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6° Convegno Europeo di Infermieristica, an online event with local hubs, 4-7 October, 2022. enc.22.eu
Title: Experiential Group for Trainee Nurses: a Strategic Model.
Authors
Michele Battuello
Romina Bilancini
Introduction.
In 2019 the organizers of the Nurse’s course at University of Rome “Sapienza” asked me to manage a lesson for the mourning process of students.
I choose to set it as an experiential group because they were at the 3rd and last year for graduation and they had just clinical experiences, facing sufferings and deaths of patients, so there were feelings, beliefs and emotional needs that were looking for answers.
The scientific literature and the stories of students/professional nurses are full of awareness and requests concerning emotions that arise in the relationship with patients but it is not easy to find specific courses, inside training programs, that offers experiential groups to access to the elaboration of these feelings.
In the last years anyway, it is increasing the interest to general “emotional learning” mostly for healthcare professionals and the number of group approaches to the field is growing but a common procedure has still to be found.
The personality of every single patient, mixed with the fear of sickness and death, reflects and activates strong emotional responses in nurses and also in all the professionals connected with health.
Everyday, we, healthcare professionals, are engaged with feelings that directly but mostly indirectly affect our quality of life with significant consequences for personal relationships and professional ones and it is also reported how the emotional impact within students causes many drops out as well as burn out so it is for senior professionals (Viviani et al, 2019).
So, as a psychotherapist, the opportunity to conduct an experiential group with students was a challenging task but I had to imagine and organize the group’s setting with aims and scopes because the experience taught that sharing emotions and feelings is a part but not the whole of an experiential group.
Some papers underline the need of experiential groups for students to learn empathy (Scott et al, 2009) but what it’s also true is the need of a deeper and more structured approach to the person, then to the relationship.
I underline that more structured could mean, in my approach, that the intention is to go to the core of the person/student, not using techniques or protocols (Gomez-Diaz et al, 2017).
Furthermore the big initial topic named “the mourning process” implies, in truth, many previous steps to be really addressed and it represents the arrival point of every relational work that leads to the capacity of separation that is for excellence, death.
The question that involves people who work with health is how is it possible to manage the emotional reactions to patients’ sufferance opening debates between involvement and detachment into the relationship, like an Amleto’s existential dichotomy.
The explanation closer to the reality of human’s experiences is given by the capacity of separation between the Self and the other: the more the professional is free from unsolved personal relation issues (of the past and sometimes of the present) the less he/she will see them reflected or will project them into patients relationship.
As a consequence of that there is the possibility of being involved and/or be detached that follows a natural process of building relationship different from every single person, therefore every single student/nurse.
The less we are scared by emotions, the more we can manage them as the here and now proposes and inspires us, with no application of hypothetic protocols.
The effective experience proposed inside the Group is the emotional dimension starting from every student’s feelings and personal experience, to proceed to more mature level of introspection and capacity of separation.
For this reason the model includes the presence of a certified psychotherapist, a specific setting and a methodological approach to the relationship.
The model.
The Group is organized in 6 meetings of 2 hours each, weekly, in the last semester of the 3rd year.
The approach is Strategic and follows basic principles that match the model of Group Training in Psychotherapy in its firs part that is the expressiveness one (Battuello et al, 2022).
In times of hyper specialization and analysis of smaller details of the total, as in organic medicine, the specialist must be thought and treated and the opposite, in an essential, basic, human way.
This is the starting of the group training in psychotherapy that represent the time and space for the person/student of who the school must take care before the patient.
The same could be imagined for nurses: the emotional learning considers the student first, as acknowledgment of human being before professional.
The emotive dimension of mourning becomes the emotive dimension of the person/student that is the first reality to be considered in the group process.
All this is included in the physiology of the relationship of the person that is the leading path of the model.
- Role of the conductor. The psychotherapist is involved in first person in group’s dynamics and he/she is not an external observer and/or only an emotive facilitator but he is active part stimulating the participants with his feelings, thoughts, personal experiences in a sort of cancelling the role to engage a genuine climax.
At the most, students, as inside in group psychotherapy, try to escape from introspection using the external facts of their clinical experiences: even if these are full of emerged and submerged emotions, they also could be defensive tricks.
Students also perceive the conductor as a Teacher and a member of University’s stuff and could maintain a detached asset inside the Group due to the role.
Therefore is so much important for the psychotherapist to be really one with and together with the others of the group to encourage intimacy.
In the specific experience of this presentation, students are ending the graduating course therefore they are in a period of extreme separation’s defences due to the arriving adult/professional time and the definitive lost of childhood.
The verbal concentration on professional issues inside the Groups could reveal protection against the growing up and assume own responsibilities.
They had also deal with many touching and expressive experiences during the clinical training and sometimes there is a strong discrepancy between personal life and its emotional experiences and training one.
- Students’ needs.
Actual times offer us many relational issues concerning adolescence, internet and the contraposition between real and virtual and students are grown with poor capacity of genuine and social interact therefore the impact with the clinical sufferance is hard and mostly protected with defences from emotions.
The protection is sustained by a cognitive conviction to be able to manage all the feelings that are coming from patients and students are convinced to be capable of splitting enough between professional and personal.
I feel groups very immature on the emotional side where immature means to be still bound to original needs and at the opposite side to find the way to be adult as the cruelty of the clinical experiences is asking.
They just want to be answered as still young first, to allow them selves to change into the professional adult, for this reason the conductor of the Group must express himself at his most.
During the first meetings the focus is to remain and stay in the here and now of the group and of the single, allowing the introspection of the individual and the capacity to reflect and to touch personal issues also expressing them inside the group.
The psychotherapist is in the position of giving feedbacks and sometimes interpretations of the dynamics emerged, integrating the mirroring function with the changing one to create new visions of individual issues and the courage and freedom from judgement of self, then of the others.
The active position of the psychotherapist has also the focus of enhancing the toleration to the wider range of emotional frustration as an experience fundamental for the tolerance of patients’ reactions, emotive answers and difficulties.
At this point the student is capable to interact with the group and to apply a genuine listening of the relationship because of the introspection and so it starts a more effective exchange.
The verb “to learn” is replaced by “to experience” because the process can’t be learnt but only felt in the life of the group and we describe it as follows:
- Student contacts own feelings: she recognizes them (no fear, no judgment).
- Student can express emotions mostly when she tolerates others’ answers even if they are not always pleasant or nice.
It is the work on the Self that is the first step for the experience of the relationship.
- Student listens to the others members and the emotional resonance doesn’t activate personal and past issues that usually lead to fears there fore to defence mechanisms.
- The emotional resonance is related to the capacity to let the self to be touched by the other with no escape from own conflicts.
- The relational answer in this way is more effective than possible because it is the result of the recognition of the other. Recognition is what we need, included patients, at the most.
- The process opens up also to the capacity of refusing what it’s coming from the others, in other words to say no that sometimes is necessary and helpful for both patient and professional.
Saying no is inside the relationship as much as saying yes but it is usually judged from the inside and the outside as a proposal of human refusal and of marginalization, discrimination of the other.
Actually, when No comes from a relational process as described, it is an answer of recognition of the person we are with, as it is for patient.
Conclusions.
This process can lead to the true possibility/capacity to deal with sufferance and deaths of our patients thanks to the acceptance of their and, as a consequence, of our fear and sadness.
The Group structured following the Strategic Experiential approach guides students to the path of expressiveness including the steps we described.
The capacity of genuine relationship has the aim to give us back the freedom to live and express what we are really feeling in that moment because it is strictly connected to the here and now of that relationship that includes the here and now of that 2 persons.
Therefore crying and suffering as to feel quiet and relaxed and also sometimes not so touched by the situation it is allowed from the relationship itself.
The experiential group for trainee nurses collocates itself between a training and a psychotherapeutic group because personal and collective dynamics are faced, interpreted and transformed.
To take care of patients requests, in advance, the taking care of the professionals.
The relationship with patients is, at first, a relationship between human beings and it’s impossible to think a way to manage some feelings, emotions and reactions. The less we protect, defend and try to control them, the more we can use our professional (included emotional) skills to be of help to patients that includes the capacity of relationship.
Michele Battuello