Cognitive

Clients and nurses both know something about health and illness in general, and about the individual client’s health concerns in particular. Clients bring their model or world view; “the way they perceive life, events, people, and situations . . . communicate, think, feel, act, and react” (Erickson et al, 1983, p. 84) to the relationship. Clients have definite knowledge about what has made them ill and interfered with their growth and fulfillment. They also know “what will make them well, optimize their fulfillment and or promote their growth.” This knowledge is called self-care knowledge (Erickson et al, 1983). As nurses we want to help our clients access and use their self-care knowledge to achieve a greater state of health and well-being. Nurses have their own views, based on their knowledge and beliefs about what will help their clients. To prevent clients and nurses from operating in isolation or at cross-purposes, they must exchange essential information.

In addition to having different ideas, clients and nurses also have preferred ways of observing their worlds and making decisions about what they see. Each of us has a preferred mental process—the one we have developed most highly, the one we use best—that forms the core of our personalities (Myers, 1998). Clients and nurses have different ways in which they prefer to use their minds, specifically, the ways they choose to perceive and to make judgments (Myers, 1998). Perceiving includes becoming aware of things, people, occurrences, and ideas. Judging includes reaching conclusions about what has been observed.

Some clients and nurses, for example, are primarily practical. They are attuned to immediate experiences, literal facts at hand, and concrete realities. Myers used the word sensing to describe this preferred way of collecting data in problem solving. Other clients and nurses prefer to think about what could be, rather than what is. Their intuitive imaginations fill their minds with ideas and explanations that do not always depend on the senses for verification. Myers called this preferred way of collecting data intuitive.

Consider the following situation to understand what the differences are in these two ways of perceiving and how they affect the client–nurse relationship.

Clients (or family members) and nurses who prefer concrete details, or sensing, would evaluate Mr. Zabrick’s situation by focusing on the visible evidence that might account for his deterioration. They would observe the lack of saliva under the tongue and its brown furry appearance, and note his report of an unpleasant taste and odor in the mouth. They would see the small, hard stools and the abdominal distention. They would feel the decreased turgor of his skin and notice the muscle weakness. They would count the amount of fluids and quantity of food consumed by Mr. Zabrick.

Clients or nurses who prefer detailed information would put these pieces together and likely come to the conclusion that Mr. Zabrick is dehydrated. Those who use this way of perceiving prefer information that is measurable, and the thinking process is systematic, with one step taken at a time.

Clients (or family members) and nurses who prefer a more intuitive perceiving process might not gather all these data before jumping to a conclusion about what is happening to Mr. Zabrick. They are likely to look for patterns in the data (as opposed to discrete pieces of information). They would start thinking about possible explanations and then work backward to obtain the facts. They might notice, for example, that Mr. Zabrick has said, “Why bother with trying anymore? If I had a chance to do it again, I’m not sure I’d take the treatments,” and wonder if his fatigue and grief are consuming him. They might remember that Mr. Zabrick’s daughter-in-law died despite rigorous chemotherapy and that his lifelong friend was diagnosed with brain cancer 3 weeks earlier, and wonder if Mr. Zabrick’s symptoms reflect his doubt about living with such losses. Another theme on which intuitive individuals might focus is the relationship between the assault on Mr. Zabrick’s body from treatments, changes in diet and exercise, and sleep deprivation, and the impact of the severe heat and humidity of the previous 7 weeks.

These two perceiving processes, sensing and intuitive, are quite different. It is important for nurses to understand their preferred way of perceiving and try to discover which process their clients prefer. Both ways of seeing the world are valuable—one is not better than the other; each simply selects different information on which to focus.

Judging—the process of making decisions about the information collected through perception—is the other mental process in which clients and nurses may differ. Some persons have logical, orderly, analytical decision-making processes and treat the world objectively (Myers, 1995). Decision makers such as these prefer to fit all experience into logical mental systems. Myers called this preference thinking and said that these people make decisions based on critical analysis of facts, valuing fairness. Other clients and nurses prefer to tune into the subjective world of feelings and values. Myers called this preference feeling and said that these individuals make decisions by analyzing how they will affect people, valuing harmony.

Each of us prefers one of these decision-making processes to the other (Myers, 1995). Consider the following situation to better understand the two judging processes.

Clients and nurses who prefer a rational, objective way of making decisions would invite Jossie to consider all the facts and then make a logical decision based on them. They would look at the consequences of any decision Jossie might make and judge it using their head rather than their heart. They would be able to remain emotionally uninvolved. They have the ability to see the “long view” and would likely encourage Jossie to consider her future pragmatically and act on the most sensible choice (Myers, 1995).

Clients, family members, and nurses who prefer to consider effects on the people in the situation would likely explore how Jossie feels about each of the choices and how each fits her values. Such people would probably emphasize the benefits of any plan Jossie considers rather than criticizing it; they would also likely support Jossie’s personal convictions.

This glimpse at two different methods for using our minds alerts us to the misunderstandings that can arise in helping relationships. We cannot assume that clients’ minds are guided by the same principles as our own. Clients, their family members, and professional colleagues may reason in the same way that you do, or they may prefer using different ways of perceiving and judging. They may not value the things you value or show interest in the same things you do (Myers, 1998).

We all use different combinations of perceiving and judging, and colleagues and clients with the same preferences are likely to be the easiest to like and understand. They will tend to have similar interests (because they share the same kinds of perceptions) and consider the same matters important (because they share the same kinds of judgment) (Myers, 1998).

On the other hand, it will be harder to understand and predict the behavior of colleagues and clients whose perception and judgment preferences differ from our own. We are likely to take opposite stands on any issue with colleagues and clients who prefer different thinking processes (Myers, 1998). “The therapeutic nurse–patient relationship is a mutual learning experience and a corrective emotional experience for the patient. It is based on the underlying humanity of nurse and patient, with mutual respect and acceptance of ethnocultural differences” (Stuart and Laraia, 2005).

If you would like to learn more about your preferences for perceiving and making decisions, as well as about other personality preferences, arrange with your school’s counseling or guidance department to take the Myers–Briggs Type Indicator (MBTI). The aim of the MBTI is to identify, from self-reporting of easily recognized reactions, the basic preferences of people in regard to perception and judgment (Myers, 1998). Learning about your own preferences will make you more aware of how your way of thinking influences your behavior in client–nurse helping relationships. The Keirsey Temperament Sorter provides similar content and is available online at www.keirsey.com or in his book (Keirsey, 1998).