The term “emotional sustainability”, coined by the psychologist Inma Puig (1), renowned for her work with high performance teams, refers to the knowledge of the impact caused on oneself and others by our own emotions and those of others. Puig puts the emphasis on care and listening, and states that when a worker feels cared for by the company, she/he will care for the client. She has also observed the powerful impact of the Pygmalion effect: “the manner in which a person watches another will determine the latter’s behaviour”. This fact invites to reflect upon individual responsibility, and to become aware of how each person contributes for reality to be as it is. To be listened as workers, as professionals. To feel that we are part of something, to feel appreciated, which leads to wanting to commit. Obviously, competences should be well defined, and those limits necessary should be determined; this is essential in order to feel well cared for by the company as workers, and to offer the best service to the population. All these aspects which place a person in two positions at the same time: as employee of an institution or company and as a professional at the service of the population, refer to the emotional sustainability enunciated by Puig.

Nurses have a legal and ethical framework which defines their competences. Therefore, the Code of Conduct collects the ethical and moral rules which every professional should follow. Specifically, it places nurses as guardians of the human dignity of those persons they care for. That way, nurses can take care of the psychoemotional sphere of a citizen without fear of intrusiveness. The Madrid Health Service (2) defines nurses as educators and trainers on self-care; they are the persons of reference who will lead individual and group educational projects, accompany people in their process of learning and management of their illness, they will train persons so that they are able to integrate positive changes in their health, and they will cooperate with other professionals and organizations in order to improve the health status of people. In this document, the first point of the competence profile of nurses refers to communication.

One of the competences of nurses acknowledges the ability to establish an effective communication with patients, family, social groups and colleagues, as well as to encourage Health Education. Throughout her professional life, a nurse might have practiced in very different settings, adding value to knowledge, different technical skills and competences. However, communication would have been a common element in them all. Based on the idea of the terms communication and emotion as a unit, it is understood that the management of personal emotions and those of others represents a constant challenge for everyone, particularly for those working with persons going through moments of maximum vulnerability. In this sense, nurses are, unknowingly, emotional sustainability agents, for example when facing a person who expresses needle phobia when about to undergo a procedure requiring puncture. In such a situation, the ability of the nurse to answer in a sustainable way, from an emotional point of view, would mean being able to reconduct the emotions of the person who expresses an disproportionately emotion. Professionals can achieve this, for example, by establishing direct visual contact, modulating their tone of voice, inviting the user to practice conscious breathing, using distraction techniques, applying verbal restraint or other strategies in order to conduct the procedure while reassuring the patient. In this sense, professionals need more resources for an in-depth knowledge of the emotional sphere, to be able to face complex situations that will sometimes overwhelm or be too much for them.

Currently, the training on communication and emotional education of healthcare professionals in general, and nurses specifically, is considered insufficient, taking into account the burden of care entailed by performing their duties and the direct contact with patients and relatives in situations of maximum vulnerability, suffering and death. There are over 27 million nurses currently registered throughout the world (3), which can explain the heterogeneity of criteria at the time of facing cross-sectional competences like the ones shown here. Therefore, in order to address emotional care from any context in a sustainable manner, it seems logical to think about the need to include emotional education as a priority in training for nurses, both for undergraduates and graduates, due to the huge benefits this could entail for the profession and the quality of care provided.
In my opinion, and based on my own personal and professional experience, there is a subject that provides knowledge and resources in communication and emotional education; it is known as Transactional Analysis. Its creator, Eric Berne (4), developed this personality theory based on humanistic philosophy, shedding light and focusing on interactions. Berne observed that the place from where communication with oneself (internal dialogue) is established, as well as with the others, can lead to effective communication or manipulation (power games). Berne discovered that caresses are the recognition unit between persons, and that lack of them can lead to having certain behaviours, such as manipulation, where relationships are established in a dishonest manner, in order to obtain the caresses needed. His disciple Claude Steiner developed the Stroke Economy Theory (5), and completed his work by teaching emotional education concepts, such as the method for becoming aware of and responsible for our own thoughts, emotions and actions.

Brigitte Champetier is a reference in inherited emotions, bringing to light the relationship between emotions and health. This author explains how our emotions can help us to respond in an adaptive manner when faced with a specific situation, and refers to other roles played by emotions on the life of persons, without their awareness (6). Likewise, she suggests elevating the level of awareness, and therefore of health, by knowing how emotions operate in life. On the other hand, Lacon mentions nurses as leaders of change (7), and advocates that nurses, as professionals, are sustainable change agents for the future, with the skills required to generate and sustain lasting changes, if information and additional support is provided in order to prepare solid strategies and solutions to achieve an environment where quality care is offered. Based on all the above, it seems logical to think that it is worth making the effort to train specifically nurses on emotional education and effective communication, giving them more resources that can help them to face complex situations involving their own emotions and/or those of others, of those they care for, if they openly demand but also if they need but keep quiet; these approach entails involving feelings, fears, expectation, uncertainty, and everything with impact on the emotional plane, often so difficult and complex to face successfully.

The pandemic has represented a major emotional challenge, and has reminded us of the relevance and need for human contact and communication, particularly in situations of disease and vulnerability. As Fisher claims, even though behaviour changes constantly from a cultural point of view, Biology keeps responding in the same way (8). It is worth remembering that, given the nature of human beings, contact and connection are necessary, as well as a feeling of belonging and knowing that we are significant for others. We nurses are health promoters; and taking into account the holistic approach of our profession, are we willing to accept the challenge of becoming visible agents for emotional sustainability? For this, we must continue acquiring skills in emotional education and effective communication, because these are essential cornerstones in order to offer excellent care.