Essential Psychology for Nurses and Other Health Professionals

Graham Russell

• Publisher: Routledge
• Year: 2002
• eBook ISBN: 9781134659227
• Topic: Medicine
• Subtopic: Health Care Delivery

This text examines the concepts which are fundamental to everyday nursing practice. Understanding how individuals function psychologically in health and illness is vital to providing appropriate care for all patients and clients.

Assuming no previous knowledge of the subject, the author explores the basis of individual psychology focusing on personality traits, beliefs systems, body-image and self-esteem. Periods of illness are seen as psychologically demanding events which individuals cope with in different ways. The book considers how we recognize and interpret the signs and symptoms of illness in ourselves, what influences the decision to seek help and whether or not we comply with advice from health professionals. The contribution of psychological factors to physical wellbeing is also examined and the link between psychological theory and patient care is examined throughout the book.

With scenarios and questions to help the reader apply the concepts to nursing practice Essential Psychology for Nurses provides an excellent introduction to the subject for pre-registration students and those studying psychological concepts in relation to health care.

Part one

Understanding
ourselves and
others

• Self-awareness and reflective practice

• The self-system

• The development of the self in childhood

• Evaluating and protecting the self

Chapter 1

Self-awareness and
reflective practice

Learning outcomes

By the end of this chapter you should be able to:

• Explain why people sometimes feel uncomfortable dealing with other people's emotions.

• Describe how knowledge leads to understanding.

• Outline why reflective practice is important in the context of nursing.

Dealing with other people's emotions

Some years ago, a close friend was killed in a car crash. I was in my early twenties and was very shaken and upset by the event. Two or three days after his death, his mother contacted me and asked if I would accompany his fiancée to a bar in Oxford that he and I had regularly frequented. I agreed to do this, but felt uneasy. I hardly knew her and was unsure why she wanted to go or what she expected of me.

In the event, we sat in the bar for what seemed like a very long time and both said very little. She was clearly very upset and appeared to be in a dazed state, whilst I felt pretty useless and uncomfortable and unable to offer her much in the way of empathy or tangible support. Worse still, I remember being so focused on my own feelings of unease that I had a strong urge to escape from the situation.

Feeling uncomfortable and out of sorts when faced with serious and relatively infrequent events, such as life-threatening illness, acute mental health problems and death, is not uncommon. Parkes (1972), for example, found that recently bereaved widows frequently complained that others avoided them and were noticeably uncomfortable when talking about the deceased. Nor are nurses and other health professionals immune from such feelings. Nichols (1985), for instance, found that nurses working in a renal unit felt ill at ease and distanced themselves from patients and partners expressing negative emotions. Similarly, the Royal College of Physicians and Psychiatrists (1995) recently published a report that suggested that a lack of confidence and unease in dealing with strong emotions might be partly responsible for the many cases of moderate to severe anxiety and depression that go undiagnosed and untreated by doctors and nurses in medical settings.

In fact, there are many reasons why individuals might feel uncomfortable dealing with other people’s emotions. Research by investigators such as Fenigstein et al. (1975) and Farber (1989), for example, has shown that some people have a limited awareness of their own emotional states and this may well motivate them to avoid situations that involve strong emotional responses. Similarly, Skynner and Cleese (1983) argue that children who grow up in social environments that discourage emotional expression, eventually learn to inhibit or shut off their emotions, because they feel ill at ease with them. Given this, it is not difficult to imagine that individuals socialised in this way might also seek to avoid situations that involve powerful emotions. Such explanations, however, probably explain individual differences in behaviour in only a small number of people, as we may assume that the majority of us mature in families that do not generally discourage the expression of emotion. So perhaps we need to look at the nature of the emotions involved and the types of event that are associated with them.

Clearly, we are not uncomfortable with powerful emotions per se. After all, many of us happily fall madly in love or willingly subject ourselves to high levels of fear on the latest theme park ride or gladly pay money to watch a ‘weepy movie’, knowing that we are going to feel sad and upset. Yet, to a large extent we have a degree of control over these emotions in that we can choose to avoid the theme park or terminate a relationship if our feelings start to threaten us, or walk out of the cinema if it gets too much. However, when emotions such as anger, sadness and grief are expressed by others in real, interpersonal situations, we sometimes perceive that we have little direct control over their expression or their effects on us. In addition, there are other tangible reasons why we might avoid certain types of emotion. Anger, for example, is generally regarded as socially unacceptable (particularly in women) and it often signifies the threat of physical or psychological harm that is to be avoided where possible (Berkowitz 1993). Furthermore, the powerful expression of grief and sadness may combine uneasily with the causal event to remind us of our own personal vulnerability and mortality (Bowlby 1980). In short, we are most likely to feel uncomfortable with emotion when it is negative in valence and potentially uncontrollable.

A final clue to the cause of our discomfort has already been alluded to in the previously cited report by the Royal College of Physicians and Psychiatrists. It suggests that clinical staff are reluctant to deal with emotional states such as anxiety and depression, because they feel they lack the necessary understanding and skills to deal with them competently (notably, anger often accompanies anxiety, depression and grief [Marks 1997]). Indeed, this perspective is echoed by Mead et al. (1997), who point out that nurses need to perceive that they are adequately trained and supported if they are to feel at ease in taking on potentially difficult interpersonal roles.

Knowledge, understanding and perception

To understand ourselves and others, we need a knowledge base that is organised in such a way that it allows us to make sense of the things that we experience. When our knowledge base is inadequate, we have difficulty understanding or perceiving what is happening and we feel uneasy. This is probably what occurred when I accompanied my friend’s fiancée to the pub that night. I found her actions difficult to understand because I knew little about the processes that characterise bereavement, and I felt inadequate because I lacked the skills to handle the situation competently.

In general terms, psychologists equate understanding with perception, which is a concept that may be loosely defined as the organisation and interpretation of knowledge. Bilton et al. (1987) state that much of what we know, and the perceptions that flow from it, is determined by culture, which has been described as the DNA of society. Culture is a major determinant of how we are educated and socialised and it influences the beliefs that are filtered through society to the level of the individual (for instance, 200 years ago, you and I might well have perceived slavery as part of the natural order of things). Despite the influence of culture, however, each individual retains a unique perception or understanding of the world, and the events that occur within it, that is a function of our particular experiences relating to education, parenting, gender, class and genetic make-up (Atkinson et al. 1993).

Perception is an important concept in the context of clinical practice too, because, as Kagan (1987) suggests, our personal perceptions define both the problem and our solution to it. To put this in perspective, imagine for a moment that you live in an isolated tribal society and awake one morning to find your brother paralysed. Your definition of the problem is shaped by your belief in the power of evil spirits to invade and enslave the body, and as you have no knowledge of medical concepts such as microbes or intra-cranial bleeding, your solution to the problem is to fetch the local witch-doctor to banish the evil spirits and restore his health.

Sometimes individual differences in perception can also lead to conflict and confusion about the causes and consequences of illness, especially when the clinician and the patient or client differ in their understanding of the condition, its prevention and treatment (Steptoe and Mathews 1984). A family doctor, for example, may try hard to persuade an under-age teenager to adopt safe sex procedures, because recent experience dealing with an HIV positive patient has reinforced her perception of risk. However, the teenager may choose to disregard the advice, because she perceives her chances of contracting the disease as remote. Similarly, conflict can arise when the nurse’s perception of what is best for the patient differs from that of the physician (Benner et al. 1996).

Reflective practice and interpersonal skills

Knowledge only leads to understanding when we consciously reflect on how our thoughts and feelings relate to the things that we observe in others or experience ourselves. In the context of nursing, this is known as reflective practice, and it involves asking questions, such as, ‘what am I doing and thinking, why and with what effect?’ (Kagan 1987, p. 33). You may find on reflection, for example, that you are irritated by an anxious patient, because you believe she is placing excessive demands on your time, or you may find that you have been avoiding a depressed patient, because he makes you feel powerless and impotent as a nurse. This form of self-awareness underpins a range of interpersonal skills that support effective nursing practice; these include communication and listening, observation of verbal and non-verbal behaviour and planning and problem-solving. Importantly, each and every one of these skills is dependent upon reflection and understanding for their effective execution, and, by the reverse order, nursing care is impoverished when understanding is constrained by overly prescriptive rules and procedures that lead to the automatic performance of tasks.

In short, reflection leads to understanding, and the more we understand about human emotion and behaviour, the more accurate are our formulations of problems and identification of needs and the more appropriate the resulting implementation of care.

Using psychological knowledge as a skill

In reading this text, you will be building upon your existing knowledge, experiences and understanding of human emotion and behaviour. In fact, students often comment that they are surprised just how much they intuitively know when they come to study psychology formally. Unfortunately, however, the feelings and perceptions that flow from ‘intuition’, or partially digested knowledge, are sometimes difficult to put into words and can often be expressed only by relating them to particular circumstances or episodes (Conway et al. 1998). In the context of nursing practice, it is obviously desirable to communicate knowledge quickly and effectively. Studying psychology can facilitate this, by providing you with a common language with which to express ideas, and by introducing you to theories, concepts and models that help you to sift and organise information in way that is conceptually coherent. This is an essential tool in the context of clinical practice. When a group of nurses collectively know about concepts such as stress, learned helplessness and depression, they are readily able to communicate their thoughts and ideas and apply them to the problem in hand.

Summary

Powerful emotions, such as anger, sadness and grief, can lead to feelings of unease, when we perceive that we lack control over their expression and effects, that they pose a potential threat to us or that we lack the understanding and skills to deal with them appropriately. One of the primary skills involved in understanding emotion and behaviour is termed reflective practice, which is based on self-awareness of the links between what we know, think and feel and what we observe in others or experience ourselves.

Psychologists often refer to understanding as perception or the organisation and interpretation of knowledge, which leads to a particular way of viewing the world. We share much of our perceptions with others, but each individual retains a unique understanding of the world based on his or her particular experiences. Such individual differences in perception can lead to conflict between health professionals, patients and clients, and it is important to reflect on how our thoughts and feelings influence the actions we take.

The formal study of psychology builds on the knowledge we already possess and gives us a common language with which to communicate ideas, theories and concepts. In fact, what you will learn in the following chapters is intended to build on what you know and to encourage reflective practice through self-awareness and an enhanced knowledge of others’ emotions and behaviours. In the next chapter we will set the first building block in place by exploring how a knowledge of the self-system can be applied in clinical practice.

Chapter 2

The self-system

Learning outcomes

By the end of this chapter you should be able to:...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Preface
• Acknowledgements
• How to use this book
• Part one Understanding Ourselves and Others
• Part two Reactions to Change, Challenging Events and Loss
• Part three Promoting and Maintaining Health
• Part four Psycho-Physiology: The Relationship Between Mind and Body
• Part five Applying Psychological Knowledge in Clinical Practice
• Glossary
• References
• Index