Optimism vs Pessimism: A function of X?

Is the glass half empty or half full? Most people can recognize their tendencies of being optimistic and pessimistic; some even distinctly categorize themselves as an optimist or a pessimist. A lot of times at the bedside, we truly want to be optimistic for our patients and families, but may have difficulty showing it, especially when family members have lost hope or when our empirical data, such as lab work, is trending the wrong way. So how can we maintain optimism while also being realistic? And is there such a thing as being overly optimistic, which can give a sense of false hope and security?

First, we as humans hate to consider the worst case scenario in our mind as reality. I believe humans are naturally optimistic, and being pessimistic generates over time based upon past experiences that have, in our minds, failed. So naturally, we attempt to block out the worst case scenario, trying to rationalize that it is impossible or unlikely. In contrast, we also generally believe “if it’s too good to be true, then it probably is,” much thanks to pessimism. So when we are given a situation when it seems “too good to be true,” we would like to believe it (as the natural optimistic human), but deep down we think there is a catch (as the damaged pessimistic human).

I’d like to give an example/scenario. Say you have a newly extubated patient. This 60 year-old patient was vented for 5 days for pneumonia. The only significant medical history is mild COPD from 15 years of past smoking.

Worst case scenario: I suppose death would be the worst case scenario. Second to that, your patient needs to be reintubated due to a low pH, high pCO2, and low SpO2. And we’re back to square one or worse.

Best case scenario: Lungs sound clear, blood gas is in your ideal range, CXR is clear, your patient wants to get up and get moving. Let’s not forget they’re alert and oriented too.

How would you think this would go? I know there is limited data to make a “knowledgeable” conclusion. What are his electrolytes, hemoglobin, etc?

I hypothesize most people would predict something in between because of that battle between optimism and pessimism. He’ll stay extubated, but will require tedious rehabilitation. We want him to soar with flying colors, but may have difficulty believing someone on a ventilator for 5 days and a past history of COPD will reach the best case scenario.

On another note, a lot of times families are so excited to see that “breathing tube” come out that they lose focus that their loved one is still unstable; they may say, “You’ll be home in no time now!” This is a very optimistic statement and may help the patient attain daily goals to reach that ultimate goal of going home. On the other hand, the patient could go downhill and need reintubation; thus, the family is devastated, leaving a feeling of helplessness and failure.

We cannot predict the future and can only speculate. As nurses, we maintain a sense of optimism, hopefully in doses that are good for the patient and family. We don’t want to be Debbie downers, nor do we want to build them up, only to result in devastation.The exact dosage is unclear, as there is a fine line between optimism and pessimism. I wonder if anyone can actually prescribe that exact dosage.

Healthy Optimism = {F(x) + G(x)} – ❤

Maybe not.

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