Learn — Emotion, motivation, stress & defence mechanisms

3 notes · 3 questions on the topic

Emotions — components, theories and control

An emotion is a stirred-up state of the whole person — a subjective feeling, a bodily arousal driven by the autonomic nervous system, an expressive behaviour of face, voice and posture, and a cognitive appraisal of what the situation means — that organises the body for action, from the Latin emovere, to move out. Emotions are asked in the psychology paper for their components and theories, and met on every ward as the fear, anger, grief and joy of patients and relatives that the nurse must read and steady.

The four components appear together: the feeling (fear), the physiological change (a fast pulse, sweating, dry mouth, dilated pupils, raised blood pressure and glucose from the sympathetic system and adrenaline), the expression (a pale face, a trembling voice, flight or freezing) and the appraisal (this is dangerous); the limbic system and the amygdala generate the response and the hypothalamus drives the body's part of it.
Primary emotions are recognised across cultures from the face — fear, anger, sadness, joy, disgust and surprise (Ekman) — and the rest are blends or learnt; in the infant, emotion differentiates from general excitement into distress and delight by three months and into fear, anger, disgust, jealousy, affection and elation by two years (Bridges).
Theories to name: James-Lange — the bodily change comes first and the emotion is the feeling of it (we are afraid because we run); Cannon-Bard — the thalamus sends the feeling and the bodily change out at the same time; Schachter-Singer's two-factor theory — arousal plus a cognitive label from the situation; and Lazarus's appraisal theory — the judgement of the event decides the emotion, which is why the same diagnosis frightens one patient and relieves another.
Emotional maturity is the capacity to feel, express and control emotion appropriately for the age and setting — delaying gratification, tolerating frustration, accepting others' feelings — and emotional intelligence (Goleman) adds self-awareness, self-regulation, motivation, empathy and social skill, the qualities the nurse needs more than the patient does.
Emotion changes the body and so the illness: fear and anger raise the pulse, pressure, glucose and cortisol, delay wound healing, worsen pain, asthma and angina and suppress immunity; grief and prolonged sadness lower appetite, sleep and self-care; chronic emotional stress is one root of psychosomatic disease, and this is the physiological reason a calm ward is treatment.
The emotions of illness follow a pattern the nurse can predict — fear of pain, death and disability, anxiety about the unknown, anger at the loss of control, guilt, shame, dependence and grief — and each is met differently: fear with information and presence, anger with acknowledgement rather than argument, grief with time and permission to express it.
Control and expression: emotions are neither suppressed nor discharged on others but recognised, named and channelled — talking (catharsis), crying, physical exercise, relaxation and breathing, creative work (sublimation), humour, prayer and social support; a nurse who cannot name her own anger and fear on a bad shift carries them into the next patient's room.

Motivation — needs, drives and Maslow's hierarchy

Motivation is the internal process that arouses, directs and sustains behaviour towards a goal — the answer to why a person does what she does — and it runs as a cycle in which a need produces a drive, the drive is directed at an incentive, and reaching the goal reduces the drive until the need returns. The syllabus asks for the kinds of motives and for Maslow's hierarchy of needs, which nursing uses both to explain a patient's behaviour and to set the order of care.

The motivational cycle: need (a deficit — the body is short of water) produces a drive (thirst, an aroused state that pushes), which selects an incentive or goal (water), and goal-directed behaviour reduces the drive and restores homeostasis; motives are inferred from behaviour, never seen directly.
Biological or primary motives are unlearnt and shared with animals — hunger, thirst, sleep, sex, pain avoidance, temperature and elimination — while psychosocial or secondary motives are learnt within a culture — achievement, affiliation, power, approval, security, curiosity and self-esteem; intrinsic motivation comes from the activity itself, extrinsic from a reward outside it.
Maslow's hierarchy (1943) sets five levels in order of prepotency: physiological needs (air, water, food, sleep, elimination, temperature, sex), safety and security (protection from danger, order, stability), love and belonging (affection, family, acceptance), esteem (respect from self and others, achievement, recognition) and self-actualisation (becoming all one can be); the lower need must be reasonably met before the next one motivates, and Maslow later added cognitive and aesthetic needs and transcendence.
Nursing uses the hierarchy to prioritise: airway, breathing, circulation, fluids, nutrition, elimination and pain come before safety, safety before belonging, and the patient's dignity and self-esteem before self-actualisation — which is also why a hungry, frightened patient cannot be taught, and why health teaching is timed after the lower needs are met.
Achievement motivation (McClelland's need for achievement, measured by the Thematic Apperception Test) drives people to set moderate goals and seek feedback, and is raised by early independence training; affiliation and power motives explain team behaviour, and the level of aspiration — the goal a person sets after success or failure — rises with success and falls with repeated failure, which is why rehabilitation goals are small and reachable.
Motivation fails in recognisable ways: conflict between motives, frustration when the goal is blocked, learnt helplessness after uncontrollable failure (the patient who stops trying), and the loss of drive in depression and chronic illness; unmet needs also show as behaviour — the demanding patient is often the frightened or lonely one.
To motivate a patient the nurse works from the patient's own needs, not the nurse's: find what matters to him, link the health behaviour to it, set goals he chose, give immediate feedback and reinforcement, involve the family as a source of belonging and esteem, and remove the physiological and safety obstacles first.

Stress, frustration, conflict and coping — defence mechanisms

Stress is the non-specific response of the body to any demand made on it (Selye), arising when a person appraises a situation as taxing or exceeding her resources; frustration is the blocking of a motivated behaviour, conflict is the clash of two motives that cannot both be satisfied, and coping and the defence mechanisms are the conscious and unconscious ways the mind protects itself. This is the most examined topic in the psychology paper — the general adaptation syndrome, the four kinds of conflict and the named defence mechanisms — and the daily material of nursing, in patients and in nurses.

Selye's general adaptation syndrome has three stages: alarm (the fight-or-flight discharge of adrenaline and cortisol — fast pulse, raised pressure and glucose, dilated pupils), resistance (the body adapts and holds the level, at a cost) and exhaustion (the reserves fail and disease appears — hypertension, peptic ulcer, infection, depression); eustress is the stress that energises, distress the stress that harms, and the same event can be either depending on appraisal and control.
Stressors are physical (heat, noise, pain, illness, surgery), psychological (fear, loss, examinations, conflict) and social (bereavement, unemployment, marriage, moving house); Holmes and Rahe's Social Readjustment Rating Scale weights life events, with death of a spouse at the top, and a high score in the past year predicts illness — the nurse asks about life events on admission for this reason.
Frustration comes from external obstacles (poverty, a locked door, a missed bus), from the person's own limits (a disability, low ability) and from conflict, and its reactions are aggression (direct or displaced), withdrawal, regression to a younger behaviour, fixation on a useless response, apathy and resignation; a patient who is rude to the nurse is usually frustrated with something else.
Lewin's four conflicts: approach-approach (two attractive goals — two good jobs), avoidance-avoidance (two unattractive — surgery or continued pain, the hardest to resolve and the one that produces the patient who leaves against advice), approach-avoidance (one goal that attracts and repels — the operation that will cure and might kill) and double approach-avoidance (two goals, each mixed).
Coping is conscious: problem-focused coping changes the situation (seeking information, planning, acting) and emotion-focused coping changes the feeling (relaxation, prayer, talking, reframing, humour, exercise, acceptance); social support is the strongest buffer, and the nurse's stress management is sleep, exercise, boundaries, time management, a confidant and the refusal to carry the shift home — burnout is exhaustion, depersonalisation and a sense of failure, and it is preventable.
Defence mechanisms are unconscious (Anna Freud) and protect the ego from anxiety: repression (pushing the unacceptable out of awareness — the basic one), denial (refusing to accept reality — the patient who says the lump is nothing), projection (attributing one's own feelings to others), rationalisation (a good reason instead of the real reason), displacement (venting on a safer target — the kicked dog), reaction formation (behaving the opposite of the feeling), regression (returning to a childish level — bed-wetting on admission), sublimation (channelling an urge into an acceptable outlet — the only fully healthy one), identification (taking on another's qualities), compensation (excelling elsewhere to cover a weakness), undoing (a ritual that cancels a wish), intellectualisation, conversion (anxiety into a physical symptom), dissociation, fantasy and introjection; suppression is the conscious cousin and is not a defence mechanism in the strict sense.
Defence mechanisms are normal in moderation and pathological when they replace reality: the nurse recognises the mechanism, does not strip it away in a crisis (denial in the first hours after a diagnosis is protective), supplies reality gently and repeatedly, and refers when the mechanism blocks treatment or when anxiety, sleeplessness, withdrawal or hopelessness persist beyond a couple of weeks.

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