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Hor SY, Wyer M, Barratt R, Turnbull M, Rogers K, Murphy M, Urwin R, Jorm C, Gilbert GL. Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey. Am J Infect Control 2024:S0196-6553(24)00557-1. [PMID: 38925501 DOI: 10.1016/j.ajic.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. METHODS An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. RESULTS Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. DISCUSSION Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. CONCLUSIONS To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.
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Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
| | - Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Margo Turnbull
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Jorm
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
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Silva LCD, Rodrigues AB, Silva FJD, Oliveira PMD, Oliveira SKPD, Carvalho REFLD, Coelho MDMF, Oliveira RM. Emotional intelligence of health personnel and safety climate in hospitals during the COVID-19 pandemic. Rev Gaucha Enferm 2024; 45:e20230102. [PMID: 38922230 DOI: 10.1590/1983-1447.2024.20230102.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/27/2023] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To analyze the relationship between the emotional intelligence of healthcare workers in a hospital environment and their perception of the safety climate in the COVID-19 pandemic. METHOD Cross-sectional, analytical study, carried out with 81 health workers who worked in hospitals during the pandemic, between September and November 2021. Data collection was carried out using an electronic form, which included a sociodemographic/occupational questionnaire and the Brazilian versions of the Safety Attitudes Questionnaire and the Schutte Self Test. Spearman's correlation test and simple and multiple linear regression analyses were applied. RESULTS An increase of 1 point in emotional intelligence levels resulted in an increase of 0.487 points in the perception of the safety climate. The most significant predictor of this perception was the ability to manage other people's emotions (β=0.334; p=0.003; R2=0.168). CONCLUSION A higher level of emotional intelligence in hospital healthcare workers was related to a greater perception of the safety climate during the COVID-19 pandemic.
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Affiliation(s)
- Laudicéa Cardoso da Silva
- Universidade Estadual do Ceará (UECE). Centro de Ciências da Saúde. Curso de Mestrado Profissional em Saúde da Criança e do Adolescente. Fortaleza, Ceará, Brasil
| | - Ana Barbosa Rodrigues
- Universidade Federal do Ceará (UFC). Faculdade de Farmácia, Odontologia e Enfermagem. Departamento de Enfermagem. Fortaleza, Ceará, Brasil
| | - Francisco José da Silva
- Universidade Federal do Ceará (UFC). Faculdade de Farmácia, Odontologia e Enfermagem. Departamento de Enfermagem. Fortaleza, Ceará, Brasil
| | - Paloma Moreira de Oliveira
- Universidade Federal do Ceará (UFC). Faculdade de Farmácia, Odontologia e Enfermagem. Departamento de Enfermagem. Fortaleza, Ceará, Brasil
| | - Sherida Karanini Paz de Oliveira
- Universidade Estadual do Ceará (UECE). Centro de Ciências da Saúde. Curso de Mestrado Profissional em Saúde da Criança e do Adolescente. Fortaleza, Ceará, Brasil
| | | | | | - Roberta Meneses Oliveira
- Universidade Estadual do Ceará (UECE). Centro de Ciências da Saúde. Curso de Mestrado Profissional em Saúde da Criança e do Adolescente. Fortaleza, Ceará, Brasil
- Universidade Federal do Ceará (UFC). Faculdade de Farmácia, Odontologia e Enfermagem. Departamento de Enfermagem. Fortaleza, Ceará, Brasil
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Martinez NG, Seidman DL, Briscoe H, Hayes CM, Ojukwu EI, Paltin D, Roberts SCM. Patients, colleagues, systems, and self: Exploring layers of physician emotions in caring for pregnant people who use substances and their newborns. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209432. [PMID: 38857826 DOI: 10.1016/j.josat.2024.209432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/24/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Pregnant people who use substances experience significant stigma, including in healthcare settings, where physicians make high-stakes decisions about treatment plans, resource allocation, and even a person's ability to parent. Previous psychology research has demonstrated the influence of emotions on decision-making, as well as on the development and expression of stigma. Yet the specific content of physician emotions, as well as approaches to processing these emotions, has been relatively under-examined. We sought to better understand the emotional experiences of physicians who practice in safety-net labor and delivery/inpatient settings to inform strategies to facilitate more humanizing, equitable care. METHODS From March 2021 to June 2022, the study team conducted semi-structured interviews with 24 San Francisco Bay Area-based physicians (obstetrics-gynecology, pediatrics, family medicine) caring for pregnant people who use substances and/or their newborns. We used deductive and inductive coding and identified themes regarding the nature, etiology, and processing of physician emotions. RESULTS Physicians described experiencing a range of emotions related to interpersonal (patients, colleagues), systems-level, and internal dynamics. Emotions such as anger, sadness, frustration, and helplessness resulted from their deep care and empathy for patients, witnessing stigmatizing colleague behaviors, disagreement with punitive systems, and recognition of their own limitations in effecting change. Few participants identified strategies for processing these emotions, and several described efforts to disengage from their emotional experience to preserve their sense of well-being and professionalism. CONCLUSIONS Physicians caring for pregnant people who use substances and their newborns experienced intense, multi-layered emotions. This study posits that additional efforts to support physician emotional processing and structural competency could improve healthcare experiences and outcomes for pregnant people who use substances.
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Affiliation(s)
- Noelle G Martinez
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161, United States of America; Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America.
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Heather Briscoe
- Department of Pediatrics, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Crystal M Hayes
- School of Social Work, Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825, United States of America
| | - Ekene I Ojukwu
- San Quentin Rehabilitation Center, 100 Main Street, San Quentin, CA 94964, United States of America
| | - Dafna Paltin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 102/103, San Diego, CA 92120, United States of America
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Street, Suite 1100, Oakland, CA 94612, United States of America
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Tjan TE, Wong LY, Rixon A. Conflict in emergency medicine: A systematic review. Acad Emerg Med 2024; 31:538-546. [PMID: 38415363 DOI: 10.1111/acem.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The emergency department (ED) is a demanding and time-pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings. We aim to synthesize the individual-, team-, and systemic-level factors that contribute to conflict between clinicians within the ED and explore strategies and opportunities for future research. METHODS Online databases PubMed and Web of Science were systematically searched for relevant peer-reviewed journal articles in English with keywords relating to "conflict" and "emergency department," yielding a total of 29 articles. RESULTS Narrative analysis showed that conflict often occurred during referrals or admissions from ED to inpatient or admitting units. Individual-level contributors to conflict include a lack of trust in ED workup and staff inexperience. Team-level contributors include perceptions of bias between groups, patient complexity, communication errors, and difference in practice. Systems-level contributors include high workload/time pressures, ambiguities around patient responsibility, power imbalances, and workplace culture. Among identified solutions to mitigate conflict are better communication training, standardizing admission guidelines, and improving interdepartmental relationships. CONCLUSIONS In emergency medicine, conflict is common and occurs at multiple levels, reflecting the complex interface of tasks and relationships within ED.
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Affiliation(s)
- Timothy Edward Tjan
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lee Yung Wong
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Department of Business, Strategy and Innovation, Griffith Business School, Griffith University, Brisbane, Queensland, Australia
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Mahmood AUD, Adily P, Francis S, Eastwood J, Bein K, Chakar BA, Montgomery A. Understanding low acuity emergency department presentations in infancy: A cohort study. Emerg Med Australas 2024; 36:401-412. [PMID: 38239022 DOI: 10.1111/1742-6723.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/06/2023] [Accepted: 12/12/2023] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Low acuity presentations (LAPs) contribute to large numbers of ED presentations and carry numerous consequences. The present study sought to improve the understanding of regional infant LAPs by analysing temporal patterns of presentation, discharge diagnoses and potential predictive factors. METHODS This retrospective observational study examined ED presentations among children less than 12 months old (infants) to the Royal Prince Alfred Hospital between 2017 and 2019. Descriptive statistics were used to identify temporal patterns of presentation and common discharge diagnoses among LAPs. Multivariable logistic regression was used to determine the association between early life, demographic and perinatal factors and low acuity presenters. RESULTS Of 6881 infant ED presentations, 19.8% were LAPs, occurring disproportionately on weekdays (82.2%) and during hours of 08.00-17.00 (69.9%). Respiratory tract infections and gastrointestinal complaints were most common overall, though non-allergic rash, feeding difficulties, eczema and developmental concerns contributed substantially among LAPs. Socio-economic status (SES) (odds ratio [OR] 1.71), overseas maternal nationality (OR 1.25) and Medicare ineligible maternal financial class (OR 0.49) were associated with low acuity presenters. Low appearance, pulse, grimace, activity and respiration score (OR 3.53), low SES (OR 3.26), complicated delivery (OR 1.64), maternal multiparity (OR 0.50), maternal partner presence (OR 0.40) and obstetric complications (OR 0.37) were associated with repeat, multi-low acuity presenters (multi-LAPs). CONCLUSION A substantial minority of infant ED presentations are LAPs. Targeted interventions may benefit from focusing on families with a background of socioeconomic disadvantage, social isolation, cultural and linguistic diversity and perinatal complications, with a view to strengthening engagement with community-based services among these groups.
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Affiliation(s)
- Areeb-Ud-Deen Mahmood
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- UNSW Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Pejman Adily
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute of Medical Research, Sydney, New South Wales, Australia
- Database Manager for The Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - Stephanie Francis
- Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia
- UNSW School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - John Eastwood
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Southern District Health Board, South Island, New Zealand
| | - Kendall Bein
- Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia
- RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia
| | - Bashir A Chakar
- Royal Prince Alfred Hospital, Emergency Department, Sydney, New South Wales, Australia
- RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia
| | - Alicia Montgomery
- Community Paediatrics, Sydney Local Health District, Sydney, New South Wales, Australia
- Database Manager for The Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
- RPA Greenlight Institute for Emergency Care, Sydney, New South Wales, Australia
- UNSW School of Psychiatry, Sydney, New South Wales, Australia
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Sattar R, Lawton R, Janes G, Elshehaly M, Heyhoe J, Hague I, Grindey C. A systematic review of workplace triggers of emotions in the healthcare environment, the emotions experienced, and the impact on patient safety. BMC Health Serv Res 2024; 24:603. [PMID: 38720302 PMCID: PMC11080227 DOI: 10.1186/s12913-024-11011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Healthcare staff deliver patient care in emotionally charged settings and experience a wide range of emotions as part of their work. These emotions and emotional contexts can impact the quality and safety of care. Despite the growing acknowledgement of the important role of emotion, we know very little about what triggers emotion within healthcare environments or the impact this has on patient safety. OBJECTIVE To systematically review studies to explore the workplace triggers of emotions within the healthcare environment, the emotions experienced in response to these triggers, and the impact of triggers and emotions on patient safety. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four electronic databases were searched (MEDLINE, PsychInfo, Scopus, and CINAHL) to identify relevant literature. Studies were then selected and data synthesized in two stages. A quality assessment of the included studies at stage 2 was undertaken. RESULTS In stage 1, 90 studies were included from which seven categories of triggers of emotions in the healthcare work environment were identified, namely: patient and family factors, patient safety events and their repercussions, workplace toxicity, traumatic events, work overload, team working and lack of supervisory support. Specific emotions experienced in response to these triggers (e.g., frustration, guilt, anxiety) were then categorised into four types: immediate, feeling states, reflective, and longer-term emotional sequelae. In stage 2, 13 studies that explored the impact of triggers or emotions on patient safety processes/outcomes were included. CONCLUSION The various triggers of emotion and the types of emotion experienced that have been identified in this review can be used as a framework for further work examining the role of emotion in patient safety. The findings from this review suggest that certain types of emotions (including fear, anger, and guilt) were more frequently experienced in response to particular categories of triggers and that healthcare staff's experiences of negative emotions can have negative effects on patient care, and ultimately, patient safety. This provides a basis for developing and tailoring strategies, interventions, and support mechanisms for dealing with and regulating emotions in the healthcare work environment.
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Affiliation(s)
- Raabia Sattar
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.
| | - Rebecca Lawton
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | | | | | - Jane Heyhoe
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Isabel Hague
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - Chloe Grindey
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
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Andreae DA, Massand S, Dellasega C. The physician experience of patient to provider prejudice (PPtP). Front Public Health 2024; 12:1304107. [PMID: 38469272 PMCID: PMC10925775 DOI: 10.3389/fpubh.2024.1304107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/01/2024] [Indexed: 03/13/2024] Open
Abstract
Background Patients can demonstrate prejudice and bias toward minoritized physicians in a destructive dynamic identified as PPtP (Patient Prejudice toward Providers). These interactions have a negative impact on the physical and mental well-being of both those who are targeted and those who witness such behaviors. Study purpose The purpose of this study was to explore the PPtP experiences of attending physicians who identify as a minority based on race, ethnicity, citizenship status, or faith preference. Methods Qualitative methodology was used to collect data using in-depth interviews. 15 attending physicians (8 male, 7 female, aged 33-55 years) who identified as minorities based on ethnicity, citizenship status, or faith practices were interviewed individually. Interviews were conducted using a guide validated in previous studies and content analysis was performed by two trained researchers to identify themes. Results Five themes were identified: A Continuum of Offenses, Professional Growth through Adversity, Organizational Issues, Role of Colleagues, and Consequences for Provision of Care. Findings suggest that although attending physicians learned to cope with PPtP, the experience of being treated with bias negatively impacted their well-being and work performance. Attending physicians also felt that white majority medical students sometimes treated them with prejudice but expressed a commitment to protecting vulnerable trainees from PPtP. Conclusion The experience of PPtP occurs consistently throughout a career in medicine, often beginning in the years of training and persisting into the phase of attending status. This makes it imperative to include strategies that address PPtP in order to successfully recruit and retain minoritized physicians.
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Affiliation(s)
- Doerthe A. Andreae
- Section of Allergy and Immunology, Department of Dermatology, University of Utah, Salt Lake City, UT, United States
| | - Sameer Massand
- Division of Plastic Surgery, Department of Surgery, Penn State Health, Hershey, PA, United States
| | - Cheryl Dellasega
- Department of Nursing, College of Medicine, Pennsylvania State University, Penn State Health, Hershey, PA, United States
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Huff NR, Liu G, Chimowitz H, Gleason KT, Isbell LM. COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: A cross-sectional study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100111. [PMID: 36467310 PMCID: PMC9710107 DOI: 10.1016/j.ijnsa.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background As the COVID-19 pandemic began, frontline nurses experienced many emotions as they faced risks relevant to both patients (e.g., making errors resulting in patient harm) and themselves (e.g., becoming infected with COVID-19). Although emotions are often neglected in the patient safety literature, research in affective science suggests that emotions may significantly impact nurses' perceptions of risk, which can have downstream consequences. Further, the use of chronic emotion regulation strategies that are known to differ in adaptability and effectiveness (i.e., emotional suppression, reappraisal) can impact risk perceptions. Objective To investigate the relationship between nurses' emotional experiences in response to the pandemic and their estimates of how likely they would be to experience adverse outcomes related to both patients and themselves within the next six months. Additionally, we investigated the extent to which the use of suppression and reappraisal processes to manage emotions are associated with these risk perceptions. Design Cross-sectional survey. Setting Online survey distributed via email to emergency nurses at eight hospitals in the northeastern United States during fall 2020. Participants 132 emergency nurses (M age = 37.05; 81.1% Female; 89.4% White). Methods Nurses reported the extent to which they experienced a variety of positive (e.g., hope, optimism) and negative (e.g., fear, sadness) emotions in response to the COVID-19 pandemic, and reported their perceptions of risk to both patients and themselves. Nurses also completed the Emotion Regulation Questionnaire, a measure of chronic tendencies to engage in emotional suppression and reappraisal. Immediately prior to providing data for this study, nurses completed an unrelated decision-making study. Results Nurses' negative emotions in response to COVID-19 were associated with greater perceptions of both patient safety risks (b = 0.31, p < .001) and personal risks (b = 0.34, p < .001). The relationships between positive emotions and risk perceptions were not statistically significant (all p values > 0.66). Greater chronic tendencies to suppress emotions uniquely predicted greater perceptions of patient safety risks (b = 2.91, p = .036) and personal risks (b = 2.87, p = .040) among nurses; however, no statistically significant relationships with reappraisal emerged (all p values > 0.16). Conclusions Understanding factors that influence perceptions of risk are important, given that these perceptions can motivate behaviours that may adversely impact patient safety. Such an understanding is essential to inform the development of interventions to mitigate threats to patient safety that emerge from nurses' negative emotional experiences and their use of different emotion regulation strategies. Tweetable abstract Covid-related negative emotions and emotional suppression are associated with greater patient and personal risk perceptions among emergency nurses @lindamisbell @Nathan_Huff_1.
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Affiliation(s)
- Nathan R. Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA, 01003 United States
| | - Guanyu Liu
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA, 01003 United States
| | - Hannah Chimowitz
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA, 01003 United States
| | - Kelly T. Gleason
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, Maryland, 21205 United States
| | - Linda M. Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA, 01003 United States,Corresponding author
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Rana K, Poudel P, Chimoriya R. Qualitative Methodology in Translational Health Research: Current Practices and Future Directions. Healthcare (Basel) 2023; 11:2665. [PMID: 37830701 PMCID: PMC10572630 DOI: 10.3390/healthcare11192665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Translational health research is an interdisciplinary field aimed at bridging the gap between basic science studies, preventative studies, and clinical practice to improve health-related outcomes. Qualitative research methods provide a unique perspective on the emotional, social, cultural, and contextual factors that influence health and healthcare and thus are recognized as valuable tools for translational health research. This approach can be embedded within a mixed method design which complements the quantitative findings. This methodological paper aims to provide a comprehensive review of the fundamental concepts and methodologies used in qualitative research, emphasizing their utilization and significance in translational health research. Several approaches to qualitative research methodology are discussed in this review, including ethnography, phenomenology, grounded theory, case study, and action research. Theoretical frameworks such as the social-ecological model, intersectionality, and participatory action research are also examined to provide a structure for understanding and interpreting complex health issues. This methodological paper also reviews commonly used sampling techniques such as purposive, snowball, convenience, theoretical, and maximum variation sampling, along with data collection methods such as in-depth interviews, focus groups, observation, document analysis, and participatory methods. Moreover, data analysis techniques such as thematic analysis, grounded theory, content analysis, narrative analysis, and reflexive analysis, are discussed in the context of translational health. Overall, this review highlights the challenges and opportunities of using qualitative methods in current practice, while also discussing future directions and providing valuable guidance and insights to researchers interested in conducting qualitative research in translational health.
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Affiliation(s)
- Kritika Rana
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia;
| | - Prakash Poudel
- Office of Research and Education, Canberra Health Services, ACT Government, Garran, ACT 2606, Australia;
| | - Ritesh Chimoriya
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia;
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, NSW 2139, Australia
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10
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Isbell LM, Graber ML, Rovenpor DR, Liu G. Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment. Diagnosis (Berl) 2023; 10:257-266. [PMID: 37185165 DOI: 10.1515/dx-2020-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/22/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Patients with mental illness are less likely to receive the same physical healthcare as those without mental illness and are less likely to be treated in accordance with established guidelines. This study employed a randomized experiment to investigate the influence of comorbid depression on diagnostic accuracy. METHODS Physicians were presented with an interactive vignette describing a patient with a complex presentation of pernicious anemia. They were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. RESULTS Fifty-nine physicians completed the study. The patient with comorbid depression was less likeable than the control patient (p=0.03, 95 % CI [0.09, 1.53]). Diagnostic accuracy was lower in the depression compared to control condition (59.4 % vs. 40.7 %), however this difference was not statistically significant χ2(1)=2.035, p=0.15. Exploratory analyses revealed that patient condition (depression vs. control) interacted with the number of diagnostic tests ordered to predict diagnostic accuracy (OR=2.401, p=0.038). Accuracy was lower in the depression condition (vs. control) when physicians ordered fewer tests (1 SD below mean; OR=0.103, p=0.028), but there was no difference for physicians who ordered more tests (1 SD above mean; OR=2.042, p=0.396). CONCLUSIONS Comorbid depression and related behaviors lowered diagnostic accuracy when physicians ordered fewer tests - a time when more possibilities should have been considered. These findings underscore the critical need to develop interventions to reduce diagnostic error when treating vulnerable populations such as those with depression.
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Affiliation(s)
- Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Mark L Graber
- Society to Improve Diagnosis in Medicine, Plymouth, MA, USA
- Stony Brook University, NY, USA
| | | | - Guanyu Liu
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Isbell LM, Chimowitz H, Huff NR, Liu G, Kimball E, Boudreaux E. A Qualitative Study of Emergency Physicians' and Nurses' Experiences Caring for Patients With Psychiatric Conditions and/or Substance Use Disorders. Ann Emerg Med 2023; 81:715-727. [PMID: 36669922 DOI: 10.1016/j.annemergmed.2022.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE Patients with psychiatric conditions and/or substance use disorders (SUDs) frequently seek care in emergency departments (EDs), where providing care for these populations can involve considerable challenges. This study aimed to develop a comprehensive data-driven model of the complex challenges and unique dynamics associated with caring for these populations in the ED, as well as the effect on patient care quality. METHODS We conducted a preplanned topical analysis of grounded theory data obtained from semistructured interviews with 86 ED physicians and nurses from 8 hospitals in the Northeastern USA. Participants provided detailed descriptions of their experiences and challenges in caring for patients with psychiatric conditions and/or SUDs. We identified themes inductively using constant comparative analysis and developed a grounded model of physicians' and nurses' perceptions of challenges, biases, and effects on patient care. RESULTS Emergency physicians and nurses described emotional, diagnostic, and logistical challenges that patients with psychiatric conditions and/or SUDs present. These challenges are magnified by existing health care system issues and social structures, which fuel and reinforce negative attitudes, expectations, and biases. In combination, these processes create negative health care experiences for patients, physicians, and nurses and can adversely affect patient care quality and ED staff well-being. CONCLUSION Our findings uncover a cyclical process whereby challenges and biases associated with patients with psychiatric conditions and/or SUDs can reciprocally threaten patient care quality. Systemic changes and localized interventions are urgently needed to mitigate challenges, reduce bias, improve patient care, and improve physicians' and nurses' experiences in the ED.
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Affiliation(s)
- Linda M Isbell
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA.
| | - Hannah Chimowitz
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Nathan R Huff
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Guanyu Liu
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Ezekiel Kimball
- College of Education, University of Massachusetts Amherst, Amherst, MA
| | - Edwin Boudreaux
- Department of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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12
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Huff NR, Chimowitz H, DelPico MA, Gleason KT, Nanavati JD, Smulowitz P, Isbell LM. The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: An experimental study using simulated patient cases. Int J Nurs Stud 2023; 143:104507. [PMID: 37196607 DOI: 10.1016/j.ijnurstu.2023.104507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 05/19/2023]
Abstract
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).
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Affiliation(s)
- Nathan R Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Hannah Chimowitz
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Maria A DelPico
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Kelly T Gleason
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, United States of America
| | - Janvi D Nanavati
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Peter Smulowitz
- Department of Emergency Medicine, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA 01605, United States of America
| | - Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America.
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13
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Jiffry AJ, Cho CS, Schmidt AR, Pham PK, Nager AL. A Mixed Methods Needs Assessment for a Debriefing Intervention Following Critical Cases. Acad Pediatr 2023; 23:85-92. [PMID: 35605897 DOI: 10.1016/j.acap.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The emergency department (ED) is a demanding environment, and critical events have been identified as contributors to stress. Debriefing is a possible intervention for staff, but there is little information regarding formulation and implementation. A needs assessment was conducted to describe the emotions of pediatric ED (PED) staff following critical events and assess opinions regarding debriefing. METHOD This mixed methods study used convergent design for triangulation. After critical cases, PED staff members were given the Peritraumatic Distress Inventory (PDI). Additionally, a questionnaire with 2 open-ended questions on debriefing was administered. Themes were extracted from the questionnaire using directed content analysis. RESULTS A total of 719 responses were collected for 142 critical cases. Physical reactions were often endorsed in the PDI, and these reactions were mirrored in the qualitative data, which included physiological responses such as stress, adrenaline high, anxiety, fatigue, and overwhelm. Helplessness and grief were 2 of the emotional PDI items frequently endorsed, which were reflected in the qualitative strand by themes such as helplessness, sadness, disheartenment, and regret. There was considerable variability between critical cases such that not every critical case elicited a desire for a debrief. CONCLUSIONS PED staff report measurable levels of stress after critical patient cases that warrant follow-up. Formal debriefing immediately after critical patient cases with specific caveats may be valuable for the reduction of stress. Any formal debriefing program will need to balance various goals with attention to the session length, setting, and timing.
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Affiliation(s)
- Arshad J Jiffry
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif.
| | - Christine S Cho
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Anita R Schmidt
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif
| | - Phung K Pham
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif
| | - Alan L Nager
- Division of Emergency and Transport Medicine (AJ Jiffry, CS Cho, AR Schmidt, PK Pham, and AL Nager), Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics (AJ Jiffry, CS Cho, and AL Nager), Keck School of Medicine, University of Southern California, Los Angeles, Calif
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14
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Scott-Fordsmand H. Evaluating emotions in medical practice: a critical examination of 'clinical detachment' and emotional attunement in orthopaedic surgery. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:413-428. [PMID: 35661283 DOI: 10.1007/s11019-022-10088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between 'clinical detachment' and empathy. Inspired by observations from my own field work and drawing on Sky Gross' anthropological work on rituals of practice as well as Henri Lefebvre's notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine-what I call emotion-entity focused frameworks-are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term 'attuned concern'-which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement-as a more fitting alternative to 'clinical detachment'.
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Affiliation(s)
- Helene Scott-Fordsmand
- Medical Museion, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, United Kingdom.
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15
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Liu G, Chimowitz H, Isbell LM. Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities. Diagnosis (Berl) 2022; 9:295-305. [PMID: 34981701 PMCID: PMC9424059 DOI: 10.1515/dx-2021-0115] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Guanyu Liu
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Hannah Chimowitz
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Linda M. Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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16
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Global and Local Trends Affecting the Experience of US and UK Healthcare Professionals during COVID-19: Twitter Text Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116895. [PMID: 35682477 PMCID: PMC9180346 DOI: 10.3390/ijerph19116895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
Background: Healthcare professionals (HCPs) are on the frontline of fighting the COVID-19 pandemic. Recent reports have indicated that, in addition to facing an increased risk of being infected by the virus, HCPs face an increased risk of suffering from emotional difficulties associated with the pandemic. Therefore, understanding HCPs’ experiences and emotional displays during emergencies is a critical aspect of increasing the surge capacity of communities and nations. Methods: In this study, we analyzed posts published by HCPs on Twitter to infer the content of discourse and emotions of the HCPs in the United States (US) and United Kingdom (UK), before and during the COVID-19 pandemic. The tweets of 25,207 users were analyzed using natural language processing (NLP). Results: Our results indicate that HCPs in the two countries experienced common health, social, and political issues related to the pandemic, reflected in their discussion topics, sentiments, and emotional display. However, the experiences of HCPs in the two countries are also subject to local socio-political trends, as well as cultural norms regarding emotional display. Conclusions: Our results support the potential of utilizing Twitter discourse to monitor and predict public health responses in emergencies.
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17
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Schlatter ST, Thérond CC, Guillot A, Louisy SP, Duclos A, Lehot JJ, Rimmelé T, Debarnot US, Lilot ME. Effects of relaxing breathing paired with cardiac biofeedback on performance and relaxation during critical simulated situations: a prospective randomized controlled trial. BMC MEDICAL EDUCATION 2022; 22:422. [PMID: 35655176 PMCID: PMC9164463 DOI: 10.1186/s12909-022-03420-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Active participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation. METHODS This randomized pilot study involved the fifth-year anesthesiology and critical care residents who participated in high-fidelity at Lyon medical simulation center in 2019. Residents were randomized into three parallel interventions: relaxing breathing, relaxing breathing paired with cardiac biofeedback, and control. Each intervention was applied for five minutes immediately after the scenario briefing. The primary endpoint was the overall performance during the simulation rated by two blinded independent investigators. The secondary endpoints included component scores of overall performance and changes in psychological states. RESULTS Thirty-four residents were included. Compared to the control group, residents in the relaxing breathing (+ 7%, 98.3% CI: 0.3 to 13.7, P = 0.013) and relaxing breathing paired with cardiac biofeedback (+ 8%, 98.3% CI: 0.82 to 14.81, P = 0.009) groups had a higher overall performance score. Following the interventions, compared to the control group, stress level was lower when participants had performed relaxing breathing alone (P = 0.029) or paired with biofeedback (P = 0.035). The internal relaxation level was higher in both the relaxing breathing alone (P = 0.016) and paired with biofeedback groups (P = 0.035). CONCLUSIONS Performing five minutes of relaxing breathing before the scenario resulted in better overall simulation performance. These preliminary findings suggest that short breathing interventions are effective in improving performance during simulation. TRIAL REGISTRATION The study protocol was retrospectively registered on clinicaltrials.gov ( NCT04141124 , 28/10/2019).
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Affiliation(s)
- Sophie T. Schlatter
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, Lyon, France
- Claude Bernard Lyon 1 University, Centre Lyonnais d’Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France
| | - Corentin C. Thérond
- Hospices Civils de Lyon, Departments of Anesthesia and Intensive Care, Lyon, France
| | - Aymeric Guillot
- University of Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, F-69622 Villeurbanne, France
| | - Simon P. Louisy
- Hospices Civils de Lyon, Departments of Anesthesia and Intensive Care, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, Lyon, France
- Hospices Civils de Lyon, Health Data Department, Lyon, France
| | - Jean-Jacques Lehot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, Lyon, France
- Claude Bernard Lyon 1 University, Centre Lyonnais d’Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France
- Hospices Civils de Lyon, Departments of Anesthesia and Intensive Care, Lyon, France
| | - Thomas Rimmelé
- Claude Bernard Lyon 1 University, Centre Lyonnais d’Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France
- Hospices Civils de Lyon, Departments of Anesthesia and Intensive Care, Lyon, France
- EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Pi3), Université Claude Bernard Lyon, Biomérieux-Hospices Civils de Lyon, Lyon, France
| | - Ursula S. Debarnot
- University of Lyon, UCBL-Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, F-69622 Villeurbanne, France
- Institut Universitaire de France, Lyon, France
| | - Marc E. Lilot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, Lyon, France
- Claude Bernard Lyon 1 University, Centre Lyonnais d’Enseignement par Simulation en Santé (CLESS, high fidelity medical simulation center), SAMSEI, Lyon, France
- Hospices Civils de Lyon, Departments of Anesthesia and Intensive Care, Lyon, France
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18
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Christensen SS, Wilson BL, Hansen SD. Using affective events theory to conceptualise nurses’ emotional behaviour: A scoping review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Cleveland RW, Deming RS, Helton G, Wilson CR, Ullrich CK. Health Care Providers' Perspectives on COVID-19 and Medical Neglect in Children with Life-Threatening Complex Chronic Conditions. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:193-199. [PMID: 35096217 PMCID: PMC8783778 DOI: 10.1007/s40653-021-00428-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 05/30/2023]
Abstract
PURPOSE Little is known regarding medical neglect in children with Life-Threatening Complex Chronic Conditions (LT-CCCs). We examined the impact of COVID-19 on concern for medical neglect in this population. METHODS Qualitative interview study of multi-disciplinary health care providers (HCPs) from critical care, palliative care, and complex care services on the topic of medical neglect in children with LT-CCCs. We used inductive thematic analysis to generate themes. Findings presented herein are derived from a sub-analysis of the larger study that focused specifically on discussion of COVID-19 by HCPs. RESULTS 9 of the 20 HCPs interviewed mentioned COVID-19 as influencing situations of potential medical neglect. These 9 represent all disciplines and teams. Interviewees reported COVID-19 increased burden on parents and likelihood of medical neglect due to: 1) Familial distancing from medical and social support and, 2) Changes to medical care delivery that impaired the medical community's ability to engage and support families. CONCLUSIONS The COVID-19 pandemic has exposed the fragility of the medical and social systems that supports families of children with LT-CCCs. These findings are consistent with previous literature that suggest that the COVID-19 pandemic has increased the risk for child maltreatment. It additionally highlights the vulnerability of this patient population.
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Affiliation(s)
- Ross W. Cleveland
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, Boston, MA USA
| | - Rachel S. Deming
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, Boston, MA USA
| | - Gabriel Helton
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Celeste R. Wilson
- Harvard Medical School, Boston, MA USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA USA
| | - Christina K. Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, Boston, MA USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
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20
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Graham JMK, Ambroggio L, Leonard JE, Ziniel SI, Grubenhoff JA. Evaluation of feedback modalities and preferences regarding feedback on decision-making in a pediatric emergency department. Diagnosis (Berl) 2021; 9:216-224. [PMID: 34894116 DOI: 10.1515/dx-2021-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare pediatric emergency clinicians' attitudes toward three feedback modalities and assess clinicians' case-based feedback preferences. METHODS Electronic survey sent to pediatric emergency medicine (PEM) physicians and fellows; general pediatricians; and advanced practice providers (APPs) with nine questions exploring effectiveness and emotional impact of three feedback modalities: case-based feedback, bounce-back notifications, and biannual performance reports. Additional questions used a four-point ordinal agreement response scale and assessed clinicians' attitudes toward case review notification, case-based feedback preferences, and emotional support. Survey responses were compared by feedback modality using Pearson's chi-squared. RESULTS Of 165 eligible providers, 93 (56%) responded. Respondents agreed that case-based feedback was timely (81%), actionable (75%), prompted reflection on decision-making (92%), prompted research on current clinical practice (53%), and encouraged practice change (58%). Pediatric Emergency Care Applied Research Network (PECARN) performance reports scored the lowest on all metrics except positive feedback. No more than 40% of providers indicated that any feedback modality provided emotional support. Regarding case-based feedback, 88% of respondents desired email notification before case review and 88% desired feedback after case review. Clinicians prefer receiving feedback from someone with similar or more experience/training. Clinicians receiving feedback desire succinctness, supporting evidence, consistency, and sensitive delivery. CONCLUSIONS Case-based feedback scored highest of the three modalities and is perceived to be the most likely to improve decision-making and promote practice change. Most providers did not perceive emotional support from any feedback modality. Emotional safety warrants purposeful attention in feedback delivery. Critical components of case-based feedback include succinctness, supporting evidence, consistency, and sensitive delivery.
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Affiliation(s)
- Jessica M K Graham
- Pediatric Emergency Medicine, Children's Hospital of Colorado, Aurora, CO, USA
| | - Lilliam Ambroggio
- Pediatric Emergency Medicine, Children's Hospital of Colorado, Aurora, CO, USA.,Pediatric Hospital Medicine, Children's Hospital of Colorado, Aurora, CO, USA
| | - Jan E Leonard
- Pediatric Emergency Medicine, Children's Hospital of Colorado, Aurora, CO, USA
| | - Sonja I Ziniel
- Pediatric Hospital Medicine, Children's Hospital of Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph A Grubenhoff
- Pediatric Emergency Medicine, Children's Hospital of Colorado, Aurora, CO, USA
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James TG, Varnes JR, Sullivan MK, Cheong J, Pearson TA, Yurasek AM, Miller MD, McKee MM. Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412901. [PMID: 34948509 PMCID: PMC8701061 DOI: 10.3390/ijerph182412901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.
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Affiliation(s)
- Tyler G. James
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
- Correspondence:
| | - Julia R. Varnes
- Department of Health Services Research, Management, and Policy, University of Florida, P.O. Box 100185, Gainesville, FL 32610, USA;
| | | | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - Thomas A. Pearson
- Department of Epidemiology, University of Florida, P.O. Box 100231, Gainesville, FL 32610, USA;
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - M. David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, P.O. Box 117047, Gainesville, FL 32611, USA;
| | - Michael M. McKee
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
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22
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Liberman AL, Cheng NT, Friedman BW, Gerstein MT, Moncrieffe K, Labovitz DL, Lipton RB. Emergency medicine physicians' perspectives on diagnostic accuracy in neurology: a qualitative study. Diagnosis (Berl) 2021; 9:225-235. [PMID: 34855312 DOI: 10.1515/dx-2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We sought to understand the knowledge, attitudes, and beliefs of emergency medicine (EM) physicians towards non-specific neurological conditions and the use of clinical decision support (CDS) to improve diagnostic accuracy. METHODS We conducted semi-structured interviews of EM physicians at four emergency departments (EDs) affiliated with a single US healthcare system. Interviews were conducted until thematic saturation was achieved. Conventional content analysis was used to identify themes related to EM physicians' perspectives on acute diagnostic neurology; directed content analysis was used to explore views regarding CDS. Each interview transcript was independently coded by two researchers using an iteratively refined codebook with consensus-based resolution of coding differences. RESULTS We identified two domains regarding diagnostic safety: (1) challenges unique to neurological complaints and (2) challenges in EM more broadly. Themes relevant to neurology included: (1) knowledge gaps and uncertainty, (2) skepticism about neurology, (3) comfort with basic as opposed to detailed neurological examination, and (4) comfort with non-neurological diseases. Themes relevant to diagnostic decision making in the ED included: (1) cognitive biases, (2) ED system/environmental issues, (3) patient barriers, (4) comfort with diagnostic uncertainty, and (5) concerns regarding diagnostic error identification and measurement. Most participating EM physicians were enthusiastic about the potential for well-designed CDS to improve diagnostic accuracy for non-specific neurological complaints. CONCLUSIONS Physicians identified diagnostic challenges unique to neurological diseases as well as issues related more generally to diagnostic accuracy in EM. These physician-reported issues should be accounted for when designing interventions to improve ED diagnostic accuracy.
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Affiliation(s)
- Ava L Liberman
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Natalie T Cheng
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Khadean Moncrieffe
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel L Labovitz
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Heer SV, Cofie N, Gutiérrez G, Upagupta C, Szulewski A, Chaplin T. Shaken and stirred: emotional state, cognitive load, and performance of junior residents in simulated resuscitation. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:24-33. [PMID: 34804285 PMCID: PMC8603881 DOI: 10.36834/cmej.71760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Patient resuscitation can be overwhelming for junior postgraduate medical residents due to its inherent complexity and high-stakes environment. Emotional states of unpleasant hyperarousal burden cognitive resources, contributing to cognitive overload and performance decline. Our objective is to characterize the associations between pre-scenario emotional state and junior residents' cognitive load and performance in a simulated-resuscitation, to provide evidence for informed curricular development. METHODS PGY-1 residents self-rated their emotional state before four simulated-resuscitation scenarios, and their cognitive load after. Faculty assessed performance with entrustment scores. Factor analysis identified the principal components of emotional state data. Linear regression models examined the relationship between pre-scenario emotional components, cognitive load, and performance scores. RESULTS 47/47 medical and surgical residents (100%) participated and completed Emotional State (99.5%) and Cognitive Load (98.9%) surveys. Positive invigoration and negative tranquility were the principal components. Pre-scenario tranquility was negatively associated with cognitive load (b= -0.23, p < 0.0001), and cognitive load was negatively associated with performance scores (b= -0.27, p < 0.0001). Pre-scenario invigoration was negatively associated with cognitive load (b=-0.18, p = 0.0001), and positively associated with performance scores (b= 0.08, p = 0.0193). CONCLUSION Amongst junior residents participating in simulated resuscitation scenarios, pre-scenario agitation (negative tranquility) is associated with increased cognitive load, which itself is associated with lower performance scores. These findings suggest residency programs should consider developing curriculum aimed at modulating residents' emotional agitation and reducing residents' cognitive burden to improve resuscitation performance.
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Affiliation(s)
| | - Nicholas Cofie
- Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | | | - Adam Szulewski
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
- Department of Psychology, Queen’s University, Ontario, Canada
| | - Timothy Chaplin
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
- Correspondence to: Timothy Chaplin, MD FRCPC, Kingston General Hospital, Department of Emergency Medicine, 76 Stuart Street, Kingston ON K7L 2V7 Canada, 613.545.7442;
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24
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Klefti G, Kaliaperumal C. Conquering fear during a Neurosurgical Emergency. Int J Clin Pract 2021; 75:e14483. [PMID: 34670347 DOI: 10.1111/ijcp.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Giovana Klefti
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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25
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Welsh M, Chimowitz H, Nanavati JD, Huff NR, Isbell LM. A qualitative investigation of the impact of coronavirus disease 2019 (COVID-19) on emergency physicians' emotional experiences and coping strategies. J Am Coll Emerg Physicians Open 2021; 2:e12578. [PMID: 34746921 PMCID: PMC8549858 DOI: 10.1002/emp2.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVE Throughout the coronavirus disease 2019 (COVID-19) pandemic, emergency physicians in the United States have faced unprecedented challenges, risks, and uncertainty while caring for patients in an already vulnerable healthcare system. As such, the pandemic has exacerbated high levels of negative emotions and burnout among emergency physicians, but little systematic qualitative work has documented these phenomena. The purpose of this qualitative investigation was to study emergency physicians' emotional experiences in response to COVID-19 and the coping strategies that they employed to navigate the pandemic. METHODS From September 2020 to February 2021, we conducted semistructured interviews with 26 emergency physicians recruited from 2 early COVID-19 epicenters: New York City and the Metro Boston region. Interviews, coding, and analyses were conducted using a grounded theory approach. RESULTS Emergency physicians reported heightened anxiety, empathy, sadness, frustration, and anger during the pandemic. Physicians frequently attributed feelings of anxiety to medical uncertainty around the COVID-19 virus, personal risk of contracting the virus and transmitting it to family members, the emergency environment, and resource availability. Emergency physicians also discussed the emotional effects of policies prohibiting patients' family members from entering the emergency department (ED), both on themselves and patients. Sources of physician anger and frustration included changing policies and rules, hospital leadership and administration, and pay cuts. Some physicians described an evolving, ongoing coping process in response to the pandemic, and most identified collective discussion and processing within the emergency medicine community as an effective coping strategy. CONCLUSIONS Our findings underscore the need to investigate the effects of physicians' pandemic-related emotional stress and burnout on patient care. Evidence-based interventions to support emergency physicians in coping with pandemic-related trauma are needed.
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Affiliation(s)
- Margaux Welsh
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Hannah Chimowitz
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Janvi D. Nanavati
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Nathan R. Huff
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Linda M. Isbell
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
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26
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Assaf RR, Pham PK, Schmidt AR, Gorab A, Chang TP, Liu DR. Pediatric emergency department shift experiences and moods: An exploratory sequential mixed-methods study. AEM EDUCATION AND TRAINING 2021; 5:e10572. [PMID: 34124518 PMCID: PMC8171774 DOI: 10.1002/aet2.10572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective was to investigate the impact of affective, social, behavioral, and cognitive factors on pediatric emergency department (PED) provider mood changes during clinical shifts, with the introduction of a novel on-shift measure. METHODS The nominal group technique was used to generate the ED experience survey (EDES), encompassing factors that may influence PED provider mood. Providers were alerted via experience sampling method to complete the EDES and positive and negative affect schedule at randomly generated times. Analyses were conducted using multilevel modeling of moods within shifts within persons. RESULTS Measures were completed 221 times during 137 shifts by 52 PED providers. Positive mood tended to increase with higher self-rated capacity to deal with challenging patient situations (p < 0.001). Having to repeat patient assessments was negatively associated with positive mood during the beginning, but not rest of shift (p = 0.01). Changes in positive mood varied across provider groups (p < 0.001). Negative mood tended to decrease with higher self-rated quality of interactions with patients/families (p < 0.001). Needing a restroom break during any time on duty was associated with negative mood (p < 0.001). Furthermore, negative mood was associated with the need to process emotions during the shift beginning (p = 0.01). Finally, not knowing about patients' outcomes was associated with negative mood during the shift end (p < 0.001). CONCLUSIONS PED providers' mood during shifts are impacted by ED-specific factors spanning physical, social, behavioral, affective, and cognitive features. Future research may explore potential entry points for mitigation of clinician stress to support provider well-being and ultimately improve patient care.
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Affiliation(s)
- Raymen R. Assaf
- Pediatric Emergency DepartmentHarbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Phung K. Pham
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Anita R. Schmidt
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | | | - Todd P. Chang
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Department of PediatricsKeck School of Medicine at University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Deborah R. Liu
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Department of PediatricsKeck School of Medicine at University of Southern CaliforniaLos AngelesCaliforniaUSA
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27
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Liu B, Zhu N, Wang H, Li F, Men C. Protecting Nurses from Mistreatment by Patients: A Cross-Sectional Study on the Roles of Emotional Contagion Susceptibility and Emotional Regulation Ability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126331. [PMID: 34208160 PMCID: PMC8296175 DOI: 10.3390/ijerph18126331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
In recent years, patient mistreatment of healthcare workers, especially nurses, has been frequent, endangering the interests of organizations while also threatening nurses’ own development. This study aims to examine from the perspective of nurses’ personal interests whether mistreatment by patients decreases nurses’ workplace well-being and career commitment, and how their susceptibility to emotional contagion and emotional regulation ability might mitigate these negative effects. This study adopted a cross-sectional study design (data were collected through self-reported questionnaires with a two-month time lag between the months of August–October 2017). A total of 289 nurses from three hospitals in Shandong province, China, were recruited to participate in our study. The results reveal that mistreatment by patients is negatively related to nurses’ workplace well-being and career commitment. Emotional contagion susceptibility moderates the relationships between mistreatment by patients and career commitment, while there is no significant buffering effect of mistreatment by patients on workplace well-being. Emotional regulation ability moderates the relationships between mistreatment by patients and both workplace well-being and career commitment. These results suggest that improvements in nurses’ emotional regulation ability and susceptibility to emotional contagion can alleviate the harmful impacts of mistreatment by patients.
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28
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Yao Y, Wei W, Hu Y, Li Y, Zhang Y. Curvilinear relationship between emotional labour and work engagement in nurses: A correlational study. J Clin Nurs 2021; 30:3355-3365. [PMID: 33991149 DOI: 10.1111/jocn.15848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/30/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine if there was a curvilinear relationship between emotional labour and work engagement in Chinese nurses. BACKGROUND Emotional labour has both positive and negative effects on work engagement, but the curve relationship between the two has not been tested. DESIGN Correlational design. METHODS Multi-stage stratified random sampling was used to recruit samples, and 528 nurses from 5 tertiary first-class general hospitals were recruited in Henan Province. Data were collected by using Hong and Kim's Emotional Labor Scale for nurse and the Utrecht Work Engagement Scale-9. Curve estimation was used to explore the functional model between emotional labour and work engagement. Results were reported according to the STROBE Statement. RESULTS The three dimensions of emotional labour, 'emotional control effort in profession', 'patient-focused emotional suppression' and 'emotional pretense by norms', had a function relationship of quadratic (R2 = .57, p < .001), quadratic (R2 = .569, p < .001) and cubic (R2 = .238, p < .001), respectively, with work engagement. CONCLUSIONS There was a one-way increasing quadratic function relationship between 'emotional control effort in profession' and work engagement. However, 'patient-focused emotion suppression' and 'emotional pretense by norms' had an inverted U-shaped curve relationship with work engagement. Below the moderate level, 'patient-focused emotion suppression' and 'emotional pretense by norms' were positively related to work engagement. After a certain level, they were negatively related to work engagement. RELEVANCE TO CLINICAL PRACTICE Our results may provide evidences to manage nurses' emotional labour and improve their work engagement. It seems that encouraging or training nurses to learn and master more strategies of emotional control may improve work engagement. Moreover, nursing managers should fully recognise the positive and negative effects of different levels of emotional suppression and emotional pretense on work engagement, so as to develop targeted management strategies.
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Affiliation(s)
- Ying Yao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wanhong Wei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yanli Hu
- School of Nursing, Guangdong Medical University, Dongguan, China
| | | | - Yanhui Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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29
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Wong AH, Roppolo LP, Chang BP, Yonkers KA, Wilson MP, Powsner S, Rozel JS. Management of Agitation During the COVID-19 Pandemic. West J Emerg Med 2020; 21:795-800. [PMID: 32726244 PMCID: PMC7390577 DOI: 10.5811/westjem.2020.5.47789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 01/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the coronavirus SARS-CoV-2 has radically altered delivery of care in emergency settings. Unprecedented hardship due to ongoing fears of exposure and threats to personal safety, along with societal measures enacted to curb disease transmission, have had broad psychosocial impact on patients and healthcare workers alike. These changes can significantly affect diagnosing and managing behavioral emergencies such as agitation in the emergency department. On behalf of the American Association for Emergency Psychiatry, we highlight unique considerations for patients with severe behavioral symptoms and staff members managing symptoms of agitation during COVID-19. Early detection and treatment of agitation, precautions to minimize staff hazards, coordination with security personnel and psychiatric services, and avoidance of coercive strategies that cause respiratory depression will help mitigate heightened risks to safety caused by this outbreak.
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Affiliation(s)
- Ambrose H. Wong
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Lynn P. Roppolo
- University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas
| | - Bernard P. Chang
- Columbia University, Irving Medical Center, Department of Emergency Medicine, New York, New York
| | - Kimberly A. Yonkers
- Yale School of Medicine, Department of Psychiatry, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut
| | - Michael P. Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Department of Psychiatry, Little Rock, Arkansas
| | - Seth Powsner
- Yale School of Medicine, Department of Psychiatry, Department of Emergency Medicine New Haven, Connecticut
| | - John S. Rozel
- University of Pittsburgh School of Law and School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
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30
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Heyhoe J, Lawton R. Social emotion and patient safety: an important and understudied intersection. BMJ Qual Saf 2020; 29:1-2. [PMID: 32217700 DOI: 10.1136/bmjqs-2019-010795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Jane Heyhoe
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Rebecca Lawton
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
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31
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Isbell LM, Tager J, Beals K, Liu G. Emotionally evocative patients in the emergency department: a mixed methods investigation of providers' reported emotions and implications for patient safety. BMJ Qual Saf 2020; 29:1-2. [PMID: 31988259 DOI: 10.1136/bmjqs-2019-010110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/26/2019] [Accepted: 12/31/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Emergency 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. METHODS Ninety-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). RESULTS Providers 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. CONCLUSIONS Positive 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.
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Affiliation(s)
- Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Julia Tager
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Kendall Beals
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Guanyu Liu
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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