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This course will expire or be updated on or before October 1, 2014.
ABOUT THIS COURSE
You must score 70% or better on the test and complete the course evaluation to earn a certificate of completion for this CE activity.
ACCREDITATION / APPROVAL
Wild Iris Medical Education, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Wild Iris Medical Education, Inc. (CBRN Provider #12300) is approved as a provider of continuing education for RNs and LVNs by the California Board of Registered Nursing.
Wild Iris Medical Education, Inc. provides educational activities that are free from bias. The information provided in this course is to be used for educational purposes only. It is not intended as a substitute for professional health care. See our disclosures for more information.
Copyright © 2011 Wild Iris Medical Education, Inc. All Rights Reserved.
COURSE OBJECTIVE: The purpose of this course is to provide information to healthcare professionals on the characteristics and functions of emotions, the neurology of emotions, management of primary emotions, and how caregivers can use emotional intelligence to communicate more effectively.
Upon completion of this course, you will be able to:
What stirs our souls when we watch a glorious sunrise, depresses our mood when we suffer loss, enflames our passion when we see injustice, or sickens us when we see repulsive behavior? Emotions do. But what are emotions? Where do they come from? Did we learn them or were they inborn? Are they the product of thought or of something else? Can we control them or are they uncontrollable? How do emotions influence our choices and decisions?
For centuries, prophets, poets, and philosophers have posed these questions. Modern-day psychologists and neurologists ask the same questions and have begun to apply scientific research to understand the origins and functions of emotions. Though recent studies reveal something about the anatomy and physiology of emotions, scientists have yet to agree on a single, comprehensive theory to explain the capacity of living creatures to experience and express this enigmatic thing we call an emotion (de Sousa, 2007).
This course addresses these issues, describes the generally accepted characteristics of emotions, identifies neurologic structures and functions involved in emotional responses, offers a distinct model to explain the purpose and nature of the emotions, and suggests practical strategies healthcare professionals can use to help individuals manage emotions.
Though scholars hold different views regarding a philosophical theory of emotions and the capacity to experience and express emotions, they agree on the following characteristics:
Major Components of the Limbic System. (Source: National Institutes of Health.)
Neurologists have found that emotions are produced by a complex organization of the brain called the limbic system. The word limbic comes from the Latin word limbus, meaning “edge” or “border,” though its major structures are located in the center of the brain. The limbic system is the area of the brain that becomes active when humans experience an emotion from a past or present event. The system influences the formation of memory and integration of emotional states with physical sensations (Boeree, 2009).
The following structures and functions of the cerebral cortex and subcortex of the brain are a part of the limbic system:
Using perceptions and thoughts, the structures of the brain’s limbic system store and retrieve information from memory, generate emotions, and provide feedback about appropriate social behavior.
However, identifying and naming these structures is just the beginning. We need to know much more in order to understand emotions. Specifically, we need to define what we mean by emotions; then we need to learn their functions, numbers, qualities, intensities, and combinations. Most important, we need to learn how to manage our emotions.
An emotion is “a complex sequence of events having elements of cognitive appraisal, feelings, impulses to action, and overt behavior; it is a feeling that accompanies an adaptive behavior for survival” (Plutchik, 1991).
Studies of the emotions have identified four positive and four negative emotions relative to the pleasure or displeasure they bring.
|Source: Adapted from Plutchik, 1991; Lazarus, 1991.|
|Primary Emotions||Degrees of Feeling||Life-Preserving Functions|
|Adoration-acceptance-toleration||Incorporation of sustenance|
|Vigilance-anticipation-hope||Exploration of the environment for safety|
|Amazement-surprise-distraction||Orientation to an unexpected and possibly dangerous event|
|Ecstasy-joy-pleasure||Reproduction of the species|
|Terror-fear-apprehension||Protection from harm|
|Rage-anger-annoyance||Destruction of the enemy|
|Loathing-disgust-boredom||Rejection of whatever may be harmful|
|Grief-sadness-pensiveness||Reintegration to wholeness|
Emotions serve life-preserving functions for the survival of the human species, including: incorporation of what is helpful, exploration of the environment, orientation for the sake of safety, reproduction for continuation of the species, protection against harm, destruction of danger, rejection of what may be harmful, and reintegration to wholeness when wounded.
An emotion is a chain reaction beginning with the perception of a stimulus event, followed by cognition (appraisal), then feeling, then impulse to act, and finally action. All of this occurs to increase the likelihood of survival. These steps are illustrated as follows:
|Source: Adapted from Plutchik, 2002.|
|Denial of need or want||Confrontation with denier||Anger
|Lash out, attack, destroy||Destruction|
|Threat from enemy||Danger||Fear
|Loss of valued person or thing||Isolation, loneliness||Sadness
|Cry for help, comfort||Reintegration|
|Sickening food or behavior||Nastiness, harmfulness||Disgust
|Expel, vomit, turn from, vomit||Rejection|
|Introduction of a potential mate||Attraction, interest||Joy
|Unfamiliar, shocking event||Need to quickly appraise situation||Surprise
|Stop: take in new information||Orientation|
|Event with an unknown future||Challenge||Anticipation
|Beneficial act of caring/kindness||Affiliation with nurturing other||Acceptance
|Holding, feeding, grooming||Incorporation|
Each emotion has varying degrees of intensity. For example:
In addition to intensity, emotions often combine to form more complex emotions, such as:
Although emotions may be called positive or negative, in themselves they are neither good nor bad. Even so, the behavior people exhibit and the action they take when they experience emotions may be harmful or helpful to themselves or others. For example, unmodulated joy may become mania; uncontrolled anger may beget violence and cruelty; unresolved sadness may lead to depression and suicide; and unfocused or inappropriate fear may become anxiety, phobia, and paranoia. For this reason, to live a balanced life people must learn to manage their emotions, accepting their reality but controlling the actions they take.
Emotions play a powerful role in the lives of individuals. Consider the capacity of anger to destroy, fear to protect, acceptance to nurture, disgust to repel, sorrow to enervate, hope to challenge, surprise to amaze, and joy to cheer. By understanding and managing these powerful capacities, people can achieve extraordinary personal goals or create great personal tragedy.
We will look at each primary emotion, its definition, the stimulus events that produce it, thoughts people have as a result of an emotion, feelings they experience, the function of each emotion, its manifestations, behaviors, and strategies for management.
Definition: Anger is an emotion designed to eliminate an obstacle to the satisfaction of an important need, such as striking down a barrier, defeating an opponent, or carrying out symbolic acts of destruction, such as cursing or belittling another person.
Stimulus event: Anger occurs when people realize someone or something is blocking the fulfillment of a need, desire, or value.
Thoughts (cognitions): Individuals think of ways they can eliminate the barrier to their desire.
Feelings (relative to intensity): People feel annoyance, frustration, anger, and intense rage.
Aim or function: The function of anger is to eliminate or destroy an obstacle or overcome a barrier to a desire.
Manifestations of anger: People may grimace and experience muscle tension and/or sympathetic nervous response.
Behaviors/actions: Physical assault, verbal assault, and passive-aggressive statements and/or actions.
Ask yourself: What is the obstacle? How powerful is it? Should I fight, take flight, or compromise? The rational-emotive approach of Albert Ellis suggests that before individuals act, they should carefully consider the emotion-triggering event, examine their belief about the event, and consider the consequences of various actions they might take (1985).
|A — Identify the activating event.||As Sam enters the hospital employee parking lot, another car pulls in front of him and take the last space. Now he will have to drive to the auxiliary lot and may be late for work.|
|B — Identify your belief about the event and the emotion related to the event.||Sam believes he deserves the space; he got there first and the other driver took something that was rightfully his. He is angry.|
|C — Consider the consequences.||Sam considers how he can make the driver of the other vehicle relinquish the parking space.|
|D — Discuss/debate various courses of action.||He debates whether he should confront the driver or just drive to the other parking lot.|
|E — Examine the effect of your action (Ellis & Bernard, 1985).||Sam examines the effect of each possible action. He concludes that he has better things to do. He will let go of his anger and drive to the other lot.|
Research studies show that fully expressing and “letting it all out” escalates anger rather than decreasing it; therefore such action is not recommended (Travis, 1989). More effective is a cognitive-behavioral strategy—wait, cognate, officiate—as demonstrated in the following example:
When the driver of the other car rushes past Sam and takes the parking space, Sam waits, then cognates (thinks through his options), then officiates. He decides that confrontation may lead to harm for himself, his automobile, or his reputation at the hospital. Sam takes a deep breath, looks away from the offending driver, shrugs his shoulders, and lets go of his anger.
When individuals are unable to manage anger using intuitive, cognitive, or behavioral strategies, violent behavior may bring them to the attention of law enforcement and healthcare. They may be referred to anger-management classes, and antianxiety drugs such as chlorazerpate (Tranxene), chlordiazepoxide (Librium), and lorazepam (Ativan) may be prescribed.
When individuals exhibit psychotic symptoms, antipsychotic medications such as chlorpromazine (Thorazine), haloperidol (Haldol), and clozapine (Clozaril) may be prescribed.
When such individuals are able to think rationally, they may be able to learn anger management strategies.
People who are ill, in pain, and experiencing exceptional stress are more likely to experience anger than those who are well and comfortable. It is no surprise, then, that healthcare professionals often encounter angry, hostile people. To respond to verbal expressions of anger, caregivers need to:
To respond to aggressive physical behavior, caregivers should:
Definition: Fear is a strong emotion intended to avoid harm and protect individuals. It is the opposite of anger; its purpose is to escape danger.
Stimulus event: Fear occurs when people perceive a threat of harm to themselves, their loved ones, or their property.
Thoughts (cognitions): Individuals believe they and/or their property are in danger.
Feelings: People feel frightened, upset, and anxious.
Aim or function: The function of fear is to protect individuals and help them escape dangerous or harmful forces.
Manifestation of fear: Adrenal system floods the body with epinephrine and stress hormones; as a consequence, the heart races, blood pressure rises, breathing quickens, the liver releases glucose, digestion stops, skin chills, and blood diverts to muscles.
Behaviors/actions: Taking defensive action (fight, flight, or withdrawal).
Ask yourself: Who is the enemy? How much threat is there? What will reduce the threat? Use the rational-emotive ABCDE approach:
|A — Identify the activating event.||Mary is a new employee at the local hospital, working nights on a medical unit. She just discovered she has given Jim Malo the oxazepam ordered for John Malo and given the temazepam ordered for Jim to John.|
|B — Identify your belief about the event and the emotion related to the event.||Mary is gripped with fear. She is not sure what might happen to the patients due to her error. She also believes that because of the error she will lose her job and perhaps even lose her license to practice, especially if the patients are harmed.|
|C — Consider the consequences.||Mary can either report the error and face the consequences or not report it and live in fear her error will be discovered. If she fails to report her error and take action, the patients may be also harmed.|
|D — Discuss/debate various courses of action.||Mary wants to escape the consequences of her action and considers her options. She realizes that the proper professional response is to report her error immediately, fill out an unusual occurrence form, and face the consequences.|
|E — Examine the effect of your action.||Mary decides to call the physician and the evening supervisor and report the error. Much to her relief, the physician affirms the patients were not harmed, and the supervisor helps her fill out the unusual occurrence form.|
Behavioral strategies can also include relaxation exercises and the creation of a safe environment.
When individuals experience a single fearful event, they may not need medication. However, some events are so horrifying that post-traumatic stress disorder results. In these cases, as well as in cases of chronic anxiety, physicians may prescribe antianxiety (antiolytic) agents such as benzodiazepine (Xanax), oxazepam (Serax), and diazepam (Valium). Behavioral strategies such as meditation, self-hypnosis, and exercise help reduce or eliminate the need for antianxiety agents.
Often patients are unfamiliar and fearful of hospitals and what goes on there. They may have seen gruesome pictures, heard or read horrific stories, or experienced painful procedures there. They know that in the hospital they are not in control of their person or property and consequently, they are afraid.
Healthcare professionals can help reduce fear in patients by:
Definition: Sadness is an emotion associated with the loss of someone or something of value to a person. It is the opposite of joy and signals a cry for help. The accompanying mild to moderate depression provides a time of healing.
Stimulus events: People feel sadness when they suffer loss of valued people or things.
Thoughts (cognitions): People who are sad realize they are deprived of the lost person or object.
Feelings: Individuals feel pensive, sorrowful, alone, numb, and mild to moderate depression.
Aim or function: The function of sadness is to provide a time of healing and reintegration.
Manifestations of sadness: In order to give people time to heal, the body and the mind respond to loss by slowing down. When there is a major loss, all of the activities of daily living are affected, both mental and physical.
Behaviors/actions: Crying, weeping, neglect of personal hygiene, changes in sleep pattern, and social isolation.
Acknowledge the loss, large or small. When loss is large and grief profound, give yourself permission and time for “grief work.” Though grief work has been defined in many ways, in essence, the term means working through the tasks of healing emotional wounds. Those tasks have been variously named: acclimation and adjustment, emotional immersion and deconstruction, and reclamation and reconciliation.
GRIEF WORK EXERCISE
Set aside at least 30 to 60 minutes every day to grieve. During this time, give yourself permission to weep and experience the loss. Actively remember the lost one. At the end of each grieving period, close that chapter of grief and return to normal activities of daily living. Gradually, reduce the number and extent of the grieving sessions until you no longer feel the need for those sessions. If the experience of loss suddenly returns, do some more grief work.
|A— Identify the activating event.||Jane’s husband of fifty-one years died after a brief illness. Until his death they had shared everything, reared three children, and never been apart except for brief periods.|
|B — Identify your belief about the event and the emotion related to the event.||Jane is overwhelmed by her loss. She does not believe she can live without her husband. Everything in her life seems surreal.|
|C — Consider the consequences.||Jane withdraws from all her normal social contacts and becomes more and more depressed. She walks around in a daze of confusion and pain.|
|D — Discuss/debate various courses of action.||The hospice worker who attended her husband suggests Jane join a grief support group sponsored by the hospice agency. Jane is hesitant to expose her feelings to strangers, but her daughter urges her to attend. Finally, Jane agrees to go to at least one meeting.|
|E — Examine the effect of your action.||Jane is welcomed by the group and receives comfort and support from its members. She learns about grief work and decides to continue attending until she no longer feels the need.|
In some circumstances, physicians may prescribe sedatives or antianxiety drugs such as temazepam (Resterol) and diazepam (Valium) for individuals in crisis due to a loss. Sometimes, they prescribe antidepressants such as paroxetine (Paxil), sertraome (Zoloft), and venlafaxine (Effexor).
For uncomplicated bereavement, physicians are reluctant to prescribe drug to which people may become dependent. Instead, they may refer people to grief counselors.
Sadness, like all emotions, is a normal human response and is experienced in a range of intensities, from profound grief to pensiveness. It is demonstrated in a variety of ways, such as weeping and withdrawing. Caregivers can help individuals and families manage the sadness of loss in the following ways:
Definition: Disgust is an emotion that arises from contact with something that is repulsive—physically, mentally, or morally. Disgust triggers rejection of an offensive object, idea, or person and is the opposite of acceptance.
Stimulus event: People contact something that is physically, socially, or morally abhorrent to them, such as spoiled food, foul odors, sexual promiscuity, rude behavior, and drunkenness.
Thoughts (cognitions): The repulsive object or person is sickening and repugnant.
Feelings: Individuals feel contempt, rejection, and repulsion.
Aim or function: The function of disgust is to reject whatever is spoiled, foul, or offensive.
Manifestations of disgust: People may show signs of avoidance, disassociation, and expulsion.
Behaviors/actions: Verbally or physically turning away or condemning a rejected object.
Identify the disgusting object, idea, or person. Evaluate your judgments. Use the ABCDE rational-emotive approach:
|A — Identify the activating event.||Sue takes great pride in her slim figure, careful grooming, and her certificate as a wound-care specialist. She works in a clinic serving poor clients, many of whom receive food stamps and Medicaid. Yesterday, a grossly obese patient named Maude, with diabetes and open sores on her lower legs, arrived in a wheelchair. Sue grimaced as she removed the stinking bandages. Maude noticed Sue’s reaction and said, “I know. I’m a disgustin’ old woman …don’t know why I keep on livin’.”|
|B — Identify your belief about the event and the emotion related to the event.||Sue did not comment, but she thought to herself that Maude was not only disgusting, but also a glutinous leach on society, using free medical care and taxpayer-provided food.|
|C — Consider the consequences.||Because of her feelings about Maude, Sue did a minimal job of treating the wounds, telling herself that Maude wouldn’t follow directions anyway. As Sue prepared to leave, Maude looked up at her and said, “Thank you. I ain’t never had nobody take care o’ me before.”|
|D — Discuss/debate various courses of action.||Sue had been offered a position in a private office, serving well-groomed, educated people who would not disgust her. Sue found herself thinking about Maude and the other obese, uncultured folk in the clinic, their hardships and gratitude. Sue had rejected them because they did not meet her standards, yet she began to realize their appreciation of and need for care. She decided to stay on in the clinic.|
|E — Examine the effect of your action.||Sue changed her view of the clinic patients from disgusting slobs to needy individuals whose lives could be changed with the expert care and education she could give.|
Medications to reduce disgust are not available.
Caregivers can manage their own feelings of disgust by the following:
Definition: Joy is a transient emotion of pleasure, enthusiasm, action, and attainment of objectives. It is the opposite of sadness and loss. Many theorists link joy to sexual excitement, creative activity, energy, and innovation.
Stimulus event: These are times when people experience fulfillment, inspiration, and sexual attraction.
Cognition (thoughts): Individuals experience self-actualization, recognition, and achievement.
Feelings: People may feel energy, elation, sexuality, and pride in accomplishments.
Aim or function: The function of joy is reproduction, fulfillment, and self-actualization.
Manifestations of joy: Individuals may experience enthusiasm,creativity, energetic enterprise, and sexuality.
Behaviors/actions: Sexual activities, dancing, singing, talking, inventing, and creating.
Recognize, acknowledge, and enjoy an expansive outlook on life and good energy level. Individuals channel their energy productively, modifying their behavior through reason. Use the ABCDE approach:
|A — Identify the activating event.||Ann woke up early; it was a beautiful morning and she felt wonderful. The night before she had a date with Tom, a senior at the college where she was a nursing student. They had gone to the musical Funny Girl, and the words of one of the songs kept running through her head: she “liked the feeling going through her, down her spine.” Like the singer, Ann felt energetic, enthusiastic, and full of joy.|
|B — Identify your belief about the event and the emotion related to the event.||Her future looks bright. She loves being with Tom and was quite sure he feels the same way about her. She is doing well in all her courses and looks forward to her next rotation in pediatric nursing.|
|C — Consider the consequences.||Because of her joyful state of mind, Ann didn’t get annoyed with her roommate, even when she found dirty dishes in the sink of their tiny kitchen. Instead, Ann hummed the tune from Funny Girl and cleaned up the mess.|
|D — Discuss/debate various courses of action.||Because she felt so good, she was tempted to take the day off, go shopping at the mall, go for a hike, and maybe ask Tom if he’d like to join her. Instead, Ann decided to use her energy to prepare for her next clinical assignment.|
|E — Examine the effect of your action.||Even though Ann’s joyful elation lessened as the day progressed, her feeling of satisfaction continued. Had her joy increased to a state of mania, Ann’s judgment would have been impaired and she would not have been able to focus her energy productively.|
Extremes of any of the emotion—even joy—can cause problems. When joy is accompanied by unusual energy, quick wittedness, and creativity, it is called hypomania. When psychic energy spins out of control and individuals become hyperactive, irritable, and irrational, their condition is called mania. Typically, mania swings to depression in a manic-depressive illness called bipolar disorder. Often, an episode of mania brings people to the attention of law enforcement and medical care.
The most common medication used to treat bipolar disorder is lithium, effective for 75% of individuals afflicted with the disorder (Freeman et al., 2009). In addition, mood stabilizers such as carbamazepine (Tegretol), divalproex (Depakote), and gabapentin (Neurontin) may be prescribed. When patients exhibit psychotic symptoms, antipsychotic drugs may be indicated.
It is important for healthcare professionals to monitor the mood of patients, noting whether they seem inappropriately elated and hyperactive or extremely withdrawn and depressed. In either case, caregivers need to enter into a conversation with these individuals to assess their mood. When mania or depression is observed, it should be noted and reported to the attending physician.
Definition: Acceptance is the opposite of disgust and rejection. It is the emotion of incorporation and nurturance. It involves accepting a beneficial stimulus from the outside world, as in eating, grooming, mating, parenting, or affiliation with members of one’s social group (Plutchik, 1980).
Stimulus event: These are time of nurturance, when people identify with others and care for others as they do themselves.
Cognition (thoughts): Individuals acknowledge and recognize others, both to give and receive.
Feelings: People feel positive regard for others.
Aim or function: The function of acceptance is to confirm inclusion, assimilation, and merger—ultimately, for the survival of the species.
Manifestations of acceptance: Embracing, recognizing, including, nurturing, eating, befriending.
Accepting people as they are, not as you want them to be, is made possible by empathetic listening, genuineness, and identifying with them as fellow humans. Recognize feelings of positive regard and identification with another person or object and then use the ABCDEF approach:
|A — Identify the activating event.||Amy gave birth to her third child, a boy she named Paul. Amy had difficulty bonding with the baby. He seemed like a stranger to her, a toy, something apart, not an extension of herself, as her two girls had seemed. Amy decided not to breastfeed the baby and went back to work when he was 7 weeks old. One day Paul spiked a high fever and was admitted to the hospital. Amy took time off from work to stay with him. Day and night she held him, fed him, and watched over him until he recovered. During that time Amy’s attachment to her son changed.|
|B — Identify your belief about the event and the emotion related to the event.||Amy came to accept her baby boy and identity with him. She believed his illness had brought a wonderful change in their relationship.|
|C — Consider the consequences.||As a result of the experience of watching over and caring for her son, Amy was able to accept and embraced all three of her children as never before.|
|D — Discuss/debate various courses of action.||Before Paul’s illness, Amy had not bonded with her baby boy as she had with her girls. When he recovered, she found she had a different relationship with him. Paul was now as dear to her as herself.|
|E — Examine the effect of your action.||By recognizing her boy as unique yet precious extensions of herself and her husband, Amy became a better parent to all three of her children.|
Acceptance of others nurtures both those who do the accepting and those who are accepted. While medications are not used to foster acceptance, specific strategies have been found to foster acceptance by mothers and infants (see below).
The healthcare specialties in which acceptance and nurturance are of great importance are maternal-child and pediatric care. When parents accept and bond with infants, babies are more likely to thrive. By definition, bonding is the intense attachment that develops between parents and infants. It makes parents want to protect and nourish their infant and give their child the loving care it needs. To foster such bonding, caregivers encourage parents to:
In hospital pediatric units, restrictive visiting hours are a thing of the past. Parents are encouraged to stay with their children, hold or touch them, read to them, and engage them in conversations. By so doing, children and their family members experience acceptance, love, and nurturance.
Similarly, in hospital adult and elderly units, visitors play an important role in supporting and nurturing patients. Their presence affirms the value, acceptance, and love of family and friends. For this reason, caregivers facilitate visitation rather than restrict it.
Definition: Anticipation is the emotion of investigation, exploration, and hope. It is the opposite of unexpected shock, astonishment, or surprise. It may include some elements of anxiety. When individuals anticipate and investigate circumstances, they are not caught off guard and are able to cope more effectively with challenges to their survival (Plutchik, 2002).
Stimulus event: People experience anticipation when they are in unfamiliar territory and feel the need to explore and investigate a situation. These are times of excitement and challenge.
Cognition (thoughts): Individuals think about potential goals and consequences; they investigate, explore, and anticipate end results.
Feelings: Anticipation is a feeling of hope and excitement, as well as a feeling of fear and dread.
Aim and function: The function of anticipation is exploration, mental mapping, and investigation about likely outcomes.
Manifestations of anticipation: Alertness, excitement, curiosity.
Become aware of feelings, consider future possibilities. Use relaxation measures to guard against or reduce anxiety, such as deep breathing, physical exercise, and meditation.Use the ABCDE approach:
|A — Identify the activating event.||Hope reads a notice on the staff bulletin board inviting applications for a new position as In-service Education Director.|
|B — Identify your belief about the event and the emotion related to the event.||She has just completed her MS degree and believes she is qualified and ready for the challenge.|
|C — Consider the consequences.||The position would give Hope recognition and career advancement, the very reasons she went to graduate school.|
|D — Discuss/debate various courses of action.||If she gets the position, Hope will earn more money, join the management team, and gain professional prestige. However, she will be required to work full-time instead of half-time and will have to deal with some difficult people in management.|
|E — Examine the effect of your action.||Hope decides to apply for the position. If she gets the job, she will enjoy all the benefits it offers and will learn to cope with its difficulties. If she doesn’t get it, she will look for other opportunities to advance her career.|
Anticipation enlivens and increases alertness in individuals, especially when the consequences are great. For this reason, there is an element of anxiety in anticipation, and for brief periods of time, those experiencing anxiety may need anxiolytic medications such as benzodiazepine (Xanax), oxazepam (Serax), and diazepam (Valium). Fortunately, behavioral strategies such as exercise, meditation, and self-hypnosis can reduce or eliminate the need for antianxiety agents.
When patients seek medical help, they are often anxious about their health problem and do not know its outcome. When their anxiety is so great that it affects recovery, physicians may prescribe the anxiolytic drugs described above. Caregivers can also help reduce anxiety in patients by doing the following:
Definition: The opposite of anticipation, surprise is an emotion of sudden shock, a response to new and unfamiliar stimuli, positive or negative. When startled, individuals must stop what they are doing, quickly reorient themselves, and take in information about the unexpected incident. When the stimulus has been evaluated, surprise changes to other emotions, such as fear, anger, or even joy.
Stimulus event: Something unexpected occurs or an unfamiliar person or animal intrudes in the environment.
Thoughts (cognition): When such an unexpected event occurs, individuals tell themselves to exercise caution and evaluate the stimulus.
Feelings: Individuals may experience startle, shock, astonishment, or arousal.
Aims and function: The function of surprise is orientation, to allow people to pause and evaluate the environment.
Manifestations (behaviors): Startle reaction, alertness, shock. The body’s response to shock is similar to that of fear. The adrenal system floods the body with epinephrine and stress hormones, the heart races, blood pressure rises, breathing quickens, the liver releases glucose, digestion stops, skin chills, and blood diverts to muscles. The alertness that results allows the person to take action.
Become aware of feelings, consider what may happen next. Maintain control, take a deep breath, and exercise your best judgment, whether the shock and surprise turns to joy or fear. Use the ABCDE approach:
|A — Identify the activating event.||The dermatologist just informed Roger that the biopsy of a mole on his face indicates the lesion is a malignant melanoma.|
|B — Identify your belief about the event and the emotion related to the event.||Roger becomes both frightened and angry. He believes he has just received a death sentence.|
|C — Consider the consequences.||A 52-year-old carpenter, Roger has worked all his life and was just beginning to feel financially security. Suddenly, his life has been turned upside down; he has two kids in college and an employer who depends on him. Roger doesn’t know what he is going to do.|
|D — Discuss/debate various courses of action.||The dermatologist explains the surgery, but Roger cannot concentrate. He feels confused and disoriented. He tries to compose himself and consider his options.|
|E — Examine the effect of your action.||The physician repeats what he said about the need for surgical removal of the tumor and the possibility of chemotherapy. Rogers shock changes to anger as he decides to fight the cancer with every means possible.|
Because the emotion of surprise lasts for such a brief time, medications are not an option.
Because of the brevity of surprise, the greater concern becomes the emotions that follow. For example, immediately after a physician tells a man he has a fatal disease, the patient experiences shock and surprise. However, the patient then experiences other emotions such as anger and fear, or simply decides to deny the reality of the shocking event. For this reason, it is especially important to give individuals nonpossessive warmth, accurate empathy, genuineness, and unconditional positive regard (Rogers, 1961; Carkhoff, 1977). By so doing, caregivers support clients during disorienting events and help them clarify their needs and concerns.
In 1995, Goleman published Emotional Intelligence: Why It Matters More Than IQ, a text that posited that emotional intelligence is different than cognitive intelligence. Since that time, investigators have found that although emotional intelligence is different, it provides an important balance to rational thinking. Segal (2010) and others have identified special capacities of emotional intelligence and noted how these abilities and skills can be learned and applied in every arena of life. These capacities are especially important for healthcare professionals. Emotional intelligence can be defined as follows:
Emotional intelligence (EI) is the ability to identify, use, understand, and manage emotions in positive and constructive ways, recognizing your own emotional state and the emotional states of others and engaging with others in ways that draw people to you (Segal, 2010).
Emotional intelligence consists of at least four special capacities:
Healthcare professionals need all four of the capacities of EI, but they are not inborn. They must be learned. The five specific skills needed to gain EI capacities are the abilities to:
It is vital to learn to notice when you are stressed and how to calm yourself so that you can stay balanced, focused, and in control. This is necessary because when people are overwhelmed by stress, their ability to think rationally is compromised. One simple method to reduce stress is the one-minute relaxation exercise, as follows:
The second key skill of emotional intelligence is to become aware of your own emotions as described earlier. To do this:
The third key skill of emotional intelligence is connecting with others by means of nonverbal communication. This wordless form of communication is emotion-driven. It asks the question, “Are you listening?” and “Do you understand and care?” (Segal, 2010). To enhance your skill in recognizing nonverbal communication, pay attention to:
The fourth key skill of emotional intelligence is using humor and play to deal with challenges. Research has found that laughter reduces stress and elevates mood. To enhance your skill in dealing with setbacks and difficulties with humor and play:
The fifth key skill of emotional intelligence is the ability to resolve conflicts in a positive, trust-building way. Conflict resolution uses the first four skills. Having learned how to manage stress, stay present and aware, communicate nonverbally, and use humor and play, you are better equipped to handle emotionally charged situations and defuse conflicts before they escalate. To enhance your skill in conflict resolution:
Indeed, caregivers everywhere need emotional intelligence. Happily, its development is within the grasp of everyone.
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