The Effect of Invalidating Interactions and Emotion Regulation on the Commission of Medical Errors

The purpose of this study was to assess the impact of invalidating versus validating social interactions on the commission of medical errors. Medical errors are a significant public health problem and are estimated to be a leading cause of death in the U.S. Several causes of medical errors have been identified, but recent studies have almost exclusively focused on working conditions. This study was designed to look experimentally at social interactions analogous to those in health care settings that would be described as invalidating. Invalidating interpersonal interactions have been shown in previous research to increase emotional arousal and distress, with a variety of negative consequences. Nurses may regularly encounter invalidating responses in their professional environments. We hypothesized that invalidating interactions and the negative emotional arousal they elicit would increase the commission of errors among nursing students and that emotion regulation skills would moderate the likelihood of committing errors. Nursing students were randomly assigned to a validating or invalidating condition. They were given a stressful task and then received validating or invalidating feedback about their stress experiences. Then, they performed a medication calculation and administration task and were evaluated for errors. After 41 participants completed the study, it was apparent that changes in affect did not differ significantly between the validating and invalidating groups. Given that the experimental manipulation did not produce expected changes in affect, an additional post hoc sample was collected to investigate possible explanations of why the experimental manipulation failed. Post-hoc analyses suggested that the amount of invalidating feedback in this study was likely insufficient to produce significant changes in affective arousal, despite findings that similar procedures in other studies had large effects, and current participants may have been buffered against invalidating responses in part by higher levels of positive affect at baseline. Reasons for these discrepancies are discussed, and additional possible explanations for the findings are explored.