The use of emotional intelligence capabilities in clinical reasoning and decision-making: A qualitative, exploratory study

Thirty years of emotional intelligence: A scoping review of emotional intelligence training programme among nurses

The stressful environment of any healthcare setting can be detrimental to nurses' mental and emotional health. In recent years, emotional intelligence (EI) has emerged as a vital psychological resource that positively impacts mental and emotional health and improves organizational functioning and success. This scoping review aimed to collate, synthesize and outline the research conducted on EI training programmes among nurses to assess their effectiveness in improving staff nurses' EI. Electronic databases of MEDLINE via PubMed, CINAHL, Scopus, Cochrane, ProQuest, Embase and Web of Science were comprehensively searched for related studies published between 1990 and 2021 (updated in May 2022). Two investigators independently screened the abstracts of the retrieved studies against the inclusion and exclusion criteria. Out of 728 initially retrieved studies, only 7 were included in the final synthesis. The PRISMA-ScR (2018) checklist was used to report the study findings. All the studies included in the review reported a significant improvement in nurses' EI after a training programme. The results also indicate that EI interventions are an effective way to improve nurses' psychological resources (improve resilience and coping skills; reduce anxiety and stress), leadership qualities, job performance and patient experience of nursing care. As nurses are exposed to a wide range of emotions, human pain and suffering, the results of this review suggest that improving the EI skills of nurses through short training programmes is an effective way to maintain their emotional and mental well-being. This scoping review is preregistered in Prospero (CRD42020161084).

Emotional intelligence competencies in the undergraduate nursing curriculum: A descriptive qualitative study

BACKGROUND

The evidence suggests that emotional intelligence is an essential interpersonal skill for the nursing profession, but there is a paucity in the literature about how these competencies are integrated into the undergraduate curriculum.

OBJECTIVES

To explore how undergraduate nursing faculty incorporated emotional intelligence competencies in baccalaureate nursing education.

DESIGN AND SETTINGS

The design for this study was a qualitative descriptive design. Participants were recruited from eight public universities with pre-licensure baccalaureate nursing programs across the United States.

PARTICIPANTS

A purposive and network sample of full-time, didactic nursing faculty members (n = 8) from pre-licensure baccalaureate nursing programs throughout the United States.

METHODS

A total of eight semi-structured interviews were conducted via Skype or Zoom between June and October 2020, with a mean duration of 58 min. All were transcribed verbatim. Data analysis continued through thematic analysis and constant comparison. The study is reported in accordance with COREQ guidelines and received IRB approval.

RESULTS

Three themes and eight sub-themes were found within the data: (a) formal strategies (communication, professional formation, empathy/caring), (b) informal strategies (interpersonal development, practice what you preach, teaching strategies), and (c) need for a systems approach (organizational framework, organizational breakdown).

CONCLUSIONS

The results suggested that participants used a combination of formal and informal strategies to cultivate emotional intelligence competence in their students and that a systems approach may be the best strategy to support curricular consistency throughout the program of study. Faculty participants unanimously agreed that emotional intelligence skills were essential components of the undergraduate nursing curriculum and were crucial to cultivating a healthy academic environment.

Rethinking clinical decision-making to improve clinical reasoning

Improving clinical reasoning techniques is the right way to facilitate decision-making from prognostic, diagnostic, and therapeutic points of view. However, the process to do that is to fill knowledge gaps by studying and growing experience and knowing some cognitive aspects to raise the awareness of thinking mechanisms to avoid cognitive errors through correct educational training. This article examines clinical approaches and educational gaps in training medical students and young doctors. The authors explore the core elements of clinical reasoning, including metacognition, reasoning errors and cognitive biases, reasoning strategies, and ways to improve decision-making. The article addresses the dual-process theory of thought and the new Default Mode Network (DMN) theory. The reader may consider the article a first-level guide to deepen how to think and not what to think, knowing that this synthesis results from years of study and reasoning in clinical practice and educational settings.

Cognitive Continuum Theory: Can it contribute to the examination of confidentiality and risk-actuated disclosure decisions of nurses practising in mental health?

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents a single-system intuitive-analytical approach to examining and understanding nurse cognition, analogous to the recommended single-system approach to decision-making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a 'common sense' blending of intuitive and analytical cognition, whereby cues presented to a decision-maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition.

Clinical judgement in nursing - An evolutionary concept analysis

AIMS

The aim of this concept analysis was to develop a contemporary operational definition of Clinical Judgement in nursing.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis. Throughout the study, the authors followed the SRQR checklist.

RESULTS

This concept analysis guided the development of an operational definition of clinical judgement, within the context of nursing, articulated as Clinical judgement is a reflective and reasoning process that draws upon all available data, is informed by an extensive knowledge base and results in the formation of a clinical conclusion.

CONCLUSION

The purpose of this concept analysis was to propose a detailed definition of clinical judgement in nursing, that reflected its theoretical base within today's contemporary healthcare system. Using Rodgers' evolutionary method of concept analysis, surrogate terms, attributes, antecedents and consequences were identified, and a contemporary definition was developed. No patient or public contribution was required to design or undertake this research.

Influence of emotional intelligence on the clinical ability of nursing interns: a structural equation model

Background

Internship is a critical period during which nursing students develop clinical skills and establish professional attitudes. Requirements for nursing interns are evolving with the development of medicine and the transformation of teaching models. The emotional intelligence (EI) of nursing students has an influence on their clinical performance. This study aimed to investigate the impact of EI on the clinical ability of nursing interns.

Methods

A cross-sectional observational study was designed to include nursing students interning in a tertiary hospital in Shanghai, China from April 1, 2019 to April 30, 2020 (N = 310). Chinese versions of the EI scale (EIS) and holistic clinical assessment tool (HCAT) were used to measure the EI and clinical ability of interns, respectively. Pearson’s correlation coefficient was utilized to determine the correlation between EI and clinical ability. Multiple linear regression analysis was performed to further explore the influence of EI on clinical ability, and the structural equation model (SEM) was used for multivariate path analysis.

Results

The mean EI and clinical ability scores of interns were 125.17 ± 14.98 and 97.91 ± 19.55, respectively, indicating an upper-moderate level in both aspects. EI scores were correlated positively with clinical ability ones (R = 0.534, p < 0.05). Multivariate path analysis showed that “managing emotions” and “facilitating thought” of EI branches have direct effects on clinical ability. Furthermore, the type of school, family financial state and the knowledge of EI indirectly influence clinical ability through their impact on “managing emotions” and “facilitating thought”.

Conclusions

EI is essential to enhancing the clinical ability of nursing students. EI training should focus on facilitating thought and managing emotions. It is also necessary for educators to consider the context of nursing students and the characteristics of schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00933-y.

Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses

Moral sensitivity helps individuals resolve moral dilemmas as a precursor to moral decision-making. Intensive care unit (ICU) nurses are at high risk for encountering moral dilemmas and should have the moral sensitivity to recognize moral issues. The activities of ICU nurses in moral decision-making are guided by moral sensitivity but are also based on emotional intelligence (EI). EI, be recognized as an integral part of moral sensitivity with long-standing theoretical foundations. It is necessary to explicate the true role of EI in moral sensitivity through empirical research. To measure the level of moral sensitivity of ICU nurses and determine the relationship between moral sensitivity and EI. We recruited 467 ICU nurses of ten hospitals from March to June 2021 in Hunan Province, China for a cross-sectional questionnaire survey. The moral sensitivity and EI were measured using the Moral Sensitivity Questionnaire-Revised Version into Chinese (MSQ-R-CV) and the Wong and Law Emotional Intelligence Scale-Version into Chinese (WLEIS-C). A self-report questionnaire covered sociodemographic characteristics. The average moral sensitivity score of ICU nurses was 39.41 ± 7.21. The average EI score was significantly positively correlated with the moral sensitivity score (p < 0.001). This study demonstrated that the moral sensitivities of ICU nurses were at medium levels. EI of ICU nurses can indeed affect their moral sensitivity, and the impact of each element of EI should be clarified for practical application.

"To get the baby out off the hook": a prospective, longitudinal, multicenter, observational study about decision making in vacuum-assisted operative vaginal delivery

Background

Since operative vaginal delivery may be risky for women and might cause neonatal complications, the aim of this study is to assess appropriateness of the procedure.

This is a prospective, longitudinal, multicenter, observational study and it was conducted in three Italian Obstetric Units (Pisa, Massa Carrara and Prato). All term pregnant women, either nulliparous and multiparous, with singleton pregnancy and a cephalic fetus, with spontaneous or induced labour, requiring vacuum-assisted delivery were enrolled.

Indications to operative vaginal delivery were grouped as alterations of fetal cardiotocography (CTG) patterns, delay/arrest of second stage of labour or elective shortening of second stage of labour. A board consisting of five among authors evaluated appropriateness of the procedure.

Results

Overall, 466 women undergoing operative vaginal deliveries were included. Cardiotocography, classified as ACOG category 2 or 3 was the indication for vacuum assisted delivery in 253 patients (54.29%). Among these, 66 women (26.1%) had an operative vaginal delivery which was then considered to be inappropriate, while in 114 cases (45.1%) CTG traces resulted to be unreadable.

Conclusion

Decision making process, which leads clinicians to go for operative vaginal delivery, is often influenced by shortness of time and complexity of the situation. Therefore, clinicians tend to intervene performing vacuum delivery without adopting critical analysis and without adequately considering the clinical situation.

Tweetable abstract

Operative vaginal delivery might be a risky procedure and should be performed only when clinically indicated and after adequate critical analysis.

Situation awareness and the mitigation of risk associated with patient deterioration: A meta-narrative review of theories and models and their relevance to nursing practice

BACKGROUND

Accurate situation awareness has been identified as a critical component of effective deteriorating patient response systems and an essential patient safety skill for nursing practice. However, situation awareness has been defined and theorised from multiple perspectives to explain how individuals, teams and systems maintain awareness in dynamic task environments.

AIM

Our aim was to critically analyse the different approaches taken to the study of situation awareness in healthcare and explore the implications for nursing practice and research as it relates to clinical deterioration in ward contexts.

METHODS

We undertook a meta-narrative review of the healthcare literature to capture how situation awareness has been defined, theorised and studied in healthcare. Following an initial scoping review, we conducted an extensive search of ten electronic databases and included any theoretical, empirical or critical papers with a primary focus on situation awareness in an inpatient hospital setting. Included papers were collaboratively categorised in accordance with their theoretical framing, research tradition and paradigm with a narrative review presented.

RESULTS

A total of 120 papers were included in this review. Three overarching narratives reflecting philosophical, patient safety and solution focussed framings of situation awareness and seven meta-narratives were identified as follows: individual, team and systems perspectives of situation awareness (meta-narratives 1-3), situation awareness and patient safety (meta-narrative 4), communication tools, technologies and education to support situation awareness (meta-narratives 5-7). We identified a concentration of literature from anaesthesia and operating rooms and a body of research largely located within a cognitive engineering tradition and a positivist research paradigm. Endsley's situation awareness model was applied in over 80% of the papers reviewed. A minority of papers drew on alternative situation awareness theories including constructivist, collaborative and distributed perspectives.

CONCLUSIONS

Nurses have a critical role in identifying and escalating the care of deteriorating patients. There is a need to build on prior studies and reflect on the reality of nurse's work and the constraints imposed on situation awareness by the demands of busy inpatient wards. We suggest that this will require an analysis that complements but goes beyond the dominant cognitive engineering tradition to reflect the complex socio-cultural reality of ward-based teams and to explore how situation awareness emerges in increasingly complex, technologically enabled distributed healthcare systems.

Nurses' perceptions of emotional intelligence in the clinical setting: A qualitative systematic review

AIM

The aim of the study is to explore available literature on nurses'/midwives' perceptions of emotional intelligence in the clinical setting.

BACKGROUND

Emotional intelligence is a crucial skill in nursing practice but little is known about nurses' perceptions of it.

EVALUATION

Eight electronic databases (CINAHL, Cochrane, Embase, ProQuest Dissertations and Theses Global, PsycInfo, PubMed, Scopus and Web of Science) were searched until November 2020. Quality appraisal was performed using the Critical Appraisal Skills Program Checklist. Data analysis was conducted using Sandelowski and Barroso's two-step approach of meta-summary and meta-synthesis.

KEY ISSUES

Five themes emerged from the 17 included studies: (1) understanding emotional intelligence in clinical nursing, (2) nurses' utilization of emotional intelligence, (3) benefits of being an emotionally intelligent nurse, (4) barriers to developing emotional intelligence and (5) recommendations to enhance emotional intelligence.

CONCLUSIONS

Nurses expressed interest in enhancing their emotional intelligence, and they identified barriers and provided corresponding recommendations to support their endeavours. Future studies should be geographically distributed and include nurses from all sectors of the profession to amass a holistic and comprehensive conceptual understanding of emotional intelligence.

IMPLICATIONS FOR NURSING MANAGEMENT

Policy makers and nursing educators should tactically and successfully integrate emotional intelligence training into the nursing profession and curricula.

The Relationship between Mindfulness and Emotional Intelligence as a Protective Factor for Healthcare Professionals: Systematic Review

Emotional intelligence is an essential trait and skill for healthcare professionals. Mindfulness meditation has proved to be effective in increasing the wellbeing of those who practice it, leading to better mental health, self-care and job satisfaction. This paper aims to identify the recent evidence on the relationship between mindfulness and emotional intelligence among healthcare professionals and students. A systematic review was conducted including the databases PubMed, Cinhal, PsycINFO and Web of Science. The main variables were emotional intelligence skills and mindfulness practice. Data were extracted according to the following outcomes: authors, year of publication, country, study design, participants, mindfulness training intervention, tools used in data collection and main results. The following inclusion criteria were applied: peer-reviewed articles; published in English or Spanish; published between 2010 and 2020; quantitative methodology; a study population of healthcare professionals or students; the relationship with the aim of the study. The Joanna Briggs Institute criteria were followed for assessing the methodological quality of the selected studies. Three researchers were involved in the review. After the selection process, 10 studies were selected out of the 197 references initially identified. These studies revealed a positive relationship between mindfulness and emotional intelligence, particularly the capacity to regulate emotions. Furthermore, mindfulness is negatively related to emotional exhaustion. Training interventions based on mindfulness have proved to be useful in promoting emotional balance, emotional awareness, emotional acceptance, emotion recognition, expressive suppression and a reduction in emotional exhaustion. This study could serve as a basis for further research on the benefits of emotional intelligence and practicing mindfulness for the bio-psycho-social welfare of healthcare professionals.

Power, autonomy and interprofessional practice in dietitian clinical decision making: An interpretive study in acute hospitals

Dietitians learn clinical decision making (CDM) predominantly as an autonomous cognitive process that considers the needs and preferences of the patient. Although interprofessional education is increasing in tertiary dietetic programmes, a paucity of research exists that explores the nature of how practising dietitians make decisions, independent or otherwise. This qualitative interpretative study explored the nature of experienced dietitian CDM in the acute care setting. Philosophical hermeneutic principles guided text construction and interpretation via in-depth, semi-structured interviews with practising dietitians with at least 3 years of experience. A reference focus group commented on the emerging findings, increasing the rigour of the research. Ten dietitians participated in the interviews and there were five dietitians in the reference focus group. CDM was found to be a highly social phenomenon with varying degrees of autonomy involving complex power relations with various other health professionals, in particular, medical practitioners. Dietitians respond to existing power relations in key ways, including building and maintaining relationships, advocating on behalf of the patient and negotiating decisions with other healthcare staff when in pursuit of improved health and nutrition related outcomes for patients. Strategic interprofessional communication skills are foundational to effective patient care and advancing the role of the dietitian. Power and autonomy in dietitian CDM are important concepts that could inform interprofessional education when seeking to promote both effective dietetic and interprofessional practice.

Influence of Experience on the Thought Process of Clinical Psychologists: An Analysis from the Dual-Process Theories Framework

In the course of their work, psychologists must make judgments and complex decisions, skills that are part of clinical reasoning. Recent models approach the analysis of such process using the dual-process theories framework. This study provides an assessment of the two systems, System 1 and System 2, in forty-five clinical psychologists with different levels of experience (novices, intermediates and experts) with the purpose of exploring their level of activation and evolution throughout such stages of expertise. According to the results, clinical psychologists mainly activate System 2, M = 70.91, SD = 6.71, than System 1, M = 60.49, SD = 3.78; $ {F}_{\left(1,\kern0.5em 41\right)}=7.99;p<.01;{\upeta}^2=.163, $ when performing their clinical duties. However, no significant changes have been observed regarding the preferential use of thinking Systems 1 or 2 throughout the experience, both systems are used in a similar way in the different levels of expertise analyzed, with an increase of System 2 at the intermediate level of expertise. The results are analyzed in terms of intermediate effect and discussed focusing on the unremitting need for System 2 in psychologist work given the idiosyncratic characteristics of each case requiring treatment in the area of psychology and on the relationship of the two systems in clinical reasoning.

A model of the multidimensional nature of experienced dietitian clinical decision-making in the acute care setting

BACKGROUND

Clinical decision-making (CDM) is an essential component of dietetic practice that can significantly affect the quality of patient care. Research around CDM in clinical dietetics is scarce, with research in other healthcare professions offering limited insight into dietitian CDM in the specific setting of the acute care hospitals. The aim of this qualitative research was to deepen our understanding of the nature of the CDM of experienced dietitians in the acute care setting.

METHODS

The present study employed philosophical hermeneutics to guide methods situated within the interpretative paradigm. This study invited dietitians currently practising in adult acute care hospitals with at least 3 years of experience to be involved two in-depth semi-structured interviews using the principles of hermeneutics. A reference focus group session was then used to provide rigour and further interpretation of the findings.

RESULTS

Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings have informed the development of A Model of the Multidimensional Nature of Dietitian CDM in the Acute Care Setting, which reflects the nature of making decisions for patient care through the synergistic relationship between five key dimensions: (i) tasks; (ii) interactions; (iii) reasoning; (iv) practitioner factors; and (v) context, all of which are managed and monitored by the higher- order reasoning process of the dietitian's clinical judgement.

CONCLUSIONS

Because there is scarcity of research on the CDM of dietitians in acute care settings, the present study can provide training and professional development insights to managers, educators and supervisors.

Person- and job-specific factors of intuitive decision-making in clinical practice: results of a sample survey among Hungarian physicians and nurses

Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of 'emergency' (necessity of making instantaneous decisions in unforeseeable situations) and 'complexity' (necessity of considering multiple perceptual and diagnostic aspects of patients' health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of 'high likelihood of emergency' or 'high complexity' increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs' propensity for IDM. Additionally, we performed content analysis of participants' free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job- and person-specific factors and HCPs' propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

Emotional intelligence as a mechanism to build resilience and non-technical skills in undergraduate nurses undertaking clinical placement

The environments in which nursing work is undertaken can be highly stressful and complex with resultant harmful outcomes for the health of both nurses and patients reported. Undergraduate nursing students are particularly challenged when on clinical placement through having only partially developed work capabilities, with wide claims that these nurses remain underprepared for work even upon graduation. Over time undergraduate nursing education has arguably not prioritized developing resilience and other non-technical skills required to respond effectively to these challenges. This paper reports findings from a qualitative study of student nurses who received training and coaching in emotional intelligence, a well-established correlate of resilience, just prior to undertaking a mental health or medical/surgical clinical placement. Of that cohort, 12 agreed to qualitative semi-structured interviews that sought to better understand how these students used the knowledge and capabilities from the training within clinical placement contexts. Four themes emerged from the thematic analysis of the interviews: (1) greater experiences of resilience; (2) responding positively to mental health consumers; (3) experiences of greater empathy and compassion; and (4) experiences of improved non-technical work skills. Implications from these findings suggest that student and patient experiences of nursing placement, and mental health nursing placements in particular, would be enhanced by pre-placement emotional intelligence training and coaching. Such training will support nursing graduates to be work-ready upon entering the workforce.

The impact of workplace bullying on flourishing: The moderating role of emotional intelligence

Orientation: Workplace bullying has detrimental effects on employee well-being. Emotional intelligence may moderate the relationship between workplace bullying and flourishing.Research purpose: The purpose of this study was to examine the nature of the relationship between workplace bullying and flourishing and to investigate the moderating role of emotional intelligence in the workplace bullying–flourishing relationship.Motivation for the study: There is a paucity of studies exploring the moderating role of personal resources such as emotional intelligence in the relationship between workplace bullying and flourishing.Research approach/design and method: The study used a cross-sectional design, quantitative approach and a convenience sampling method. Employees from a higher education institution (N = 1102) participated in this research. Descriptive, correlation and moderation analysis was used to analyse the data.Main findings: The results showed that there was a significant negative relationship between workplace bullying and flourishing. Emotional intelligence significantly moderated the relationship between workplace bullying and flourishing.Practical/managerial implications: Organisations should develop and/or strengthen the level of emotional intelligence in employees in order to reduce the negative effect of workplace bullying on well-being.Contribution/value-add: The findings of this research contribute to the limited body of research investigating personal resources such as emotional intelligence as a moderator in the bullying-well-being relationship.