Study: Doctors, nurses face emotional rollercoasters themselves in high-stress scenarios

Author: “ER providers are on the front line of this pandemic, and stress, anxiety and anger are increasing.”

AMHERST, Mass. — Working in an emergency room on any given day can stir lots of emotions for medical professionals, but when an influx of sick patients threaten to overwhelm the system, high-stress is an understatement. How are practitioners able to keep it together and help those in their care while battling their own bouts of stress and anxiety? A new study finds that doctors, nurses, and other hospital staff members face a tremendous level of pressure while on the job, and many would benefit from better training on how to help themselves in addition to the patients.

The study shows that nurses and doctors in emergency rooms and departments at four community hospitals and academic centers in the U.S. experience a wide range of emotions. These emotions can be triggered by patients, hospital resources, and societal factors. Study author Linda Isbell, a social psychologist at the University of Massachusetts Amherst, wanted to find out how these emotions affect patient care.

Isbell says most ER health care providers employ strategies they use to regulate their emotions to avoid compromising the quality of care. Some of these strategies, however, such as suppressing or ignoring feelings can cause more harm than one might realize. ER workers now face even more stress than normal during the COVID-19 pandemic, making the need for emotional intelligence training all the more urgent.

“ER providers are on the front line of this pandemic, and stress, anxiety and anger are increasing,” says Isbell, a professor of psychology in the university’s College of Natural Sciences, in a release. “As we all face anxiety about the fallout of this pandemic, anger about a healthcare system that was already stretched thin and under-resourced is likely to grow. It is important to be mindful that these emotions might impact patient care.”

For the study, Isbell interviewed 86 experience ER health care workers, 45 physicians and 41 nurses. The study is believed to be the first comprehensive, data-driven study of the triggers and consequences of the emotions of ER providers. Researchers carried out face-to-face interviews between February and August 2018. Their results show a great need for emotional intelligence training and a general shift in culture to spark meaningful discussion about emotions and regulating them.

There were several factors that affected ER workers’ emotions. First and foremost is the patients themselves, naturally eliciting both positive and negative emotions depending on outcomes and individual situations. Other factors, such as understaffing, overcrowding, and a generally limited supply of resources for homeless and mentally ill patients caused overwhelmingly negative emotions among the ER doctors and nurses.

“These physicians care deeply about their patients. They’re working in a health care system that makes it really hard for them to practice the way they envisioned,” Isbell said. “They are asked to handle and solve problems that are incredibly trivial or incredibly serious, and some aren’t even medical problems. There is awareness that emotions could influence what they do with the patients.”

Isbell confirmed that emotions affect how these medical professionals interact with patients subconsciously, too.

“Emotions subconsciously play a role in every single patient and how you work them up, and how you diagnose them, and what you do for them,” said an ER specialist in an interview.

A good example of this is when doctors and nurses encounter angry, difficult, or unreasonable patients, they may spend less time with them at their bedside or order tests that could resolve the medical issue as quickly as possible.

“…I do think it is likely that when you have significantly contentious relationships with patients that … you don’t gain as much data [and to an] extent that could lead to diagnostic error,” one doctor explained.

The test subjects identified their coping strategies to avoid letting emotions affect their care. Isbell said these strategies allow many to perform their jobs more effectively at the time. “But we know from the emotion literature that’s not a good strategy,” she said. “It tends to rebound. You may take it out later on your kids or your spouse or dog. It’s bad for your body physically and for your mental health.”

Isbell called for further research to find out if ER workers’ emotion regulation strategies are effective at reducing the risk of harm to patients.

The study was published in the journal BMJ Quality and Safety.

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Ben Renner

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