© 2008 The Author Journal compilation © 2008 Blackwell Publishing Ltd. Learning in Health and Social Care, 7, 3, 157–167 Original article Blackwell Publishing Ltd Strategies used by nurses when managing the emotional needs of patients John Anthony Fulton Ed D, M Phil, M Sc, BA, RN Principal Lecturer in Nursing and Health Studies, School of Health, Natural and Social Sciences, University of Sunderland,Wharncliffe Street, Sunderland SR1 2SD, UK Abstract This paper explores the ways in which nurses in acute care settings can address the emotional needs of their patients and uses psychoanalytical concepts to provide a level of explanation. It is acknowledged that dealing with the emotional needs of patients is a key function of the nurse’s role; however, there is much in the literature, particularly that from a psychoanalytical perspective, that would suggest that, in practice, defences are often used as a way of avoiding involvement with patient. This qualitative study used observational techniques as a means of collecting data from two settings in a large teaching hospital, one an acute surgical ward and the second setting was award specializing in haematological conditions. In the two settings, nurse–patient interactions differed. In the haematological ward, the emotional needs were acknowledged and addressed, whereas in the acute surgical ward institutional defences predominated, which prevented close patient involvement. The emotional needs were often passed onto the medical staff or nurse specialists, which could prevent nurses developing the requisite skills. Certain important conclusions were elicited from the data. As with any qualitative analysis, this was in keeping with a particular research framework and another framework, or indeed another researcher may have drawn different conclusions. The main conclusions drawn were the following: the nurses working in the haematological setting had developed many of the skills necessary to deal with patients’ emotional needs. In the surgical setting, the organizational system did not allow the nurses to engage sufficiently to build and develop these particular skills. Keywords emotions, observation, psychoanalysis, qualitative research Corresponding author. Tel. 0191 515 2529; fax: 0191 515 2229; e-mail: john.fulton@ sunderland.ac.uk Introduction In nursing, as in all the healthcare professions, there is a drive to give holistic care that focuses not only on the physical needs of patients but also on their emotional and social needs. In the literature, there is a body of work, focusing on insights from psychoanalysis, which would suggest that this might