cause a decrease in measured EI. One study compared the stress level of nursing students at the beginning and end of a BSN program and found that general stress was higher for students in the final year of the program. Factors contributing to the increased stress were the pressure of performance of clinical skills and the overall environment of professional training (Oliveira Bosso, Marques Da Silva, & Siqueira Costa, 2017). Academic demands, navigating the clinical environment, and caring for patients and families in the health care setting contribute to students' stress and can cause mental fatigue that causes students to lose sight of the reasons they were initially inspired to become a nurse, thus impacting EI ability (Alzayyat & Al-Gamai, 2014). Whereas nursing research indicating EI should increase over the course of baccalaureate education does not currently exist, a decrease in EI during a nursing program of study is concerning due to this profession's required emotional ability skills set.
The findings of this study indicate that measuring EI in nursing students is not enough. Faculty education on the relevance of EI impact in nursing practice is needed. Nurse educators need to evaluate the nursing curriculum and determine if EI competencies are included. If the answer is yes, then these skills should be emphasized as important by all faculty. If the answer is no, the construct of EI must be introduced and integrated in the curriculum using a scaffolding approach similar to the approach used with other traditional nursing constructs, including safety, effective leadership, and communication skills.
CONCLUSION
In today's complex health care system, where nurses are expected to function immediately upon graduation, there is mounting evidence that emotional competencies are minimal or missing from the majority of nursing curricula. The results of this study indicate that measured EI decreased over the course of a professional nursing program. Additional research exploring EI should be investigated to examine the impact it may have on the science of nursing. Literature supports that nurses with high EI are better leaders, better team members, and more effective health care providers (Codier et al., 2015). In order to promote new graduate success and prepare nurses for longevity in the health care field, educators must be intentional about promoting EI development in nursing education.
REFERENCES