What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care
What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care
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DOI：
10.1136/bmjqs-2019-010179
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发表时间：
2020-10-01
影响因子：
5.4
通讯作者：
Kimball, Ezekiel
中科院分区：
文献类型：
--
作者：
Isbell, Linda M.;Boudreaux, Edwin D.;Kimball, Ezekiel
尽管有人呼吁研究医疗服务提供者的情绪如何影响患者安全，但很少有研究涉及这一主题。当前研究旨在全面了解急诊科（艾德）提供者的情绪体验，包括触发他们情绪的因素、情绪对临床决策和患者护理的感知影响，以及提供者用来管理的策略他们的情绪以降低患者安全风险。方法采用扎根理论，我们对来自美国东北部四个学术医疗中心和四个社区医院的有经验的艾德提供者（45名医生和41名护士）进行了86次半结构化定性访谈。恒定的比较分析被用来开发一个接地模型的供应商的情绪和病人的安全在艾德。结果艾德供应商报告说，经历了广泛的情绪反应病人，医院和系统层面的因素。患者触发积极和消极情绪，医院和系统层面的因素在很大程度上触发了消极情绪。提供者表示意识到负面情绪对临床决策可能产生的不利影响，并强调了对患者安全的担忧。提供者描述了他们用来调节情绪的策略，包括情绪抑制，分散注意力和认知重新评估。许多供应商认为，这些策略有效地防范了情绪的风险，负面影响他们的临床decisionmaking.Conclusion情绪在患者safety的作用是在其早期阶段，研究人员，教育工作者和临床医生有很多机会进一步解决这个重要的问题。我们的研究结果强调了未来工作的必要性，以（1）确定提供者的情绪调节策略是否有效地减轻了患者的安全风险，（2）将情商培训纳入医疗教育，（3）改变医学文化规范，以支持围绕情绪的有意义的话语。
Background Despite 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.Methods Employing 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.Results ED 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.Conclusion The 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.