Healthcare Training Institute - Quality Education since 1979

Section 16
Domineering Resident Technique #1
Recognizing your Denial and Stages of Stress

Table of Contents | NCCAP/NCTRC CE Booklet

After reading the "Introductory Comments" at the beginning of this manual, if you find yourself saying, "What's the big deal?  Residents control my program?  No way!", ask yourself, "Is it possible to not know that you are the target of a domineering resident?" As odd as it sounds, yes.  Denial allows this to happen. What do I mean "Denial allows this to happen?"  Denial is a process we all use to pro­tect ourselves from something that we think is so personally threatening that we could be immobilized if we face it head-on. Denial blocks our awareness of a painful reality. It is important to realize that denial in its various forms is not deliberately deceitful. It is automatic and happens below our conscious awareness level. It is a useful unconscious safety-valve that the mind invokes to keep from being overwhelmed by circumstances.

Denial is adopted by individuals, both staff members and Domineering Residents, volunteer groups, entire organizations, and even on a larger scale, nations. For brevity here, let’s talk only about the staff member’s denial, a self-denial of an unacceptable, painful reality.  This reality may be “Yes… I have a Harry or Hester who really pushes my buttons, and I allow this resident to control me and even my program!”

However, the term “denial” encompasses many forms that serve to protect you.  All forms of denial involve self-talk, adopting a script that when repeated serves to convince your own mind that the denial is the right thing to do. Here’s what I mean.  Below three common forms of denial are described.

Simple Denial
Maintaining that a resident is not acting domineering towards you, despite evidence that he or she is, is known as the old “see, hear, and speak no evil” approach. When staff discusses what the domineering resident does, do you want to leave the room?  Do you ever actually leave the room, believing that “out of sight, out of mind” is the best, perhaps emotionally safest, stance to take?  If you are protecting yourself from the pain of dealing with your "Domineering Resident Situation" by denying, you may be practicing "good old avoidance."

Minimizing
Minimizing involves admitting that the resident is domineering, but downplaying it in such a way that it appears to be much less serious than it is. The lines “It's no big deal!” and “I have to grow a thicker skin, that’s all!” run through your mind.  You disregard or push down your true feelings of frustration with this resident, and continually minimize a situation.  Thus, you attempt to invalidate the way you feel.

Rationalizing
Rationalizations are offering reasons or justifications for the behavior of the domineering resident. To make the resident’s dominating attitude seem like acceptable behavior, you convince yourself that the domineering resident’s tactics are some­how justified. This leaves the you with no one to blame but herself. “I must have done something to cause her to criticize me.”  You take the blame, let the Domineering Resident off the hook and rationalize by saying to yourself something like, "Well, gee, she does have cancer."  Or "Gee, she has been through a lot."  Or "Gee, she is 80 years old."  Well guess what?  If someone was a controlling, ill-tempered 20, 30, 40, etc. years old, they are usually a controlling, ill tempered 80 year old.  Sad, but sometimes true.  Right?

Stages of Stress
Some Domineering Residents are the source of your stress—the resident and the havoc he or she wreaks is the stressor. It is the responses of your body and mind to stressors that determine the extent of damage inflicted. The sequence of biological stress is well known. Here are the three stages, as described by Hans Selye:
1. Alarm—the turning on of your entire body’s defense systems:  This enables the “flight or fight” response in the face of danger, physical or psychological. Unfortunately, the body reacts to fright from the impending pounce of a tiger the same way it does to a verbal attack from your Domineering Resident, as she exclaims loudly, perhaps to the CMS Surveyor, "I want Bingo!" Alarm triggers the sympathetic nervous system that releases adrenaline to deal with this stressor.
2. Alert State—the maintenance of an alert stage: Your body expects, and needs, this Alert Stage to be turned off so that normal functions can resume. Resistance to the domineering resident, however, may be continuous, and that depletes the body’s defenses. If you stay in resistance and, therefore, this alert stage too long, your body reacts and actual physical damage occurs even when the stressor is gone!
3. Exhaustion—a full system breakdown, mental and physical: It demands that the stressor be removed, or it will claim your life. To get to exhaustion, you have to ignore all the warning signs that your body gives… all the back pain, sleepless nights, headaches, raised blood pressure, sugar cravings, etc. Of course, these can lead to death if the stressor never disappears and your body and mind continue to fight indefinitely

Would it be beneficial for you to continue the above exercises to increase you awareness of these stressors in your Journal?