What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care

Abstract

BackgroundDespite calls to study how healthcare providers’ emotions may impact patient safety, little research has addressed this topic. The current study aimed to develop a comprehensive understanding of emergency department (ED) providers’ emotional experiences, including what triggers their emotions, the perceived effects of emotions on clinical decision making and patient care, and strategies providers use to manage their emotions to reduce patient safety risks.MethodsEmploying grounded theory, we conducted 86 semi-structured qualitative interviews with experienced ED providers (45 physicians and 41 nurses) from four academic medical centres and four community hospitals in the Northeastern USA. Constant comparative analysis was used to develop a grounded model of provider emotions and patient safety in the ED.ResultsED providers reported experiencing a wide range of emotions in response to patient, hospital, and system-level factors. Patients triggered both positive and negative emotions; hospital and system-level factors largely triggered negative emotions. Providers expressed awareness of possible adverse effects of negative emotions on clinical decision making, highlighting concerns about patient safety. Providers described strategies they employ to regulate their emotions, including emotional suppression, distraction, and cognitive reappraisal. Many providers believed that these strategies effectively guarded against the risk of emotions negatively influencing their clinical decision making.ConclusionThe role of emotions in patient safety is in its early stages and many opportunities exist for researchers, educators, and clinicians to further address this important issue. Our findings highlight the need for future work to (1) determine whether providers’ emotion regulation strategies are effective at mitigating patient safety risk, (2) incorporate emotional intelligence training into healthcare education, and (3) shift the cultural norms in medicine to support meaningful discourse around emotions.

Emotionally evocative patients in the emergency department: a mixed methods investigation of providers’ reported emotions and implications for patient safety

“…Using different research methods and samples of ED providers, these results converge with those from a recent large-scale qualitative interview-based investigation of physicians’ and nurses’ emotional experiences in the ED 4. Both studies reveal that providers perceive negative emotions to influence patient care both when discussing this issue in general4 and when reflecting on their own specific patient encounters.…”

“…Following each description, participants completed emotion and engagement measures that assessed the extent to which they felt (1) angry (angry, frustrated, annoyed, irritated; Cronbach’s alpha=0.90), (2) sad (sad, down, discouraged; Cronbach’s alpha=0.71), (3) anxious (anxious, uneasy, nervous, uncertain, at ease, calm, relieved; Cronbach’s alpha=0.80), (4) fatigued (fatigued, exhausted; Cronbach’s alpha=0.86), (5) happy (satisfied, happy, pleased; Cronbach’s alpha=0.85), (6) self-assured (proud, self-assured, confident; Cronbach’s alpha=0.74) and (7) engaged (empathic, engaged, attentive; Cronbach’s alpha=0.70) during the encounter. These scale items were chosen based on findings from (1) an extensive review of emotion scales used in psychological research, and (2) a subsample of ED physicians (n=18) and nurses (n=14) who participated in a separate interview study (with LMI) in which providers described their emotions in the ED 4. Participants responded to each item using continuous unnumbered sliding scales.…”

“…Despite widespread awareness that patients can elicit significant emotions in healthcare providers,1–4 and that providers’ emotions may play an important role in patient safety,1 4–9 the role of emotions remains a rarely explored ‘blind spot’ 5 6 10. Yet a substantial body of research in social cognitive and affective science demonstrates that emotions such as anger and happiness reliably and profoundly influence how people think,11–15 including the extent to which individuals process information in a heuristic, abstract, and superficial manner versus a more careful, detailed, and analytical manner (ie, system 1 vs system 216).…”

“…Using a valid, reliable, and commonly used emotion elicitation method (ie, vivid autobiographical recall) from psychological research,25 26 the current research systematically assessed healthcare providers’ reported emotions in response to their own recent patient encounters. Given that diagnostic errors, patient safety events, and emotions are particularly prevalent in emergency medicine4 27–29 due to unique challenges in the emergency department (ED; eg, unpredictability, stress, overcrowding, interruptions30), we conducted our investigation in this context.…”

Social emotion and patient safety: an important and understudied intersection

“…In the second study, 12 interviews with 86 clinicians were used to explore patient-level, hospital-level and system-level triggers of emotion. Clinicians were able to identify the discrete emotions they experience and the triggers in the clinical setting that elicited these feelings.…”