The purposes of this study were firstly to identify ICU nurses’ experience of using emotion management strategies in emotional incidents at work, and to explore the incident outcome and the influence of the outcome on the involved ICU nurses. Through social learning perspective, this study also aimed to understand ICU nurses’ learning process for emotion management. This chapter reviewed some findings of previous research studies and connected this study’s main theories to nursing work.
Emotion Management Strategies
In this part, emotion management was defined at first and then related emotion management strategies and models were explained and reviewed in the following sections.
Definition
As time goes, the term “emotion management” has been defined by many scholars and researchers as shown in Table 2.1.
Table 2.1.
Definition of Emotion Management
Emotional Labor
Emotional labor is a kind of occupational emotional demand, which describes that an individual needs to regulate his or her emotions to comply with social norms or to meet organization expectations (Hochschild, 1983). Emotional labor involves people who enhance, suppress, or fake their emotions to modify the emotional expressions (Grandey, 2000). In the organization, people may need to modify or regulate their emotions because of the display rules regarding the expectations of organization (Ekman & Friesen, 1975; Goffrnan, 1959). In Ashforth and Humphrey’s perspective (1993), they defined emotional labor as the act that one displays appropriate emotions for managing the impression for the organization, so they considered emotional labor as an observable behavior more than a management of feelings.
Hochschild (1983) proposed two main ways of managing emotions: surface acting and
Source Definition
Hochschild (1983) “The management of feeling to create a publicly observable facial and bodily display” (p.7).
Lazarus (1994) Emotion management refers to cognitive and behavioral regulatory strategies that individuals adopt to maintain emotion harmony and reduce negative emotions when facing disturbing situations that elicit negative emotions.
Lee (2002) Individuals can express emotions appropriately through perceiving others’ and their own emotions, and regulating their emotions effectively while understanding and empathizing others’ emotions to reach physiological and psychological coordination.
deep acting. Surface acting means the regulation of emotional expressions; deep acting means the modification of feelings in order to express the desired or expected emotions.
These two ways demand different resources, because surface acting is about going through the motions, while deep acting requires putting one’s self in another’s shoes (Diefendorff, Croyle, & Gosserand, 2005). Surface acting means the expressions of emotional labor are not their real feelings inside; instead, they express it by faking. The modification of expressions usually with the goal of meeting organization’s expectations or display rules, so surface acting usually leads to emotion dissonance within emotional labor (Yu, 2012). When emotional labor workers try to modify their own real emotions in order to show a consistency with organization’s display rules, they are using deep acting strategy. The emotional labor workers who use deep acting strategy can have more sincere and natural expressions and are less likely to lead to emotion dissonance (Yu, 2012).
Grandey (2000) developed a theoretical model of emotional labor, which is presented in Figure 2.1. The model was developed through utilizing and reviewing the general emotion regulation theories to provide a new way to conceptualize emotional labor. In the model, the situational variables, which are antecedents of emotion regulation, include the interactions between employees and customers. In previous emotional labor studies, the situational variables, which involve customer contact and the display rules of organization, are the factors that contribute to the emotional labor process (Morris & Feldman, 1996; Hochschild, 1983).
Figure 2.1. Conceptual framework of emotion regulation. Adapted from “Emotion regulation in the workplace: A new way to conceptualize emotional labor,” by A. A.
Grandey, 2000, Journal of Occupational Health Psychology, 5(1), p.101. Copyright 2000 by the Educational Publishing Foundation.
Emotion Regulation Strategies
The first precursor of emotion regulation research has focused on reducing negative emotion experience through mental or behavioral control. However, the focus has expanded to concern with both conscious and unconscious processes that affect an individual’s positive or negative emotion experience (Mayer & Salovey, 1995; Parrott, 1993). The second significant precursor of emotion regulation research at first focused on responses to physical challenges and later expanded to responses to psychological challenges. Psychological stress and coping research, which is one of the roots of emotion regulation research, has concerned Situational Cues Emotion Regulation Process Long-Term Consequences Interaction Expectations
with adaptive, conscious coping processes and has focused on situational variables instead of person variables (Parker & Endler, 1996). Stress and coping research has been distinguished between problem-focused coping and emotion-focused coping. The purpose of the former is to solve the problem, while the latter is to decrease negative emotion experience (Gross, 1998a).
Emotion is elicited in different ways, including individuals’ subjective experience, physiological influence, and response tendencies. Emotion regulation is a process in which individuals try to have cognitive or behavioral change through situation reappraisal in order to influence the emotional incidents and modify the type, intensity, duration, or expression of emotion (Gross & Muñoz, 1995; Gross, 2009; Koole, 2009). Because emotions are unfolded over time during multi-componential processes, emotion regulation involves changes in
“emotion dynamics” (Thompson, 1990). Emotion dynamics refer to responses’ impact in behavioral, experiential, or physiological domains as emotions proceed in different stages, which are latency, rise time, magnitude, duration, and offset.
According to the consensual model as shown in Figure 2.2, emotion usually begins with evaluating external or internal emotion cues. Then, a set of behavioral, experiential, and physiological emotional response tendencies are triggered by the evaluations to express adaptive responding to the stimulus. However, the modulation of response tendencies forms the final shape to display emotional responses (Gross, 1998a).
Figure 2.2. A consensual process model of emotion regulation highlighting two major classes of emotion regulation. Adapted from “Antecedent-and response-focused emotion regulation,” by J. J. Gross, 1998a, Journal of Personality and Social Psychology, 74, p.226.
Copyright 1998 by the American Psychological Association.
During the process of emotion generation, ERS are potentially limitless, so it is difficult to find a way to organize countless strategies. As shown in Figure 2.3, Gross (2002) developed a process model of emotion regulation that shows how specific strategies can be differentiated along the timeline of the unfolding emotional responses. In his definition, emotion regulation refers to “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions”
(p.275). In Figure 2.3, emotions can be regulated at two distinguishing phases:
antecedent-focused emotion regulation and response-focused emotion regulation. The former occurs before the emotion is generated and modifies the stimulus, while the latter occurs after the emotion is generated and modifies an individual’s response to the stimulus (Gross, 1998a;
Gross & Muñoz, 1995).
Emotional Cues
Emotional Responses Emotional
Responses Tendencies
‧Behavioral
‧Experiential
‧Physiological
Evaluation Modulation
Figure 2.3. A process model of emotion regulation. Adapted from “Emotion regulation:
Affective, cognitive, and social consequences,” by J. J. Gross, 2002, Psychophysiology, 39, p.282. Copyright 2002 Society for Psychophysiological Research.
Antecedent-focused strategies refer to the things we do before emotional response tendencies are triggered and behavior and physiological responding is changed (Gross, 2002).
The strategies used in antecedent-focused emotion regulation stage are similar to deep acting proposed by Hochschild (1983). Individuals regulate emotions through changing external situations and stimulus or internal psychological state (Gross, 1998b). For example, you can see a job interview as a chance to know more about a company instead of a decisive test.
Strategies involving in antecedent-focused regulation process are further divided into four categories: (1) situation selection, (2) situation modification, (3) attentional deployment, and (4) cognitive change (Diefendorff et al., 2008), which were explained respectively later.
Response-focused strategies refer to the things we do to modify our ongoing emotional response tendencies after emotion has already generated (Gross, 2002). The strategies used during this process are similar to surface acting proposed by Hochschild (1983). Individuals
instance, one may hide his embarrassment after he makes a slip of the tongue in public speech. The strategy used during this emotion regulation process is response modulation, which was also discussed in the followings.
Situation selection.
The first of these strategies is situation selection, which regulates emotion by approaching or avoiding a certain situation involving particular people, places, or things (Gross, 2002). For example, you can choose a seat away from a friend who always disturbs and chats with you in class. However, short-term and long-term emotional benefits of situation selection often involves complex trade-offs. In Leary’s (1986) example, a shy person who avoids social occasions to decrease anxiety and get short-term relief may in the long run become social isolation.
Situation modification.
Second strategy is situation modification, which refers to a situation that may be tailored to modify its impact on one’s emotion (Gross, 2002). For example, if a patient is afraid of having an injection and judges that you look poor at it, you can reassure him by saying you are the expert (Chen, 2007).
Attentional deployment.
Third, situations have different aspects (e.g., a1, a2, a3…), and attentional deployment is that you can select which aspect of the situation you want to focus on. Three specific strategies here are distraction, concentration, and rumination (Gross, 2002). For example, you can distract yourself from an upsetting conversation by appreciating the restaurant’s decoration or by concentrating particularly on a topic or task.
Cognitive change.
The forth strategy is cognitive change, meaning to select one of the many possible meanings (e.g., m1, m2, m3) you attached to that aspect you chose. For example, you can see the exam as a self-evaluation of learning result instead of see it as a measure of your value.
Cognitive change is often used to decrease or magnify one’s emotional response, and even to alter the emotion itself, such as transforming anger at a piece of news into sympathy. The meaning that a person attaches to the situation is important because it would have powerful influences on physiological, experiential, and behavioral response tendencies that would be elicited in that situation.
Response modulation.
The last strategy is response modulation, which means trying to influence emotion response tendencies once they have been generated. In the model, the symbol “-“ means the response tendencies are regulated by decreasing expressive behavior, while “+” means reinforcing the expressive behavior. Emotional response tendencies involve three kinds of responses: behavioral, experiential, and physiological responses. For example, you might hide your fear and nervousness by standing behind a desk when giving a presentation.
Physiological responses such as depression and anxiety can be controlled by drugs.
Reappraisal and suppression.
As mentioned above, it is difficult to organize all strategies because there are lots of different ways that an individual can use to regulate emotions. Two commonly used regulation strategies highlighted here are cognitive reappraisal, which happens in antecedent-focused emotion regulation process and expression suppression, which happens in response-focused emotion regulation process. Cognitive reappraisal is one of antecedent-focused strategies and a type of cognitive change. Reappraisal is defined as
“construing a potentially emotion-eliciting situation in nonemotional terms” (Gross, 2002, p.
283). Expressive suppression is one of response-focused strategies and a type of response modulation. Suppression is defined as “inhibiting ongoing emotion-expressive behavior”
(Gross, 2002, p. 283). To investigate the consequences produced by these two emotion regulation strategies, Gross (2002) conducted an experimental study to compare each
condition were not asked to use any regulation strategies and thus were free to regulate if they want. The premise of this study is that antecedent-focused strategies concern whether emotion response tendencies are triggered, and that response-focused strategies concern how emotion response tendencies would be modulated if they have been elicited. The affective consequences presented in the findings shows that based on the process model of emotion regulation, reappraisal leads to lesser physiological, experiential, and behavioral responses.
Compared to reappraisal, suppression decreases expressive behavior but not decrease emotion experience. Further, the effort to inhibit ongoing emotion-expressive behavior might even increase physiological responses. In cognitive consequences, suppression requires self-monitoring and self-corrective actions in an emotional incident and impairs memory;
while reappraisal does not need self-regulatory effort in an emotional incident and leaves memory intact (Richards & Gross, 2000).
Summary
During emotion generative process, different strategies that act at different points may have different consequences; therefore, the adoption of Gross’s (2002) model as a foundation helped this research identify ERS that could be used in different phases and explored more potential strategies and the potential consequences among those strategies.
Social Learning Theory
In this part, the development of learning theory in exploring human behavior was explained at first, and then the core concepts of social learning theory (SLT) and related research studies within nursing field were reviewed in the following sections.
Learning and Human Behavior
Many theories have been developed over years to explore why people behaved as they do (Bandura, 1977). Early theories depicted behavior as driven by inner forces, which may be needs, and impulses that often happened below the level of consciousness. However, an
internal motivator cannot explain all the variation of human behavior for different social roles under different situations. The later development of learning theory changed the focus from inner determinants to external influences on human responsiveness. Researchers analyzed human behavior by investigating the antecedent stimulus that induced the behavior and the reinforcing consequences that altered the responsiveness. The findings showed that human behavior or response could be induced, eliminated, and regained simply by external environmental influences. In the social learning perspective, human is driven not simply by inner forces or environmental influence, but by a reciprocal interaction between behavior, environment, and cognitive factors.
One can always learn something from an experience (Mumford, 1995). In traditional theories of learning, human behavior was viewed as the product of directly experienced response consequences. Actually, in addition to direct experience, an individual can also learn on a vicarious basis by observing others’ behavior and its consequences for them.
Learning by observation enables an individual to acquire modeled behavior without having to build up the behavior patterns by trial and error.
Observational Learning and Modeling
The core concepts of social learning theory are observational learning and modeling.
Bandura (1977) thought that learning involved two different processes, one was learning from the consequences of direct experiences; the other was learning through observation processes. In social learning theory, it is emphasized that an individual’s behavior can be influenced by others in a social context. To elaborate this concept, Bandura provided observational learning and modeling as explanation. Observational learning refers to learning by observing others’ behavior. For instance, a little girl who has seen her mother putting on lipsticks may imitate her mother’s behavior and put on lipsticks by herself. During
modeling activities, which directs observers to produce appropriate behaviors.
Observational learning involves four processes (Bandura, 1977; Olson & Hergenhahn, 2009):
Attentional processes. During the first phase of observational processes, individuals must firstly pay attention to the essential features of the role model’s behavior otherwise it is impossible to learn through observation. In this phase, the individuals need to select a role model that they would pay close attention to, and they choose the most relevant characteristics from the role model’s behavior. Observational experiences are influenced by lots of factors including the characteristics of the role model’s behavior, the role model’s characteristics and similarity, observers’ features, associational preferences and interaction relationship between role models and observers (Bandura, 1977; Black & Mendenhall, 1989).
Retention processes. An observer cannot be much influenced by a role model’s behavior if he does not keep it in his memory, so the second phase of observational learning is retention processes. During retention process, observers transform the role model’s behavior into symbolic representations and keep in their memories so that they can remember the role model’s behavior with the absence of the role model. Bandura considers the observational learning mainly relies on two representational systems—an imaginal and a verbal system (Black & Mendenhall, 1989). The imaginal representation, for instance, when we hear the name of a friend, we always experience the imagery of his or her physical characteristics. The verbal coding of observed event, for example, when we try to memorize the itinerary, we may transform the visual information into a sequence of right and left turns instead of relying on the visual imagery (Bandura, 1977).
Reproduction processes. The third component of processes involves transforming the observational learning into overt actions and the observers represent the modeled behavior.
Actual reproduction of the modeled behavior can have physical limitations due to the physical differences between the role model and the observer. For example, a young child can
learn how to drive an automobile by observing his father’s action but if he is too short he is not able to drive successfully. Four phases of enactment are required for reproducing the modeled behavior (Bethards, 2013): (1) cognitive organization, (2) initiation, (3) monitoring, and (4) refinement based on feedback.
Reinforcement and motivational processes. In the fourth stage, learners’ motivation of adopting modeled behaviors is influenced by the consequences of their behavior representation. They may be motivated by intrinsic motivation, which comes from inside an individual, by extrinsic motivation, which refers to any external source, or by vicarious association (Bethards, 2013; Black & Mendenhall, 1989). When an individual is motivated by positive incentives, the previous observational learning behavior is promptly translated into overt expressions (Bandura, 1965). The reinforcement function of observational learning consequences can help enhance the possibility that the learner represents the modeled behavior (Bandura, 1977).
In observational learning, the role model can be anyone whom the individual has the opportunity to observe, such as family members, employers, co-workers, and teachers, who would either encourage or discourage the individual through the social learning steps (Betz &
Hackett, 1981; Krumboltz, Mitchell, & Jones, 1976). During the social learning process, the presence of a role model and the relationship between individuals and role model can lead the individual to different result. For example, in Scherer, Adams, Carley, and Wiebe’s (1989) research of role model and entrepreneurial career preference, the career preference of individuals with a parent entrepreneurial role model is significantly different from individuals with an entrepreneurial role model, and from individual without a role model. SLT was also applied in simulation experience, and it was found that the participation in observer role has the same learning opportunities as the participation in process-based role (Bethards, 2013;
Kaplan, Abraham, & Gary, 2012). In some research, SLT was also utilized as a theoretical
outlined a new framework for the cross-cultural training (Black & Mendenhall, 1898, 1990).
To shed some light on ICU nurses’ learning of emotion management, this study adopted SLT as a theoretical basis for understanding ICU nurses’ learning experience for emotion management.
Social Learning and Nursing Work
Nurses who are trained to be able to work independently and professionally are also required to learn how to work in a team. Nurses who engage in effective teamwork can not only improve patients’ safety but also benefit less experienced nurses (Brunetto et al., 2013).
To understand the role of social learning in terms of teamwork, which is important in nursing units, it is found that social learning opportunities in teams can vary from different situations.
Among all situations, three modes are identified as consistent patterns of actions, interactions, and observations in social learning (Singh et al., 2012):
(1) Learning from personal interaction (PI): Individuals can learn from personal experience with the task or from the direct interactions with others, which are the most direct form of
(1) Learning from personal interaction (PI): Individuals can learn from personal experience with the task or from the direct interactions with others, which are the most direct form of