Perceived Impact of Affect Labeling and Social Sharing in Healthcare: Insights from a Pilot Study and Opportunities for Future Investigation

Abstract

Burnout and declining well-being among healthcare professionals is an ongoing concern. This pilot project aims to explore how affect labeling and social sharing of feelings can impact emotional well-being and perceived connection among teams using an intervention to facilitate sharing of feeling during daily huddles. The population sample included staff across six nursing units within two acute care hospitals. One thousand ninety-one feelings were shared. Four distinct themes emerged in postpilot participant interviews; psychological safety, mindfulness, connection, and bonding. The results of this study can provide insights into the development of future interventions to promote well-being among healthcare professionals. Burnout and declining well-being among healthcare professionals is an ongoing concern. This pilot project aims to explore how affect labeling and social sharing of feelings can impact emotional well-being and perceived connection among teams using an intervention to facilitate sharing of feeling during daily huddles. The population sample included staff across six nursing units within two acute care hospitals. One thousand ninety-one feelings were shared. Four distinct themes emerged in postpilot participant interviews; psychological safety, mindfulness, connection, and bonding. The results of this study can provide insights into the development of future interventions to promote well-being among healthcare professionals. Key Points•Interventions are needed to improve healthcare professional well-being.•Affect labeling and social sharing utilizing a Feeling Wheel is a way to manage one’s emotions and connect with peers. Future work is needed to better understand the role of this intervention in improving emotional and overall well-being. •Interventions are needed to improve healthcare professional well-being.•Affect labeling and social sharing utilizing a Feeling Wheel is a way to manage one’s emotions and connect with peers. Future work is needed to better understand the role of this intervention in improving emotional and overall well-being. The instability and declining well-being of the healthcare workforce continue to outpace recovery efforts. Healthcare professionals (HCPs) are tired and burnt out, and this has been well documented by several prominent nursing and healthcare-related organizations.1American Association of Critical-Care Nurses (AACN)Healthy Work Environments. Aacn.org, 2019https://www.aacn.org/nursing-excellence/healthy-work-environmentsDate accessed: April 17, 2023Google Scholar,2American Nurses AssociationNurse burnout: what is it & how to prevent it. ANA.https://www.nursingworld.org/practice-policy/work-environment/health-safety/nurse-burnout-and-how-to-prevent-it/Date: 2023Date accessed: April 23, 2023Google Scholar Additionally, up to 50% of nurses now report intentions to leave the profession,3Naegle M.A. Kelly L.A. Embree J.L. et al.American academy of nursing consensus recommendations to advance system level change for nurse well-being.Nurs Outlook. 2023; 71101917Abstract Full Text Full Text PDF Scopus (1) Google Scholar which means there will not be enough nurses left in the profession to care for our growing patient population. This “silent pandemic” has been declared a national priority by leading nursing organizations including the American Nurses Association, American Organization of Nurse Leader, and, more broadly, by the US Surgeon General. Interventions must be implemented to counteract these threats and promote well-being in the nursing profession.4Altman M. Delgado S. The importance of nurse well-being and how to achieve it.Crit Care Nurse. 2021; 41: 69-71Crossref PubMed Scopus (1) Google Scholar,5Patrician P.A. Bakerjian D. Billings R. et al.Nurse well-being: a concept analysis.Nurs Outlook. 2022; 70: 639-650Abstract Full Text Full Text PDF Scopus (4) Google Scholar Emotional intelligence, or the comprehensive ability to perceive; understand; and then manage one’s emotions, can help HCPs manage stress; minimize negative emotions; improve their physical and mental health; facilitate a healthy work environment; and reduce burnout.6Prufeta P. Emotional intelligence of nurse managers: an exploratory study.J Nurs Adm. 2017; 47: 134-139Crossref PubMed Scopus (17) Google Scholar, 7Christianson K. Fogg L. Kremer M. Relationship between emotional intelligence and clinical performance in student registered nurse anesthetists.Nurs Educ Perspect. 2020; 42: 104-106Crossref Scopus (5) Google Scholar, 8Anari N. The relationships between the emotional intelligence and job satisfaction: empirical findings from higher education institution in Malaysia.J Health Care Prof Soc Sci. 2012; 5: 124-139Google Scholar Therefore, interventions that focus on self-awareness and management of emotions, as well as social awareness and relationship management, may result in improved well-being and connection among peers. Understanding and managing emotions plays a crucial role in overall well-being, both personally and professionally. One effective strategy for emotional regulation is affect labeling.9Marks E. Walker R. Ojalehto H. Bedard-Gilligan M. Zellner L. Affect labeling to facilitate inhibitory learning: clinical considerations.Cogn Behav Pract. 2019; 26: 210-213Crossref Scopus (5) Google Scholar Social sharing is another practice that can foster connection and build empathy and trust.10Keltner D. Haidt J. Social functions of emotions at four levels of analysis.Cogn Emot. 1999; 13: 505-521Crossref Scopus (1162) Google Scholar These practices have been shown to positively impact various aspects of well-being (see Table 1). The pilot project aims to understand how affect labeling and social sharing by HCPs in a team setting relates to one’s emotional well-being and perceived connection among healthcare team members. The following table expands on the key variables that were used to develop the conceptual model in Figure 1. This model provided the framework for the project.Table 1Variables Impacting Well-beingVariableDefinitionImpact on Well-beingAffect labelingProcess of identifying and verbally expressing one's emotions9Marks E. Walker R. Ojalehto H. Bedard-Gilligan M. Zellner L. Affect labeling to facilitate inhibitory learning: clinical considerations.Cogn Behav Pract. 2019; 26: 210-213Crossref Scopus (5) Google Scholar•Important tool for nurses in promoting both personal and professional well-being.11Vitale E. The mindfulness and the emotional regulation skills in Italian nurses during the COVID 19 pandemic: a descriptive survey-correlational study.J Holist Nurs. 2021; 39: 345-355Crossref Scopus (8) Google Scholar•Method of improving nurses' well-being due to increased empathy and understanding towards others.12Tamir M. Ford B. Should people pursue feelings that feel good or feelings that do good? Emotional preferences and well-being.Emotion. 2012; 12: 1061-1070Crossref Scopus (78) Google ScholarSocial sharing of emotionExpressing emotions with others.10Keltner D. Haidt J. Social functions of emotions at four levels of analysis.Cogn Emot. 1999; 13: 505-521Crossref Scopus (1162) Google Scholar•Positive impact on one's well-being, relationships, and overall health; reducing stress and enhancing interpersonal relationships.10Keltner D. Haidt J. Social functions of emotions at four levels of analysis.Cogn Emot. 1999; 13: 505-521Crossref Scopus (1162) Google Scholar,12Tamir M. Ford B. Should people pursue feelings that feel good or feelings that do good? Emotional preferences and well-being.Emotion. 2012; 12: 1061-1070Crossref Scopus (78) Google Scholar•Validation and support from social networks lead to feelings of connectedness and improved well-being.13Gross J. John O. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being.J Pers Soc Psychol. 2003; 85: 348-362Crossref PubMed Scopus (6342) Google ScholarHuman ConnectionConnections with others can be classified as positive or negative. The lack of human connection is loneliness, while positive human connection is empathy.14Soler-Gonzalez J. Delgado-Bolton R. Vivanco L. Human connections and their roles in the occupational well-being of healthcare professionals: a study on loneliness and empathy.Front Psychol. 2017; 8: 1475Crossref Scopus (31) Google Scholar•Developing positive human connections is important in influencing worker well-being.14Soler-Gonzalez J. Delgado-Bolton R. Vivanco L. Human connections and their roles in the occupational well-being of healthcare professionals: a study on loneliness and empathy.Front Psychol. 2017; 8: 1475Crossref Scopus (31) Google Scholar•Work environments supporting the promotion of civil working relationships through human interactive connection and the personal development of resilience contribute to lower burnout and emotional exhaustion resulting in increased professional satisfaction.15Hart P.L. Brannan J.D. De Chesnay M. Resilience in nurses: an integrative review.J Nurs Manage. 2014; 22: 720-734Crossref PubMed Scopus (255) Google ScholarEmotional Well-beingSuccessfully navigating stress and adapting in challenging times.16National Institutes of HealthEmotional wellness toolkit.https://www.nih.gov/health-information/emotional-wellness-toolkitDate: 2022Date accessed: April 30, 2023Google Scholar A component of well-being,4Altman M. Delgado S. The importance of nurse well-being and how to achieve it.Crit Care Nurse. 2021; 41: 69-71Crossref PubMed Scopus (1) Google Scholar,5Patrician P.A. Bakerjian D. Billings R. et al.Nurse well-being: a concept analysis.Nurs Outlook. 2022; 70: 639-650Abstract Full Text Full Text PDF Scopus (4) Google Scholar and referred to as emotional wellness or emotional health.•Addressing emotional well-being can impact overall well-being.4Altman M. Delgado S. The importance of nurse well-being and how to achieve it.Crit Care Nurse. 2021; 41: 69-71Crossref PubMed Scopus (1) Google Scholar,5Patrician P.A. Bakerjian D. Billings R. et al.Nurse well-being: a concept analysis.Nurs Outlook. 2022; 70: 639-650Abstract Full Text Full Text PDF Scopus (4) Google Scholar•Many interventions aimed at improving well-being are focused on the emotional aspects of well-being.4Altman M. Delgado S. The importance of nurse well-being and how to achieve it.Crit Care Nurse. 2021; 41: 69-71Crossref PubMed Scopus (1) Google Scholar Open table in a new tab Figure 1 depicts the ripple effect of labeling and social sharing on human connection and emotional well-being. Comparable to the ripple effect of a single drop in a larger body of water, the reaction that can occur has a meaningful influence on the surrounding environment and overall well-being. The population sample for this investigation included registered nurses and patient care techs across six inpatient nursing units within two acute care hospitals in the same state. The chief nursing office of each facility selected units with varying attributes. Figure 2 outlines the process used for the 4-week pilot period. The Feeling Wheel (Figure 3) was placed on the respective units in a highly trafficked, visible area prior to rollout to generate excitement and promote curiosity prior to implementation of the pilot.Figure 3Feeling Wheel.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The Feeling Wheel is a tool created by Gloria Wilcox in 1982 to help people identify and express emotions.17Wilcox G. The feeling wheel: a tool for expanding awareness of emotions and increasing spontaneity and intimacy.Trans Anal J. 2017; 12: 274-276Google Scholar Wilcox’s original tool was adapted for the pilot project to convey an equal focus on negative and positive emotions for participants to select (Figure 3). A total of 78 unique feelings are divided into six segments corresponding to six primary feelings: joyful, powerful, peaceful, mad, sad, and scared. During the 4-week pilot period, 1091 check-ins (Figure 4) were completed. Due to the anonymity of the check-ins upon submission for data analysis, these check-ins cannot be considered unique check-ins. Check-in data did ebb and flow over time. Leaders saw decreased check-ins during the night and weekend shifts throughout the pilot period. Hospital 2 had more consistent check-ins over time, whereas Hospital 1 had a decrease in participation over the pilot period. The most common emotion labeled over the 4-week pilot period was “Tired,” which is categorized on the Feeling Wheel as “Sad” (Figure 5). Furthermore, “Sad” was the most labeled primary emotion category (Figure 6).Figure 5Top 15 Identified Emotions Across Pilot Participants.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 6Primary Category Check-ins Across Pilot Participants.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Four themes emerged from the interviews with participants: “Building a culture of psychological safety,” “Affect labeling/mindfulness as a practice of habit,” “Connection and bonding with team members,” and “Impact of connection and bonding on the professional environment.” The Feeling Wheel pilot brought forward whether a culture of psychological safety existed on the units or had to be cultivated. Psychological safety is a condition in a group dynamic when team members feel emotionally and physically safe with one another.18Psychological safety.in: Mcray J. Leadership Glossary: Essential Terms for the 21st century. Mission Bell Media, Stratford2015: 144Google Scholar One nurse stated, “It was awkward to share my feelings in a whole group” while another stated “At first it was awkward, but then became easier and helped the team to connect on how they were feeling at work.” Another participant stated they “were not comfortable sharing with the group because night shift is not a feeling group.” Other participants expressed difficulty sharing suboptimal feelings with their team because of their preceptor or charge nurse. They were concerned that their team may feel that they may be the cause of their suboptimal feelings. Only 1 participant said they already incorporated a daily practice of checking in with themselves and identifying emotions prepilot. This participant found it helpful, and the pilot helped this participant see the benefit for the unit. The other participants responded very similarly conveying that “connecting a feeling to an emotion was helpful” and the fact that being more aware of feelings “enhanced [their] mood while at work.” One participant stated, “Being comfortable with our emotions allows us to lean on each other” and another stated “I had an epiphany that how people really felt was not always how they were acting.” The Feeling Wheel pilot shed additional light on the team connection variance between the pilot units. One nurse said, “Our unit is a family. We are all close friends already. The pilot did not impact these connections. It is common for our team to work through emotions together due to the numerous emotionally charged situations we encounter every day.” Another nurse stated, “I used the information on how others were feeling to check in with them. It was helpful to see when others had the same feelings. It helped validate my feelings and was a good conversation starter.” Tenured participants stated that the pilot allowed them to help coach new members, better support the team, and created a sense of belonging. Overall, participants felt the pilot enhanced connection with team members and helped them connect and check-in with one another. A charge nurse participant stated that during rough nights, she would intentionally ask the team members “How can we help each other get out of these feelings?” prompting conversation and dialog amongst the teams. Unanimously, the participants conveyed that their emotions directly impact the work environment. “Everything we do impacts the care environment and culture. If we feel like we belong, then we are more engaged.” One participant conveyed that the practice was helpful in reframing emotions stating, “We blame the organization when we really need to look inward.” Most participants declared that affect labeling was helpful and allowed the team to identify where they were emotionally to intervene sooner as individuals and as a collective. Overall, participants found the practice helpful due to the space to share and connect with their teammates more uniquely than ever before. As stated previously, there is a need for interventions to improve well-being for HCPs. This project aimed to understand how affect labeling and social sharing by HCPs in a team setting relates to one’s emotional well-being and perceived connection among healthcare team members. The implementation methods and change management strategies are essential to understand and an opportunity for future work. Although this intervention was not consistently sustained throughout all six units for the pilot period, sustainment was achieved at 1 hospital. The decreased participation from Hospital 1 was attributed to competing priorities during the huddle time. Huddles typically take place at the start of each shift. While this is an opportune time to share information with the entire team gathered, there is often an abundance of information shared that can be overwhelming and lead to communication inefficiencies. The timing of the intervention is an important consideration for successful implementation. Additionally, there was a decrease in check-ins on night and weekend shifts. This decrease was thought to be related to leadership presence during day shift huddles which may have prompted more engagement. The Feeling Wheel was used to promote affect labeling and sharing of emotions. While the effectiveness of the wheel was not directly measured, and there may be other ways to promote reflection and sharing, the wheel provided a quick way to identify feelings and share the feelings directly on the wheel. It also allowed participants to “connect a feeling to an emotion,” 1 participant described. The use of the wheel also allowed the participants to use consistent language when relating to one another. The pilot steering team realized there may have been confusion about whether “tired” meant emotionally or physically tired. After the pilot, it was noted that “tired” was selected most frequently. After the pilot, “tired” was changed to “weary” to better describe the emotional state. Other emotions that were added were frazzled, triggered, burned out, exhausted, and terrified. The participant feedback revealed the need for psychological safety. This is an important finding because this intervention may not be effective in environments where psychological safety is lacking or absent. Conversely, this intervention could help to develop psychological safety as the participant feedback revealed sharing became easier with time. Although the project did not hypothesize the cause-and-effect relationship, the qualitative feedback received showed a meaningful impact and a greater sense of bonding, psychological safety, and improvement of the professional environment. Throughout this project and after collecting qualitative feedback from the end users, the authors identified several opportunities for future investigation.1.Correlating suboptimal feelings with systemic operational challenges: The team members expressed suboptimal feelings and commented on the need for fixes to address the challenges. Further investigation is necessary to understand the relationship between suboptimal feelings and systemic operational challenges such as workforce shortages.2.Examining the impact of nursing culture on emotional expression: A common misconception in nursing culture is that nurses should compartmentalize their emotions and feelings from the work environment. Nurses tend to put on an armor of stoicism, which can lead to a lack of emotional expression. Future research can investigate how nursing culture affects emotional expression and strategies to encourage nurses to give themselves permission to feel and be human in the workplace.3.Investigating the relationship between leadership styles and psychological safety: Different leadership styles can have varying effects on the psychological safety of team members. Leaders who are more comfortable with leading with vulnerability may model desired behaviors and increase the act of affect labeling and social sharing of their team. Future research can examine the impact of different leadership styles on psychological safety and vulnerability in teams and how this can affect team performance and well-being. As healthcare teams continue working under extreme challenges, they will face obstacles with workforce shortages and must have opportunities to connect and care for themselves, personally and professionally. Developing emotional intelligence, such as identifying and sharing feelings, can help nurses better understand and manage their own emotions and consider those of their peers. This skill can lead to improved communication, increased empathy, and stronger connections among team members, all of which can help reduce stress and burnout. Creating a sense of belonging and connection can enhance professional fulfillment and emotional well-being. By identifying and implementing interventions to support affect labeling and social sharing, nurse leaders can help their teams feel more supported, leading to deeper connections and increased engagement.