Table 5.
Self-reported impact of emotions in mental health encounters and representative quotes (for participants who indicated their emotions influenced their clinical reasoning and decision-making in their mental health encounter)*
| Mental health encounters (n=34; 20 physicians, 14 nurses)† | ||
|---|---|---|
| Detrimental effects | 25 (74%) | |
| Failed to provide best possible care | 11 (32%) | |
| Acted less professionally or compassionately | ‘I felt frustrated and not empathetic towards the patient. I could have verbally de-escalated sooner and not ignored the patient to the point where she got angry.’ (16, physician) | 4 (12%) |
| Spent less time with patient | ‘I was scared to go in the room and only went in when I needed to. I did not talk with her as much as I would have other patients.’ (123, nurse) | 4 (12%) |
| Acted on bias | ‘I was biased against finding true physical illness due to the vagueness of complaints and overlay of multiple diagnosis suggesting mental health component to presentation.’ (30, physician) | 3 (9%) |
| Provided unnecessary treatment | ‘The frustration of the nursing staff may have made me more likely to give higher doses of sedating meds than I normally would.’ (12, physician) | 2 (6%) |
| ‘I feel that because I don’t have the time in a busy ED [Emergency Department] filled with “sick” medical patients to be constantly redirecting and talking to mental health patients, I opt for physical and chemical restraints more often than I should.’ (140, nurse) | ||
| Delayed or failed to provide necessary exam or treatment | ‘I was definitely swayed by the report from nursing that the patient had been difficult to deal with earlier in the day- otherwise I would have given him Narcan [naloxone] right away…’ (27, physician) | 2 (6%) |
| Premature closure | ‘I think when I became so angry over how the patient and family treated me that my better judgement of just agreeing with the doctor to discharge the patient to home definitely took over.’ (136, nurse) | 2 (6%) |
| General negative impact on provider’s mood | 20 (59%) | |
| ‘I was fed up with her, and I think she’s ridiculous the way she acts and needs real coping skills.’ (139, nurse) | ||
| ‘The frustration and exhausted feeling certainly unincentivized me to provide best care possible. We need to prioritize the time and effort [with] limited time in the ED [Emergency Department]. The emotion often is a variable that makes some contributions to the prioritization.’ (37, physician) | ||
| Beneficial effects | 18 (53%) | |
| Provided best possible care | 18 (53%) | |
| Acted with empathy, patience, and understanding | ‘Perhaps being somewhat afraid when entering the room made me calmer and attempt to be more patient in an attempt not to upset or anger her, knowing she had a history of violent tendencies.’ (119, nurse) | 13 (38%) |
| ‘Understanding her underlying mental illness made me more patient and understanding of her, tried to listen instead of just order tests on her.’ (21, physician) | ||
| Advocated for patient or provided extra care | ‘I went out of my way to take care of his emotional/physical needs. I paid attention to his outbursts I sought him out to help him.’ (128, nurse) | 9 (27%) |
| ‘I think some of the empathy I felt for her helped me to provide better care for her and motivated me to go the extra mile to try and make her ED [Emergency Department] stay better (eg, contacting social work etc.) But it was also the right thing to do.’ (48, physician) | ||
| Spent more time with patient | ‘I was able to be mindful and conscientious, taking care to note his wounds and do a thorough exam so he would get proper care further down in his evaluation…’ (133, nurse) | 5 (15%) |
| Miscellaneous (does not fit in any categories) | 2 (6%) | |
*
Codes are not mutually exclusive; 62% of the responses were coded into two or more categories. Percentages that are highlighted reflect the percentage of participants whose responses were coded in at least one category within the highlighted theme or subtheme. Percentages that appear below these reflect the percentage of participants whose responses were coded for that specific category.
†
All participant who indicated that their emotions may have influenced their decision-making included a free-text response.