A qualitative investigation of the impact of coronavirus disease 2019 (COVID-19) on emergency physicians\u27 emotional experiences and coping strategies

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

Do emotional control beliefs lead people to approach positive or negative situations? Two competing effects of control beliefs on emotional situation selection

Control beliefs are widely acknowledged to play a critical role in self-regulation and well-being, but their impact on decisions to approach or avoid situations that vary in emotional valence remains unclear. We propose that two contradictory, yet equally intuitive, predictions can be made about the impact of control beliefs on emotional situation selection. On the one hand, control beliefs might encourage individuals to initiate proactive emotion regulatory efforts, helping people select positive situations. On the other hand, control beliefs might promote a sense of confidence in one’s ability to manage emotions once they arise, helping people select negative situations. We propose that both effects occur via different mechanisms and suppress one another: control beliefs facilitate (1) positivity engagement by enhancing awareness of opportunities to regulate emotions, and (2) negativity engagement by enhancing confidence in one’s ability to handle negative situations. We found support for this framework in four studies. Consistent with our hypotheses, control beliefs (measured in Studies 1–3 and manipulated in Study 4) exerted two simultaneous and competing effects on emotional situation selection (assessed via self-report measures in Studies 1 and 2 and behaviorally in Studies 3 and 4) via the proposed mechanisms, and evidence of suppression was found. New opportunities for research on control beliefs, emotion regulation, and motivation are discussed

The impact of negative emotions on self-concept abstraction depends on accessible information processing styles

Research suggests that anger promotes global, abstract processing whereas sadness and fear promote local, concrete processing (see Schwarz & Clore, 2007 for a review). Contrary to a large and influential body of work suggesting that specific affective experiences are tethered to specific cognitive outcomes, the affect-as-cognitive-feedback account maintains that affective experiences confer positive or negative value on currently dominant processing styles, and thus can lead to either global or local processing (Huntsinger, Isbell, & Clore, 2014). The current work extends this theoretical perspective by investigating the impact of discrete negative emotions on the self-concept. By experimentally manipulating information processing styles and discrete negative emotions that vary in appraisals of certainty, we demonstrate that the impact of discrete negative emotions on the spontaneous self-concept depends on accessible processing styles. When global processing was accessible, individuals in angry (negative, high certainty) states generated more abstract statements about themselves than individuals in either sad (Experiment 1) or fearful (Experiment 2; negative, low certainty) states. When local processing was made accessible, however, the opposite pattern emerged, whereby individuals in angry states generated fewer abstract statements than individuals in sad or fearful states. Together these studies provide new insights into the mechanisms through which discrete emotions influence cognition. In contrast to theories assuming a dedicated link between emotions and processing styles, these results suggest that discrete emotions provide feedback about accessible ways of thinking, and are consistent with recent evidence suggesting that the impact of affect on cognition is highly context-dependent

Affect and memory : a theoretical note

Research and theory on the role of affect in information processing often assumes that persons' feelings influence the accessibility of concepts and knowledge in memory and that these cognitions, in turn, influence judgments and behavioral decisions concerning their referents. In contrast, the present article argues that although affective reactions can be responses to cognitions, and can stimulate cognitive activity, they are not themselves features of the representations of knowledge that are formed and stored in memory. If this is so, findings that have often been attributed to the influence of affect on concept and knowledge accessibility and information retrieval must be due to other factors

Affect and information processing

In this chapter, we develop a conceptualization that incorporates the implications of diverse phenomena and the cognitive processes that underlie them. Our formulation specifies the possible determinants and consequences of the affect that individuals experience in both laboratory and daily life situations. In doing so, it takes into account the phenomena implied by many existing theories of affect and cognition. In many cases, however, it suggests interpretations of these phenomena that differ from those that have typically been proposed

What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care

BACKGROUND: Despite calls to study how healthcare providers\u27 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\u27 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\u27 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. permissions