Altered Reality: Cognitive Distortions in Nursing Students

J.Adderton, BSN, MSN

Jennifer

Jennifer is a preparing to administer her very first intramuscular injection. Jennifer calculates the correct dose, prepares the injection, and explains the procedure to her patient. With her clinical instructor present, Jennifer positions to inject the medication. The instructor reminds Jennifer to clean injection site with alcohol. Jennifer notes the reminder and administers the injection. During lunch, Jennifer describes the huge mistake to her peers and dreads the day's post-conference. Filtering is magnifying negative details and filtering out all positive details. In this scenario, Jennifer is focusing on the instructor's reminder instead of her many successes. As she dwells on the negative, the reality of her clinical performance becomes distorted. Jennifer is also falling into "black and white thinking". Students often place performance and situations into two categories- total success or total failure. When we overgeneralize, we expect the same bad thing to happen repeatedly.

Tyler

Tyler is in his last semester of nursing school and assigned to participate in a mock nursing interview with the program's director. Tyler arrived on time for his interview and dressed business casual. The interviewer asked for a copy of his resume and Tyler realized forgot to bring a copy to the interview. The program director printed off the resume from her email and began the interview. As Tyler left the interview, he began to think about how he should have prepared differently for the interview. Tyler did not realize he was terrible at interviews and expects the program director will score him poorly. "Should" statements are often used by students and often lead to guilt, shame and ineffectiveness. For example, "I should study for 8 hours daily before my next test"; "I should have made an A on my last exam". Students often use negative labels for themselves based on an exaggerated or false perception. Tyler labeled himself as a "terrible interviewee" before he ever received feedback from the interviewer. Fortune telling is a cognitive distortion used to convince yourself things will turn out badly. For example, "I bombed the interview and now my grade will be significantly lower".

Mary Kate

Mary Kate scored a 68 on her most recent nursing exam. Although she scored 88 on previous exam, Mary Kate is concerned she will fail the course. Due to the distraction of clinical paperwork, Mary Kate did not have the time needed to study. To make matters worse, Mary Kate is convinced the instructor intentionally made the exam harder to bring down grades. Catastrophizing is when students exaggerate an unpleasant event and predicting a negative outcome before it occurs. Minimizing is downplaying positive outcomes, such as good test scores or clinical performance. Mary Kate also blamed the clinical assignment and a perceived instructor vendetta for her low exam score.

Good News! You can change your pattern of thinking and decrease the negative effects of cognitive distortions. The first step is to identify what cognitive distortions you use that alter your perception of reality. Once you recognize a cognitive distortion, you can then honestly examine the evidence. For example, do you "always fail" exams or have you experienced more successes? Another way to counter negative thinking is to apply a double standard. When you are having harsh and negative self-talk, you can simply try talking to yourself in a caring/compassionate way. Talk to yourself like you would when providing support to a friend. The goal is to replace your negative thought patterns to change the way you feel about yourself and your potential in nursing school.

Resources

Fixing Cognitive Distortions

12 Cognitive Distortions That Limit College Success

Altered Reality: Cognitive Distortions in Nursing Students

Jennifer

Tyler

Mary Kate

About J.Adderton, BSN, MSN

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