International Journal of Nursing Practice 2014; 20: 588–596

RESEARCH PAPER Relationship between self- and in nursing students

Emine S¸enyuva PhD BSN Assistant Professor, Nursing Education Department, Istanbul University Florence Nightingale Nursing Faculty,˙ Istanbul, Turkey

Hülya Kaya BSN PhD Associate Professor, Nursing Education Department, Istanbul University Florence Nightingale Nursing Faculty,˙ Istanbul, Turkey

Burçin Is¸ik PhD BSN Assistant Professor, Faculty of Health Sciences Nursing Department, Zirve University, Gaziantep, Turkey

Gönül Bodur BSN PhD Student, Nursing Education Department, Istanbul University Florence Nightingale Nursing Faculty,˙ Istanbul, Turkey

Accepted for publication March 2013

S¸enyuva E, Kaya H, Is¸ik B, Bodur G. International Journal of Nursing Practice 2014; 20: 588–596 Relationship between self-compassion and emotional intelligence in nursing students

Nursing focuses on meeting physical, social and emotional health-care needs of individuals, families and society. In health care, nurses directly communicate with and try to empathize with them. Nurses give care under emotionally intense conditions where the individual undergoes and distress. Research is aimed at analysing the correlation of self-compassion and emotional intelligence of nursing students. The population of the research consisted of all the undergraduate students (571 students) of the 2010–2011 fall semester of the department of nursing. An information form, Self-compassion Scale and Emotional Intelligence Assessment Scale were utilized to obtain data for the research. For the assessment of the findings of research, Statistical Package for Social Sciences 16.0 for Windows was utilized for statistical analysis. Results indicated that there is a correlation between self-compassion and emotional intelligence and that emotional intelligence, which includes the individual perceiving one’s and using the knowledge one gained from them to function while directing thoughts, actions and professional applications, has positive contributions to the features of nurses with developed self-compassion. Key words: emotional intelligence, nursing, nursing education, nursing students, self-compassion.

INTRODUCTION Nursing focuses on meeting the physical, social and emo- Correspondence: Emine S¸enyuva, Istanbul University Florence Nightin- tional health-care needs of individuals, families and gale Nursing Faculty, Nursing Education Department, Abide-i society. In health care, nurses directly communicate with Hürriyet Street, Çag˘layan-S¸is¸li/I˙stanbul 34381, Turkey. Email: patients and try to empathize with them. Nurses give care [email protected] under emotionally intense conditions where the individual

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undergoes pain and distress.1 Nurses need to be in contact self-, mindfulness and common humanity.7,12 with the individual, be open towards his/her , be Self-kindness is the ability to treat oneself with care, supportive in accepting his/her emotions, be affectionate rather than harsh self-judgment and self-criticism.12,17 and approach the mistakes and lapses without prejudice Common humanity is recognizing that failure, during the time when they provide care.1 In relevant and hardship are shared aspects of the human experience studies, it is indicated that this situation increases depres- in general, rather than socially alienated and sion, decreases job satisfaction and causes psychosocial isolated by these imperfections. It states the acknowledge- problems in nurses where in time, they are desensitized ment of the fact that one’s happy or distressful experi- towards the people they meet, feel emotionally exhausted ences are not solely distinct to oneself and that all other and lose their sense of personal success and sufficiency.2–4 human beings have similar experiences.12,17,18 Mindfulness Hence, the quality of life and self-compassion of nurses is the discernment that aids an individual in accepting the are adversely affected. However, nurses need to notice hardest and saddening emotions of life without letting the truth about individual failures and realize that negative oneself be carried away by the exaggerated storyline of emotions and thoughts result from such an attitude distress.12,19 In other words, it can be defined as balancing towards life and need to show to keep it on the and thoughts of suffering and hardship, not balance.5 This situation requires nurses to be professional avoiding them, and accepting them without being over- members with developed self-compassion and emotional identified with them or exaggerating them.12 Although intelligence, which are crucial elements for rendering these three dimensions of self-compassion conceptually caregiving.1,6 Self-compassion is the ability to be compas- differ from each other and are phenomenologically sionate to oneself, without this ability nurses might not be experienced on different levels, they interact with, engen- prepared to be compassionate to /individuals/ der and enhance one another.12,13 family.7 One aspect of the role of the professional nurse in Studies also demonstrated that self-compassion is nega- practicing humanizing nursing is being aware of his/her tively associated with self-criticism, , , self as a variable in the nurse–patient relationship. It is rumination and thought suppression and positively associ- proposed that students and nurses to be sensitive to their ated with social relationship, , awareness, own feelings and encouraged in the development of this self-improvement, emotional intelligence and self- self-awareness. Although both self-compassion and emo- determination.12–14,20,21The term ‘emotional intelligence’ tional are important concepts in nursing little is known has been coined by Salovey & Mayer22 to define the ability about these characteristics in nursing students. So, it is to understand feelings of oneself and other people, choose most important to be developed nursing students’ among them and apply this knowledge in one’s actions. self-compassion and emotional intelligence.1 Goleman defines emotional intelligence as the ability to understand one’s own feelings, empathize with other Background people’s feelings and arrange to enrich experiences and A variety of different concepts intended for the individual holds a five-dimension approach towards it, consisting of to develop healthy attitudes towards oneself, maintain awareness of one’s feelings (self-awareness), control over his/her , cope with stress and establish one’s own feelings (self-management), self-, healthy relationships have been defined by many psycholo- and social awareness.23,24 Self-awareness is the gists. Self-esteem, self-efficacy, personal character and ability to recognize and construe one’s emotions, values, self-compassion are among few to name.8–11 aims, strengths, weaknesses and skills. Self-management According to Neff, self-compassion is being receptive is the ability to have internal control over oneself; to adapt to one’s feelings that cause suffering and hardship, to unexpected conditions and change; to be receptive of approaching oneself with concern and warmth, being new ideas, approaches and knowledge; to take respon- sensible and non-judgmental towards oneself in times of sibility for the consequences occurred; to question insufficiency and failure and accepting that negative oneself; and to cope better with the problematic aspects of experiences are a part of human living.12–15 In other life. Self-motivation is the ability to direct one’s emotions words, self-compassion is the ability to handle suffering- in order to achieve goals, recognize opportunities and act related emotions tenderly, with great and upon difficulties to change them into opportunities and to consciously.16 Self-compassion has three dimensions: be more productive and active despite all shortcomings.

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Empathy is the skill of understanding other individual’s students especially those who are thought to be nurses to emotions, recognizing their points of view, developing provide care for individuals with different individual and susceptibility in this sense and caring for their feelings socio-cultural characteristics and develop an efficient without being judgmental or defensive. Social awareness training period if they improve themselves about emo- is the ability to understand and control the emotions and tional intelligence and self-compassion. Both emotional thoughts of other individuals along with one’s own; to intelligence and self-compassion are thought to be the provide and solutions in cases of disagree- qualifications that nurses need to have in order to develop ment, directing the behaviours of other individuals more effective relationships with individuals, families and towards one’s demands; to arrange healthy relationships the community in the future, be good role models, cope in one’s environment; and, in result of these, lead a with problems that they could encounter with individuals successful and happy life.23,24 from a variety of age groups and maintain a healthy private Emotional intelligence can be considered in terms of life with their friends, families and spouses. Furthermore, what the individual contributes to the world with an effec- as an adult, realizing one’s own emotions, expressing tive self-management, how much sensitivity he/she has them in different ways, controlling stressful situations, towards his/her own opinions and emotions as well as motivating oneself for compatible behaviour instead of others’, whether he/she has a developed interrelationship being harshly self-judgmental or self-condemning will and the willingness to do a self-criticism to find a solution improve their emotional intelligence and contribute their to personal, developmental and emotional problems.25 self-compassion in terms of identifying, understanding, Thus, emotional intelligence and self-compassion can be expressing and managing their emotions. It is vital to thought to be two basic characteristics that have a assess the current situation and develop educational pro- reciprocal interaction. grammes according to the results for the training of nurses Self-compassion can be considered as a multiple-phased with high self-compassion and emotional intelligence and beneficial emotional arrangement strategy. Being aware for enhancing these qualities.1,26–28,35–37 This study holds that distressful and saddening emotional experiences are significance in terms of its contribution to the literature common to all people, an individual with self-compassion and opening a new door into further related studies. would encourage oneself with a gentle and kind attitude rather than avoid these experiences. Thus, an individual Nursing education in Turkey with self-compassion gains a clear comprehension of the In Turkey, nursing education was based on elementary vitality of one’s current situation by transforming the schools until 1959. The Health Ministry maintained these negative emotions to a more positive perception and can programmes, which lasted 4 years following 8 years of govern the actions that could help oneself or one’s envi- basic education. Students learned nursing courses in addi- ronment to a more suitable and productive structure. In tion to general high school courses. At the end of this this sense, self-compassion can be considered as a crucial programme, students were given a diploma and the title element of emotional intelligence that includes the indivi- of nurse. Baccalaureate degree programmes started in dual’s perception of emotions and utilization of the fol- 1955, and soon, the baccalaureate degree became lowing knowledge from these emotions to function for required for entry into professional nursing practice in producing thoughts and actions.7,12–14,21,22 Turkey. There were various other programmes in nursing It is observed that the studies on self-compassion and education until 1977 including: a high school diploma emotional intelligence in Turkey are evaluated separately. programme, an associate degree programme and a bacca- No study was found concerning the correlation of laureate programme. Admission requirements for bacca- self-compassion and emotional intelligence.6,26–31 Self- laureate programmes until 2007, included satisfactory compassion is analysed in terms of self-esteem, satisfac- scores in the ÖSS (Examination for Student Selection) tion in life, positive and negative moods,32 motivation and (general exam to get into universities) and also obligation fatigue,33 success tendencies,14 submissive behaviours34 to be female. Since April of 2007, men have been and interpersonal cognitive distortions.15 accepted into nursing programmes. Until 1990, only five Although self-compassion and emotional intelligence universities in Turkey offered nursing programmes. How- are important qualifications for nursing, little is known ever, the number of baccalaureate programmes increased about these qualifications in nurses. It will be possible for rapidly meanwhile associate-degree programmes were

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closed. Today, nursing education is provided in 4- study included 471 students. The data were collected year programmes in universities following high school voluntarily on written consent of the students. graduation. Eventually in 1997, all nursing education was undertaken in universities where the nursing schools com- Tools menced offering a 4-year university education. There are A questionnaire form, the Self-compassion Scale, and the now 85 nursing schools offering baccalaureate pro- Emotional Intelligence Assessment Scale were utilized to grammes, most of which are in state universities. Master obtain data for the research. of Science degree (Msc) programmes in Turkey started in 1968. Nursing doctoral programmes started in 1972, and Questionnaire form today nine nursing schools offer a doctoral programme. It was developed by the researchers in the light of litera- By 1986, Turkey was one of only five European countries ture. Questions consisting of the grade, age, sex, high providing nursing education based upon university level. school, main living location and current location of the Nursing doctoral education in Turkey began as a single nursing students were asked in the form. nursing programme; today, it is divided into eight branches: Fundamentals of Nursing, Medical Nursing, Self-compassion Scale Surgical Nursing, Women’s Health and Obstetrics, The Self-compassion Scale, developed by Neff12 and a Children’s Health and Diseases, Mental Health and Turkish study of validity and reliability done by Akın, Psychiatry, Public Health and Education in Nursing and Akın and Abacı,13 consisted of 27 items and six sub- Management in Nursing.38–42 The nursing faculty, which scales of self-kindness (five items), self-judgment (five this research was carried out, has no self-compassion and items), common humanity (four items), alienation/ emotional intelligence courses. However, there is Human (four items), awareness (five items) and over- Behaviours and Relationships, Assertiveness Training and identification (four items). The options of response for the Critical Thinking. scale that had been prepared according to the five-point Likert scale were ‘always’ (5), ‘very often’ (4), ‘some- The study aim times’ (3), ‘rarely’ (2) and ‘never’ (1). Internal consist- The aim of this research is to analyse the correlation of ency coefficients of the scale were between 0.72 and 0.80, self-compassion and emotional intelligence of nursing and test–retest reliability coefficients of the scale were students. between 0.56 and 0.69. The points scored on the scale The research was carried out in definitive and cross- indicated the following self-compassion levels: 1–2.5 sectional quality. points, poor; 2.5–3.5 points, fair; and 3.5–5 points, The answers to the following questions were sought in good. Every subscale, the individual scored high on dem- this research: onstrated that the individual held the qualities that the 1. What is the self-compassion of nursing students? particular subscale measured. Grading of the scale was 2. What is the emotional intelligence of nursing students? performed separately for each subscale.12,13,17 3. Do the self-compassion and emotional intelligence Total Cronbach’s alpha values 0.87 was obtained from of nursing students differ according to socio- this research (see Table 1). demographic characteristics? 4. What is the correlation of self-compassion and Emotional Intelligence Assessment Scale emotional intelligence of nursing students? Developed by Hall43 and a Turkish study of validity and reliability done by Ergin,44 the Emotional Intelli- METHOD gence Assessment Scale consisted of 30 items and Sampling five subdimensions of self-awareness (six items), self- This study is a descriptive correlational study. The management (six items), self-motivation (six items), research consisted of all the undergraduate students (571 empathy (six items) and social awareness (six items). The students) of the 2010–2011 fall semester of one Nursing response options of the scale that had been prepared Faculty. Research was carried out with the 476 students according to the six-point Likert scale were ‘completely who accepted to contribute. Five forms were excluded agree’ (6), ‘mostly agree’ (5), ‘slightly agree’ (4), owing to missing information. Thus, the sample for this ‘slightly disagree’ (3), ‘mostly disagree’ (2) and ‘strongly

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Table 1 Cronbach’s Alpha values on Self-compassion Scales and Table 3 Students’ socio-demographic characteristics (n: 471) its subscales Socio-demographic characteristics n % Self-compassion subscales Cronbach’s alpha Grade First graders 122 25.9 Self-kindness 0.75 Second graders 109 23.1 Self-judgement 0.77 Third graders 119 25.3 Common humanity 0.62 Fourth graders 121 25.7 Isolation 0.56 Age range 20.65 ± 1.35 Awareness 0.76 Gender Women 393 83.4 Overidentification 0.73 Men 78 16.6 Total 0.87 Graduate of seconder High school 156 33.1 school Anatolian high school 179 38.0 Technical and vocational 37 7.9 education high school Table 2 Cronbach’s Alpha values on Emotional Intelligence Other 99 21.0 Assessment Scale and its subscales Main living location City 251 53.3 District 149 31.6 Emotional Intelligence Subdimensions Cronbach’s alpha Town 22 4.7 Village 49 10.4 Self-awareness 0.87 Individuals of living My family 134 28.5 Self-management 0.72 together Dormitory/campus 192 40.8 Self-motivation 0.86 At home with my friends 87 18.5 Empathy 0.87 Besides relatives 44 9.3 Relationship control/social awareness 0.60 At home, alone 9 1.9 Total 0.94 Other 5 1.1 disagree’ (1). The total of Cronbach’s alpha of the scale Limitations of the research was detected a 0.84. No reversed expressions were used This study involved one nursing faculty education only, 44 in evaluation. with a small sample size. The results cannot, therefore, be Total Cronbach’s alpha values 0.94 was obtained from generalized to all other nursing school. Results might not this research (see Table 2). be representative of the wider nursing student population. The forms were distributed to students in groups after getting the adequate permissions from first the faculty FINDINGS principle and then the responsible faculty member. They Findings concerning the identified qualities of nursing stu- were asked to fill out the forms after necessary explana- dents, the factors that self-compassion and emo- tions were announced and verbal consent was received. tional intelligence and the correlation of self-compassion and emotional intelligence are shown in Tables 3–6. Data analysis 1. Students’ socio-demographic characteristics The data were analysed using SPSS for Windows (version Of the students comprising the research 25.9% first, 11.0; SPSS Inc., Chicago, IL, USA) for statistical analysis. 23.1% second, 25.3% third, 25.7% fourth graders con- Socio-demographic characteristics of events were given tributed; 71.1% of them were Anatolian High School or in number, percentage, arithmetic mean and standard high school graduates, 83.4% were women and 16.6% deviation values. Mann–Whitney, Kruskal–Wallis, and were men. The age range of the students was minimum Spearman correlation tests were used in order to assess of 17 to maximum of 28, and their mean age was the levels of relationship between the scale scores. The > 20.65 ± 1.35. 53.1% of the students stated that their results were assessed in the reliability range of 95% and main living location was the city, 40.8% stated to be P < 0.05 level. accommodating at dormitory (Table 3).

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Table 4 Average scores of students on the Self-compassion Scale self-management, self-motivation, empathy and social- and its subscales (n: 471) awareness subdimensions of emotional intelligence. It was found that there is positive correlation between the ± Subdimensions of Self-compassion X SS overidentification and isolation subdimensions of self- compassion, and self-management and self-motivation ± Self-kindness 2.98 0.70 subdimensions of emotional intelligence; that there is ± Self-judgement 3.59 0.73 a negative correlation between the overidentification ± Common humanity 2.97 0.75 and isolation subdimensions of self-compassion, and the Isolation 3.48 ± 0.82 social awareness sub dimension of emotional intelligence; Awareness 3.14 ± 0.74 that there was no correlation between the overidenti- Overidentification 3.50 ± 0.77 Total 3.28 ± 0.51 fication and isolation subdimensions of self-compassion, and the self-awareness and empathy subdimensions of emotional intelligence. It was found that the self- judgment subdimension of self-compassion was positively Table 5 Average scores of students on the Emotional Intelligence correlated with the self-awareness, self-management, Assessment Scale and its subscales (n: 471) self-motivation and empathy subdimensions of emotional Emotional Intelligence Subdimensions X ± SS intelligence, whereas it was not correlated with the social awareness subdimension of emotional intelligence Self-awareness 26.5 ± 6.69 (Table 6). Self-management 24.3 ± 6.63 4. Self-compassion and Emotional Intelligence of Nurs- Self-motivation 25.5 ± 6.45 ing Students According to Their Socio-demographic Empathy 26.4 ± 6.37 Characteristics Relationship control/social awareness 25.6 ± 7.31 No significant distinction on the statistical level was assessed between the grade and self-compassion of the students. (F: 6.058 P: 0.109), significant differences were 2. Self-compassion and Emotional Intelligence of found between their grades and emotional intelligence Nursing Students (F:8.859 P: 0.031). A Kruskal–Wallis test analysis indi- According to Table 4, from Self-compassion Scales of cated that the difference between the grade and emotional students, the highest average was on self-judgment intelligence of the students was welded starting from the (3.59 ± 0.73), the lowest average was on common third grade; it was assessed that the emotional intelligence humanity (2.97 ± 0.75) and the Self-compassion Scale levels of the third-grade students were significantly low total score average was measured as 3.28 ± 0.51. Accord- compared with students in other grades (P > 0.05). ing to the assessment of the scale, the students had a fair No statistically significant distinction was found level of self-compassion. between the age, sex, high school, main living location According to Table 5 from Emotional Intelligence and current location and self-compassion (P > 0.05) and Assessment Scales of students, the highest average was on emotional intelligence scores. self-awareness (26.5 ± 6.69) and the lowest average was on self-management (24.3 ± 6.63). According to the DISCUSSION scale assessment, the students were found to have a fair This research was carried out in order to assess the cor- level of emotional intelligence. relation of the self-compassion and emotional intelligence 3. Correlation of Self-compassion and Emotional Intelli- of nursing students; it is compared with a limited number gence of Nursing Students of studies as there is no known research on the correla- A fair level of significant positive association was tion of the self-compassion and emotional intelligence of assigned between the self-compassion and emotional nursing students in Turkey or elsewhere. intelligence of students (r = 0.400, P > 0.01). This research indicates the fair level of self-compassion It was assessed that the awareness, common humanity of the students (Table 4). Bas¸aran et al., Çiftçi et al., and self-kindness subdimensions of self-compassion Nazik & Arslan, and Kurt et al. have shown in their studies were positively (good) related with the self-awareness, with nursing students that they have a fair level of

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Table 6 The correlation of self-compassion and emotional intelligence of students (n: 471)

Self-awareness Self-management Self-motivation Empathy Social awareness

Overidentification 0.049 0.241** 0.136** 0.034 −0.006 0.287 0.000 0.003 0.464 0.896 Awareness 0.350** 0.412** 0.410** 0.303** 0.233** 0.000 0.000 0.000 0.000 0.000 Isolation 0.069 0.185** 0.099* 0.040 −0.015 0.132 0.000 0.032 0.391 0.745 Common humanity 0.285** 0.297** 0.298** 0.234** 0.236** 0.000 0.000 0.000 0.000 0.000 Self-judgement 0.147** 0.180** 0.156** 0.118 0.048 0.001 0.000 0.001 0.011 0.302 Self-kindness 0.312** 0.357** 0.332** 0.217** 0.179** 0.000 0.000 0.000 0.000 0.000

Pearson correlation. * P > 0.05; ** P > 0.01. self-compassion.26–28,45 The Emotional Intelligence Scale is actually an important component of emotional score averages of the students indicate that they have a fair intelligence.12,17,20–22 These results led to a conclusion that level of emotional intelligence (Table 5). This research any educational activity in nursing education aiming at the result supports the results of the researches carried out by development of either self-compassion or emotional intel- Altuntas¸, Akyıl & Burkay, Kaya & Keçeci, Kuzu & Eker, ligence could enhance both features positively and for that and Ünsar et al.6,27,29–31 Self-compassion and emotional , these features could be considered integrated. The intelligence are the basic elements of nursing care. These aim of the study is to show that one should be able to qualifications play an important role in relationship and regulate his/her own negative emotions and see them communication between nurses, patients and families. with clarity through the processes that involve giving one Emotional intelligence and self-compassion advanced self-compassion. nurses themselves, their patients and other individuals are When the differences in grades were studied, it was perceived more accurately and clearly and their care is assessed that there was no distinction between grades stressed individuals exhibit sensitivity.1 These results concerning self-compassion, whereas there was a signifi- point out that nursing student do not qualify for the cant difference of emotional intelligence to the detriment required levels of self-compassion and emotional intelli- of third-grade students. The study carried out by Kaya & gence and that they could encounter communication Keçeci with the nursing students also showed that third- problems in understanding the emotions of patients and grade students have lower emotional intelligence levels their families during care giving. compared with other graders.29 These results weigh on A fair level of significant positive relationship was iden- the fact that there is no significant change among grades tified between the self-compassion and emotional intelli- concerning self-compassion but at the third grade, some gence of students (Table 6). Studies carried out by problems are encountered preventing emotional intelli- Heffernan et al., Akın, Neff, Rude & Kirkpatrick and gence development; however, the increasing average in Akın, Akın & Abacı also indicated a positive significant the fourth grade indicates that the problem is partially correlation between self-compassion and emotional intel- solved. However, it is decided that these should ligence.1,13,14,46 Study findings reveal that self-compassion be studied in qualitative researches. and emotional intelligence affect each other. In the litera- ture, self-compassion, monitoring and tracking informa- CONCLUSION AND SUGGESTIONS tion obtained from the individual’s emotions to guide The results of study indicated that nursing students have thoughts and actions, including the use of functional form, fair self-compassion and emotional intelligence and there

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