Isabel Menzies Lyth revisited institutional defences in public health nursing in South Africa during the 1990s

Abstract

In this paper we revisit Isabel Menzies Lyth's work which sheds light on institutional defences in British hospital nurses during the 1960s. Today this work continues to inform dynamic organizational consultation in diverse areas, but to our knowledge it is not well known or applied by the nursing profession. We describe clinical examples of the work patterns of nurses in a tuberculosis-control programme in the Western Cape, South Africa, to illustrate examples of splitting, detachment and depersonalization. We discuss the tension between caring for the sick individual and containing an epidemic which threatens public health. We argue that Menzies Lyth's framework still serves as a useful tool for understanding the dynamics of relationships between health providers and patients, and that it is robust enough to provide useful insights in the South African public-health context.