Chapter 25
THE PSYCHOLOGY OF THE NURSE (Continued)
EMOTIONAL EQUILIBRIUM
Suppose that when you first enter the ward you are wishing with all your heart you had never decided to become a probationer. Perhaps the white screen and its possible meaning has so frightened you that your thoughts refuse to go beyond it. Suppose the very sight of so much sickness has agitated you instead of strengthening your determination to help nurse it. That is, suppose your emotions, your feelings, so fill your mind that perception is necessarily inaccurate and blurred. Then tomorrow your account of the ward will be hazy, and your desire will probably be against returning to a place where so many unpleasant feelings were aroused.
The emotional balance which refuses to allow feelings to obscure judgment by leading reason astray is a necessary safeguard for the work of the nurse. There is little place in the profession for the woman who is "all sentiment," but perhaps there is less for the one without sentiment.
Feeling, we found, is the first expression of mind--feeling which in the early months is entirely selfish. The happiest baby you know is not sweet and winning to please you, but because he feels comfortable and happy and cannot keep from expressing it. His universe is his own little self and you exist only in your relation to him. If you give him pleasure he likes you; if pain, he does not want you. His mother often fails to please him, but satisfies him so much more frequently than anybody else that he loves her best. Then comes nurse or father--if he proves the satisfactory kind of father, or she a nurse he can love. To the baby whatever he happens to want is good. What is not desirable is bad. And such emotional responses are altogether normal in early months, yes, even until the child is old enough to use reason to choose between two desires the one that will in the end prove more satisfying. But they are defects in adult life.
The nurse who would always act as her first feeling dictates would not be in training many days. Unpleasant sights and sounds, the fear of making a mistake which might harm a patient, the undesirability of long hours of hard work in caring for patients who frequently only find fault with her best efforts, would early decide her in favor of another life-work. Comparatively few so-called "grown-ups" are guided only by feeling; and most of those are in institutions that are well safeguarded. But a great many mature men and women allow feeling to unduly influence their thinking. The sentimental nurse, for instance, may find it very difficult to give an ordered hypodermic. The patient dreads the pain and the nurse fears hurting her. Suppose she were to fail to give it on such grounds. This is an almost unthinkable case. But the very nurse who agrees that such an emotional weakling should not be allowed to train, will help her patient, even when recuperating nicely, to grow inexcusably self-centered, by sympathizing with every complaint, warning her at every turn, by allowing her and even encouraging her, perhaps, to discuss her illness and suffering in the minutest detail. This nurse is more damaging than the sentimentalist who fails to give the hypodermic; for that slip is easily discovered, and the transgressor must immediately reform and obey orders, or be dismissed. But the second nurse may take perfect care of the sick body, and the doctor never realize that she is developing the sickness idea in her patient's mind.
In both of these instances reason has followed the leadings of feeling. It is unpleasant to hurt the patient, and she is disagreeable, too, when you insist on carrying out the orders. It is easier to agree with her ideas and sympathize with her troubles, much easier than to find some other avenue for her thinking, or to search for feeling substitutes. It is pleasanter right now to allow her mind to slip unmolested into sick reactions than to lead her, unwilling as she is, into the ways of health. Reason follows feeling's logic, which suggests that it is much better for the patient to talk of her ills than to keep them pent up inside; and judgment is sadly obscured.
The emotionally balanced nurse hears the story once, that she may have the material for helping the need. Feeling, perhaps deep and genuine sympathy with a real trouble, is aroused, and rightly. But this brings a keen desire to help the situation. Reason insists that talking of sufferings, real or fancied, only makes them more insistently felt; that there must be some better way to meet them. It suggests various methods to divert the patient's attention, to change the train of thought until she is able herself to direct it into healthful channels; judgment weighs the propositions and decides upon the one which will lead toward establishing a health attitude.
The nurse is continually meeting the necessity of acting contrary to fear and discouragement and weariness of spirit. How can she secure emotional equilibrium for herself?
Keep in mind the fact that most sick people are very suggestible; that you have a definite responsibility to make your suggestions to your patient wholesome; and that your mood is a constant suggestion to him. Remember that he needs your best. Then, if your own trouble seems too great to bear, determine that, so long as you remain on duty, you will not let it show. Try an experiment. See if you can go through the day carrying your load of sorrow, or disappointment or chagrin, with so serene a face that the sick for whom you are caring will not suspect that you have a burden at all. That is a triumph worth the striving. Then--if you can let it make you a little more comprehending of others' pain, a little more gentle with the sickest ones, a bit more patient with the trying ones, more kindly firm with the unco-operative, realizing that each one of them all has his burden too--you have not choked feeling, but you have fulfilled reason's counsel: that sick people are not the ones to help you in your stress; that a good nurse should rise above personal trouble to the duty at hand. Your judgment has compared your reasons, and decided that you should act before your patients as you would if all were well. And _will_ holds you to emotional equilibrium. Such a thing can be done in a very large measure; and no better opportunity for emotional control will ever be offered than the necessity of being calm and serene before your patients, no matter how you feel.
But, while reason and judgment teach us to control the expression of certain feelings, they urge that this control be exercised in transforming those feelings into helpful ones and giving them an adequate outlet. Such a substitution has been suggested above. Let us not forget that nothing in existence is of personal value until it gives some one an emotion; that feeling is the beauty of life; that living, without the happy, wholesome affective glow, would not be worth the effort; that beauty and strength and sweetness of feeling make for a worthy self. Remember, too, that feeling is the curse of life. It is feeling that would make us give up the whole struggle; and ugliness and weakness and bitterness of feeling make for a despicable self.
Hope lies for us all in the realization that we can choose our feelings, our responses. We can be utterly discouraged, and bitter and depressed at failure; or we can recognize it as a sign-board telling us that the other way than the one we just followed leads to the goal. And we can follow its pointing finger with faith in a new attempt because, now, we know at least how _not_ to go. We can learn despair from all the bitter and the hateful and the mean; or we can learn that they never could be called so if there were not the sweet, the lovable, and the generous with which to compare them. You can learn to search as with a microscope for all the undesirable traits of your patients, or you can calmly accept all that assert themselves as undeniable facts, but use your microscope to find their desirable characteristics which offer possibilities of being brought to the foreground.
You cannot constructively help yourself or your patient by denying the existence of the less worthy traits; but you can resolve to call out the something better. And if you do not find it, as may rarely be the case, you can refuse to let it make you skeptical of finding it in others. Let us remember always that, "It is not things or conditions or people that harm us; it is only the way we respond to them that can hurt." This one great truth, if really believed and made a part of all our thinking, would save scores of people from nervous wreckage. It is a favorite saying of a wise man who has helped a great many people to endure and take new courage when life seemed too hard to meet.
That big, broken-arm case on the ward cursed you yesterday because you would not loosen his splints. And you rushed from the room angry and humiliated, wishing you could quit nursing forever, and asked to be moved because you had been insulted. But that man cannot harm you. He has never known a real lady in his life before. His training from childhood has been to regard women as chattels to do man's bidding; his experience in life is that they usually do what he asks--women of his kind. Moreover, he has never had a serious pain before, and it is not to be endured.
Of course, the man must be dealt with and made to realize the distinction between his new surroundings and the old. Probably the intern or the doctor is the one to do it. Also he must be brought to apologize, or leave the hospital, perhaps. But he did not hurt you. Your own reaction did that. For outside things or people cannot damage what we are in ourselves. The way we respond to them does the harm. When you can control your expression of anger and humiliation, and substitute for your intense feeling a desire that such a patient may learn that pain is often the gateway to healing; that some respect for women may be kindled in him, so that eventually such an outburst in the ward may be impossible for him or for anyone who heard it; then you are choosing between emotions the one of helpfulness, for the one of justified indignation; and feeling has followed reason, rather than leading reason astray. The judgment which decides you to try methods which will shame or inspire some manliness into the patient was one influenced by a well-balanced emotional life.
If we would really acquire emotional poise, there are a few practical, proved methods we might adopt for ourselves.
When we can hold back the expression of the almost overpowering impulse or passion of anger and resentment and hurt; absolutely shut tight our lips until we can think; then wait until we can think without the strain of intense feeling, we will not only keep ourselves out of trouble, but will be able to calmly state our position, right the wrong done us if wrong there was, or recognize that we ourselves were wrong. For we seldom analyze the situation properly under the influence of strong feeling. If we want to accomplish anything with our words, let us wait until we can speak them without having to choke down our sobs or cram back our hot anger, or forcibly restrain ourselves from tearing things or slamming doors. After all that "wild fire" of emotion is gone, judgment will lead us to wisely reasoned action.
SELF-CORRECTION
Accuracy in work, a primary essential to the nurse, can become automatic if she will demand of herself accuracy of perception, and concentrate on learning and doing until details almost take care of themselves; if she will correct her own work by the standards taught her, and recognize just why and wherein she falls short. Not that she can always do things with the nicety in which they were taught. She cannot give eighteen ward patients in eight hours the same detailed care her private patients would receive if she had only two of them for the same length of time. In such a case she must often sacrifice refinements of detail in service; but there is no excuse for sacrificing accuracy in the necessary treatments of her charges. The nurse merely chooses between the multitude of things which can be done for her ward, the important ones which must be done. Because she is rushed is no excuse for giving a poor hypodermic injection or a careless bed-bath. Accuracy in doing the essential things should be so automatic that it takes not a whit more time than inaccurate doing; and such accuracy is chiefly dependent on constant self-correction when the task is still new, and on never letting up in practice until the details of the doing become practically automatic.
TRAINING THE WILL
There is no better opportunity for will-training than the hospital affords the nurse. The constant necessity of acting against desire, of doing tasks which in themselves cannot be agreeable, calls for a developed will, while it gives it constant exercise. Moods of discouragement and depression cannot be indulged. The nurse must do her work no matter how tired or blue or "frazzled" she feels, if she is not too sick to be on duty; for all time lost, she knows, is to be made up to the hospital before training is completed.
Can this _will to do_, despite strong desire to the contrary, this mood control and the ability to disregard physical discomfort, be acquired; and if so, how?
It is a law of the mind and of the body that any task becomes easier by repetition. We found that automatic habit eases much of the strain of action. What seemed repulsive service to the probationer on her first day in the hospital, she forced herself to do because she wanted to be a nurse. She may go on through her three years unreconciled to these particular duties, yet holding herself to them because she likes other features of her work, or because she must earn her living and this seems the best avenue open to her, or because her will to become a nurse is strong enough to make her act continually against desire. And finally, for almost every nurse, the interest in the end to be attained overshadows the unpleasant incidents in its way. The tasks are actually easier by their constant repetition, and her feeling of repugnance becomes only a mild dislike. She has strengthened her will by continuing to act against desire. But there is a better way to the same goal.
The woman who has thought out the reasons for and against taking training; who has considered it carefully as a profession, and has chosen to put up with any obstacles in the way of becoming a graduate nurse, can find a happy adjustment to the disagreeable incidents it involves. Realizing that the paths of learning are seldom thoroughly smooth, she can resolve to use their very roughness for firmer footholds, as a means to self-control, as a fitting for the sterner hardships of self-support, of nursing the dangerously ill, alone, of meeting suffering and death in her patients with quiet courage and faith. In other words, she can meet the thousand and one personal services which in themselves might be disagreeable and prove pure drudgery, not merely with the stern will to do them because they are a necessary part of obtaining a desired end, but also for the sake of adding to the comfort and well-being of each patient in her care. The emotion of interest and kindly desire will ease the strain which will undergoes in demanding that she not shirk the disagreeable. For there is little stress in doing what we wish to do.
It is psychologically possible to find genuine pleasure in the meanest tasks if the doing is backed up by a strong desire to make life count as much for others as possible. The nurse who comes to realize the waste involved in carrying out against desire what _reason_ proposes and volition dictates, will try to secure the co-operation of desire, and save will-force for more worthy accomplishment.
A constant opportunity for will-strengthening comes to many a nurse during the early weeks and months of training in the necessity of going on despite the sheer tiredness, the weary backs and swollen, tender, aching feet. The one who means to "see it through" disregards them as far as possible on duty, gets all the out-of-doors her time permits, takes special exercises to strengthen weak spots, and relaxes her body while she reads or studies or visits in her off-duty time. In the end, not only does her body adjust itself to the new work, but her will has become a better ally for the next demands upon it; her endurance is remarkably increased.
When she can accept hardship, drudgery, weariness of mind and body and perhaps of soul, the nagging of unco-operative patients, and the demands on her sympathies of the suffering; when she can meet these as challenges to develop a strong will--a will not only to endure, but to find happiness and give service through it all--then the nurse has learned the art of making every circumstance a stepping-stone to mastery and achievement.