Elaine Gray, BSc, BA, MSc (Research), RN; Sylvia Cavanagh, BSc, RN; Dr Harriet Mowat, PhD
Elaine-Lecturer, School of Nursing and Midwifery, University of Dundee; Sylvia-Ward Charge Nurse and Research Nurse, Assessment Unit, Royal Victoria Hospital, Dundee; Harriet-Research Supervisor and Depute Director of Gerontology and Health Studies, University of Paisley, Paisley
Over the past decade there have been several published articles acknowledging as good practice the involvement of patients in providing an evaluation of health services (Brooker, 1997; Chambers, 2000; NHS Scotland, 2000). The NHS Plan(Department of Health, 2000) recognises that old-fashioned demarcations and barriers between services still exist. There is a need to create a patient-centred NHS with different parts connecting efficiently.
The research question was: ‘What is the experience of patients and their carers during the admission process to a care of the elderly rehabilitation/ medical assessment ward?’ Various methods of answering the study question were investigated and, initially, some of the more traditional methods were rejected as inappropriate, including a randomised controlled trial, questionnaires, interviews and diaries.
Several factors had to be negotiated before beginning the study.
Observation is time consuming, so given the constraints of the study, timetable and budget the study sample was realistically small, consisting initially of two patients from each of the six wards within the unit. Four patients were later added to this sample to clarify experience over the hospital/ community interface. The study did not rely solely on observation. The integrity of the observations and initial conclusions drawn from them was checked with the patients and carers through very short, semi-structured interviews on the evening of admission and longer ones once the observation had finished (24-36 hours after arriving in the ward). Through these interviews, the researchers aimed to clarify reactions noted during observation and gain a greater understanding of the emerging themes. The admitting staff were also interviewed and asked for their view of the admission - had it gone smoothly, was all relevant information readily available, had there been frequent interruptions?
The researchers’ preconceptions were that the admission process was tiring for patients and carers, with many different professionals demanding often duplicate information. The outcomes showed that some patients, however, found the attention given during the admission process stimulating rather than tiring. The more strongly emerging concerns were with information and communication, and with maintaining the identity and relationships of both patients and carers while acknowledging their expertise. From these concerns a theory of what constitutes a ‘good’ admission was built and tested by the production of 14 good-practice recommendations based on the study findings and supported by the literature review. (Examples of the recommendations are given in Box 1). These recommendations were presented to a group of 20 stakeholders who were chosen to represent the team of people involved in the admission process and consisted of doctors and nurses from primary and secondary care and staff from the social work department, ambulance service and professions allied to medicine, together with service managers, patients and carers.
ValidityQualitative research should be assessed according to its validity, defined as the extent to which the account accurately represents the social phenomena to which it refers (Murphy et al, 1998). One method of enhancing this validity is triangulation - looking at the study situation from different angles and comparing the views in order to obtain a full and complete picture of the area under study. Hammersley and Atkinson (1983) have suggested three methods of triangulation. All three were included in the study:
Nurses should be concerned with giving the best care possible to each unique, individual patient (RCN, 1993).
Using a variety of techniques (observation, interviews, brainstorming and questionnaires) this study was able to describe patient and carer experiences during admission to hospital. Common concerns were identified and these have informed the production of 14 good-practice recommendations that will be used for standardising and improving care.
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