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

Abstract

BackgroundEmergency department (ED) physicians and nurses frequently interact with emotionally evocative patients, which can impact clinical decision-making and behaviour. This study introduces well-established methods from social psychology to investigate ED providers’ reported emotional experiences and engagement in their own recent patient encounters, as well as perceived effects of emotion on patient care.MethodsNinety-four experienced ED providers (50 physicians and 44 nurses) vividly recalled and wrote about three recent patient encounters (qualitative data): one that elicited anger/frustration/irritation (angry encounter), one that elicited happiness/satisfaction/appreciation (positive encounter), and one with a patient with a mental health condition (mental health encounter). Providers rated their emotions and engagement in each encounter (quantitative data), and reported their perception of whether and how their emotions impacted their clinical decision-making and behaviour (qualitative data).ResultsProviders generated 282 encounter descriptions. Emotions reported in angry and mental health encounters were remarkably similar, highly negative, and associated with reports of low provider engagement compared with positive encounters. Providers reported their emotions influenced their clinical decision-making and behaviour most frequently in angry encounters, followed by mental health and then positive encounters. Emotions in angry and mental health encounters were associated with increased perceptions of patient safety risks; emotions in positive encounters were associated with perceptions of higher quality care.ConclusionsPositive and negative emotions can influence clinical decision-making and impact patient safety. Findings underscore the need for (1) education and training initiatives to promote awareness of emotional influences and to consider strategies for managing these influences, and (2) a comprehensive research agenda to facilitate discovery of evidence-based interventions to mitigate emotion-induced patient safety risks. The current work lays the foundation for testing novel interventions.

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

“…System-level issues are challenging to address without significant community-based interventions,35 broad healthcare reform, and changes to public policies 36. Despite these challenges, efforts to raise awareness of the myriad societal factors driving people to use the ED may prove helpful in reducing negative emotions and biased judgements of these patients 37. Considerable research demonstrates that individuals tend to automatically attribute the causes of other people’s behaviours to internal characteristics (eg, seeking ED care due to laziness or convenience) without considering the influence of broader contextual factors (eg, lack of insurance or unemployment) 38.…”

“…However, the extent to which these strategies actually mitigate patient safety risks remains unclear. In addition, although providers believe that positive emotional responses to patients improve care, such emotions also have the potential to increase risk by prompting overtesting and overtreatment 37. Thus, future work on the effectiveness of emotion regulation strategies among healthcare providers should consider both negative and positive emotions.…”

Reducing the Risk of Diagnostic Error in the COVID-19 Era

“…Both physical and psychological safety of clinicians and health system capacity are compromised and can affect clinical decision-making. 2 Situational factors such as staffing shortages and workarounds are more common, and clinicians in certain geographic areas are experiencing epic levels of stress, fatigue, and burnout. Finally, decisions in busy, chaotic and time-pressured healthcare systems with disrupted and/ or newly designed care processes will be error prone.…”

Translation and psychometric validation of the Chinese version of the Emotional Labour Scale for nurses

“…To date, most of the emotional labour measurement tools for nurses in China have been introduced from abroad and revised, such as the Emotional Labour Scale (ELS) of Grandey (Grandey, 2003), the ELS of Brotheridge and Lee (Brotheridge & Lee, 2003) and Diefendorff's emotional labour strategies questionnaire (Diefendorff, Croyle, & Gosserand, 2005). However, these scales were developed in a Western cultural context and not specifically for the nurse population, and there are significant differences in the emotional labour of nurses and general service employees because the health care setting involves complex emotional demands (Isbell, Tager, Beals, & Liu, 2020). In nursing fields, nurses must manage patients' anxiety, depression, anger, distress, suffering, trauma, death and bereavement and express positive emotions, embodying the characteristics of the nursing profession (Riley & Weiss, 2016).…”