The development of socio-emotional competencies in nursing education: integrative review

Thainá Oliveira Lima1, Cláudia Mara de Melo Tavares1

1 Fluminense Federal University, RJ, Brazil

ABSTRACT

Objective: to identify how the socio-emotional skill development process occurs in the nursing training.  Method:  integrative literature review, in LILACS, MEDLINE, SCIELO, IBECS, BDENF databases. The research included publications between 2004 and 2019,  8 articles that met the established criteria were identified for the review. Results:  it was identified in the articles that the development of the emotional aspects of nursing students is still emerging, are often tangentially, or worked indirectly. Discussion: the  proposal of the studies is to develop an internal emotional management that allows an emotional expression appropriate to the situations. Conclusion:  although studies emphasize the need to break away from the Cartesian/traditional training model, they still seek a ready, acceptable, identifiable conduct, leading to rationalization of issues that are intrinsically part of the human dimension, such as emotions. 

Keywords: Nursing; Teaching; Emotions; Competency-Based Education.

INTRODUCTION

The university plays a unique role  in the social, political, economic and cultural system changes of individuals and society. According to each era, the university, which taught in the traditional way, transforms itself according to the needs of humanism and science, transposing this traditional standard into the standards of the modern university of the 21st century. With the current technological and scientific advances, it is necessary to search for ways that consolidate pedagogical projects consistent with such advances, that is, prepare professionals capable of meeting the challenges of modernity, without losing sight of the perspectives of their personal and emotional dimensions(1).

The need to change nursing education is related to the current social needs related to the country's health conditions, i.e., it recommends the need to break away from training  based only on the clinical model (flexenerian/curative), and the need for broader, comprehensive training.  Most universities that reformulate the Political Pedagogical Projects (PPPs) of nursing courses, and consequently their curricula, follow the critical-reflective training model, which intends to train a generalist, critical and reflective professional, capable of working as a team, making decisions and intervening in the health-disease process, promoting nursing care in a humanized way and be responsible for updating their competencies, and consequently, socio-emotional competencies (1).

Young people belong to a social group with specific characteristics and, because they are leaving adolescence and entering adulthood, they often have a strong internal pressure, especially in the way they perceive life, and external charges, represented in how society considers them.  The sociocultural collection that these young people suffer is evident and is still considered taboo today, which ends up, several times, being reflected in their attitudes, leading them to a lifestyle harmful to health in various aspects (2).

Young university students are a specific group and often deal with particular challenges because they are inserted in an academic environment in which they suffer great psychosocial pressure. They are exposed to constant demands, which sometimes lead to dysfunctions in their well-being, which can lead to various pathological processes, including neuropsychic ones. This problem is reported by Cremasco and Baptista in their research on the mental health of psychology students, which reveals a percentage of 15% to 25% of undergraduate students who develop some type of mental disorder during their education, with depression being one of the most prevalent disorders(3).

Suicide is the second leading cause of death among college students, it is estimated that about one million students commit suicide each year in the world, equivalent to one death due to suicide every 40 seconds (1). Factors such as separation of the family nucleus, increased responsibilities and reassessment of activities, situations that must be faced especially by university students, can cause such emotional and physical instabilities, resulting in high levels of anxiety. Thus, the susceptibility of university students to acquire depression and to commit suicide was identified(2).

This situation represents a challenge to universities, exemplified by the significant influence of these pathologies on the university student performance, and it is the institution’s responsibility to develop diagnoses and intervention measures(3). 

In this context, the idea of competence arises when the construction of learning goes beyond the formal acquisition of academically validated knowledge and also includes constructed knowledge from the most diverse experiences that the subject faces, whether in studies or throughout life(4). The socio-emotional skills, unlike the abilities of emotional intelligence, refer to the transforming capacity, which results in the appearance or development of a set of qualities in the person.

It is worth mentioning that, while emotional intelligence consists in the acquisition of dexterities in relation to their own emotions and others (idea of control, mastery of emotions), emotional competence implies not only the incorporation of skills, but also includes them, promoting a transformation process in which the person incorporates consciousness and emotional understanding.  An emotionally competent person has characteristics such as compassion, equanimity, optimism, empathy, perseverance. A person with emotional competence is a person in transformation who incorporates new characteristics into his personality (5).

Academic training with an emphasis on emotional aspects is responsible for strengthening the individual and showing them to the world, with all the competence that is expected of a professional who knows how to deal with situations and conflicts that may eventually arise. Thus, it is vital that we perceive the world around us, that we awaken the critical sense, intellectual curiosity and the development of the ability to communicate, especially in socio-professional interaction in nursing, which aims to provide the nursing professional with knowledge inherent to interpersonal relationships and interpersonal and emotional competencies(6).

It is also important to highlight that the quality of care will be strongly marked by the attitudes and behaviors of those who care. Competent professional performance requires a know-how to mobilize, integrate and transmit the knowledge acquired in the scope of training, which can be made possible by the development of competencies through new pedagogical opportunities during initial academic training(7). With this perspective, training and education  begin to have other meanings than those attributed by scientific dimensions, because it is necessary to feel the need to recover a human being who is able to re-cultivate his passions, instincts and emotions(8).

Thus, the aim of this study is to identify how the socioemotional skill development process occurs in the nursing training.

METHOD

An integrative review, with a qualitative approach, according to 6 proposed steps: identification of the theme and selection of the hypothesis or research question for the preparation of the review, establishment of inclusion and exclusion criteria of studies, definition of information to be extracted from the selected studies/categorization of studies, evaluation of studies included in the integrative review, interpretation of results and presentation of knowledge production (9). In order to answer the following question: "How does the socio-emotional skill development process occur in nursing training ?" 

The descriptors used for the search were "Nursing" AND "Teaching" AND "Emotions" AND "Competency-Based Education", the study was conducted between September and October 2019 (submitted to updates in October 2020)  in the Literature databases Latin American and Caribbean In Health Sciences (LILACS), Online Medical Literature Search and Analysis  System (MEDLINE),  Scientific Electronic Library Online (SCIELO), Spanish Bibliographic Index in Health Sciences (IBECS), Nursing Database(BDENF).

For the purpose of article selection, the following inclusion criteria were used: articles developed in the last 15 years (from 2004 to 2019 – this time frame was established  due to the difficulty of finding articles in the last 5 years related to the theme in question; as there were no articles, the time frame was expanded), in the Portuguese, English and Spanish languages, and addressing the theme of emotions in nursing education. The exclusion criteria were: articles that addressed the theme of emotions outside the scope of academic training. Articles related to the emotional issues of graduates were not considered.

RESULTS

Thus, 548 studies were found. After reading the titles and abstracts, 19 articles were selected. In Figure 1,  the article selection process (matching the descriptors in the databases and articles selected in the databases according to the established criteria) can be verified below.

Figure 1 - Article selection process, 2010, Brazil.

Source: Prepared by the authors.

Pairing of descriptors in databases and articles selected in the databases according to the criterias established according to the steps of Prisma (which proposes steps for the elaboration of systematic/integrative reviews).

The review of the articles was carefully performed by the authors, who in order to verify the application of the inclusion criteria described above, read the articles in full, totaling 8 selected articles. The selected articles met all the requirements of this review. Figure 2 summarizes the article selection/elimination process.

 Figure 2 - Process of selection/elimination of articles, 2020, Brazil

Source: Prepared by the authors.

The article selection process according to the reading of titles and abstracts and then proceeded the full reading of the articles for the final selection of 8 articles.

In Figure 3, it is possible to observe the results obtained in the databases from which the 8 articles were extracted. These selected articles were only in 2 databases. 

Figure 3 - Articles selected in 2 databases (LILACS and SCIELO), 2020, Brazil.

Source: Prepared by the authors.

These 8 articles were only found in 2 databases (LILACS and SCIELO).

Among the 8 (100%) studies found, 2 (25%) are Portuguese and 6 (75 %) are Brazilian, no studies have been found in other countries. The methods used are diverse and the samples range from 560 to 10 students; some studies include professors, nursing professionals and students from other areas, such as technology and education. The study participants are mostly youths.  In relation to the production year, the oldest article is from 2004 and the most recent is from 2018, establishing a time frame of 14 years for the selected articles.

One of the studies found in the search deals with the development of emotional skills and aspects of student education more directly. It is a Portuguese study that deals with the support of the supervising nurse/advisor for the development of competencies, aiming at the performance of emotional work. The other seven touch on emotions since they work with aspects of the human dimension in academic education.

To facilitate the understanding of the data, a table was created with the items obtained from each study, which was completed as the selected articles were analyzed. The items extracted from the articles included authors' names, country of study, year, method and sample and main findings/strategies identified. Data analysis and presentation were performed descriptively. Figure 4  shows the results found in detail.

Figure 4 - Summary of the Results of the Integrative Literature Review, 2020, Brazil.

Source: Prepared by the authors.

Summary of the articles selected for research.

DISCUSSION

Next, we highlight 2 thematic axes in order to discuss the articles found.

The need to reframe the teaching model based on biomedical training and scientific technical knowledge to mobilize the development of socio-emotional skills. 

In this context, the importance of consolidating institutional networks that allow the opening of new learning scenarios that constitute rich spaces for the formation of subjects, which are involved and appropriate to their real work processes (10), are highlighted. 

Studies done to identify and analyze the perceptions and feelings of the undergraduate nursing course, in relation to their training as a person/professional, reveal that academic training is centered on technical-scientific knowledge, focused especially on meeting the needs of those who will be cared for, without considering the person who cares for them, in addition to evidencing that the academic trajectory is permeated by various feelings that appear due to the experiences that occurred throughout it (11).

Another study highlights little ability to establish a therapeutic relationship that can account for the various dimensions of human suffering. There may be, therefore, possible consequences that will accompany the student throughout his or her course or even during his/her professional practice. Thus, strategies such as the creation of the Nursing and Society discipline become indispensable, because they create the possibility of breaking with the technical-scientific model recreating forms and developing competencies through workshops that allow us to reflect on the meaning of life and on the meaning of nursing education, consequently contributing to the development of socio-emotional competencies (10).   This can also be verified in the study that presents the creation of the moment of socialization within the  nursing fundamentals discipline based on active methodologies, promoting a space of realistic simulation.  It is characterized as a moment of exchange, reflection and analysis of the performance and personal and professional growth of students(12). These devices create new ways of obtaining knowledge and learning, enabling the construction of competencies previously not reachable by the traditional nursing teaching model. As the study from the point of view of neurosciences exposes, the most required skills at the brain level, in order to learn, are cognitive, technical, relational and emotional(13).

The development of the human dimension of nursing students, implications for the development of socio-emotional competencies.

The feelings experienced by students during the course, which manifested themselves in a diversified way, changing and alternating, from euphoria for passing the entrance exam, achievement, joy, curiosity, interest in growing, pride in attending Nursing, to feelings of anguish, sadness, fear, terror, failure, loneliness, feeling of helplessness, inferiority, incapacity, disappointment, willingness to give up, anger, revolt, insecurity, pity, suffering and pain(14). The author  Ferreira in his study identified the difficulty which students have in talking about their emotions or in apprehending the meaning of the questions during the interview, which were related to this aspect (14). The author  Damásio  argues that emotional development is an integral part of the decision-making process and functions as a vector of actions and ideas, consolidating reflection and discernment(15). In this sense, it is important to highlight  the study that is configured as a strategy to support nursing students, contributing to the development of emotional competencies through clinical supervision, as the clinical course is permeated with situations that generate positive and negative emotions(16). The study's proposal is to guide students to manage their emotions and those of the client to more appropriate emotional responses(17, 18). Concerning the development of competencies in students, the results of the study demonstrate that the support function of the supervising nurse enhances the performance of emotional work and promotes personal growth, leading to attitude changes (posture, discourse, analysis, adaptation and tranquility), the development of trust, initiative and autonomy, the recognition of difficulties and the acceptance of criticism in a constructive way. But it also leads to the acquisition of theoretical knowledge resulting from the confrontation with other forms of interpretation of circumstances, requiring an adaptation to new experiences. Therefore, nursing education "should not be confined to the technical and scientific process, but also to underline the student's personal development by the role that he/she has in all competencies"(7, 19). 

CONCLUSION

The process of developing socio-emotional competencies in nursing education occurs in such a way as to focus on strategies and approaches that are not declared as being for socioemotional development. It is perceived, in studies, that this occurs in an indirect or sometimes unintentional way, as the aspects of life, academic training and curricular restructuring work for more humanized molds with emphasis on the integrality of teaching and care. The selected articles point to discussions with students about the urgency of developing the emotional dimension, but do not clearly name strategies that make this development feasible. The studies, for the most part, bring criticism to the training model based on technical and scientific aspects, which do not take into account the dimensions of the emotional field in training. 

It is also notorious that studies deal with the development of socio-emotional skills in order to seek the best expression of emotions during  care. The proposal of the studies is to develop emotional management that allows an appropriate emotional response/expression to the situations. The criticism presented here is whether it is possible to control emotions to such an extent. Is it possible to develop an emotional behavior managed in each situation? 

Although they emphasize the need to break with the Cartesian model, studies conducted with this perspective still seek a ready, identifiable conduct, leading to the rationalization of issues that are of the human dimension, such as emotions. It is important that, in future studies, the focus on emotional aspects allows an approach that is not restricted to an accepted emotional conduct. It is necessary to dimension the real needs of nursing education and emotionally strengthen students for the practice of nursing practice. 

In addition to the above, it is possible to add that the emotional condition and the development of socio-emotional skills are beyond academia, as they are influenced by the various dimensions of life. The development of socio-emotional competencies should be present in teaching since the basic cycle, constituting a curricular component which is developed gradually. The dimension of an emotionally competent training requires the compression and work of the other dimensions of students' lives, this highlights the need for a curricular restructuring of the initial training cycles (elementary and high school).

In short, the relevance of this study is to enable the development of support that contribute to reflections on the socio-emotional competences that reveal themselves to be part of the professional learning process, allowing the nurse's academic training to be re-signified.  In addition, it seeks to contribute so that the emotional experiences of nursing students are perceived and experienced as powerful devices of creativity/sensitivity, both of the student and of the patient, aiming to corroborate the foundation of their integration in the curricular programs of nursing courses from the beginning with an impact on the future practice of care.

REFERENCES

1. Padovani O, Corrêa AK. Currículo e formação do enfermeiro: desafios das universidades na atualidade. Saúde Transform Soc [Internet]. 2017 [Cited 2020 jun 25];8(2):112-119. Available from:  http://incubadora.periodicos.ufsc.br/index.php/saudeetransformacao/article/vie/3841   

2. Almeida HMDS, Benedito MHA, Ferreira BS. Quebrando tabus: os fatores que levam o suicídio entre universitários.  RPI - Rev Pesq Interdisc [Internet]. 2017 [Cited 2020 jun 25]];2(suplementar):647-659. Available from: http://revistas.ufcg.edu.br/cfp/index.php/pesquisainterdisciplinar/article/view/383 

3. Cremasco GS, Baptista MN.  Depressão, motivos para viver e o significado do suicídio em graduandos do curso de psicologia. Est Interdisc Psic [Internet]. 2017 [Cited 2020 jun 25]; 8(1): 22-37. Available from: http://pepsic.bvsalud.org/scielo.php?script=sci_abstract&pid=S223664072017000100003&lng=pt&nrm=iso  

4. Souza JJGC, Cavalcanti ATA, Monteiro EMLM, Silva MI. Como será o amanhã? Responda quem puder! Perspectivas de enfermeirandos quanto ao seu futuro profissional. Rev Bras Enferm [Internet]. 2013 [Cited 2020 jun 25]]; 56(4), 453-458. Disponível em: https://www.scielo.br/scielo.php?pid=S003471672003000400031&script=sci_abstract&tlng=pt 

5. Casassus J. Fundamentos da educação emocional. 1.ed. Brasília: Unesco/Liber; 2009.

6. Ferla, JBS. Ênfase nas relações interpessoais na formação do enfermeiro sob o paradigma ético-humanista.Trab Educ Saúde [Internet]. 2013 [Cited 2020 jun 25]; 11(3):633-657. Available from: https://www.scielo.br/scielo.php?pid=S198177462013000300010&script=sci_abstract&tlng=pt 

7. Lopes RCC, Azeredo ZAS, Rodrigues RMC. Competências relacionais: necessidades sentidas pelos estudantes de enfermagem. Rev Latino-Am  Enfermagem [Internet]. 2012 [Cited 2020 jun 25]; 20(6):1-10. Available from: https://www.scielo.br/scielo.php?pid=S010411692012000600010&script=sci_abstract&tlng=pt  [incluído na revisão]

8. Lima TO. A premência do desenvolvimento de competências socioemocionais na formação do enfermeiro: estudo sociopoético (Dissertação de Mestrado). Universidade Federal Fluminense, Rio de Janeiro, Brasil, 2017.

9. Mendes K, Silveira R, Galvão C. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm [Internet]. 2008 [Cited 2020 jun 25]; 17(4):758-764. Available from: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S010407072008000400018 

10.  Lima RCD, Galavote HS, Schwartz TD, Ramos MC, Prado TN, Maciel, ELN. Significando os sentidos da vida na formação dos profissionais de saúde: com a palavra os estudantes. Cogitare Enferm [Internet]. 2011 [Cited 2020 jun 25]; 16(1): 167-70. Available from: https://revistas.ufpr.br/cogitare/article/viewFile/21129/13955  [incluído na revisão]

11. Perbone JG, Carvalho EC. Sentimentos do estudante de enfermagem em seu primeiro contato com pacientes. Rev Bras Enferm [Internet]. 2011[Cited 2020 jun 25]; 64(2): 343-347. Available from: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S003471672011000200019  [incluída na revisão]

12. Carraro TE, Prado ML, Silva DGV, Radünz V, Kempfer SS, Sebold LF. Socialização como processo dinâmico de aprendizagem na enfermagem. Uma proposta na metodologia ativa. Invest Educ Enferm [Internet]. 2011 [Cited 2020 jun 25]; 29(2): 248-254. Available from: http://www.scielo.org.co/scielo.php?pid=S012053072011000200010&script=sci_abstract&tlng=pt   [incluída na revisão]

13. Pereira WR, Ribeiro MRR, Depes VBS, Santos NC. Competências emocionais no processo de ensinar e aprender em enfermagem na perspectiva das neurociências. Rev Latino-Am Enfermagem [Internet]. 2013 [Cited 2020 jun 25]; 21(3):1-7. Available from: https://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0663.pdf  [incluída na revisão]

14. Ferreira M, Duarte J, Cardoso AP, Cabral L, Guiné R, Campos S, Alves C. Competências emocionais e prevenção do abandono nos estudantes do ensino superior politécnico. Rev Port Enferm Saúde Mental [Internet]. 2018 [Cited 2020 jun 25]; (Spe. 6): 17-24. Available from: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164721602018000200003    [incluído na revisão]

15. Damásio A. E o cérebro criou o Homem. 1.ed. São Paulo: Companhia das Letras, 2011. 

16. Diogo P, Rodrigues J, Lemos SO, Martins H, Fernandes N. Supervisão de estudantes em ensino clínico: correlação entre desenvolvimento de competências emocionais e função de suporte. Rev Port Enferm Saúde Mental [Internet]. 2016 [Cited 2020 jun 25]; 115-122. Available from: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164721602016000400017  [incluída na revisão]

17. Smith P. The emotional labour of nursing revisited: Can nurses still care? 2 st Edition. Hampshire: Palgrave Macmilla, 2012.

18. Hochschild A. The managed hearth. Commercialization of human feeling. 1st Edition. Berkeley: University of California Press, 1983.

19. Rabiais I. Sensibilidade emocional dos estudantes de enfermagem na aprendizagem de cuidar. Emoções em saúde – Contributos [Internet]. 2010 [Cited 2020 jun 25];  36-53. Available from: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164721602016000400017  [incluída na revisão]

Received: 10/04/2020

Revised:12/04/2020

Approved:01/21/2021