Emotional labour: clinicians' attitudes to death and dying.

PURPOSE This paper aims to understand the impact of emotional labour in specific health care settings and its potential effect on patient care. DESIGN/METHODOLOGY/APPROACH Multi-method qualitative ethnographic study undertaken in a large ICU in Sydney, Australia using observations from patient case studies, ward rounds and family conferences, open ended interviews with medical and nursing clinicians and managers and focus groups with nurses. FINDINGS Clinician attitudes to death and dying and clinicians' capacity to engage with the human needs of patients influenced how emotional labour was experienced. Negative effects were not formally acknowledged in clinical workplaces and institutional mechanisms to support clinicians did not exist. RESEARCH LIMITATIONS/IMPLICATIONS The potential effects of clinician attitudes on performance are hypothesised from clinician-reported data; no evaluation was undertaken of patient care. PRACTICAL IMPLICATIONS Health service providers must openly acknowledge the effect of emotional labour on the care of dying people. By sharing their experiences, multidisciplinary clinicians become aware of the personal, professional and organisational impact of emotional labour as a core element of health care so as to explicitly and practically respond to it. ORIGINALITY/VALUE The effect of care on clinicians, particularly care of dying people, not only affects the wellbeing of clinicians themselves, but also the quality of care that patients receive. The affective aspect of clinical work must be factored in as an essential element of quality and quality improvement.