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Qualitative study
End-of-life care in the emergency department: nurses who invest in the nurse–patient relationship are better able to manage the emotional aspects of caring for dying people and their relatives
  1. Estelle Codier
  1. University of Hawaii, Manoa, School Of Nursing And Dental Hygiene, Honolulu, Hawaii, USA
  1. Correspondence to: Estelle Codier
    University of Hawaii, Manoa, School Of Nursing And Dental Hygiene, 2528 McCarthy Mall, Webster Hall Room 440, Honolulu, HI 96822, USA; codier{at}

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Implications for practice and research

  • Development of EI (emotional intelligence) skills may be related to both effective EOL (end-of-life) care and retention/burnout prevention in nursing work in the ED (emergency department)

  • Further nursing EI research is warranted, particularly on the models of EI most relevant for nursing

  • Development of emotional intelligence in the clinical setting holds the potential for both improved patient care and improved performance and retention for clinical staff.

  • Effective EOL care in the ED requires nurses’ investment in the nurse–patient relationship, management of emotional labour and development of EI ability.

  • Development of EI abilities by nurses is a part of effective EOL care, retention and burnout prevention.


As the population ages, nurses in the ED will have more involvement with EOL care. Expertise in EOL care is important not only for patient outcomes but also as it impacts on nurse emotional labour.


In their descriptive, qualitative study, Bailey et al explored the development of ED nurses’ expertise in EOL care. Using ethnographic methods, data were collected over 12 months during 900 h of ED EOL care observation and in 28 interviews with patients, family and care team members. Thematic analysis was performed to provide the basis for a model for nurses’ development of expertise in EOL care.


The model described EOL care expertise developed through three stages: investment in relationship, emotional labour management and EI skill development.


EI is a relatively new concept in nursing. Research across numerous professions has provided ample evidence for the importance of EI skills in successful job performance, organisational coping and leadership effectiveness. Research in nursing has validated many of these findings. Nurse EI scores correlate with the levels of clinical staff performance, coping, positive organisational behaviours, retention in nursing and patients’ perceptions of nurse caring.1–4 The conclusions of Bailey et al about nurse burnout and retention are supported elsewhere in the nursing EI literature.5 Bailey, et al utilised the EI ‘mixed’ model, first popularised in 2000. It is neither the model utilised most in existing nursing EI research nor is it the one best suited to application to nursing practice.

Three main models of EI are currently in use, with significant differences between them. The Ability model conceptualises EI as a skill set of measurable abilities. The Personality model conceptualises EI as a set of personality traits. The Mixed model, utilised by Bailey et al conceptualises EI as both trait and ability. The models differ in concept validity and instrumentation validity and reliability.6 Face validity is problematic in the Personality and Mixed models, which so overlap with the existing personality theory as to make differentiation between EI traits and traditionally defined personality concepts difficult. Both 360 ‘other reporting’, used in Mixed model instruments, and ‘self reporting’ used in the Personality model instrument pose reliability issues.6 With both the models, accuracy of EI assessment is completely dependent on the self or other's assessment accuracy and may be confounded by a wide range of organisational and interpersonal variables.6 In contrast, in the Ability model. instrumentations require the performance of emotional skills. The instrument most used to measure ability EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT, V.2), has rigorously established validity and reliability and is less susceptible to the confounding variables other instrumentations are vulnerable to.6

The first 20 years of interdisciplinary EI research across many cultures, disciplines and settings were complicated by the wide variety of conceptual models used. In addition, the instruments used, some of which had poor if any validity or reliability testing, made meta-analyses of the whole body of research challenging. To avoid the same pitfalls, nurse researchers are encouraged to attend to the important differences between EI models and maintain high standards for instrumentation used in nursing EI research.


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  • Competing interests None.

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