"I should have discharged him but I felt guilty": a qualitative investigation of clinicians' emotions in the context of implementing occupational therapy

Abstract

BACKGROUND: Clinicians' emotions about practice are a potentially powerful yet largely overlooked factor in implementation of good-quality care. The present paper expands the current, limited evidence about clinicians' emotions by (i) describing clinician-reported examples of emotions about practice and (ii) identifying the clinical situations in which, according to clinicians, emotions emerge and influence practice. METHODS: Semi-structured, face-to-face interviews with 25 clinicians (children's occupational therapists) were conducted across six health care organisations. Participants were asked to reflect on their practice in two recent patient cases, one that they perceived 'successful' and another 'unsuccessful'. Interviews were transcribed verbatim, and the transcripts were analysed for emerging themes. A proportion of transcripts were independently read and coded, and the themes were validated through critical discussion. RESULTS: A key theme was clinicians' emotions, especially negative emotions including guilt, anger, worry, frustration and inadequacy. These were described in connection with situations where the clinicians perceived that (i) they failed to provide good quality care, (ii) they were unable to achieve positive health outcomes or engage the patient or (iii) there was conflict between what they were asked to do and the norms they held important. CONCLUSIONS: Clinicians experience a range of negative emotions about practice. These are particularly likely to emerge in situations where clinicians perceive that their actions and practice fall short of the standards, norms or outcomes that they hold as important. The results inform the specification of emotions and emotion-triggering situations for future investigations of health care implementation.