Cognitive Reframing 

Stress can result from a change in one’s environment that is threatening, causes challenges, or is perceived as damaging to a person’s wellbeing. It is the body’s nonspecific response to any damage made upon it and a stressor, whether perceived as good or bad, the produces a biological response in the body. The response to stress and anxiety is affected by age, gender, culture, life experiences and lifestyle – all of which play an important role in our development into adults. In Psychiatric/Mental Health Nursing (NURS 411), I learned how our childhood plays an important role in how we turn out as adults. One of the concepts that has impacted me significantly from this course is the idea of cognitive reframing. Cognitive reframing is the ability to look at irrational cognitions (thoughts) in a more realistic light and to restructure those thoughts in a more positive way.

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I believe that nursing is one of the most demanding, fast-paced but rewarding degrees that one can obtain.. The nursing curriculum is designed to ensure the most dedicated and hardest working students can endure the rigor of the courses and profession. When beginning the upper division portion of the nursing program, classes such as Chemical Therapeutics (NURS 324) and Foundations of Nursing Practice (NURS 312 ) were the two courses that would be particularly challenging, but required to prepare us for the rigors of upper division. Our first exam of the semester was for Foundations of Nursing Practice and it covered an array of material – but this was the first time I encountered the difficulty of ‘nursing style questions’. These questions encompassed knowing what disease process was occurring during a scenario and choosing the best answer that will benefit the patient most. All of the answer choices are correct in some way, it's choosing the most correct answer that is challenging. I studied by rewriting notes and reading the book and went into the exam feeling confident. I made a 74. I was devastated. At this point, I did not think I was going to make it through the program. I remember fighting back tears until I got into the car and Face timed my mom to tell her the news. I contemplated dropping the courses because I knew it would only get harder and I did not want to give myself false hope. In the nursing program a grade of a 75 is what is needed to pass didactically. If a 75 is not obtained by the end of the course, you fail the class. A 75 must also be obtained before clinical can be averaged in which uses boosts the grades significantly.  The seniors in the program had made it clear to us that our goal was always a 75 or above.  I failed the Pharmacology exam even worse, and again I cried. I had to figure out how to study in order to be successful, but I also had to better prepare myself mentally and that’s where cognitive reframing began to play a role for me. At the time I had no idea that this concept had a name, but I knew I had to turn my negative thoughts into positive ones because our thoughts can manifest themselves into physical form. Instead of saying “I’m struggling” or “It’s too hard” I had to ask myself what I can do differently next time to be successful. Before going into exams, I give myself pep talks saying, “you got this” and “you’re almost there” instead of the past where I would say “I don’t know any of this.” I have truly come a long way as a student and believe that positive words, become positive actions, which becomes a positive life.

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Cognitive reframing outside of the classroom has been beneficial in the clinical atmosphere. There is often a lot of uncertainty and anxiety which causes an increased amount of stress. I can recall a significant encounter with a patient my junior year who was admitted due to a COPD exacerbation. He had only been married for a month and his health was slowly declining. I can remember going in to bathe him and being that he was a larger man, it took myself and 2 other classmates in order to be efficient and effective. He was very kind and talked to me about his life as a newlywed. At one point he said, “This is horrible, I can’t even do for myself anymore” and I responded with “There are so many things you helped us do. You washed your own face and you helped me wash your hair.” He pondered on it for a second and replied by saying, “I guess you’re right.” Teaching this patient this concept helped him to focus on all of the things he could do instead of what he could not. Being in the hospital is stressful enough. Cognitive reframing is important to implement in patient care to improve health outcomes. It allows the patient to view themselves in a more positive manner and restructure their thinking, aiding in the healing process.

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My Capstone experience has been a roller coaster. One of my most recent encounters was with a doctor who came on the floor yelling at a nurse and one of my classmates even though they were doing everything correctly. He was extremely rude and yelled to convey his message. I found myself questioning his behavior and I realized that he wanted the best outcome for the patient. Although it could’ve been handled more professionally, cognitively reframing that situation allowed me to see his overarching goal. Providing quality care is a common goal throughout healthcare. By understanding this, I was able to use this cognitive reframing to determine that the doctor was not trying to be rude but ensure the patient was not in any distress. This experience was valuable because as a nurse I will encounter many doctors and patients who are going through some very difficult times and I have to be able to maintain a positive environment.

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Cognitive reframing has become second nature in my life. As soon as negative thoughts cross my mind, I quickly shut it down with all the positive going on in my life. This concept has allowed me to grow significantly personally and academically and will continue to in my career. Utilizing cognitive reframing with patients under my care allows me to establish rapport and help them to better cope with whatever they may be going through. As a nurse, it is vital to provide the best atmosphere for patients to foster their healing. I will always strive to help my patients utilize this concept while under my care because I know how powerful words are and how they can easily influence the mind. 

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