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- Asia Pac J Oncol Nurs
- v.2(2); Apr-Jun 2015
- PMC5123486
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Asia Pac J Oncol Nurs. 2015 Apr-Jun; 2(2): 107–111.
PMCID: PMC5123486
PMID: 27981101
Edna Ruiz Magpantay-Monroe
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Abstract
Objective:
Emotional intelligence (EI) within nursing appears to be a growing interest as evidenced by the expanding number of literature reviews conducted on the subject. The inquiry for this historical research is to understand the work and characteristics of Florence Nightingale and EI.
Methods:
The assumption is that nurses who are emotionally intelligent are the most likely to not only survive the nursing profession but to thrive and make compassionate future leaders. Nightingale's letters, pictures and other writings were used to evaluate her viewpoints as an inspirational nurse and leader.
Results:
Nightingale was a catalyst for change; internally motivated to be a great nurse and had the zeal to develop others as well.
Conclusions:
Exploring Nightingale's characteristics of EI such her confidence, determination, integrity and compassion, her teachings and beliefs can transcend time to mold successful nurses more than a century later.
“The voice of a leader. It is as resounding as the heart it encourages, as far-reaching as the change it invokes. It is tuned by its keen sense of the voices around it and speaks back in a language they can understand. Its breath enters all that truly hear it, and when it no longer speaks, it can still be heard.”
—Mae Taylor Moss
Keywords: Emotional intelligence, Florence Nightingale, compassionate nurse, leadership
Introduction
I was selected to receive the Harris Manchester College Summer Research Institute scholarship. I had 1-week to work on a specific research or writing project in Oxford, England. My primary goal was to undertake an extensive literature review about emotional intelligence (EI) and student success. I decided to focus my research on the EI of Florence Nightingale, the mother of modern day nursing. I was inspired by being in the country where Florence Nightingale was born and lived her life to probe into her life and work. The purpose of my inquiry was to shed light on how Nightingale's EI is germane to student success in today's nursing schools.
The expanding number of literature reviews conducted on EI points to the growing interest of the subject within nursing.[1,2,3,4,5] According to Bulmer Smith et al.[5] research on EI is important to build in-depth insight of nursing education, practice and leadership. My inquiry effort regarding EI was to understand the work and characteristics of Florence Nightingale and EI. The assumption was that nurses who are emotionally intelligent are the ones most likely to not only survive in the nursing profession, but to thrive and make compassionate future leaders.[6,7,8]
Mayer and Salovey[9] best summarized EI as “the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth”(p. 5). Intelligence and emotions are elements of mental operations and as physiological and behavioral patterns within an environment that can affect one's core abilities.[5] EI as a core ability has an impact on the future of understanding emotions of nurses as they render patient centered care. The writings and works of Florence Nightingale are key to understanding an integrated and holistic way of providing optimal nursing education, practice and leadership.[10,11]
Materials and Methods
Study design
The use of historical research for this project allowed me to use story-telling to create the foundation for this study [Figures [Figures11–3]. I decided to use Nightingale's own words to elucidate her skills and traits that qualified her as an emotionally intelligent nurse. I acquired primary sources through the Tate Library at Harris Manchester College at Oxford in the form of books and letters written by Florence Nightingale. I also collected secondary sources such as pictures and writings by others about her to shed light on my inquiry of her EI. I visited St. Thomas Hospital where I spent time at the Florence Nightingale Museum in London. My intention was to find evidence that Nightingale was both emotionally intelligent and a compassionate leader in order to support my assumption. Throughout my journey of discovery it was imperative that I was genuine to the information presented to me about Nightingale. I had to be aware of my own biases and assumptions. Though it was challenging conducting this historical research in such a limited time frame, this opportunity allowed me to validate my assumptions and gave me a better understanding of the zeitgeist that shaped Nightingale's life.
Figure 1
Characteristics of Nightingale within the four domains of emotional intelligence.
Figure 3
Selected artifacts and references.
Figure 2
Pictures from the Florence Nightingale Museum in London. These are samples of pictures that supported my historical research.
Theoretical framework
A positivist paradigm provided the framework for the exploration of a link between EI and student success in nursing. Based on this positivist mindset, an objective reality exists and is knowable. Therefore, the assumption was made that the artifacts that I used as sources were reliable and accurate representations of Nightingale's life and time. The ability to infer a cause and effect relationship between EI and Nightingale's success as a compassionate leader illustrated patterns that translate to the success of today's nursing students.
The artifacts were analyzed through a lens of Mayer's and Salovey's definition of EI. In addition, Nightingale's characteristics and traits were further examined using Goleman's four domains of EI. Goleman's model includes self-awareness, self-management, social awareness and relationship management. Multiple models of EI exist but Goleman's model was selected because it takes into account both learned skills and innate traits, including control of one's impulses, self-motivation, empathy and social competence in interpersonal relationships.[12]
Analysis
An understanding of Nightingale's characteristics and work are essential to connect EI to her persona and role in nursing education, practice and research. A visionary yet practical woman such as Nightingale led us to believe that the purpose in life is to serve our patients in an honorable way. Honour lies in loving perfection, consistency and in working hard for it: In being ready to work patiently: Ready to say not “how clever I am!” But “I am not yet worthy: But Nursing is worthy: And I will live to deserve and work to deserve to be called a trained nurse” (p. 116).[13] This quote is one of the many that demonstrates Nightingale's understanding and desire to intentionally regulate emotions in order to achieve intellectual growth, a fundamental part of Mayer and Salovey's definition of EI.
Florence Nightingale conceptualized nursing as a calling from god, an honorable calling.[13,14] She set rigorous standards to inspire nurses to work with patients from a holistic perspective.[13,14,15] Nightingale considered the patient as a partner to health promotion and wellness. In the book Florence Nightingale to her Nurses, Nightingale wrote “and I am not at all saying that our patients have everything to learn from us. On the contrary, we can, many a time learn from them, in patience … One of our sisters told me that she has often learnt more from her patients than from any one else. And I am sure I can say the same for myself” (p. 26).[13] She always viewed health from a preventative standpoint and knew that social conditions affect health promotion.[14]
Stories and writings about Florence Nightingale showed her extraordinary energy to succeed even more than half a century after the Crimean War.[16] Nightingale[13] believed that “a person in charge must be felt more than she is heard — not heard more than she is felt … She must exercise authority without appearing to exercise it” (p. 13). The voice of a silent power was exemplified here. In the 19th century women were expected to take on a traditional role of wife and mother and Nightingale struggled to find her place in a patriarchal environment.[15] She critically questioned situations especially when faced with a task that seemed nearly impossible to accomplish.
Emotional intelligence domains
The influence of the environment on Nightingale shaped her points of view and her ability to be an effective leader, aspects of self-awareness, the first of Goleman's EI domains. According to Denton,[17] self-awareness is the highest form of awareness, contemplating and reflecting on one's own existence. Nightingale's writings were supportive of her ability to recognize her moods, emotions and drives. She was a very confident and adept woman. She used her strong belief in god and the environment as the foundation for understanding herself. In Florence Nightingale to her Nurses, she mentioned that “humility — to think our own life worth nothing except as serving in a corps, god's corps unflinching obedience, steadiness and endurance in carrying out his work … and may god give it to us nurses and make us his own nurses” (p. 136).[13] Nightingale also knew that nursing needed to focus on health promotion and prevention to combat unsanitary conditions rather than treatment of the illness.
Goleman's second domain of self-management is the ability to be comfortable with ambiguity and have the openness to change.[5,18] To self-manage is to take the initiative to think and act without being told which direction to take. Nightingale interpreted the importance of acute observation as a skill in providing patient centered care and warned her nurses on observing conditions and making judgments on the basis of insufficient information.[19] In Nightingale's notes on nursing she eloquently wrote “the most important practical lesson that can be given to nurses is to teach them what to observe-how to observe-what symptoms indicate improvement-what the reverse-which are of importance-which are of none-which are the evidence of neglect-and of what kind of neglect … For it may safely be said, not that the habit of ready and correct observation will by itself make us useful nurses, but that without it we shall be useless with all our devotion” (p.105).[19] It is clear that Nightingale never shied away from change when it came to ensuring there was rationale for change.
Social awareness, the third domain, is closely connected to the practice of empathy.[9] Florence Nightingale was an introvert who savored solitude but appeared to show empathy in her writings and works. Service to the sick was what she always strived for. In one of her selected letters from Ever Yours, Florence Nightingale, she wrote: “I believe I shall go for the present to the nearest at hand — to nurse a sick aunt and wait to see what I can find out to be god's work for me” (p. 61).[20] Even though she was an introvert, a trait which often has a negative connotation, Nightingale was fueled by her energy from her inner thoughts and reflections which promoted positive actions.[10,21]
Relationship managementis about leading change despite challenging situations and is the fourth of Goleman's EI. Nightingale had an ambitious nature but her loving response to god and her work provided the simplicity of her drive to be a virtuous nurse.[22] Though her relationships with family and friends may have suffered, she used her practicality and political abilities to influence others.[10,14] In Florence Nightingale to her nurses, she persuasively wrote “but there is a greater charity even than these: To do good to those who behave ill to us, to serve with love those who do not even receive our service with good temper …” (p. 21).[13] She used expert power to implement change.[10]
Visual created by Sarah Jarvis, MS, RN and Edna R. Magpantay-Monroe Ed.D, APRN
Background sketch artist — Francis Pathenope Nightingale taken from Cecil Woodham Smith (1983) New York: McGraw-Hill Book Co., Inc.
Discussion
Nurses that have flourished in the profession had characteristics with a strong parallel to those of Florence Nightingale including intelligence and determination. In her book, Florence Nightingale to her nurses, she wrote: “The free woman in Christ obeys or rather seconds all the rules, all the orders given her with intelligence, with all her heart and with all her strength and with all her mind” (p. 11).[13] She knew that despite the view of women in her time, she had to be strong to provide what was morally righteous to develop the character of a good woman.[13,22] To be a good woman of character also meant to be charismatic and influential for the common good of the cause. Nightingale had an enigmatic personality, was a strong role model to her nurses in training and was a major influence during the Crimean War. She was considered a social reformist who knew her place. She was a steward of resources and was not easily discouraged.[10,23]
A current challenge in nursing education and practice is finding the balance of the intellect and heart to care for our most difficult patients. How do we measure the four domains of EI without risking the value of the human element? How does one view a cancer patient when a new graduate has not been exposed to caring for such complicated patient with physical, physiological and spiritual needs? How does one overcome working with a homeless, mentally ill veteran when in reality there is no formula to be genuinely empathetic? A seasoned nurse is equally as vulnerable as a new graduate when working with different patient situations that appear to be simple on the surface but prove to be complex in providing that holistic patient centered care.[24,25]
Addressing the above issues using EI and following Nightingale's example can improve both patient outcomes and nursing satisfaction in any clinical setting. For example, oncology nurses are consistently exposed to emotionally charged environments. Nurses in this specialty will have a better understanding of how to provide patient centered care if they have a greater awareness of their own emotions and how to manage and respond to them appropriately. Emotionally intelligent nurse leaders will be instrumental as change catalyst in a constantly changing health care environment. Nursing needs leaders that are transparent, resilient, accountable, empathetic and embrace change in their service to others and the profession; nurses needs leaders that can emulate Nightingale's bravery and brilliance. Her passionate commitment for the truth makes her still today such a powerful leader in nursing education, practice and research.
Conclusion
I began to delve into Nightingale's writings in order to evaluate her viewpoints as an inspirational nurse and leader. In this brief inquiry, tracking back EI to Florence Nightingale has been as stimulating as it has been edifying. I believe she is a catalyst for change. She was internally motivated to be a great nurse and had the zeal to develop others as well. The EI of Florence Nightingale has been revealed through her pictures, letters and other writings. By continuing to explore Nightingale's characteristics of EI such her confidence, determination, integrity and compassion, her teachings and beliefs can transcend time to mold successful nurses more than a century later. The desire to understand Nightingale's writings and work presented a journey to satisfy a sincere need to create a more complete picture of an emotionally intelligent nurse who can be a compassionate leader.
Future Recommendations
In a previous study, I described the phenomenon of the attractiveness of nursing academia to practicing nurses who chose to become nursing educators.[26] Interestingly, many of the characteristics of Nightingale are similar to those of the nurses in that study. Future research could include exploring EI in nursing educators and how it contributes to the success of students including how Nightingale's EI may have contributed to the success of her students. Looking at EI of nurses who work in specialty areas and how it impacts patient centered care is another prospective study. EI is becoming a growing interest in nursing. There are many potential research opportunities for both academia and clinical practice.
Acknowledgements
This project was supported by Dr. Lawrence Tseu for the 2014 Harris Manchester Summer Research Institute Scholarship and Chaminade University of Honolulu. Thank you to the Harris Manchester College Principal, Dr. Ralph Waller, and the staff, especially from Tate Library. Thank you to Sarah Jarvis, MS, RN, Research Assistant of Chaminade University of Honolulu School of Nursing.
Footnotes
Source of Support: Nil.
Conflict of Interest: None declared.
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Articles from Asia-Pacific Journal of Oncology Nursing are provided here courtesy of Elsevier
