Associations among emotional intelligence, resilience and humanistic caring ability in nursing postgraduates: A response surface analysis and moderated mediation model

doi:10.21203/rs.3.rs-3083279/v1

Background

The foundation of nursing work lies in providing humanistic care, and nursing education places significant emphasis on fostering the development of humanistic caring ability (HCA). The objective of the current research was to explore the correlations between emotional intelligence (EI), resilience, and HCA, thus providing a reference for cultivating HCA among Chinese nursing postgraduates.

Methods

A multi-center cross-sectional study was conducted. A total of 189 postgraduates in nursing were recruited from four Universities across Eastern and Central China, and the following instruments were included in the survey: the demographic information questionnaire, the Wong and Law Emotional Intelligence Scale (WLEIS), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) and the Caring Ability Inventory (CAI). Correlation, response surface, and moderated mediation analyses were conducted.

Results

The average score of CAI for nursing postgraduates was 182.86 ± 17.70. The correlation analysis and response surface analysis results revealed a significant positive association of EI and resilience with HCA. Resilience (B = 0.311, BootSE = 0.075, 95% CI: 0.169 ~ 0.470) remarkably mediated the relationship between emotional intelligence and HCA in nursing postgraduate students. The interaction between the master program and emotional intelligence was significant (B = 0.126, 95% CI: 0.004 ~ 0.248, P = 0.043).

Conclusions

Chinese nursing postgraduates had poor HCA. EI and resilience were identified as two positive factors associated with HCA, with resilience potentially mediating the correlation between EI and HCA. Additionally, the master’s program may play a moderating role between EI and resilience.

Trial registration:

ChiCTR2000038693. Registered on 28-09-2020.

Humanistic caring ability

emotional intelligence

resilience

nursing postgraduates

Humanistic caring ability (HCA) refers to the capacity of an individual to externalize attitude, knowledge, and humanistic literacy in professional procedures. (1) In terms of nurses, HCA involves the skills to actively listen to the needs and desires of patients, comprehend their emotions, communicate effectively with them, and recognize the inherent value of life to carry out nursing interventions. (2) Therefore, humanistic care extends beyond fulfilling the needs of patients; it demands nurses place greater emphasis on the spiritual, psychological, ethical, and moral dimensions. (3) Humanistic caring ability is the basis of nursing intervention, which dominates the quality of nursing work. (4) Nursing is not only a knowledge-intensive industry with high-tech content but also the most humane work, which must be a perfect combination and unity of science and technology and humanity. (5)

Emotional intelligence (EI) refers to a range of abilities linked to the emotional, psychological, and social behaviors of individuals enabling them to effectively respond to and overcome stress and demands encountered in their daily lives. (6) Individuals with high EI possess the capacity to be more attuned to their own emotions and the emotions of others. They are adept at self-control, motivating and influencing others, and proficient in effectively managing emotions within social and work environments. (7) With regard to nursing, EI can support nurses in managing situational stressors, making decisions, and mitigating the adverse effects of stress and emotion within the work environment. Furthermore, EI has a positive impact on the quality of nursing work as well as the physical and mental well-being of nurses. (8) In specific, when nursing students possess the ability to accurately perceive emotional changes in others and effectively express their emotions through language and nonverbal cues while also demonstrating appropriate self-control in varying situations, they can attentively address the needs and emotions of patients, facilitating the development of a harmonious nurse-patient relationship. (9) Research conducted in Spain during the COVID-19 pandemic has demonstrated that nurses with high EI exhibit high levels of engagement and achieve exceptional performance when dealing with stress and fear. (10)

Resilience is a process that enables individuals to effectively cope with adversities and challenges while protecting themselves from detrimental impacts. (11) Nurses with a high level of resilience perform better in handling challenges, maintaining their mental health, employing adaptive coping strategies, communicating with their patients, and having higher job satisfaction in the work environment. (12, 13, 14, 15) Unquestionably, these factors can contribute to providing compassionate, empathetic, and patient-centered care, leading to improved patient outcomes.

In nurses, higher levels of EI are associated with better resilience, improved coping strategies, and higher job satisfaction. (16, 17) Furthermore, studies have consistently found a significant positive correlation between EI and HCA. (18, 19) Nursing students with higher EI possess the ability to comprehend the feelings of patients, discern their needs, and proactively take measures to address and resolve their concerns. (20)

Postgraduate education in nursing plays a crucial role in facilitating advanced practice nursing (APN) by training nursing talent to navigate complex situations, assume clinical leadership roles, and effectively implement evidence-based practice and quality improvement strategies. (21) As of the end of 2021, the number of nursing master programs in China has significantly increased to 122, comprising 78 academic (Master of Science, MS which focuses on research training) and 44 professional programs (Master of Nursing Specialist, MNS, which emphasizes advanced clinical practice). This marks a substantial growth from the 28 programs available in 2011, indicating a continuous expansion in the availability of nursing master's degree program in the country. (22) Consequently, the master's degree program serves as a distinctive and invaluable element in preparing future nurses who are poised to initiate and drive transformative changes in Chinese healthcare delivery. Hence, it is worth investigating whether resilience could serve as a mediating factor in the association between EI and HCA, to enhance education among nursing postgraduates.

In summary, existing studies indicate that EI is correlated to resilience and HCA in Chinese nursing students. (16, 19) However, the relationship between resilience and HCA is unclear, and studies exploring the relationship between EI, resilience, and HCA in Chinese nursing postgraduates are still scarce. Therefore, this study proposed the following three hypotheses:

1. EI exerts a significantly positive impact on HCA.

2. Resilience exerts a significantly positive impact on HCA.

3. Resilience plays a mediating role in the relationship between HCA and EI.

4. Mater program may play a moderated role among EI, resilience, and HCA.

Participants

The study recruited nursing postgraduates who volunteered to participate and provided their informed consent. Students diagnosed with mental disorders, such as anxiety or depression, were excluded from this study. All participants were recruited from four universities with Schools of Nursing in China, spreading from Central to Eastern China, including Henan, Hunan, and Guangdong provinces.

Instruments

Demographics

As per the previous literature, the demographic survey encompassed the collection of information regarding age, gender, grade, type of college and master program, homeplace, family income, whether the participants were an only child or not, experience as a student leader, and experience working as a nurse.

Emotional intelligence

Chinese version Wong and Law Emotional Intelligence Scale (WLEIS) revised by Wang and Shi was used to assess the level of emotional intelligence of participants, and it showed good reliability and validity in Chinese University students. (23, 24) This scale includes a total of 16 items which were divided into four dimensions: self-emotion appraisal (SEA), regulation of emotion (ROE), use of emotion (UOE), and others' emotion appraisal (OEA). All items are rated on a 7-point Likert scale, with "1" representing "strongly disagree" and "7" representing "strongly agree". The higher the total score, the higher the emotional intelligence. The coefficient α in the present study was 0.93.

Resilience

The Chinese version of the 10-item Connor–Davidson resilience scale was the third part of the questionnaire and was used to measure the resilience level of subjects. (25) The items of this scale were on a cumulative 5-point Likert scale (0 = never to 4 = almost always) with total scores ranging from 0 to 40, with higher scores indicating higher resilience levels. In the Chinese population, 10-items CD-RISC has shown excellent psychometric qualities as a measure of resilience. Cronbach's α in this study was 0.90.

Caring ability inventory

The Chinese version Caring Ability Inventory (CAI), translated by Xu & Liu, was employed to assess the level of caring ability, and it presented good reliability and validity in Chinese nurses. (26) The CAI, a seven-point Likert scale, consists of 37 items and three dimensions: knowing (14 items), courage (13 items), and patience (10 items). Responses of subjects were based on the range from 1 = strongly disagree to 7 = strongly agree, with the total score of CAI ranging from 37 ~ 259 (knowing: 14 ~ 98, courage: 13 ~ 91, and patience: 10 ~ 70) and higher scores indicating better humanistic caring ability. The Cronbach's α in the current research was 0.86.

Data analysis

Firstly, the demographic characteristics of the respondents were assessed by frequency, percentage, mean, and standard deviation. The t-test and ANOVA were employed to compare the mean HCA by demographic characteristics of nursing postgraduates, and the correlation between EI, resilience, and HCA was performed using Pearson Correlation Coefficients.

Secondly, response surface analysis (RSA) was conducted to estimate the congruent and discrepant impacts of EI and resilience on HCA. This analysis consisted of five factors: resilience, emotional intelligence, resilience*resilience, resilience*emotional intelligence, and emotional intelligence*emotional intelligence.

Thirdly, Harman's one-factor model was used to explore the potential existence of the common method variance (CMV). After that, the mediator effect of resilience was explored on the correlation between EI and HCA by the PROCESS macro (Model 4) of SPSS.

Fourthly, a moderation analysis was performed to explore the moderating role of demographic characteristics on the correlations among EI, resilience, and HCA via PROCESS macro (Models 5,7, and 14) of SPSS.

Data analysis was performed with the aid of IBM SPSS 28.0 (IBM Corp., Armonk, NY, USA) and R 3.3.2.

Characteristics of the participants

The study included 189 nursing postgraduates, with a mean age of 24.28 years (SD=2.14). The majority of the participants were female (92.6%). In terms of educational background, 47.1% studied at Western medical schools, and 52.95% studied at traditional Chinese medicine schools. Among the participants, 71.4% were pursuing a Master of Science in Nursing degree, while 28.6% were pursuing a Master of Nursing Specialist degree. Regarding the grade level, 69.3%, 26.5%, and 4.2% of the participants were in their first, second, and third years, respectively. In terms of geographical distribution, 58.2% were from rural areas, and 41.8% were from urban areas. With respect to the monthly average household income, 43.4% had an income less than or equal to 4000 Chinese Yuan, and 56.6% had an income greater than 4000 Chinese Yuan. Additionally, 30.2% used to work as a nurse, 69.8% had experience as a student leader, and 73.5% were the only child in their family. More details are demonstrated in Table 1. T-test and ANOVA indicated that there was no considerable variation in the CAI score based on the characteristics of the participants.

Table 1 Demographic information and relevant variables differences in scores of HCA*.

Variable	Mean±SD (HCA)	N (%)/Mean±SD	P value
Gender
Male	182.36±14.34	14(7.4%)	0.912
Female	182.90±17.97	175(92.6%)
Age	182.86±17.70	24.28(2.14)	0.497
Type of school
Western medical school	184.18±18.15	89(47.1%)	0.336
Chinese medicine school	181.69±17.29	100(52.9%)
Master's program*
Master of Nursing Specialist (MNS)	182.33±18.04	135(71.4%)	0.517
Master of Science (MS)	184.19±16.92	54(28.6%)
Grade
Year 1	184.18±18.27	131(69.3%)	0.245
Year 2	179.26±15.60	50(26.5%)
Year 3	183.75±19.57	8(4.2%)
Place of residence
Rural area	182.18±16.94	110(58.2%)	0.534
Urban area	183.81±18.77	79(41.8%)
Monthly average household income, CNY
≤4,000	181.99±17.53	82(43.4%)	0.553
>4,000	183.53±17.88	107(56.6%)
Only Child
Yes	180.68±17.29	50(26.5%)	0.311
No	183.65±17.84	139(73.5%)
Student leaders
Yes	183.90±17.86	132(69.8%)	0.22
No	180.46±17.23	57(30.2%)
Work experience
Yes	182.32±15.45	57(30.2%)	0.781
No	183.10±18.64	132(69.8%)
Resilience	182.86±17.70	24.30±5.54	<0.001
Emotional intelligence	182.86±17.70	66.70±12.84	<0.001

*: MS focuses on research training, and MNS emphasizes advanced clinical practice, HCA: humanistic caring ability.

The level of emotional intelligence, resilience, and caring ability and correlation analysis

The mean scores of EI, resilience, and HCA were 66.70±12.84, 24.30±5.54, and 182.86±17.70, respectively. The details are shown in Table 1. EI (r = 0.57, P < 0.001) and resilience (r = 0.58, P < 0.001) were moderately correlated with HCA. More details are demonstrated in Figure 1A.

Response surface analysis

The results of the response surface analysis are shown in Figure 1B. As the figure shows, the score of HCA in the upper left corner in the back (high EI and high resilience) was considerably higher than the score in the upper left corner in front (high resilience and low EI) and the upper right corner in the back (low resilience and high EI). These results indicate that the total positive effect of EI and resilience on HCA was higher than their individual effects. Furthermore, the score of HCA in the upper left corner in front (high resilience and low EI) was considerably higher in contrast to the upper right corner in the back (low resilience and high EI), indicating that resilience exhibited a more positive impact on HCA than EI.

Mediation analysis

The first factor explained 25.1% of the variance, which did not reach the threshold of 50%. This suggests that the influence of common method bias on the results was negligible. (27) Figure 2 showed that EI played a predictive role for the HCA (β = 0.478, P < 0.0001, Figure 2A), and resilience exhibited a positive impact on HCA in nursing postgraduates (β = 1.182, P < 0.0001, Figure 2A). The indirect effect of EI through resilience on HCA was significant (B = 0.311, BootSE = 0.075, 95% CI: 0.169 ~ 0.470, Figure 2B), including knowing (B = 0.114, BootSE = 0.035, 95% CI: 0.0481 ~ 0.183 Figure 2B) and patience (B = 0.061, BootSE = 0.024, 95% CI: 0.0162 ~ 0.108, Figure 2B).

Moderating effect of the master program on the association between EI and resilience

The outcomes of the moderation analysis are shown in Figure 3. In model 1 (emotional intelligence → humanistic caring ability) and model 3 (resilience → humanistic caring ability), the interactions of master program with EI (B = 0.195, 95% CI: -0.191 ~ 0.580, P = 0.321, Figure 3A) and resilience (B = -0.221, 95% CI: -1.023 ~ 0.580, P = 0.586, Figure 3C) were not significant. In model 2 (EI → Resilience), the significant moderation effect of the master program was observed (B = 0.126, 95% CI: 0.004 ~ 0.248, P= 0.043, Figure 3B) and visualized in the simple slope test (β _MNS = 0.238, p < 0.001; β _MS = 0.364, P < 0.001, Figure 3D).

This research explored the correlation between EI, resilience, and HCA. Specifically, a response surface analysis and moderated mediation model were conducted to examine the effects of EI and resilience on HCA.

Firstly, the EI, resilience, and HCA of nursing postgraduates in the present study were in the medium level (66.70 ± 12.84), medium level (24.30 ± 5.54), and low level (182.86 ± 17.70), respectively. The findings indicated that the HCA in nursing postgraduates was poor, which may be related to the current lack of systematic and coherent courses on HCA in nursing education in China. (28) Compared to the studies focusing on undergraduates, the finding was higher than the results acquired by Lina (29) but lower than the findings of the study conducted by Li. (30) Furthermore, the outcomes of this research showed no significant difference in the level of HCA in different grades. This could be attributed to the gradual internalization of HCA through the life and learning experience of an individual, and that it may be a long process. (31) Therefore, it cannot be simply assumed that the level of education can directly impact the level of HCA among nursing professional students.

Secondly, EI was moderately associated with HCA and resilience in nursing postgraduates. This finding was in line with prior research. (17, 32) This observation might be attributed to the influence of EI on various aspects of nursing students, including the quality of their learning, ethical decision-making abilities, critical thinking skills, and utilization of evidence and knowledge in practice. (33) Nursing work was also considered a process involving an affective dimension, entailing emotional knowledge, and competencies. Consequently, nursing educators were required to employ specific pedagogical approaches to activate, engage, and address the emotional requirements of nursing students. (34, 35) Therefore, it was necessary to set training programs to elevate the level of EI of nursing students. Currently, several effective training programs are available to improve EI. These programs typically consist of 4–16 sessions delivered through various methods such as lectures, role plays, case studies, and group discussions. (36, 37, 38, 39, 40) These effective training programs have the potential to be adapted and implemented for Chinese nursing postgraduates. Meanwhile, developing EI skills can contribute to increased resilience, which is vital for nursing students to cope with the demands of their profession and maintain their well-being. (41) By improving EI, nursing postgraduates can enhance their ability to manage stress and communication effectively and maintain a positive outlook.

Thirdly, there was a positive association between resilience and HCA, which is in line with prior research focusing on Chinese midwifery students. (42) However, a study conducted by Foster reported no significant relationship between resilience and HCA. (43) The relationship can be elucidated through Watson's theory of nursing caring ability, which presumed that interpersonal interaction is at the core of humanistic nursing care. According to this theory, nursing care aims to facilitate physical, psychological, and socio-cultural health for patients and their families. (44) Moreover, research has demonstrated a positive correlation between resilience and clinical communication ability. Thus, nurses with elevated levels of resilience are more likely to possess strong communication skills and actively engage in patient care. (17, 45)

Fourthly, the mediation model revealed that resilience remarkably acted as a mediator in the relationship between EI and HCA. As per the pathway of EI → Resilience → HCA, it is crucial to develop strategies aimed at enhancing resilience among nursing postgraduates as a means to improve their HCA. In 2015, Reyes introduced the "Pushing Through" model, which specifically addressed resilience among nursing students. This model illustrated the process of overcoming challenges and taking proactive steps toward achieving goals. (46) Based on the model, the strategies for support, education, and reflection to increase the resilience of nursing students were identified. (47) These pedagogical approaches are equally applicable to the educational milieu in the Chinese context.

Finally, the master program was confirmed as a moderator between EI and resilience. Compared to MNS, the positive effect of EI was more significant in MS students. This moderation effect could be attributed to the emphasis of the MNS program on clinical nursing practice. Moreover, MNS students are more prone to experiencing burnout events, which can negatively impact resilience. This, in turn, may weaken the positive effect of EI on resilience. (48, 49)

Limitations

Firstly, the current research was conducted in only three provinces of China, which restricts the generalizability of the findings. Furthermore, due to this limited scope, the results cannot be applied to the entire country. Hence, it is recommended to expand the sample size.

Moreover, the distribution of gender in this research was unbalanced, which introduces the potential for statistical bias between males and females.

Finally, quantitative research is subjected to inherent limitations in exploring the perceptions of postgraduates toward caring ability and other underlying mechanisms of HCA.

This research revealed that Chinese nursing postgraduates displayed poor HCA. Additionally, the results demonstrated a positive correlation between resilience and EI. Moreover, it was revealed that resilience plays a mediating role in the link between EI and HCA. Additionally, the master's program was found to significantly moderate the association between EI and resilience. The findings of this research can provide valuable insights for nurse educators, enhancing their comprehension of the correlations between EI, resilience, and HCA.

HCA: Humanistic caring ability

EI: Emotional intelligence

MNS: Master of Nursing Specialist

MS: Master of Science

WLEIS: Wong and Law Emotional Intelligence Scale

CD-RISC: Connor–Davidson resilience scale

CAI: Caring Ability Inventory

Ethics approval and consent to participate

The present study is part of the Be Resilient to Nursing Career (ChiCTR2000038693) program and was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (ZYYEC-ERK [2020] 132). Participants allowed us to use their data for academic research and publication. All participants provided informed consent, and the study was conducted in accordance with the Declaration of Helsinki.

Consent to publication

Not applicable.

Availability of data and materials

The datasets generated during and analyzed during the current study are not publicly available due to human subjects’ protections but are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This research was funded by grants from National Natural Science Foundation of China (No. 72274043 and 71904033), Young Elite Scientists Sponsorship Program by CACM (No.2021-QNRC2-B08), Humanity and Social Science Foundation of Department of Education of Guangdong Province (No. 2020WTSCX009), Humanity and Social Science Foundation of Guangzhou (No. 2021GZGJ57), Guangdong Research Center for TCM Service and Industrial Development, Guangzhou University of Chinese Medicine (No. 2022ZDA03), and Humanity and Social Science Foundation of Guangzhou University of Chinese Medicine (No. 2021SKYB07).

Authors' contributions

YJZ contributed to the conceptualization, data curation, methodology, software development, and writing of the original draft. MXX was responsible for the investigation, acquiring resources, software application, and validation. ZYH participated in the investigation and software utilization. YD was involved in the investigation and provision of resources. YYW contributed to resource management, supervision, and writing review. YZJ took part in supervising the project and reviewing and editing the manuscript.

Acknowledgements

The authors would like to thank all the nursing postgraduates for completing surveys and supporting data collection.

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No competing interests reported.

Associations among emotional intelligence, resilience and humanistic caring ability in nursing postgraduates: A response surface analysis and moderated mediation model

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Trial registration:

Figures

Background

Methods

Participants

Instruments

Demographics

Emotional intelligence

Resilience

Caring ability inventory

Data analysis

Results

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1