Nurse-Patient Interaction
DATE: 1976
LENGTH: 14 min
DIRECTOR: Barnett Addis
PRODUCER/PUBLISHER: Barnett Addis, Neuropsychiatric Institute, UCLA Center for the Health Sciences
CATEGORY: Educational & Instructional, Sound, Color
In the 1960s and 1970s, the psychologist Norman Kagan created an educational model known as Interpersonal Process Recall (IPR), a training method used to develop interpersonal skills and self-awareness.
Commonly used to train nurses and counselors, Kagan’s method employed videotape recording and playback to allow trainees to reflect on how they interacted and so to encourage their awareness of the relation between intentions and behavior. In practice, this involved the trainee being videotaped attending to a patient or client, after which the trainee was asked, upon viewing the video, to stop the tape and comment on the interaction. The aim was to use the incidents captured on video to enable trainees to explore their own affective responses to a wide range of interpersonal challenges.
The movie presented here adopts a different—albeit related—method of encouraging nurse trainees to reflect on their responses to how patients and co- workers present themselves, verbally, physically, and emotionally. Based on Kagan’s affect-stimulus technique, the camera takes the perspective of a trainee nurse who is presented with a series of different people who speak directly to the camera. Thus, the viewer is put into the situation of the trainee nurse and is invited to respond to and reflect upon the different, sometimes difficult, interpersonal situations he or she encounters. The film would have been shown as part of a broader training program in which the training group—having been told to imagine themselves as the nurse to whom the person on screen is talking—was asked to consider and discuss their affective and verbal responses to these situations.
The people the viewer encounters are a mix of patients and co-workers. Sometimes they praise the viewer; sometimes they question his or her competence or emotional maturity. Some proposition the viewer, some are confrontational, some vulnerable, some passive aggressive. They all provide puzzles of motive and meaning. Patients may be inarticulate or articulate. Their words may say the opposite of what they seem to mean. Some are resentful, others vulnerable looking for empathy, others patronizing, and others looking for a date. There is tragedy in some of their stories, appeals for support, attempts to come to terms with illness, to understand how it has changed their lives. Kagan told instructors to use vignettes such as these sparingly so as to adequately explore trainee reactions to them. He also encouraged instructors to cut and splice films to suit their purposes: student responses to a film might be videotaped and used in IPR sessions. Film/videotape was thus used to dramatize difficult interpersonal situations, to elicit viewers’ responses to these situations, and to record these responses for further discussion.
Conclusion
Nurse-Patient Interaction is very different to the earlier films in this collection. The first four are all stories of transition or transformation, unfolding processes with a resolution internal to the film. In The Army Nurse, the nurses morph from women to army nurses, and help wounded service men transition towards recovery, some to return to the U.S., others back to the front. In Evening Care, the corpsmen help sickroom patients transition from the day-time activities to the quiet of night, calming their patients, monitoring the very sick. In Girls in White, Betty transforms from woman to nurse, as do her co-trainees, as they prepare for their chosen careers. And in Unsuspected, Johnny’s near accident helps Linda Thorpe persuade Johnny Walsh’s mother to go into a sanatorium, where she is transformed from a public health threat to a non-threat and from ill-health to health. Mary Walsh’s story is a restoration narrative, a story of her recovery from tuberculosis to health, as well as a conversion narrative, since Mary (unaware of her illness) has to be persuaded that she is a danger to her family and that she must follow medical recommendations.
By contrast, the narrative trajectory in Nurse-Patient Interaction is open-ended. Each short, even abrupt sequence breaks off without resolution, and none give clues as to the outcome, no solutions to the issues raised by the sequence, no conclusion. In some of the sequences, there are hints of the surveillance delineated in the other films. Through the camera, the viewer/nurse trainee observes patients and listens to them, but unlike the earlier films the consequences of this surveillance are not portrayed, nor are the patients the obedient grateful figures of the other films. Nor it seems are the nurses simple helpmates to their white-coated male colleagues. They are subject to angry tirades from two, or praise that may be something more. The professional roles of the nurse, so clearly outlined in the earlier films, are tested by patients and colleagues alike. Without a conclusion within the film, the viewer is asked to complete the story, perhaps under surveillance by another camera or instructor, after which iteration their reactions would be reviewed.
Finally, Nurse-Patient Interaction makes a very different use of fear to the others. While there is fear in the other films—the fears of wounded patients, the fears that Mary Walsh’s illness might affect her family, and perhaps the fears of failure among the nurse trainees—they are all contained within a reassuring narrative in which these fears are eased (for the patients) by the professionalism of the nurses and doctors who offer reassurance and the hope of recovery, and (for the nurse trainees) the inspirational conclusions of each movie. Nurse-Patient interaction, however, made one sort of fear—interpersonal fear—central to its educational method. The assumption behind this film is that fears—such as giving and receiving affection or expressing and receiving hostility—limit the ability of nurses to work effectively with colleagues and patients alike. The film sequences (and the videotape recall component) aimed to help trainees experience and accept these fears, and by extension gain skills necessary to respond to these and other difficult inter-personal situations they might encounter in their professional life. If the earlier films in this collection scripted all interpersonal behavior, and portrayed the outcome of this behavior within the movie, Nurse-Patient Interaction only scripted one part of the interaction, avoiding an outcome within the film to focus on the unscripted responses of the nurse trainees, some off-camera, others recorded for later discussion.
David Cantor is an investigador (researcher) at the Instituto de Desarrollo Económico y Social (IDES), Buenos Aires Argentina and an adjunct professor in the School of Public Health at the University of Maryland, College Park. His scholarly work focuses on the history of medicine in the twentieth century, most recently the histories of cancer, stress and medical film. He was for several years affiliated with the National Library of Medicine and also worked in the Office of History, National Institutes of Health. His publications include Reinventing Hippocrates (2002); Cancer in the Twentieth Century (2008); Meat, Medicine and Human Health in the Twentieth Century (2010), co-edited with Christian Bonah and Matthias Dörries; Stress, Shock, and Adaptation in the Twentieth Century (2014), co-edited with Edmund Ramsden; and Health Education Films in the Twentieth Century (2018), co-edited with Christian Bonah and Anja Laukötter. He is series coeditor of Social Histories of Medicine published by Manchester University Press.