This case study of George, age 48, presents a classic Type A personality. George operates under a consistently high level of emotional and physical stress. While some of this stress is the result of his work, part of it is also self-imposed and is the product of a personality type who often refuses to seek help unless in a crisis. George works two demanding high-stress jobs. One is as a machinist with a construction company, which is very physically stressful. The other is as a cab driver, which can place physical stress on the patient due to long hours of driving. Although only middle-aged, George has suffered three heart attacks. There is empirical evidence to suggest that there is an association between personality and susceptibility to suffering cardiac conditions: “The hypothalamic-pituitary-adrenal (HPA) axis and the stress hormone cortisol provide key links between emotions and the heart. The HPA axis controls various body functions by releasing hormones into the bloodstream” (“Type D Personality,” 2018, par.7). Genetics, smoking and poor lifestyle decisions can likewise increase a patient’s susceptibility to heart attacks. Although it is not stated, working long hours and shift work in general often can reduce the likelihood a patient has time to exercise and eat healthy meals. Thus irregular work and sleeping patterns are likewise associated with increased cardiovascular risk (Mosendane, Mosendane, & Raal, 2008). George’s patriarchal cultural attitudes about women working and the need to be a breadwinner clearly intensify his...

George is very resistant to the idea of his wife working and shouldering some of the financial burden of the family.
Crisis Paradigm

Although George may not feel as though he is living in a state of crisis, his youthful age combined with the risks posed by his heart attacks indicates that he warrants a crisis-based approach in terms of his treatment. His unwillingness to seek help likewise suggests that such an approach may be needed. One helpful model for emotional crisis intervention is the transtheoretical model of change, which suggests pre-contemplation, contemplation, readiness, action, maintenance are the steps involved in any change process (“Transtheoretical Model,” 2018). Currently, George is in the pre-contemplation stage, in which he denies the need for change entirely. Pre-contemplation is characterized by a lack of awareness and a lack of the ability to connect behaviors like smoking, stress, and working long hours with negative consequences. There is no indication that George has made any lifestyle changes since his previous heart attacks. In fact, his views about his need to work hard have appeared to become even more entrenched.

Given this fact, an important part of the nurse’s job is to convince George about the need for change. This means laying before George the statistics that his health status is not normal. Going over George’s lifestyle, including his diet, exercise, and sleep habits, would also be useful as a wakeup…