Predictable chaos: a review of the effects of emotions on attention, memory and decision making

A Phenomenological Exploration of Physicians' Moral Distress: Situating Emotion Within Lived Experiences

PURPOSE

Physicians often experience moral distress from being prevented from taking what they believe to be the right course of action. Although causes and consequences of moral distress have been studied, little research offers insight into the significance of feeling morally challenged, especially in medicine. This study was undertaken to advance understanding of what physicians experience when encountering morally challenging situations and to examine how those experiences influence their interactions with the world of health care.

METHOD

Guided by hermeneutic phenomenology, the authors conducted semistructured interviews with purposefully sampled Canadian physicians from September 2022 to January 2023. Analysis used Van Manen's 6 activities of hermeneutic research and included "story crafting" to sharpen insights. Late in that process, Van Manen's "lived existentials" was determined to provide a strong framework for physicians' experiences of moral distress.

RESULTS

Of the 12 physicians interviewed, all experienced varied and long-lasting emotional reactions to morally challenging experiences. The emotions associated with moral distress, reported as inevitable, were experienced in ways that aligned with the lived existentials of body, space, time, and relations.

CONCLUSIONS

A richer understanding of physicians' lived experiences with moral distress can help mentors and educators more thoughtfully engage in conversations about it with colleagues and learners. This study highlights the core dimensions of moral distress through body, space, time, and relations, thereby providing a means to enrich discussion about emotions and their transformational power. Through such nuanced consideration, calls for emotional candor may be strengthened to enhance practice by acknowledging the scope of impact that efforts to deliver care are likely to provoke.

Older and younger job seekers' attention towards metastereotypes in job ads

Building on social identity theory and cognitive models on information processing, the present paper considered whether and how stereotyped information in job ads impairs older/younger job seekers' job attraction. Two eye-tracking experiments with older (Study 1) and younger job seekers (Study 2) investigated effects of negatively metastereotyped personality requirements (i.e., traits) on job attraction and whether attention to and memory for negative information mediated these effects. Within-participants analyses showed for both older and younger job seekers that job attraction was lower when ads included negative metastereotypes and that more attention was allocated towards these negative metastereotypes. Older, but not younger job seekers, also better recalled these negative metastereotypes compared to not negative metastereotypes. The effect of metastereotypes on job attraction was not mediated by attention or recall of information. Organizations should therefore avoid negative metastereotypes in job ads that may capture older/younger job seekers' attention and lower job attraction.

The Planned Risk Information Seeking Model Applied to Vaccine Information Avoidance and the Role of Affect, Emotion and Perceived Benefits

Using a stratified sample of German residents (N = 1,508), we examined intentions to avoid information about vaccination against COVID-19. The study was guided by the planned risk information seeking model (PRISM), also taking into consideration benefit perceptions, positive affective responses, and discrete emotions. Our findings generally supported the utility of the extended PRISM to predict information avoidance intentions; most of the hypothesized relationships were supported and the model accounted for 58.8% of the variance in intentions to avoid information about COVID-19 vaccination. Furthermore, perceived benefits of vaccination, and positive affect felt toward vaccination played significant roles in explaining intentions to avoid information about vaccination. A more nuanced view on affective predictors showed that hope and interest were weakly associated with less pronounced avoidance intent, whereas we found no link between avoidance intent and fear, anxiety, and anger.

Measuring Situational Cognitive Performance in the Wild: A Psychometric Evaluation of Three Brief Smartphone-Based Test Procedures

Mobile devices provide new opportunities to draw conclusions about cognitive performance in everyday situations. To gain insights into cognitive performance patterns in healthy adult populations, we adapted three established cognitive tests for smartphone use: the Digit Symbol Substitution Task (DSST), Sustained Attention to Response Task (SART), and Psychomotor Vigilance Task (PVT). To increase their feasibility for ambulatory assessment, we identified the minimum measurement durations that provide reliable and valid state measures of cognitive performance. Over 2 weeks, 46 participants performed each test once per day at random times, along with self-reports (e.g., on concentration, mood, and mental demands). The validity and reliability of change are promising for the 30-second PVT and 90-second DSST and SART. The DSST and SART provide fruitful outcomes for ambulatory field studies linked to mood, stress, and mental demands. We provide digital versions of the adapted DSST and SART online for free.

Extended reality training for mass casualty incidents: a systematic review on effectiveness and experience of medical first responders

INTRODUCTION

Mass casualty incidents (MCI) are unforeseeable and complex events that occur worldwide, therefore enhancing the training that medical first responders (MFRs) receive is fundamental to strengthening disaster preparedness and response. In recent years, extended reality (XR) technology has been introduced as a new approach and promising teaching technique for disaster medicine education.

OBJECTIVE

To assess the effectiveness of XR simulation as a tool to train MFRs in MCIs, and to explore the perception and experience of participants to these new forms of training.

DESIGN

Systematic review.

METHODS

This systematic review was conducted in accordance with the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA) statement. Four databases were searched (MEDLINE, EMBASE, CINAHL and LILACs) using a comprehensive search strategy to identify relevant articles, and MetaQAT was used as a study quality assessment tool. Data from included studies was not pooled for meta-analysis due to heterogeneity. Extracted data was synthesised in a narrative, semi-quantitative manner.

RESULTS

A total of 18 studies were included from 8 different countries. Studies encompassed a variety of participants (e.g., nurses, paramedics, physicians), interventions (virtual, mixed and augmented reality), comparators (comparison between two groups and single groups with pre-post evaluation), and outcomes (effectiveness and MFR perception). The synthesis of data indicated that XR was an effective tool for prehospital MCI training by means of improved triage accuracy, triage time, treatment accuracy, performance correctness and/or knowledge acquired. These XR systems were well perceived by MFRs, who expressed their interest and satisfaction towards this learning experience and emphasized its usefulness and relevance.

CONCLUSION

This research supports the usefulness and significance of XR technology that allows users to enhance their skills and confidence when facing forthcoming disasters. The findings summarize recommendations and suggestions for the implementation, upgrade and/or assessment of this novel and valuable teaching method.

The relative importance of affect variability and mean levels of affect in predicting complex task performance

Although research indicates affect variability-the extent to which an individual's emotions fluctuate-is associated with behavioral outcomes related to adjustment and adaptability, it is unclear to what extent findings make important contributions to the literature when past research has failed to account for the role of mean levels of emotion. Accordingly, we conducted a repeated-measures laboratory study of college students (N = 253) learning to perform a complex computer task to examine the relative importance of affect variability indices (i.e., spin, pulse, and flux) compared to mean levels in explaining variance in off-task attention and task performance before and after changes in task demands (i.e., skill acquisition and adaptation). In doing so, we also disentangled valence and arousal (i.e., activating versus deactivating) aspects of emotion. Relative importance analyses showed mean levels of emotion were the most dominant predictors (i.e., explained the most variance)-negative deactivating emotions for off-task attention and positive activating emotions for performance. However, flux in negative activating and negative deactivating emotions also explained enough variance to be considered important, suggesting that flux has been overlooked in empirical research. Our findings also highlight that future research must account for mean levels when examining relationships between affect variability and outcomes of interest.

Comparing an In-Person and Online Continuing Education Intervention to Improve Professional Decision-Making: A Mixed Methods Study

Purpose: This paper compares two iterations (in-person and online) of a multi-stage continuing education program for improving high-risk decision-making among mental health workers. Methods: The mixed-methods study analyzed the following: (1) physiological and psychological arousal during simulated patient interviews; (2) physiological and psychological arousal recorded during real-time decision-making over four months; and (3) thoughts on the process and outcomes of the intervention raised in reflective interviews. Findings: Quantitatively, there were no statistical differences in stress measures between in-person and online simulated interviews or decision-making logs, suggesting they were effective in eliciting reactions commonly found in challenging clinical situations. Qualitatively, participants in both iterations indicated that the intervention caused them to reflect on practice, consider a wider range of factors related to the decisions, and enact approaches to improve decision-making. Conclusions: A carefully constructed online continuing education experience can result in outcomes for experienced social workers that are equivalent to an in-person iteration.

The effect of mood on shaping belief and recollection following false feedback

The current study examined how mood affects the impact of false feedback on belief and recollection. In a three-session experiment, participants first watched 40 neutral mini videos, which were accompanied by music to induce either a positive or negative mood, or no music. Following a recognition test, they received false feedback to reduce belief in the occurrence of the events displayed in some of the videos (Session 2). This was followed by an immediate memory test and a delayed memory assessment one week later (Session 3). The results revealed that participants in negative mood reported higher belief scores compared to those in positive moods, despite an overall decline in belief scores for all groups following the false feedback. Notably, individuals in negative moods exhibited less reduction in their belief scores after encountering challenges, thereby maintaining a higher accuracy in their testimonies. Over time, a reduction in the clarity of participants' memory recall was observed, which correspondingly reduced their testimony accuracy. This study thus indicates that mood states play a role in shaping belief and memory recall under the influence of false feedback.

The use of artificial intelligence to detect students' sentiments and emotions in gross anatomy reflections

Students' reflective writings in gross anatomy provide a rich source of complex emotions experienced by learners. However, qualitative approaches to evaluating student writings are resource heavy and timely. To overcome this, natural language processing, a nascent field of artificial intelligence that uses computational techniques for the analysis and synthesis of text, was used to compare health professional students' reflections on the importance of various regions of the body to their own lives and those of the anatomical donor dissected. A total of 1365 anonymous writings (677 about a donor, 688 about self) were collected from 132 students. Binary and trinary sentiment analysis was performed, as well as emotion detection using the National Research Council Emotion Lexicon which classified text into eight emotions: anger, fear, sadness, disgust, surprise, anticipation, trust, and joy. The most commonly written about body regions were the hands, heart, and brain. The reflections had an overwhelming positive sentiment with major contributing words "love" and "loved." Predominant words such as "pain" contributed to the negative sentiments and reflected various ailments experienced by students and revealed through dissections of the donors. The top three emotions were trust, joy, and anticipation. Each body region evoked a unique combination of emotions. Similarities between student self-reflections and reflections about their donor were evident suggesting a shared view of humanization and person centeredness. Given the pervasiveness of reflections in anatomy, adopting a natural language processing approach to analysis could provide a rich source of new information related to students' previously undiscovered experiences and competencies.

Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study

While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.

Teaching clinical reasoning: principles from the literature to help improve instruction from the classroom to the bedside

Clinical reasoning has been characterized as being an essential aspect of being a physician. Despite this, clinical reasoning has a variety of definitions and medical error, which is often attributed to clinical reasoning, has been reported to be a leading cause of death in the United States and abroad. Further, instructors struggle with teaching this essential ability which often does not play a significant role in the curriculum. In this article, we begin with defining clinical reasoning and then discuss four principles from the literature as well as a variety of techniques for teaching these principles to help ground an instructors' understanding in clinical reasoning. We also tackle contemporary challenges in teaching clinical reasoning such as the integration of artificial intelligence and strategies to help with transitions in instruction (e.g., from the classroom to the clinic or from medical school to residency/registrar training) and suggest next steps for research and innovation in clinical reasoning.

Patient safety, what does clinical simulation and teaching innovation contribute?

Clinical simulation in Intensive Care Medicine is a crucial tool to strengthen patient safety. It focuses on the complexity of the Intensive Care Unit, where challenging clinical situations require rapid decision making and the use of invasive techniques that can increase the risk of errors and compromise safety. Clinical simulation, by mimicking clinical contexts, is presented as essential for developing technical and non-technical skills and enhancing teamwork in a safe environment, without harm to the patient. in situ simulation is a valuable approach to practice in realistic environments and to address latent security threats. Other simulation methods as virtual reality and tele-simulation are gaining more and more acceptance. Herein, we provide current data on the clinical utility of clinical simulation related to improved safety in the practice of techniques and procedures, as well as improvements of teamwork performance and outcomes. Finally, we propose the needs for future research.

Development and Validation of the Emotion Laden Sentences Toolbox for Emotion Recognition (ELSTER)

Introduction

Emotion recognition plays a crucial role in our social interactions and overall well-being. The present cross-sectional study aimed to develop and validate Emotion Laden Sentences Toolbox for Emotion Recognition (ELSTER), that utilizes emotion-laden sentences as stimuli to assess individuals' ability to perceive and identify emotions conveyed through written language.

Methods

In Phase I, a comprehensive set of emotion-laden sentences in English language were validated by 25 (eight males and 17 females) qualified mental health professionals (MHPs). In Phase II, the sentences that received high interrater agreement in Phase I were selected and then a Hindi version of the same sentences was also developed. The English and Hindi database was then validated among 50 healthy individuals (30 males and 20 females).

Results

The percentage hit rate for all the emotions after exclusion of contempt was 84.3% with a mean kappa for emotional expression being 0.67 among MHPs. The percentage hit rate of all emotion-laden sentences across the database was 81.43% among healthy lay individuals. The mean hit rate percentage for English sentences was similar to Hindi sentences with a mean kappa for emotional expression being 0.63 for the combined English and Hindi sentences.

Conclusion

The ELSTER database would be useful in the Indian context for researching textual emotion recognition. It has been validated among a group of experts as well as healthy lay individuals and was found to have high inter-rater reliability.

"It´s like walking in a bubble", nursing students´ perspectives on age suit simulation in a home environment - group interviews from reflection seminars

BACKGROUND

Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults.

METHODS

A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis.

RESULTS

The analysis generated three main themes; "It's like walking in a bubble", "An eye opener" and "Concerns about ageing and the current structure of geriatric care". The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability.

CONCLUSIONS

Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons.

Factors influencing the engagement of older adults with neurocognitive disorders in the design of decision aids: A qualitative descriptive study

OBJECTIVE

To identify factors influencing the engagement of older adults with neurocognitive disorders (NCDs) in the design of decision aids (DAs).

METHODS

We conducted a qualitative descriptive study using semi-structured interviews with 23 older adults with NCDs who were accompanied by 27 caregivers. This is a secondary analysis of a published study to identify the features of DAs designed for this population and their caregivers.

RESULTS

Several behaviours and attitudes of caregivers and researchers hindered the older adults' engagement in the DA design process. Specific communication strategies can be employed to support their engagement and overcome the communication challenges inherent to this population, such as memory, attention, hearing, or visual impairments. Adopting the appropriate attitude, taking the time, and providing guidance to the older person can help them focus on the topic, while developing trust between participants is a facilitator to obtain their feedback.

CONCLUSION

Findings from this project could serve to inform the communication and co-design of DAs with older people with NCDs and their caregivers.

PRACTICE IMPLICATIONS

Caregivers and researchers have key roles to play in facilitating communication with older persons with NCDs so they are empowered to help in co-designing DAs.

Improving counseling effectiveness with virtual counselors through nonverbal compassion involving eye contact, facial mimicry, and head-nodding

An effective way to reduce emotional distress is by sharing negative emotions with others. This is why counseling with a virtual counselor is an emerging methodology, where the sharer can consult freely anytime and anywhere without having to fear being judged. To improve counseling effectiveness, most studies so far have focused on designing verbal compassion for virtual counselors. However, recent studies showed that virtual counselors' nonverbal compassion through eye contact, facial mimicry, and head-nodding also have significant impact on the overall counseling experience. To verify this, we designed the virtual counselor's nonverbal compassion and examined its effects on counseling effectiveness (i.e., reduce the intensity of anger and improve general affect). A total of 40 participants were recruited from the university community. Participants were then randomly assigned to one of two virtual counselor conditions: a neutral virtual counselor condition without nonverbal compassion and a compassionate virtual counselor condition with nonverbal compassion (i.e., eye contact, facial mimicry, and head-nodding). Participants shared their anger-inducing episodes with the virtual counselor for an average of 16.30 min. Note that the virtual counselor was operated by the Wizard-of-Oz method without actually being technically implemented. Results showed that counseling with a compassionate virtual counselor reduced the intensity of anger significantly more than counseling with a neutral virtual counselor (F(1, 37) = 30.822, p < 0.001, ηp2 = 0.454). In addition, participants who counseled with a compassionate virtual counselor responded that they experienced higher empathy than those who counseled with a neutral virtual counselor (p < 0.001). These findings suggest that nonverbal compassion through eye contact, facial mimicry, and head-nodding of the virtual counselor makes the participants feel more empathy, which contributes to improving the counseling effectiveness by reducing the intensity of anger.

The Influence of Stress on Student Performance during Simulation-based Learning: A Pilot Randomized Trial

Background

Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions.

Objective

This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance.

Methods

Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected.

Results

Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (P = 0.02). Higher anxiety was correlated with poorer skill performance (r = -0.410).

Conclusions

Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.

Barriers to Implementing the Kidney Disease Outcomes Quality Initiative End-Stage Kidney Disease Life Plan Guideline

OBJECTIVE

The updated 2019 National Kidney Foundation Kidney Disease Outcomes Quality Initiative vascular access guidelines recommend patient-centered, multi-disciplinary construction and regular update of an individualized end-stage kidney disease (ESKD) Life-Plan (LP) for each patient, a dramatic shift from previous recommendations and policy. The objective of this study was to examine barriers and facilitators to implementing the LP among key stakeholders.

METHODS

Semi-structured individual interviews were analyzed using inductive and deductive coding. Codes were mapped to relevant domains in the Consolidated Framework for Implementation Research (CFIR).

RESULTS

We interviewed 34 participants: 11 patients with end-stage kidney disease, 2 care partners, and 21 clinicians who care for patients with end-stage kidney disease. In both the clinician and the patient/care partner categories, saturation (where no new themes were identified) was reached at 8 participants. We identified significant barriers and facilitators to implementation of the ESKD LP across three CFIR domains: Innovation, Outer setting, and Inner setting. Regarding the Innovation domain, patients and care partners valued the concept of shared decision-making with their care team (CFIR construct: innovation design). However, both clinicians and patients had significant concerns about the complexity of decision-making around kidney substitutes and the ability of patients to digest the overwhelming amount of information needed to effectively participate in creating the LP (innovation complexity). Clinicians expressed concerns regarding the lack of existing evidence base which limits their ability to effectively counsel patients (innovation evidence base) and the implementation costs (innovation cost). Within the Outer Setting, both clinicians and patients were concerned about performance measurement pressure under the existing "Fistula First" policies and had concerns about reimbursement (financing). In the Inner Setting, clinicians and patients stressed the lack of available resources and access to knowledge and information.

CONCLUSION

Given the complexity of decision-making around kidney substitutes and vascular access, our findings point to the need for implementation strategies, infrastructure development, and policy change to facilitate ESKD LP development.

A scoping review of emotions and related constructs in simulation-based education research articles

BACKGROUND

While acknowledgement of emotions' importance in simulation-based education is emerging, there are concerns regarding how education researchers understand the concept of emotions for them to deliberately incorporate emotionally charged scenarios into simulation-based education. This concern is highlighted especially in the context of medical education often lacking strong theoretical integration. To map out how current simulation-based education literature conceptualises emotion, we conducted a scoping review on how emotions and closely related constructs (e.g. stress, and emotional intelligence) are conceptualised in simulation-based education articles that feature medical students, residents, and fellows.

METHODS

The scoping review was based on articles published in the last decade identified through database searches (EMBASE and Medline) and hand-searched articles. Data extraction included the constructs featured in the articles, their definitions, instruments used, and the types of emotions captured. Only empirical articles were included (e.g. no review or opinion articles). Data were charted via descriptive analyses.

RESULTS

A total of 141 articles were reviewed. Stress was featured in 88 of the articles, while emotions and emotional intelligence were highlighted in 45 and 34 articles respectively. Conceptualisations of emotions lacked integration of theory. Measurements of emotions mostly relied on self-reports while stress was often measured via physiological and self-report measurements. Negative emotions such as anxiety were sometimes seen as interchangeable with the term stress. No inferences were made about specific emotions of participants from their emotional intelligence.

CONCLUSIONS

Our scoping review illustrates that learners in simulation-based education are most often anxious and fearful. However, this is partially due to medical education prioritising measuring negative emotions. Further theoretical integration when examining emotions and stress may help broaden the scope towards other kinds of emotions and better conceptualisations of their impact. We call for simulation education researchers to reflect on how they understand emotions, and whether their understanding may neglect any specific aspect of affective experiences their simulation participants may have.

Paramedic perspectives of job stress: Qualitative analysis of high-stress, high-stakes emergency medical situations

The time from when an ambulance paramedic receives the 911 alarm notification until they have determined the differential diagnosis of a patient is highly stressful. During this time, there is a high demand placed on the paramedic, and they have a low level of control. Recent advances in prehospital care that place more responsibility on paramedics have exacerbated this high-stress phenomenon. Twenty paramedics from across the United States were interviewed and evaluated using descriptive phenomenology to better understand one of the most stressful moments of high-stakes decision-making that paramedics regularly face. Using descriptive phenomenology, we identified six categories in the paramedics' interview responses: pressure, overwhelm, emotional extremes (with sub-categories of adrenaline rush and time-dilation), dissociation, multi-tasking, and disconnect. This analysis of the paramedic's lived experience of this high-stress, high-stakes phenomenon provides insight into how paramedics experience the unique stress of this phenomenon. This understanding is key to elucidating the effects of this acute stress that may impact the judgment and, ultimately, the care performed by the paramedic. Both early- and late-career paramedics from thirteen different states in all regions of the United States were interviewed. Further qualitative data from paramedics from a diverse range of regions and backgrounds are essential to identify ways in which to ameliorate the negative effects of acute stress experienced by paramedics. Addressing such issues will reduce turnover and burnout among paramedics.

Delivering Bad News: Emotional Perspective and Coping Strategies of Medical Students

Purpose

The aim of our study was to analyze students' emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN).

Patients and Methods

291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience - whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA).

Results

Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy.

Conclusion

The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.

Impact of emotional competence on physicians' clinical reasoning: a scoping review protocol

INTRODUCTION

Clinical reasoning (CR) is a key competence for physicians and a major source of damaging medical errors. Many strategies have been explored to improve CR quality, most of them based on knowledge enhancement, cognitive debiasing and the use of analytical reasoning. If increasing knowledge and fostering analytical reasoning have shown some positive results, the impact of debiasing is however mixed. Debiasing and promoting analytical reasoning have also been criticised for their lack of pragmatism. Alternative means of increasing CR quality are therefore still needed. Because emotions are known to influence the quality of reasoning in general, we hypothesised that emotional competence (EC) could improve physicians' CR. EC refers to the ability to identify, understand, express, regulate and use emotions. The influence of EC on CR remains unclear. This article presents a scoping review protocol, the aim of which will be to describe the current state of knowledge concerning the influence of EC on physicians' CR, the type of available literature and finally the different methods used to examine the link between EC and CR.

METHOD AND ANALYSIS

The population of interest is physicians and medical students. EC will be explored according to the model of Mikolajczak et al, describing five major components of EC (identify, understand, express, regulate and use emotions). The concept of CR will include terms related to its processes and outcomes. Context will include real or simulated clinical situations. The search for primary sources and reviews will be conducted in MEDLINE (via Ovid), Scopus and PsycINFO. The grey literature will be searched in the references of included articles and in OpenGrey. Study selection and data extraction will be conducted using the Covidence software. Search and inclusion results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review model (PRISMA-ScR).

ETHICS AND DISSEMINATION

There are no ethical or safety concerns regarding this review.

REGISTRATION DETAILS

OSF Registration DOI: https://doi.org/10.17605/OSF.IO/GM7YD.

Kindness Isn't Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace

The healthcare workplace is a high-stress environment. All stakeholders, including patients and providers, display evidence of that stress. High stress has several effects. Even acutely, stress can negatively affect cognitive function, worsening diagnostic acumen, decision-making, and problem-solving. It decreases helpfulness. As stress increases, it can progress to burnout and more severe mental health consequences, including depression and suicide. One of the consequences (and causes) of stress is incivility. Both patients and staff can manifest these unkind behaviors, which in turn have been shown to cause medical errors. The human cost of errors is enormous, reflected in thousands of lives impacted every year. The economic cost is also enormous, costing at least several billion dollars annually. The warrant for promoting kindness, therefore, is enormous. Kindness creates positive interpersonal connections, which, in turn, buffers stress and fosters resilience. Kindness, therefore, is not just a nice thing to do: it is critically important in the workplace. Ways to promote kindness, including leadership modeling positive behaviors as well as the deterrence of negative behaviors, are essential. A new approach using kindness media is described. It uplifts patients and staff, decreases irritation and stress, and increases happiness, calmness, and feeling connected to others.

Understanding emotional intelligence and its relationship to clinical reasoning in senior nursing students: A mixed methods study

BACKGROUND

The complex healthcare environment requires nursing students to be prepared to effectively reason in emotionally charged situations. Clinical reasoning is a complex cognitive process that involves many elements, with little attention given to the role of emotions in this process.

PURPOSE

The purpose of this pilot study was to explore the EI of senior Bachelor of Science in Nursing (BSN) students and its relationship to clinical reasoning to gain a better understanding of how emotions are used in clinical learning experiences.

METHODS

This study utilized a convergent parallel mixed methods design.

RESULTS

Quantitative findings indicated a positive relationship between Strategic EI and the clinical reasoning scale of inference (r_s = 0.489, p = .044). A positive relationship was also found between the EI branch of Understanding Emotions and overall clinical reasoning (r_s = 0.559, p = .024) and the clinical reasoning scale of induction (r_s = 0.530, p = .035). The three categories that resulted from the qualitative findings: (1) Sadness for…, (2) Shifting Emotions, and (3) Presence converged with quantitative findings.

CONCLUSION

EI is an important construct when it comes to reasoning and providing care during clinical experiences. Fostering the development of EI may be one way nurse educators can better prepare nurses for safe practice.

The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: An experimental study using simulated patient cases

BACKGROUND

Engaging with human emotions is an integral but poorly understood part of the work of emergency healthcare providers. Patient factors (e.g., irritable behavior; mental illness) can evoke strong emotions, and evidence suggests that these emotions can impact care quality and patient safety. Given that nurses play a critical role in providing high quality care, efforts to identify and remedy factors that may compromise care are needed. Yet to date, few experiments have been conducted.

OBJECTIVE

To examine the effects of emotionally evocative patient behavior as well as the presence of mental illness on emergency nurses' emotions, patient assessments, testing advocacy, and written handoffs.

DESIGN

Experimental vignette research.

SETTING

Online experiment distributed via email between October and December 2020.

PARTICIPANTS

Convenience sample of 130 emergency nurses from seven hospitals in the Northeastern United States and one hospital in the mid-Atlantic region in the United States.

METHODS

Nurses completed four multimedia computer-simulated patient encounters in which patient behavior (irritable vs. calm) and mental illness (present vs. absent) were experimentally varied. Nurses reported their emotions and clinical assessments, recommended diagnostic tests, and provided written handoffs. Tests were coded for whether the test would result in a correct diagnosis, and handoffs were coded for negative and positive patient descriptions and the presence of specific clinical information.

RESULTS

Nurses experienced more negative emotions (anger, unease) and reported less engagement when assessing patients exhibiting irritable (vs. calm) behavior. Nurses also judged patients with irritable (vs. calm) behavior as more likely to exaggerate their pain and as poorer historians, and as less likely to cooperate, return to work, and recover. Nurses' handoffs were more likely to communicate negative descriptions of patients with irritable (vs. calm) behavior and omit specific clinical information (e.g., whether tests were ordered, personal information). The presence of mental illness increased unease and sadness and resulted in nurses being less likely to recommend a necessary test for a correct diagnosis.

CONCLUSIONS

Emergency nurses' assessments and handoffs were impacted by patient factors, particularly irritable patient behavior. As nurses are central to the clinical team and experience regular, close contact with patients, the effects of irritable patient behavior on nursing assessments and care practices have important implications. We discuss potential approaches to address these ill effects, including reflexive practice, teamwork, and standardization of handoffs.

TWEETABLE ABSTRACT

Experimental evidence links irritable patient behaviors to lower quality emergency department nurse handoffs, which may compromise patient safety @(lindamisbell) @(Nathan_Huff_1).

Developing a Virtual Reality Educational Tool to Stimulate Emotions for Learning: Focus Group Study

BACKGROUND

By watching 360° videos in virtual reality headsets, students may experience being immersed in the portrayed situation. There is a paucity of empirical studies on the application of immersive 360° videos watched in virtual reality headsets for students in health care and social work education and the pedagogical theory guiding the development of such educational tools. This led to our interest in exploring how a virtual reality educational tool involving 360° videos can stimulate emotions and how this can be used as a pedagogical tool in these educational programs.

OBJECTIVE

The aim of this study was to explore the experiences of faculty members and students regarding a prototype 360° video watched in virtual reality headsets during the development phase of an educational project. We addressed the following research questions: How does the virtual reality prototype stimulate emotions? How can virtual reality be used in higher education for health care and social work students?

METHODS

We used a qualitative design and collected data through focus group interviews with project participants. The data were analyzed using qualitative content analysis.

RESULTS

Our analysis identified 2 main themes in participants' experiences with the virtual reality prototype. The first theme highlights that when participants experienced watching the 360° video in a virtual reality headset, it stimulated their emotions as an authentic professional experience would. The second theme, contextualization of virtual reality, highlights participants' perceptions of how the virtual reality experience should be incorporated into a safe educational context.

CONCLUSIONS

Our findings suggest that 360° videos with human actors who use eye contact with the camera can trigger emotions in the viewer and therefore serve as a pedagogic tool that can create authentic professional experiences for students. The participants expressed the view that the virtual reality educational tool could be used to prepare students for real-life practice in health care and social work. However, they underlined that 360° videos in virtual reality need to be contextualized in educational programs to create a safe environment for learning and to ensure follow-up on the emotions such experiences can trigger in students. Our results highlight the perceived importance of allowing students to reflect on the virtual reality experience in a safe setting and of follow-up by faculty members. In-person follow-up with students can be resource intensive for programs with large numbers of students and makes it challenging to offer repeated training, something that has been identified as one of the benefits of virtual reality.

Investigating the interaction of pleasantness and arousal and the role of aesthetic emotions on episodic memory using a musical what-where-when paradigm

Recent evidence suggests that the presence of music experienced as pleasant positively influences episodic memory (EM) encoding. However, it is unclear whether this impact of pleasant music holds regardless of how arousing the music is, and what influence, if any, music-induced aesthetic emotions have. Furthermore, most music EM studies have used verbal or facial memory tasks limiting the generalisability of these findings to everyday EMs with spatiotemporal richness. The current study used an online what-where-when paradigm to assess music's influence on EM encoding in a rich spatiotemporal environment. 105 participants carried out the what-where-when task in the presence of either silence or one of four musical stimuli falling into the four corners of the 2-D circumplex emotion model. We observed an interaction effect between the pleasantness and arousingness of music stimuli, whereby for pleasant stimuli, the low arousing excerpt was associated with better recall performance compared to the high arousing excerpt. We also observed that, across all excerpts, experience of negative aesthetic emotions was associated with compromised recall performance. Together, our results confirm the deleterious influence arousing stimuli can have on memory and support the notion that aesthetic-emotional experience of music can influence how memories are encoded in everyday life.

Positive emotions and their upregulation increase willingness to consume healthy foods

While highly relevant for everyday life, it is unclear whether experiencing incidental positive or negative emotional states, and active emotion regulation, influence the weighting of perceived taste and health in food choices. In Experiment 1, we examined two emotion regulation strategies, reappraisal and distraction, used to decrease negative emotions. Participants were cued to experience or decrease their emotional response for either neutral or negative incidental emotion-inducing images. They subsequently rated their willingness to consume foods, which varied in their taste and health attributes. Mixed-effects model analysis showed that compared to neutral, negative emotions decreased willingness to consume, regardless of perceived taste and health, but neither emotion regulation strategy had a significant effect. Experiment 2 used images inducing incidental positive emotions in combination with three emotion regulation strategies: reappraisal, distraction, and increasing positive emotions. Experiencing positive emotions generally increased willingness to consume, with stronger effects for tasty and healthy foods. Decreasing positive emotions via reappraisal decreased willingness to consume, particularly for healthy foods. Increasing positive emotion intensity further increased willingness to consume, with stronger effects for healthy foods. The results suggest that experiencing positive emotions increases desire particularly strongly for healthy foods, which can additionally be modulated via emotion regulation. This has important implications for designing health-related interventions targeting mood improvement.

Targeting Patients' Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study

BACKGROUND

The task complexity involved in connecting to telehealth video visits may disproportionately impact health care access in populations already experiencing inequities. Human intermediaries can be a strategy for addressing health care access disparities by acting as technology helpers to reduce the cognitive load demands required to learn and use patient-facing telehealth technologies.

OBJECTIVE

We conducted a cognitive load theory-informed pilot intervention involving warm accompaniment telehealth helping sessions with patients at a Federally Qualified Health Center (FQHC). We demonstrate how to design and report recruitment methods, reach, delivery process, and the preliminary impact of a novel equity-focused intervention.

METHODS

Early into the COVID-19 pandemic a telehealth helping session was offered to patients at FQHC via phone. Graduate students led the sessions on conducting a telehealth video test run or helping with patient portal log-in. They systematically recorded their recruitment efforts, intervention observations, and daily reflection notes. Following the intervention, we asked the intervention participants to participate in an interview and all patients who had telehealth visits during and 4 weeks before and after the intervention period to complete a survey. Electronic health records were reviewed to assess telehealth visit format changes. Descriptive and inferential statistical analyses of the recruitment records, electronic health record data, and surveys were performed. Through integrative analysis, we developed process-related themes and recommendations for future equity-focused telehealth interventions.

RESULTS

Of the 239 eligible patients, 34 (14.2%) completed the intervention and 3 (1.2%) completed subsequent interviews. The intervention participants who completed the survey (n=15) had lower education and less technological experience than the nonintervention survey participants (n=113). We identified 3 helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem-solving, and being on the same page to counter informational distractions. Intervention participants reported increased understanding but found that learning the video visit software was more difficult than nonintervention participants. A comparison of visit experiences did not find differences in difficulty (cognitive load measure) using telehealth-related technologies, changes to visit modality, or reported technical problems during the visit. However, the intervention participants were significantly less satisfied with the video visits.

CONCLUSIONS

Although a limited number of people participated in the intervention, it may have reached individuals more likely to need technology assistance. We postulate that significant differences between intervention and nonintervention participants were rooted in baseline differences between the groups' education level, technology experience, and technology use frequency; however, small sample sizes limit conclusions. The barriers encountered during the intervention suggest that patients at FQHC may require both improved access to web-based technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized, equity-focused studies should investigate blended strategies to facilitate video visit access.

"Studying cognitive reappraisal as an antidote to the effect of negative emotions on medical residents' learning: a randomized experiment"

BACKGROUND

Medical trainees often encounter situations that trigger emotional reactions which may hinder learning. Evidence of this effect on medical trainees is scarce and whether it could be counteracted is unclear. This study investigated the effect of negative emotions on medical residents' learning and whether cognitive reappraisal counteracts it.

METHODS

Ninety-nine medical residents participated in a three-phase experiment consisting of: (1) watching a video, either a neutral or an emotion-induction version, the latter either followed by cognitive reappraisal or not (2) learning: all participants studied the same medical text; study-time and cognitive engagement were measured; (3) test: a recall-test measured learning. Data was analysed using Chi-square test and one-way ANOVA.

RESULTS

Study time significantly varied between conditions (p = 0.002). The two emotional conditions spent similar time, both significantly less than the neutral condition. The difference in test scores failed to reach significance level (p = 0.053). While the emotional conditions performed similarly, their scores tended to be lower than those of the neutral condition.

CONCLUSION

Negative emotions can adversely affect medical residents' learning. The effect of emotions was not counteracted by cognitive reappraisal, which has been successfully employed to regulate emotions in other domains. Further research to examine emotion regulation strategies appropriate for medical education is much needed.

Slow tempo music preserves attentional efficiency in young children

Past research has shown that listening to slow- or fast-tempo music can affect adults' executive attention (EA) performance. This study examined the immediate impact of brief exposure to slow- or fast-tempo music on EA performance in 4- to 6-year-old children. A within-subject design was used, where each child completed three blocks of the EA task after listening to fast-tempo music (fast-tempo block), slow-tempo music (slow-tempo block), and ocean waves (control block), with block-order counterbalanced. In each block, children were also asked to report their pre-task subjective emotional status (experienced arousal and valence) before listening to music and their post-task emotional status after the EA task. Three major results emerged. First, reaction time (RT) was significantly faster in the slow-tempo block than in the fast-tempo, suggesting that listening to slow-tempo music preserves processing efficiency, relative to fast-tempo music. Second, children's accuracy rate in the EA task did not differ across blocks. Third, children's subjective emotional status did not differ across blocks and did not change across the pre- and post-task phases in any block, suggesting the faster RT observed in the slow-tempo block cannot be explained by changes in arousal or mood.

Pulling our lens backwards to move forward: an integrated approach to physician distress

The medical community has recently acknowledged physician stress as a leading issue for individual wellness and healthcare system functioning. Unprecedented levels of stress contribute to physician burnout, leaves of absence and early retirement. Although recommendations have been made, we continue to struggle with addressing stress. One challenge is a lack of a shared definition for what we mean by 'stress', which is a complex and idiosyncratic phenomenon that may be examined from a myriad of angles. As such, research on stress has traditionally taken a reductionist approach, parsing out one aspect to investigate, such as stress physiology. In the medical domain, we have traditionally underappreciated other dimensions of stress, including emotion and the role of the environmental and sociocultural context in which providers are embedded. Taking a complementary, holistic approach to stress and focusing on the composite, subjective individual experience may provide a deeper understanding of the phenomenon and help to illuminate paths towards wellness. In this review article, we first examine contributions from unidimensional approaches to stress, and then outline a complementary, integrated approach. We describe how complex phenomena have been tackled in other domains and discuss how holistic theory and the humanities may help in studying and addressing physician stress, with the ultimate goal of improving physician well-being and consequently patient care.

The Role of the Emotional Sequence in the Communication of the Territorial Cheeses: A Neuromarketing Approach

Over the past few years, many studies have shown how territoriality can be considered a driver for purchasing agri-food products. Products with certification of origin are perceived as more sustainable, safer and of better quality. At the same time, producers of traditional products often belong to small entities that struggle to compete with large multinational food corporations, having less budget to allocate to product promotion. In this study, we propose a neuromarketing approach, showing how the use of these techniques can help in choosing the most effective commercial in terms of likeability and ability to activate mnemonic processes. Two commercials were filmed for the purpose of this study. They differed from each other in terms of emotional sequence. The first aimed primarily at eliciting positive emotions derived from the product description. The second aimed to generate negative emotions during the early stages, highlighting the negative consequences of humans' loss of contact with nature and tradition and then eliciting positive emotions by presenting cheese production using traditional techniques as a solution to the problem. Based on the literature on the emotional sequences in social advertising, we hypothesised that the second commercial would generate an overall better emotional reaction and activate mnemonic processes to a greater extent. Our results partially support the research hypotheses, providing useful insights both to marketers and for future research on the topic.

Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities

Psychological research consistently demonstrates that affect can play an important role in decision-making across a broad range of contexts. Despite this, the role of affect in clinical reasoning and medical decision-making has received relatively little attention. Integrating the affect, social cognition, and patient safety literatures can provide new insights that promise to advance our understanding of clinical reasoning and lay the foundation for novel interventions to reduce diagnostic errors and improve patient safety. In this paper, we briefly review the ways in which psychologists differentiate various types of affect. We then consider existing research examining the influence of both positive and negative affect on clinical reasoning and diagnosis. Finally, we introduce an empirically supported theoretical framework from social psychology that explains the cognitive processes by which these effects emerge and demonstrates that cognitive interventions can alter these processes. Such interventions, if adapted to a medical context, hold great promise for reducing errors that emerge from faulty thinking when healthcare providers experience different affective responses.

Analysis of Factors Influencing Public Behavior Decision Making: Under Mass Incidents

Most mass incidents are created by economic or social concerns brought on by fast socioeconomic change and poor local government. The number of mass occurrences in China has significantly increased in recent years, putting the country’s steady growth and public behavior decision-making in harm. We examine the factors that influence public behavior decision-making in the following significant factors, contributing to the development of effective prevention and response strategies. The structural equation (SEM) approach is used to analyze the main determinants influencing public behavioral decisions in the aftermath of mass incidents using surveys of a large population. The finding shows that media plays a mediating role in the relationship between mass occurrences and influencing factors impacting public emotion. The direct and indirect effects of public behavior decision-making and its role increasingly social changes as things happen, government credibility, media plays mediating role in public emotional factors. All directly impact public behavior decision-making, while emotional factors have an indirect impact via media intermediaries. The escalation of public behavior decisions is seen as a result of structural transmission and the increase of dynamic as well as other factors.

Cardiac sympathetic-vagal activity initiates a functional brain-body response to emotional arousal

We investigate the temporal dynamics of brain and cardiac activities in healthy subjects who underwent an emotional elicitation through videos. We demonstrate that, within the first few seconds, emotional stimuli modulate heartbeat activity, which in turn stimulates an emotion intensity (arousal)–specific cortical response. The emotional processing is then sustained by a bidirectional brain–heart interplay, where the perceived arousal level modulates the amplitude of ascending heart-to-brain neural information flow. These findings may constitute fundamental knowledge linking neurophysiology and psychiatric disorders, including the link between depressive symptoms and cardiovascular disorders.

A century-long debate on bodily states and emotions persists. While the involvement of bodily activity in emotion physiology is widely recognized, the specificity and causal role of such activity related to brain dynamics has not yet been demonstrated. We hypothesize that the peripheral neural control on cardiovascular activity prompts and sustains brain dynamics during an emotional experience, so these afferent inputs are processed by the brain by triggering a concurrent efferent information transfer to the body. To this end, we investigated the functional brain–heart interplay under emotion elicitation in publicly available data from 62 healthy subjects using a computational model based on synthetic data generation of electroencephalography and electrocardiography signals. Our findings show that sympathovagal activity plays a leading and causal role in initiating the emotional response, in which ascending modulations from vagal activity precede neural dynamics and correlate to the reported level of arousal. The subsequent dynamic interplay observed between the central and autonomic nervous systems sustains the processing of emotional arousal. These findings should be particularly revealing for the psychophysiology and neuroscience of emotions.

First year student radiographers' perceptions of a one-week simulation-based education package designed to increase clinical placement capacity

INTRODUCTION

The radiography workforce is short-staffed and under increasing pressure to meet service pressures. Combined with the impact of Covid-19, where student face-to-face clinical time was abruptly halted for safety, there is cause to change the pedagogical approach to teaching diagnostic radiography to students, increasing capacity and ensuring the continuance of qualifying radiographers to support the profession. This paper shares the perceptions of first year student radiographers on a one-week simulation-based education package designed to replace one week of clinical placement experience.

METHODS

Two cohorts of first-year radiography students engaged in a one-week simulation-based education package. Simulations increased in complexity throughout the week and included conventional imaging techniques, mobile and theatre radiography, and cross-sectional imaging. Thirty-six students consented to the thematic analysis of their reflective blogs.

RESULTS

Five themes emerged from the data: feeling anxious, understanding and skill development, building confidence, communication, and patient-centred care.

CONCLUSION

The simulation package had a positive impact on students learning, no matter the stage at which it was incorporated into their clinical placement block. Students engaged well with the activities and saw value in the experience. The findings indicate that the simulation-based education package is a suitable replacement for one week of clinical placement, supporting skills development in students and providing increased placement capacity.

IMPLICATIONS FOR PRACTICE

A successful, engaging simulation-based education package is presented, which first year student radiographers perceived as a suitable replacement for one-week of clinical placement. Further research into the acceptability of use of simulation-based education packages in second- and third-year student radiographers would be a useful next step.

Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses

Moral sensitivity helps individuals resolve moral dilemmas as a precursor to moral decision-making. Intensive care unit (ICU) nurses are at high risk for encountering moral dilemmas and should have the moral sensitivity to recognize moral issues. The activities of ICU nurses in moral decision-making are guided by moral sensitivity but are also based on emotional intelligence (EI). EI, be recognized as an integral part of moral sensitivity with long-standing theoretical foundations. It is necessary to explicate the true role of EI in moral sensitivity through empirical research. To measure the level of moral sensitivity of ICU nurses and determine the relationship between moral sensitivity and EI. We recruited 467 ICU nurses of ten hospitals from March to June 2021 in Hunan Province, China for a cross-sectional questionnaire survey. The moral sensitivity and EI were measured using the Moral Sensitivity Questionnaire-Revised Version into Chinese (MSQ-R-CV) and the Wong and Law Emotional Intelligence Scale-Version into Chinese (WLEIS-C). A self-report questionnaire covered sociodemographic characteristics. The average moral sensitivity score of ICU nurses was 39.41 ± 7.21. The average EI score was significantly positively correlated with the moral sensitivity score (p < 0.001). This study demonstrated that the moral sensitivities of ICU nurses were at medium levels. EI of ICU nurses can indeed affect their moral sensitivity, and the impact of each element of EI should be clarified for practical application.

Twelve tips for mindful teaching and learning in medical education

Mindfulness practice has been shown to have many positive benefits for patients, clinicians, and trainees. Mindfulness fosters compassion, connection, and enhanced clinical reasoning and can reduce burnout among clinicians. A primary focus of mindfulness is present-moment awareness and may be achieved through openness, curiosity, perspective-taking, and letting go of judgment. We propose that the core principles of mindfulness can be harnessed by educators to enhance their teaching skills specifically around creating a supportive and safe learning environment, using questions effectively, providing feedback, and serving as role models. Mindful teaching promotes mindful learning, which focuses on context, openness to new possibilities, reflection, and critical thinking, as opposed to rote repetition and memorization. This article describes core mindfulness principles and strategies that can be used to become a more mindful teacher.

Emotions in simulation-based education: friends or foes of learning?

In simulation-based education, there is growing interest in the effects of emotions on learning from simulation sessions. The perception that emotions have an important impact on performance and learning is supported by the literature. Emotions are pervasive: at any given moment, individuals are in one emotional state or another. Emotions are also powerful: they guide ongoing cognitive processes in order to direct attention, memory and judgment towards addressing the stimulus that triggers the emotion. This occurs in a predictable way. The purpose of this paper is to present a narrative overview of the research on emotions, cognitive processes and learning, in order to inform the simulation community of the potential role of emotions during simulation-based education.

Dose-Response Relationship between High-Fidelity Simulation and Intensive Care Nursing Students' Learning Outcomes: An Italian Multimethod Study

Background: The best application modality of high-fidelity simulation in graduate critical care nursing courses is still rarely investigated in nursing research. This is an important issue since advanced nursing skills are necessary to effectively respond to critically ill patients' care needs. The aim of the study was to examine the influence of a modified teaching model based on multiple exposures to high-fidelity simulations on both the learning outcomes and the perceptions of graduate students enrolled in a critical care nursing course. Methods: A multimethod study involving a sample of graduate critical care nursing students was conducted. A theoretical teaching model focused on multiple exposures to high-fidelity simulations is currently applied as a teaching method in an Italian critical care nursing course. According to the Kirkpatrick model for evaluating training programs, the performance, self-efficacy, and self-confidence in managing critically ill patients were considered learning outcomes, while satisfaction with learning and students' lived experiences during the experimental phases were considered students' perceptions. Results: Multiple exposures to high-fidelity simulations significantly improved performance, self-efficacy, and self-confidence in managing virtual critically ill patients' care needs. The satisfaction level was high, while lived experiences of participants were positive and allowed for better explanation of quantitative results of this study. Conclusions: Multiple exposures to high-fidelity simulations can be considered a valuable teaching method that can improve the learning outcomes of graduate nurses enrolled in an intensive care course.

A rollercoaster of emotions: An integrative review of emotions and its impact on health professional students' learning in simulation-based education

AIM

Simulation-based education establishes a specific learning environment capable of activating emotions before, during and after the task. Research has identified stress and anxiety related to simulation. However, the role of various emotional experiences in a simulation that favour learning is still unclear. This review describes, interprets and synthesizes the current research findings on health professional students' experience of emotions and the effects on student learning in simulations.

DESIGN

This study design was guided by integrative review method.

METHODS

Databases were systematically searched for articles. 9,323 records were screened and 16 studies met the inclusion criteria. The study protocol was reported in Prospero.

RESULTS

Three themes emerged from the analysis: (a) simulation as a fearful and stressful situation, (b) variability in emotions experienced during simulation as a rollercoaster of emotions and (c) emotions wide-ranging effects on students' learning in the simulation.

Exploring the relationship between emotion and cognitive load types during patient handovers

Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.

Medical educators' views and experiences of trigger warnings in teaching sensitive content

BACKGROUND

Trigger warnings-prior notification of topics so recipients may prepare for ensuing distress-are encountered widely in contemporary culture. Students at some universities have expressed expectations for trigger warnings. Medical education routinely exposes students to numerous potentially distressing topics. However, this topic remains understudied in medical education. Little is understood about educators' views or practice relating to warnings in the context of medical education.

METHODS

Twenty medical educators from a medical degree programme in the UK participated in a semi-structured qualitative interview study, exploring medical educators' views and experiences of managing distressing situations and, specifically, their use of warnings. We analysed interview transcripts by thematic coding and identified themes.

RESULTS

Analysis identified themes relating to educators' conceptualisation of trigger warnings and rationale for use, concerns about the use of warnings and the critical purpose of medical school in ensuring preparedness for clinical practice. Participants shared that warnings were given to empower students in approaching distressing topics and to enable engagement with learning. Warnings acknowledged that some experiences would be distressing and normalised and signalled acceptability of emotional responses. Decisions to use warnings were influenced by the nature of content and, reactively, in response to experiences of student distress. Terminology regarding trigger warnings was interpreted varyingly by participants. A broad variety of topics were identified as potentially sensitive. A number of concerns were noted regarding the use of warnings.

DISCUSSION

Warnings alone did not fulfil educators' responsibility in supporting students' professional development, but may be a useful adjunct, signalling that self-care is valued and should be prioritised. Despite frequent use of warnings, individual educator practice was shaped by varying rationale. A framework that addresses competing tensions of preventing distress and supporting professional development is needed as part of a trauma-informed approach to medical education.

Mental Resilience and Coping With Stress: A Comprehensive, Multi-level Model of Cognitive Processing, Decision Making, and Behavior

Aversive events can evoke strong emotions that trigger cerebral neuroactivity to facilitate behavioral and cognitive shifts to secure physiological stability. However, upon intense and/or chronic exposure to such events, the neural coping processes can be maladaptive and disrupt mental well-being. This maladaptation denotes a pivotal point when psychological stress occurs, which can trigger subconscious, "automatic" neuroreactivity as a defence mechanism to protect the individual from potential danger including overwhelming unpleasant feelings and disturbing or threatening thoughts.The outcomes of maladaptive neural activity are cognitive dysfunctions such as altered memory, decision making, and behavior that impose a risk for mental disorders. Although the neurocognitive phenomena associated with psychological stress are well documented, the complex neural activity and pathways related to stressor detection and stress coping have not been outlined in detail. Accordingly, we define acute and chronic stress-induced pathways, phases, and stages in relation to novel/unpredicted, uncontrollable, and ambiguous stressors. We offer a comprehensive model of the stress-induced alterations associated with multifaceted pathophysiology related to cognitive appraisal and executive functioning in stress.

Analysis of Emotion and Recall in COVID-19 Advertisements: A Neuroscientific Study

In this research, neuroscience techniques are applied to the field of marketing in the analysis of advertisements that include the COVID-19 pandemic in their stories. A study of emotion and memory in these audiovisual productions is carried out as two fundamental factors for the knowledge of consumer habits and decision making. By means of facial recognition biosensor systems (AFFDEX) and various tests, six informative and narrative, emotional and rational advertisements are presented to the subjects of the experiment to detect which emotions predominate; how they affect variables such as neuroticism, psychoticism or extroversion, among others; or what is remembered about the different works, brands and advertisers. Outstanding results are obtained in both emotional and cognitive analysis. Thus, in the field of public health, it is found that messages referring to COVID-19 included in advertisements are remembered more than other narratives or even the brands, products or services themselves. Likewise, joy is the predominant emotion, and its significance in such varied advertising stories stands out. Finally, it is clear that neuroscience research applied to marketing requires new methods and integrated applications to obtain satisfactory results in the advertising field.

'A roller coaster of emotions': a phenomenological study on medical students lived experiences of emotions in complex simulation

BACKGROUND

Simulation-based education can induce intense learner emotions. The interplay between emotions and learning is less well understood. Gaining greater insights into learner emotions has potential to guide how best we manage emotions and optimise learning. This study aimed to understand learners' lived emotional experiences in complex simulation and the perceived impact on learning.

METHODS

Eight final-year medical students participated in the study. Wearing video-glasses, participants took part in a ward-based simulation. Video-footage was used to elicitate exploratory interviews and analysed using Template Analysis reflexively.

RESULTS

Analysis yielded four main themes: 'nervous anticipation': encapsulating the fear, anxiety and uncertainty experienced by learners prior to simulation; 'shock and awe': feelings of anxiousness and being overwhelmed at the start of a simulation; 'in the moment: flowing or buffeting with the emotions': experiencing fear of being judged as incompetent, but also experiencing positive emotions such as satisfaction; 'safe-landing?': whilst debriefing aimed to encourage more positive emotions, negative emotions about the simulation could persist even with debriefing.

CONCLUSIONS

Complex simulation can evoke intense emotions in students. If students experienced a positive progression, they reported positive emotions and felt competent which was perceived to have a positive impact on learning. If students experienced failure, they reported strong negative emotions which made them question about their future performance and was perceived as negative for learning. Bringing to the surface these complex emotional dynamics, could permit educators to be aware of and adapt the emotional climate within simulation in order to optimise learning.