Case Study 4.1

RIDING THE EMOTIONAL ROLLER COASTER

Louise Damiani's work is an emotional roller coaster most days. The oncology nurse at CentraState Health-care System in Freehold Township, New Jersey, soars with joy as patients beat their cancer into remission.

Then there are the low points when one of her patients is given grim news about his or her cancer. She also battles with the frustration of office politics.

But even after a long shift, Damiani doesn't let her negative emotions surface until she gets into her car and heads home. "You have to learn how to pick and choose and not bring that emotion up," Damiani advises. "You say, ‘OK, I can deal with this. I can focus on the priority, and the priority is the patient.'"

As well as managing her own emotions, Damiani has mastered the skill of creating positive emotions in others. She recently received an award in recognition of her extraordinary sensitivity toward patients' needs and concerns. For example, one of Damiani's patients wanted to return to her native Mexico but, with an advanced stage of cancer, such a journey wasn't possible. Instead, Damiani brought "Mexico" to the hospital by transforming a visitors' lounge into a fiesta-type setting and inviting the patient's family, friends, and hospital staff to attend the special event.

Lisa Salvatore, a charge nurse at the recently built Leon S. Peters Burn Center in Fresno, California, also recognizes that her job involves supporting patients' emotional needs, not just their physical problems. "With burns, you don't just treat something on the outside," she says. "You treat something on the inside that you can't see." Salvatore also experiences the full range of emotions, including the urgency of getting burn patients out of emergency within an hour to improve their prospects of recovery. "I like high stress. I like trauma," she says.

Still, she acknowledges the emotional challenges of treating children with burns. "I deal with it and then I cry all the way home. I just sob on my way driving home." Anil Shandil, a medic from the 328th Combat Support Hospital in Fort Douglas, Utah, has witnessed more severe burns and injuries than most medical professionals. For two years at the Landstuhl Army Regional Medical Center in Germany, he aided soldiers who had been wounded in Iraq or Afghanistan.

The tour of duty was extremely emotionally taxing.

"You get a lot of severed limbs, a lot of traumatic brain injuries, a lot of death and dying," says Shandil. "So the compassion fatigue is rather high." People who work closely with victims of trauma often suffer compassion fatigue, also known as secondary traumatic stress disorder. The main symptom is a decreasing ability to feel compassion for others.

In spite of the risk of compassion fatigue, Shandil has volunteered for an even more challenging assignment. He and 85 other soldiers in the 328th are now in Iraq providing medical care for Iraqi detainees being held there by the U.S. military. So, along with managing emotions from constant exposure to trauma cases, these medics must also show respectful compassion to those who fought against American comrades. Shandil knows it will be hard. "Yes, these are people who were not kind to us. But as a medic, it's our job to care for them, no matter if that is your friend or your enemy."

Discussion Questions

1. To what extent do the three people featured in this case study manage their own emotions on the job? How do they accomplish this? To what extent do you think they effectively manage emotions under these circumstances?

2. This case study states that nurses and other medical staff need to manage the emotions of their patients. Why is emotions management important in this job? In what ways do medical staff alter the emotions of their patients?

3. Stress is mentioned throughout this case study. How does this stress occur? What stress outcomes occur for people in these types of jobs? How can these people try to minimize high levels of stress?

Sources:

"Providing Emotional Comfort,"

Journeys

(CentraState Medical Center Magazine), 4 (Winter 2008), p. 1; M. L. Diamond, "When Job Stress Bubbles Up, Keep a Lid on Your Emotions," Seattle Times, 4 May 2008, p. H2; B. Anderson, "First Stop on a Long Road," Fresno Bee, 25 May 2008, p. A1; M. D. LaPlante, "Medics' Compassion to Be Tested," Salt Lake Tribune, 17 September 2008.