Emotional-Social Intelligence in Health Science Students and its Relation to Leadership, Caring and Moral Judgment

The purposes of this study were to describe and compare the emotional-social intelligence (ESI) of students in nursing, physical therapy and health science programs, and to determine the relationship between ESI and each of leadership, caring and moral judgment. Subjects were 154 students from nursing, physical therapy and bachelor of health science (BHSc) programs in a Canadian university and a physical therapy program in an American college. Data were collected by means of self-report measures of ESI, leadership, caring, and moral judgment. The measures included the Bar-On Emotional Quotient Inventory Short (EQ-i:S), the Self-Assessment Leadership Inventory (SALI), the Caring Ability Inventory (CAI), the Caring Dimensions Inventory 35 (CDI-35) [for nursing only] and the Defining Issues Test (DIT-2) [for physical therapy and BHSc only]. One-way analyses of variance (ANOVA ) revealed no differences between groups for the EQ-i:S, SALI, or DIT-2. There were significant differences for the Courage subscale of the CAI between students in the American physical therapy program and in the Canadian nursing program (p=.025). Pearson correlation coefficients were significant for EQ-i:S and each of SALI (r=.53), CAIKnowledge (r=.59) and CAI-Courage (r=.60). The EQ-i:S scores were not related to the CDI (r=.15) or the DIT-2 (r=-.06). The results of this study confirmed the positive relationship between ESI and leadership and suggested that ESI may be an important construct in caring. There were no major differences between students in different health science programs, and ESI was not related to moral judgment. INTRODUCTION Traditionally intelligence quotient (IQ), a measure of cognitive function, has been used to predict the likelihood for life successes including job performance. However, in the last 10 years another set of individual and social competencies labeled emotional intelligence (EI), or emotional-social intelligence (ESI), has been identified and reported to be necessary for individual and workplace success.1-3 Bar-On defines EI/ESI as; “a multi-factorial array of emotional and social competencies that determine how effectively we relate with ourselves and others and cope with daily demands and pressures.”4 Emotional-Social Intelligence in Health Science Students and its Relation to Leadership, Caring and Moral Judgment 2 © The Internet Journal of Allied Health Sciences and Practice, 2008 He further suggests that ESI is a determinant of success in life. Along with cognitive intelligence, ESI is an important part of general intelligence, changes over time and can be improved with training.4 Emotional-social intelligence would appear to be an important construct, particularly if the measurement of ESI can predict success in life and in specific jobs/careers. Further, if ESI can be improved through training, as claimed by Bar-On4 and others,5 then it should be considered in the curricula of educational programs. In the health care field, professionals require leadership and communication skills in order to work effectively in an ever changing, complex system. They must collaborate with a variety of health providers, facilitate and/or adapt to change within health care organizations, and provide care to individuals with diverse health issues, cultural backgrounds and beliefs.6 If the measurement of ESI can predict who has these skills, then ESI could be part of the application process for health science students,7 and/or students could be trained specifically to improve their ESI within the curricula.8 Although Bar-On reported moderate to high correlations between ESI and leadership ability, and ESI and work performance,3 the associations have not been as clear in other publications.9,10 Bar-On studied recruiters and persons considered for leadership positions in the military, and reported correlations of .39-.82 between ESI and measures of work performance or leadership.3 McQueen referred to studies that indicated those with higher ESI have better interactive skills, are more cooperative and develop closer relations.11 These are skills that are valuable in the health professions. Nurses who were identified as “high early career performers” by nurse managers rated characteristics they felt important to their success.12 These included: ability to empathize, to work with a variety of people, and to learn from their errors. Researchers have suggested that higher ESI may help prevent burnout in nurses.11,13 However, Farmer found that ESI was not related to job satisfaction in this group.13 “Caring” is an important concept in the health professions.14-16 Definitions vary, but include reference to both the physical actions and emotional concern of the “carer” as he/she supports and responds to the needs of others.11 Caring has also been described as a relationship that involves receptivity, engrossment and reciprocity of the one caring and the person being cared for.14 Although several authors have theorized about the importance of ESI in the caring process,7,11,15 we could find no literature quantifying the relationship between caring and ESI. As with other claims about ESI, the literature provides conflicting evidence for the link between ESI and academic success. BarOn reported a correlation of r=0.45 between the ESI at entrance to university and the grade point average (GPA) in the middle of the academic year.3 Grace found no association between ESI and GPA in nursing students, but did note that some aspects of ESI predicted satisfaction with the educational program.9 The ESI scores of physical therapy students had a low but significant correlation with academic success,17 and with scores on 2 out of 24 items on a clinical performance measure.18 Scott found that ESI was related to moral judgment in Liberal Arts and Career and Technical undergraduate students, with no difference between educational programs.19 The specific objectives of this study were to: 1) describe and compare ESI of nursing, physical therapy and bachelor of health science students, and 2) determine if ESI was associated with effective leadership styles, caring, and moral judgment in these students. It was hypothesized that graduate students would have higher ESI than undergraduate, and that students entering a health profession (nursing and physical therapy) would have higher ESI than those entering a general program (bachelor of health science). It was also expected that ESI would be positively correlated with leadership, caring and moral judgment. METHODS Design This study was a cross-sectional, correlational design comparing four groups of students. Ethical approval was obtained from the ethics review boards of the two institutions involved in the study. Subjects Four groups of students from two educational institutions (McMaster University, Ontario, Canada and Ithaca College, New York, USA) and three disciplines/programs (Nursing, Physical Therapy, Bachelor of Health Science) were contacted to participate in the study. All the students who were enrolled in the first year of their programs in September, 2006 were informed of the study by e-mail or through announcements in classes/tutorials. They contacted the research assistant if they were interested in participating. All students that participated provided informed consent. As indicated in Table 1, the subjects were from undergraduate and graduate programs, traditional and problem-based programs, and professional and non-professional programs. The sample size calculation indicated that 25 subjects per group were needed to detect a difference of 1 SD with an Emotional-Social Intelligence in Health Science Students and its Relation to Leadership, Caring and Moral Judgment 3 © The Internet Journal of Allied Health Sciences and Practice, 2008 alpha of .05 and power of .80. A total of 84 subjects were needed to detect a significant correlation of .3 between measures of ESI and leadership, caring and moral judgment. Measurement Tools All data were collected by means of self-report questionnaires which the students filled out in one sitting lasting approximately one hour. All students completed the Bar-On Emotional Quotient Inventory: Short (EQ-i:S), the Self-Assessment Leadership Inventory (SALI), and the Caring Ability Inventory (CAI) in that order. Only the nursing students answered the Caring Dimensions Inventory-35 (CDI-35), a measure designed specifically for nurses. The other three groups completed the Defining Issues Test (DIT-2). The Bar-On Emotional Quotient Inventory: Short (EQ-i:S) is a self-report measure of emotional and social intelligent behaviors.3 The EQ-i:S contains 51 items in the form of short sentences. Respondents rate each statement from 1 “very seldom or not true of me” to 5 “very often or true of me”. A total score and 5 subscale scores can be calculated. The subscales are: intrapersonal, interpersonal, stress management, adaptability and general mood. The results are presented as standard scores based on age and gender. The mean is set at 100, and persons who score between 85 and 115 (one standard deviation) are considered to be functioning effectively. Those who score above 115 are considered to have enhanced ESI and those with scores below 85, to be in need of improvement. Internal consistency was confirmed by an alpha of .97. Intraclass correlation coefficients (ICCs) for test retest reliability were .72 for males and .80 for females.20 The SelfAssessment Leadership Instrument (SALI) is a measure of leadership characteristics, where leadership is defined as the process of influencing the behaviors of other persons in their efforts towards goal setting and achievement.21 This instrument was originally developed in 1970 by Yura and incorporated various leadership theories.22 Respondents are asked to consider 46 behaviors as they relate to their leadership. A 5-point Likert scale is used indicating, “usually not behave in this manner” (0) to “almost always behave in this manner”(4). A higher total score indicates high self-assessment of leadership characteristics. Testing for reliability produced a Cohen’s coefficient K of .54. The SALI was able to discriminate between groups expected to be different on leadership ability.21 The Caring Ability Inventory (CAI) is a selfreport questionnaire designed to measure the degree of a person’s ability to care for others.23 Although the development of the CAI was based on eight indicators of caring as identified by Mayeroff,16 factor analysis of the original 80 questions reduced the items to 37 and the subscales to three. Respondents rate each item on a scale from 1-7. Some of these items are reversed scored so that higher values indicate a greater degree of caring. The subscales scores are calculated by summing the items in that subscale. The Knowing subscale [CAI_K] (14 items) includes items on understanding self and others. Courage [CAI_C] (13 items) captures ability to cope with the unknown, and Patience [CAI_P] refers to tolerance and persistence (10 items). Nkongho reported internal consistency of .79 to .84, a test retest coefficient of .75, and a content validity index of .80.23 Validity of the CAI was further supported by its ability to discriminate between students and nurses and between females and males, by factor analysis, and by results supporting hypotheses consistent with theory.23 The Caring Dimensions Inventory – 35 (CDI-35) is a self-assessment questionnaire designed to ascertain nurses’ perceptions of what represents caring in nursing, and includes psychosocial, professional, technical and organizational aspects.24,25 Respondents rate on a scale from 1 (strongly disagree) to 5 (strongly agree) whether they consider each item (nursing activity) to be caring.26 The higher the score the more likely the nurse considers these behaviors to be caring. Watson noted an ICC of .67 for test-retest reliability of the total score of the CDI-35.27 An earlier study using the original instrument (CDI-25) demonstrated high internal consistency (Cronbach’s alpha = .91).28 Content validity was addressed through an extensive review of the literature. In the present study, a general caring score was determined by totaling the responses from 22 items that weighed on one factor.29 The Defining Issues Test (DIT-2) is derived from Kohlberg’s theory of the development of moral judgment, a process by which people determine one course of action is morally right and another course is morally wrong.30 The process involves defining the moral issues, determining how conflicts are to be settled and having a rationale for a course of action. The test consists of five ethical “dilemmas”. For each dilemma, the respondents are asked to make a decision about the action to take and then rate 12 statements (on a 5-point scale) for their importance in making the decision. Finally they rank the 4 most important statements. A number of scores can be computer-generated. The N2 score was used in this study. It is a combined measure of ability to recognize principled items (ranking of these as most important) and to discard the simplistic and biased solutions (rate these lower than principled items). The construct validity has been supported by correlations between the N2 score and moral comprehension, prosocial behavior and civil libertarian attitudes, by differences in age/educational groups, and by longitudinal and interventional changes.31 Emotional-Social Intelligence in Health Science Students and its Relation to Leadership, Caring and Moral Judgment 4 © The Internet Journal of Allied Health Sciences and Practice, 2008 Analysis The results of all measures were evaluated for fit with a normal distribution. The groups were compared on all measures by means of a one-way analysis of variance (ANOVA), with the alpha set at p<.05. Tukey post hoc analysis was used to determine the location of any significant differences. Pearson’s coefficients were calculated to determine the correlation of the EQ-i:S with each of the other measures. RESULTS The total number of students enrolled in the study was 154. The distribution of the numbers over the four programs and the characteristics of the students are indicated in Table 1. ______________________________________________________________________________________________________ Table 1. Characteristics of Subject Groups Program N Male/Female Age mean (SD) Education Level Professional Education Mode McMaster Health Science 21