Understanding Ourselves and Our Relationships



Understanding Ourselves and Our Relationships


Christine L. Williams DNSc, APRN, BC

Carol M. Davis DPT, EdD, MS, FAPTA





OBJECTIVES



  • To discuss the importance of self-awareness to effective helping


  • To analyze the interaction of the self and our relationships with others


  • To examine the development of a mature person as described by Erikson


  • To describe the role of childhood development in the formation of identity and self-esteem

It has been said that a nurse’s most important tool is the therapeutic use of self. Our personalities and styles of relating have everything to do with how effectively we facilitate the healing process. If we were to ask nurses to assess their ability to relate effectively with people, few would admit to lapses in temper, irritability, or prejudice. Yet these and other negative behaviors can occur, especially when nurses lack self-awareness.

Although difficult to observe, behaviors such as lack of honesty and loyalty to one’s colleagues and breaking confidences are common in health care. Often, nurses are unaware of their unprofessional behavior or the effect of their behavior on others. Clients challenge our sensitivity and maturity in unique ways. Clients react out of the stress of their illnesses or pain, but nurses must also work under stress. It requires great maturity and patience to respond in healing ways in less than ideal situations.


▪ EMOTIONAL INTELLIGENCE

Because intelligence is multidimensional, cognitive or thinking intelligence is not enough to ensure that a nurse will be effective with patients. Another type of intelligence is necessary as well: emotional intelligence.1 Emotional intelligence is the ability to notice, understand, and regulate one’s emotions.2 The nurse who can choose where, when, and how to express his or her emotions will avoid impulsive expression of potentially destructive emotions such as anger. Such self-awareness is essential to therapeutic interaction.

Emotional intelligence is important in another component of therapeutic interaction: the ability to understand emotions in others. Responding with compassion is possible when the nurse can see the hurt in an angry client’s outburst or the fear in individuals who delay treatment until their condition becomes life threatening. Understanding the emotions that trigger behavior is fundamental to appreciating and caring for clients.1

Emotions cannot be separated from their neurobiological basis. LeDoux writes that there are two pathways from perceiving threat to action. One is a direct route through the emotional center of the brain, the amygdala. This kind of reaction is immediate and results in behavior on an emotional level without much thought. The other route is through the neocortex, the thinking part of the brain, where emotions are considered along with knowledge and experience. This slower, more thoughtful approach is likely to lead to rational behavior. When
faced with a threat, the individual may react without thinking and come to regret those actions later. Therapeutic communication depends on the nurse’s ability to react with thought as well as emotion to handle emotionally charged situations in a rational way.3

Emotional reactions have a powerful biological and psychological impact on other people. Our moods spread to others around us, especially those with whom we have close contact. Emotions of caring and compassion for our clients promote clients’ trust and, in turn, facilitate our ability to promote client healing.


▪ SOCIAL INTELLIGENCE

Noticing and regulating emotions in self and others is only a first step in becoming a competent helper. We need to use those abilities to develop effective relationships. Goleman4 describes a person’s interaction skill as his or her social intelligence. Nurses reveal their social intelligence in everyday clinical situations. Does the nurse treat the client respectfully, with dignity, and as an individual? A nurse’s awareness of the client as a person is revealed at the most basic level with politeness and warmth in his or her interactions with the client. Social intelligence is conveyed by attentiveness to a client’s needs. The client feels good when they are with you.

Examples of social intelligence at work include checking with the client to see if he or she needs pain medication, providing an explanation when a client is left waiting for an appointment, and providing comfort measures without being asked. Contrast this to nurses who perform tasks while barely noticing the person for whom the tasks are performed. For nurses, social intelligence goes beyond social skills. It includes treating the person as a person rather than an object.4

Our social aptitude will determine how effective we are in stressful situations. Imagine caring for a mother with a very sick child or a tearful adolescent in labor on a maternity unit. Are you confident that you can focus on the client’s needs rather than your own discomfort? We provide compassionate care to clients who are suffering by knowing what they feel, understanding what they need, and wanting to help.5 Self-awareness and life experience both play important roles in the process of coming to understand another person in need and interacting effectively to relieve their suffering.

In their review of research on suffering and caregiving,5 Shulz and colleagues concluded that compassion had adverse effects on family caregivers’ health. Nurses are also susceptible to the stresses of everyday exposure to clients who are suffering. The effect of helping on caregivers seems to be related to whether caregivers feel successful in reducing the care recipient’s distress and whether they feel capable of meeting the caregiving challenge. Successful helping is very beneficial to mental and physical health. When caregivers are successful, they benefit from an increased sense of competence and self-esteem.6


▪ INFLUENCE OF THE FAMILY ON SELF-ESTEEM

Each of us views the world from a unique perspective that we begin to develop as small children. Our worldview evolves out of what we hear and experience as children growing up in a unique family unit. Important adults, such as parents, close relatives, and teachers, influence us through their interactions.7 Significant others guide children with tenderness when their behavior meets with their approval, or they redirect behaviors that fail to meet expectations. These learning experiences, combined with inborn characteristics, develop into a unique way of experiencing the world. Even twins growing up under the same circumstances will develop different views based upon which each chooses to notice.

Children are not little adults, as Piaget first clearly described.8 Children have underdeveloped nervous systems and lack the capacity to move, think, and act in the same manner as adults. Children live in a land of make-believe, enjoy fantasy, and are egocentric. They are unable to handle abstract logic and are very present oriented and concrete. If you ask a child which of two parallel, identical pencils is longer, she or he will say, correctly, that both are the same length. But then if you slide one pencil so that it is ahead of the other, though still parallel, and then ask, “Which pencil is longer?” she or he will say the pencil that is ahead of the other is longer. In other words, children cannot conserve information. Likewise, children are unable to come outside of themselves and view themselves. Ask a child who has a brother if he has a brother and he’ll say, “Yes.” Ask him if his brother has a brother, he’ll say, “No.”9

Finally, children idolize their parents. They cope with feelings of helplessness and dependence by believing that their parents (or caregivers) are powerful and will protect them and care for them. Even when parents fail to protect them or meet their needs, most children continue to believe in them and will deny the negative experiences of the past.




Case example

Samuel experienced severe neglect from his mother, Claire, during his early years. When he was 10 years of age, they were separated for 6 months except for occasional supervised visits while Claire was treated for substance abuse in a long-term drug rehabilitation program. He was cared for by loving and attentive relatives. During the separation, he longed to be returned to his mother and looked forward to her visits with great excitement. He never referred to his suffering during those early years and seemed to remember only positive memories.

Erik Erikson10 developed a useful description of the development of personality that centers on the successful resolution of tension in a series of steps encountered by the growing person from birth onward. A certain degree of accomplishment is required at each stage or the person will have to master those tasks later in life. Table 1-1 summarizes Erikson’s theory of development. Case examples demonstrate how Erikson’s stages can be applied to client situations.










Table 1-1 Psychosocial Theory of Development: A Summary of Erikson’s Stages of Development10, 11





























































Trust vs Mistrust (birth to 1 year)


Infants who receive consistent, tender care learn to trust. Because no caretaker is perfectly predictable and consistent, some mistrust does arise during infancy and continue throughout the life span. A person’s ability to trust is related to the quality of care received during the first year of life. It is important to emerge from this stage with hope. Hope comes from more trust than mistrust. Predominance of mistrust will adversely affect relationships until positive life experiences help the person to develop more trust.

Case example


Sheryl, age 32, has been engaged to be married several times and has broken the engagements every time. Her relationships have been troubled since childhood and she has difficulty with trust. Sheryl’s parents were drug addicts when she was an infant and she was raised by a variety of relatives. Life was usually unpredictable and she was never sure who to trust.


Autonomy vs Shame and Doubt (2 to 4 years)

Case example


Toddlers begin to experiment with autonomy or independence. They discover that they can hold on to people and things or they can let go or push them away. They can say “No!” and they often do! Their growing biological independence promotes feelings of autonomy. Shame comes from the realization that they can make mistakes and be judged. Doubt arises when the child realizes that he or she is not completely independent. To emerge from this stage with a sense of will, the child must experience more autonomy than shame and doubt. For autonomy and will to prevail, children need experiences with sensitive adults who encourage their growing independence and redirect their problematic behavior without harsh criticism.

Throughout his early years, Jack, age 46, was rarely rewarded for independent action. His parents were controlling and perfectionists. They criticized him constantly. Now he finds it difficult to take risks at work. He sees others being promoted and earning higher salaries, yet his fear of making mistakes and his severe reactions to criticism keep him from being more successful.


Initiative vs Guilt (4 to 5 years)


At this stage children become aware of sexuality and sex roles. They become interested in competing with one parent for the love of the other parent. Have you ever noticed a young child trying to squeeze between their parents on the couch? Healthy parents communicate their love for their child while demonstrating that the child cannot really come between them. As children learn to restrict their competitive behaviors to more socially acceptable outlets, they develop self-control and the capacity for guilt. Children at this age are ready to channel their ambitions by playing, learning, communicating, and competing with peers. Adults react to the child’s initiatives with approval or disapproval. As adults encourage children to engage in socially acceptable pursuits and approve of their imaginative play, they foster a sense of purpose and minimize guilt and inhibition.

Case example


Stacey, age 24, grew up with parents who took an active interest in her developing imagination. Her mother posted her artistic creations around the house and praised her for cooperative play with peers. When her curiosity and exuberance led her to infringe on the rights of others, her parents gently redirected her to other pursuits. Stacey has a clear sense of purpose in her life and confidence in her ability to succeed.


Industry vs Inferiority (6 to 11 years)


The school age years bring children into contact with other adults such as teachers, coaches, and other adults in the community. Their contacts with peers increase through school and other activities. These experiences provide the opportunity to develop cognitive and social skills. They also learn skills that will help them to be successful at work such as showing up on time, organization, attention to detail, and perseverance. If they find that their efforts are rewarded with approval, they develop a sense of industry and competence. If they receive disapproval regardless of effort, they develop feelings of inferiority instead. Children can be rejected for factors outside their control (e.g., race, religion, poverty), and these experiences can result in feelings of inferiority.

Case example


Tom grew up in an urban neighborhood plagued by poverty and crime. His mother worked long hours and had little time to encourage him to do well at school. Most of the families in the neighborhood expected little from their children. When he went to school, Tom felt inferior to his peers who had money for designer clothes and social activities. A teacher took an interest in his artistic talents and helped him to develop a sense of competence at school.


Identity vs Role Confusion (12 to 18 years)


Sexual and aggressive drives become active during adolescence. These strong feelings propel children toward seeking relationships with others. They worry about how they appear to others. Will they be accepted? What groups do they want to find acceptance from? All this questioning leads to the ultimate questions: Who am I? What am I good at? The adolescent tries out different identities. As part of the pursuit of uniqueness and independence, adolescents often choose identities that bring negative reactions from parents. These actions are generally temporary if they are not reinforced. Being part of a group of peers is very important to the development of an identity. Finding an identity enables one to practice fidelity or commitment to a way of life.

Case example


Marcia, a college student, was close to failing in school. She changed her major three times and was afraid that she wouldn’t be able to decide on a career choice. She shocked her parents when she dropped out of school to travel and to “find herself.” During her year of travel and odd jobs, she was able to come to a decision and commit to a career. She returned to school with a better sense of her identity and was successful in her course work.


Intimacy vs Isolation (19 to 34)


With a firm sense of who they are, young adults are freer from self-absorption and ready to find intimacy. They are now able to focus more on what a partner wants and needs than on how they appear to the potential partner. The challenge for young adults is to learn to be emotionally intimate with a partner without giving up one’s separate identity. Sexual intimacy is not enough to accomplish this task. A firm sense of identity is necessary to make emotional intimacy possible. Without identity the young adult may find the task of emotional intimacy too frightening. Failure to achieve this task results in loneliness and isolation.

Case example


Ingrid and Alberto, ages 22 and 23, are young adults in love. They frequently argue and defend their separate identities and their “rights” in the relationship. Gradually they become more comfortable with taking risks to share their vulnerabilities without fear of rejection or of being overwhelmed by the other. They begin to make plans for a committed relationship.


Generativity vs Stagnation (35 to 60)


When adults are comfortable in their ability to develop and sustain intimacy with a partner, they can focus on caring for others and helping the next generation. Adults achieve generativity in many ways. The obvious way is to have children and to “give back” by helping them to grow and develop. Adults can also “give” to the next generation by mentoring others at work, teaching, or becoming involved in causes that improve the environment or the wider world. Stagnation occurs when the adult remains self-absorbed. This can occur whether or not one is a parent.

Case example


Mitch, age 50, has been addicted to cocaine throughout adulthood and exemplifies stagnation. His relationship with his ex-wife and children is strained, and he rarely sees them. He has had a troubled employment history and spends much of his time in crisis.


Integrity vs Despair (60 to death)


In late life, adults struggle with accepting themselves and question the meaning of their lives. Was my life meaningful? Am I at peace with my decisions? Am I satisfied with my relationships, what I achieved or failed to achieve? If they are satisfied with the answers to these self-examinations, they can face death with integrity. If not, they experience bitterness, depression, and despair.

Case example


Samuel Chase is 90 years old and hospitalized for pneumonia. Despite his nurse’s attempts to make him comfortable, he complains constantly. He is irritable and verbally abusive. He doesn’t have visitors, which is no surprise to the staff. They find it difficult to respond to him with empathy. He exemplifies despair.


Source: Adapted from Ramsden, E. (1986). Affective dimensions in client care. In O. Payton (Ed.), Psychosocial aspects of clinical practice. New York: Churchill Livingstone.

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Related posts:

  1. Communicating with Children
  2. Communicating with Older Adults
  3. Communicating at Times of Loss and Grief
  4. Health Literacy and Communication

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Oct 7, 2016 | Posted by in NURSING | Comments Off on Understanding Ourselves and Our Relationships

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