Social intelligence, empathy, and self-esteem among undergraduate nursing students: a correlational study

E. Thorndike introduced SI as the ability of an individual to relate to others, recognize social situations, correctly interpret them, and react accordingly. According to Goleman¹ SI can be defined as (1) social awareness (SA), which comprises primal empathy, atonement, empathic accuracy, and social cognition, and (2) social facility, which includes synchrony, self-presentation, influence, and concern. It allows an individual to successfully build and manage interpersonal relationships, navigate social environments, and play appropriate social roles.² SI can be learned and improved through practice by being more aware of self and social environment, and by being empathetic toward others.³ As a domain of work readiness, SI skills are also necessary for the successful transition of graduate students into the workplace.⁴

In a healthcare setting, SI and empathy can be considered essential skills, as they are closely linked to nurses’ ability to successfully build a therapeutic nurse-patient relationship. Empathy can be defined as “an individual’s ability to understand and share the feelings of others,”⁵ which helps to form positive bonds between individuals and strengthens interpersonal relationships.⁶ It allows nurses to tune into the patients’ emotions, which often goes beyond spoken words. Being able to understand others, knowing community norms, understanding complex social situations, and being competent in managing people are vital in nursing. Thus, appropriate expressions of empathy can build patient trust, calm anxiety, and improve overall health outcomes.

Although there is convincing evidence that empathy plays an important role in patient care, the literature suggests that current-generation students in medical services not only show less empathy but also fail to recognize the significance of empathy.⁷ However, previous studies conducted among nursing students have shown positive results, i.e., nursing students were found to have an acceptable level of empathy.^8,9 The available literature also shows that sociodemographic and academic factors, year of study, future career preference, personality traits, sense of power, stress, and burnout may affect a student’s empathy.¹⁰

Empathy is also very closely related to self-esteem, i.e., when individuals react empathetically to others, they often boost their self-esteem in the process.¹¹ The term self-esteem was first coined by James in 1984 which refers to the contentment or satisfaction individuals have with their characteristics, emotions, thoughts, and status.² A descriptive survey finding by Kim¹² shows that empathy has a positive and significant correlation with self-esteem, interpersonal relationships, and self-efficacy. It infers that empathy may also impact self-esteem, self-efficacy, and better interpersonal relationships of an individual, and vice-versa.

Self-esteem begins developing in adolescence and evolves through middle age. It is an essential quality students must have as it helps them take failure in their stride. A healthy level of self-esteem allows one to view the situation positively and learn from their mistakes. Individuals with a greater level of self-esteem have been shown to have better well-being,¹³ be more socialized,¹⁴ manage stress effectively,¹⁵ be more attentive and be more willing to help others.¹⁶ Previous studies have also reported that nursing students have a higher level of stress and low self-esteem, which put them in a vulnerable position to develop serious mental illnesses such as anxiety and depression, impacting their academic performance¹⁷ and interpersonal relations.¹⁸

The current study has adapted King’s conceptual systems theory to examine the relationship between SI, empathy, and self-esteem among student nurses. It has been established in prior research that King’s conceptual system theory is a useful framework for analyzing the interactions and connections between the 3 systems that make up an individual: the personal, the interpersonal, and the social systems.¹⁹ According to the theory, each system is an open system with a unique set of characteristics and capabilities. The open systems interact and influence one another. The investigator assumes that student nurses may use SI, empathy, and self-esteem as tools to facilitate this interaction. The conceptual framework for the research is displayed in Figure 1.

Figure 1.

Conceptual framework adapted from King’s Conceptual Systems Theory.

The researchers felt the need to conduct this study because Social Intelligence (SI), empathy, and self-esteem are 3 essential attributes for nursing students that may also affect their performance, few research studies have been conducted on the relationship between them among nursing students. This research will provide valuable insight into understanding how the personal resources of nursing students, such as SI, empathy, and self-esteem are related to each other. The results of this research will also help in identifying the areas where student nurses may need additional support or training, which can be further used to develop effective training programs. Thus, the present correlational study aims to (a) assess the level of SI, empathy, and self-esteem among undergraduate nursing students, and (b) find the relationship between SI, empathy, and self-esteem among undergraduate nursing students at various nursing colleges.

This descriptive correlational study aims to determine the relationship between SI, empathy, and self-esteem among undergraduate nursing students.

The study was conducted in 4 nursing institutions of selected Taluk that provided permission to conduct the study. These institutions have various nursing programs, with students from different regions of the country.

The study was conducted among undergraduate (BSc) nursing students enrolled in different colleges in a selected district of a lower-middle-income country (LMIC). The sample size was estimated at 489 participants, based on a standard deviation (SD) of 10.3 (taken from the study findings of Chettri)²⁰, an absolute error of 1%, a 95% confidence interval, and a 20% attrition rate. The participants were selected using a complete enumerative sampling technique. During the data collection period, a total of 500 students were available at the selected study sites. Data were collected directly from the students on-site who were willing to participate in the study and were available during the data collection period. Invitations to participate in the study were also sent through Google Forms to approximately 200 students. The final sample consisted of 465 undergraduate nursing students, with a response rate of 93%.

The study included nursing students enrolled in BSc nursing programs at a selected district of an LMIC, and who consented to participate. Student nurses who were unavailable during the data collection period, and who did not provide consent were excluded from the study.

The data were collected from the participants between April and November 2021. The investigators explained the purpose of the study and obtained consent from each participant. The tools were administered to the consented participants in their classroom or sent to the participants in the Google form based on the institutional administrator’s request. Anonymity and confidentiality were maintained throughout the study.

Data were analyzed using IBM SPSS Statistics for Windows version 20 (Armonk, New York, The USA). Scores were calculated for each of the variables and expressed as means and SD. The Shapiro–Wilk test showed that the data were not normally distributed. Hence, non-parametric tests such as Kruskal–Wallis, Mann–Whitney U test, and Spearman’s Rho correlation were used to analyze the data and report the findings.

Permission was obtained from the Institutional Ethics Committee (IEC:01/2021). The study was also registered in the Clinical Trial Registry of India (CTRI/2021/04/032725). Permission from all the colleges of nursing administrators was also obtained. All the participants gave written informed consent.

The data were collected from 465 undergraduate nursing students (BSc Nursing Program). Table 1 shows that the majority (86.2%) of the participants were female students aged 18–21 years from the first year of the BSc nursing program (42.2%), belonging to nuclear (83.2%) Christian (63%) families living in rural areas (76.8%), and could speak 1–2 languages (72.9%). Most of the students’ parents (40% father and 31.8% mother) have secondary education.

The results show that most of the participants (52.7%) scored <4.38 ± 0.46, whereas 47.3% scored >4.38 ± 0.46 on the Tromso Social Intelligence Scale (TSIS). Table 2 displays the mean and SD of the subscales of the TSIS. The findings demonstrated that SIP (M = 36.07, SD = 6.2) was rated as the highest subscale followed by SS (M = 29.87, SD = 5.2) and SA (M = 26.03, SD = 6.25).

The findings from this study show that the mean empathy score among nursing students was 96.53, where the minimum score was 45, whereas the maximum was 134. It can be inferred that the student nurse’s empathy was at an acceptable level.

The results show that most of the students (88.2%) had a high level of self-esteem, whereas 11.8% had healthy self-esteem.

The data presented in Table 3 show that there was a statistically significant difference in SI between different years of study, H (3) = 14.179, P = 0.003, with a mean rank of 225.25, 261.69, 203.52, and 271.30 for the first, second, third, and fourth-year undergraduate nursing students, respectively. The data also showed a statistically significant difference in empathy and different years of study among the nursing students, H (3) = 18.422, P = 0.001 with a mean rank of 217.90, 270.73, 207.30, and 265.22 for first, second, third, and fourth-year undergraduate nursing students respectively. Additionally, a statistically significant difference was observed in self-esteem and years of study among the nursing students, H (3) = 19.148, P = 0.001, with a mean rank of 202.56 for year 1, 264.85 for year 2, 243.69 for year 3, and 255.50 for year 4.

There was no association found between gender, SI, empathy, and self-esteem, as shown in Table 4. It can be inferred that the skills of SI, empathy, and self-esteem are not dependent on the gender of an individual.

The SS subscale of TSIS was significantly associated with gender at P = 0.047, with a mean rank of 228.06 and 263.96 for females and males, respectively (Table 5). It can be inferred that the SS component of SI was higher in nursing students who identified themselves as males than females.

Spearman’s rank correlation was computed to assess the relationship between SI, empathy, and self-esteem (Table 6). The study results show that there is a significant but weakly positive correlation between empathy and SI, r (462) = 0.315, P = < 0.001; a significant but negative weak correlation between empathy and self-esteem, r (462) = −0.101, P = 0.03; and a negative weak but not significant correlation was found between SI and self-esteem, r (462) = −0.066, P = 0.15.

Spearman’s rank correlation was performed between the subcategories of the TSIS. The results show that there is a positive significant but weak correlation between SS and SIP, r (462) = 0.312, P = < 0.001; a weak negative but significant correlation between SA and SIP, r (462) = 0.353, P = < 0.001; and no correlation between SS and SIP, r (462) = 0.000, P = 0.995.

One of the strengths of this study was using a conceptual framework as a foundation for the study. A nursing theory was used innovatively to develop the conceptual framework. This provided the researchers with a guide to frame the research questions and a direction for the study. Additionally, by providing a comprehensive analysis of student nurses’ SI, empathy, and self-esteem, the study adds valuable insight to the literature, which can help researchers identify areas where student nurses need additional support or training, which is the second strength of this study.

There were a few limitations to the study. First, because the current study used a non-probability sampling technique, no generalizations can be made about the findings. Second, even though this is typical in psychological assessments, the data may be biased because they were collected via self-report questionnaires. The third limitation is the sample size; as the number of students from each college was different and the female-to-male ratio was high, so it is difficult to make comparisons.

As the skills of SI, self-esteem, and empathy can be learned, utilizing these in theoretical and clinical learning would contribute to nursing students’ professional and personal development. In planning interventions to enhance the SI, self-esteem, and empathy of nurse students, it would be beneficial to consider their personal and cultural characteristics. Incorporating these components into the nursing curriculum would also help student nurses in their professional careers. Future studies may also investigate the effects of cultural influences and training programs on SI, self-esteem, and empathy of nursing students.

The results of this study provide meaningful insight into the relationship between SI, self-esteem, and empathy which has practical, educational, and professional implications for nursing students. Since the results of this study suggest that student nurses had lower SI and that there is a relationship between student nurses’ self-esteem and empathy with their year of study, it may be useful to incorporate these skills as a part of their theoretical and clinical learning. Nurse educators and nurse administrators may use the findings of this study to design training programs and update the nursing curriculum that not only provides theoretical and technical knowledge to nursing students but also teaches humanistic and SS that would contribute to further nursing students’ professional and personal development.