Development of Emotional Labor Measurement Tool for Hospital Nurses

Hye Ri Nam; Ji Yun Lee

doi:10.11111/jkana.2018.24.3.221

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Nam and Lee: Development of Emotional Labor Measurement Tool for Hospital Nurses

Original Article

J Korean Acad Nurs Adm 2018;24(3):221-233.

Published online: 17 January 2018

DOI: https://doi.org/10.11111/jkana.2018.24.3.221

Development of Emotional Labor Measurement Tool for Hospital Nurses

Hye Ri Nam^1,, Ji Yun Lee²

¹Hoban Hospital

²Department of Nursing, Kangwon University

Corresponding author: Nam, Hye Ri Hoban Hospital, 663 Yetgyeongchun-ro, Chuncheon 24239, Korea. Tel: +82-33-251-9911, Fax: +82-33-251-9941, E-mail: chong0620@naver.com

Received 6 March 2018 Revised 9 April 2018 Accepted 23 April 2018

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The study was done to analyze attributes of emotional labor experienced by clinical nurses working in domestic hospitals and to develop tools for measurement.

Methods:

The concept of nurse emotional labor was verified through concept analysis based on Hybrid model. The preliminary Nurse Emotional Labor Scale were examined for content validity, reliability and validity. The scale was verified with 500 nurses working in general hospitals located in Kangwon-do.

Results:

Attributes of the nurse emotional labor concept were derived from three types: surface type, internalize type and control behaviors and identified as having six constitutive factors: conscious surface behaviors, casual behaviors, empathy effort, repress, solve and endure. The results of the construct validity test of the tool showed 8 factors. The Nurse Emotional Labor Measurement Tool had a significant correlation (r=.35, p<.001) with the Scale of Morris & Felman in result of criterion-related validity. And the internal consistency reliability Cronbach’s ⍺ coefficient was .93.

Conclusion:

The development process showed that to accurately describe emotional labor of nurses, it is necessary to consider not only quantitative aspects but also qualitative aspects and content aspects.

Keywords: Nurses, Emotions, Factor analysis, Measurement, Hospitals

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Figure 1.

Research procedure in the development of measurement tools.

Figure 2.

Conceptual analysis derived from the pre-theory and in-depth interviews.

Table 1.

Factor Analysis

Factor	Items	F1	F2	F3	F4	F5	F6	F7	F8
Empathy effort	30. I try to understand and sympathize with the emotions expressed to the patient (caregiver).	.81	.05	.20	.12	.07	.06	-.07	.07
	29. I sincerely try to understand sick patients.	.79	.09	.13	.15	.11	.10	-.06	.13
	26. I try to pay attention to the emotional state of the patient (caregiver).	.77	.20	.13	.02	.16	-.02	.08	-.00
	25. I sincerely try to feel sincerely the emotions and conditions (physical pain, psychological emotional tension, etc.) of the patient (caregiver).	.76	.16	.12	-.00	.03	.02	.18	-.07
	28. I try to make the patient (caregiver) feel that s/he has received genuine care.	.70	.20	.09	.21	.12	-.02	-.09	.16
	27. I try to understand the position of colleagues and other departmental staff.	.62	.23	-.01	.10	.11	.06	.14	.26
Endurance	41. I try to endure because I can not refuse patient care, even if there is emotional conflict with the patient (caregiver).	.16	.72	.27	.06	.06	.15	.03	.10
	39. It is hard to control my feelings, but I try to endure.	.16	.71	.03	.11	.09	.04	-.04	.09
	42. I try to endure emotional conflict with doctors and other departmental staff because I have to continue to work.	.13	.71	.24	-.01	.10	.25	.17	.03
	40. I try to endure even if the patient (caregiver) expresses negative feelings about the doctor or other staff.	.17	.64	.24	.10	.11	.34	.04	-.02
	38. I try to control my emotions by using internal/external resources to remove emotionally difficult conditions (Using friends, games, trips, etc.).	.18	.62	-.00	.17	.06	-.01	.03	.30
	43. I try to endure emotional conflict with my fellow nurses.	.14	.58	.19	.06	.12	.39	.06	.08
	37. When I give nursing care to the patient, I try to shake off the negative feelings experienced in the previous situation and try to treat the patient with a new mind.	.40	.44	.02	.04	.08	.11	-.04	.23
Role-oriented behavior	14. I try to treat the patient (caregiver) kindly, even if s/he treats me differently from the doctor. 16. To reduce patient complaints, I apologize even though I do not want to.	.15 .10	.12 .29	.73 .62	.12 .14	.08 .19	.09 .03	-.02 .08	.08 .03
	18. Placed between the patient and the doctor, I fabricate my feelings to solve the situation when the other person is angry about something that is not my responsibility.	.22	.09	.54	.22	.01	.11	.38	.11
	17. I try to express myself calmly so that the patient feels respected.	.31	.03	.54	.01	-.06	.18	.29	-.01
	5. I pretend that everything is fine when the other persons (patient, caregiver, employee) expresses negative feelings.	.00	.17	.50	.14	.25	.26	.04	.16
	15. I would like to ask the staff of other departments (department of labor, laboratories, etc.) for smooth progress in patient treatment.	-.03	.27	.49	.28	.20	.00	.08	.15
	7. I try to look friendly to colleagues and other departmental staff.	.19	.03	.44	.26	.37	.09	-.13	.13
	6. I try to express my friendliness and concern to the patient (caregiver).	.39	.14	.41	.24	.35	-.04	-.16	.08
Be seen as an expert	10. I pretend to be proficient in nursing skills and to have a lot of experience to give confidence to the patient (caregiver). 11. I try to show calm and rational attitudes to give confidence to my colleagues and other departmental staff.	-.08 .16	.05 .03	.14 .12	.73 .69	.09 .19	.04 .12	.25 .05	.01 .19
	9. I act as if I have a good grasp of the patient's condition and overall treatment to give the patient (caregiver) a sense of trust.	.16	.17	.13	.67	.27	.00	.12	-.02
	12. As a nurse, I try to show that I understand and empathize with others' feelings.	.25	.06	.31	.61	.22	.11	.02	-.01
	13. I deliberately express faith and confidence in order to help the patient (caregiver) to find stability in anxious and nervous conditions.	.21	.10	.34	.50	.26	.02	.00	.17
	19. In order to follow the course of treatment, I try to express myself to the patients strictly and decisively at times.	.23	.23	-.03	.43	.02	-.16	.26	.22
Surface behavior	2. I try to show smiles and laughs regardless of my feelings. 3. I try to adjust myself to the emotional state of the other person(s) (patient, caregiver, employee).	.05 .20	.07 .09	.11 .17	.12 .15	.77 .71	.09 .03	.15 .03	.06 .01
	1. I express my facial expression, tone and gesture to the other person(s) (patient, guardian, employee) with conscious control.	.03	.13	-.02	.18	.69	-.00	.03	.13
	4. I try to look kind to the other person (s) (patient, caregiver, employee).	.24	.10	.31	.22	.67	.05	-.03	-.01
Pull	35. I try not to be angry with the unfair response of a doctor or other departmental staff.	.03	.18	.15	-.03	.02	.82	.11	.10
oneself together	34. I hide my bad feelings for colleague nurse even if I have been fakseky accused	-.00	.18	.04	.11	.04	.76	.07	.11

	36. I try to control my feelings when hings are unjust and unfair.	.14	.39	.18	.07	.08	.61	-.05	.20
Casual behavior	20. I treat the patient (caregiver) in a standardized form rather than paying attention to the feelings of the patient (caregiver).	-.07	.01	.00	.29	.06	.13	.71	-.05
	23. I do not care about my colleagues and other staff who express negative feelings, but rather try to respond with a mere formality.	.01	.06	.05	.12	-.05	.06	.71	.12
	24. Even if I am in a situation that affects my emotions, I do not feel emotional, but respond mechanically.	.06	.01	.12	-.02	.14	-.03	.65	.16

Repression	33. I try not to express bad feelings due to my personal circumstances to the other persons (patient, caregiver, employee) during work.	.26	.15	.16	.13	.12	.26	.07	.68

	32. I try to hide sad feelings, even if I am sympathetic to the tough situation of the patient (caregiver). (Hiding tears, crying, etc.)	.09	.17	.09	.13	.05	.18	.20	.66

	31. I try to suppress the negative emotions that come up when responding to a patient (caregiver) who is swearing, talking down to me, or acting in a threatening manner.	.12	.32	.34	.02	.12	.05	.12	.56

Eigen value		11.43	2.89	2.78	1.96	1.53	1.23	2.17	1.09
Cumulative variance (%)		28.6	35.8	42.8	47.7	51.5	54.6	57.5	60.2

Table 2.

Correlation between the Morris & Feldman (1996) and Nurse Emotional Labor Scale

Variable	Total	Empathy effort	Endurance	Role-oriented behavior	Be seen as an expert	Surface behavior	Pull oneself together	Casual behavior	Repression
Variable	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
Morris & Feldman (1996)	.35	.06	.26	.32	.27	.25	.31	.24	.22
	(＜.001)	(.180)	(＜.001)	(＜.001)	(＜.001)	(＜.001)	(＜.001)	(＜.001)	(＜.001)

Table 3.

Internal Consistency

Variables	Categories	n	Cronbach's ⍺
Surface type	Surface behavior	4	.79
	Be seen as an expert	6	.80
	Role-oriented behavior	8	.82
	Casual behaviors	3	.63
Internalize type	Empathy effort	6	.89
Control	Repress	3	.72
behaviors	Pull oneself together	3	.77
	Endure	7	.86
Total		40	.93

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