Abstract
This work builds on our experience with a group of twelve nurses, ages twenty-four to thirty, all on their first assignment in a hospice in the province of Rome, where they care for end-stage cancer patients. This new facility asked us to create a sharing space where the nurses could feel supported and monitored with respect to the tough situations they face from time to time with patients and their families. The dual purpose was immediately clear: to create and integrate the group and, at the same time, meet the immediate need of discussing the most difficult cases.
In attempting to deal with these demands, we sought a method for creating a work group using group discussion and the recognition and sharing of emotions. It seemed to us that the “weaving thoughts” method created by Johan Norman and Björn Salomonsson (2005), adapted to the context of the hospice, was the most appropriate way to allow the group to grow and to learn how to modulate emotions.
This method follows very precise rules whose principal aim is to discuss the problems associated with the presentation and discussion of clinical material and to deal with issues related to this difficult work. The method is meant to help the group take into account and develop other points of view. Appropriately called “weaving thoughts,” the method was inspired by Bion’s formulation “thoughts without a thinker” and by his Experiences in Groups (1961). Group participants reflect on the material presented in a way that can be described metaphorically as the creation of a tangle of thoughts that emerge from the material itself. The purpose of the method is to foster an atmosphere of teamwork that allows thoughts to wander, avoiding the establishment of basic assumptions that would compromise the participants’ integrity.
Objectives
The aim of our study is to observe and describe a group intervention with hospice nurses using the “weaving thoughts” technique to assess patients’ treatment compliance, the results that can be achieved, and any changes within the group. In particular, the observation will be aimed at
Assessing how the group climate changes
Assessing how the experience of the structure and of colleagues changes
Analyzing the clinical cases presented
Monitoring the burnout level
Assessing the satisfaction level regarding the support received
Assessing the increase in the ability to recognize and manage emotions
Materials and Method
The proposed method, based on Norman and Salomonsson’s research, includes a presentation followed by participants’ comments and free associations. The group is led by a moderator whose task is to allow participants to speak, but without intervening with his own free associations. The basic idea is that the participants’ free associations can help “weave” a network of thoughts helpful in understanding deeper levels of the nurse-patient relationship.
The project involves a one-and-a-quarter-hour meeting with the twelve hospice nurses every fifteen days. Three self-report questionnaires are administered before the meeting cycle begins (t0) and at the end of the meetings (t1); two self-report questionnaires are administered during the cycle to monitor group performance. Materials include (1) the TAS-20 (Toronto Alexithymia Scale; ); (2) FATA.S.G (specific and nonspecific factors in the groups); (3) the GCQ (Group Climate Questionnaire; Mackenzie 1981); (4) the MBI (Maslach Burnout Inventory); and (5) written material regarding the clinical cases presented.
Results
The first observational results show an increased ability in the nurses to recognize and talk about their emotions, less conflict, and a greater capacity for dialogue and discussion. The group is seen as a resource, and through the narration of clinical cases a space for debate without fear of questioning has been created.