Nursing students’ emotional intelligence, coping styles and learning satis-
faction in clinically simulated palliative care scenarios: An observational study

Ana Rosa Alconero-Camarero, Carmen Marı́a Sarabia-Cobo, Silvia

González-Gómez, Isabel Ibáñez-Rementerı́a, Lucı́a Lavı́n-Alconero, Ana
Belén Sarabia-Cobo

PII: S0260-6917(17)30267-8
DOI: doi:10.1016/j.nedt.2017.11.013
Reference: YNEDT 3661

To appear in: Nurse Education Today

Received date: 17 February 2017

Revised date: 9 October 2017
Accepted date: 6 November 2017

Please cite this article as: Alconero-Camarero, Ana Rosa, Sarabia-Cobo, Carmen Marı́a,
González-Gómez, Silvia, Ibáñez-Rementerı́a, Isabel, Lavı́n-Alconero, Lucı́a, Sarabia-
Cobo, Ana Belén, Nursing students’ emotional intelligence, coping styles and learning
satisfaction in clinically simulated palliative care scenarios: An observational study, Nurse
Education Today (2017), doi:10.1016/j.nedt.2017.11.013

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Research article

NURSING STUDENTS’ EMOTIONAL INTELLIGENCE, COPING STYLES AND

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LEARNING SATISFACTION IN CLINICALLY SIMULATED PALLIATIVE CARE

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SCENARIOS: AN OBSERVATIONAL STUDY.

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Ana Rosa Alconero-Camareroa, Carmen María Sarabia-Coboa, Silvia González-Gómezb, Isabel

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Ibáñez-Rementeríab, Lucía Lavín-Alconeroa, Ana Belén Sarabia-Cobo.c
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a
Department of Nursing. University of Cantabria. Santander, Spain.

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Cantabrian Health Service. Santander (Cantabria), Spain.
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Universidad de Oviedo (Cantabria), Spain.
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Corresponding author
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Ana Rosa Alconero- Camarero

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Department of Nursing. University of Cantabria. Santander, Spain

Avenida Valdecilla s/n. CP 39008

Santander (Cantabria) SPAIN

alconear@unican.es

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

Funding information
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This research did not receive any specific grant from funding agencies in the public,

commercial, or not-for-profit sectors.

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Word count: 5569

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Abstract

Background. Emotional intelligence is highly relevant in palliative care training,

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considering the coping styles used by nursing students. Clinical simulation provides the

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opportunity to evaluate these variables in a realistic and natural context.

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Objectives. To analyze the possible relation between emotional intelligence, coping

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styles and satisfaction with one’s own self-learning in nursing students participating in

simulated scenarios related to palliative care at the end of life.

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Methods. A descriptive, observational and correlational study of students in their
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second year of nursing at a Spanish University during the 2015/2016 academic year.

Three variables were measured: emotional intelligence (Trait Meta-Mood Scale-24),

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coping styles (the Questionnaire for Dealing with Stress) and satisfaction with students’
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own learning (Student Satisfaction and Self-Confidence in Learning Scale, Spanish

version CSLS-Sv).
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Results. In total, 74 students participated in this study (ME: 20.3 years). An association
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was found between satisfaction with learning, according to the EI attention subscale (in
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which the highest scores were registered) and two specific coping styles (FSP, with high

scores and open emotional expression).

Conclusions. Emotional intelligence and coping styles are desirable qualities in

students, especially as they have a relevant role in satisfaction with one’s own learning.

Nonetheless, in part, these results depend on the characteristics of the educational

activities designed, which is especially relevant in simulation applied to palliative care.

Keywords. Nursing students; emotional intelligence; learning; coping styles;

simulation.
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Introduction

Numerous studies have demonstrated that emotional intelligence (EI) is an important

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and desirable characteristic in nursing professionals as, on the one hand it contributes

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towards establishing appropriate relationships with others (Augusto-Landa & López-

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Zafra, 2010; Farshi et al., 2015) and, on the other, it is helpful for improving the

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management of the many emotions derived from the care process (stress, burnout, grief,

etc.) (Cherry et al., 2014; El-Sayed et al., 2014). Emotional intelligence seems to

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provide an appropriate response to the numerous vicissitudes that a person must face in
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their daily life, facilitating a positive state of mind, and decreasing negative incidences

together with abnormal or dysfunctional emotional reactions (Zeidner et al., 2016;

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Mayer & Salovey, 1997).

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The interest raised by emotions in nursing practice is well-known, supported by the

theoretical reasoning underpinning the discipline. One of such contributions is the

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“Theory of Human Caring” presented by Jean Watson. Here, the practice of caring is
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directly related with the emotional dimension of the person cared for as well as that of
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the professional providing care. Doctor Watson defends nursing from a

phenomenological and existentialist perspective, where the complexity of each

individual is contemplated from an affective point of view, including feelings and

emotions (Watson, 2011; Watson & Smith, 2002). Feelings or emotions and thinking

have been identified as forces that may affect one's learning styles (Kolb, 1984),

emotional social intelligence, and success (Bar-On, 2004) and coping styles (Suliman,

2010). An overview of emotions, emotion functioning and regulation is alluded to, to

give credence to the application of the transactional model of stress and coping as

purported by Lazarus & Folkman. The central assumption of this theory is that the
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interaction between an individual and the environment creates stress experienced by the

individual. The cognitive transactional model of stress-appraisal-coping can be applied

in the sense making process for nursing students. The model is cognitive because it is

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based on the assumption that students' thinking processes will act to mediate in

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determining stress and coping resources. If we assume that Emotional Intelligence is a

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particular type of intellectual ability, the construct should overlap with cognitive ability

to some extent (Mayer, Salovey, & Caruso, 2000). According to Mayer's model as

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ability model, EI as a combination of four emotion-related abilities: the perception of

emotions, the integration of emotions through thought processes, the understanding of

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relations between emotions and circumstances, and the regulation of emotions, also

called emotion management (Mayer et al., 2000).

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An increasing number of articles establish a relation between EI, coping styles in

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response to stress and academic performance among Health Science students (Suliman
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2010; Beauvais et al., 2014; Farshi et al., 2015; Saklofske, 2012). These studies, albeit
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non-conclusive, seemingly establish that those students with greater EI and appropriate

coping styles display improved academic performance and more adaptive learning
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styles (Benson et al., 2010; Fernández et al., 2012).

Considering the characteristics of the curricular education of nursing students who must

face critical life situations, such as death or pain during their clinical placements, these

students ultimately undergo considerable levels of stress (Edo-Gual et al., 2011; Reeve

et al., 2013; Grobecker, 2016). Emotional intelligence is known to be directly connected

with social relations, which, in turn, impacts one’s own emotional control and the way

stressful situations are faced (Codier & Odell, 2014; Codier et al., 2010). Relations have

been established between EI and learning styles, which seem to indicate that certain

learning styles, such as reflective thinking and clinical placements, favor the
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development of components of EI, such as self-control, motivation and relations with

others (Por et al., 2011; Pool & Qualter, 2012).

Of all the possible stressful situations students face for the first time during their clinical

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placements, one of the most shocking is patient death (Alzayyat & Al‐Gamal, 2014;

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Pulido‐Martos et al., 2012). Concerning the process of dying, the education in end-of-

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life palliative care during nursing studies is not only aimed at acquiring knowledge on

the appropriate end-of-life care, but rather focused also on the development of personal

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skills, such as communication, empathy, and teaching students to manage their

emotions, etc. (Mok et al., 2002; Gillan et al., 2014). Related research suggests that
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there is a correlation between students with greater EI presenting more effective coping

styles which, at the same time, results in a greater satisfaction with their professional
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development (Beauvais et al., 2014; Rivera et al., 2014).

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On the other hand, concerning styles of learning, more recently, the use of clinical
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simulation (CS) has been noteworthy in improving the acquisition of professional

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competence (Norman, 2012; Foronda et al., 2013). Specifically, in recent years, several
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studies have highlighted the use of simulation in the context of end-of-life care,

especially regarding the development of skills such as communication and the

development of empathy (Lewis et al., 2016; Fabro et al., 2014; Kunkel et al., 2016;

Ladd et al., 2013). In this sense, CS enables the ability to create safe learning

environments for students, and the use of the same is related with a high student

satisfaction, who see it as a particularly relevant method of learning within palliative

care (Sarabia-Cobo et al., 2016; Dame & Hoebeke, 2016). Satisfaction with one’s own

learning seems to be related with increased academic performance (Lahti et al., 2014;

Papathanasiou et al., 2014) and, likewise, with more effective coping styles for facing

stressful situations and with greater EI (Beauvais et al., 2014; El-Sayed et al., 2014). If
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the learning method encourages greater student satisfaction, it seems recommendable to

further explore this resource as, if we can develop satisfactory learning environments,

this in turn, can improve the acquisition of professional competences.

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To our knowledge, there are no studies that have explored the existing relation between

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EI, coping styles and satisfaction with one’s own learning in the simulated environment

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of a stressful situation, such as the care of dying patients. The studies seem to suggest

that, in general, nursing students who have high levels of EI and the appropriate coping

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strategies for stress, achieve high scores in the scales measuring satisfaction and self-

confidence in learning (Lee & Gu, 2013; Suliman, 2010). However, these studies are
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inconclusive as the conclusions are not easily generalizable and the definition of

concepts (IE, coping styles, etc.) are different in each study, which means further
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studies are needed along these lines. Therefore, it is necessary to explore whether the
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activity of learning in itself can influence satisfaction in one’s own learning. If we

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consider that the process of learning favors the acquisition of competences highly
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related to EI and personal styles of coping, a positive relation may be established

between learning style, EI and coping.

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The aim of the present study was to analyze the possible relation between EI, coping

styles and satisfaction with one’s own self-learning in nursing students participating in

simulated scenarios related to palliative care at the end of life.

Methods

Design

A descriptive, observational and correlational study.

Subjects
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Nursing students who were in their second year of undergraduate studies based at a

university participated in this study. This research took place during the 2015/2016

academic year. The participation was voluntary and offered to all students enrolled in

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the course (a total of 74). The sample selection was therefore for convenience. The

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University is public and serves a whole region of northern Spain. The students

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performed a practice based on clinical simulation within a mandatory subject which is

taught in the second year, called “Attention in Special Circumstances”. All students

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were informed that participation in the study was voluntary. Furthermore, they were

explained that anonymity of the test was guaranteed and that their decision to participate
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or not in the study would not affect their grades in any way. The only exclusion criteria

was not wanting to participate in the study. The only inclusion criteria was that
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participants had to be student enrolled in the subject Attention in Special

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Circumstances. After being informed, all agreed to participate voluntarily and gave their
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consent.
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Design of the activity

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The activity was carried out in a simulation laboratory of a virtual hospital. Before

beginning the activity, the instructor explained the case to the students, together with the

notes from the patient history, the variables for beginning the examination, and the

changes required according to the expected care actions. Previously, students were

explained the general requirements for the procedure (for example, confidentiality

regarding the acts of the participants and the characteristics of the simulated cases).

Also, students were informed that the activity was not for the purpose of assessment,

but rather to encourage learning.

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Two scenarios were designed which recreated two patients diagnosed in the terminal

phase: a woman admitted to intensive care with the diagnosis of cerebral hemorrhage

and, a man admitted to the hospitalization unit, with the diagnosis of lung cancer with

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metastasis. In both cases, the simulation was performed using a low fidelity mannequin

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which enabled the instructor to observe simple physiological and non-modifiable

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responses.

There were twenty one-hour sessions, in groups of three or four students, so that

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everyone could participate. Once, the activity was finished with the debriefing (duration

25 minutes). The debriefing approach used in this activity is the so-called debriefing
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with good judgment; this approach openly shares personal opinion, assuming the best

that students bring. It is based on asking them the highest standards and assuming that
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their answers deserve great respect. This style allows making mistakes and discussing
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them feeling valued and capable, and the instructor, show their experience and make
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constructive criticism (Maestre and Rudolph., 2015).

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Assessment outcomes

The study variables included age, sex, emotional intelligence and coping styles.

Emotional intelligence. The Trait Meta-Mood Scale (TMMS) was used (Salovey,

Mayer, Goldman, Turvey, & Palfai, 1995), developed by the Salovey & Mayer research

group (1990). A shorter version is available in Spanish, the TMMS-24 (Fernández-

Berrocal, Extremera, & Ramos, 2004) which has demonstrated to have good

psychometric properties in order to be used in Hispanic speaking populations. In this

study, we used the recently validated Spanish version for use with nursing students

(Espinoza-Venegas et al., 2015). The original scale evaluates metaknowledge

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concerning emotional states via 48 items. Concretely, the scale includes skills which

serve to increase awareness of our own emotions as well as our ability to regulate them.

The TMMS-24 contains three key dimensions of EI with 8 items for each: Attention to

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emotions [AE], Clarity of feelings [CL] and Mood repair [RE]. Different cut-off points

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are described according to whether they are men or women. In the attention to emotions

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subscale, scores in the mid-range (22 to 32 in men; 25 to 35 in women) indicate

appropriate attention to emotions, whereas high scores (>33 in men;> 36 in women) and

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low scores (<21 in men;<24 in women) indicate that the ability to attend to emotions

should improve. In contrast, in the clarity of feelings subscale, the low range scores
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indicate that they must improve (<25 in men, <23 in women), whereas mid-range scores

(26 to 35 in men; 24 to 34 in women) indicate appropriate clarity and the high scores
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(>36 in men; >35 in women) indicate excellent emotional clarity. Likewise, in the mood
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repair subscale, low scores (<23 in men and women) indicate that this must be
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improved, mid-range scores (24 to 35 in men and 24 to 34 in women) are indicative of

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appropriate repair and high scores (>36 in men, >35 in women) indicate excellent mood

repair. Respondents must assess each of the 24 affirmations about themselves on a

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Likert scale from 1 to 5 points which represents their level of agreement with each of

the items. The final score is obtained by adding the responses from each subscale,

ranging from 8 to 40 points. The multidimensionality of this scale was confirmed via

factorial analysis, which evidenced the three theoretically conceived factors: perception,

comprehension and regulation, quantified via a Cronbach’s alpha coefficient of 0.86,

0.87, 0.82, respectively (Fernández-Berrocal et al., 2004).

Dealing with stress. The Questionnaire for Dealing with Stress (CAE) contains a

validated 42-item scale (Sandín & Chorot, 2003). This is a self-report measure designed

to evaluate seven basic styles of coping: (1) focused on the solution to the problem, (2)
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negative self-focus, (3) positive reassessment, (4) open emotional expression, (5)

avoidance, (6) search for social support (7) religion. This tool has demonstrated to have

appropriate psychometric properties, obtaining a mean Cronbach’s alpha reliability

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coefficient of 0.79 for the seven subscales. The subscales represent: 1) Focused on the

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solution to the problem [FSP]: the person analyzes the causes, and plans and

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implements solutions to face the situation. 2) Negative self-focus[AFN]: the person self-

blames, has feelings of helplessness and inability, resignation, dependence, loss of

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control and pessimism. 3) Positive reassessment [REP]: recognizes the stressful event

but is centered on the positive aspects of the situation. 4) Open emotional expression
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[EEA]: vents bad humor on others, insults, is hostile, irritable and pour out their

feelings. 5) Avoidance [EVT]: concentrates on other things, prefers not to think of the
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problem. 6) Search for social support [BAS]: identifies people and support networks to
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provide an appropriate management of the stressful situation. 7) Religion [RLG]: relies

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on religious beliefs in order to face a situation, due to a feeling of losing control. The
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Cronbach’s alpha reliability coefficients for the 7 subscales varied between 0.64 and

0.92 (mean = 0.79). A second order factor analysis revealed a structure with two factors,
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which represented rational coping styles focused on emotion.

Student Satisfaction and Self-Confidence in Learning Scale Spanish version (CSLS-SV).

A total of 13 items assess students’ attitudes regarding satisfaction with instruction and

self-confidence in learning in simulation-based learning (Jeffries & Rizzolo, 2006). The

Spanish version was validated by the authors of this study (Sarabia-Cobo et al., 2016 in

press). The questionnaire consists of two dimensions with a number of items above the

limit considered to be appropriate for factor analysis (Costello & Osborne, 2005;

Tabachnick & Fidell, 2013). The two dimensions evaluated are: Satisfaction with

instruction, containing five items related to simulation activities, and Self-Confidence in

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Learning, with eight items measuring how confident students felt about the skills they

practiced and their knowledge of how to obtain help to solve clinical problems in

simulated scenarios. For each item, participants were requested to indicate their

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personal feelings about a statement that described their own attitudes or beliefs. The

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response options were based on a Likert-style scale and were 1) strongly disagree, 2)

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disagree, 3) undecided, 4) agree, and 5) strongly agree using a Likert-style scale.

Cronbach's alpha has been reported as 0.94 for the satisfaction subscale and 0.87 for the

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self-confidence subscale (Jeffries & Rizzolo, 2006; Franklin et al., 2014). Scores are

calculated by summing responses; higher scores indicate more satisfaction and more
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self-confidence.

The TMME-24 and CAE questionnaires were administered prior to the clinical
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simulation activity in palliative care. The CSLS-Sv questionnaire was completed by

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students after participating in the activity.

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Statistical analysis
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The data were analyzed using IBM SPSS Statistics, version 22. Descriptive statistics

were used to describe the sample characteristics for the three questionnaires, in order to
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obtain both the global scores as well as those that correspond with each subscale. A

multifactorial ANOVA was performed to establish relationships between the subscales

of the three questionnaires. A correlational study was also conducted (Spearman’s rho)

to establish possible associations between the questionnaires. The significance level was

set at 0.05 and all tests were bilateral.

Ethical considerations

All students were informed verbally and in writing that the allocation of learning would

be handled confidentially and anonymously throughout the study. They were also

requested to sign a consent form to grant permission for researchers to use the results
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for informative purposes and when the confidentiality of personal data would not

contravene.

Likewise, personal data could not be disclosed during the investigation. The

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questionnaires were printed in paper form and students’ responses were anonymous.

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The research considered the ethical considerations of these types of studies and obtained

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all the necessary permissions prior to the commencement of the study. Approval was

sought from the management of the nursing school XXX and the ethics and humanities

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committee of the XXX.
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Results

The study participants were 74 students in their second year of nursing studies with a
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mean age of 20.3 years, of which 91.4% were women. All students were Spanish.
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Table 1 displays the mean results of the scores in all three dimensions of the TMME-24
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scale and the statistical test to determine the differences between men and women

(N=74).
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[Insert table 1 about here]

As can be observed, there were no differences between men and women (the sample of

men was very low in comparison with the female participants). The most prevalent

dimension was attention to emotions, in which excellent scores were obtained and the

lowest was emotional clarity which, together with repair, scored in the mid-range.

Table 2 features the mean scores for the CAE subscales. No statistically significant

differences were found between men and women for any of the subscales (p>.05).

[Insert table 2 about here]

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We can observe that the most prevalent coping styles were: positive reevaluation,

focusing on the solutions, and searching for social support. The least prevalent were

negative self-focusing, emotional expression and religion.

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The results obtained in the student satisfaction and self-confidence in learning scale

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Spanish version are displayed in Table 3.

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[Insert table 3 about here]

The scale with the highest score was satisfaction with one’s own learning and the lowest

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score was instruction intervention. Nonetheless, all subsections showed high scores,

close to 5.
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A multifactorial ANOVA was performed to establish relations between the subscales of

the three questionnaires (Table 4), however statistically significant differences were
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only found for the satisfaction with current learning- attention to emotions and FSP
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subscales (F= 1.91, p= .03) and for the satisfaction with current learning - attention to
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emotions and open emotional expression subscales (F= 1.78, p= .04).

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[Insert table 4 about here]

A correlational study was performed to determine the existence of an association

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between the dimensions of the three questionnaires, however the results were negative

with a few significant, albeit weak correlations, such as the one found between the

avoidance dimension of the TMME-24 and the CAE emotional clarity (r = .244, p=.04).

Discussion

Among the main results of this study, the association between satisfaction with learning

and the attention subscale of EI was noteworthy (which is where students obtained the

highest scores) and two specific styles of coping (FSP, with high scores and open

emotional expression). Our hypothesis is partly confirmed: the highest score on the
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attention to emotions subscale is associated with certain coping styles and with

satisfaction with learning however, there does not seem to be a relation with self-

confidence in the student’s own learning. This seems to suggest that student’s

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confidence in their own learning is not only due to intrinsic factors of the student’s

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personality, but rather external factors such as the educational system in itself, the

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curricular design, etc., which leads to more passive students with regards to the

acquisition of knowledge and with less encouragement for independent work (Beauvais

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et al., 2014; Chew et al., 2015).

If we analyze the results separately, regarding the results for EI, nursing students
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notably obtain high scores, which confirms previous reports (Benson et al., 2010;

Aradilla‐Herrero et al., 2014; Cherry et al., 2014). The most prevalent dimension was
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attention to emotions, in which excellent levels were obtained, whereas the levels of
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emotional clarity and repair obtained scores in the mid-range. The attention dimension
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is characterized by confrontation and emotional regulation. People who presented only

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moderate attention to emotions levels also more frequently used more adaptive

regulation strategies as they were able to use the information obtained by their emotions
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more with greater efficiency (Aradilla‐Herrero et al., 2014). Emotional intelligence

constitutes an essential competency for nurses in that, in order to establish therapeutic

relations, it is necessary to identify and understand one’s own emotions, those of the

patients and, naturally, those of their family members. Nurses should know how to

manage those emotions arising from the continuous contact with illness and death

(McQueen, 2004; Aradilla- Herrero et al., 2010). In the last decade, science is

demonstrating that this spectrum of personal skills decisively influences the

psychological adaptation of the professional regarding their emotional wellbeing and

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even their professional achievements (Poor et al., 2011; Scott‐Ladd, & Chan Suliman

2004; Benson et al., 2010; McQueen, 2004).

Regarding styles of coping, the most prevailing ones were positive evaluation, focused

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on solutions and the search for social support. These results are similar to other studies

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by demonstrating that, among health professionals, coping strategies are developed that

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are focused on the search for positive solutions and social support (Goff, 2011). Jackson

et al., (2007) revealed that the nature of health work itself leads to high levels of stress

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and suffering, whereas Pines et al., (2014) indicate that health professionals and

students learn to develop coping styles that are appropriate regarding stress and in order
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to face the situations that arise in clinical practices or in the place of work. These styles

seem to have a relation with EI itself (Augusto-Landa et al., 2008; Kim & Agrusa,
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2011). Our results seem to support other studies indicating that high levels of EI help
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minimize the negative effects of stress, effectively improving coping styles (Por et al.,
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2011; Suliman et al., 2010). As described in the literature, there seems to be a clear
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relation between EI and styles of coping, as if EI were a protector for stress (El-Sayed et

al., 2014; Martins, Ramalho, & Morin 2010).

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Regarding satisfaction with one’s own learning, after the simulation activity, high

scores were obtained in all three dimensions, but especially in satisfaction with one’s

own learning, applying simulation to learning. However, we have not found a

significant association, which seems an interesting finding. We know that the relation

between EI and academic results has been widely studied, yet with contradictory results

(Lee et al., 2013; Shanta, & Gargiulo 2014; Bulmer Smith et al., 2009; Suliman, 2010;

Beauvais et al., 2014). Perhaps, the key to EI is not related with academic results but

rather with one’s own learning experience mediated, in this case, by the satisfaction

with the same. If we consider that EI can improve and that it is a complex phenomenon,
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it seems interesting to address the improvement of satisfactory learning styles. Learning

with EI is complex and it is unclear which is the best mechanism (Suliman, 2010;

Zeidner et al., 2015; Codier & Odell 2014). However, designing experiential learning

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strategies, such as simulation and clinical placements seems key for increasing

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satisfaction with learning. Thus, our results seem to indicate that it is necessary to

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address the quality of the methodological design of learning and not only seek strategies

that favor the improvement of EI or coping styles. This is positive, as it suggests that

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students with low levels of EI or inappropriate coping styles do not necessarily lead to

low levels of satisfaction with learning. This is in discrepancy with studies that suggest
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that it is necessary to have high levels of EI in order to have a satisfying learning

experience which, in our opinion, is a statement that is too deterministic (Inglés et al.,
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2016; Lee et al., 2013; Suliman et al., 2009). This means that teachers have room for
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maneuver in order to help those students who are facing learning difficulties and under
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increased stress, in order to help them to increase their confidence in their own learning,
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via the design of appropriate activities, which is something that simulation is able to

facilitate in a controlled manner.

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However, the results indicate that although there is no association between high levels

of EI, coping styles and satisfaction with learning, the students showed high scores in

all three measures. This seems to suggest that by favoring activities targeted towards

increasing students’ EI, as well as coping styles against stress, this favors students being

more satisfied with their own learning, and therefore may justify the fact that, on

occasion, it is not enough to design educational strategies aimed exclusively at

knowledge and skill acquisition, but rather, it is necessary to integrate psychological

aspects (EI, coping) in order to attain students who are satisfied with their own learning.

Limitations
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There are certain limitations inherent within this study which includes the fact that the

data were collected from a small sample and from only one nursing school and,

therefore, there may be limitations regarding the generalization of results. Another

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limitation is that the questionnaires employed take a long time to complete and the

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fatigue of the students themselves may have influenced the responses. It would be

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advisable for future study designs to take this into consideration by having students

complete the questionnaires over time, although not too far apart. Another limitation is

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that the response to assessment measures regarding EI and coping styles may be

influenced by the sincerity in the response and at the same time, this may be influenced
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by recent episodes in the students’ personal life or events that have taken place during

clinical placements. And last, but not least, is the consideration of the Hawthorne Effect
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(phenomenon of altered behavior or performance resulting from awareness of being a

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part of an experimental study). Phenomenon overcome because the students have

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previously done to this study at least five sessions of simulation, favoring the reduction
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of this effect.
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Conclusions

In conclusion, research of this type is necessary in educational contexts. The

establishment of relations between psychological variables, such as coping with stress

or EI with attitudinal variables such as one’s own satisfaction with learning give us

tools for improving the design of the educational curriculum in nursing. This is relevant

in professions such as nursing in which the importance of being trained in attitudes,

skills and personal values is crucial. Areas such as palliative care training are associated

with important difficulties for evaluating the students’ attitudes, especially in relation to
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the stress that is generated by caring for patients in pain or facing death. Our study

seems to suggest that students with appropriate coping styles are more psychologically

prepared. However, what is noteworthy regarding our study is that the student’s

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confidence in their own learning is not due to the intrinsic personality factors, but rather

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external factors such as the educational system itself and the curricular design. This

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establishes the importance of continuing to work towards constructing appropriate and

coherent educational activities with the associated technical and, above all, human

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requirements of the profession.
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Conflict of Interest
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No conflict of interest has been declared by the authors.

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Table 1. Results for the three dimensions of the TMME-24 and statistical text for

studying differences between men and women.

Attention Clarity Repair p

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Mean 26.93 26.00 27.75 .084

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SD 6.05 6.15 5.63
Sd: Standard deviation

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Table 2. Mean scores of the CAE subscales (n=74).

FSP AFN REP EEA EVT BAS RLG

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Mean 15.06 8.47 15.42 8.22 13.99 14.68 2.04
SD 4.09 3.10 3.20 3.32 3.45 6.53 3.12

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SD: Standard deviation

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Focused on the solution to the problem [FSP]. Negative self-focus[AFN]. Positive reassessment [REP]. Open
emotional expression [EEA]. Avoidance [EVT]. Search for social support [BAS]. Religion [RLG]

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Table 3. Mean scores in the three scales of the CSLS-Sv.

Satisfaction with Self Confidence in Instructor’s

Current Learning Learning intervention

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Mean 4.61 4.30 4.18
SD .26 .54 .73

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SD: Standard Deviation

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Table 4. Multifactorial ANOVA

SCL SELFC IIN FSP AFN REP EEA EVT BAS RLG AE CL RE
F (p) L F (p) F (p) F (p) F (p) F (p) F (p) F (p) F (p) F (p)
F (p)
SCL - - - 1.23 0.89 1.58 2.36 0.98 1.23 1.88 1,910 0.87 1.25

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(.36) (.74) (.89) (.84) (.25) (.22) (.33) (.03) (.36) (.35)
SELFC - - - 1.85 2.58 2.11 1.25 1.87 2.47 2.87 1.78 1.22 1.52

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L (.85) (.21) (.92) (.08) (.32) (.31) (.09) (.04) (.011) (.12)
IIN - - - 1.33 1.54 1.85 2.47 2.74 2.44 1.35 2.74 1.85 1.52
(.25) (.62) (.21) (.32) (.06) (.65) (.84) (.22) (.32) (.06)

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FSP 1.23 1.85 1.33 - - - - - - - 1.22 1.47 2.33
(.36) (.85) (.25) (.08) (.22) (.42)
AFN 0.89 2.58 1.54 - - - - - - - 1.88 3.33 1.84

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(.74) (.21) (.62) (.23) (.54) (.31)
REP 1.58 2.11 1.85 - - - - - - - 4.21 5.33 1.65
(.89) (.92) (.21) (.33) (.40) (.22)
EEA 2.36 1.25 2.47 - - - - - - - 1.88 1.88 3.22
(.84) (.08) (.32) (.25) (.10) (.23)

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EVT 0.98 1.87 2.74 - - - - - - - 2.36 2.33 1.46
(.25) (.32) (.06) (.80) (.58) (.72)
BAS 1.23 2.47 2.44 - - - - - - - 1.74 2.85 3.63
(.22) (.31) (.65) (.09) (.63) (.52)
RLG 1.88 2.87 1.35 - - - - - - - 1.87 3.84 5.36
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(.33) (.09) (.84) (.32) (.36) (.85)
AE 1,910 1.78 2.74 1.22 1.88 4.21 1.88 2.36 1.74 1.87 - - -
(.03) (.04) (.22) (.08) (.23) (.33) (.25) (.80) (.09) (.32)
CL 0.87 1.22 1.85 1.47 3.33 5.33 1.88 2.33 2.85 3.84 - - -
(.36) (.011) (.32) (.22) (.54) (.40) (.10) (.58) (.63) (.36)
RE 1.25 1.52 1.52 2.33 1.84 1.65 3.22 1.46 3.63 5.36 - - -
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(.35) (.12) (.06) (.42) (.31) (.22) (.23) (.72) (.52) (.85)
CSLS-SV : Satisfaction_Current_Learning [SCL]. Self_Confidence in_Learning [SELFCL]. Instructor´s intervention [IIN]
CAE: Focused on the solution to the problem [FSP]. Negative self-focus[AFN]. Positive reassessment [REP]. Open
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emotional expression [EEA]. Avoidance [EVT]. Search for social support [BAS]. Religion [RLG]
TMMS-24: Attention to emotions [AE], Clarity of feelings [CL] Mood repair [RE].
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Highlights

Emotional intelligence minimizes the negative effects of stress, improving coping.

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Clinical simulation scenarios improve student confidence and learning.

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Students’ confidence in their own learning is associated with external factors.

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