Empathy, caring and compassion: toward a Freudian critique of nursing work

The aim of this paper is to summarise key psychoanalytic concepts first developed by Sigmund Freud and apply them to a critical exploration of three terms that are central to nursing’s self-image—empathy, caring and compassion. Looking to Menzies-Lyth’s work I suggest that the nurse’s strong identification as carer can be understood as a fantasy of being the one who is cared for; critiques by Freud and others of empathy point to the possibility of it being, in reality, a form of projective identification; reading Lacan and Žižek I propose that repeated research into caring and repeated complaint about barriers to caring can be understood as manifestations of the death drive first posited by Freud. I conclude that psychoanalytic insights suggest that caring roles can raise profoundly ambivalent issues for those who care but they can also point the way to freedom from painful and self-destructive symptoms inherent in such work

Resilience: part of the problem or part of the solution?

The article gives a summary of where notions of resilience in health first came from, how discussion of resilience has proliferated across widely different sectors, how it has been taken up by individualising tendencies in culture and finally how it is the perfect neoliberal tool. I want to also argue that if you understand something of the political and policy context of today’s healthcare it can allow you to avoid taking on personal responsibility for situations that have been brought about by others – by politicians and policy makers for example. This awareness can give you and your colleagues what I will call ‘critical resilience’

Caring after Francis: moral failure in nursing reconsidered

This discussion paper considers recent nursing failures. Drawing on a selection of key literature and on-going research, it argues that nursing failures are a possibly inevitable consequence of work in healthcare systems with their combination of cognitive, bureaucratic, professional and work related pressures. It also argues that nursing has a residual tendency to be viewed as primarily character-based moral work and that this can encourage understandings of causes of failures and their solutions in similar terms i.e. as moral failures of caring requiring recruitment of those with the appropriate characters. Drawing on on-going research with those training for the profession at an English university, it suggests that while the profession focuses on the recruitment of those with a ‘caring’ orientation it has not developed an adequate explanation to support new recruits in understanding the causes of inadequate practice. This leaves those entering the profession without a strong model with which to understand their own work or its failures what I refer to as ‘critical resilience’

Guest editorial: What's wrong with resilience

Editoria

Autonomy and caring: towards a Marxist understanding of nursing work

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of “caring” and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change

Lagrangian Cobordisms via Generating Families: Constructions and Geography

Embedded Lagrangian cobordisms between Legendrian submanifolds are produced from isotopy, spinning, and handle attachment constructions that employ the technique of generating families. Moreover, any Legendrian with a generating family has an immersed Lagrangian filling with a compatible generating family. These constructions are applied in several directions, in particular to a non-classical geography question: any graded group satisfying a duality condition can be realized as the generating family homology of a connected Legendrian submanifold in R^{2n+1} or in the 1-jet space of any compact n-manifold with n at least 2.Comment: 34 pages, 11 figures. v2: corrected a referenc

Professional identity in nursing: UK students' explanations for poor standards of care

Research concludes that professional socialisation in nursing is deeply problematic because new recruits start out identifying with the profession’s ideals but lose this idealism as they enter and continue to work in the profession. This study set out to examine the topic focussing on the development of professional identity. Six focus groups were held with a total of 49 2nd and 3rd year BSc nursing students studying at a university in London, UK and their transcripts were subject to discourse analysis. Participants’ talk was strongly dualistic and inflected with anxiety. Participants identified with caring as an innate characteristic. They described some qualified nurses as either not possessing this characteristic or as having lost it. They explained strategies for not becoming corrupted in professional practice. Their talk enacted distancing from ‘bad’ qualified nurses and solidarity with other students. Their talk also featured cynicism. Neophyte nurses’ talk of idealism and cynicism can be understood as identity work in the context of anxiety inherent in the work of nurses and in a relatively powerless position in the professional healthcare hierarchy

Slavery and jouissance: analysing complaints of suffering in UK and Australian nurses’ talk about their work

Nursing has a gendered and religious history, where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealised notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing’s professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis we focus on the nurses’ apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as ‘slaves’ or ‘martyrs’ in the healthcare system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse’s role. We argue that a remnant of a quasi-religious ethic within the profession makes it acceptable for nurses to talk about self-sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions

Autonomy, evidence and intuition: nurses and decision-making

Aim: This paper is a report of a study conducted to examine how nurses represent professional clinical decision-making processes, and to determine what light Jamous and Peloille’s ‘Indeterminacy/Technicality ratio’ concept can shed on these representations. Background: Classic definitions of professional work feature autonomy of decision-making and control over the field of work. Sociologists Jamous and Peloille have described professional work as being high in ‘indeterminacy’ (the use of tacit judgements) relative to technicality (activity able to be codified). The rise of the evidence-based practice movement has been seen as increasing the realm of technical decision-making in healthcare, and it is relevant to analyse nurses’ professional discourse and study how they respond to this increase. Method: Three focus groups with qualified nurses attending post-qualifying courses at a London university were held in 2008. Participants were asked to talk about influences on their decision-making. The discussions were tape-recorded, transcribed, and subjected to discourse analysis. Findings: Participants described their decision-making as influenced by both indeterminate and technical features. They acknowledged useful influences from both domains, but pointed to their personal ‘experience’ as the final arbiter of decision-making. Their accounts of decision-making created a sense of professional autonomy while at the same time protecting it against external critique. Conclusion: Pre- and post-registration nurse education could encourage robust discussion of the definition and roles of ‘irrational’ aspects of decision-making and how these might be understood as components of credible professional practice