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EMOTIONAL MANAGEMENT OF TEAMS IN A HOSPITAL
ENVIRONMENT
Marco José Barbas Pinto1
Abstract: The paper addresses the importance of emotional management and teamwork in
the organizational context of a hospital, highlighting that the effectiveness of a team depends on
alignment with the organization’s objectives, collaboration between different hierarchical levels, and
employee motivation. Leadership plays a crucial role, and the leader must be democratic and involved,
promoting an environment of support and effective communication. In addition, the text emphasizes
that interaction between team members generates synergies that enhance creativity, exibility, and
productivity. Maslow’s theory of human needs is mentioned, suggesting that satisfying basic needs
is fundamental to employee motivation and self-realization. Finally, creating a team spirit and being
results-oriented are essential for organizational success.
Keywords: hospital, management, leadership, and organizational cultur
1 Nurse Specialist in Medical-Surgical Nursing in critically ill patients, at the Médio Tejo Local Health Unit
and is a Nurse in Pre-Hospital in Immediate Life Support Ambulance - Guest Adjunct Professor of Medical-Surgical
Nursing at the Santarém School of Health. Guest Assistant in Medical-Surgical Nursing at the Leiria School of Health.
Postgraduate in Management of Health Units and Clinical Supervision. Trainer of Health Professionals. Member of the
Regional Nursing Council of the Southern Regional Section of the Order of Nurses for the 2016-2019 term. Member of
the Regional Fiscal Council of the Southern Regional Section of the Order of Nurses for the 2020-2023 term. Member of
the Regional Fiscal Council of the Southern Regional Section of the Order of Nurses for the 2024-2027 term. He holds
differentiated and advanced competence in Clinical Supervision, differentiated competence in Extra-Hospital Nursing
and advanced competence in management. He completed his Bachelor’s Degree in Nursing from the Escola Superior de
Enfermagem de Portalegre, 2009, followed by a Specialization in Medical-Surgical Nursing from the Escola Superior de
Saúde de Évora, in 2016, and a Master’s Degree in Critical Illness Nursing from the Escola Superior de Saúde de Leiria, in
2019. Collaborating researcher at UMIS at ESSS, collaborating researcher at the Clinical Research and Innovation Center
of the Unidade Local de Saúde do Médio Tejo and collaborating researcher at the Quality of Life Research Center of the
Instituto Politécnico de Santarém.
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INTRODUCTION
Emotional Intelligence (EI) is a concept that can be dened as the ability to perceive, value,
and express emotions rigorously; to access or generate feelings that facilitate thought; to understand
emotions and emotional knowledge of oneself and others and to regulate emotions, promoting
emotional and intellectual growth. (Serpa, A. 2022).
Emotional management is a crucial process for nurses, as they deal daily with situations of
high pressure, human suffering and complex decision-making.
This process involves controlling one’s emotions in order to maintain a professional
and empathetic posture, ensuring a balanced response to the needs of patients and the rest of
the multiprofessional team. For this emotional management to be effective, nurses need to adopt
mechanisms that help them deal with stress, avoiding emotional and physical exhaustion. Some of the
strategies include: Emotional self-awareness, stress management, development of empathy and active
listening, and professional reection and continuous development.
Managing the emotions of team members is a great challenge for any leader. Your
interventional and constructive capacity at this level is a key and decisive point in the growth and
maturity of your team.
Currently, leadership has a central concern with regard to professional satisfaction, as this is
one of the factors that is reected in human behavior.
Nurses are faced with emerging challenges, namely, moments of challenge and change, with
constant technological advances, where there is the frequent appearance of new complex pathologies
and patients with new and more demanding needs, thus there is a need to optimize all professionals
in their resources and skills to deal with this reality. An emotionally intelligent leader can channel
the emotions of his team to respond to this real challenge that we all feel in our professional context.
The services are equipped with teams and, within them, there are people who relate to each
other. The greater or lesser effectiveness of this relationship depends on the power and ability to
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communicate with each other and also with the leader.
Developing emotional skills is a challenge for nurses today to be able to survive in this
exhausting and intense professional reality to which they are subject in their work contexts, requiring
constant updating and adaptations.
It is up to the leader to accompany his employees on this path, taking into account that the
path is different for each one, moving towards keeping them all satised, emotionally balanced and
with the feeling that without their
presence (of the professional) the achievement of the objectives is not possible. To make all
elements feel without exception, as an integral part of the team.
The leader has a crucial role in supporting and promoting strategies for the empowerment
of professionals, where environments of trust are created for decision-making. For the team to
feel autonomous and satised, the leader must have a facilitator attitude, encouraging the active
participation of his team members, delegating tasks with clarity, allowing them to make decisions and
assume responsibilities.
MANAGEMENT AND LEADERSHIP
Management is for Teixeira (2005, p.3) “the process of achieving results (goods or services)
with the efforts of others.” There must be an organization where a group of several people work who
develop an activity to achieve the same goal.
Management in a company/hospital/service intends to interpret the objectives it has set itself
through the planning, organization, direction and control of all efforts made in all areas and levels of
the company in order to achieve these same objectives.
The management process of any company, which also includes hospitals and in this case,
more specically, a unit/service has four fundamental functions, which are:
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• Planning - the process of determining in advance what should be done and how;
• Organization - contemplates the establishment of formal relationships between people
and between them and resources, to achieve the proposed objectives;
• Direction - process that determines, affects or inuences the behavior of others and
involves the components: motivation, leadership and communication;
• Control - comparison of the organization’s current performance with previously
established standards, pointing out possible future corrective actions to move towards
quality.
In management, we have to consider three levels, which are: institutional, intermediate, and
operational.
The institutional level includes professionals with a strong strategic component. Refers to the
Board of Directors (BoD).
At the intermediate level, the tactical component predominates, which is characterized by
the movement of resources, the elaboration of specic plans and programs. It is performed by service
directors.
At the operational level, we nd the heads of service who are the leaders of their Teams.
The leader of a service is responsible for managing it, critical thinking and correct decision-making.
To achieve the objectives of his service, the leader cannot neglect the importance and importance
of human resources. According to Frederico (1999, p. 105) “... they are the most complex in the
organization and therefore require particular attention... Its management requires high levels of care,
attention and specialization.”
At the beginning of the twentieth century, the study of leadership from a scientic point of
view began. Since then, several theories have emerged. They take into account the conceptualization
of a leader with the skills and efciency to adapt to an ever-changing world. Thus, it is imperative that
nurse leaders not only seek leadership development, but also exert effort to keep up to date in their
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understanding and application of contemporary leadership principles.
The role of the nurse leader, at the level of his service, is decisive for the quality of the care
provided and for the calm environment within his team. As a way of facing these responsibilities and
demands, he must know new dimensions to obtain quality results. It also has the responsibility of
ensuring an adequate selection of its employees, the maintenance of a cohesive nursing team and a
high-quality service by investing in the motivation and training of its team.
It is not the title alone that makes the leader. The person’s behavior is what determines
whether or not he occupies a leadership position. To function well and to their full potential, leaders
must be well integrated into the reality of the service they lead.
Due to the rapid and drastic changes that have taken place in nursing and health services, it
is increasingly important that nurses develop their skills in leadership roles.
Each and every leader should seek in the performance of their activity:
• Ensure that the work of its employees is aligned with the objectives dened by the
organization;
• Work collaboratively with the upper and lower hierarchical levels, optimizing everyone’s
efforts;
• Motivate its employees, providing the necessary knowledge, skills and resources;
• To centralize in their competence and personality the basis of their power;
• Use the data of the processes in which it is involved, to understand its variability and act
before occurrences;
• To guide their behavior, based on ethics, sincerity and transparency.
Regarding leadership styles, according to the existing bibliography in this area, the following
are identied: autocratic, participatory, democratic and laissez-faire.
The autocratic leader - the one who communicates to his subordinates what they have to do.
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He expects to be obeyed without problems.
The participative leader - the one who involves subordinates in decision-making, but retains
the nal authority, that is, the last word is always his.
The democratic leader - tries to do what the majority of subordinates want. Many of those
who adopt this type of leadership say that it is due to the high productivity rates they achieve.
In the style of laissez-faire - the leader is not involved in the work of the group, leaves his
decisions to the consideration of subordinates. It is a type of leadership that is hardly acceptable,
except in exceptional cases where the elements involved in the group/team are well motivated.
The leader must always bear in mind that people or human resources are endowed with
skills, knowledge, work, communicability, ... and personality characteristics, expectations, personal
goals, particular stories, ... that explain human behavior in organizations. (Goleman 2002)
The leadership in the human dimension that is so much talked about today is the part of the
organization that cares about people. Goleman (2002, p.23) says that “Great leaders thrill us.” He says
that a good leader inspires the best in his employees and cares about them and the management and
guidance of their emotions.
In their activities, leaders have to create strategies to mobilize teams for action. The success
of what they do depends on how they do it. If they fail at the fundamental task of directing emotions
in the right direction, nothing they have done will work well.
Inserted in this current reality, and with the emotions of your employees as a concern, you
must have knowledge about prevention and action in phenomena such as mobbing and presenteeism
that have serious repercussions on professional performance.
By having the discernment to understand the individual abilities of each member of his team,
the leader prevents presenteeism phenomena that may be associated with more discreet phenomena,
but loaded with greater violence such as mobbing.
Presenteeism refers to the phenomenon in which the professional is present in the workplace,
but is unable to be productive, due to factors such as: lack of motivation, headaches, irritation,
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tiredness, anxiety, anguish, depression, insomnia, gastrointestinal changes. Initially these symptoms
go unnoticed, but over time they begin to be noticed and become part of the person’s daily life. She
starts to be constantly stressed, unfocused and discouraged. This phenomenon can cause a greater
drop in productivity than absenteeism. If, on the one hand, the worker feels coerced to attend his
workplace for fear of reprisals, on the other hand, he cannot be productive, because he does not feel
well.
Mobbing is a relatively recent phenomenon, it emerged in Sweden, from the 80s, on the
initiative of a group of scholars led by psychologist Heinz Leymann. In 1984, the rst scientic
publication on this subject appeared.
Mobbing can be dened as any abusive behavior, translated into words, acts, or any other form
of individual communication, which may negatively affect the physical/mental dignity or integrity of
a person, the performance of activities in the context of a function or a certain work environment.
João, A. (2023) denes mobbing as being, “... complex practice of vexatious or persecutory or
psychological violence, deliberately and repeatedly carried out by an employer or by direct superiors...
with the aim of provoking a state of deep malaise, isolation and psychological terror suitable for
causing notable damage to his psycho-physical balance.”
The person who suffers from this phenomenon is intentionally attacked by the so-called
aggressor or mobber who assumes a strategic behavior appropriate to their psychological, social and
professional destruction. The mobber is usually a person with a conictual character, and the mobber
is a person identied as having a lack of condence in himself, with a sense of disorientation at work,
poorly adapted to the workplace and who, even without fault of any mistake, assumes it as his own,
convincing himself of it. (João, A., 2023)
Mobbing reaches its peak of severity when the victim’s life is destabilized from the family,
affective and social points of view, as a consequence of the imbalance existing in the professional
eld.
As already mentioned, another important characteristic of the leader is the ability to
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stimulate the motivation of team members. Chiavenato (1989, p.99) “Motivation is an important eld
of knowledge of human nature and the explanation of human behavior.”
People are different when it comes to motivation. Needs vary from individual to individual,
producing different patterns of behavior. Social values as well as the capacities to achieve goals are
equally different. In fact, needs, social values and abilities vary in the same individual over time.
The satisfaction of some needs is temporal and temporary, that is, human motivation is
cyclical and needs-driven. Behavior is the result of a process of solving problems and satisfying needs
as they arise.
Maslow was one of the theorists, who dedicated himself to the study of human motivations
as a way to facilitate the understanding of behaviors. He built a pyramid, which he called the pyramid
of needs. In it, he hierarchized the needs staggered into primary and secondary. As primary needs,
it identied physiological and safety needs, and as secondary needs, it considered social, self-esteem
and self-realization needs.
In his theory, Maslow argues that each need has to be at least partially satised for the person
to have the will to satisfy a need of the level immediately above, each time he manages to overcome
a step, he will be motivated by the type of need corresponding to the next step
Very recently, we have begun to talk about the spiritual needs of employees within
organizations, which are nothing more than the apex of the pyramid of needs mentioned above. This
concern may seem utopian, this concern makes sense in many companies, especially the most avant-
garde ones, because leaders have realized that people are not just labor, but people with feelings and
emotions like them. An emotionally balanced and satised employee is more productive.
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Figure 1- Maslow’s Pyramid
Source: http://1.bp.blogspot.com/_RvCkXIxJBk/RdDShnq8KwI/AAAAAAAAAA8/peEMCEYFc3I/
s320/pir%C3%A2mide%2Bde%2Bmaslow.gif.
EMOTIONS AND FEELINGS
According to Damasio (2004), emotions precede feelings, because in the historical evolution
of humanity, emotions were built from simple reactions that had the main objective of ensuring
survival and that were adopted over time. Each reaction is built from pieces of simpler ones. All
of them aim at survival and well-being. Thus, emotions are nothing more than a natural means of
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evaluating the environment around us and reacting adaptively.
For Damásio (2004, p.33) “emotions are actions or movements, which are manifested in the
face, voice or in specic behaviors”, being as such visible to the eyes of others. As basic examples
of emotions we have: fear, shame, sadness and happiness. It is this particularity of visibility that
distinguishes them from feelings.
Keltner, D. (2019), “feelings are made up of mental images elaborated at the level of the brain
and as such invisible to the eye.”
Emotions are unusual and sometimes disconcerting phenomena, because they are rare and
temporary and at the same time have an explosive character, which seems linked to the exceptional
circumstances that trigger them. In fact, emotions erupt abruptly and are extinguished quite quickly
without a trace.
Emotions accompany a large number of visceral manifestations that are felt as physiological
disturbances or anomalies. All neurophysiological functions, such as circulation, respiration, digestion
and secretions, can be disturbed by retardation or acceleration, contraction or relaxation.
Becoming aware of our feelings and emotions helps us to understand more easily those of
others. Empathy means sharing the position, vision, and emotion of another human being.
COMMUNICATION
Communication is the basis of any and all relationships, whether personal, family or work,
it is also through communication that a connection is established that triggers a relationship.
The value of having effective communication skills in the workplace is incalculable. Wrong
words, miscalculated gestures or misinterpreted meanings can lead to unsatisfactory results, or even
disastrous at the communication level.
For Teixeira (2005, p.184) “Communication is the process of transferring information, ideas,
knowledge or feelings between people.”
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For Frederico (1999, p.32) communication “is a complex process of symbolic interaction,
essential and indispensable to human relationships, which comprises the emission and reception of
coded messages, integrates a signal, which is the stimulus and which has meaning through messages
that provide information.”
In its genesis, it implies the existence of a sender, receiver and transmission channel that
holds the message of the sender – leader for the receivers – team.
The ability to communicate with people is largely a form of success for the leader.
Communication provides the means by which team members can be induced to implement the planned
actions and to do so motivated and enthusiastic.
Effective communication and information contribute to total involvement, because they allow
the generation and maintenance of the enthusiasm of everyone in the organization, by understanding
the reason for the actions and the objectives to be achieved.
The use of work teams is today an important management tool, indispensable to promote
motivation, creativity and quality improvement.
Teamwork is decisive to obtain high levels of productivity, exibility, creativity and speed of
response that the context of the organization requires.
In organizational terms, a team is a group of people who interact playing different roles, have
similar attitudes, values and perceptions and aim to achieve common goals.
A team is not equal to the sum of the individuals that compose it. Within a group there are
synergies caused by the interaction, interdependence and interstimulation of its members.
According to Oliveira (1998, p.22) when professionals get together in work teams they can
benet from numerous advantages:
• “To share knowledge and experiences;
• Overcome functional and hierarchical barriers;
• Minimize the feeling of insecurity in the face of change;
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• Solve complex problems;
• Move faster than when working alone.”
She also argues (1998, p.23) that the effectiveness of any team depends on:
• Knowledge of its mission and objectives;
• The creation of a support organization;
• Correct orientation towards results;
• From the idea that to err is human, although within certain limits;
• The creation of team spirit;
• From consensual decision-making;
• The self-evaluation of its effectiveness.
When a team is formed, its members initially seek to identify the behaviors and attitudes that
are accepted or rejected by others. Each member seeks, through trial and error, to clarify their position
in the team, which is necessarily determined by the positions that the other elements assume.
When a new member joins an already constituted team, it ceases to exist and becomes
another team, with new rules and values.
This process requires a high degree of accountability from everyone and in particular from
the leader, who is responsible for representing and ensuring that the group’s norms and values are
observed.
The leader’s performance conveys the values and norms accepted in the work team. Working
in a group is not always easy and peaceful. Sometimes conicts arise that need to be faced and
resolved.
It is very important to value teamwork for the success of an organization, because it depends
not only on the individuals who make it up, but also on the way they interact.
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THE CHANGE IN THE LEADERSHIP PROCESS
Change is the whole process where changes occur in relation to a certain situation, making it
different. It corresponds to a transformation originating changes in habits and customs. It is necessary
for organizational and/or personal growth, even if it is planned it can produce anxiety and fear for
those associated with it. Changes in health organizations give rise to transformations that aim to
provide care to the community, raising the level of quality. Because it is inevitable, we must be
prepared not only to accept it, but to participate in its process, thus adopting a proactive rather than a
reactive position.
Talking about change is nowadays a banal term when we refer to organizations in general.
This, since they are subject to a set of pressures that lead to the need to introduce more or less profound
changes in their operation. These pressures come from the changes that have taken place in terms of
technologies, the functioning of the economy and socio-cultural values, as well as the changes that
have occurred in terms of the needs, expectations and standards of demand of its own customers. A
process of change cannot be abrupt and sudden, but continuous and with lasting results. To do this, it
must be based on an organizational strategy accepted and internalized by all its professionals.
Emotionally intelligent leaders take responsibility for change, participate in and positively
support ideas for improvement, offering innovative solutions to overcome obstacles that arise,
contributing to strengthening the culture of learning and organizational growth.
For (Lewin in Andrews, 1994, p.9), the theory of change is based on three phases: thawing,
movement and refreezing.
• Thawing – there is the motivation to impose change. A problem has been identied and
an appropriate solution has been selected;
• Movement – the support of those who will be affected by the change is sought;
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• Refreezing – changes are implemented and the situation stabilized. It is a decisive phase
for lasting change.
Since we live in a time of uncertainty, it is important to know how to act ever faster to the
challenges of change. To do this, we need to reformulate our perspective on the leadership role and
encourage a new leadership practice at all levels. Also according to (Lewin in Andrews, 1994, p.9)
in this process of change there are driving forces (that facilitate) and resistant forces (that hinder the
process), and it is extremely important to identify them so that they can act as agents of change, which
(Broome in Andrews, 1994, p.9)) dened as:
“Someone who identies the big problem areas and opportunities for change,
great readiness and commitment, builds a renewed system by creating a cli-
mate of change, and establishes the internal capacity to sustain the efforts that
led to the change, in order to evaluate and improve it.”
Nurses must be prepared to be agents of change in health organizations and need to change
their practice, that is, they must know how to deal with change by understanding its meaning and
participating in its process.
According to Goleman’s idea (2007, p. 273), the competencies of an emotionally intelligent
leader, with the capacity to change in the current context, should be the ones listed below:
• In terms of self-awareness, you should promote your inner development, in terms of your
emotional self-awareness, self-evaluation and self-condence;
• In the context of self-management, it is intended to develop their self-control, transparency,
adaptability, capacity for achievement, initiative and optimism;
• At the level of social awareness, empathy, organizational awareness, spirit of service
cannot be neglected;
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• Finally, in the context of relationship management, leaders must give relevance to
inspiring leadership, have the ability to inuence, the ability to develop others, be a
catalyst for change, efcient in conict management and a collaborative and team spirit.
The use of work teams is today an important management tool, indispensable to promote
motivation, creativity, quality improvement and speed of response. Thus, knowing how to manage a
work team is decisive to obtain high levels of productivity, exibility, creativity and speed of response
that the context of the organization requires. Each and every process of change is directly related to
the behavior of individuals, with mutual inuences. “People behave according to the expectations
of others who are signicant to them.” quoted by Charon, (1979); Stryker and Statham, (1985) and
referred to by Basto (1998, p.96).
Leaders adopt different strategies to implement the change, however they must choose the
most appropriate one according to the objectives to be achieved. Bear in mind that the strategy must
be acceptable to the individuals involved in it and they must be willing to accept the change.
There are several strategies for change. (Chin and Benne in Andrews, 1994, p.10) highlight
three: empirical - rational, coercive power and normative - re-educational. Each of them is based on
different principles about people’s motivations for change:
• Rational empirical - use of incentives and rewards to implement the change;
• Coercive power - is associated with the management and leadership of those who have
power, authoritarian regime. It is a top-down method, adopted by many nurse managers.
Change is imposed through threats and implemented with the aim of obedience to power;
• Re-educative norms - the change agent adopts a democratic approach, delegating
responsibilities, encouraging participation, there is openness and access to available
information so that they can make decisions. This strategy is time-consuming but
effective since its goal is to change attitudes and beliefs.
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Changes are usually dynamic, requiring motivation and commitment on the part of all
elements, however it is essential that the organization/service itself recognizes/values/encourages and
gives equal opportunity for working conditions to all people, in order to ensure that these changes are
efcient. Nor can team spirit, interpersonal relationships, mutual help, cohesion and the communication
pattern in the elements be underestimated as principles underlying innovation. Not all nurse managers
have leadership skills, which may be the result of a changing environment or lack of preparation for
the roles they assume. The training of nurses should be based on the preparation of leaders in order to
face change as an integral part of their role.
FINAL CONSIDERATIONS
The management of emotions and the intervention and constructive capacity are a great
challenge currently posed to any leader and with decisive power in the construction and maturity of
the team.
The greater or lesser effectiveness of this relationship depends on the power and ability to
communicate between the team and the leader.
Developing emotional skills is a great challenge for nurses and leaders in their work contexts
today, and constant updates and adaptations are necessary.
It is up to the leader to accompany their professionals, taking into account that the path is
different for each one, in order to keep them satised, committed and emotionally balanced.
The relationship between the multidisciplinary team in the hospital environment is also
very important. The patient is the most important, it is necessary that the emotion is dened and
controlled, namely in certain services such as Emergency, Block and Intensive Care, where there are
many feelings, many changes in mood, many conicts. In this case, it is necessary to have a leader
present, democratic and involved among the professionals.
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