Especially during acute healthcare situations, professionals need to keep an overview, try to sequence steps in diagnosis and treatment, allocate scarce resources, evaluate the situation, and re-evaluate decisions. They need to relate to the patient, colleagues, and occasionally bystanders. They must manage their own insecurities, tensions, fears, and may question the things they are really sure about. Also, during regular practice, there are many aspects that one might like or dislike, and often both hopes and disappointments. In both types of situations, acute and routine, a lot of different capabilities are needed. This is reflected in models that describe competence of healthcare professionals. One of the different aspects they need to master is how to deal with emotions.
At first glance the strategy seems to be to dissociate emotions from the professional role. Once you take your work clothes on and switch on your professional role, emotions should not play a role anymore. You are supposed to (as objectively as you can) analyse the situation of the patient, make up your mind (based on the huge knowledge you have collected) what the available options are, then weigh advantages and disadvantages and pick the best course of action. So far the theory – one set of theories. Consider, however, how you take decisions in practice, how you implement them. Our hypothesis is that human decision-making functions in a different way. Gerd Gigerenzer, for example, points out that humans use a lot of heuristics – rules of thumb.(1) Some call them biases and see them in negative light. Gigerenzer points to their value. These fast, automatic, intuitive ways to just see and feel what the right thing is to do, these rules make human beings extremely efficient in interacting with the world. Occasionally they lead us astray. We might overlook certain aspects, forget to see others. However, all in all, our intuition makes us humans super-fast in understanding the keypoints of situations and in selecting appropriate ways to respond. Certainly, there are also many situations that cannot be solved by intuition, where a careful analysis is required. And yet – that is our point – emotions play a role in both types of situations.
Intuitions are based on pattern recognition. With experience, we see differences that we did not see before. We see effects of our actions and see what was a good solution and what was not so good a solution. Good solutions feel good, bad solutions feel worse. Pattern recognition gets paired with emotional qualities – emotions help us in getting what is “right” and what is “wrong”. Ever felt ashamed about an action? Likelihood is decreased that you repeat the action. It is not a one-to-one connection, but emotions play a role. Emotions also are related to the sentences and actions we pick up on the way as we are growing as human beings. We observe our role models, paying attention to how they act (and a bit to what they say). We agree with some people and disagree with others. We connect – at least at times – our sympathies for people to their actions. Actions (and speaking is acting), things, thoughts – all have a value to us. This value is partly related to their emotional quality. There are other elements as well, for example, how well an action helps us in reaching our goals. But here we concentrate on the emotional aspect. All the different pieces that make up the value of actions, things, and thoughts combined is what psychologists call affordances. (2) If you know, what affordance an action, a thing, a thought has for a person, you will likely be able to explain their actions and predict how they will act in relation to that thing, that action, that thought (might they, for example, be – deep inside of themselves – be ashamed about their feelings towards you?).
Therefore, whether in acute or routine situations, we need to understand the web of affordances that any situation has with the many things, the many possible actions, the many possible thoughts. Only then can we describe, understand, and predict human action and experiences – that is what psychologists aim to do. These reflections are in turn important for patient safety and the quality of care. In order to educate pre-graduate, train post-graduates, in order to design work systems that make it easy to do the right thing – we need to take into account the affordances that are at play. Otherwise, we might misunderstand, overlook, fail to take into account what is a big contribution to the situation. That is one reason to look at emotions – they help to optimize decision making, teamworking, leadership, task management, and situation awareness – in addition to diagnostic and interventive decisions. They play a role, even if they are hidden, but also, for professionals. The literature on biases is testament for that.
That is one reason, why emotions are important.
The other reason is the mental health of healthcare professionals. No matter how healthcare is organized, healthcare professionals interact with situations that have at least the potential to be emotionally challenging. While the interaction with some situations can be overwhelming immediately, other situations can be thought of as a little extra weight in one’s backpack. This backpack gets heavier over time and it might not be easy to discuss its content with someone. The family at home might not understand and one you might not want to burden them with the things one saw. There are also easily issues with confidentiality that make it hard to be open with people outside healthcare. Colleagues will understand, but might not have the time – or might be competitors and therefore not the conversation partners that provide most psychological safety for conversations around challenges. Many healthcare professionals talk about how informal conversations helped them to sort the things in their backpack – but they also then say something like: “I was lucky that this person in my department listened to this” or “did say that”. Such helpful conversations seem to happen randomly – not planned. So, there is a given in healthcare – emotionally challenging situations. But this given meets random help – at least at times – to deal with this aspect. It is not a given that healthcare professionals learn how to deal with these issues.
We would argue that, if the challenges are a given, so should be the learning, how to deal with them. And here it gets tricky – it is very individual, what help is useful for a person. There are no recipes, and each person needs to find out, how to deal with these challenges. And this is not an easy task – but would help in supporting healthcare professionals in staying healthy. In some specialties, like psychiatry, there is a tradition to look at the backpack content (to stay in the picture) in a planned fashion. We argue that we should find forms of teaching and forms of helping the individual to deal with such challenges during routine and acute situations.
We provided two reasons, why we should address emotions in healthcare. They are important to describe, understand, and predict human action and experience and emotions are important to consider in order to keep healthcare professionals healthy.
Therefore, we do – in the Safety+ project and other work – address emotions in those two aspects. We are interested in how we can create learning situations that set the focus on emotions and we want to create debriefing concepts that help healthcare professionals to address them in a constructive way. We try to see human beings in both their private and professional side as both are important for patient safety, quality of care, and the well-being of healthcare professionals.
Written by Peter Dieckmann, Camilla Normand, Une Strømer, Nina Vatland, Thor Ole Gulsrud, from the University of Stavanger
References:
1. Gigerenzer G, Selten R. Bounded rationality: The adaptive toolbox: MIT press; 2002.
2. Lewin K. Principles of topological psychology. (Available online > access 05. July, 2022)
