USING KING'S INTERACTING SYSTEMS

THEORY TO LINK EMOTIONAL

INTELLIGENCE AND NURSING PRACTICE
LINDA L. SHANTA, PHD, RN⁎ AND MARIA CONNOLLY, PHD, CNS/APN, CNE, ANEF, FCCM†

King's theory is a broad theory designed to provide a framework for nursing (I.M. King, 1981),
whereas emotional intelligence (EI; J.D. Mayer & P. Salovey, 2004) is a theory that is specific for
addressing potential competency in dealing with emotions and emotional information. J.D.
Mayer, P. Salovey, D.R. Caruso, and G. Sitarenios (2001) defined EI as the “ability to recognize
the meaning of emotions and their relationships and to use them as a basis for reasoning and
problem solving” (p. 234). These researchers believed that EI is related to cognitive intellect
through the ability to use reasoning by way of information to find meaning. J.D. Mayer and
P. Salovey (2004) argued that the skills that comprise EI were likely enhanced through obtaining
a liberal education infused with values exploration. J.D. Mayer, P. Salovey, D.R. Caruso, and
G. Sitarenios (2001) contended that there are 4 branches of abilities that create EI: (a) the
skill of perceiving emotion within oneself and others, (b) assimilation of an emotion to
facilitate thinking, (c) understanding and knowledge of emotion, and (d) conscious regulation of
emotion. Each level or branch builds upon the previous one, and awareness of what each branch
offers the individual in enhancing relationships with others is a key component of healthy
emotional interactions.
This article will provide a theoretic foundation based upon King's interacting systems theory
(IST; 1981) that embraces EI as a crucial component in the nurse's ability to provide holistic care
for patients, peers, and themselves. King's IST underscores the necessity of nurses possessing
abilities of EI as they care for others but does not fully describe a mechanism to understand and
incorporate emotions within the complex nurse–patient interactions and communications that
are part of the nursing process. (Index words: Emotional intelligence; Nursing practice) J Prof
Nurs 29:174–180, 2013. © 2013 Elsevier Inc. All rights reserved.

T HE MANNER IN which nurses care for their

patients and work with their colleagues relates to
their own ability to perceive interactions within their
personal system. This ability includes perceiving one's
own emotional responses to the environment. Peplau
(1952, cited in Schafer & Middleton, 2001) stressed that
unrecognized needs of the nurse can move the focus of
care away from the patient. Further, she felt that the nurse
who is unprepared to form appropriate interpersonal
relationships could potentially cause the nurse to relate to
*Assistant Professor, College of Nursing, University of North Dakota,
Grand Forks, ND.
†Professor of Nursing, University of St. Francis College of Nursing,
Joliet, IL.
Address correspondence to Dr. Shanta: College of Nursing,
University of North Dakota, 430 Oxford Street, Stop 9025, Grand
Forks, ND 58202-9025. E-mail: linda.shanta@email.und.edu
8755-7223/12/$ - see front matter
174 Journal of Professional Nursing, Vol 29, No. 3 (May/June), 2013: pp 174–180
http://dx.doi.org/10.1016/j.profnurs.2012.04.023
the patient in a manner that may be harmful to the patient
(Peplau, 1989a, cited in Schafer & Middleton, 2001).
It is important that nurses are able to establish effective
ways to communicate with others in the health care team
and as part of a healthy interpersonal system. To do this,
nurses often must use their own emotions to facilitate
thinking about a problem and to understand the
implications of emotions in them and in others in order
to offer possible solutions to complex health care
problems. Likewise, to negotiate through a complex
health care environment that increases the number and
types of interactions within a social system, nurses must
not only be able to manage their own emotional
responses but also be able to manage the emotional
responses of others (Freshwater & Stickley, 2003).
The ability to respond therapeutically requires that
nurses have the capacity to perceive, facilitate, understand,
and manage the interactivity of human systems, and this
© 2013 Elsevier Inc. All rights reserved.
KING'S INTERACTING SYSTEM
is particularly true for successfully caring for the emotional
responses of patients facing changes in their health
(Benner, 2001; King, 1981). To explain the complex
nature of human beings, King offered the interacting
systems theory (IST), which centers on the dynamic
interaction of humans with each other and the environ-
ment and in which perception is considered essential to all
interactivity. King's theory provides a framework for
nurses to manage the interactivity of the patient with the
nurse and within himself or herself in order to meet the
complex needs necessary for health. The organizing
framework of the theory includes three interacting
systems: personal, interpersonal, and social. Each system
has distinguishing concepts and characteristics that
define and explain the particular system and its
interactions within the individual and between the
individual and others.
King's IST Theory
King's theory (1981) maintains that each system interacts
constantly and intricately. For purposes of defining the
three systems, these are artificially separated in this
description. The personal system is the realm in which
individuals take in and process information. The system
relies on individual perception as the essential charac-
teristic to allow understanding of self and others. The
interpersonal system concentrates on interaction, com-
munication, transaction, role, and stress. The third
interactive system that King addressed was the social
system. In this system, interaction occurs within and
between groups of people that share common goals,
interests, and values representative of the social system. It
is within this system that boundaries are set roles,
behaviors, and demands of nurses.
King's theory (1981) defines and constructs a concep-
tual framework implying that these skills are necessary;
yet, the framework does not fully explain a mechanism to
develop and foster these skills as part of a nurse's
practicing tool kit. The emotional intelligence (EI)
abilities theory adds an opportunity to gain clarity of
emotions and resulting coping behavior in the complex
health care environment that nurses are likely to practice
within (Pellitteri, 2002; Salovey et al., 1995).
The Abilities Model of EI
Mayer et al. (2001) defined EI as the “ability to recognize
the meaning of emotions and their relationships and to
use them as a basis for reasoning and problem solving”
(p. 234). These researchers believed that EI is related to
cognitive intellect through the ability to use reasoning by
way of information to find meaning. This model is
composed of four branches of abilities that create EI. Each
level or branch builds upon the previous one and
awareness of what each branch offers the individual.
Enhancing relationships with others is a key component
of healthy emotional interactions. The following is a brief
description of the four branches. The first branch is the
perception of emotion, which is the skill of accurately
distinguishing emotion within oneself and others. Using
175
emotions to facilitate thinking is the second branch. This
branch enhances an individual's ability to assimilate
emotion, to facilitate thinking, and to prioritize thinking
and judgment. Understanding emotion follows as the
third branch, which allows application of the emotional
knowledge gained in the first two levels of skills to
translate emotions to meaning within the context of
events. The highest level of the skills of EI is the
conscious regulation and management of emotion. This
level of the model allows the individual to remain
receptive to emotional information while reflecting on
the usefulness of it. This reflective ability provides the
ability to evaluate emotional reactions not only within
self but also those conveyed by others. By evaluating the
reactions, the individual is able to manage the emotions
without changing the intensity of the expression.
Significance of Emotional
Intelligent Nurses
Historically, nurses have not only cared for patients
physically but also emotionally and spiritually (Jackson,
2004a). In today's health care environment, nurses are in
short supply, and health care organizations, suffering
from budget cuts, have further reduced the numbers of
available staff (Benner, Sutphen, Leonard, & Day, 2010),
thereby increasing the already overwhelming burden of
nurses. In a system that often demands that nurses do
more with fewer resources, nurses not only have less time
to focus on individual needs of the patient but also
perceive that institutions place less value on the invisible
work of meeting the emotional needs of the patient
(Bone, 2002). In a qualitative study, Bone found that
nurses felt that the most compelling constraint in
providing emotional care to patients was lack of time.
Emotional competency might enable nurses to respond
effectively to the emotional reactions of their patients and
colleagues even in a chaotic environment (Bone, 2002).
Conversely, the result of not fostering development of EI
within nurses could adversely impact patient outcomes
when the emotional needs are not addressed (Bone, 2002;
Raingruber, 2000). Patient outcomes may also be harmed
by an exacerbated shortage of nurses if conditions within
the practice setting are incongruent with the value nurses
hold for holistic care and if they leave the profession
(Bone, 2002).
Although the health care community recognizes the
crisis and its influence on nurses' job satisfaction and the
toll on nurses' mental and physical health, some literature
have focused on the external environment of practice
(Abraham, 2000; Jackson, 2004b). Other literature
examined if nurses inherently contribute to the problem
in health care or to a solution (Bellack, 1999; Leiter, Price,
& Laschinger, 2010; Lucas, Laschinger, & Wong, 2008;
Smith, Profetto-McGrath, & Cummings, 2009; Utley-
Smith, 2004). Ultimately, the profession of nursing must
not only look externally to assign blame or for solutions
to the plight of modern health care. It is crucial to
examine every facet of the profession to help nurses gain
competencies necessary for ethical, holistic care of the
176
patients and families in which they serve. The recent
study conducted by the Institute of Medicine (IOM) and
the Robert Wood Johnson Foundation and released in
October 2010 examined the way in which nurses are
educated. Specifically, the study provided four major
recommendations that further show the need for nurses
to have a fully developed ability to deal with emotional
information. There are four key messages that summarize
the recommendations:
• Nurses should practice to the full extent of their
education. This means that nurses must be able to
interact with all levels of health care stakeholders to
remove barriers to effective practice.
• In order to practice to the full extent of their
education, nurses must be able to collaborate with
all health care professionals to leverage equal and
valid influence at all levels of health care. This
means that nurses should lead the care planning of
complex patients in a clinical situation and help
shape overarching health care policy.
• Eighty percent of the nurses should hold a
baccalaureate degree by 2020, but holding a
baccalaureate degree is no guarantee that nurses
will practice at the level envisioned—a curriculum
that is infused with a full scope of liberal arts and
content that provides a broader view of the
profession than a traditional curriculum that is
task based. In a separate study, Benner et al. (2010)
issued a similar appeal for fundamental and deep
changes in the way that nurses are educated.
• Work force planning and development must im-
prove to include strengthening the infrastructure.
One part of this infrastructure includes the recom-
mendation that nurses should be afforded the same
transition into practice that other valued health care
professional enjoys. Residency and other transitional
programs usher physicians, chiropractors, physical
therapists, pharmacists, and other professionals into
practice. This recommendation will help to establish
more effective means for nurses to enter practice.
As demonstrated by the recommendations of the IOM
report (2010) and the Benner et al. study (2010), nurses
must possess specific competencies to interact thera-
peutically with those they care (King, 1981). These
therapeutic interactions are multifaceted and deal with
complex emotional and physical needs (Davies, Jenkins,
& Mabbet, 2010; Smith et al., 2009). Emotion is a
human response with which a nurse must develop the
capacity to sort out and manage within himself or
herself and in the patients and families for which they
care (Smith et al., 2009). EI is the ability to process and
manage emotions, and all humans are born with a
certain level of EI (Mayer et al., 2001). EI is an emerging
theory; the research is just beginning in the area of EI
and nursing (Codier, Muneno, & Freitas, 2011; Smith et
al., 2009). Codier, et al. presented a compelling article
that describes the importance of how EI relates to care
of patients, team relationships, and nurse self-care. In
SHANTA AND CONNOLLY
the 2009 study of postentry competence published by
the National Council State of Boards of Nursing (2009),
nurses indicated that the interpersonal skills that allow a
nurse to deal with crises with composure and compas-
sion were most highly valued as competence. Thus,
according to this theory, one could conclude that high
EI levels in nurses should enhance the nurse/patient
relationship, thereby enhancing nurses' abilities to care
for patients. The purpose of this article is to offer a
theoretical framework for the integration of EI as an
underpinning for effective nursing practice.
The Intersection of IST and EI for Nursing Care
Competencies vital for navigation within King's (1981)
three systems may be enhanced by competencies
associated with the abilities model of EI (Mayer &
Salovey, 2004). This section will provide details and
evidence to support this position. The personal system,
integral to the individual's sense of self, is addressed first.
The systems are artificially segregated in this section to
clearly highlight two main features. First, this will
demonstrate the importance of nurses having the ability
to manage interactions between and within each of the
systems effectively. Second, this will make explicit what
is now implicit in the IST (1981), that is, how emotional
responses, within nurses and between nurses and their
patients and colleagues, are foundational to communica-
tion and emotional interaction. In other words, the intent
is to illustrate how competencies of EI might enhance
nurses' abilities to interact therapeutically with complex
patients and as leaders within the health care team.
Personal System and EI
King (1981) stated that perception, judgment, and
mental action are the basis for all human behavior.
According to EI theory, emotions are considered a
human response to an internal or external event
(Salovey & Mayer, 1990). Emotions can result when
an individual perceives changes in relationships within
his or her environment. How these emotions are
expressed differs among individuals and is related to
cultural and familial influences (Davies et al., 2010;
King, 1981; Mayer & Salovey, 2004) and has been
shown to affect health through body–mind connections
(Latorre, 2000). King's conceptual framework indicates
that effective management of emotion requires two
skills—the ability to perceive emotions of self and
others accurately and the ability to use emotions to
promote thinking and judgment.
The first skill allows nurses to focus on the patient's
emotional issues (King, 1981; Raingruber, 2000; Yorks &
Sharoff, 2001). Within health care, nurses come in
contact with patients who express emotions related to
events affecting their lives (Beck, 2001; Morse, 2001). In
order to provide reflective care, accurate assessment of
the patient's perception of his or her emotional state and
physical condition is important to help the patient
achieve health (King, 1981). The second skill might aid
nurses to use emotional information to solve problems in
KING'S INTERACTING SYSTEM
the practice environment (Jackson, 2004b). To accom-
plish this goal, it is necessary for the nurse to accurately
perceive emotions that may be triggered within self from
events happening in his or her practice (King, 1981). It
is essential for nurses to realize that their own
perception might be altered in high emotional states
(King, 1981; Morse, 2001; Yorks & Sharoff, 2001).
Nursing competence that is enhanced by EI will be
required if nurses are to practice to the full extent of
their education and to serve the health care stakeholders
as full partners (IOM, 2010).
In a study of the accuracy of recognizing emotions in a
state of high stress, Engelberg and Sjoberg (2003) found
that accurate perception of emotions can also enhance
appropriate judgments. Perception is an essential concept
within the personal system. Perception of one's feelings is
crucial to effective responding. Conversely, high emo-
tional states, such as anger, fear, and love, may distort
accurate perception. The ability to process emotions
within the personal system is essential to precision of
judging the feelings being displayed by the behavior of
others (Engelberg & Sjoberg, 2003). Nurses' awareness
of factors that impact their perception is vital in caring
for their own emotional needs and responses and those
of their patients (King, 1981). Besides accurate percep-
tion, the cognitive competencies within EI (Mayer &
Salovey, 2004) may enhance effective management of
emotions as described within King's personal system.
Emotional processing may moderate stress that an
individual nurse feels and while trying to balance the
needs of others with the personal needs of self in order to
prevent burnout (McQueen, 2004).
Interpersonal System and EI
The process of interaction, according to King (1981),
requires perception, judgment, mental action, and re-
actions. King asserted that the concept of perception is
fundamental to human interaction through a two-way
relationship. Behavior, such as a nurse planning and
executing a nursing intervention for a patient, flows from
perception, and in turn, perception influences one's
behavior (King, 1981). Interpersonal communication is
the means to share perceptions and obtain certain forms
of feedback and is based on mutuality of verbal and
nonverbal messages. These messages often relate to
emotional reactions. Reciprocity of interpersonal com-
munication could clarify and create holism within
relationships (King, 1981). Transaction is always present
between individuals when values are exchanged (King,
1981). Many transactions occur in a nurses' daily work
between professional colleagues, assistive personnel, and
with patients.
Effective interaction is essential to establishing a
caring relationship between nurse and patients. This is
particularly crucial to address the magnitude of possible
emotions because a patient's perception of threats to
health presents challenges that the nurse needs to
accurately address. Other nursing literature acknowl-
edges the emotional side of the interpersonal system
177
through the concept of empathy (Holm, 1997; Jackson,
2004a; Olsen, 2001). Such mutuality of shared feelings
often triggers an emotional response of empathy
(Olsen, 2001).
Empathy is defined as the ability to understand
another's subjective feelings (Salovey & Mayer, 1990).
It is related to the interpersonal system because it can
emerge within dynamic human interactions, such as
purposeful nurse–patient engagement. The operative
word is can; it does not have to emerge or may not be
able to emerge if the necessary emotional skills are not
sharpened and honed (Jackson, 2004a). Empathy con-
sists of several components, each engaging and building
upon the next (Holm, 1997). The first component
requires perceiving another's innermost experience
(Holm, 1997; Salovey & Mayer, 1990). Salovey and
Mayer contended that empathy requires examination of
one's own feelings and those of others in a circular
reaction that results in experiencing the feelings of
another by recognizing them through behavioral cues.
Empathy in health care is used to describe the ability to
recognize and respond to patients' emotions as they
experience changes in health (Beddoe & Murphy, 2004).
In order to facilitate empathy for others, nurses need to
recognize and understand their own emotions and
experiences that result in emotional responses (Scotto,
2003). It is the understanding of human interactions that
allows the nurse to observe and interpret information about
the patients (King, 1981). Thus, the level of empathetic
skills the nurse uses emerges through the nurse's ability for
accurate perception during interpersonal interactions with
patients and, thus, aligns with the ability to perceive
emotion (Mayer, Caruso, & Salovey, 1999).
Research demonstrates close association of EI to
empathy (Salovey, Stroug, Woolery, & Epel, 2002) and
positive influence on interpersonal relationships (Lopes,
Salovey, & Straus, 2004). Although empathy has been
reported as resulting in positive patient outcomes (Hojat,
Fields, & Gonnella, 2003), empathic response from
health care providers is often lost in the tangle of
technology and stressors that envelop today's health
care environment (Beddoe & Murphy, 2004; Hojat et
al., 2003). Without the skills and ability to understand
and manage the emotional responses of self, patient,
and colleague, nurses are at risk of emotional suffering
when reexperiencing patients' or colleagues' feelings
(Morse, 2001).
Managing emotions and understanding interpersonal
feelings are essential for supportive collaborative re-
lationships (Dwyer, 2002). Nurses need emotional
support, not isolation, from their colleagues to contend
with the suffering encountered on a daily basis (Fawzi &
AlRub, 2004; Jackson, 2004b). EI in nurses has been
found to be related to the ability to handle conflict and,
ultimately, to increase collaboration between nurse
colleagues (Morrison, 2008). In a study of the literature
related to outcomes of nurse leaders' level of EI,
Akerjordet and Severinsson (2008) found that increased
EI resulted in expanded empowerment activities directed
178
toward staff nurses with the goal of improved patient
care. EI is required for collegial support and professional
conversation (Davies, Jenkins, & Mabbett, 2010). Lucas
et al. (2008) found that managers with higher level of EI
provided staff with more support, feedback, and
guidance. They further concluded that the competence
of the manager to regulate his or her own emotions and
the relationships with his or her staff was linked to the
amount of empowerment the staff felt. It is through
reflective cognition that the nursing manager builds
collegiality among the nursing colleagues through
compassion (Morrison, 2008). King (1981) underscores
the essential nature of cognition in effective human
interaction. Along the same line, Mayer et al. (1999)
defined intelligence as the capacity to reason validly
about information through use of related mental abilities.
Social System and EI
The social system in which nurses function is the health
care environment and covers a variety of settings ranging
from simple organizations such as a one-physician rural
clinic to the highly complex health care system of the
United States (IOM, 2010). Social systems define
themselves through lines of authority, power, and status
(King, 1981). Identification of defining characteristics of
a social system may impact authority and power
distribution (King, 1981). EI and associated abilities
provide an avenue to understand how behavior within
the social system might be enhanced to achieve power,
authority, and status necessary to become part of the
decision-making body within organizations.
Nurses have a foundational role in health care
organizations as active participants in designing and
directing most of the care for patients (King, 1981;
Richardson & Storr, 2010). King felt that nurses should
be included in decision making at all levels of the system
because nurses play such a vital role in the organization
and because professional satisfaction equates with control
over the practice environment. This perspective is central
to the IOM (2010) recommendations that nurses be equal
partners in the transformation of the current health care
system. However, even at the organizational level, there
are barriers to nurses leading patient-centered care
models, as envisioned by the IOM report.
Currently, the greatest focus of the literature related to
EI in nursing is focused on nursing leaders and managers,
who purportedly already have the authority and status to
influence staff nurses' involvement in policy making,
with goals focused on improving patient care. Evidence
that supports the conclusion that a higher level of EI
improves the effectiveness of nurse leaders is emerging.
Specifically, emotionally intelligent managers may help to
manage the chaos and stress within the units and facilities
using the current evidence to transform the environment
that will improve collegiality, competence, and interper-
sonal relationships (Akerjordet & Severinsson, 2008;
Lucas et al., 2008; Smith et al., 2009). EI can serve as a
key component in decisions that are made within moral
boundaries and transformational leadership (Sivanathan
SHANTA AND CONNOLLY
& Fekken, 2002), but it is not enough for only nurse
managers to possess the abilities of EI. The level of staff
nurses' EI is equally important in improving the social
system in which they work and care for patients. The
association of EI with intellectual abilities is foundational
to the argument that EI could underpin nurses' continued
effort to gain additional competence that will boost their
power and status within the institution and that will
contribute engaging nurses in the efforts to change the
current health care environment.
Stress and conflict is a daily reality for many nurses
(Morrison, 2008). Outcomes of the patient care is linked
to the ability of nurses to manage the stress within the
health care systems that will allow them the power
necessary to be patient advocates (Davies et al., 2010;
Lucas et al., 2008; Smith et al., 2009). Control over
nursing practice depends upon the ability of nurses to
develop high level of thinking and expertise (Manojlo-
vich, 2007), and EI has been found to significantly
contribute to cognitive-based performance (Lam &
Kirby, 2002). In this way, enhanced levels of EI in nurses
of all levels of practice might contribute to more effective
leadership, from bedside to boardroom.
If the profession of nursing is to meet the demand
for the transformation of nursing practice in the social
system of health care to address the full scope of
recommendations presented by the pivotal IOM, nurses
will need to develop skills necessary for leading and
advocating for change. The following illustrates how
each branch of EI of the Mayer and Salovey model
(2004) could contribute to the efforts of nurses to gain
authority, power, and status necessary to enter the
policy and decision making within the social system.
The ability to accurately perceive emotions supports the
nurse's ability to distinguish between authentic re-
actions by administrators and other health care pro-
fessionals to recommendations for change versus the
less genuine or patronizing responses. Similarly,
emotional information directs attention to problems
that need to be addressed through multiple points of
view and to be engaged in creative problem solving.
The third level of EI provides nurses with the ability to
recognize transitions in feelings that often result when
the status quo of an organization is challenged. Finally,
the nurses' ability to manage emotion in themselves and
others is essential when creating teams. The social
system is made up of professional, paraprofessionals,
and clinical and nonclinical focused people. The
recommendations presented by the Future of Nursing:
Leading Change, Advancing Health Report (IOM, 2010)
requires that all nurses be leaders. Staff nurses with
high EI can transform into leaders, who can use the
emotional information to stimulate thinking and
problem solving to facilitate organizational goals.
Implications for Future Research Focus
Current literature is providing emerging evidence that
higher levels of EI is associated with positive patient
outcomes (Codier et al., 2011; Davies et al., 2010). This
KING'S INTERACTING SYSTEM
article has provided a theoretic link of EI and nursing
practice. However, there are many questions that emerge
as the connection was developed. Future research is
necessary to answer questions such as the following:
1. How does a nurse develop high levels of EI?
2. Do higher levels of nursing education increase
an individual's EI?
3. What are the characteristics and behaviors of
nurses who have high levels of EI?
4. Will the level of EI in nurses influence patient
outcomes?
5. Does high EI in nurses improve leadership and
collegiality within the health care team?
6. Does a high EI in nurses contribute to status,
authority, power, and influence necessary to
create change in the health care system?
Conclusion
King's (1981) IST provides the nursing profession a
framework within which to understand better the complex
calculus of caring for themselves, patients, and peers and
the ability to negotiate within the health care environment.
Each level within the systems demands a different set of
skills that are interrelated and build upon one another. This
complex interplay, as described here, points to the
necessity of development of competence to interact within
the systems. EI presents skills that seemingly will enhance
the nurses' ability to navigate these systems. Nurses should
continue to find ways to develop skills that are necessary to
respond to the profound recommendations of leaders in
health care as presented by the IOM. EI is a new area of
research that presents opportunity for nursing to explore
its value in improving the full range of nursing practice,
from the interaction and effectiveness of the individual
nurse with meeting the needs of the patient to establishing
the position of nursing for decision and policymaking.
Through a foundation of EI, nurses at all levels of the health
care system can lead and exert maximum influence on the
essential redesign that is central to meeting the profound
recommendations presented by the IOM (2010) report.
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