Calibrated Emotional Engagement in Perioperative Care: A Middle-Range Theory for Sustainable Clinical Practice

Emotional engagement in clinical practice has been theorised as a professional virtue, a form of emotional labour and a potential pathway to compassion fatigue and burnout. Although these traditions have shown that emotional practice is shaped by relational and organisational conditions, they have less clearly specified how clinicians regulate engagement in high-demand perioperative settings, or what organisational conditions make such regulation achievable. Drawing on emotion regulation theory, nursing scholarship on caring and emotional labour and Donabedian's structure-process-outcome framework, we introduce calibrated emotional engagement as a middle-range theoretical concept describing the dynamic, professionally regulated adjustment of emotional, attentional and relational involvement required to remain clinically responsive without becoming detached or overwhelmed. Calibrated emotional engagement is understood as a multilevel process: individually enacted, team-mediated and organisationally conditioned. A three-zone model, comprising under-engagement, over-engagement and a calibrated zone of functionally sustainable engagement, offers a way of conceptualising the range of emotional states in high-demand perioperative settings, including the cue-deprived character of the operating room where anaesthetised patients and sterile draping remove the relational feedback that ordinarily supports empathic practice. We further propose that organisational conditions, including staffing, team stability, autonomy and recovery structure, constitute an empathic infrastructure that shapes whether calibrated engagement is achievable in practice. The concept opens new directions for perioperative education, workforce policy and research that move beyond individual resilience towards systemic accountability for the emotional conditions of care.