title: Emotion and coping in the aftermath of medical error: a cross-country exploration.
abstract: OBJECTIVE
  Making a medical error can have serious implications for clinician well-being, affecting the quality and safety of patient care. Despite an advancing literature base, cross-country exploration of this experience is limited, and a paucity of studies has examined the coping strategies used by clinicians. A greater understanding of clinicians' responses to making an error, the factors that may influence these, and the various coping strategies used are all essential for providing effective clinician support and ensuring optimal outcomes.The objectives were therefore to investigate the following: a) the professional or personal disruption experienced after making an error, b) the emotional response and coping strategies used, c) the relationship between emotions and coping strategy selection, d) influential factors in clinicians' responses, and e) perceptions of organizational support.
  
  
  METHODS
  A cross-sectional, cross-country survey of 265 physicians and nurses was undertaken in 2 large teaching hospitals in the United Kingdom and the United States.
  
  
  RESULTS
  Professional and personal disruption was reported as a result of making an error. Negative emotions were common, but positive feelings of determination, attentiveness, and alertness were also identified. Emotional response and coping strategy selection did not differ because of location or perceived harm, but responses did appear to differ by professional group; nurses in both locations reported stronger negative feelings after an error. Respondents favored problem-focused coping strategies, and associations were identified between coping strategy selection and the presence of particular emotions. Organizational support services, particularly including peers, were recognized as helpful, but fears over confidentiality may prohibit some staff from accessing these.
  
  
  CONCLUSIONS
  Clinicians in the United Kingdom and the United States experience professional and personal disruption after an error. A number of factors may influence clinician recovery; these factors should be considered in the provision of comprehensive support programs so as to improve clinician recovery and ensure higher quality, safer patient care.
authors.affiliation: From the *Institute of Psychological Science, University of Leeds, Leeds, England; †IHI Open School, Institute for Healthcare Improvement, Cambridge, Massachusetts; ‡School of Health Studies, University of Bradford, Bradford, England; and §Center for Professionalism and Peer Support, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Reema
authors.initials: R
authors.lastname: Harrison
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lawton
authors.forename: Jessica
authors.initials: J
authors.lastname: Perlo
authors.forename: Peter
authors.initials: P
authors.lastname: Gardner
authors.forename: Gerry
authors.initials: G
authors.lastname: Armitage
authors.forename: Jo
authors.initials: J
authors.lastname: Shapiro
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety; D001143:Arousal; D001288:Attention; D003430:Cross-Sectional Studies; D004644:Emotions; D006167:Guilt; D006801:Humans; D019300:Medical Errors / Q000523:psychology*; D009726:Nurses / Q000523:psychology*; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D012649:Self Concept; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014481:United States