Group discussions with nurses in a hospital for alcoholics: Some problems confronting nurses working in a therapeutic community

Abstract

IN RECENT years considerable attention has been focussed on the problems of psychiatric nursing and on the changing role of the nurse in a psychiatric unit (1. 2.3,). As interest has shifted from the patient’s intrapersonal conflicts to include his interpersonal relationships, there has been a change of emphasis from individual psychiatric treatment in a custodial setting to treatment within a therapeutic community. The modifications in social organization of a hospital unit accompanying such changes in therapeutic approach have recently been summarised by Maxwell Jones c4 ), who emphasises that “ . . . . patient-patient interaction or nurse-patient interaction has now to be analysed in much greater detail than formerly when little attention was paid to what went on at this relatively untrained level.” He indicates that special training is needed to equip the student nurse for her therapeutic role. An early approach to provide further training for the nurse on the ward was described by Ackner et al. in 1955 (5). The value of group methods for teaching nurses and for helping them to overcome their high initial emotional barriers against learning psychiatric techniques was stressed by the World Health Organization Expert Committee on Psychiatric Nursing (l). Main c6) reported in detail on a rather specialized group of nurses which was formed to consider the problems aroused by a special type of neurotic patient. He described the strains imposed on nurses by the care of certain types of patients and the increase in skill acquired by the nurses as they retrospectively discussed and analysed the difficulties that had occurred. Other instances of the use of group methods for providing training for nurses in a clinical setting have been reported but only in very general terms(‘* *I. The aim of the present paper is to describe in some detail the nursing problems in a psychiatric hospital for the treatment of alcoholism as they became manifest in regular group discussions of the nurses with a psychiatrist. Some of the problems were related to the impact on psychiatrically untrained nurses of their first contact with emotionally disturbed patients and psychiatric treatment methods, others