Applied Nursing Research 28 (2015) 293298

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Applied Nursing Research

journal homepage: www.elsevier.com/locate/apnr

Original Article

Impact of emotional intelligence and spiritual intelligence on the caring

behavior of nurses: a dimension-level exploratory study among public
hospitals in Malaysia
Devinder Kaur, PhD a, Murali Sambasivan, PhD b,, Naresh Kumar, PhD c
a
b
c

Asia Pacic University of Technology and Innovation, Bukit Jalil, Malaysia

Taylors Business School, Taylors University Lakeside Campus, Subang Jaya, Malaysia
Global Entrepreneurship Research and Innovation Center, Universiti Malaysia Kelantan, Kelantan, Malaysia

a r t i c l e

i n f o

Article history:
Received 26 July 2014
Revised 25 December 2014
Accepted 7 January 2015
Available online xxxx
Keywords:
Emotional intelligence
Spiritual intelligence
Caring behavior
Nurses
Malaysia

a b s t r a c t
Purpose: The purpose of this research is to study the impact of individual factors such as emotional intelligence
(EI) and spiritual intelligence (SI) on the caring behavior of nurses.
Methods: A cross-sectional survey using questionnaire was conducted by sampling 550 nurses working in seven
major public hospitals in Malaysia. Data were analyzed using structural equation modeling (SEM).
Results: The main ndings are: (1) critical existential thinking and transcendental awareness dimensions of SI
have signicant impacts on assurance of human presence dimension of caring behavior; (2) personal meaning
production and conscious state expansion dimensions of SI have signicant impacts on perception of emotion
and managing own emotions dimensions of EI; and (3) managing own emotions dimension of EI has signicant
impacts on respectful deference to other and assurance of human presence dimensions of caring behavior
of nurses.
Conclusion: The results can be used to recruit and educate nurses.
2015 Elsevier Inc. All rights reserved.

1. Introduction
Nurses are among one of the largest groups of health care providers.
As pivotal gures in patient care who interact with patients more
frequently than other health care providers, nurses have a major caring
role (Khademian & Vizeshfar, 2008). Nurses spend more time with
hospitalized patients than do other groups of health care providers
and therefore have a signicant impact on patients' perceptions about
their hospital experience. They are present 24 hours a day, 7 days a
week regardless of the physical setting in a hospital (Nussbaum,
2003). Therefore, caring behavior of nurses contributes to the patients'
satisfaction, well-being and subsequently to the performance of the
healthcare organizations.
Literature suggests that (1) antecedents of caring behavior have not
been identied and investigated extensively (Kaur, Sambasivan, &
Kumar, 2013; Rego, Godinho, McQueen, & Cunha, 2010) and (2) individual factors have a telling effect on the work outcomes (Kaur et al.,
2013). This study considers emotional intelligence (EI) and spiritual
intelligence (SI) as two important individual factors that affect caring
behavior of nurses. Greenhalgh, Vanhanen, and Kyngas (1998) denes
caring behaviors as acts, conduct and mannerisms enacted by professional nurses that convey concern, safety and attention to the patient
Corresponding author. Tel.: +60 129350065.
E-mail address: Sambasivan@hotmail.com (M. Sambasivan).

(p. 928). The dimensions of caring behavior are: (i) respectful deference
to other (RDO), (ii) assurance of human presence (AHP), (iii) positive
connectedness (PC), and (iv) professional skill and knowledge (PSK)
(Wu, Larrabee, & Putman, 2006).
Emotional intelligence is a key component of competent nursing
practice (Akerjordet & Severinsson, 2007; Warelow & Edward, 2007)
and it enables a nurse to think and function in a constructive and
rational way in the clinical setting (Akerjordet & Severinsson, 2007;
Kaur et al., 2013). Sumner and Townsend-Rocchiccioli (2003) have
asserted that the ability to effectively manage one's own and others'
emotions is critical to the provision of excellent patient care. Therefore,
EI can have a signicant impact on the caring behaviors of nurses.
Despite the theoretical support, empirical studies that link the concept
of EI and caring behaviors are scarce (Akerjordet & Severinsson, 2007;
Kaur et al., 2013; Rego et al., 2010).
Spirituality is seen as an inherent aspect of human nature and is
considered as the source of all thoughts, feelings, values and behaviors
of individuals (Hosseini, Elias, Krauss, & Aishah, 2010). The concept of
spirituality is important and forms the basis of nursing actions (Van
Leeuwen & Cusveller, 2004). However, very few empirical studies
have provided supporting evidence that spirituality is correlated with
the caring behaviors of nurses (Kaur et al., 2013). In this research, SI is
dened as as a set of mental capacities which contribute to the
awareness, integration, and adaptive application of the nonmaterial
and transcendent aspects of one's existence, leading to such outcomes

http://dx.doi.org/10.1016/j.apnr.2015.01.006
0897-1897/ 2015 Elsevier Inc. All rights reserved.

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D. Kaur et al. / Applied Nursing Research 28 (2015) 293298

as deep existential reection, enhancement of meaning, recognition of a

transcendent self, and mastery of spiritual states (King & DeCicco,
2009: p. 69).
The contributions of this research are twofold. First, this study
extends existing research about EI and SI and is one of the very few
studies that empirically examine the inuence of dimensions of SI on
the dimensions of EI. The results can enrich the theories related to EI
and SI. An earlier study by Rego et al. (2010) has studied the impact of
dimensions of EI on caring behavior of nurses. A recent study by Kaur
et al. (2013) has studied the impact of SI, EI, burnout, and psychological
ownership on the caring behavior of nurses. However, the authors have
studied the relationships at the construct level. This research analyzes
(1) the impact of the dimensions of EI and SI on the dimensions of caring
behavior of nurses and (2) inter-relationships between the dimensions
of EI and SI. Second, this research has been carried out in a fast developing country in South-east Asia, Malaysia. Specically, the samples were
taken from seven large public hospitals. Studies from this part of the
world are a rarity.
2. Hypotheses development
2.1. SI and EI
Many researchers have argued SI as a core ability that penetrates
into and guides other abilities (Ronel, 2008). Specically, some authors
have asserted that SI inuences EI (Hosseini et al., 2010; Zohar &
Marshall, 2000). The four dimensions of SI (King & DeCicco, 2009) are:
(i) critical existential thinking (CET), (ii) personal meaning production
(PMP), (iii) transcendental awareness (TA), and (iv) conscious state
expansion (CSE). The four dimensions of EI (Schutte et al., 1998) are:
(i) perception of emotion (PE), (ii) managing one's own emotions
(ME), (iii) managing other's emotions (MOE), and (iv) utilization of
emotion (UE). Based on the denitions by King and DeCicco (2009:
p. 70), it is argued that CET (capacity to critically contemplate meaning,
purpose and existential issues), PMP (ability to construct personal
meaning and purpose in all experiences), TA (capacity to perceive
transcendent dimensions of the self, others and of the physical world)
and CSE (ability to enter spiritual states of consciousness at one's own
discretion) help nurses understand and manage their own and other's
emotions and utilize them in a manner that benets the patients.
Therefore, the hypothesis is as follows:
H1. SI and its dimensions have positive relationships with EI and
its dimensions
2.2. SI and caring behavior of nurses
According to Kaur et al. (2013), spirituality and nursing have been
linked since the origins of the nursing profession (p. 3194). The nature
of nursing profession is such that the nurses are constantly bombarded
by stressors at work and the environment. When stressors are at work it
has been shown that the dimensions of SI can help reduce the negative
impact of the stressors (King & DeCicco, 2009). This in turn helps nurses
provide better care to the patients. Therefore, it is argued that SI and its
dimensions have a positive impact on the caring behavior of nurses and
the hypothesis is as follows:
H2. SI and its dimensions have positive relationships with caring
behavior of nurses and its dimensions.
2.3. EI and caring behavior of nurses
According to Rego et al. (2010), researchers have suggested that
EI is crucial for building, nourishing, and sustaining the emotionally demanding labor that nurses are required to carry out in their interactions
with patients (p. 1421). Therefore, nurses with high levels of EI can

provide better care to the patients (Akerjordet & Severinsson, 2007).

These arguments lead to the following hypothesis:
H3. EI and its dimensions have positive relationships with caring
behavior of nurses and its dimensions.

3. Method
Seven large public hospitals located in and around Kuala Lumpur,
capital of Malaysia were chosen for the study. These hospitals have a
total capacity of 6194 beds and employed 7446 nurses in different departments such as general surgical, general medical, pediatrics, obstetrics and gynecology, and orthopedics. A questionnaire was designed
that captured the demographic characteristics of nurses, three constructs (SI, EI, and caring behavior of nurses) and their dimensions. A
sample of 550 was selected at random from the seven public hospitals
in different departments and the questionnaires were distributed
through head nurses.
The permission to conduct the study was obtained from the Ethics
and Research Committee of Ministry of Health (Malaysia) to conduct
the study. The letter from the ministry helped the researchers gain
access to the hospitals. The nurses were told that they were under no
obligation to participate in the study and they contributed to the
study of their own volition.

3.1. Measures
The questionnaire designed for the study consisted of four sections
to capture the three constructs and the demographic information. The
questionnaire items were made available in English and Bahasa
Malaysia (national language of Malaysia). The back-to-back translations
were checked by the experts and subsequently by the Ethics and Research Committee of Ministry of Health. Section One captured EI, and
the scale with 33 items developed by Schutte et al. (1998) [Schutte
Self-Report Emotional Intelligence Test (SSEIT)] was adopted in this
study. Section Two captured SI, and the scale with 24 items developed
by King and DeCicco (2009) [Spiritual Intelligence Self-Report Inventory
(SISRI)] was adopted in this study. Section Three captured caring behaviors of nurses, and the scale with 24 items developed by Wu et al.
(2006) was adopted in this research. Section Four captured the demographic data. Besides, this study also captured the patient satisfaction
with overall nursing care to validate the ndings on the nurses' own
perception of their caring behaviors. This scale contained three items
and was adopted from the study by Otani, Waterman, Faulknew,
Boslaugh, and Dunagan (2010). Written permissions were obtained
from all the authors before using their scales.

3.2. Handling common method bias

According to Podsakoff, MacKenzie, Lee, and Podsakoff (2003),
common method bias is the bias that is attributable to the measurement method rather than to the constructs the measures represent (p. 879). Our research obtained responses on SI, EI and caring
behavior from one source, namely nurses. Seeking responses from
one source can potentially introduce error in the form of bias in
our results (Conway & Lance, 2010). Therefore, we used Herman
one-factor method to assess if common method bias is a cause of
concern in our research. We loaded all the items (33 items of EI,
24 items of SI, and 24 items of caring behavior) on a common factor
using Exploratory Factor Analysis and observed that the total
variance explained was 18.4%. This is less than the maximum 50%
suggested by Podsakoff et al. (2003) and therefore, we conclude
that the effect due to common method bias is not signicant.

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D. Kaur et al. / Applied Nursing Research 28 (2015) 293298

4. Results
A total of 550 questionnaires were distributed and 487 were received. A total of 448 responses (38 questionnaires were incomplete
and one returned without answering) were deemed usable and the effective response rate was 81.5%. The reliability test was performed
(Cronbach's alpha) using SPSS and the validity test (conrmatory factor
analysisCFA) using Lisrel 9.01 (student version) and the results
are: (1) Cronbach alpha scores EI = 0.89, SI = 0.92 and caring
behavior = 0.92; (2) Fit statistics for CFAroot mean square error of
approximation (RMSEA) = 0.0399 (threshold maximum = 0.08), chisquare/degrees of freedom = 1.712 (threshold maximum = 3),
normed t index (NFI) = 0.984 (threshold minimum = 0.9), comparative t index (CFI) = 0.993 (threshold minimum = 0.9), goodness of t
index (GFI) = 0.971 (threshold minimum = 0.9), and root mean square
residual (RMR) = 0.0287 (threshold maximum = 0.08). Based on
the results of CFA, convergent and discriminant validity tests were
performed as specied by Hair, Black, Babin, and Anderson (2010).
The results of these tests are given in Table 1 and the results indicate
that the reliability and validity test results are good. The mean, standard
deviation, and the correlation values between the dimensions of SI, EI,
and caring behavior are given in Table 2.
The salient features of demographic information are: majority of
nurses are women (about 98%), average age of nurses is 34.5 years,
and average work experience is 10 years. The salient features of the
descriptive statistics are: moderate level of SI dimensions [mean CET
(critical existential thinking) = 3.36, mean PMP (personal meaning
production) = 3.67, mean TA (transcendental awareness) = 3.60, and
mean CSE (conscious state expansion) = 3.51], moderate to high level
of dimensions of EI [mean PE (perception of emotion) = 3.70, mean
ME (managing own emotions) = 4.09, mean MOE (managing others
emotions) = 3.74, and mean UE (utilizing emotions) = 3.88] and
high level of dimensions of caring behavior [mean RDO (respectful deference to others) = 4.25, mean AHP (assurance of human presence) =
4.23, mean PC (positive connectedness = 4.04, and mean PSK (professional skill and knowledge) = 4.39]. The data on patient satisfaction
(data collected from 348 patients) indicate that 90% of the patients are
satised with the care provided by the nurses, 80% are willing to return
if needed, and 78% are willing to recommend public hospitals to others
(Kaur et al., 2013). These data were collected to validate the nurses' own
perception of their caring behavior.
The hypotheses were tested using Structural Equation Modeling
(SEM) software, Lisrel 9.1. The nal framework with signicant relationships and t statistics are given in Fig. 1. Many interesting ndings
have emerged from this analysis. First, hypothesis H1 is supported. Of
the four dimensions of SI, three dimensions have signicant positive relationships with two dimensions of EI. Personal meaning production
(PMP) ( = 0.231, p = 0.002) and CSE (conscious state expansion)
( = 0.234, p = 0.000) of SI are positively correlated with PE (perception of emotion) dimension of EI. Personal meaning production (PMP)
( = 0.430, p = 0.000) and TA (transcendental awareness) ( =
0.147, p = 0.008) are found to be correlated with ME (managing
own emotions) dimension of EI.

295

Second, hypothesis H2 is supported. Of the four dimensions of SI,

only two dimensions correlate signicantly with one dimension of caring behavior. Critical existential thinking (CET) correlates negatively
( = 0.130, p = 0.004) and TA (transcendental awareness) correlates
positively ( = 0.176, p = 0.000) with AHP (assurance of human presence) dimension of caring behavior. Third, hypothesis H3 is supported.
Of the four dimensions of EI, only one dimension has a direct impact
on two dimensions of caring behavior. Managing own emotions (ME)
has positive correlations with RDO (respectful deference to others)
( = 0.277, p = 0.000) and AHP (assurance of human presence)
( = 0.102, p = 0.004).
Besides testing the hypotheses, the inter-relationships between the
dimensions of each construct were tested. These tests have revealed
some interesting results. First, among the dimensions of EI, (1) PE (perception of emotion) is positively correlated to ME (managing own emotion) ( = 0.446, p = 0.000), MOE (managing other's emotions) ( =
0.256, p = 0.000) and UE (utilizing emotions) ( = 0.174, p = 0.000),
(2) ME is positively correlated to MOE ( = 0.472, p = 0.000) and UE
( = 0.401, p = 0.000), and (3) MOE is positively correlated with UE
( = 0.221, p = 0.000). Second, among the dimensions of caring behavior of nurses, (1) RDO (respectful deference to others) is positively correlated to AHP (assurance of human presence) ( = 0.670, p = 0.000),
PC (positive connectedness) ( = 0.442, p = 0.000), and PSK (professional skill and knowledge) ( = 0.277, p = 0.000) and (2) AHP is positively correlated to PC ( = 0.262, p = 0.000) and PSK ( = 0.443, p =
0.000). These results indicate that studying the inter-relationships between the dimensions of constructs EI and caring behavior can help the
researchers understand these constructs and their dimensions better.
The impact of nurse's duration of experience on the dimensions of EI,
SI, and caring behavior was also studied. The age and duration of
experience were strongly correlated ( = 0.907, p = 0.000). Therefore,
duration of experience was chosen to be included in the SEM model.
The results indicate that experience has a positive impact on all the
dimensions of SI, on two dimensions of EI (managing other's emotions
and utilizing emotions), and one dimension of caring behavior (respectful deference to others).

5. Discussion
This research set out to answer a fundamental question: What are
the individual constructs (and their dimensions) that inuence the
work related outcome (caring behavior and its dimensions) of nurses?
This study has deviated from the earlier studies (Kaur et al., 2013;
Rego et al., 2010) by studying (1) the relationships between the dimensions of SI (spiritual intelligence), EI (emotional intelligence), and caring
behavior and (2) the inter-relationships between the dimensions of
each construct. For example, the research by Kaur et al. (2013) considered the relationships between SI, EI and the caring behavior at the
construct level and found that (i) SI inuenced EI and (ii) EI inuenced
caring behavior of nurses. In order to justify the need for a dimensionlevel study, an analysis of the structural model was made at the construct level and it was found that: (1) SI had a positive relationship

Table 1
Results of reliability and CFA (conrmatory factor analysis).
Variable

No. of items/dimensions

Cronbach alpha/CR/AVE (N = 448)

Validity (CFA)a

Emotional intelligence
Spiritual intelligence
Caring behaviors

33/4
24/4
24/4

.89/.84/.57
.92/.91/.72
.92/.91/.72

Factor loading: min0.684, max0.825

Factor loading: min0.773, max0.900
Factor loading: min0.668, max0.860

Model t statistics: 2/df1.71 (p-value0.87), RMSEA = 0.040, RMR = 0.029, GFI = 0.97, NFI0.98, CFI0.99.
Legend: 2chi-square value, dfdegrees of freedom, RMSEAroot mean square error approximation (must be b0.08), RMRroot mean square residual (must be b0.08), GFIgoodness
of t index (must be N0.9), NFInormed t index (must be N0.9), CFIcomparative t index (must be N0.9).
a
CFA (conrmatory factor analysis) was done using LISREL 9.01 student version. Analysis was done at the construct-dimension level; CRcomposite reliability; AVEaverage variance
extracted.

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D. Kaur et al. / Applied Nursing Research 28 (2015) 293298

Table 2
Descriptive statistics and correlation values.
Correlation values
Dimension

Mean

SD

EI1

EI2

EI3

EI4

SI1

SI2

SI3

SI4

CB1

CB2

CB3

CB4

EI1
EI2
EI3
EI4
SI1
SI2
SI3
SI4
CB1
CB2
CB3
CB4

3.70
4.09
3.73
3.88
3.36
3.67
3.60
3.51
4.25
4.23
4.04
4.39

0.38
0.37
0.39
0.43
0.60
0.55
0.46
0.57
0.45
0.50
0.53
0.48

1.00
0.561
0.521
0.514
0.334
0.393
0.368
0.398
0.152
0.168
0.176
0.227

1.00
0.616
0.635
0.303
0.495
0.340
0.407
0.277
0.308
0.247
0.319

1.00
0.559
0.363
0.470
0.389
0.436
0.228
0.210
0.207
0.251

1.00
0.339
0.420
0.377
0.394
0.189
0.219
0.197
0.224

1.00
0.647
0.694
0.679
0.155
0.127
0.184
0.103

1.00
0.751
0.768
0.203
0.245
0.186
0.221

1.00
0.727
0.189
0.247
0.207
0.197

1.00
0.169
0.219
0.202
0.178

1.00
0.711
0.628
0.665

1.00
0.576
0.692

1.00
0.531

1.00

(All correlations are signicant at 0.05 signicance level).

Legend: EI1perception of emotion (PE), EI2managing own emotions (ME), EI3managing others' emotions (MOE), EI4utilizing emotions (UE), SI1critical existential thinking
(CET), SI2personal meaning production (PMP), SI3transcendental awareness (TA), SI4conscious state expansion (CSE), CB1respectful deference to others (RDO), CB2assurance
of human presence (AHP), CB3positive connectedness (PC), CB4professional skill and knowledge (PSK).

exp
0.446

0.256

0.174

0.472

0.401
0.221

EI3

EI2

EI1

0.200
0.105 0.106

EI4

0.277
CB1

0.102
CB2
0.231

0.430

-0.147

0.670

0.234
0.176

0.262
CB3

-0.130

0.442

CB3
SI2

SI1

0.443

SI4

SI3

CB4
0.717

0.803

0.793

0.277

0.798

exp

Legend: EI1 perception of emotion (PE), EI2 managing own emotions (ME), EI3 managing others emotions
(MOE), EI4 utilizing emotions (UE), SI1 critical existential thinking (CET), SI2 personal meaning production
(PMP), SI3 transcendental awareness (TA), SI4 conscious state expansion (CSE), CB1 respectful deference to
others (RDO), CB2 assurance of human presence (AHP), CB3 positive connectedness (PC), CB4 professional
skill and knowledge (PSK), exp experience.
Model fit statistics: Chi-square/df = 2.39, RMSEA = 0.0556, NFI = 0.976, CFI = 0.986, GFI = 0.972, RMR =
0.0684.
Fig. 1. Research framework (with signicant relationships).

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D. Kaur et al. / Applied Nursing Research 28 (2015) 293298

with EI ( = 0.617, p = 0.000), (2) EI had a positive relationship with

caring behavior ( = 0.333, p = 0.000), and (3) there was no signicant
relationship between SI and caring behavior ( = 0.077, p = 0.255).
However, the analysis at the dimension level shows that two dimensions of SI [CET (critical existential thinking) and TA (transcendental
awareness)] have signicant relationship with AHP (assurance of
human presence) dimension of caring behavior with CET having a
negative relationship and TA having a positive relationship. Therefore,
a study at the dimension level is as important as a study at the construct
level (Wong, Law, & Huang, 2008) to understand the complete effects.
The important ndings of this study are given in the following sections.
5.1. Impact of dimensions of SI
Critical existential thinking (CET) has a negative inuence on the
AHP (assurance of human presence) dimension of caring behavior.
At this point, it is useful to recap the characteristics of CET. It involves
the capacity to critically contemplate meaning, purpose and other
existential or metaphysical issues (e.g. reality, the universe, space,
time, death) (Zohar & Marshall, 2000). The critical contemplation may
require an individual to be alone (away from the presence of others).
It is plausible that nurses experiencing this dimension of SI may spend
less time with the patients and therefore, a negative relationship
between CET and AHP is justied.
Personal meaning production (PMP) dimension of SI has a strong
inuence on PE (perception of emotion) and ME (managing own emotions) dimensions of EI. The nding suggests that nurses that have the
ability to construct a purpose in life and have a sense of direction,
a sense of order and a reason for existence are in a better position to
understand and manage their emotions effectively (Reker, 1997).
The inter-relationships between the dimensions of EI suggest that
nurses who can handle their own emotions are in a better position to
handle others' emotions and utilize them to their own and the patients'
benets. According to Akerjordet and Severinsson (2007), the ability of
nurses to identify, handle and manage emotions implies important
personal and interpersonal skills in nurses' therapeutic use of self,
critical reection and stimulates the search for a deeper understanding
of professional nursing identity.
Transcendental awareness (TA) dimension of SI has a negative inuence on ME (managing own emotions) dimension of EI and a positive
inuence on AHP (assurance of human presence) dimension of caring
behavior. It involves the capacity to perceive transcendent dimensions
of the self, of others and of the physical world during normal states of
consciousness (Mayer, 2000). This study reveals that this dimension is
a double-edged sword. TA brings down the nurse's ability to manage
own emotions but helps in talking, appreciating and quickly responding
to the patients' needs. The negative correlation between TA and ME is
interesting. Transcendental awareness (TA) involves temporarily
disconnecting from physicality, and feeling or experiencing a sense of
union or oneness with humanity, the universe or a higher power
(Mayer, 2000). This disconnection may lead to a situation whereby an
individual may not be able to manage his/her own emotions effectively.
Conscious state expansion (CSE) dimension of SI has a positive inuence on PE (perception of emotion) dimension of EI. It refers to an
individual's ability to enter into higher or spiritual state of consciousness. This state helps an individual's mind to be in meditative and
relaxed mode (King & DeCicco, 2009). When the mind is relaxed, the
ability of nurses to appraise emotions accurately and discriminate
between accurate and inaccurate feelings increases signicantly
(Mayer, Salovey, & Caruso, 2004). Therefore, it is logical to observe a
positive relationship between CSE and PE.
The ability of the nurses (1) to construct personal meaning and purpose in all physical and mental experiences and (2) to enter spiritual
states of consciousness (e.g. pure consciousness, cosmic consciousness,
unity, oneness) at one's own discretion (as in deep reection, meditation, prayer, etc.) can help them accurately assess their own emotions,

297

recognize the feelings of others, and manage the emotions effectively.

In fact, this capability of nurses is critical to provide effective care to
patients (Kaur et al., 2013).
5.2. Impact of dimensions of EI
As indicated earlier, of all the dimensions, ME (managing own emotions) plays a major role in inuencing RDO (respectful deference to
others) and AHP (assurance of human presence) dimensions of caring
behavior. Besides, this study indicates that each dimension of EI has a
cascading effect on the other dimensions of EI with PE (perception of
emotion) being the main driver. Assuming that a nurse has a right
perception of emotion, how well he/she performs in his/her job is
dependent on how well he/she manages own emotions. This in turn
will have a profound impact on managing other's emotions and utilizing
emotions. This study reveals that a nurse's ability to handle her own
emotions plays a crucial role in (1) caring activities such as being
honest, showing respect and giving information to the patient to make
decisions and (2) providing hope to the patients.
How can the results of this study be used to recruit and educate the
nurses? According to Kaur et al. (2013), the importance of spirituality
in nursing has resulted in the emergence of a body of literature that discusses the role of education in meeting the spiritual needs of rst the
nurses and then their care recipients (p. 3199). A spiritual care education model for nurses has been developed by Narayanasamy (2006).
Therefore, the nursing curricula must include the element of spirituality.
According to Cadman and Brewer (2001), EI is a vital prerequisite for
recruitment in nursing. Nursing is considered to be a signicant therapeutic interpersonal process and therefore, nurses have to be adept at
handling their own and others' emotions. Therefore, nurse educators
must develop assessment strategies that will identify EI during recruitment because EI cannot be developed quickly enough through interpersonal skills training (Cadman & Brewer, 2001). Once the right
candidates for student-nurses are recruited, then proper education to
develop their EI and SI can be provided. This study has clearly demonstrated the positive role of experience of nurses (time duration). The
experience of nurses guides their SI (all four dimensions), EI (managing
other's emotions and utilizing emotions), and caring behavior of
nurses (respectful deference to others). The managers of hospitals can
appoint senior nurses as mentors to junior nurses. The mentormentee
relationship can help junior nurses exhibit the right behavior towards
the patients.
6. Limitations and conclusions
This study has some limitations. First, the study has been carried out
only in a few departments in seven public hospitals in Malaysia. Therefore, generalization of results has to be exercised with caution. Second,
this study is a cross-sectional study. The causal relationships between
the variables cannot be empirically validated. Third, ideally, the
responses on the caring behavior of nurses must be obtained from the
patients the nurses are attached to. In this study, the caring behavior
of nurses is self-assessed. The caring behavior of nurses was indirectly
validated based on general level of patients' satisfaction level.
This research has improved on other studies by analyzing the relationships between EI, SI, and caring behavior at the dimension level.
The signicant ndings of this research are: (1) CET (critical existential
thinking) and TA (transcendental awareness) dimensions of SI have
signicant impacts on AHP (assurance of human presence) dimension
of caring behavior; (2) PMP (personal meaning production) and CSE
(conscious state expansion) dimensions of SI have signicant impacts
on PE (perception of emotion) and ME (managing own emotions)
dimensions of EI; and (3) ME dimension of EI has signicant impacts
on RDO (respectful deference to others) and AHP dimensions of caring
behavior of nurses.

Please cite this article as: Kaur, D., et al., Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimensionlevel exploratory study ..., Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.006

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Please cite this article as: Kaur, D., et al., Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: a dimensionlevel exploratory study ..., Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.006