Grounded theory study of the education of hospital nurses: How education for interpersonal relating influences the way nurses relate to each other in the college and on the ward.

This study was initiated as a result of a concern that the philosophy and practice of facilitative interpersonal relating espoused in pre-registration nurse education was not transferring with ease into educational interactive teaching and learning processes nor to the practice of nursing, particularly between nurses themselves. Working from one of the premises of humanistic education which is that people will integrate professional and personal learning so that they can be 'enabling' for others in professional practice, and combining this with the definition of nursing which nurses themselves gave in this study, which centred on the quality of their interpersonal relationships with patients, this research focused on:a) what constituted interpersonal relationships for the nurses studied, b) how the education of nurses addressed interpersonal relationships in teaching and nursing practice, c) how the development of interpersonal relationships as therapeutic enabling behaviour was practised among nurses themselves in educational and hospital ward practice. A Grounded Theory approach (after Glaser and Strauss 1967) was used to discover what were the sociopsychological processes guiding how nurses related to each other. A total of 176 nurses were sampled in this research. There was an initial purposive sample of 31 nurses from student nurses to tutors in the School of Nursing and trained nurses on some of the wards of a general hospital engaged in the study. This was followed by theoretical sampling with those same nurses and with other nurses outside the research site. The main method used was unstructured intensive interviews, many informal interviews, group discussions with some non-participant observations and use of curriculum documents. The main findings were that nurses felt emotionally and behaviourally ill equipped to form enabling (socio-psychological) relationships with each other, and for the most part unwilling to be 'enabling' to each other. In nurse education socio-psychological training was given, little priority over the 'clinical' curriculum and most tutors felt unable to teach the interpersonal curriculum experientially. Students recognised the need to develop interpersonal "enabling" skills; however, most did not demonstrate an investment in learning 'how to be enabling' in experiential education. The possible reasons for the lack of ability or lack of investment in developing "enabling" interpersonal relating were identified as core processes of personal vulnerability and fear of intimacy. These fears were shielded by the basic sociopsychological process of With-holding Self as a Strategy for Selfmanagement in which nurses seemed to be engaged. This was 'a holding back' from intimacy; that is being honest, spontaneous and creative as defined by Berne (1972) (Appendix H) Aligned with the 'With-holding' and in some cases a manifestation of 'with-holding' was the other basic sociopsychological process identified, which was: the 'Professional shield' as a self-protective sociopsychological mechanism protecting against personal rejection, (real or imagined) and its auxiliary category: 'Conformity to try to belong to the ward team' as a strategy to counteract the perceived overuse of hierarchical power and control mainly within the ward team. Fear of rejection and fear of intimacy were core categories which gave rise to the defensive strategies which nurses used in their interpersonal relationships with each other. As a result of these findings, some more definite questions could be asked which would form the bases of further research. One question addressing the sociopsychological relationships among nurses could be: What is the investment for nurses (as a profession) in maintaining unsatisfactory interpersonal relations which maintain a state of dis-empowerment? There is a recommendation for nurse educators generally to work within an educational psychological learning contracting for interpersonal skills training, and that such training be called psychosocial education to give it more prominence and status in the curriculum