Empathy and Adaptation

[Davey Do]

In another thread, a discussion regarding the stimulus for entering the nursing profession was taking place. Daisy4RN said, "I was a candy striper, add to that the childbirth experience, and then when my mom had leukemia, all those together were what propelled me in the nursing direction, and later when the time was right I acted on that!"

I responded with, "Does it seem yo you, Daisy, in your nursing career, those nurses who had a rather involved background history in the nursing field worked more gracefully as a nurse? Such as you, with your candy striping experience and your Mom's illness? 

I think of Eleanor, my work wife, who had close family members who suffered from some relatively severe mental illness diagnoses. She is an extraordinary psych nurse.

And of course, I include myself, as a 19 year old, confined to bed due to multiple injuries and having to lie in my own waste for an extended amount of time before receiving hygienic measures. I took a First Aid course thereafter, got certified in CPR, got my EMT and worked with the volunteer emergency corps before getting into nursing.

Empathy and adaptation goes a long way."

I thought about the line, "Empathy and adaptation" as applied to entering and working in the nursing field and wondered if any other nurses see a pattern with this? Do the newbies struggle more when their only experience is the nursing program? Do those with personal experience with trauma fare better? How do those without personal or prior experience acclimate and become good nurses?

 

 

 

[speedynurse, ADN, BSN, RN, EMT-P]

Honestly....I am not sure if past trauma helps our survival rates in the nursing field or not.

Here is a little of my domino background that led to nursing....as a child, I survived a prognosis that I was never supposed to survive. At one point, I was completely disabled and in organ failure and should have never lived to adulthood. However, I did. I still have issues and sometimes it actually makes my job very difficult to get through. Lately, as I have had more struggles with my health again, I keep looking for a non-bedside option or shorter shifts.

It has given me more empathy for my patients. I really feel for my pediatric patients and am happy when I can make them laugh when they were crying over an IV start five minutes prior, or the mother crying over the loss of her unborn baby after the news of her miscarriage, or the middle aged man who is recovering from surgery and is astounded that he does not have intense nerve pain down his arm anymore. It has made me more resilient in a very different way.

However, many times, I feel "less strong" as a nurse in a healthcare system that is very faulty in my opinion. I remember being so much more angry and frustrated with the safety issues in the ER - when I spoke up about it, the answer I received was often along the lines of...."well, every ER is like this." I remember the frustration with the system processes and sometimes lack of empathy of other patients and families....such as when I was struggling to keep an actively dying pediatric patient alive and when I finally checked on my other patients, I was was met with often hostility and anger over chief complaints that were much lower acuity. I think my supposed "burnout" happened a lot faster in the ER than many of my peers because of my personal history and when I did make mistakes or when there were safety events, I took it a lot more personally and to heart when some of my peers would have just shrugged and blown it off as something they couldn't help. 

I think our society has actually fostered an unrealistic image of what strength, resilience, and empathy is supposed to look like. I see nurses lasting longer than me in the ER, either because they have no trauma in their lives and are able to separate themselves from their jobs or because they are so past burnout that they stop caring about what happens to their patients or their team. That's how the common phrase that I have heard way too many times starts, "Well every ER is like this."

Ironically, my niche was ER nursing. It was what I was competent at and could almost do in my sleep. I stayed with my first ER team for years and actually grieved when I had to leave that team. However, there were many many reasons I left ER nursing. I am now in pre-op/PACU nursing and I do miss a lot of the critical thinking and I miss the field that I was comfortable in. However, I am happier with myself and that I can go the extra mile sometimes with my patients, whether it's sitting beside them to talk about their lives or giving them a comfort measure that I never could in the ER. I also enjoy being able to sometimes help a nurse on another floor that's struggling.....an ER nurse who doesn't have time to start an extra line on a patient because she is with an unresponsive patient...no problem, I can do that.....or the exhausted pregnant floor nurse who was crabby on the phone, but then melts when literally all I do is take a set of vital signs for her and help get her patient comfortable before I leave the floor. Those very simple things have made me happy and at peace with myself in this job for now.

Wow, I just realized this is a very long-winded response to the empathy and adaptability post....so long response short....yes, I think our history does make us more empathetic if we have been through a lot in life. Sometimes, it can make us less empathetic with minor things. I think it can make us more adaptable, but sometimes we also have to change things in our career to ensure that. I also think it can lead to so-called burnout or a need to change specialties because of the trauma of our past. I also think we see the flaws in healthcare and the safety issues much more blatantly and clearly then those without complicated histories. 

[Davey Do]

38 minutes ago, speedynurse said:

Wow, I just realized this is a very long-winded response to the empathy and adaptability post....so long response short....yes, I think our history does make us more empathetic if we have been through a lot in life. Sometimes, it can make us less empathetic with minor things.

A long-winded, but good read nonetheless, speedynurse.

"Sometimes, it can make us less empathetic with minor things" stood out for me, for I hadn't considered the flipside of experience and a history dealing with trauma as causing us to be less empathetic when I initiated this thread. 

There's a lot of truth in that statement that I can see in myself. I've needed to remind myself, "Look, Dave, this patient or nurse has not had the same experiences- or support- that you've had, so go easy on them!"

Thanks for sharing your personal information and perspective, speedynurse!

[Daisy4RN]

I believe that life experience has much to do with how we see the world around us and react to any types of issues including our jobs and careers. When we encounter personal trauma we react by becoming more resilient or becoming bitter (or somewhere along the continuum, or sometimes back and forth). This choice can be driven by many factors including family, friends, spirituality, personality, coping ability, and other past experiences etc. Personally, and probably because I tend to have a stubborn streak, I choose to overcome (trauma) and move forward, thus choosing to become resilient (that which doesn’t kill you makes you stronger).  Add to that the examples I previously gave which were all positive examples of the healthcare field /nurses (for me at that time) and there you have the decision to become a nurse, I wanted to help others as those before me had helped me and my family.

So, I came to the table with the ability and desire to show empathy along with the ability to adapt (because of life’s experiences and choices that went with those). None of us can ever fully walk in another’s shoes but can definitely bring more empathy when we have experienced more life and especially if we encounter those with similar life experiences/traumas, we can identify with them. That said, some people are more in tune to their feelings, are more sensitive etc. so they may be able to feel/show empathy with little to no life experience and then there are those who have become bitter who will feel or show little empathy or even sympathy.  But  in general, I do think that newbies do struggle more if they are on the younger side, the older newbies (like I was) tend to do better because of many  life experiences and also because they have had more time to learn how to adapt and develop coping skills etc. When either you are young or just haven’t had a certain experience (getting fired for example) you tend to really fear that until you experience it ( as you pointed out in the other thread)but  once you have gone through that (trauma) you fear it less, you’ve learned how to cope and adapt, and now you have the ability to help others, you can feel/show empathy.  My personal experience, coping with my mom’s Leukemia and death, put me in a good place to feel/show empathy to those patients/families that I don’t think I would have had otherwise. And my ability to cope and adapt with her illness/death came from previous personal trauma, it all works together.  

I think those that come with little to no personal trauma/ life experiences will acclimate with ‘on the job training’ so to speak. They will do it the same way we all do/did but will just do it (or least some of it) through work experiences which may be a little easier because they will be (hopefully) surrounded by professionals  who can assist with keeping it in perspective etc or at least now most employers offer EAP’s etc. That said the healthcare system isn't what is used to be so who knows. I also agree that our hx can make us less empathic if we deem something unimportant so we do need to be aware, I have also been guilty of this.

Whenever I talk to people who seem to be fearful of any particular situation I ask them “what is the worst thing that can happen”.  Gets them thinking and when one thinks worst case scenario it sometimes doesn’t seem that scary after all.

 

OK, my post got a little long winded too. But I think speedys is longer and that's my story and I'm stickin to it!

[Davey Do]

10 minutes ago, Daisy4RN said:

OK, my post got a little long winded too. But I think speedys is longer and that's my story and I'm stickin to it!

Both yours and speedy's post are real page turners, Daisy. I could spend voluminous amounts of time dissecting and discussing your posts alone.

Daisy said, "When we encounter personal trauma we react by becoming more resilient or becoming bitter (or somewhere along the continuum, or sometimes back and forth)." 

It's interesting how some will prevail and persevere against adversity while others will be devastated. I think of my Dad and Belinda who both had to deal with several major crises in their lives and were/are calm, easy-going people. Then I consider those who merely hit a bump in the road and fly off the handle.

I am a firm believer in the genetic predisposed personality template and our reactions are more nature than nurture. It's more in the way in which we are wired than a personal conscious decision to take the high road.

Daisy also said, "I think those that come with little to no personal trauma/ life experiences will acclimate with ‘on the job training’ so to speak."

Or become victims and blame others for their pain, and in order to give a rationale for their incapability to acclimate.

Then Daisy said, "Whenever I talk to people who seem to be fearful of any particular situation I ask them 'what is the worst thing that can happen'.  Gets them thinking and when one thinks worst case scenario it sometimes doesn’t seem that scary after all."

Good tact to take, Daisy, however...

I have used the example of a great intake worker who was a Vietnam vet and got frazzled over something like a lost intake form. This nice big guy told me that anxiety would set in as if he were in combat. He had seen worse case scenarios and a lost intake form is nothing compared to what he had experienced in 'nam.

I don't know. There are just so many variables to consider.

 

 

 

[Davey Do]

1 hour ago, Daisy4RN said:

I think those that come with little to no personal trauma/ life experiences will acclimate with ‘on the job training’ so to speak.

I worked with a great therapist, Suzanne, back in the '80's who told me of something she said to a new group. Suzanne sat down in front of this new group of patients who were seeking treatment for their alcohol/drug addictions and said, "We're going to start this group off by each one of you stating your name and then sharing with the group the most embarrassing moment of your life".

Suzanne sat there and waited in the dead silence among blank stares. Then she said, "Just kidding!"

That was a real ice breaker, because everyone in the group sighed a breath of relief and laughed!

When I met new students assigned to work the unit I was on, I would often asked them what brought them into nursing. The responses were always interesting and I could identify with them, or at least give verbal feedback.

One time, with a student, I thought I'd try Suzanne's technique. "So tell me", I said, "What was the most embarrassing thing that ever happened to you?"

Of course I believed that I would receive the same quiet/stare reaction that Suzanne had. But, no...

This student hyperverbally launched into a detailed story about something which I considered to be really very trite.

I wonder, @Daisy4RN, do you think this student would easily acclimate to be bathed, as we nurses sometimes are, in the Fires of Hell?

[JBMmom, MSN, NP]

I came to nursing in a roundabout fashion. In high school I identified MD as my career path of choice. I was accepted into a medical school program, I had volunteered for three summers as a candy striper in pediatrics, med-surg and psychiatric units. I *thought* I knew what I was getting into, and I had watched the TV show Northern Exposure, I was going to be a family doctor off in the wilderness somewhere. Then I started college and part of our program required volunteering in the hospital, I chose the ED on the weekends. Hearing the people coming into the ED, I realized that I had very little tolerance for their "complaints". In my sophomore year one of my favorite professors, in molecular biology, said "I'm not saying you're not good with people, but have you considered research?" I switched tracks, got my BS and MS in biochemistry and molecular biology and got a career in pharmaceutical research.

Fast forward 17 years and my pharmaceutical company decided to downsize me and a few thousand others. My options were relocate (for the third time), to try and keep my job, or change careers. With aging parents and three kids in middle school years, I wasn't portable anymore, so change careers it was. I could place out of many pre-requisites thanks to my job description- Microbiology, Chemistry, etc. so going back for a nursing degree required less classes than other career options. Mainly a practical decision from someone that really hadn't cared for anything larger than a cell in my professional career. I had some concerns about my patience and tolerance for people given my previous experience. However, by the time I embarked upon this new career venture 11 years ago, I had become a mother, and having three kids had taught me patience, tolerance and even a little bit of empathy. I've always been considered by others to be a bit emotionally distant, even my own family. But I believe that I provide competent, patient centered care and I have an appropriate amount of empathy in my work with patients and families. 

I was never a "called to nursing" person. No trauma, no family or personal illnesses. Just a need to provide for my family and the appropriate education to do so. I don't think it's negatively impacted my ability to practice, but then again, I've never really asked my patients what they think of me. 

[Davey Do]

13 hours ago, JBMmom said:

 I had watched the TV show Northern Exposure, I was going to be a family doctor off in the wilderness somewhere.

Northern Exposure is probably my most favorite TV show ever, JBMom!

I learned of Joseph Campbell, aesthetics of the transitory, and all sorts of quotes and concepts from that show! When I was painting a mural of the Aurora Borealis (which is a favorite 1st season episode) for a Anomaly Little Theatre back in the '90's, the director of the play introduced me as "a cross between Chris Stevens and Adam".

Speaking of "Adaptation", Both the character Dr. Joel Fleischman and the actor Rob Morrow really never did adapt to Cicely Alaska or the show. Joel and Rob left the show in the fifth season, it went downhill, and was cancelled.

Where's the "Empathy"? 

[Davey Do]

Here's a concept explaining why we have difficulty feeling empathy when exposed to some behavioral character traits:

The negative behavioral character trait that, say a patient exhibits, is one in which we subconsciously identify. That patient embodies and  becomes the personification of that negative behavior trait. Personality traits that we don't like in ourselves, we despise in others.

Now, this does not apply in every circumstance. Some behavioral character traits are just downright despicable on their own merit.

But when I heard some male patient whine over some insignificant something, I wanted to box his ears. Now, it could be that whining is just plain irritable, or it could be because I'm a whiner and that patient was the personification of my whiney self.

Have you ever been able to identify a personification of your very own negative character trait?

 

[TheMoonisMyLantern, ADN, LPN, RN]

I don't think personal trauma is necessary to be a good nurse or clinician, however having a trauma, I think can strengthen the veracity of the nurse if they go into a field related to that event. For instance, a friend of mine lost her mother to cancer prior to her going to nursing school. And out of school she went into oncology and is an incredible and knowledgeable oncology nurse now. I have NO doubt that her loss empowered her to be the best she can be in that role.

Trauma certainly led me to nursing, which I won't go into here. But what I would share is the positive experiences I had growing up that have led me to my favorite patient population to work with whether it's mental health or medical, and that's geriatrics! I was so lucky to have amazing grandparents that I saw every day growing up as child all the way into adulthood. They are no longer living, sadly. But from them I learned so much about loving and respecting our elders, also about life changes as you get older and it becomes harder to have meaning and purpose and that even when we get old we want to feel needed. Because of them I have always been drawn to taking care of geriatric patients. Or at least I like to give them the credit.

[Davey Do]

3 minutes ago, TheMoonisMyLantern said:

Because of them I have always been drawn to taking care of geriatric patients. 

Besides working for the Summer of '75 as an attendant at a residential DD facility, I began my caregiving career at a children's home. It was 1979, I was 22 years old, and I was a houseparent for boys between the ages of 14-18. I was a mere 4 years older than the oldest boys.

I ended my caregiving career working in geriatric psych, providing services for patients who were around the same age as me.

TMIML, you were drawn, and I was led.

[Daisy4RN]

On 1/20/2021 at 4:00 PM, Davey Do said:

I am a firm believer in the genetic predisposed personality template and our reactions are more nature than nurture. It's more in the way in which we are wired than a personal conscious decision to take the high road.

Could be, but I think it is more both, nature and nurture. But then again I have studied very little psychology.

 

On 1/20/2021 at 4:38 PM, Davey Do said:

This student hyperverbally launched into a detailed story about something which I considered to be really very trite.

I wonder, @Daisy4RN, do you think this student would easily acclimate to be bathed, as we nurses sometimes are, in the Fires of Hell?

Sounds like an overachiever and/or an oversharer.  I had a couple of these types in nursing school. Always raising their hand to share some long drawn out story that had zero to do with what we were talking about, we rolled our eyes and said here we go again, more BLS (boring life stories). Would only easily acclimate if learned a little self control, LOL

 

10 hours ago, Davey Do said:

Have you ever been able to identify a personification of your very own negative character trait?

As soon as I can pin point one I will get back to you

 

On 1/20/2021 at 4:00 PM, Davey Do said:

have used the example of a great intake worker who was a Vietnam vet and got frazzled over something like a lost intake form. This nice big guy told me that anxiety would set in as if he were in combat. He had seen worse case scenarios and a lost intake form is nothing compared to what he had experienced in 'nam.

I guess there are always extenuating circumstances where that might not work too well, PTSD?