The patient,the nurse,his life and her mother: Psychodynamic influences in nurse education and practice

Using the film The Cook, the Thief His Wife and her Lover (from which this paper's title is borrowed) as a powerful illustration, the paper examines some of the unconscious processes which form part of everyday life for nurses working in the community, particularly on the wards of our hospitals. It is an attempt to describe some of these processes and to understand the conditions that promote them. With acknowledgements to the pioneers in this sort of work, such as Main, Menzies-Lyth, Trist, Bamforth and Jaques, the paper looks at the ethology of institutions and at activity that takes place on the boundaries between self and other, between the inner world and external reality, and between various levels in the hierarchy.

The paper identifies some of the ‘routines’ which grew up in nursing (and those which have replaced them), the unconscious purpose of which is to safeguard the emotional and psychological integrity of the nurse, through creating a distance between herself and her patients. The paper argues against removing these necessary defences until more helpful alternatives are in place. To fulfil this aim, it recommends that clinical supervision and support seminars should become a regular part of all nurse-training programmes, and should continue throughout the professional life of the nurse.