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

The task of nursing people with severe and enduring mental illness can evok e stresses and anxieties for staff which are not consciously known about, b ut which, nevertheless, impinge upon the quality of care delivered. As a wa y of exploring this issue, the interactions between staff and between staff and residents in long-term residential care were observed. Alongside effor ts to rehabilitate residents, nurses behaved in ways at variance with this task. These behaviours seemed to serve a function of protecting the staff g roup from the unconscious anxieties the work provoked. These can be underst ood in terms of three fundamental anxieties regarding the client group, ste mming from their mental illness (fears of 'madness' and loss of control), t he severity of their disabilities (responsibility and vulnerability), and t he chronicity of their difficulties (failure and despair). Better ways of m anaging these anxieties may be possible if they can be known and thought ab out.