Research Demonstrates Efficacy of Cultivating Emotional Intelligence with Nurses Through Equine Facilitated Experiential Learning

Back in 2009 we introduced, “The Emotionally Resilient Nurse”, a relationship-based, equine facilitated experiential learning program designed specifically to cultivate Emotional Intelligence(EI) competencies in nurses.  This program came right on the heels of our pro bono program, “Warriors in Transition”, designed to help combat veterans and their families wrestling with PTSD, and quite often PTSD/TBI.  For anyone participating in or monitoring our warriors program, the efficacy was remarkably apparent.  Sleep patterns improved, agitation levels diminished, and family relationships improved almost overnight.  The program, which we’ve helped to introduce in six states, was formally commended by General David Petraeus in 2010.

Having worked in the health care field for two decades, I had personally witnessed the challenges nurses face on a daily basis.  Their environment is emotionally toxic and they are constantly walking a tightrope, without a net, of expressing authentic empathy through healthy, professional boundaries.  It is not a task for the faint of heart.  Having witnessed the success of our approach with combat veterans, migrating this approach into acute care hospital settings, specifically designed for other front line professionals, seemed like a no-brainer.  Unfortunately, at the time, hospital administrators were still laying off nurses to cut costs.  In the very short term, this may have helped the bottom line, but over time, lowering staffing levels only exacerbated the costly problems of nurse burnout, high turnover rates (the Florida Nurses Association reports that it costs a hospital an average of $64,000 to backfill an open nursing position.  Extrapolated across the nation, this problem adds approximately $17 billion in hard dollar costs to the health care delivery system, adding absolutely no value whatsoever.) and perceptions of quality of care with patients and their families.

As we do with the development of all of our programs, we dove into the peer-reviewed, published research on the effects of cultivating emotional intelligence in nurses on the delivery system.  Here’s a snapshot of what we discovered:

    • Patient satisfaction is a widely recognized measure of medical care quality and a predictor of several positive consequences for organizations and patients (e.g. patient adherence to treatment regimens, fewer malpractice suits, hospital employees’ satisfaction, and financial performance).2
    • Compassionate behavior is threatened by technological concerns and economic constraints.3 “Continually, we experience situations where patients received excellent technical care but, when the emotional side of their care was not met, they believed that their care was inadequate”.4
    • By understanding the patients’ emotions, and being more empathetic, nurses are more able to understand the values, worries, and fears of patients. They are more apt to automatically connect with patients, appreciate the patients’ perspectives, understand the impact of their actions, understand and satisfy patients’ needs5 and respond appropriately.6
    • Nurses need to interpret and understand how patients feel, to ascertain their motives and concerns, and demonstrate empathy in their care. They also need to understand and manage their own emotions, not just for high quality care, but for their own self-protection and health as well.7
    • Nurses capable of a self-reflective process become aware of their own emotions.  When nurses recognize their own feelings they are more likely to manage them and communicate in appropriate ways.8
    • Non-verbal interactions play a vital role in nurse-patient perceptions.  The non-verbal interactions include patient-directed eye gaze, affirmative head nod, smiling, leaning forward, touch, and instrument touch.9
    • Emotional Intelligence in nursing leads to more positive attitudes, greater adaptability, improved relationships, and increased orientation towards positive values.10
    • Emotional Intelligence has a positive impact on nursing team cohesiveness and patient/client outcomes.11
    • Emotional Intelligence minimizes the negative stress consequences of nursing.12
    • Emotional Intelligence is important in managing stress and reducing nurse burnout.13
    • Emotional Intelligence is an important characteristic for building successful nursing leadership, enhancing nursing performance, and reducing nurse burnout.14
    • Emotional intelligence scores in clinical staff nurses correlate positively with both performance levels and retention variables. Clinical staff nurses with higher emotional intelligence scores demonstrate higher performance, have longer careers, and display greater job retention.15
    • Emotional Intelligence should be integrated into the nursing profession by a model of transformational learning for nurse education.16

It seemed as if we’d made a fairly strong case for how cultivating the soft skills in nursing could save hard dollars in health care.  Unfortunately, we were in hindsight, more that a bit ahead of our time.  With the coming of HCAHPS, and the effect these patient satisfaction surveys will have on 30% of a hospital system’s reimbursements from the Medicare, perhaps it is time to revisit the value this approach represents.  An approach that is capable of delivering an ROI that soars into the thousands of percent.

Adding to the evidence, a pilot study has just been conducted and released from the University of Kentucky that warrants attention.  The study, authored by Patricia Dyk, and Robyn Cheung, et al, entitled, “The Effectiveness of Equine Guided Leadership Education to Develop Emotional Intelligence in Expert Nurses“, demonstrates statistically signifiant improvements in Emotional Intelligence competencies with nurses employing this approach.  This comes as no surprise to us, as we’ve been traveling the United States for the past four years, conducting our evidence-based approach to Equine Facilitated Experiential Learning, seeing consistent, reproducible results in very challenging populations.

The fact is, we’ve crossed a threshold into a period of adaptive challenges.  Unprecedented challenges that require unprecedented solutions.  The complexity of the challenges institutions and enterprises face today will require the integration of seemingly disparate disciplines and methodologies in order to find sustainable solutions.  One thing’s for certain, investing in our nurses would be a major step forward in improving the health care delivery system in the United States.

Copyright 2013, Terry Murray.

 1.)  Daniel Goleman, (1995).  “Emotional Intelligence”, Bantam Books, New York, NY.

2.)  Gesell, S.B. & Wolosin, R.J., (2004).  Inpatients’ Rating of Care in 5 Common Clinical Conditions. Quality Management Health Care, 13(4), 222-227.

3.)  Godkin, J. & Godkin, L., (2004).  Caring Behaviors Among Nurses:  Fostering a Conversation of Gestures. Health Care Management Review, 29(3), 258-267.

4.)  Kerfoot, K., (1996).  The Emotional Side of Leadership:  The Nurse Manager’s Challenge.  Nursing Economics, 14(1), 59-62.

5.)  Ibid., 59-62.

6.)  Vitello-Ciccui, J.M., (2003).  Innovative Leadership Through Emotional Intelligence.  Nursing Management, 24(10), 28-34.

7.)  McQueen, A.C.H., (2004).  Emotional Intelligence in Nursing Work.  Journal of Advanced Nursing, 47(1), 101-108.

8.)  Ibid., 101-108.

9.)  W. Caris-Verhallen, (1999).  Effects of Video Interaction Analysis Training on Nurse-Patient Communication in the Care of the Elderly.  Patient Education and Counseling, Volume 39, Issue 1, 91-103.

10.)  Kristin Akerjordet & Elisabeth, (2007).  Emotional Intelligence: A Review of the Literature with Specific Focus on Empirical and Epistemological Perspectives. Journal of Clinical Nursing. 16(8); 1405-1416.

11.)  Quoidbach & Hansenne, (2009).  The impact of trait emotional intelligence on nursing team performance and cohesiveness.  Journal of Professional Nursing, Volume 25, Issue 1, pp. 23 – 29.

12.)  Montes-Berges & Augusto, (2007).  Exploring the Relationship Between Perceived Emotional Intelligence, Coping, Social Support and Mental Health in Nursing Students.  Journal of Psychiatric and Mental Health Nursing. 14 (2);163-171.

13.)  Linda Gerits, Jan J. L. Derksen, & Antoine B. Verbruggen, (2004).  Emotional Intelligence and Adaptive Success of Nurses Caring for People with Mental Retardation and Severe Behavior Problems.  Mental Retardation: 42, (2); 106-121.

14.)  Vitello-Ciccui, Joan M., (2002).  Exploring Emotional Intelligence:  Implications for Nursing Leaders.  Journal of Nursing Administration.  32(4):  203-210.

15.)  Codier, Estelle PhD, RN; Kamikawa, Cindy MSN, RN, NE-BC; Kooker, Barbara M. DrPH, APRN, NEA-BC; Shoultz, Jan DrPH, MPH, (2009).  Emotional Intelligence, Performance, and Retention in Clinical Staff Nurses.  Nursing Administration Quarterly:  October/December, Volume 33, Issue 4, 310-316.

16.)  Dawn Freshwater & Theodore Stickley, (2004).  The Heart of the Art:  Emotional Intelligence in Nurse Education.  Nursing Inquiry. 11(2); 91-98.

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