main purpose of health and social centers, regardless of their level
of care and the professionals who work in them, is to care, support
and improve the health of the population, providing the best health
care resources available. To achieve this goal, health professionals,
not only use their knowledge and clinical skills, but also all their
professional skills, including ethical values, experience and a
wide range of abilities related to emotional intelligence, such
as empathy and communication skills. It is accepted that quality
health care includes science and art simultaneously1
and therefore requires an appropriate combination of scientific
knowledge, technical means, creative and communicative skills of
In fact, the many benefits of good communication with patients are
but mastering these skills and dedicating the required time on a
daily basis still entails a challenge.5
general, professionals value positively the opportunity to be trained,
and courses related to the development of communication skills are
often among the most requested.6
Training opportunities to meet this kind of demand are varied and
include various teaching methods,7
including particularly artistic disciplines. These educational experiences
characteristically deviate from the theoretical realm of classical
training and build knowledge through personal experience.1,8,9
This type of training, still pioneer in our country, is best known
in the English-speaking world, especially when it is part of the
theory of transformational learning and includes theatrical techniques
Education focused on transformational learning involves people acting
out a fact or a problem experienced which they evaluate critically.
The teacher's role is to promote critical thinking, pose challenges,
promote autonomous decision-making and encourage reflection on practice.
It aims to lead the learner towards actively interpreting and giving
meaning to their experience, the strategies used to address the
situation and to integrate this new interpretation to their cognitive
system transforming their own practice.11
article aims to describe an educational intervention designed to
strengthen and unite the skills related to emotional intelligence,
as well as to collect the reflections, opinions and satisfaction
of participating professionals.
2008 and 2013, a multidisciplinary team designed and delivered fifteen
editions of a course based on a transformational educational approach
using acting training methodology. In each issue, between 12 and
18 people received 24 hours training (four sessions of six hours,
once a week).
A mixed design was used
to evaluate the perception and satisfaction of participants using
qualitative and quantitative methodology. Qualitative data were
obtained by requesting a written reflection on their personal learning
experience. Quantitative data were obtained from the standard questionnaire
used in MútuaTerrassa to assess the opinion and overall satisfaction
with the training. Confidentiality was guaranteed.
transversal and voluntary training was addressed to the 706 professionals
of MútuaTerrassa of the twenty socio-healthcare centers (including,
besides pure socio-healthcare, geriatric care centers, mental health
and care for the intellectually disabled). All in all, they serve
a dependent population of 1,295 people in three provinces and twelve
locations: Barcelona (L'Ametlla del Vallès, Badalona, Barcelona
city, El Prat de Llobregat, Sant Cugat del Vallès, Sant Feliu
de Llobregat, Sant Just Desvern, Sabadell and Terrassa), Girona
(Tossa de Mar) and Tarragona (Cambrils, Mora la Nova).
course was based on 16 exercises that focused on the experience
and guided reflection in intrapersonal areas (self-knowledge) and
interpersonal (relations) (Table 1). The exercises impelled
participants to use their emotional intelligence, understood as
the ability to recognize their own and other people's emotions and
the ability to channel them properly. Intrapersonal intelligence
emerges from managing skills of self-awareness (ability to know
what we are feeling), emotional regulation and its externalization,
as well as the ability to motivate oneself and others. Likewise,
interpersonal intelligence is held in empathy ("mental and
emotional ability to identify with another's feeling", as defined
by the Royal Spanish Academy)12
and social skills.
All exercises resorted
to the kinetic experience to familiarize participants with the body
potential as a transmitter of information. Occasionally, participants
were deprived of sight and speech to raise awareness of other personal
resources, such as intense listening, information acquired through
touch and communication by the emission of non-verbal sounds (resources
often used by the users of the socio-healthcare centers to express
their needs). Other exercises addressed the information conveyed
and received by a simple look.
was used to build awareness in the shared reflection with the group
guided by teachers (feedback). Exercises should be taken into consideration
as being significant as a personal experience, but only got their
real value as a "tool" (Table 2) to be discussed
and analyzed in this context (Table 3).
drama techniques (role play of 4-6 people) set in health care situations
were also used. Participants-actors role-played two versions
of the event: the real one and the desired one.
1. Emotional Intelligence: Intrapersonal and
covered in class
2. Seven tools for stress management
3. Course objectives
effectiveness of the exercises depended on the ability of spontaneous
response of the participants. The "wow factor" was considered
as an essential element of learning, so confidentiality was requested.
Moreover, in performing the exercises, they were given only the
essential guidelines, so that each participant had to explore in
situ its own resources to develop the proposed activities.
the analysis of reflective essays of participants on their perception
of the experience, qualitative methodology was used, as this enables
researchers to work with the hypothesis that "nothing is trivial
and everything has the potential to be a clue that could reveal
a greater understanding of the subject matter".13
Two researchers independently reviewed the writings, codified the
main ideas and organized them by category. Subsequently, all authors
participated in reorganizing the topics and developing the narrative
summary and tables where the best comments of the participants
Regarding the statistical
tests used, the reliability of the questionnaire was assessed by
Cronbach ? and descriptive statistics. The qualitative variables
were expressed as n and percentages and quantitative variables as
mean. SPSS version 17.0 was used. (SPSS Inc., Chicago, IL, USA).
study was approved by MútuaTerrassa Ethics Committee for
total of 33% of professionals working in health and social centers
in MútuaTerrassa (n = 231) participated in the study: 94%
were women (n = 217) with a mean age of 38 years. By professional
category, 26% were registered nurses or other related postgraduate
studies (n = 60), 6% consultants and other graduates (n = 15), and
68% nursing and clinical assistants, monitors, social workers, and
administrative staff (n = 156).
of the participants on the training received was assessed by analyzing
their reflective essays, which expressed satisfaction and perception
of rediscovering natural resources and skills that promote effective
communication and professional and personal development. The reflections
were grouped into two groups: "Self-knowledge" and "empathic
and communication skills in professional practice" (Table 4).
writings highlighted the positive assessment on ethical issues involved
in the relationship between patients and professionals. Subjectively,
the participants expressed greater compassion and attention to the
needs of the patients. This was achieved by integrating their personal
and professional skills, enabling them to interact without being
protected behind attitudes that distance themselves from the emotional
experience of the people they serve. Among the skills that most
strongly became part of their conscious resources, further to transformational
learning, they mentioned active listening and non-verbal language.
They reported how this learning process in integrating their own
values and resources, contributed to increase their self esteem
and enrich their relationships.
expressed satisfaction and gratitude for the opportunity to participate
in the experience. They also said they had discovered or deepened
skills and resources they already had and now benefited by consciously
using them. They also showed satisfaction with the effectiveness
of the methods used as shown in their comments ("The course
was great; congratulations to the company for supporting it",
"It was a dose of optimism"), as well as in the institutional
questionnaire. In this questionnaire, the participants rated the
overall satisfaction, on average, with 9.8 points (Table 5).
The Cronbach a coefficient was 0.854.
directors of healthcare centers highlighted the increased team cohesion
among professionals who had received this training even when they
participated in different editions. Hence, they proposed new courses
to delve deeper into this line of work.
4. Participants reflections
5. Results of the standard satisfaction questionnaire
on the course given. Scale 1-10
study shows the satisfaction of healthcare professionals to explore
their emotional intelligence skills through creative activities
that allow them to connect with their emotions and express them
appropriately in the context of a safe setting. Theatrical interpretation
techniques were the training tools for emotional education of healthcare
professionals and to enhance their awareness of professional ethics.
"Invisible" skills enhanced during the course have a positive impact
on patients and professionals, though its worth is not always recognized.14
should be noted that strictly speaking, most of the exercises were
not specifically theatrical as they missed the essential element
defining the scenic fact: the audience. The learning process was
based upon two main cornerstones: personal experience taking place
during exercise (provided both as impulses and conditioned learning);
and further reflection (focused on the analysis of the decisions
taken during the experience). This verbal reflection, which was
shared by all participants, was guided by teachers, influenced by
group dynamics and the relationships established during the exercise
performed. Thus, through a transformational teaching methodology
focused on practice and reflection, the training aimed at working
on resources that facilitated the awareness of one's own emotions
to manage them as key opportunity; as well as to communicate effectively
both verbally and nonverbally, assertively express themselves and
In the context
of professionals working in socio-healthcare centers, which serve
mainly elderly patients with chronic diseases and disabilities,
it is possible that a daily challenge consists in keeping an adequate
and balanced emotional involvement to provide quality care. Knowing
their own emotional intelligence skills such as self-awareness,
social awareness and empathy facilitate this task. Self-consciousness
allows to address the intense emotions that sometimes seize patients
(fear, sadness and others) and can vent (sometimes with anger) on
the professionals who serve them. Knowing how to manage one's emotions
enables the professional to channel these situations. Social awareness
contributes to active and reflective listening as well as interpreting
nonverbal communication. Likewise, empathy enables professionals
to perceive the patient's feelings, recognize and validate them,
facilitating a relationship based on trust, which can therefore
improve the therapeutic effectiveness.15
It is important in this sense to be aware that this ability is not
exempt from the possibility of being misunderstood and associated
with excessive emotional implications and unwanted effects.3,16
In addition, the perception of empathy is variable and can be evaluated
differently by patients and healthcare professionals.17,18
Taking care of these aspects, together with the validation of emotions,
improves patient cooperation and general attention.3,19
benefit of the course was a greater feeling of team cohesion among
those professionals involved. Professionals often evaluated positively
the opportunity to establish social relationships with peers, being
it a known factor that contributes to professionals' satisfaction.20
The collaboration of participants was also highlighted, who aware
of the strategic nature of the "wow factor" for the proper
development of the course, respected the request for confidentiality
and did not transmit information to colleagues who participated
in later editions.
Among the limitations
of this study, we noted that after reviewing the measuring instruments
mostly used, as the Jefferson scale of empathy or the interpersonal
reactivity index, among others, none of the questionnaires completely
met our goals. So qualitative methodology was chosen for this first
approach to the experience of professionals, albeit with a mixed
qualitative and quantitative design when systematically collected.
since the point of view of the experience of communication differs
between health professionals and patients,18
it is interesting to analyze simultaneously if after an intervention
of this kind, the perception of beneficial effects of the professionals
is also shared by the patients they serve.
well-known aspect is that many healthcare professionals state that,
altruist and humanitarian reasons are among the main reasons for
choosing their profession as well as their dedication and commitment
to people, and that this social vocation is its driving force. However,
compassion, even being sincere, not always achieves the goal of
helping others, and thus it is currently accepted as possible and
beneficial to teach and learn skills of emotional intelligence.1,2
Nonetheless, this training is still a pending issue, both in undergraduate
and graduate curricula, and it is not yet given due prominence as
it should given their positive impact on satisfaction and quality
of care received by patients.8
Occasionally, implementing empathy at work is confronted with difficulties
in providing more time to patients and with the need to revise the
value system of healthcare.4
This misalignment supports the need for a new paradigm to reformulate
how society deals with disease, disability and death21
and altogether opens far-reaching philosophical reflections that
were often also raised by participants in the course.22,23
By training emotional intelligence skills, however, professionals
feel better endowed to deal with these or other adverse conditions
and protect the quality of the relationship with the patient.
fact we might ask ourselves: why asking professionals to leave their
comfort zone and encourage them to break their defenses to become
another and feel fragile? Why taking them, for example, to their
future as the elderly person (as proposed in one of the exercises
of the course) if not for some to discover (or remember) that their
most powerful motivation, standing out the daily difficulty is to
treat patients as they would like to be treated themselves in the
future? The answer to these questions is that by setting participants
in the place of the essential vulnerability of human beings, most
rediscover their own essential strength. Given the above, professionals
were satisfied with the skills learned and consider developing them
throughout their career and live them as a real source of motivation
and enthusiasm. They also stressed the strong sense of pride and
vocation to the chosen profession.
short, theatrical interpretation techniques, properly guided, were
perceived as effective for transformational learning in emotional
intelligence of health professionals by allowing them to connect
with their own emotions and appropriately express them in a safe
environment. Besides expressing their satisfaction, participants
also showed their enthusiasm and interest in this type of training.
thanks to Patricia Vigués for correcting the English version
of abstract and translating the manuscript. We also thank all professionals
MútuaTerrassa socio-healthcare centers, and especially Mireia
Boté for their collaboration in this study. Finally, we show
our gratitude to all patients treated at these centers who we would
like, somehow, to have brought some benefit.
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