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What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care
  1. Linda M Isbell1,
  2. Edwin D Boudreaux2,
  3. Hannah Chimowitz1,
  4. Guanyu Liu1,
  5. Emma Cyr1,
  6. Ezekiel Kimball3
  1. 1 Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
  2. 2 Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  3. 3 College of Education, University of Massachusetts Amherst, Amherst, Massachusetts, USA
  1. Correspondence to Dr Linda M Isbell, Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; lisbell{at}


Background Despite calls to study how healthcare providers’ emotions may impact patient safety, little research has addressed this topic. The current study aimed to develop a comprehensive understanding of emergency department (ED) providers’ emotional experiences, including what triggers their emotions, the perceived effects of emotions on clinical decision making and patient care, and strategies providers use to manage their emotions to reduce patient safety risks.

Methods Employing grounded theory, we conducted 86 semi-structured qualitative interviews with experienced ED providers (45 physicians and 41 nurses) from four academic medical centres and four community hospitals in the Northeastern USA. Constant comparative analysis was used to develop a grounded model of provider emotions and patient safety in the ED.

Results ED providers reported experiencing a wide range of emotions in response to patient, hospital, and system-level factors. Patients triggered both positive and negative emotions; hospital and system-level factors largely triggered negative emotions. Providers expressed awareness of possible adverse effects of negative emotions on clinical decision making, highlighting concerns about patient safety. Providers described strategies they employ to regulate their emotions, including emotional suppression, distraction, and cognitive reappraisal. Many providers believed that these strategies effectively guarded against the risk of emotions negatively influencing their clinical decision making.

Conclusion The role of emotions in patient safety is in its early stages and many opportunities exist for researchers, educators, and clinicians to further address this important issue. Our findings highlight the need for future work to (1) determine whether providers’ emotion regulation strategies are effective at mitigating patient safety risk, (2) incorporate emotional intelligence training into healthcare education, and (3) shift the cultural norms in medicine to support meaningful discourse around emotions.

  • patient safety
  • diagnostic errors
  • emergency department
  • qualitative research

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  • Contributors LMI and EB designed the project in close collaboration with qualitative research expert EK. LMI managed the project and conducted all interviews. LMI, EK, HC, GL and EC analysed the qualitative data; coding of qualitative data was supervised by LMI and EK and was conducted by HC, GL and EC. LMI, EK, HC and GL drafted the manuscript. All authors contributed to the revision, editing, finalisation and the approval of the final version of the manuscript.

  • Funding This project was funded by the Agency for Healthcare Research and Quality (AHRQ) (grant number R01HS025752), US Department of Health and Human Services (HHS) awarded to LMI. The authors are solely responsible for this document’s contents, findings and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of HHS.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board at the University of Massachusetts Amherst approved this study (protocol number 2016–3160).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The data generated in this study are confidential interview transcripts that are not available for sharing.

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