Emotional Intelligence Educational Program for First Line Mangers on the Nurses' Motivation and Empowerment at Minia University Hospital

Introduction

Nursing is a challenging profession because it requires expertise in a broad range of skills and abilities. The nursing profession demands the nurse in the process of care to interact with the patients, the medical fraternity, and with the health care workers constantly. This interaction is not just conversation, but also a complex process that involves nurse perception, understanding of the patient emotions, and utilization of the perceptions; in order to manage patient problems that achieve the goal of effective patient care which facilitated when nurses having emotional intelligence (EI)(1).

  The professional nurse should have the ability to understand the views and needs of a wide variety of people; as well as to remain sensitive and empathic to patient concerns; be able to keep personal emotional reactions in perspective; handle stress and promote social responsibility which is encompassing within the framework of emotional intelligence (2).

In order to understand the effects of managers’ and all employees’ moods and emotions, it is important to take into account their level of emotional intelligence(3).Emotional intelligence defined as the capacity for recognizing feelings as well for motivating and managing emotions for self and others. Emotional competencies are learned capabilities that based on emotional intelligence and contribute to effective performance at work (4).

Emotional intelligence have been classified into five components: first self-awareness and accurate self-assessment, second self-regulation, impulse management and conscientious responsibility along with integrity, third motivation and higher achievement through optimistic thinking, fourth using empathy to help others to develop, and fifth managing relationships and building collaborative teams—influencing change through empathy (5).

In the health care systems, motivation plays an important role in retaining health care personnel. This increases productivity of the health care systems which is manifested in patients’ outcomes. There are several motivational patterns in the nursing profession such rewards, relationship, challenge, control and drive (6).

Motivated human resources are the most important assets of any health system. (7).This resource, especially nursing department works directly with the health consumers (patients). Once the nurses are motivated, the work productivity increases resulting in good outcome which is good patients’ outcomes. In recent years it has been increasingly recognized that improving the motivation of health personnel should be at the core of any sustainable solution to patient outcome. However, it is widely acknowledged that health systems are not producing the desired outcome of health intervention due to factors such as insufficient skilled and experienced health personnel, demotivated health personnel, lack of management skills, poor working conditions and environment and inadequate remuneration (8).

Motivation is the act of providing a motive that causes a person to take action. In most cases motivation comes from some need that leads to behavior those results in some type of reward when the need is fulfilled. Motivation defined as a willingness to exert effort to achieve a goal or objective for rewards (6).

Emotionally intelligent people are self-motivated. They're not motivated simply by money or a title. They are usually resilient and optimistic when they encounter disappointment and driven by an inner ambition (9).   Employees with high emotional intelligence almost possess higher levels of job satisfaction due to proficiency in evaluating and modifying their emotions compared to low emotional intelligence employees (10).

Empowerment through emotional intelligence is the way you utilize your communication skills, your ability to create rapport and empathy with people, to influence outcomes and the behaviors of other people (11).Emotional intelligence is the ability to understand, express and precise evaluate of their own and others' emotions and also the ability to access and generate emotions and empower the staff (12).

Organization that are committed to employees empowerment they are in position to motivate and retain their employees , employees empowerment is concerned with trust , motivation ,decision making and breaking the inner boundaries between management and employees(13). In recent years there has been considerable academic and practitioner interest in the topic of employee's empowerment, which has become a buzzword, and recent management trends in both the public and private sector (14).

Empowerment has received a wide recognition as an important subject in management circles, mainly, because it is seen as one of the fundamental elements of managerial and organizational effectiveness that increases when power and control are shared in organization (15). Empowerment programs have been introduced in a number of organizations in order to improve productivity, increase customer satisfaction and enhance competitive advantage .Thus; employee's empowerment has been hailed management technique which can be applied universally across all organizations as means of dealing with the needs of modern global business (16). Leaders have advocated for empowerment of employees to help organizations compete successfully in highly competitive marketplace (17).

Significance of the Study

Emotional intelligence (EI) is important which help leaders to have the ability to recognize emotions within one and to express those feelings to others. This enables the leader to use their positive emotions to influence others and facilitate the vision of the organization through job performance (18).

In addition, during the clinical training of the nursing students at Minia University Hospital, The researchers observed different situations in clinical areas revealed that first line mangers (head nurse) have limited knowledge and experience in personnel management especially emotional intelligence. First line nurse mangers might be aware of the concept of emotional intelligence but they are lacking the knowledge and sound principles of emotional intelligence which may increase nurses’ motivation and empowerment.

There was an international study which ensured that emotional intelligence has positive impact on motivation, empowerment and organizational structure by percent 80%   (19).

In addition, there was an Egyptian thesis which ensured that leadership competences among nursing leaders increased after application of emotional intelligence program and it can be improved through continuances training by percent 77% (20). And another thesis that conducted and found that the forcing and smoothing conflict management styles were the most two used by the nurse mangers in handling conflict with their subordinate, and there is a negative correlation between EI and avoid conflict style by percent 54% (21).

 Emotional intelligence (EI) is helping nurses to manage stress, enhance well-being, improve performance, improve quality patient care, decision making abilities, effective communication, more motivated and more empowered to work. All these benefits of emotional intelligence, therefore carrying out emotional intelligence educational program for first line nurse mangers may help nursing staff to be motivated and empowered.

Aim of the study:

The aim of this study to investigate the effect of emotional intelligence educational program for first line nurse managers on the nurses' motivation and empowerment at Minia University Hospital                                                                                                         

Research Hypothesis:

H1: First line nurse manager's knowledge score about emotional intelligence (EI) will increase after the implementation of an educational program than before implementation.

H2: First line nurse managers' emotional intelligence components will be higher after the implementation of an educational program than before implementation.

H3: Staff nurse motivation score and empowerment score will be increased after implementing emotional intelligence educational program for first line nurse managers (head nurse).

Subjects and method

Research design:

Quasi-experimental design was utilized in this study.

Setting:

The study was carried out at Minia University Hospital.

Subjects

A convenience sample of all available first-line nurse managers' were included in the study (total no= 25 head nurses) and staff nurses (total no =150 nurses).         Tools of data collection:

Four tools were used in this study: emotional intelligence knowledge questionnaire, Emotional intelligence self-assessment questionnaire, Motivation Scale and Empowerment Scale.

Tool I: Emotional intelligence knowledge questionnaire, this tool was included two parts as follows:

1st part was including: Socio-demographic characteristics data sheet for first-line nurse mangers It included questions related to; (age, gender, marital status, years of experience, educational qualification and department …..etc.).

2nd  part was including: emotional intelligence knowledge questionnaire was developed by the researcher based on related literatures to assess first-line nurse managers' knowledge regarding emotional intelligence. It consisted of 40 questions related to: emotional intelligence, self-awareness, self-regulation, empathy, motivation and human (social) relation……….etc. The questions scored as one for the correct answer and zero for the incorrect answer. The scoring system of this tool divided as follows: Low emotional intelligence knowledge (<60%), moderate (60% = <75%), and high emotional intelligence knowledge (=>75%). The higher score, the higher knowledge of first line nurse managers about emotional intelligence.                          

  Tool II: Emotional Intelligence Self-assessment Questionnaire: developed by (Mohaple, 2015) (22) which adopted and modified by the researchers to assess first line nurse manager's emotional intelligence. The scale consisted of 40 items categorized in 4 subscales namely; self-awareness (ten items), emotional management (ten items), social emotional awareness (ten items), relationship management (ten items). Responses rated on 5 points likert scale ranging from (4) always to (0) never. The scoring system of this tool classified as a follows: Low emotional intelligence (<53), moderate (53 = > 106) and high emotional intelligence < 106.

Tool III: Motivation Scale: developed by (Whitaker, (2011) (23)., which adopted and modified by the researchers to assess nurses' motivation that provided by first line nurse managers (head nurses). The scale consisted of 22 items. Responses rated on 5 points likert scale ranging from (1) strongly disagree (5) strongly agree. The scoring system of this tool classified as a follows: Low motivation (<60%), moderate (60% = <75%), and high motivation (=>75%).                                                                

 Tool IIII: Empowerment Scale: developed by the researchers based on reviewing the related literatures. Used to assess nurses' empowerment that provided by first line nurse managers. The questionnaire consisted of 25 items. Responses rated on 3 points likert scale ranging from (1) rarely to (3) always. The scoring system of this tool classified as follows: Low empowerment (<60%), moderate (60% = <75%), and high empowerment (=>75%).                                                                                                  

Validity and reliability

Content validity of the four tools was revised by five experts in the field of study which classified as follows: two Assistant professors of Nursing Administration Department – Faculty of Nursing – Minia University and 3 professors of Nursing Administration Department – Faculty of Nursing – Assuit University. Accordingly some items were modified.  The reliability for the study tools were done using alpha coefficient to measure the internal consistency reliability of the three tools; it was (0.78) for emotional intelligence knowledge questionnaire, (0.91) for emotional intelligence self-assessment questionnaire, (0.89) for motivation scale and (0.75) for empowerment scale.

Pilot Study

A pilot study for the three tools was conducted on 3 head nurses and 15 staff nurses which represent (10%) that were included in the study subjects, selected randomly from the different hospital departments in order to check applicability of the tools; identify obstacles and problems that may be encountered during data collection and estimate the time needed to fill the questionnaires. In the light of the findings of the pilot study, no changes occurred in the tools and the tools were put in their final form.        

Procedure

The study was conducted in three phases: Assessment and planning phase, implementation phase, and evaluation phase.                                                                 

• Assessment and planning phase                                                                                    
• An official permission was obtained from the Dean of Faculty of Nursing- Minia University.                                                                                                              
• A review of the related literatures which covering various aspects of the problem was done. The review of literatures developed in sixth months from beginning of August 2017 to the end of January 2018.                                                              
• The researchers developed handout about emotional intelligence in sixth months from beginning of March 2017 to August 2017.
• The researchers prepared timetable of the program, the learning environment in which the study was conducted, and all needed resources as (conference rooms in the hospital and data show).

Implementing phase (implement Emotional Intelligence training program)          

• Pre-test was done before implementing program using tool (I) Knowledge test and (II) Emotional Intelligence self-assessment questionnaire for the first line nurse manager, Motivation and Empowerment Scales  for the staff nurses
• The program was implemented for two-groups, each subgroup contained from 10 to 15 head nurses, and the researchers applied the program for each sub-group on separate time. All sessions were occurred within the working time of the participants in the hospital education building and teaching room.
• In the first session the researchers explained the aim of the study, program objectives, content and time table.
• At the beginning of each session, the objective of the session was explained. Daily feedback was done about the previous session and at the end of each session there a summary was provided.
• The training program was implemented in three months from the beginning of February 2018 to the end of April 2018.

Evaluation of Emotional Intelligence Training Program:

Evaluation of the training program was carried out after implementation of Emotional Intelligence training program for first-line nurse managers using the following tools; the post-test knowledge and Emotional Intelligence self-assessment questionnaire; as well as post-test done for staff nurses using Motivation and Empowerment Scales for the staff nurses. The post test was done three times; first immediately after implementation, after three months, and follow-up after 6 months. 

Ethical considerations

• This study was granted approval by the Ethical Committee of the Faculty of Nursing, Minia University.
• The researchers explained to first line nurse managers and staff nurses who participate in the study, the aim of the study.
• Informed consents were obtained from all the participants before the procedure enrollments after that a detailed explanation of study objectives was provided.
• The study participants were reassured that their participation was voluntary and they had the right to withdraw from the study at any time if they want that.
• The study participants were reassured that their anonymity was maintained although the study and collected information wouldn't be used except for the purpose of this study.

Statistical Analysis

Data were analyzed using the statistical package for social science (SPSS) version 20. Numerical data were expressed as mean and SD. Quantitative data were expressed as frequency and percentage. For quantitative data, comparison between two variables was done using t-test, and comparison between more than two variables used ANOVA test and paired t- test. Relations between different numerical variables were tested using Pearson correlation. Probability (p-value) less than 0.05 was considered significant and less than 0.001 was considered highly significant.

Results   

Table (1): Demographic characteristics of the study subjects (First line managers' and staff nurses)

Table (1): Shows that less than three quarter (72 %) of first line nurse managers were in the age group between 30-40 years,  the majority of the study sample were females and married (80% & 84%) respectively , more than half of the study sample (56%) had from 5-15 years of experience , all of the study sample (100%) had Baccalaureate degree of Nursing and more than three quarters (76%) of them worked in the general areas.

Regarding personal and job characteristics of staff nurses , table (1) revealed that more than three quarters (84 %) of staff nurses were in the age group between 20-40 years, less than two thirds (66.7%) of them were females, less than three quarters (72%)  of them were married, more than half of the study sample (51.5%) had from 5-15 years of experience , half  of them(50%)  had Secondary School of Nursing Diploma, and more three quarter (77.3%) of them worked in the general areas.

Table (2): Total knowledge score of first line managers' (head nurses) about emotional intelligence during different times of testing at Minia university hospitals (No =25)

Table (2) Illustrates that (4.0%) of first line nurse managers had high level of knowledge in pre-test. While at the immediate post-test it was (76%) of them had high level of knowledge. After three months of program implementation there was change in knowledge level between first line nurse managers, (64%) of them had high level of knowledge. While after sixth months of program implementation the knowledge level had decrease, (56%) had high level of knowledge, with statistically significant differences(p=0.001) between pretest and different times of testing )pretest with immediately posttest, pretest with after three months of posttest, and pretest with after six months of posttest).

Table (3): Frequency distribution of total emotional intelligence components among first line nurse managers at Minia University Hospital during different times of testing (N=25) 

Table (3) Summarizes that , (8%) of first line nurse managers' had high effective emotional intelligence before program implementation  compare with (52%) immediately post program implementation, as well as (48%) after three months of program implementation and (40%) after sixth months from program implementation, with statistically significant differences(p=0.001) between pretest and different times of testing )pretest with immediately posttest, pretest with after three months of posttest, and pretest with after six months of posttest)

Table (4): Distribution total motivation score of staff nurses during different times of testing at Minia University Hospital (No =150)

Table (4) Summarized that (2.7%) of staff nurses had high level of motivation score in pre-test. While at the immediate post-test it was (92.7%) of them had high level of motivation score. After three months it was (72.6%) of them had high level of motivation score. While after sixth months of program implementation decrease to (35.3%) had high level of motivation score, with statistically significant differences (p=0.001) between pretest and different times of testing

.

Table (5): Distribution total empowerment score of staff nurses during different times of testing at Minia University Hospital (No =150)

Table (5) Summarized that (4%) of staff nurses had high level of empowerment score in pre-test. While at the immediate post-test it was (96%) of them had high level of empowerment score. After three months it was (84%) of them had high level of empowerment score. While after sixth months of program implementation decrease to (42.7%) had high level of empowerment score, with statistically significant differences (p=0.001) between pretest and different times of testing.