INTERPERSONAL LEARNING IN GROUPS - AN INVESTIGATION

The dissatisfaction of patients with communication in health care has largely been addressed by providing more communication skills training. Research into why skills training might be ineffective has identified various factors, which include organizational resistance, personal defences against anxiety and a need for personal reflection and support. In one college of nurse education small group discussion and reflection had become established practice for students in their first and second clinical experience. The groups met once weekly and were facilitated by a nurse teacher. Discussion was unstructured and focused on the nurse's interpersonal relationship with his or her patients. This project examined one such group and sought to examine the use of small group reflective discussion by nurses about their patients as a means of improving interpersonal communication. The research was conducted over a period of 6 months with nine student nurses meeting once weekly during their first two episodes of clinical experience. Kelly's personal construct theory was used and two repertory grids were constructed by the group. One grid examined processes and change in intrapersonal construing, and the other grid examined processes and change in construing about certain patients. These grids were completed by the students at the beginning and at the termination of the groups. Notes were taken after each group meeting, which recorded impressions and processes; these were discussed once weekly with supervision. The notes were analysed using a grounded theory methodology. The results show some changes in patterns of constructing in relation to self which indicate an increase in anxiety and reluctance to self-reflect. The need for defensive structures in order to facilitate self-reflection is discussed in the light of the qualitative analysis. Finally the value of this type of work is supported by evidence of the group working as a social microcosm. The limitations and indications for further research are noted, but this project supports the contention that in order to be truly effective those who come in contact with the emotional needs of patients need some support and reflection for themselves. The arena for this type of self-reflection and support could be small group discussion. However, it may be necessary for those who facilitate this type of group to be aware of the need for some defensive structure.