University of Peloponnese Faculty of Human Movement & Quality of Life Sciences Department of Nursing
National & Kapodistrian University of Athens. Faculty of Nursing Department of Public Health Laboratory: Community Health Nursing
Nursing as Emotional Labour: A specialised pedagogical approach as the new challenge and innovative educational intervention for health promotion Εvangelia Loukidou1, Vassiliki Ioannidi2, Athena Kalokerinou-Anagnostopoulou3 PhD Organizational Behaviour, Loughborough University UK, ΜSc Organization Studies, Warwick University UK. E-mail:
[email protected] ² PhD School of Philosophy, National and Kapodistrian University of Athens. Teaching Staff, Department of Nursing, University of Peloponnese. E-mail:
[email protected] 3
PhD, Assistant Professor of Nursing, Nursing Department, University of Athens, Hellas. E-mail:
[email protected]
What is emotional labour? Emotional labour (Hochschild, 1983) refers to the display of socially desired emotions during work encounters. The basic characteristics of emotional labour are three: 1. the face-to-face or voice contact between employees and clients· 2. the expression of specific emotions and attitudes during work that might be in contrast with the real feelings that the individual experiences· 3. the display rules derive from three main sources: a) training programs for a particular profession, b) organizational norms of work behaviour, c) social stereotypes of behaviour for certain occupational categories. Nursing as emotional labour There are two elements that constitute nursing as one of the occupational categories high in emotional labour (Hochschild, 1983· Bolton, 2001): A. The social representations of nurses, B. The constant management and suppression of real feelings A. Stereotypes of nursing It has been identified by several theorists (Leidner, 1991· James, 1992) that a common social representation is the nurse who is caring, sympathetic, loving and involved with patients. For some academics such public views of the nursing role not only are acceptable but have come to determine the essence of nursing (Mackintosh, 2000). Showing commitment, supporting patients emotionally and sympathising with them are part of the emotional role that nurses have to perform (Shannon, 1991). The existence of such stereotypes has led to the characterization of nurses as “emotional jugglers” (Bolton, 2001, p. 97). B. Suppression of authentic feelings 1 2
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Being responsible for patients’ hygiene is a basic nursing duty that demands the suppression of feelings of disgust and therefore constitutes an emotional act (Meerabeau, 2004). Nurses must hide their repulsion or disgust, in order to be able to carry out such tasks and to express at the same time a caring “face”. Another basic nursing duty is providing emotional support to patients (Shannon, 1991). Dealing with terminal diseases and intolerable pain requires effective management of personal emotions and the mobilization of appropriate defence mechanisms in order for nurses to beneficially attend patients. Nurses have to manage their emotions when there is incongruence between their professional ethical standards and the organizational demands that often obstruct nursing work (Jameton, 1984).
Effects of emotional labour on nurses • One of the prominent reasons for nurses’ stress was the display of a “caring” face (McVicar, 2003). • Emotional labour may also affect employees’ somatic health. Continuous suppression of “real” emotions has a negative impact on the immune system, with further implications on health, that range from sleeplessness and fatigue to hypertension and cancer (Ashkanasy, 2001). • The emotional dissonance between real and displayed emotions may influence negatively other aspects of employees’ well-being, such as self-esteem, alienation, cynicism, depression and moral distress (Raines, 2000). • Emotional labour may also affect employees’ performance. Low involvement, dissatisfaction, low performance and high withdrawal intentions are among the various outcomes of performing emotional tasks (Cigantesco et al., 2003). Health promotion for nursing staff Need to address these questions: 1. How can we have a healthier nursing workforce? 2. What is the best approach to deal with the emotional hurdles of nursing work? The key concepts that answer the above questions are two: acting before the problem occurs (prevention) and teaching nursing students about the practical and emotional aspects of their future work (empowerment). The role of nursing educational institutions becomes crucial in the development of a workforce that not only will be aware of the informal emotional skills necessary in practice but will also know how to use them effectively for his/her personal benefit as well as for the benefit of patients. Pedagogical prerequisites in nursing education: Specialised educational intervention as a health promotion challenge An initial strategic action involves the re-definition of nursing education in relation to its values, aims and practices. In order to do that, we suggest the following principles, upon which nursing schools could operate3: • Promote critical thinking and encourage students to evaluate their personal attitudes and behaviours in order to allow and help them (students) to explore their interests, abilities, difficulties (Forneris & Peden-McAlpine, 2006). • Focus on teaching ethical codes of clinical practice, decision-making and health care (Ioannidi, 2008). • Promote/Increase students’ clinical practice in order to help them understand more fully their future professional role, through a nursing curriculum that: includes problem-solving/ problembased learning (Drosos & Dimoliatis, 2005, p. 614) in relation to specific problems that students encounter during their practice, incorporates teaching of project management techniques based on real work situations (Higuchi et al., 2006), employs role playing in the class (McLaughlin et al., 2006) and story-telling as a method to transfer experiences and enhance tacit knowledge (Cangelosi & Whitt, 2006). 3
See Ioannidi, V., Vasileiou, Μ., Καlokerinou, A. (3-5 Αpril 2009). Presentation: Health and social behaviour: The example of bullying. Focusing on pedagogical intervention. “Health and Society Conference”. Cyprus Sociology Association and the University of Nicosia, Cyprus (www.sociology.org.cy).
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In specific, nursing education should be based on the following criteria and aims: • Application of modern teaching methods in which learning is achieved through team-working and cooperation (Kotzampasaki, 2006). In this way, students learn to seek support from their peers, a skill that can be transferred in the work setting. Hence, the adverse effects of emotional labour could be diminished by teaching student nurses to benefit from their professional network. • Incorporation of health promotion principles in order to modernise the profile of nurse educators (Dermitzakis & Ioannidi, 2004). • Expansion of the roles of nursing educators, such as that of coach, mentor and mediator between practice and theory (Kapsalis & Papastamatis, 2006). Conclusions There is a need to make “emotional labour visible and valued and counter the potential for ignoring and exploiting staff and patients’ emotional needs” (Smith & Gray, 2001, p. 236). In order to limit the effects of emotional labour and thus promote the health of the nursing workforce, the application of preventive strategies is a vital and cost-effective (in comparison to treatment) measure. Academic institutions can equip nursing students, through specific educational techniques and actions, with the necessary skills and practical knowledge that will help them manage the emotional aspect of nursing work, communicate to them a clearer and more practical-based nursing role and teach them to adopt more holistic approaches in the provision of health care.
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