Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients

The development of a psychodynamic group comprising seven female nurses was studied for 1 year (31 sessions). The group was part of a 1-year postgraduate training in patient-centred nursing. The members of the group all worked on the same unit; none of them left the unit or the group during the study. As the nurse-patient relationship is considered to be crucial for patient-centred nursing, the group sessions focused on the problems which the nurses experienced in their relationships with the patients. The objective of the group-work was to improve the nurses' ability to reflect on these relationships. The purpose of the study was to evaluate the group sessions, concentrating on the characteristics of patients selected for discussions, group process over time, and impact of specific patient characteristics on the group-work. Transcriptions of the tape-recorded group sessions were made for systematic analysis. A category system was developed and validated to rate reflection about the patient, the nurses themselves and the nurse-patient relationship. The results showed that the nurses over-proportionally selected terminally ill patients, as well as patients who were female and within a similar age range as themselves. These results could be due to an identification with these patients, causing increased psychological stress on the nurses. Throughout the year, the nurses' verbal activity and their reflections about their patients increased, whereas their reflections about themselves decreased. The need to withdraw and protect oneself by focusing more on the patient than on oneself might have been a strategy the nurses used to cope with growing stress.