Investigation into the correlation between humanistic care ability and emotional intelligence of hospital staff

The term “Care” is an important concept in the healthcare profession [1]. This outwardly affectionate behavioral action is contingent on the internal properties of cognition, practice, and education, an integration of knowledge, attitude, emotion, and behavior, all of which translate into conscientious service [2]. Empathy is a necessary personality and psychological trait of medical staff. Because the primary goal of medical personnel is to care for patients, a humanistic and altruistic mindset is expected of them at all times. Humanistic behavior is a prerequisite for social development and harmonious nurse-patient relationships; however, particularly in China, the humanistic characteristics that are necessary for giving effective care are frequently disregarded at management level [3]. The results of Chen and Liu [4] show that there were different degrees of flaws in the knowledge structure of humanistic medicine among medical staff in China. Further, humanistic care ability (HCA) is influenced by many factors, including personal character, social support, psychological characteristics, and work-related factors [5], and so HCA training therefore extends beyond the acquisition of medical knowledge.

Emotional intelligence refers to the ability of an individual to monitor his/her as well as others’ emotions, and to use this information to guide his /her thoughts and behavior [6]. Among healthcare practitioners, emotional intelligence is a necessary trait and skill. Salovey and Mayer [7] defined emotional intelligence as a “subset of social intelligence, including monitoring of one’s own and others’ feelings and emotions”. The ability to detect, use, comprehend, and manage one’s emotions can facilitate the enhancement of problem-solving ability in one’s emotional life. In recent years, there has been a gradual increase in the investigation of emotional intelligence in management, leadership, organizational behavior, and other fields. The influence of emotional intelligence on leadership, work pressure, work performance, turnover rate, self-concept, and other variables including commitment, morale, and health has been confirmed [8]. Rochester et al. [9] state that health workers must understand their own and others’ emotions to successfully interact with patients, cope with stress and uncertainty, and improve treatment outcomes. Other studies [10] have also shown that the level of emotional intelligence of the medical staff affects their career development and their relationship with patients. Individuals with higher emotional intelligence can better deal with highly emotional work (the art of managing one’s feelings) and are more likely to form a good doctor-patient and nurse-patient relationship. Weng [11, 12] showed that doctors with higher emotional intelligence were more likely to gain trust from patients. A study in South Korea [13] employed the dimensions of emotional perception, emotional expression, and empathy in emotional intelligence for the prediction of the doctor-patient relationship. Compared with doctors having negative emotions, such as irritability, anxiety and depression, those with high emotional intelligence could better respond, understand, and feel patients’ inner emotional experience from patients’ perspective, and were more likely to resonate with their patients [14]. As well as improving doctor-patient communication and promoting the doctor-patient relationship, the cognitive and regulatory abilities inherent in emotional intelligence also play an important role in improving clinical diagnosis, treatment and promoting patients’ health [15]. For clinical nurses, the perception of patients’ emotions is inseparable from exploring patients’ needs. Nurses with highly emotional perceptions are more likely to avoid nurse-patient conflict. In addition, emotional intelligence has also been found to be critical for managing the relationship between stress and mental health. People with poor emotional control tend to refuse the help of family, friends and others due to emotional problems, and so bear greater mental pressure [16]. Healthcare professionals often face pressure in their clinical work of consolidating and maintaining the health of patients. When coping with stress and fear, those with high self-perception and emotional intelligence display strong levels of engagement and attain great performance. This connection has recently been demonstrated by the results of a cross-sectional study conducted in several Spanish hospitals shortly after the COVID-19 outbreak in 2020 [17]. Therefore, it is necessary to proactively develop the emotional competencies of the healthcare workforce, especially in high-emotional demand contexts.

Currently, research on HCA and emotional intelligence worldwide is focused mainly on nurses and medical college students, including medical students and nursing students [18‐22]. For example, Simmons and Cavanaugh [23] surveyed the HCA of female nursing graduates in the United States; Hables [24] conducted a cross-sectional CAI survey on nurses in the United States; Xu et al. [25] conducted a predictors-based CAI survey on nurses in China; Cho et al. [26], Hiroshi and Kohsuke [27] and Li et al. [28] surveyed the emotional intelligence of undergraduates. In addition, there have been a number of studies on the CAI evaluation of family caregivers of patients with chronic diseases in countries outside China [29]; Wan and Noor [30] conducted a study on the emotional intelligence of administrators. In short, the canon of knowledge on the HCA and emotional intelligence of the whole hospital staff is relatively sparse.

This study on the correlation between the level of HCA and level of emotional intelligence focused on the whole hospital staff including nurses, doctors, and technicians. We hypothesized that the hospital staff who had a high level of emotional intelligence had a high level of HCA; there were different levels of emotional intelligence and HCA among the hospital staff with different job titles; the hospital staff who received comprehensive and in-depth humanistic care training had a high level of HCA compared with those who lacked such training; the hospital staff were able to recognize their own emotions; and the hospital staff of different genders had different levels of HCA.

This study reveals variations among the hospital staff in terms of development of internal factors of emotional intelligence. Among them, HCA was at a relatively low level, and emotional intelligence was found to be positively correlated to HCA. The average CAI score was 197.77 ± 20.3, lower than the international norm (198.79 being the lower level among nurses), but higher than that reported by Xu et al. [25], Chi et al. [20], Ge et al. [18], and Zhao et al. [19]. The CAI score lower than the international norm might be ascribed to different cultural backgrounds and educational systems. In traditional Chinese culture, care tends to occur only in intimate relationships, while medical care for patients is implicit. The low average CAI score might also be a reflection of the low premium attached to service and humanistic care in Chinese medical education. On the other hand, Western medical education is known to pay more attention to practical care education for medical students, resulting in higher CAI scores.

In general, in Western countries there is more academic research on the HCA of medical students. For example, the survey results of Labrague et al. [40] for 167 medical students from four countries show they generally exhibited positive caring behavior. The research results of Cheng et al. [41] show that the total CAI score and each dimension score of Chinese medical students are significantly lower than those of American medical students. Fjortof et al. [42]. investigated the caring ability of 323 pharmacists in the United States. Their CAI score was 203.0 ± 17.7, which was not a high level. There exist sizeable differences in terms of CAI scores between medical and healthcare personnel in different countries. It should also be noted that pharmacists’ CAI scores are not directly comparable with those of medical and healthcare personnel.

In this study, the average score of each dimension of CAI (from high to low) (knowing, patience, and courage) indicate that the hospital staff had a relatively good understanding of themselves, others, and the surrounding environment. Also, their patience (endurance and toughness) score was similar to the research results of Wessel [43] and the research results of Xu [25], and their score for courage was significantly higher than that reported by Xu [25]. The scores for understandings and patience, and the total score of this study sample were higher than those reported by He et al. [44]. These differences exist probably because Xu [25] and He et al. [44] only studied nursing staff, while this study was conducted on the whole hospital staff. Caring is multidimensional, and caring behavior can be taught and learned [32]. Unlike China, in many foreign countries the provision of medical humanistic education has existed for many years. Bevis and Watson [45] established humanistic care courses back in 1989. Tomura et al. [46] pointed out that humanistic care education should focus on the distinctly human elements of appreciating nature, as well as science, art and relationship. Currently, medical humanities courses account for 20–30% of total class hours in the United States, and about 10–15% in the United Kingdom [47]. In terms of teaching and evaluation methods, foreign medical colleges have adopted various teaching methods and means, such as course lectures, group discussions, academic discussions, extracurricular reading, reflection diaries, and essay-writing. Arveklev [48] used improvisation, role play, and forum drama to improve students’ understanding of caring and to enable them to explore the caring experience. By comparison, there are some problems within the setting of medical humanities courses in China, such as insufficient resourcing, lack of unified standards, lack of coherence, and absence of cross-disciplinary course design. Regarding course content, humanities courses are mainly focused on ethics and psychology [49]. Further, in China the proportion of humanities courses is about 7–8%, which is relatively low compared with that in many foreign medical colleges. The teaching and evaluation methods are structured upon a large class teaching system. Teaching tends to be heavily theoretical, and thus lacking in flexibility and diversity. As observed in previous studies, there exist significant shortcomings in the humanistic care curriculum in China’s medical colleges, although in recent years, many practitioners in these institutions have taken steps to improve the curriculum [50]. Further, the proportion of humanistic care courses across medical colleges in China has increased, and the teaching styles are more diversified. However, there is still a long way to go before the educational effect of these innovations will impact on the HCA of clinical front-line medical and healthcare personnel.

This study has shown that the average score for the emotional intelligence of hospital staff was 84.21 ± 13.48, higher than the research results of Yu [51] and Wang et al. [52]. The scores of each dimension, ranked from high to low, are as follows: self-emotion assessment and expression (23.06 ± 3.63), self-emotion utilization (20.84 ± 4.08), emotion recognition of others (20.41 ± 4.26), and self-emotion management (19.91 ± 4.61). These results indicate different levels of development of internal factors of emotional intelligence among the hospital staff. Davies et al. [53] reported that regulation of emotion in oneself involved change of his/her mood. This may explains why the scores of self-emotion management in our study were low. A person’s mood may change all the time, so it is difficult to maintain emotional stability. This suggests that the hospital staff’s ability for self-emotion management needs to be improved through training programs, especially rapid correction of one’s emotions.

Our study has also shown that the hospital staff’s scores of self-emotion assessment and expression were higher than their scores of emotion recognition of others. This is similar to the research result of Acosta-Prado [38], which reported that Colombian managers had a stronger ability to evaluate their own emotions and a weaker ability to recognize the emotions of others. The population of our study is different from that of the study of Acosta-Prado [38], but the results are similar, indicating a possible common weakness in emotion recognition of others in different population groups. Emotional intelligence is not innate [54], and it can be improved by self-learning, environmental intervention, and other measures. Hospital management shall train staff on emotional intelligence, and stimulate the internal emotions of individuals, in order to help them better understand and predict the emotions and behaviors of others. The training mode can include education courses, such as listening training, self-management, interpersonal communication, and regular organization of lectures on emotional intelligence.

The results of this study also show that females possess higher HCA than males, a pattern which is consistent with that reported in several studies [18, 20]. These results may be indicative of women’s potentially higher patience, carefulness, empathy, and emotional sensitivity. The CAI and WLEIS scores of those who chose their majors based on their own interests were higher than those who had selected majors for other reasons (employability, suggestions from family or others, etc.). Regarding internal driving force, employees have different feelings and draw satisfaction from work for different reasons. In general, employees who feel satisfied with their jobs have a stronger ability to overcome difficulties [55]. Those who choose their majors and occupation voluntarily gain a greater sense of professional value and are more willing to express concern for patients [56]. Therefore, stimulating employees’ interest and love for their work in a variety of ways could improve their HCA and emotional intelligence. For example, the situational simulation training in doctor-patient communication could enable the doctor to communicate with the patient with transposition thinking, thereby making the doctor better understand the patient’s emotions during diagnosis and treatment. Hospital managers are advised to give the staff complete freedom to provide suggestions, thereby making the staff feel valued. The CAI and WLEIS scores were higher for staff who received more comprehensive and in-depth humanistic care training, compared with those who lacked such training. The study of Luo et al. [57] showed that emotional intelligence training for clinical nurses helped promote general health and improve the emotional intelligence of the trainees. Their study results were consistent with those in earlier studies [54, 58]. Moreover, researchers have found that medical students who participated in social practice more often have better humanistic care ability compared with non-participants [49]. Paige et al. [59] found that people can gain satisfaction from having a variety of social practice interaction opportunities. Practice is the source of cognition. In practice, care can be effectively practiced in the process of contacting patients, which can promote the improvement of humanistic care ability to a certain extent [60].

Volunteer activity is one form of clinical practice. The results of this study show that CAI scores of those who had participated in volunteer service activities were higher than those who had not. This is because volunteer servicing entails dedication, and, as a result, promotes humanistic care for others. In addition, these volunteers might have received relevant training in their activities and experienced the atmosphere of humanistic care, which may explain why their humanistic care scores were higher than those who did not participate [18, 20, 57].

In our study, the Pediatrics Department staff had higher WLEIS score than the Outpatient and Emergency Department staff, indicating different levels of emotional intelligence and HCA among the hospital staff. This may be due to long-term contact with pediatric patients, which can fortify feelings of empathy for children. Furthermore, pediatric staff work is not only for children, but also for their families. Due to the particularity of their work objects and the impact of work pressure, pediatric nurses pay more attention to the regulation of self-emotion, hence why the WLEIS scores of pediatric staff are higher [61].

In the correlation analysis, it was found that the hospital staff’s emotional intelligence was positively correlated with HCA. The higher the emotional intelligence score, the higher the HCA, a pattern which is consistent with the results of conclusions of Chi et al. [20]. Individuals with high emotional intelligence are more likely to observe emotional changes occurring in patients, family members, and colleagues around them, and are more capably of forming good interpersonal relationship with them. Individuals with low emotional intelligence are more self-centered, less aware of the feelings of people around them, and exhibit poorer humanistic care [51]. Emotional intelligence could stimulate the internal emotions of individuals into practical action, translating their emotions into humanistic care for patients.

In summary, the hospital staff’s levels of emotional intelligence affects their levels of HCA. It may be argued that the internal factors of emotional intelligence among the hospital staff are at different levels of development, with many of them exhibiting low HCA. Therefore, it is necessary to provide more emotional intelligence training for hospital staff to improve their HCA. Implementation of humanistic teaching activities closely combined with clinical practice through the design and training of the knowledge structure construction module of humanistic medicine is needed to improve the hospital staff’s humanistic knowledge structure, communication ability, and HCA.