• Johannes Christiaan Schoombee Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa.
  • Johanna Marié van der Merwe Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
  • Lou-Marie Kruger Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa



Following global trends in health reforms, South Africa has followed a primary health care approach since the eighties (Petersen & Swartz, 2002; Van der Walt, 1998). The implementation of this approach at first was regarded as selective and piecemeal (Van der Walt, 1998), but with the emergence of a democratically elected government in 1994 a series of health reforms focused on equalising the coverage of service (Van Wyk, 2005). The South African health system can thus best be described as one that has been characterised by time-consuming restructuring processes aimed at the implementation of a comprehensive primary health care service. Within this system all health-care professionals have been exposed to stressful working conditions. However, mental health professionals (psychologists and social workers) agree that the impact of these conditions on nurses is specifically important as they form “…the largest cadre of frontline health providers in South Africa” (Van der Walt & Swartz, 2002:1002).


Download data is not yet available.


ABRAHAMS, N., JEWKES, R. & MVO, Z. 2001. Health care-seeking practices of pregnant women and the role of the midwife in Cape Town, South Africa. Journal of Midwifery & Women's Health, 46(4):240-247.

ALTUN, I. 2002. Burnout and nurses’ personal and professional values. Nursing Ethics, 9(3):269-278.

ARTHUR, D., PANG, S., WONG, T., ALEXANDER, M.F., DRURY, J., EASTWOOD, H., JOHANSSON, I., JOOSTE, K., NAUDE, M., NOH, C.H., O’BRIEN, O., SOHNG, K.Y., STEVENSON, G.R., SY-SINDA, M.T., THORNE, S., VAN DER WAL, D. & XIAO, S. 1999. Caring attributes, professional self concept and technological influences in a sample of Registered Nurses in eleven countries. International Journal of Nursing Studies, 36:387-396.

BELLE, D. 1982. The Stress of Caring: Women as Providers of Social Support. In: GOLDBERGER, L. & BREZNITZ, S. (eds) Handbook of Stress. New York: Free Press.

BENNETT, P., LOWE, R., MATTHEWS, V., DOURALI, A. & TATTERSALL, A. 2001. Stress in nursing: coping, managerial support and work demand. Stress and Health, 17:55-63.

BILLETER-KOPONEN, S. & FREDÉN, L. 2005. Long-term stress, burnout and patient–nurse relations: qualitative interview study about nurses’ experiences. Scandinavian Journal of Caring Sciences, 19(1):20-28.

BOLTON, S.C. 2001. Changing faces: nurses as emotional jugglers. Sociology of Health & Illness, 3(1):85-100.

BRINDLEY, M. 1999. Doctor should end his jibes at hard-working nurses... 'What the doctor witnessed', February 24, p.27. Nursing Times, 95(11):18.

BROWN, A.M. 2003. Foucauldian Perspectives on Midwifery Practices and Education. Internet Journal of Advanced Nursing Practice, 6(1):15-30.

BURMEISTER-NEL, H. 2005. The psychological experience of pregnancy: A review of the literature. Stellenbosch: University of Stellenbosch. (M thesis)

BUTCHART, A. 1997. Objects without origins: Foucault in South African socio-medical science. South African Journal of Psychology, 27(2):101-110.

CARTER, P. 1999. Rotten apples. Nursing Times, 95(8):28-30.

CECI, C. 2003. Midnight reckonings: on a question of knowledge and nursing. Nursing Philosophy, 4(1):61-76.

CECI, C. 2004. Nursing, knowledge and power: A case analysis. Social Science & Medicine, 59(9):1879-1889.

CHARMAZ, K. 1990. ‘‘Discovering’’ chronic illness: Using grounded theory. Social Science & Medicine, 30:1161–1172.

CHARMAZ, K. 1995. Grounded theory: Rethinking methods in psychology. London: Sage.

CILLIERS, F. 2002. Salutogenic coping with burnout among nurses: A qualitative study. South African Journal of Labour Relations, Summer Issue:61-79.

CLARKE, L. 1999. Darkness visible...shedding light on nurse abuse of people with disabilities. Nursing Times, 95(34):36-37.

CORBET-OWEN, C. & KRUGER, L. 2002. The health system and emotional care: Validating the many meanings of pregnancy loss. Families, Systems & Health.

COX, K.B. 2001. The effects of unit morale and interpersonal relations on conflict in the nursing unit. Journal of Advanced Nursing, 35(1):17-25.

CRAWFORD, M. & KIMMEL, E. 1999. Promoting methodological diversity in feminist research. Psychology of Women Quarterly, 23(1):1-7.

FITZGERALD, G. 2003. Listen up. Good nurses need not fear a civil standard of proof. Nursing Times, 99(26):16.

FONOW, M.M. & COOK, J.A. 1991. Back to the future: A look at the second wave of feminist epistemology and methodology. In: FONOW, M.M. & COOK, J.A. (eds) Beyond methodology: Feminist scholarship as lived research. Bloomington: Indiana University Press.

GASTALDO, D. & HOLMES, D. 1999. Foucault and nursing: a history of the present. Nursing Inquiry, 6(4):231-240.

GAVEY, N. 1989. Feminist Poststructuralism and Discourse Analysis. Psychology of Women Quarterly, 13(4):459-475.

GEORGES, J.M. & MCGUIRE, S. 2004. Deconstructing Clinical Pathways: Mapping the Landscape of Health Care. Advances in Nursing Science, 27(1):2-11.

GIBSON, D. 2004. The gaps in the gaze in South African hospitals. Social Science & Medicine, 59(10):2013-2024.

GILBERT, T. 1995. Nursing: empowerment and the problem of power. Journal of Advanced Nursing, 21(5):865-871.

GOLDING, L. & CLEAR, D. 2001. A proactive approach to preventing abuse. Nursing Times, 97(43):32-33.

GROSSMAN, F.K., KRUGER, L. & MOORE, R.P. 1999. Reflections on a feminist research project. Subjectivity and the wish for intimacy and equality. Psychology of Women Quarterly, 23:117-135.

GROSSMAN, F.K., KRUGER, L. & MOORE, R.P. 2000. Reflections on a feminist research project. Subjectivity and the wish for intimacy and equality. In Kimmel, E.B. & Crawford, M. (eds) Innovations in feminist psychological research. Cambridge: Cambridge University Press.

GULLAND, A. 1999. Clear and present danger. Nursing Times, 95(47):16-17.

HEARTFIELD, M. 1996. Nursing documentation and nursing practice: a discourse analysis. Journal of Advanced Nursing, 24(1):98-103.

HIRST, S.P. 1999. Resident abuse within the culture of long-term institutions. Alberta: University of Alberta. (D thesis)

HUNTINGTON, A.D. & GILMOUR, J.A. 2001. Re-thinking representations, re-writing nursing texts: possibilities through feminist and Foucauldian thought. Journal of Advanced Nursing, 35(6):902-908.

JEWKES, R., ABRAHAMS, N. & MVO, Z. 1998. Why do nurses abuse patients? Reflections from South African obstetric services. Social Science and Medicine, 47(11):1781-1795.

KETTUNEN, T., POSKIPARTA, M. & GERLANDER, M. 2002. Nurse-patient power relationship: preliminary evidence of patients' power messages. Patient Education and Counseling, 47(2):101-113.

KLINE, D.S. 2003. Push and pull factors in international migration. Journal of Nursing Scholarship, Second Quarter:107-111.

KRUGER, L. 2003. Narrating motherhood: the transformative potential of individual stories. South African Journal of Psychology, 33(4):198-205.

KRUGER, L. & VAN DER SPUY, T.M. 2005. Obscuring the pregnant body: Losing touch “with the hard surfaces of life” as methodological problem or substantive issue. South African Journal of Psychology. In print.

LAY, M.M. 2003. Midwifery on Trial: Balancing Privacy Rights and Health Concerns after Roe v. Wade. Quarterly Journal of Speech, 89(1):60-77.

LAY, M.M., WAHLSTROM, B.J. & BROWN, C. 1996. The Rhetoric of Midwifery: Conflicts and Conversations in the Minnesota Home Birth Community in the 1990s. Quarterly Journal of Speech, 82(4):383-401.

LAZARUS, J. & KRUGER, L. 2004. Small meetings: Reflections on the application of psychodynamic thought in community work with low-income South African children. Part 1: Reflections on the literature. Psychoanalytic Psychotherapy in South Africa, 12(1):52-73.

LAZARUS, J. & KRUGER, L. 2004a. Small meetings: Reflections on the application of psychodynamic thought in community work with low-income South African children. Part 2: Reflections on a case study. Psychoanalytic Psychotherapy in South Africa, 12(2).

LEVERT, T., LUCAS, M. & ORTLEPP, K. 2000. Burnout in psychiatric nurses: contributions of the work environment and a Sense of Coherence. South African Journal of Psychology, 30(2):36-43.

LUPTON, D. & FENWICK, J. 2001. ‘They’ve forgotten that I’m the mum’: Constructing and practising motherhood in special care nurseries. Social Science and Medicine, 53(8):1011-1021.

NAZARKO, L. 2001. See, hear – then speak out…every nurse who witnesses abuse or neglect has a duty to speak out. Nursing Standard, 15(20):22.

NEAL, K. 1999. When power corrupts. Nursing Times, 95(8):29.

PECKOVER, S. 2002. Supporting and policing mothers: an analysis of the disciplinary practices of health visiting. Journal of Advanced Nursing, 38(4):369-377.

PETERSEN, I. & SWARTZ, L. 2002. Primary health care in the era of HIV/AIDS. Some implications for health systems reform. Social Science & Medicine, 55(6):1005-1013.

PIDGEON, N. & HENWOOD, K. 1997. Using grounded theory in psychological research. In: HAYES, N. (ed) Doing Qualitative Analysis in Psychology. Hove: Psychology Press.

PILLEMER, K. & BACHMAN-PREHN, R. 1991. Helping and hurting. Research on Aging, 13(1):74-96.

PILLEMER, K. & MOORE, D.W. 1989. Abuse of patients in nursing homes: findings from a survey of staff. Gerontologist, 29(3):314-320.

PORTER, S. 1996. Contra-Foucault: Soldiers, Nurses and Power. Sociology, 30(1):59-71.

POWELL, S. & TUCKER, R. 2004. The way we were: nurses recall ‘shameful’ incidents of restraint. Learning Disability Practice, 7(4):3-5.

PRYCE, A. 2000. Frequent observations: sexualities, self-surveillance, confession and the construction of the active patient. Nursing Enquiry, 7(2):103-111.

RAMAZANOGLU, C. & HOLLAND, J. 2002. Feminist methodology: challenges and choices. London: Sage.

RIESSMAN, C.K. 1993. Narrative Analysis. Qualitative research methods series 30. Newbury Park, CA: Sage Publications.

RILEY, R. & MANIAS, E. 2002. Foucault could have been an operating room nurse. Journal of Advanced Nursing, 39(4):316-324.

SAND, A. 2003. Nurses’ personalities, nursing-related qualities and work satisfaction: a 10-year perspective. Journal of Clinical Nursing, 12:177-187.

SILVERMAN, D. 1993. Interpreting qualitative data. Methods for analyzing talk, text and interaction. London: Sage.

SMIT, J. 2002. A feminist exploration of the concept of Postpartum Depression. Stellenbosch: University of Stellenbosch. (M thesis)

SMITH, V.M. 1993. Real issues of abuse...survey on abuse of patients by nurses. Registered Nurse, 5(6):5.

SPIES, D. 2001. The coping mechanisms of female farmworkers in the Western Cape: a grounded theory study. Stellenbosch: University of Stellenbosch. (M thesis)

STEENKAMP, W.C. & VAN DER MERWE, A.E. 1998. The psychosocial functioning of nurses in a burn unit. Burns, 24(3):253–258.

SWARTZ, L., GIBSON, K. & GELMAN, T. (eds) 2002. Reflective practice: Psychodynamic ideas in the community. Cape Town: Human Sciences Research Council.

TSELEBIS, A. & MOULOU, A. 2001. Burnout versus depression and sense of coherence: Study of Greek nursing staff. Nursing and Health Science, 3:69-71.

VAN DER WALT, 1998. Nurses and their work in tuberculosis control in the Western Cape: Too close for comfort. Cape Town: University of Cape Town. (D Thesis)

VAN DER WALT, H.M. & SWARTZ, L. 2002. Task orientated nursing in a tuberculosis control programme in South Africa: where does it come from and what keeps it going? Social Science & Medicine, 54:1001-1009.

VAN WYK, B. 2005. Caring for caregivers: psychodynamic interventions for staff-support for primary health care workers. Stellenbosch: Stellenbosch University. (D Thesis)

WALKER, L. & GIBSON, L. 2004. 'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa. Social Science and Medicine, 59(6):1251-1261.

WHITE, C. 1999. How abuse happens. Nursing Times, 95(8):26-27.

WILLIG, C. 2001. Introducing qualitative research in Psychology: Adventures in theory and method. Buckingham: Open University Press.

WILSON, H.V. 2001. Power and partnership: A critical analysis of the surveillance discourses of child health nurses. Journal of Advanced Nursing, 36(2):294-301.

WINSTANLEY, S. & RICHARD, W. 2002. Anxiety, burnout and coping styles in general hospital staff exposed to workplace aggression: a clinical model of burnout and vulnerability to aggression. Work & Stress, 16(4):302-315.




How to Cite

Schoombee, J. C., van der Merwe, J. M., & Kruger, L.-M. (2014). THE STRESS OF CARING: THE MANIFESTATION OF STRESS IN THE NURSE-PATIENT RELATIONSHIP. Social Work/Maatskaplike Werk, 41(4).