Using psycho-dynamic small group work in nurse education: Closing the theory-practice gap?

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Using psycho-dynamic small group work in nurse
education Closing the theory-practice gap?

Helen Allan Division of Health Social
Care Faculty of Health Medical Sciences
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Aim

• Illustrate the role of psychodynamic small group
  work in integrating theory and practice for
  nursing students

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Background

• Menzies-Lyth
• The nurse-patient relationship changes ordinary
  social relationships and there is a need to
  manage the intimate and emotional nature of these
  clinical, non-social relationships.
• Fabricius
• As well the clinical dimension of care, there are
  the social and emotional processes at work in
  interactions with patients.

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The psychodynamic approach

• Psychodynamic model
• emotions shape our being in the world and
  reactions to the world
• Small group work can help nurses and doctors work
  therapeutically through reflection and learning
  from reflection
• Balint Menzies Tavistock Clinic
• Peplau
• Gilmartin 2008 Ashburner et al 2004 Clifford
  2004

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Psychodynamic approach to emotions

• The study of the psychological forces that
  underlie human behavior, which emphasises the
  interplay between unconscious and conscious
  motivation (Brown Pedder 1991)

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Personal experience as a tutor

• Participated in small group work as a tutor run
  by Julia Fabricius
• Fabricius J (1991a) Learning to work with
  feelings a psychodynamic understanding and
  small group work with junior student nurses.
  Nurse Education Today 11,13442.
• Fabricius J (1991b) Running on the spot or can
  nursing really change? Psychoanalytic
  Psychotherapy 5, 97-/108.
• Fabricius J (1995) Psychoanalytic understanding
  and nursing A supervisory workshop with nurse
  tutors. Psychoanalytic Psychotherapy 9, 1729

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My experience with personal tutees

• Small group supervision
• Meeting regularly, bringing clinical material
• Staying with the emotions
• Managing emotions to help them learn
• Support to help them learn
• Containing to help them learn

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Presentation of some supervision material

• Clinical material is brought to supervision
  sessions by students
• Reflected on in the supervision
• Reflected on by the supervisor afterwards
• Journaling to help reflection

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Using small group work to integrate the T/P Gap

• The theory practice gap can sometimes feel like a
  fact of nursing life it exists but of course
  each of us reproduces it in our teaching (as I
  have show) and in our practice (as the material
  described here shows).

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Using small group work to integrate the T/P Gap
(contd.)

• It is possible to integrate theory and practice
  for our students and ourselves if we reflect and
  recognise the split and projection by working
  psychodynamically.
• By integrating theory and practice internally, it
  may be possible to integrate at the structural
  level also.

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Conclusions

• Of course, such work needs training and an
  acceptance that working with feelings is firstly,
  possible and secondly, desirable I say this as
  resistance to participating in small groups has
  been well described in the literature (Ashburner
  et al 2004Fabricius 1995Gilmartin 2008).

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Conclusions (contd.)

• Arranging meetings once in placement
• Large cohorts means groups divided and personal
  tutor groups not part of same curriculum group
• Geography
• Financial
• Resistance
• Less with students than trained staff