Clinician Distress in the Care of Seriously Ill Hospitalized Patients: A Mixed Methods Integration of Qualitative...

Caring for seriously ill hospital patients can cause psychological, emotional, moral, ethical, spiritual or existential distress. Yet little is known about the manifestation and experience of clinician distress, the triggers for distress, and how clinicians seek support in real-time. In preliminary analyses, cluster analysis of 142 encounters yielded four distinct clusters which formed a quantitative distress typology: low, moderate, variable, and high which needed further validation and development.

This study aims to further develop the clinician distress typology by using quantitative and qualitative data to validate and describe the four clusters.

A mixed methods (QUANàqual) explanatory sequential design was conducted. Qualitative data augmented the identification of distress typologies by providing context and a richer understanding of the clinicians' experience of distress.

Hospital clinicians (n=25) were interviewed, and qualitative themes examined the experience of distress by typology. Mixed analysis confirmed typologies with inductive themes and mean distress thermometer score (DT1) as well as clinician emotional experience mean (Gallup) score.

Mixed analysis supported the clusters in the typology and expanded understanding of the depth and breadth of emotions experienced by clinicians caring for hospitalized seriously ill patients: (i) low distress typology theme of "equanimity…but not like a robot"(DT1=0.73; Gallup=0.53); (ii) moderate distress typology theme of "tightrope"(DT1=2.98; Gallup=2.05), (iii) variable distress typology "comfortable in the chaos" (DT1=3.25; Gallup=2.19), and (iv) high distress typology inductive code of "weight/waiting" (DT1=5.79; Gallup=3.55). Clinicians were less distressed if they felt supported in a positive work environment. This mixed methods study advances the understanding of clinician psychological distress and has vital implications for healthcare systems developing workplace resources for support.