Emotional influences in patient safety.
Emotional influences in patient safety.
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DOI：
10.1097/pts.0b013e3181f6c01a
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发表时间：
2010-12-01
影响因子：
2.2
通讯作者：
Wu, Albert W
中科院分区：
文献类型：
--
作者：
Croskerry, Pat;Abbass, Allan;Wu, Albert W
目的：卫生保健提供者的感觉，无论是在自己和对他们的病人，可能会影响他们的临床表现和影响病人的安全，但这方面的提供者的行为得到了相对较少的关注。如何供应商的感觉，他们的情绪或情感状态，可能会对他们的病人产生重大的，意想不到的影响，并可能危及safety.METHODS：我们研究了广泛的文献，跨多个学科，以审查情绪，决策和行为之间的相互关系，并评估其对病人安全的潜在影响。有大量证据表明，医疗保健提供者的情绪状态可能受到包括患者特征、医疗保健环境中的环境条件、昼夜、昼夜节律、亚昼夜和季节变量在内的因素的影响，以及个体提供者的内源性疾病。这些影响可能导致决策中的情感偏差，从而导致错误和不良事件。临床推理和判断可能特别容易受到情绪的影响，特别是那些依赖于直觉judgment.CONCLUSIONS：有很多方法，医疗保健提供者的情绪状态可以影响病人的护理。为了减少情绪错误，应该提高对这些因素的认识水平。应将情感技能培训纳入卫生保健专业人员的教育。具体来说，临床教学应促进更多的开放性和讨论有关提供者对病人的感情。应制定策略，以帮助供应商识别和消除偏见，对情绪的影响，可能会影响护理，特别是在情绪唤起病人自己。提供者的精神疾病，可能会危及病人的安全，需要及时检测，诊断和管理。
OBJECTIVE: The way that health care providers feel, both within themselves and toward their patients, may influence their clinical performance and impact patient safety, yet this aspect of provider behavior has received relatively little attention. How providers feel, their emotional or affective state, may exert a significant, unintended influence on their patients, and may compromise safety.METHODS: We examined a broad literature across multiple disciplines to review the interrelationships between emotion, decision making, and behavior, and to assess their potential impact on patient safety.FINDINGS: There is abundant evidence that the emotional state of the health care provider may be influenced by factors including characteristics of the patient, ambient conditions in the health care setting, diurnal, circadian, infradian, and seasonal variables, as well as endogenous disorders of the individual provider. These influences may lead to affective biases in decision making, resulting in errors and adverse events. Clinical reasoning and judgment may be particularly susceptible to emotional influence, especially those processes that rely on intuitive judgments.CONCLUSIONS: There are many ways that the emotional state of the health care provider can influence patient care. To reduce emotional errors, the level of awareness of these factors should be raised. Emotional skills training should be incorporated into the education of health care professionals. Specifically, clinical teaching should promote more openness and discussion about the provider's feelings toward patients. Strategies should be developed to help providers identify and de-bias themselves against emotional influences that may impact care, particularly in the emotionally evocative patient. Psychiatric conditions within the provider, which may compromise patient safety, need to be promptly detected, diagnosed, and managed.