Joy, fear, guilt, courage and shame are some emotions we experience in every walk of life. Emotions bring colors to human existence, they are the subjective experiences accompanied by physiologic and behavioral responses (Weitin, 2010).Every situation brings a lot of emotions for an individual which play a role in driving ones behavior. Health care settings also carries a pool of emotions with it; there are feelings of happiness when someone is born, sadness when someone dies, depression to see suffering, hope to see recovery after loads of efforts and time, in there lies many more like these. This array of feelings includes difficult emotions, which according to DeMarrais and Tisdale (2002) are feelings that are difficult to understand and handle. This paper focuses on the handling of three difficult emotions; anger, anxiety and depression that exist in health care setups. A nurse spends more time with a patient than a doctor, hence she has more interaction with them that gives her an advantage to observe any change in their affect and take care accordingly. Patient with difficult emotions are considered to be difficult patients as these emotions create a barrier for therapeutic communication and effective care. These emotions as a part of everyday life can be felt by a patient at any time; a nurse should therefore be skilled enough to handle such patients. These emotions are normal responses of an individual but if they persist or start disrupting a patient’s life then it becomes harmful and deteriorates their mental health. Holistic care of the patient is a nurse’s responsibility, hence a nurse should not be just focused on the major complain a patient comes with rather she should consider all the emotional, social or physical problems a patient is going through. Hence as a health care provider a nurse needs to understand that the art of dealing with difficult emotions of a patient is important for better quality of care.
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Grabbed by her responsibility of completing her tasks, a nurse runs through the corridors throughout the shift, ignoring her hunger, controlling her nearly exploding bladder to fulfill her job in time but there comes a time when she has to face the anger of an unsatisfied patient. This is a common situation observed many times at the clinical areas. Anger is one of the primary emotions present in all humans, although there are variations in its intensity and expression (Turner, 2010). Patients are seen to convey their anger by their behavior, verbal expression or by physical portrayal. Working in a safe environment is a nurse’s right, for the same a zero tolerance policy towards violence being followed is observed at many hospitals, Khowaja & Somani (2012) and Rippon (2000) also supports this. Anger is an emotional response to stress (Thomas, 2009) which may be experienced by patients when their demands are not satisfied, they don’t see improvement in their health despite spending a high cost, or when they could see their death coming towards them as Kubler Ross Model state that anger is a usual emotional response to a diagnosis of a life-threatening illness (Kissane & Philip, 2010).
Nursing may be a very dignified profession worldwide but still it is not the same case in some areas of developing countries, especially Pakistan. This disrespect may be a cause of patient’s anger (Khowaja & Somani, 2012) as they consider nurses to do everything they want. Regardless of all the efforts a nurse has to take the blame of others’ mistakes; it has been noted that it’s the tendency of patients to attribute all the blame on the nurses, during my clinical in a surgical ward a patient was disparaging a nurse because the doctor has not visited him the entire day. The nurse tried to explain that she called the doctor a lot of times but they said that he was on his rounds and will reach there in few minutes. It wasn’t the nurse’s fault that the doctor was delaying it. It would have been her fault if she wouldn’t have contacted him, this is very infuriating for a nurse but she bared the insult considering that arguing with him at that moment will increase his temper, hence the deep seated anger lies within her.
As Turner, (2010) says “emotions have powerful effects on people’s thoughts and emotions.” The patient’s quality of care will be compromised if a patient is angry over a nurse this makes him think that her nurse is incompetent and doesn’t let the nurse care for her. Anger although justifiable but if it is too intense and frequent it gets damaging and results in confrontations which can worsen the situation In response to patient’s anger a staff gets defensive, angry or feels threatened but these reactions are unhelpful in decreasing a client’s anger (Kissane & Philip, 2010). Therefore, managing patient’s anger at the right time is a healthy option. To begin with, realizing that a patient’s anger is not always personal it is genuine, so instead of taking on themselves and feeling guilty or defensive the nurse should look from the other perspective and identify the cause of the anger. Duxbury and Whittington (2005) suggest that strategies to manage anger should be addressed to the problem. For example at a private psychiatric hospital a patient was angry at everyone because he felt the place was a prison to him, where he was locked up and no one would listen to him. The nurse refused talking to him saying that it was because of his illness that he is irritated. While the patient’s anger was not a symptom of his illness but lack of therapeutic communication which gave birth to the emotion of anger, so instead ignoring his anger the nurse should have listened to him and help adapt with the environment. Listening, reflecting what is being said, exploring details, empathy and find solutions are some therapeutic communication techniques that helps patient relax (Matheisen, 2012 & handbook). When dealing with an angry client a nurse should be careful of her gestures which might enrage the patient. Let the patient feel that his concern has been understood and that the nurse will work to solve it.
Anxiety is another prevalent emotion in the healthcare setup that is considered to be a common response of a person towards his life stressors or threat. It might be adaptive if it helps a person cope with the situation effectively for example if a person is anxious about his upcoming life sufferings this helps him adhere to the rigorous treatments. (Traeger, Greer, Robles, Temel, & Pirl, 2012) otherwise this emotional response becomes maladaptive which is attributed by Stark and House (2002) with impatience, quest of reassurance, worry, poor concentration, and fatigue. These attributes doesn’t work in decreasing the anxiety or cope with the situation. Mirza and Jekins, (2004) identified Finance, family problems, marital disputes, and low education levels as causes of anxiety amongst Pakistani population. Considering the hospital settings there are many anxiety provoking situations for patients some of them includes uncertainty of life, future, an upcoming surgery, stress about finances and family at home.
Suffering with intense pain, a 16 year old girl was admitted to the surgical ward for the removal of appendix. When will the pain end? Will the operation be successful? What will happen during the procedure? Will it hurt? Will I die? When will I meet my friends? With these questions the young lady bombarded her nurse. The nurse recognized the girl’s anxiety and instead of getting angry she skillfully tackled her by asking about her worries and answering her questions and providing her with the knowledge she required to decrease the anxiety. Every day, nurses encounter patients like these who are anxious about their treatments, procedures, diseases and for this they may have several queries. Management of anxiety is therefore a part of nursing care. Using open ended questions and giving leads to patient during the communication will be helpful for patient to open up and speak about their anxieties that would help a nurse identify the causes (Stark & House, 2002). Jackson , McNeil and Schlegel (2008) identifies therapeutic touch as a helpful intervention to release anxiety that has imbalanced the energy field of the body. It’s a non invasive complementary therapy that involves hand movements over the body without physical touch to balance the body energy. Balanced energy promotes healing. It’s a fruitful nursing intervention that should be taught to nurses and practiced by them to improve patient’s recovery. Guided imagery and relaxation techniques are successful techniques to deal with anxious patients (Bruera &Yennurajalingam, 2011). It has been observed that usually nurses opt this intervention and are comfortable using in using it. They encourage patients to relax by reading something, watching television or go for a walk in the garden. Anxiety can affect a person’s sleep, appetite and ability to concentrate; hence a nurse should competently deal with anxious client and work to decrease their anxiety and protect from other problems.
Sitting all day alone on his bed, curtains drawn all over, a patient at a private hospital refuses to meet any visitor, spends his day in a sad mood and doesn’t show any interest in activities, has decreased appetite and verbalizes that he is tired of living, he has not done anything good for his family, he is not a good son. He was suffering from depression; that is a very common disorder and there are several people around us who are undiagnosed. Along with the above mentioned symptoms Bruera &Yennurajalingam (2011) includes feeling of unproductive life, agitation, decreased strength to the characteristics of a depressed person. Depression is a pathological state of sadness that is prolonged and consistent (WHO, 2001). In early stages depression exist as just being sad. Although it doesn’t hinder a person’s everyday life but it does makes things less worthy to him. While in severe cases the feeling of worthlessness may exacerbate and lead to suicidal thoughts (WHO, 2001 & Murphy, Buszewlcz & Haddad, n.d.). External stressors, poor socialization, life sufferings and inferiority complex and serious illness are few causes attributed to depression observed at hospital settings and its also supported by WHO (2001).
Since depressive clients suffer from feelings of worthlessness and inferiority therefore a major task of a nurse in dealing with a depressive client is to give them a sense of empowerment. As observed in clinical areas nurses practice this by listening to the client’s concerns, provide them with information and allow them to control their care, encourage them to do their tasks themselves. Client should be encouraged to stop blaming and criticizing themselves, participate in activities to keep their minds distracted.
In today’s world where everyone is striving for a good quality of life for themselves and their families, the people in developing countries like Pakistan are not behind, they strive harder every day, they suffer more everyday because low income and increasing prices are a great concern for them. With that, poverty and low literacy are enough components to make a person suffer depression. Such a person when brought to hospitals are found not just physically ill but suffering from depression too. During the treatment more than the illness the upcoming bill and his family’s suffering is what bothers him more. It’s a nurses responsibility to assess and care for it. Although one cannot change their lives but a few interventions by a nurse can be very beneficial for a patient. Amongst Pakistanis the major sources of depression are financial problems and marital disputes (Mirza&Jekins, 2004). To handle depressed clients nurse should helpthem find gratitude in their lives, that is to think about good things of life. Religious practices (Kasi, et all., 2012), relazation exercises, help patient make decisions (Murphy, Buszewlcz & Haddad, n.d.)
Anger, anxiety and depression are prevalent emotions of a patient that a nurse encounters. Understanding that holistic care should be focused a nurse should assess the client’s emotions by verbal and non verbal cues and intervene accordingly to promote health and assist clients to improve their coping abilities and prevent further disability and detoriation of health.Using the methods discussed above a nurse could effectively help patient handle these difficult emotions. A common technique for it is therapeutic communication that is an integral part of nursing care, as through it a nurse will be able to identify patient’s problems , coping skills , need for care and it is communication that will help a nurse practice the skills to help patient manage their emotions and evaluate its effectiveness.