Applied Psychology for Nurses - Mary F. Porter (top 10 best books of all time TXT) 📗

short, and people deplore our weakness. If we learn our lesson of self-control and adaptability, and gain in beauty of character through experience, it has served a purpose. But the nurse deals with the average of human nature, and she finds their reaction faulty. Very often, if she is observant, she will discover that a patient responds in a very different way to some other nurse, who somehow finds that “trying” sick woman charming or thoughtful, likable or sweet. Of course, it may be because the other nurse weakens discipline and caters to the patient’s whims; but it is just as likely to be because she has tempered her care and her strictness with understanding. She has grasped the patient’s point of view; and with that start, the chances are 50 per cent. more in favor of the patient grasping and acceding to the wise nurse’s point of view.

Shall we not remember that our trying, cranky, stubborn patient is a sick person, and learn to treat that stubbornness or crankiness as a symptom indicating her need, just as we would a rising temperature?

When we can meet her attitude with comprehension, and, if necessary, with quietly firm disregard, then we are beginning to be good nurses.

Some of the most common of these sick reactions with which the nurse must deal are enhanced suggestibility, repression, oversensitiveness, stubbornness, fear, depression, and irritability. And each one demands a different method of approach if real help is to be given.

Old Isaac Walton wrote a book many, many years ago called “The Complete Angler.” He was a famous amateur fisherman, and he says there are only three rules to be observed and they will bring sure success:

Study your fish. Study your fish. Study your fish.

If the angler follows these directions, he is not apt to offer the wrong bait. When he knows all their little peculiarities, he will know how to catch his fish. The “complete angler” has an unlimited patience and an infinite sense of repose and calm. He never hurries the fish, lest they become suspicious of his bait. And he proves that these three rules work.

The nurse who accepts every patient as like every other, and treats him accordingly, will never be a great success. The nurse who “studies her fish” and learns their psychology, will be a therapeutic force. She will know the why of the way that patient acts.

The Deluded Patient

If the patient’s mind is temporarily clouded through infection or suffering, he may be reacting to a delusion, an obsession, a fixed idea of disability, a terrifying fear. Sometimes he persistently refuses food, and gives no reason for it. The unthinking nurse is tried, puzzled, and irritated. In other ways, perhaps, the patient seems quite normal. But, after all, the explanation is very simple. He probably is as confident that the food is poisoned as you are that it is as it should be. No arguing would convince him, for, to his mind, the nurse is either a complete dupe or an agent of the people whom he knows are plotting his death. And urging him only strengthens his conviction.

The writer recalls one such case of a patient who had to be tube fed through many months, though a tray was set before her three times a day—and as regularly refused. Then one day she was seen slipping food from off another patient’s tray and eating it greedily, not knowing she was observed. When questioned, though she had never before given a reason for refusing food served to her, she said that “they” had nothing against Mrs. B., so wouldn’t try to poison her. Her reasoning was excellent when one accepted her premises. She had bitter enemies. They were not enemies of Mrs. B. and would not harm Mrs. B. Therefore she dare not touch her own food, but could eat Mrs. B.’s if no one knew.

These deluded patients live in a world we often do not sense, a world whose reality we do not appreciate. The nurse, after much experience, finds that there is a key to every resistance, to every lack of co-operation, to abnormal attitudes and actions. She realizes that a powerful emotion of desire or fear, of love or hate, of ambition or self-depreciation, of hope or despair, of faith or distrust, unchecked by reason or judgment through the years, has provided a soil upon which emotional thinking alone can grow. The patient is a mere puppet of the suggestions of emotions which may not be at all pertinent to the facts.

Nursing the Deluded Patient

The nurse soon realizes the uselessness of attempting to argue a patient out of his delusions, of trying to convince him that the things he sees and hears and perhaps tastes and feels, are but hallucinations. Her very insistence only fastens his attention more firmly upon the false conclusion or makes him more convinced that his mind is giving him a true report from the senses of sight and hearing and taste and feeling. But often a quiet disregard of the delusions while the nurse goes on her way and holds her patient to his routine, consistently and confidently, as she would in case they were not true, will eventually cause him to question their reality just because no calamity results. The nurse acts as if these delusions and hallucinations were non-existent in reality, and when the occasion arises, through the patient’s questioning, she urges him to exert his will to act also as if they were not true; to try it and see what happens. Arguing, also, she finds, usually antagonizes or makes the patient stubborn. He cannot prove by her logic his point, but he “knows” from inner experience that he sees what he sees, hears what he hears, and knows what he knows. The fact that the nurse does not is merely annoying evidence that she is blind, deaf, or stupid to these things of his reality. He knows he is lost and damned, or tainted; that he is King George, Cæsar, or the Lord, as the case may be; or that his internal organs are all wrong. He “feels” it and the nurse can’t—therefore, he alone has true knowledge of it. In the end, the wise nurse who never disputes with him, but leads him on to action which utterly disregards these things, may bring about a gradual conviction in the patient’s mind that a man couldn’t do what he does if all these things were true; and the delusion slowly may lose its force or the hallucination fade away. Many patients drop them from their lives entirely. Many others in whom dementia is not indicated, or in whose cases it is indefinitely delayed, can come to an intellectual realization that all these things are fantasies, and do not represent reality; that despite their continued, frequent, or occasional demands upon feeling life, they can be consistently ignored. These psychopathic individuals may act as they would if the delusions never came henceforth to their consciousness, and so be enabled to live a comparatively normal life.

The Obsessed Patient

A patient who is suffering from obsessions must carry out certain abnormal actions, or be wretched. She cannot do otherwise. It is as though she were forced by some outside agent, though the forcing is actually from within. When the nurse realizes this, and the more essential fact—that many patients, who have not true obsessions, yet have a tendency toward obsessed ways of thinking and doing—when she comprehends it almost as she would if she were the victim, then she is ready to help the patient by gently making the action impossible, and at the same time diverting attention.

The Mind a Prey to False Associations

Sometimes a nurse reminds a patient of some one in the past who has complicated her life in an unhappy way, so she distrusts or dreads her or is made constantly uncomfortable in her presence. In such a case, if the nurse reports her patient as resistive, or fearful or cringing, or distrustful, she is really misrepresenting her; for under another’s care that patient may show an entirely opposite reaction.

The nurse can only sense the strength of the influence of heredity and environment and habit of thought, which would give the explanation of many things in her patient’s attitude. Nor can she realize just what shade of meaning certain phrases and words have for her charge. To the nervously overwrought person the most innocent reference—father, sister, wife, home—may bring concepts that are unbearable. The association of the word may make for deep unhappiness, of which the nurse knows nothing. But she can learn that all these things do influence attitude, can appreciate the difficulty of her patient’s effort at adjustment, and do all in her power to make that adjustment possible. If the patient is reasonable she can appeal to her reason. If she is too sick for that, the nurse can use happy suggestions. If the mind is deluded and obsessed she can use firm kindness. She can learn what loss of privileges will affect the rude and unco-operative patient, and may be allowed to try that. She can sometimes help the patient to self-control by making her realize that after each outburst she will be constructively ignored.

But the point we wish to make is this: There are some sick reactions which the nurse, if she recognizes as such, can help the patient to transform into wholesome ones. At the very least the wise nurse can learn to simplify her own difficulties by accepting the unpleasant patient as possibly the result of her illness, and refusing to allow her trying attitude to get on her nerves. The patient may be reacting normally to the stimulus her untrained and toxic brain received. And when the nurse can see into the other’s mental workings, get her point of view, she is ready to give fundamental help.

CHAPTER XII
THE PSYCHOLOGY OF THE NURSE

The mind can be as definitely developed and strengthened as the body. The man who has suffered for years an organic disease will never have the same force as he who has never been seriously ill; but his constitution can be built up and made as efficient as possible within its limitations. Many a man or woman who has an organic heart disorder, through treatment and the proper exercises gradually increased, can very often approximate through many years the output of a normally strong person. The individual weakened by a tuberculous infection can frequently, by following a prescribed regimen for a time, by wise, scientific diet and rest treatment and the help of the out-of-doors, then by carefully increased physical activity, finally live the useful, average life. But it takes scientific care to evolve the weak body into a strong one; and in some cases, at best, it can never stand the same strain that the uninjured one carries with ease. However, even damaged bodies can be made very productive within their limited spheres. Also the naturally perfect physique can quickly become unfit through neglect or infections or misuse.

In the same way, and just as definitely, can the mind be developed and strengthened. Some are by nature keen, alert, brilliant. They may develop into masterfulness; or they, too, may degenerate, through abuse, or from the effect of body infections, into uselessness. The germ-plasm has foreordained some individuals to psychic disorders; but training and mode of life can modify many of these defects. And the average mind, like the average physical organs, can be made more efficient through partaking of the proper mental food, through careful training and wise use.

No more urgent necessity faces the professional woman than this of training her mind to its highest productiveness. Argument is not needed to convince intelligent people today that the accomplishment of life