Earlier in this chapter, there was a brief discussion of crisis management and the events that might precipitate the need to put crisis or disaster management plans into operation. No matter how one prepares for a crisis, it is assumed that no one is completely ready for the details of a crisis as it unfolds.
In this context, we will think of crisis as anything from job burnout to an overwhelming explosion of events—that is, anything that may disrupt the normal flow of things and cause unexpected problems. While this is a very loose definition of the term crisis, the application to emotional skill is that preparation for anything of such a nature should include a fundamental knowledge of which events precipitate or contribute to which emotions and how transitions from one emotional state to another are likely to progress. There is an amount of reasoning present in understanding emotions—that is, in determining their meanings and implications (Mayer, Salovey, and Caruso, 2000).
Genetic risk testing is one technology that has raised a multitude of ethical questions. Such dilemmas as whether to disclose a parent's potentially harmful genetic diagnosis to a child of childbearing age present many emotional situations. Garrison (2003) relays an account of a mother who did not want her physician to disclose her diagnosis of Huntington's disease to her daughter. The daughter's ignorance of her own risk for the disease, let alone that of unborn children, obviously had implications for future generations, but disclosing the diagnosis was an option the patient did not want to consider. Because medical science has captured so much information about genetic risk, we now have the ability to cause or prevent emotional situations from occurring, based on the level of information we make available and to whom.
On the surface, the issue is whether the patient's wishes should be honored. In other words, would advising the patient's daughter of her risk, either directly or indirectly, breach the patient's right to privacy? Further, would withholding the information from the daughter increase her potential offspring's chances of genetic disease so greatly that the information should, according to duty, be disclosed?
There are ethical principles that govern such decisions, and volumes of literature and hours of study have been devoted to formulating a process that would help to resolve this conflict. However, this scenario contains a volatile emotional potential. The patient may be feeling some combination of fear, anger, guilt, grief, or other emotions, and these feelings may lead her to seek to hide her diagnosis, regardless of the risks to her immediate family. A practitioner who is skilled at emotional understanding could help the patient perceive her own emotions and understand how those emotions facilitated other emotions—or even a decision. After all, it is highly likely that this patient's wishes were driven not by scientific and medical facts but at least somewhat by emotion. Perhaps the patient does not even recognize the emotions she is feeling or how they are affecting the decisions she is making. She may, but this clarification would likely be helpful to both patient and practitioner. Decisions made while under emotional duress may be questioned afterward (Hughes, 2002), so it is worthwhile to help the patient become aware of all the factors in play at the time a decision is made.
The ability to understand emotions and the way they can transition from one to the next would help the practitioner to realize that breaching the patient's privacy, especially in the absence of talking about her emotions or even tacitly acknowledging them, might lead to an escalated emotion, such as rage, on the part of the patient. This understanding affects a practitioner's decision making, so the practitioner needs to make sure that his perception of the patient's emotion is accurate and also that the patient understands how the emotion is affecting her mental process.
Withholding information about a diagnosis from the patient may also have emotional ramifications. How the physician conveys the information will affect the care team. Open, honest care will not be possible if lies are building on lies, and credibility and trust may be lost (Hughes, 2002). This ethical dilemma has haunted practitioners and families for decades, partly because it is laden with emotional implications.
Staff members need to apply their understanding of emotions not only to high-stakes situations but also to the everyday perceptions and frustrations involved in patient-nurse relationships. The man who was angry about the water may very well become enraged if his frustrations go unnoticed and unvalidated. Tired, ill, and vulnerable, he may withdraw and become noncompliant. He may become angrier and more vocal about his frustrations. He may become more difficult because the nurse categorized him that way in the first place. The worried family may draw their own conclusions from the nurse's silence and launch themselves into panic mode, transferring their insecurity about the patient's condition to the patient himself.
Leaders should understand emotions, too, when relating to their staff. The nurse who is "having a problem" may have an emotional one. She may be having problems at home or a conflict with another staff member. There may simply be insecurity that has gone unrecognized or an issue with a patient's family member that is bothering the nurse. As leaders in health care, we watch those we lead providing medical knowledge to patients and sometimes forget that they are not immune from the same emotional turmoil as the patients and families whom they are supporting. We must understand how these emotions affect their thought processes and what consequences may result if the emotions are not addressed and resolved.
To review, the hierarchy of emotional aptitude thus far includes recognizing and perceiving what emotions are being experienced, being aware of how those emotions either have facilitated or can facilitate thought and communication, and understanding how those emotions can change and define relationships and events (Mayer, Salovey, and Caruso, 2000). The next step, managing emotion, can help pull it all together so that a common ground can be established despite the myriad challenges that consume our time, tax our cognitive resources, and make us vulnerable to crisis.
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Hypnosis has been defined as a state of heightened suggestibility in which the subject is able to uncritically accept ideas for self-improvement and act on them appropriately. When a hypnotist hypnotizes his subject, it is known as hetero-hypnosis. When an individual puts himself into a state of hypnosis, it is known as self-hypnosis.