The relationship amongst student nurses’ values,emotional intelligence and individualised care perceptions

Abstract

Background:

Students’ gaining and adopting basic professional values, improving their emotional intelligence skills during the process of nursing education plays a significant role on meeting the needs of healthy/patient individual and his or her family, and individualized care practices.

Objectives:

This (descriptive, correlational) research was carried out to evaluate the nursing values, emotional intelligence levels, and individualized care perceptions of senior nursing students and to determine the relationship between them.

Research question:

(1) What is the status of students to adopt nursing values? (2) What is the level of students’ emotional intelligence? (3) What is the students’ individualized care perception? (4) Is there a relationship between students’ nursing values, levels of emotional intelligence, and individualized perceptions of care?

Participants and research context:

The research was carried out with 218 senior nursing students at the Faculty of Nursing, affiliated to a state university in Istanbul, who agreed to participate in the study, completing basic nursing education in May 2017.

Ethical considerations:

Ethical approval for this study was obtained from the Ethics Committee of Clinical Investigations of the Istanbul University Dentistry Faculty. Written permission was also obtained from the institution that research would be conducted. Before the data were collected, verbal permission was obtained by the investigator.

Findings:

It was observed that nursing values perceptions of students, emotional intelligence levels and individualized care perceptions were at a good level and there was a supportive relationship between them in the positive direction. It was determined that emotional intelligence skills of students, adoption of nursing values and individualized care perceptions increased in parallel with each other.

Conclusion:

In nursing education, nursing values peculiar to affective field, caring behaviors, and emotional intelligence skills that are guiding to maintain and direct these behaviors should be gained to students by supporting with correct learning methods and role models.

Keywords

Emotional intelligence individualized care nursing students nursing values professional values

Introduction

Nursing is a profession that achieves its goal of helping, which is its basic responsibility, with care and that provides services to individual, family, and society in any situation they need.¹ When offering this service, nurses face many situations that require them to make decisions. Every decision about a healthy/patient individual should be given with respect to the individual’s life, dignity, and individuality.²

Professional values constitute the basis for attitudes and behaviors of nurses and nursing students as standards of action or behavior. Values, which are an important element for the development of professional identity, are also a framework in their interaction with healthy/sick individuals, colleagues, other professional members, and society.^3,4

In the philosophy of nursing, the individual is defined as the only, unique and supreme being with his or her honor, beliefs, attitudes, preferences, and values. In this light of philosophy, which shows the nursing profession’s view of human, caring actions are individualized.¹ In individualized care, the individual’s personal values that guide his or her responses to health and illness, decisions and behaviors, and that reflect his or her wishes and preferences which he or she gained in the process of socialization should be taken into account. On the other hand, nurses are expected to be advanced individuals who can guide their professional actions and decisions, internalize their professional values by adopting them, be aware of their own emotions, and manage their emotions in patient–nurse relationship which initiate and sustain the caring activities, empathize and in other words who have developed emotional intelligence skills.^1,5

Nursing profession is one of the professions where interpersonal relationship is most experienced. Nurses fulfill their caring practices through effective communication skills.⁶ Each nursing practice requires emotional intelligence skill. Throughout the health/illness process, nurses must understand and manage the feelings of both themselves and others in order to effectively meet the emotional needs of the patient and his or her family.⁷ Moreover, nurses with developed emotional intelligence skills can find appropriate initiatives for individualized care practices by showing sensitivity not only to the physiological needs of the individuals they help, but also to their emotional needs.⁸ The ability to understand and manage emotions strengthens individual centered care, enhances the quality of nurse–patient relationships, and affects the satisfaction level of the patient by increasing compliance to caring.⁹

It is a prerequisite for nursing students to be taught nursing self concepts during their basic education, to make them gain caring attitudes and behaviors, and to assume responsibilities by adopting professional roles. In this sense, it is important in nursing education to acquire nursing values, caring behaviors, and emotional intelligence skills that guide and maintain these behaviors specific to affective areas as well as scientific knowledge, supported by correct learning models and role models.^1,10

When the literature is examined, it is seen that the nursing students have studies that examine occupational values, emotional intelligence levels, and individualized care perceptions separately. However, there are no studies comparing students’ occupational values, emotional intelligence levels, and individualized care perceptions. For this reason, this research has been planned in a descriptive and relation seeking manner in order to identify the correlation between nursing values, emotional intelligence levels, and individualized care perception of senior nursing students by evaluating them.

Research question

What is the status of students to adopt nursing values?

What is the level of students’ emotional intelligence?

What is the students’ individualized care perception?

Is there a relationship between students’ nursing values, levels of emotional intelligence, and individualized perceptions of care?

Methods

Design and sample

A descriptive, correlational study design was used. The population of the research was comprised by senior students (375) who graduated from the Nursing Department of Nursing Faculty of a state university in Istanbul in 2016–2017 academic year, completing nursing education. These students took the course “Ethics in Nursing” in the second year of their education. Sample selection was not made in the survey and 218 nursing students who agreed to participate in the research after being informed about the purpose, content, and method of the research constituted the sample.

Data collection

The data were obtained with Structured Information Form, The Nurses’ Professional Values Scale—Revised (NPVS-R), Emotional Intelligence Evaluation Scale, and Individualized Care Scale A—Nurse Version (ICS-A-Nurse). Structured Information Form prepared by the researcher in the direction of the literature information contained including characteristics such as age, gender, marital status, and the status of choosing nursing profession intentionally.^1,11 NPVS-R was developed by Darlene Weis and Mary Jane Schank in 2009 to determine the adoption of professional values by nurses and nursing students, reflecting American Nurses Association’s code of ethics. The adaptation of the scale to Turkish society was made by Acaroglu in 2013. The scale consisting of 26 items is of a 5-point Likert type. Each item is scored as 5 (too much very important), 4 (important), 3 (significant), 2 (little important), and 1 (not important) and scale scores are obtained by adding these scores. The points that can be taken from the scale are 26–130 and the high scores on the scale indicate that the professional sense of value is high. In the subdimension-free scale, there are sub-factors that contribute to the interpretation of the data: Caring, Professionalism, and Trust.^12,13 Cronbach’s alpha coefficients for NPVS-R were 0.95 in this study.

Emotional Intelligence Evaluation Scale was developed by Nick Hall in 1999 with the aim of assessing the level of emotional intelligence. The adaptation of the scale to the Turkish society was carried out by Ergin.¹⁴ It is a 6-point Likert-type scale consisting of 30 items, with five sub-dimensions, namely “Empathy,” “Emotional Awareness,” “Social Skills,” “Self-Motivation,” and “Managing Own Emotions..” Each single item is scored as 1 (totally disagree), 2 (partially disagree), 3 (I disagree very little), 4 (I agree very little), 5 (partially agree), and 6 (totally agree). Scale scores are obtained by summing the scores of the response to each item. Scores that can be taken from the scale are 30–180. The higher the total score on the scale, the higher the level of emotional intelligence. Cronbach’s alpha coefficients for Emotional Intelligence Evaluation Scale were 0.95 in this study.

ICS-A-Nurse was developed by Suhonen et al.¹⁵ in 2007 to determine the views of nurses about individualized care. Adaptation of the scale to Turkish society was carried out by Sendir et al.¹⁶ The scale consists of two dimensions. In the first dimension, supporting the individuality of the patients in the nursing care practices (ICS-A-Nurse), in the second dimension, perceptions of nurses’ individualizing the patient care (ICS-B-Nurse) are evaluated. First part of the scale was used in this study. ICS-A-Nurse consists of a total of 17 items and is of a 5-point Likert type and is scored as 1 (I strongly disagree), 2 (disagree to some extent), 3 (neither agree nor disagree), 4 (agree to some extent), and 5 (strongly agree). ICS-A-Nurse involves three sub-scales: Clinical Situation, Personal Life Situation, and Decisional Control Over Care.^17,18 The calculation of these sub-scales is performed by dividing the sum of the item scores contained in the sub-scale into the number of items. ICS-A-Nurse total and sub-scale scores are 1–5. High scores indicate that the nurses’ perceptions of supporting patients’ individuality are high.¹⁶ Cronbach’s alpha coefficients for ICS-A-Nurse were 0.96 in this study.

Data analysis

SPSS for Windows (Statistical Package for the Social Science for Windows, Version 22.0) package program was used in the evaluation of the data. The information obtained from the data collection form was encoded and transferred to the computer. Mean, standard deviation, median, lowest, highest, frequency, and ratio values were used in the descriptive statistics of the data. The distribution of the variables was measured by the Kolmogorov–Simirnov test. The Mann–Whitney U test was used in the analysis of quantitative independent data. The Spearman correlation analysis was used for correlation analysis.

Ethical considerations

Written permission from the institution to be investigated and the approval of ethics committee from the Ethics Committee of Clinical Investigations of the Istanbul University Dentistry Faculty have been obtained. Permission has been obtained from the authors who developed the scales used for the collection of research data, and the authors who adapted them to the Turkish society. Before the data were collected, it was informed by the investigator, the purpose, content, and coverage, and what is expected from the students. Verbal permission was obtained from the students after the informing and was guaranteed anonymity and confidentiality. The research data were collected in sections where students spent their free time in the school, except during class hours. The questionnaire forms were filled in approximately 30 min by the students themselves

Findings

When the individual characteristics of the students included in the study are examined, it was determined that the average age was 22.2 ± 0.8 years, 79.4% (n = 173) were female, 94.5% (n = 206) were single, and 50.52% (n = 110) made their choice of occupation unwillingly (Table 1).

Table 1.

Demographic characteristics (n = 218).

Age (mean + SD)	22.2 ± 0.8 (Min = 22; Max = 25) (in %)
Gender
Female	173	79.4
Male	45	20.6
Marital status
Married	12	5.5
Single	206	94.5
Choice of nursing profession
Willingly	108	49.5
Unwillingly	110	50.5

The mean NPVS-R score of the students was 100.9 ± 18.8. The mean scores for the factors were determined as Caring 59.0 ± 11.2, Professionalism 30.6 ± 6.2, Trust 11.3 ± 2.6 (Table 2).

Table 2.

Levels of Nurses Professional Values Scale—Revised Score of the Students (n = 218).

Scale and factors	Min	Max	Mean	SD
Total score	26.0	130.0	100.9	18.8
Caring	15.0	75.0	59.0	11.2
Professionalism	8.0	40.0	30.6	6.2
Trust	3.0	15.0	11.3	2.6

It was determined that the average score of the students’ Emotional Intelligence Evaluation Scale was 132.7 ± 30.2. The average of the scores for the sub-dimensions is from high to low, Empathy 27.2 ± 7.1, Emotional Awareness 27.0 ± 6.4, Social Skills 26.8 ± 6.2, Self-Motivation 26.1 ± 7.8, and Managing Own Emotions 25.6 ± 6.2 (Table 3). In the students who voluntarily chose the nursing profession, it was observed that the average score of the Emotional Intelligence Assessment Scale and the average of the Emotion Management, Self-Motivation, Empathy, Social Skills sub-scale scores were statistically significantly higher than the students who did not choose (p < 0.05).

Table 3.

Levels of Student’s Emotional Intelligence Evaluation Scale Score (n = 218)

Emotional Intelligence Assessment Scale	Min	Max	Mean	SD
Total Score	30.0	180.0	132.7	30.2
Emotional Awareness	6.0	36.0	27.0	6.4
Managing Own Emotions	6.0	36.0	25.6	6.2
Self-Motivation	6.0	36.0	26.1	7.8
Empathy	6.0	36.0	27.2	7.1
Social Skills	6.0	36.0	26.8	6.2

The total item average score of ICS-A-Nurse of the students was 4.10 ± 0.70. Item average scores for sub-scales are from high to low, Clinical Situation (4.12 ± 0.73), Decisional Control Over Care (4.12 ± 0.76), and Personal Life Situation (4.03 ± 0.78) (Table 4).

Table 4.

Levels of Student’s Individualized Care Scale A—Nurse Version Score (N = 218).

Individualized Care Scale A—Nurse Version	Min	Max	Mean	SD
Total Score	1.00	5.00	4.10	0.70
Clinical Situation	1.00	5.00	4.12	0.73
Personal Life Situation	1.00	5.00	4.03	0.78
Decisional Control Over Care	1.00	5.00	4.12	0.76

There was a significant positive correlation between NPVS-R total and factor score averages and Emotional Intelligence Evaluation Scale total and some sub-scale score averages of the students included in the study (r = 0.444) (p < 0.001) (Table 5). There was a significant positive correlation between NPVS-R total and factor score averages and Clinical Situation, Personal Life Situation, Decisional Over Care sub-scale item score averages of the students (r = 0.434) (p < 0.001) (Table 5). There was a significant positive correlation between the Emotional Intelligence Evaluation Scale total and sub-dimensions score averages and ICS-A-Nurse total and sub-scale item score averages of the students (r = 0.574) (p < 0.001) (Table 6).

Table 5.

The correlation between Students’ Nursing Values, Levels of Emotional Intelligence, and Individualized Perceptions of Care (N = 218).

NPVS-R		Emotional Intelligence Assessment Scale						Individualized Care Scale A—Nurse Version
NPVS-R		Total Score	Emotional Awareness	Managing Own Emotions	Self- Motivation	Empathy	Social Skills	Total Score	Clinical Situation	Personal Life Situation	Decisional Control Over Care
Total Score	r	0.444	0.475	0.343	0.391	0.425	0.413	0.434	0.436	0.359	0.389
Total Score	p	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001
Caring	r	0.409	0.444	0.308	0.357	0.390	0.378	0.389	0.379	0.321	0.359
Caring	p	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001
Professionalism	r	0.472	0.490	0.363	0.416	0.459	0.441	0.440	0.456	0.348	0.390
Professionalism	p	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001
Trust	r	0.389	0.437	0.336	0.357	0.348	0.337	0.415	0.426	0.350	0.361
Trust	p	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001	0.001

NPVS-R: Nurses’ Professional Values Scale—Revised.

Spearman Korelasyon (p < 0.001)

Table 6.

The correlation between students’ levels of emotional intelligence and individualized perceptions of care (N = 218).

Emotional Intelligence Assessment Scale		Individualized Care Scale A
Emotional Intelligence Assessment Scale		Total Score	Clinical Situation	Personal Life Situation	Decisional Control Over Care
Total Score	r	0.574	0.519	0.472	0.528
Total Score	p	0.001	0.001	0.001	0.001
Emotional Awareness	r	0.535	0.499	0.400	0.498
Emotional Awareness	p	0.001	0.001	0.001	0.001
Managing Own Emotions	r	0.452	0.415	0.378	0.417
Managing Own Emotions	p	0.001	0.001	0.001	0.001
Self-Motivation	r	0.550	0.490	0.457	0.518
Self-Motivation	p	0.001	0.001	0.001	0.001
Empathy	r	0.547	0.497	0.460	0.494
Empathy	p	0.001	0.001	0.001	0.001
Social Skills	r	0.569	0.521	0.483	0.504
Social Skills	p	0.001	0.001	0.001	0.001

Spearman Korelasyon (p < 0.001)

Discussion

The basic function of the nursing profession is to present the help that the individual needs with care actions.¹⁹ It is important for nurses to be aware of their values that are fundamental to their professional behavior and to reflect on their behaviors by acquiring knowledge and awareness in this regard during their basic education so that nurses can offer a personable care that is regarded as a unique asset.^4,5 Care, which is at the core of the nursing profession, is a constantly developing relationship that starts with at least two people.⁵ In the establishment and development of this relationship, the nurse’s emotional intelligence skill is an important component.⁶ Nurses with advanced emotional intelligence skills can meet the emotional needs of the individual by directing the feelings of both themselves and the individuals they help with during care practices and can set an individualized care relationship by becoming aware of the emotions and thoughts that make the individual more privileged than others.⁸

Acquisition specific to the emotional field of nursing students will enable the development of professional ethics, thereby enabling the successful professional members to become involved in understanding the professional values and becoming internalized into behavior.¹¹ In the light of this information, this research was carried out with the aim of determining the influence of the relations and individual characteristics between the students by evaluating the nursing values, emotional intelligence levels, and individualized care perceptions of the students.

NPVS-R total average score and factor-related average scores of the students showed that nursing values perceptions were at a good level (Table 2). When the literature is examined, it is seen that the value perceptions of nurses and nursing students are at a good level in similar studies carried out at national and international level.^1,13,20,21 In the study, it was seen that the highest perceptions of nursing students were about the “caring” factor, which included behaviors reflecting values of altruism and justice. This was followed by the “Professionalism” factor, which refers to the maintenance of practices in line with competency/integrity, and the “Trust” factor, which reflects the behavior associated with the justice principle. In the study conducted by Kaya et al.,²² it was seen that in the professional value order of the nursing students, human honor took the first place and the value of justice took the second. Acquiring professional values begins with nursing education and continues as a professional member throughout life. In the study of Kantek et al.²³ using NPVS scale in 2017, it was found that professional perceptions of values of senior nursing students were significantly higher than those of first-year students and the importance of transferring professional values of nursing education was emphasized. This finding, which was obtained from the research, was assessed as a demonstration of nursing students’ internalization during their basic education, guiding their professional behavior and adopting professional values.

As shown in Table 3, the emotional intelligence levels of the students according to the Emotional Intelligence Evaluation Scale total score averages were within normal limits. At the same time, it was observed that the average scores of the sub-dimensions remained within the normal limits that could be taken from the scale. This finding supported the findings of the research which found that nursing students had normal levels of emotional intelligence.^24,25 On the other hand, studies determining that the levels of emotional intelligence of students are moderate and low have been encountered.^11,26 However, it was observed that nursing senior students were not included in the sample groups of these studies. This finding of the research also emphasized the importance of planning a curriculum that would provide the development of emotional intelligence skills from the first year when the students started training, while supporting the knowledge of the literature suggesting that emotional intelligence could be improved by education as opposed to cognitive intelligence. However, the emotional intelligence levels of students who voluntarily selected nursing profession were higher than those who did not intentionally choose nursing profession. This finding is consistent with the literature that indicates that loving and willing to choose and maintain the profession contributes to the adoption of professional knowledge, skills, and attitudes, as well as to the increase of occupational satisfaction and productivity.^27,28

In Table 4, it was seen that students’ individualized perceptions of care were high. When the ICS-A-Nurse sub-scale item scores were examined, it was determined that the students had the highest item score average from the “Clinical Situation” sub-scale, which included the perceptions of the individual’s disease/health status, the answers and the meanings they conveyed for them, and the care perceptions to support their individuality in matters concerning their care needs (Table 4). This sub-scale was followed by “Decisional Control Over Care,” which includes behavioral perceptions that reflect the individual’s feelings, thoughts, and desires and support their participation in decisions about their care (Table 4). It was identified that it was “Personal Life Situation” sub-scale which takes into account individual differences such as habits, preferences, and hospital experiences based on value and belief that an individual has a care behavior, perceived by the students in the third place (Table 4). This finding of the research showed that students who could be described as young graduates developed perceptions of positive behaviors toward their care practices during their education. It was determined in the studies in which care behaviors of nursing students were evaluated with a different scale that care perceptions of the students were good and the highest score were on “Trusting Relationship” and “Comforts” sub-scales.^29,30 The “Trusting Relationship” sub-scales includes care behaviors such as having the ability to establish a reassuring communication environment with the patient and respecting the differences of the individual and accepting it, and it overlaps the Clinical Situation from the ICS-A-Nurse sub-scales. The “Comforts” sub-scale, which reflects maintenance approach with a holistic approach by focusing on individual care, was found to be compatible with the “Personal Life Situation” from the ICS-A-Nurse sub-scales. Considering this situation, it can be said that the results obtained from the studies of Birimoglu and Ayaz²⁹ and Eskimez³⁰ are similar to this finding. In similar studies carried out with nurses, the individualized care perceptions of the nurses were found to be at a good level and it was determined that sub-scale item score averages were ranked as “Clinical Situation,” “Decisional Control Over Care,” and “Personal Life Situation.”^1,31,32

There was a significant positive correlation between the professional value perceptions of students, emotional intelligence levels, and individualized perceptions of care (Table 5). At the same time, there was also significant positive correlation between the emotional intelligence levels of the students and individualized perceptions of care (Table 6). With these findings obtained from the research, it was considered that as the emotional intelligence skills of the students increased, the state of nursing values reflecting the nursing philosophy and supporting the moral dimension of the nursing also increased. Nursing values, individualized care, and emotional intelligence constitute the skills specific to the affective domain of the nursing and are expected to have a synergistic interaction with each other.^8,33
–35 As a matter of fact, in this study, a meaningful relation between the average of the total scores obtained from the scales evaluating these skills of the students (Tables 5 and 6) supports this view and also agrees with the literature knowledge about the subject.

Limitations of the study

This study has some limitations. Work participation has been voluntary and participants have not been randomly selected. This research cannot be generalized because it is only done with senior students of a nursing faculty.

Conclusion

In this study, it was determined that students had good nursing value perceptions, emotional intelligence levels, and individualized perceptions of care, and there was a supporting relationship between them in the positive direction. As the students in the scope of the research increase their ability to be aware of their own feelings and the feelings of the opposite person and manage them correctly, perceptions of ethical and professional values regarding the dignity, uniqueness, integrity, and protection of the rights of the individual, and consequently, the perception of behavior toward supporting individualism in care practices has also increased. It was determined that as the nursing value perceptions which contain the ethical principles that contribute to the development of nursing and the sustainability of nursing of the students increased, the ability to manage individual emotions, thoughts, and decisions differently from others in the care practices, and the ability to manage emotions successfully also increased. In the direction of these results, it may be suggested that the structuring of the content of the curriculum which will give students the knowledge and skills specific to the affective area of the nursing at all basic nursing education institutions.

Footnotes

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Yeliz Culha

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