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Review
Emotional intelligence education in pre-registration nursing
programmes: An integrative review
Kim Foster
a,
⁎, Andrea McCloughen
b,1
, Cynthia Delgado
c,d,2
, Claudia Kefalas
d,3
, Emily Harkness
e
a
Faculty of Health, Disciplines of Nursing & Midwifery, PO Locked Bag 1, University of Canberra, ACT 2601, Australia
b
Sydney Nursing School, University of Sydney, 88 Mallett Street, Camperdown, NSW 2006, Australia
c
Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
d
Royal Prince Alfred Hospital, Sydney Local Health District, P.O. Box M50, Missenden Road, Camperdown, NSW 2050, Australia
e
School of Psychology, University of Sydney, NSW 2006, Australia
summaryarticle info
Article history:
Accepted 17 November 2014
Keywords:
Emotional intelligence
Emotional labour
Nurse education
Curriculum
Pre-registration
Objective: To investigate the state of knowledge on emotional intelligence (EI) education in pre-registration
nursing programmes.
Design: Integrative literature review.
Data sources: CINAHL, Medline, Scopus, ERIC, and Web of Knowledge electronic databases were searched for
abstracts published in English between 1992–2014.
Review methods: Data extraction and constant comparative analysis of 17 articles.
Results: Three categories were identified: Constructs of emotional intelligence; emotional intelligence curricula
components; and strategies for emotional intelligence education.
Conclusions: A wide range of emotional intelligence constructs were found, with a predominance of trait-based
constructs. A variety of strategies to enhance students' emotional intelligence skills were identified, but limited
curricula components and frameworks reported in the literature. An ability-based model for curricula and
learning and teaching approaches is recommended.
© 2014 Published by Elsevier Ltd.
Background
The ability to establish therapeutic relationships and to communi-
cate effectively with patients, families, and colleagues are ess ential stan-
dards for competent registered nurses (Nursing and Midwifery Board of
Australia, 2006; UK Nursing and Midwifery Council, 2008). These
relational abilities are vital as nursing practice involves complex care
for people who are emotionally vulnerable due to physical or mental ill-
ness. The significance of human relationships in nursing (Freshwater
and Stickley, 2004), and the critical importance of skilled nursing care
which addresses patients' emotional and physical needs, are evidenced
by recent healthcare reports (e.g. Francis, 2013)callingfornurseeduca-
tion with an increased focus on developing students' compassion and
caring.
In order to meet patients' and families' emotional needs effectively
during the health/illness journey nurses engage in caring practices of
managing their own and others' emotions. This emotional labour, or
work, involves induction and/or suppression of emotion; the purpose
of which is to sustain an outer appearance that makes others feel safe
and cared for (Hochschild, 1983). Theodosius (2008) identifies three
types of emotional labour (EL) in nursing: Instrumental EL involves
the use of interpersonal skills while carrying out a clinical procedure
in order to make the process more comfortable and to minimisepatient
distress. Therapeutic EL involves listening to and encouraging expres-
sion of patient/family feelings with the intention to establish an inter-
personal relationship and promote emotional wellbeing. The final type
is Collegial; the interpersonal relationships and communication
between nurses and within the interdisciplinary team which has the
purpose of processing important information and facilitating effective
nursing care.
Emotional labour calls upon the use of personal and interpersonal
skills or ‘intelligences’(McQueen, 2004). Leading theorists have defined
emotional intelligence (EI) as an intelligence comprising the ability to
perceive emotions, integrate emotions to facilitate thinking, understand
emotions, and to regulate or manage emotions to promote personal
growth (Mayer and Salovey, 1997). EI has, however, been variously
defined and understood. The credibility of the construct has been
challenged due to the array of conceptual perspectives and definitions.
Nurse Educat ion Today 35 (2015) 510–517
⁎Corresponding author at: Facultyof Health, Locked Bag 1, University ofCanberra, ACT
2601, Australia. Tel.: +61 2 6201 5131; fax: +61 2 6201 5128.
E-mail addresses: Kim.Foster@canberra.edu.au (K. Foster),
andrea.mccloughen@sydney.edu.au (A. McCloughen), Cynthia.Delgado@sydney.edu.au
(C. Delgado), ckef4655@uni.sydney.edu.au (C. Kefalas), emily.harkness@sydney.edu.au
(E. Harkness).
1
Tel.: +61 2 91144085; fax: +61 2 93510679.
2
Tel.: +61 2 9114 4080; fax: +61 2 9351 0649.
3
Tel.:+61295158714.
http://dx.doi.org/10.1016/j.nedt.2014.11.009
0260-6917/© 2014 Published by Elsevier Ltd.
Contents lists available at ScienceDirect
Nurse Education Today
journal homepage: www.elsevier.com/nedt
Researchers have identified two main EI conceptual models; one based
on abilities, the other on personality traits (Roberts et al., 2010a). The
ability-based model views EI as a form of information-processing and
is considered the most conceptually and empirically valid (Roberts
et al., 2010a, 2010b). The ability model is grounded in the work of
Mayer and colleagues. Their four factor or branch model involves a hier-
archy of abilities starting with emotional perception (accurately per-
ceiving emotions in self and others); emotional facilitation (using
emotions to facilitate tasks); emotional understanding (understanding
the relationship between emotions and situations); and emotional
management (regulation of own and others' emotions) (Mayer et al.,
2003). From an educational perspective, the concept of EI as ability-
based is salient as it presumes that EI can be learnt, and EI abilities can
be taught (Foster and McKenzie, 2012).
The trait-based EI model, on the other hand, includes a mix of com-
petencies and personality traits such as assertiveness, stress manage-
ment, self-awareness, and social awareness (Bar-On, 1997; Goleman,
1998). Key proponents of this approach, Bar-On (1997) and Goleman
(1998) have constructed self-report measures based on these conceptu-
al underpinnings. Goleman's (1995) model encompasses a range of
emotional skills and personality traits and includes two types of compe-
tencies: emotional and personal. Emotional competencies include self-
awareness, self-regulation and motivation, whereas social competen-
cies comprise of empathy and social skills. Accordingly, while these
competencies are grounded in possessing the trait of EI, individuals
must learn and develop the associated skills to be effective in the work-
place and enhance professional behaviour. Because of the mixture of
characteristics attributed to EI in the trait-based model however, it is a
heterogeneous construct (Gignac, 2010a) which has been critiqued for
having substantial overlap with personality. Due to its self-report
measurement, there is also potential limited personal insight and/or
faking of higher scores (Roberts et al., 2010a).
Despite the lack of consensus on the EI construct, over the past
decade there has been a growing body of international literature inves-
tigating pre-registration nursing students' levels of emotional intelli-
gence (Benson et al., 2010; Namdar et al., 2008; Por et al., 2011;
Rankin, 2013). These studies have used EI measures based on a range
of EI constructs, with little consistency in measurement. While findings
identify that EI is negatively correlated with stress management,
practice performance, academic performance, and retention for nursing
students (Por et al., 2011; Rankin, 2013), there is limited ability to make
comparisons between studies due to the heterogenous measurement of
EI.
Given the substantial emotion work entailed in nursing practice,
there is a need to develop students' EI capacity during pre-registration
education. Internationally, numerous calls have been made, primarily
by mental health academics, for inclusion of EI education in pre-
registration programmes (e.g. Freshwater and Stickley, 2004; Hurley,
2008; Hurley and Rankin, 2008). Due to the varying theoretical under-
standings of EI, however, there is lack of consensus on the construct in
nursing (Bulmer Smith et al., 2009), and little systematic examination
of EI education in pre-registration curricula. Preliminary scoping of the
literature revealed minimal review of EI nurse education. As part of a
broader review of EI in nursing, McQueen (2004) argued that while EI
has been acknowledged as relevant to nursing curricula, it was yet to
be a requirement of nursing programmes. She recommended self-
awareness, self-regulation and socialskills as key skills to be incorporat-
ed in curricula, and that teaching methods and key learning outcomes
relevant to EI needed to be explicit. This is consistent with Bulmer
Smith et al. (2009), who concur that EI needs to be overt in curricula
and concluded it was important to identify whether curricula included
emotional knowledge and skills as EI could influence the quality of
student learning and critical thinking, and their ability to make ethical
decisions and use evidence in practice.
Nurses acknowledge how important EI capabilities such as self and
other emotion awareness and management are to effectively perform
their work (Hurley, 2013), and recognise the need for adequate prepa-
ration to maintain their emotional wellbeing in practice (Rose and
Glass, 2010). Due to the mounting imperative to include EI education
in pre-registration nursing programmes, and the lack of substantial re-
view of EI education, the present study sought to extend understand-
ings of EI preparation of the nursing workforce and investigate EI
education in pre-registration nursing programmes.
Aim and Questions
Aim
To investigate and synthesise the state of knowledge on emotional
intelligence education in pre-registration nursing.
Questions
1. What theoretical constructs of emotional intelligence are evident in
pre-registration nurse education literature?
2. What emotional intelligence components are considered important
to include in pre-registration nursing curricula?
3. What emotional intelligence educational strategies have been
proposed and/or developed for pre-registration nursing curricula?
Method
Whittemore and Knafl's (2005) integrative review methodology
was used to guide the review and ensure a systematic and rigorous pro-
cess was followed. Integrative review method is inclusive of empirical
and/or theoretical literature, and aims to synthesise findings in order
to provide greater understanding of an issue.
Data Sources
CINAHL, Medline, Scopus, ERIC, and Web of Knowledge electronic
databases were searched for abstracts (Table 1).
Inclusion and Exclusion Criteria
Peer-reviewed research or discussion papers focusing on education
for EI in the context of pre-registration nursing programmes, published
in English between 1992 and 2014, were included. Literature reviews
and grey literature were excluded. Papers that addressed EI education
for postgraduate nursing or registered nurses, or did not have EI as the
central focus, were excluded. Empirical research investigating or mea-
suring nursing students' emotional intelligence (EI) were also excluded
as the focus of the review was on how students were being educated for
EI, rather than on students' levels of EI.
Table 1
Search terms.
Concept Subject headings Text words
Emotional intelligence:
AND
Emotional intelligence OR
Emotional competence OR
Self-competence OR
Self-competence
Emotional intelligence OR
Emotional competenc* OR
Self competenc* OR
Self-competenc*
Nurse:
AND
Nursing Nurs*
Education: Education OR
Students OR
Educat* OR
Student* OR
Health occupations OR
Pre-nursing OR
Curricul*
Limit to English language and years 1992 to 2014.
*Define.
511K. Foster et al. / Nurse Education Today 35 (2015) 510–517
Screening
Titles and abstracts of 305 records were initially reviewed against
the inclusion/exclusion criteria. Full texts of retained articles were
read and screened and reference lists were hand searched, resulting in
17 relevant articles for review (Fig. 1).
Analysis
Constant comparison method was used to guide data analysis
(Patton, 2002). Data were extracted and coded for the 3 review ques-
tions. In an iterative comparison and contrast process within and across
articles, key concepts and meaning units relevant to each question were
grouped. In a final process of comparison and integration, relevant ele-
ments were synthesised into an integrated summary (Whittemore and
Knafl, 2005). Key words and constructs were also counted in order to
gain an understanding of the contextual use and emphasis of content
in the articles (Hsieh and Shannon, 2005).
Results
The review included 17 published articles from 1992–2014. These
were mainly discussion/opinion papers (15/17); two papers reported
primary research studies. Authors were predominantly from the
United Kingdom (11/17) and six authors had written more than one
article. Over half the articles (10/17) addressed EI in the context of
mental health pre-registration nursing; the remainder focused on
pre-registration nursing generally. Findings are categorised according
to the three review questions.
Constructs of Emotional Intelligence
A range of EI constructs and definitions were referred to. The prima-
ry EI theorists were Goleman (15/17 papers), Salovey and Mayer
(11/17) and Bar-On (6/17). A summary of the theories and main
constructs are in Table 2.
Goleman's (1998) definition of EI was quoted by two authors
(Harrison and Fopma-Loy, 2010; Roberts, 2010)as“the capacity for
recognising our own feelings and those of others, for monitoring our-
selves, and for managing emotions in ourselves and in our relation-
ships”(Goleman, 1998; p. 317). Most commonly, however, Goleman's
EI concept was briefly outlined as comprising a range of emotional skills
and personality traits involving personal and social competence
(e.g. Bellack et al., 2001; Wasylko and Stickley, 2003). Specific aspects
of these competencies were expanded on by several authors. Cadman
and Brewer (2001) and Harrison and Fopma-Loy (2010) referred to
Goleman's (1995) domains of self-awareness (emotional awareness,
accurate self-assessment, and high self-esteem/self-confidence);
self-regulation and motivation (emotional self-control, flexibility in
managing change/adaptability, optimism, innovation and initiative);
social awareness (encompassing empathy, organisational awareness
and service) and relationship management/social skills (inspiration,
influence, persuasiveness, conflict management and leadership skills).
There was variation in the terms and language used to describe
Goleman's model of EI competencies and qualities. Bellack (1999)
and Hurley (2008) outlined personal competence as comprising
self-confidence, self-awareness/knowing one's strengths and limits,
self-control of emotions, trustworthiness, flexibility, adaptability/being
comfortable with new ideas or change, initiative, drive, commitment,
optimism, accountability and drive to be one's best. Qualities of social
Fig. 1. Search and Screening.
512 K. Foster et al. / Nurse Education Today 35 (2015) 510–517
competence were described as interest and concern for others,
recognising and responding to customer needs, valuing diversity, polit-
ical awareness, effective listening, communication, leadership, influenc-
ing and inspiring others, cooperating and collaborating with others,
managing change, and resolving conflict (Bellack, 1999; Hurley, 2008).
Roberts (2010) referred to high self-esteem, self-motivation and
conflict management as examples of Goleman's EI components.
Across papers, ‘emotional intelligence’was used alongside and
interchangeably with ‘emotional competence’,‘emotional literacy’,
‘emotional labour’and ‘countertransference’.‘Emotional competence’
was particularly used when describing whether and how EI could be
learned or developed. Harrison and Fopma-Loy (2010) discussed that
emotional competence has its basis in EI, but is a learned capacity
which leads to excellent work performance. Wilson and Carryer
(2008) identified emotional competence as the product of life experi-
ence and professional experience. Notably, they were critical of the
interchangeable use of the various terms, and MacCulloch (1999)
acknowledged that the terms EI and emotional competence were not
synonymous.
Salovey and Mayer's (1990) construct of EI (11/17 papers), was
identified as a type of social intelligence involvingthe ability to monitor
own and others' emotions, to discriminate among them, and to use the
information to guide one's thinking and actions. Roberts (2010)
explained that for Salovey and Mayer (1990), EI is a mutually beneficial
interdependence between emotion states and ability to think, learn and
adapt to the environment. The four hierarchical branches of EI ability
were identified: 1) perceive emotion —through nonverbal behaviour,
2) use emotion to facilitate cognition 3) understand emotions by analy-
sis and prediction and 4)manage, regulate and reflect upon emotions in
the context of other personality characteristics (Hurley and Rankin,
2008; Hurley, 2008; Roberts, 2010). The importance of this construct
of EI to guide decision making and behaviour wasemphasised by sever-
al authors (Brewer and Cadman, 2000; Cadman and Brewer, 2001; Por
et al, 2011; Harrison and Fopma-Loy, 2010). Salovey and Mayer's
model was recognised as highlighting the cognitive components of
emotional intelligence, in line with the traditionof standard intelligence
(Por et al., 2011).
Bar-On's (1997) model of EI was highlighted in six papers and com-
ponents of the model including intrapersonal and interpersonal factors,
adaptability, stress management and general mood/motivation factors,
were specifically addressed in four papers (Freshwater and Stickley,
2004; Freshwater, 2004; Hurley, 2008; Hurley and Rankin, 2008; Por
et al., 2011; Roberts, 2010). Intrapersonal EI encompasses emotional
self-awareness, assertiveness, self-regard, self-actualisation and inde-
pendence; interpersonal EI comprises empathy, interpersonal relation-
ships and social responsibility; adaptability relates to problem solving,
reality testing and flexibility; stress management includes stress toler-
ance and impulse control (Hurley and Rankin, 2008; Hurley, 2008).
When compared to Goleman's, Bar-On's model is a mixed approach
(Por et al., 2011) where EI encompasses a range of personality traits, so-
cial skills and work related competencies (Roberts, 2010). These include
empathy, high self-esteem, self-motivation, self-control, self-awareness,
conflict management and adeptness in relationships (Por et al., 2011;
Roberts, 2010).
Other theorists on interpersonal communication and related aspects
of emotional wellbeing were also referred to in order to substantiate or
elaborate on EI. Examples include Gardner's (5/17) construct of multi-
ple intelligences, Heron's (2/17) emphasis on the impact of unresolved
personal distress in the quality of interactions with clients, and Orbach's
(2/17) term ‘emotional literacy’. In the main (12/17), the eclectic nature
of the various EI theories was neither discussed nor critiqued. Hurley
(2008) however, noted the lack of agreementand clarity about whether
EI was a construct of competencies or personality characteristics. He
concluded that the major EI theorists (Goleman, 1995; Salovey and
Mayer, 1990; Bar-On, 1997) were not only attempting to define a
universally accepted construct, but also trying to provide the language
to describe the construct, placing different emphasis on its defining as-
pects. Harrison and Fopma-Loy (2010) and Por et al (2011) acknowl-
edged there were ‘ability’models such as Salovey and Mayer (1990)
which differed from mixed models, such as Goleman (1995) and
Bar-On (1997), while Freshwater and Stickley (2004) and Roberts
(2010) acknowledged that the models contrasted with one another.
Emotional Intelligence Curricula Components
Components of EI considered important to incorporate into pre-
registration programme curricula for nurses were outlined by most au-
thors (15/17) (Table 3). These were highlighted as standard qualities
Table 2
Terms used to describe primary theories of emotional intelligence.
Author Goleman
Personal competence:
–Motivation
–Self-awareness
–Self-regulation
Social Competence:
–Empathy
–Social skills
–Emotional
competence
Salovey & Mayer
Intelligence
–Ability to perceive emotion
–Understand emotions
–Use emotion to facilitate cognition
–Manage, regulate and reflect upon emotions
Bar-On
Intrapersonal
Interpersonal
–Adaptability
–Stress-management
–General mood/motivation
Bellack (1999) √
Bellack et al (2001) √
Brewer and Cadman (2000) √√
Cadman and Brewer (2001) √√
Evans and Allen (2002) √
Freshwater (2004) √ √
Freshwater and Stickley (2004) √√ √
Harrison and Fopma-Loy (2010) √√
Hurley (2008) √√ √
Hurley and Rankin (2008) √√ √
MacCulloch (1999) √
Por et al. (2011) √√ √
Proctor and Welbourn (2002) √√
Roberts (2010) √√ √
Stickley (2003)
Wasylko and Stickley (2003) √
Wilson and Carryer (2008) √√
513K. Foster et al. / Nurse Education Today 35 (2015) 510–517
necessary for effective nursing practice, and included: self-awareness
and reflection, self-management, social awareness, relationship
management, ability to maintain professional and social boundaries
and balance emotion, and rational thinking in order to effectively
make decisions.
Specific aspects of Goleman's EI framework identified as important
for nursing education and curricula (6/17) were personal competence
including self-awareness, self-regulation and motivation, and social
competence including empathy and social skills (Bellack et al., 2001;
Brewer and Cadman, 2000; Harrison and Fopma-Loy, 2010; Hurley
and Rankin, 2008; Roberts, 2010). Additionally, Goleman's five domains
of reflective practice; exploration of self and other's emotional re-
sponses, continuing personal and professional growth, feedback to aid
understanding of self and others, and development of micro skills,
were promoted as providing a foundation for establishing high-level
therapeutic communication skills (Proctor and Welbourn, 2002). The
importance of including components of EI aligned with Goleman's
framework, although he was not specifically cited, were outlined in a
further five papers (Evans and Allen, 2002; Freshwater and Stickley,
2004; Por et al., 2011; Stickley, 2003; Wasylko and Stickley, 2003).
Hurley (2008) argued that within the context of EI, and mental
health nursing specifically, curricula require a clear identification of req-
uisite abilities students should exit with. Drawing from professional re-
views and user-based research, a range of shared EI values that should
be embedded into curriculum were recommended: empathy for self
and others, responsiveness, unstated morality, communication, related-
ness, reflection, awareness and self-management (Hurley, 2008).
Freshwater and Stickley (2004) and Bellack (1999) also contended
nursing curricula should not be dominated by one understanding of
knowledge and intelligence, butneeds to manage a balance of the ratio-
nal and emotional and recognise the merit of the complex relationship
between self and intelligence. They saw a need to embed factors related
to self-awareness, therapeutic use of self and reflective practice into
curricula that stimulates inquiry into the world of emotions and focuses
on transformatory learning (Freshwater and Stickley, 2004). At the
same time, initiative, organisational skills, teamwork abilities, customer
orientation and self-responsibility were also important to the develop-
ment of students' EI (Bellack, 1999).
The ability to preserve personal and professional boundaries while
still maintaining empathic communication with patients was acknowl-
edged as an important skill (Freshwater and Stickley, 2004) and as a
specific target for pre-registration curricula (Wasylko and Stickley,
2003). MacCulloch (1999) highlighted the importance of enhancing
awareness of transference and countertransference, and Heron's
(1990) components of emotional competence, as areas to be developed
in students. Wilson and Carryer (2008) identified themes of effective
communication, recognising and regulating own emotions and
reactions, recognising others' emotions, and personal development.
In addition to outlining essential EI curricula components, a few au-
thors identified that pre-registration students should possess specific
EI-related qualities upon entering nursing. They contended this could
reduce attrition rates (Cadman and Brewer, 2001) while also providing
candidates with formative evaluation directing them to the relevance of
EI and areas for self-development (Hurley, 2008). Brewer and Cadman
(2000) and Cadman and Brewer (2001) identified that students should
possess a balance of divergent, lateral thinking ability, and convergent,
logical thinking ability, while Hurley (2008) proposed that empathy,
self-awareness, stress coping, and relating could be measured during
nursing education.
Strategies for Emotional Intelligence Education
Strategies for EI education in pre-registration curricula were
highlighted in all papers, with many referring to multiple strategies
(Table 4). These included EI self-assessment, reflection activities,
modelling of EI behaviours and development of empathy. Three papers
outlined programmes with strategies that had been designed and
implemented to enhance EI skills. These all drew heavily on Goleman's
EI model.
Bellack et al. (2001) used Goleman's (1998) EI framework to provide
the structure for operationalising leadership that aimed to enhance be-
ginning leadership competencies in students. Leadership was defined as
a broad competency that embraced managing self and relationships
with others. Self-assessment of EI and leadership competencies and
subsequent interpretation of results were used by nursing faculty and
clinical partners as a starting point to redevelop curriculum with anem-
phasis on improving these competencies in graduates (Bellack et al.,
2001). Harrison and Fopma-Loy (2010) developed and tested a series
of student reflective journal prompts, designed to stimulate reflection
and discussion around 18 EI competencies related to Goleman et al.'s
(2002) domains of self and social awareness and self and relationship
management. The prompts were effective in assisting students to pro-
gressively build selected EI competencies. Prompts focused on essential
competencies identified as: emotional self-awareness and accurate
self-assessment, emotional self-control, developing others' abilities
and conflict management (Harrison and Fopma-Loy, 2010,p.646).
Proctor and Welbourn (2002) drew on Hochschild's (1983) concept
of EL and Mayer and Salovey(1997) and Goleman's (1995) constructs of
EI when developing a communication module aimed at enhancing nurs-
ing students' therapeutic communication and emotional awareness
skills using an experiential and reflective process. Experimental tasks
(exploration of own emotional issues and understanding of psycholog-
ical/emotional roadblocks) incorporating activities to practice skills,
video demonstration of therapeutic communication, peer assessment,
reflective processes and continuous feedback were used to develop
students' effective therapeutic skills incorporating aspects of EI.
Table 3
Components of Emotional Intelligence for Inclusion in Curricula.
Author Self-awareness/
reflective practice
Self/emotion
regulation
Commitment/motivation/
personal growth
Empathy/responsiveness Communication/
interpersonal skills
Emotional decision
making/reasoning
Bellack (1999) √√
Bellack et al (2001) √√√ √ √
Brewer and Cadman (2000) √√√ √ √ √
Cadman and Brewer (2001) √√ √ √ √
Evans and Allen (2002) √ √
Freshwater and Stickley (2004) √√√
Harrison and Fopma-Loy (2010) √√ √
Hurley (2008) √√ √ √
MacCulloch (1999)
Por et al (2011)
√
√
√√ √ √
Proctor and Welbourn (2002) √√√ √ √
Stickley (2003) √√√
Wasylko and Stickley (2003) √√√√
Wilson and Carryer (2008) √√√
514 K. Foster et al. / Nurse Education Today 35 (2015) 510–517
Students reported that the module enhanced their insight and aware-
ness of emotional processes (Proctor and Welbourn, 2002).
Strategies that promoted self-awareness and personal growth, and
incorporated aspects of supervision/support from others, were most
commonly recommended (12/17 papers). For example Por et al.
(2011) identified students' need for adequate support structures such
as clinical supervision while on clinical placement to assist with
recognising and managing their emotional responses. MacCulloch
(1999) pointed out the need for professional support via mentoring,
peer self-help groups and role development supervision, to achieve
emotional competence and effective communication.
The next most recommended strategies were reflective learning or
enquiry-based learning (7/17) and experiential learning (7/17).
Brewer and Cadman (2000) recommended dividing students into re-
flective groups and questioning aspects of practice within a collective
learning experience where students shared their ‘clinical’stories.
Experiential learning specifically incorporated reflective discussion
and writing, skills practise and role play, video for observation and
feedback, and incorporation of art, drama, music, film and poetry
(Freshwater and Stickley, 2004).
Ongoing assessment of EI competencies (6/17), including self-
assessment by teachers (Bellack, 1999) and students (Brewer and
Cadman, 2000), and modelling of EI behaviours and empathy by
teachers (6/17) were also identified as important components for cur-
ricula. Three papers referred to the merit of including health consumers
in planning curriculum and having them in co-facilitation roles in the
classroom (e.g. Hurley and Rankin, 2008), and the need to provide
clear goals and to have transparency around expectations for EI compe-
tencies (2/17). While the challenges of incorporating EI into nursing
curricula were widely acknowledged, two papers (Bellack, 1999;
Wilson and Carryer, 2008)specifically highlighted the difficulty of de-
veloping students' EI competency due to time and resource constraints.
While not a strategy for inclusion in curricula, screening of potential
students so that only those with high EI are admitted into programmes
was recommended.
Discussion
This review has analysed and synthesised the published literatureon
emotional intelligence (EI) education in pre-registration nursing. The
reviewed literature was from three countries only (UK, USA, NZ). This
may reflect EI as a western construct and/or the drive of individual aca-
demics to embed EI within curricula. The predominance of UK-based
mental health authors also appears to reflect the pre-registration nurs-
ing programme pathways in the UK, which include mental health. Given
the increasing measurement and reporting of EI in pre-registration stu-
dents across countries however, there is a concomitant need for devel-
opment of EI-specific curricula and broad-based reporting of the
pedagogy and curricula within which students' EI is being assessed.
Reviewed articles were primarily discursive or opinion pieces, with
only two primary research papers. The lack of empirical evidence on
EI curricula development and implementation can be understood to re-
flect the emergent nature of the EI construct in nursing education and
more widely. The review covered the period from the 1990s when the
EI construct was emerging in the broader literature (Salovey and
Grewal,2005)andwhenGoleman's (1995) work was being popularised
in world media. It is not surprising that this model was initially taken up
widely in nurse education.
In respect to the theoretical constructs of EI evident in pre-
registration literature (Review Q.1), the eclectic collection of EI theories
found in the reviewed articles, and predominant use of trait-based or
mixed EI constructs, critiqued in the wider literature as heterogenous
(Gignac, 2010a) and as less conceptually and empirically robust than
the ability-based model (Roberts et al, 2010a, 2010b), raises several is-
sues. These include a lack of EI construct clarity taught in nursing
programmes; with subsequent implications for development of EI
knowledge and skills in students, and forempirical measurement of stu-
dents' EI over the course of programmes. The review findings indicate a
need for greater consensus on EI as a construct in nurse education, and
for more consistent use of an empirically validated construct. Without
clear construct definition, it will be difficult to develop relevant educa-
tional approaches that address students' need to recognise and manage
effectively their own and other's emotions in the context of healthcare.
In respect to the EI components considered important for pre-
registration curricula (Review Q.2), these were articulated clearly with-
in the included papers. However, as per Q.1 findings, future curricula
will need to include components consistent with the EI framework
(eg. Mayer & Salovey (1997) ability model) used to guide the curricu-
lum, rather than a diverse group of components based on various EI con-
structs. In respect to EI educational strategies for pre-registration
nursing programmes (Review Q.3), while an eclectic range of strategies
to enhance students' EI were proposed by authors, there was a paucity
(n = 3) of EI-specific modules or approaches developed and tested for
inclusion in curricula. These findings further highlight the emergent
nature of EI nurse education.
Continued calls for screening of EI as part of selection criteria for stu-
dent admission into pre-registration nursing programmes (Cadman and
Brewer, 2001; Brewer and Cadman, 2000; Wilson and Carryer, 2008)
also warrant careful consideration. Although this strategy may address
the need for emotionally intelligent students it does not take into
Table 4
Emotional intelligence education strategies proposed for curricula.
Author Reflective learning/.
enquiry-based learning
Reflection activities/
support/personal
growth/counselling
Assessment of EI/
self-assessment
& feedback
Teachers to
model EI skills
Experiential/role
play/theatre/
art/poetry
Service user
involvement
Transparency
of EI skills
expectations
Bellack (1999) √
Bellack et al. (2001) √ √
Brewer and Cadman (2000) √√
Cadman and Brewer (2001) √
Evans and Allen (2002) √√ √
Freshwater (2004) √
Freshwater and Stickley (2004) √√√√√√
Harrison and Fopma-Loy (2010) √√ √
Hurley and Rankin (2008) √√ √√
Hurley (2008) √√ √√√
MacCulloch (1999)
Por et al. (2011)
√
√
Proctor and Welbourn (2002) √√ √
Roberts (2010) √
Stickley (2003) √
Wasylko and Stickley (2003) √√√
Wilson and Carryer (2008) √ √
515K. Foster et al. / Nurse Education Today 35 (2015) 510–517
account the validity and variance across EI measures. As EI abilities can
be strengthened through education (Foster and McKenzie, 2012), this
strategy also does not take into consideration the impact that EI nurse
education can have on building students' EI abilities. As an alternative,
we recommend students are screened for EI as part of recruitment,
but not necessarily excluded based on their results. Formative assess-
ments relating to EI abilities throughoutthe programme can help devel-
op students' knowledge and skills in personal and interpersonal
emotion awareness and management, and can form part of require-
ments for passing specific units/subjects within the programme.
Conclusion
As a way forward for EI nurse education, we recommend that EI be
explicitly included as a construct on which to scaffold EI theory and abil-
ities throughout pre-registration programmes, and as a core ability out-
come expectation for pre-registration nursing students. We contend
that emotional intelligence and emotional labour can be understood
as threshold concepts, or learning thresholds (Meyer and Land, 2003),
which form the basis for mastery of personal and interpersonal emotion
management in nursing practice, and provide an opportunity for stu-
dents to develop new ways of thinking about and practising effective in-
terpersonal communication. From a theoretical standpoint the EI ability
construct can be used as an organising heuristic or framework (Salovey
and Grewal, 2005) which includes personal and interpersonal skills re-
lating to emotion work and provides a validated conceptual basis from
which to develop and scaffold curricula components, and to subse-
quently measure students' EI ability. There are a range of developed EI
resources and components relating to healthcare, including those
reported in this review. Roberts et al. (2010b) for example, provide an
overview of measures, resources, and learning and teaching approaches
relevant to the ability model that could be used to inform the develop-
ment of EI curricula.
Based on the findings of this review, a summary of recommendations
for EI education in pre-registration nursing curricula is outlined (Table 5).
These include educational strategies such as arts-based learning ap-
proaches combined with conventional approaches, which can provide
more diverse opportunities for students to engage with learning about
emotions and develop their capacity for the art of interpersonal interac-
tions (Freshwater and Stickley, 2004). Further, the inclusion of healthcare
consumers/patients and family in curriculum development and co-
teaching can increase the relevance of EI education, support the develop-
ment of students' empathy, and improve students' communication skills
through in-situ educational interactions (Hurley, 2008). In order to
build a robust evidence base for EI education, there is a need for compre-
hensive evaluation and reporting of newly developed EI curricula and
components that includes key stakeholder perspectives (i.e. students,
academic & clinical staff, patients and family, & health services).
To conclude, EI education and preparation of students at pre-
registration level have significant implications for registered nurses'
emotional welfare, workplace performance, and patient care. EI has
been found to have significant positive effects on registered nurses'
wellbeing and job stress(Karimi et al., 2014), and is a key strategy to im-
prove nursing retention and reduce the substantial negative impacts of
issues such as workplace bullying (Bennett and Sawatzky, 2013).
Nurses' empathy, however, can decreasewith age,which is problematic
for a caring profession (Harper and Jones-Schenk, 2012). Subsequent to
pre-registration EI education,there is a concomitantneed for continuing
education in EI for registered nurses, and inclusion of EI education in
postgraduate nursing programmes.
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EI construct for curricula Ability-based model (e.g.. Mayer and Salovey, 1997)
Learning & teaching
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GENOS (Gignac (2010b))
Educational strategies Self-awareness, self-management, & interpersonal
communication as foundation skills for EI
Explicit education on emotional labour & emotional
intelligence theory & science
Mixture of arts-based and conventional learning
approaches (see Table 3 for examples)
Multimedia & online EI education in addition to
classroom teaching
Include healthcare consumers & family in curricula
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