Emotional Intelligence and Biomarker Measurement in Nursing

Emotional intelligence(EI)

In the ever-changing modern world, human life is intertwined with a spectrum of day-to-day requirements. Meeting challenging tasks by sustaining pressure or stress can be the major concern for individuals who are work- or job-oriented. Very often, the role of the brain in executing the job function under stressful situations may be determined by its acuity or intelligence. This kind of intelligence may be considered emotional intelligence (EI). It is an important factor needed for evaluating the success in human lives and their comfort. EI is also vital for structuring the balance between the work atmosphere and the individuals. There is growing research interest on the role of EI concerning its impact on stress and work performance. As such, the present description is concerned with highlighting the concept of EI and its connection with stress, especially in nurse care professionals, and the description of a suitable biomarker for measuring stress levels.

Nursing employees experience routine occupational stress at the workplace and need instantly to manage and cope with it. Studies conducted on the workplace of employees have used such methods as general Health Questionnaire (GHQ-28), Subjective Work Evaluation Questionnaire and Emotional Intelligence Questionnaire have revealed that the levels of emotional intelligence were vital in the occupational stress perception and avoiding employees dedicated to patient service from adverse outcomes in health (Bulik, 2005). This could enhance the potential to handle the emotions and the related information in the job environment (Bulik, 2005). Frequently, nurses encounter health ailments and stress due to work characteristics and their attitude to patient’s life and even death cases. This may enable them to become emotionally disturbed and influence their job outcomes.

Strategies applied have shown that nurses who had good scores in emotional repair reports and clarity had a decreased stress level (Landa et al., 2008)

Stress measurement

Emotional intelligence level among nurses is better associated with the unambiguous mode of receiving the work stress so that management strategies could be precisely targeted and a better positive outcome in job performance could be expected. Among clinical staff nurses, their work atmosphere, healthy associations, positive handling of conflict behaviors, and growth in interactions could be facilitated through an EI framework. This could be because there were positive relationships that have been found significant between EI scores and level of clinical performance (Codier, Kooker & Shoultz, 2008).

Four components of EI

EI was reported to involve four components. They are a). emotional awareness where there is a perception of emotion in self and others, in addition to a capability to convey and precisely evaluate one’s thoughts and requirements; b). emotional capability to promote thinking where emotions facilitate in fixing the important issues, enable sensible partnerships, and help in making decisions; c). capability to understand meaningful feelings to evaluate and understand difficult emotions, their origin, and transitions between various states; d). control of emotions to facilitate logical development, which is a skill of controlling the feelings about positive and negative states to improve thinking (Landa & Zafra, 2010). It was described that an emotionally intelligent nurse exhibits concordance with feelings and thoughtful expressions. In addition, emotional competence development in the form of empathy is a vital factor worth considering in theories of nursing. EI is the potential in facilitating nurses to build a therapeutic connection to comply with patients and the care providers, who may be family members, and also predicts social assistance and mental health in nursing student professionals. It was also reported that emotional control was associated with emotional self-esteem positively and anxiety and depression negatively (Landa & Zafra, 2010).

Burnout problem in nurses

In-clinical nurse encounter with stressful conditions is often represented by a term known as ‘burnout’ (Erickson & Grove, 2008). It is considered as a kind of stress syndrome where emotional exhaustion is reflected. Due to the work nature, nurse care professionals and others in health care settings are at increased risk for “burnout” episodes. This condition is considered dangerous and eliminates nurses from their job profession as the frustration, exhaustion, anger, and stress levels grow in the routine schedule of nurses.

The association between deep motive to leave job and “burnout” feelings was well observed. According to a study, nearly 43 % of nurses working in the surgical wards were found to report about the increases in “burnout” levels and have intentions to give up jobs in another twelve months. The negative perception of jobs in nurses about “burnout” feelings is more probably impacted by practices adopted in work organizations that rule the work atmosphere by the inbuilt tasks developed in caring for patients (Erickson & Grove, 2008). Recently, a South African study has described that chronic stress leading to “burnout” experienced by nurses could be reduced by increased EI. This was revealed when the levels of burnout EI and stress were measured, a sample size of nurses employed in several wards of hospitals using Maslach Burnout Inventory, Sources of Work Stress Inventory, Swinburne University Emotional Intelligence Test amounted to 122. This has suggested the significance of using EI interventions and their incorporation into the nursing policy.

Most importantly, an improvement in the health of nurses could be possible when there are high emotional coping facilities and improved social skill development. The method of addressing “burnout” problems is worth applying in developing countries due to the association of factors, such as shortage of nursing staff, and budget barriers with environmental stressors (Ekermans & Brand, 2012).

Hence, it is reasonable to mention that EI moderates the association between occupational stress and job performance among nursing professionals.

Salivary cortisol

Next, stress may induce the production of certain secretions like cortisol. It is an adrenal gland secreted by steroid hormones. Apart from its role in stress responses, cortisol is also important for nervous, immune, and circulatory systems, metabolism of carbohydrates, proteins and fats, and bones (Cortisol level, 2011). Its normal accepted laboratory values are 6 – 23 micrograms per deciliter (mcg/dL), which corresponds to the samples of blood collected at 8 am (Cortisol level, 2011). Cortisol measurement is essential in detecting variations in the body which may be stressors, individuals who are vulnerable to stress-induced diseases, and the reliability of stress-preventing strategies (King & Hegadoren, 2002). In the recent period, the determination of salivary cortisol is considered a very sensitive and specific procedure. This could be so because, in saliva, cortisol is available in a free form. Saliva could be obtained from the mouth by making use of capillary tubes, paper foams, or swabs made of cotton (Törnhage, 2009).

The importance of saliva is because it represents changes in emotional metabolic and endocrinal states of the body’s physiological system. Emerging trends in this area have turned this laboratory test into a novel approach to salivary diagnostics. Point-of-care (POC) technologies have been reported to offer simple, instant, and inexpensive measurements (Wei & Wong, 2012). Biomarkers of the oral cavity have been attracted much research interest with the feasibility and applications of PCR for RNA and DNA and ELISAs for proteins. By employing non-invasive, user-friendly devices and saliva sampling, significant results could be obtained using blood and urine samples (Giannobile et al., 2011). Available information has furnished insights into the significance of salivary cortisol as a biomarker of stress. Ahmed, Torre, and Wahlgren (2004) have described that salivary cortisol was positively associated with elevations in 24-hour serum blood pressure in acute stroke patients.

Here, salivary cortisol was tested for evaluating stress. This has indicated that blood pressure resulted from the contributing factor, stress and the study further underscored the role of salivary cortisol in predicting stress (Ahmed, Torre & Wahlgren, 2004). Cortisol stress responses were found to be determined by defensive cognitive appraisal responsible for neuroendocrine stress response. Hence association between psychobiological stress responses and serum cortisol was strengthened (Gaab et al., 2005). Interventions aimed at reducing stress in critical care nurses have been assessed to evaluate their influence on stress responses through cortisol testing. Cortisol secretion associated with subjective stress and objective workloads were measured in nurses along with salivary cortisol testing. Subjective work stress associated with high cortisol production indicated that workplace interventions required a strategy of one-item summary as a measuring tool of subjective work stress (Metzenthin et al., 2009). Salivary cortisol was found to be elevated in nurses, experiencing stress-related burnouts (Wingenfeld et al., 2009). This mode of testing has reflected the importance of salivary cortisol in nurse care.

Therefore, according to the above information, it can be concluded that emotional intelligence (EI) is an important factor that is essential for understanding occupational stress and job performance in nurses. The workplace atmosphere poses a major challenge to nurses, making them leave their work due to stress-related burnouts. However, implementing a standardized framework in the nursing curriculum to manage stress management about job performance produces significant changes. Salivary cortisol has been identified as a reliable biomarker of stress responses, and its utility in nurse care is a worthy intervention.


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