Managing the stresses of nursing people with severe and enduring mental illness: a psychodynamic observation study of a long-stay psychiatric ward.

Abstract

The task of nursing people with severe and enduring mental illness can evoke stresses and anxieties for staff which are not consciously known about, but which, nevertheless, impinge upon the quality of care delivered. As a way of exploring this issue, the interactions between staff and between staff and residents in long-term residential care were observed. Alongside efforts to rehabilitate residents, nurses behaved in ways at variance with this task. These behaviours seemed to serve a function of protecting the staff group from the unconscious anxieties the work provoked. These can be understood in terms of three fundamental anxieties regarding the client group, stemming from their mental illness (fears of 'madness' and loss of control), the severity of their disabilities (responsibility and vulnerability), and the chronicity of their difficulties (failure and despair). Better ways of managing these anxieties may be possible if they can be known and thought about.