Journal des soins infirmiers et des soins

When Paradoxes Hamper The Search For Meaning: The Psychodynamics of Work of Nurses in a Residential and Long-Term Care Facility

Abstract

Marie Alderson

Abstract This article seeks to analyze the effects of changes in the organization of work performed by nurses on long-term care wards in a residential and long-term care facility (centre d’hébergement et de soins de longue durée, CHSLD) in Quebec. The changes involved are 1) the introduction of a modular care system, a “living environment” approach and a computerized client-information system specifically for residential and long-term care centres (SICHELD).

Problem: The changes have been implemented in most of Quebec’s CHSLDs but have not been evaluated. Theoretical Framework: The theoretical approach used here is that of the psychodynamics of work, which was developed in France by C. Dejours and adopted in Quebec by M-C. Carpentier-Roy and others.

Method: The investigative methodology of the psychodynamics of work is fundamental to the examination. Study groups formed of nurses who volunteered to participate comprised 26 (out of a possible 76) nurses representing all the wards and all the shifts in the CHSLD.

Results: Major sources of suffering take the form of paradoxes and undermine the meaning of work. The suffering the participants experience is evidenced by their resorting to a wide range of defensive strategies.

Implications: Various considerations related to the structure and organization of work raise important questions about the nurses’ role. The discussion expands on the issues of role conflict, the ambiguous exercise of power and a broad search for identity; the situation is marked by an identity crisis and an impasse in action