What can trauma patients' experiences and perspectives tell us about the perceived quality of trauma care?:a qualitative study set within the uk National Health Service

The global drive for improvements in the efficiency and quality of healthcare has led to the development of frameworks to assist in defining and measuring 'good quality care'. However, such frameworks lack a systematic or meaningful definition of what 'good quality care' means from the patients' perspective. The present research provides an in-depth analysis of patients' experiences in a hospital setting from a quality of care perspective. Forty-five adults (aged 16-70) hospitalised in one of four UK NHS trusts following an unintentional injury were interviewed about their experiences of care. The findings show variability in perceived quality of care within the same hospital episode which cannot be meaningfully captured by existing frameworks. The context of trauma care (e.g. distressing nature of injury, patient vulnerability, expectations of hospitalisation and participants' interaction with different service providers) defined the care experience and the value of being 'cared for'. Participants identified some aspects of good and care which related to holistic, person-centred and personalised care beyond the medical needs. Participants discussed the value of being understood, staff thinking of their needs beyond hospitalisation, staff trying 'their best' despite constrains of current care, having their emotional needs recognised and addressed and staff competence. Patients reported also poor quality of care and 'not being cared for' by specific staff groups which they expected to fulfil this role, rushed and unsympathetic care, lack of recognition for emotional impact of injury mapped onto existing quality frameworks e.g. safety, equity, accessibility and patient-centeredness as well as quality of interaction with providers, empathetic care which extended beyond medical needs, coordination of care, and the positivity of care delivery as important dimensions of quality care with implications for their recovery. The findings have implications for quality frameworks and theoretical definitions of quality of care; they demonstrate the importance of patient experience in addition to clinical effectiveness and safety as an essential dimension of quality care. In terms of practice, the findings support the need to incorporate knowledge and training of injured adults' psychological needs, and the value of interaction with professionals as a patient defined dimension of the quality of care.</p

Yarning as an Interview Method for Non-Indigenous Clinicians and Health Researchers

In this article, we discuss the origins, epistemology, and forms of Yarning as derived from the literature, and its use in research and clinical contexts. Drawing on three Yarns, the article addresses the extent to which non-Indigenous researchers and clinicians rightfully use and adapt this information-gathering method, or alternatively, may engage in yet another form of what can be described as post-colonialist behavior. Furthermore, we argue that while non-Indigenous researchers can use Yarning as an interview technique, this does not necessarily mean they engage in Indigenous methodologies. As we note, respectfully interviewing Aboriginal and Torres Strait Islander peoples can be a challenge for non-Indigenous researchers. The difficulties go beyond differences in language to reveal radically different expectations about how relationships shape information giving. Yarning as a method for addressing cross-cultural clinical and research differences goes some way to ameliorating these barriers, but also highlights the post-colonial tensions

Expectations and experiences of recovery in the context of leukaemia

It is well recognised that the completion of an acute phase of cancer treatment may signal only a partial exiting from the sick role. The concepts of remission - whether complete (the presence of disease is no longer detectable although recurrence is possible) or partial (the disease is stable or in abeyance but signs of disease remain) - and of survivorship (living with and beyond cancer) reflect this complexity. The notion of recovery has received less attention in the sociological literature on cancer; exceptions include Winterling et al 2009. Leukaemia, including as it does both acute and chronic forms, offers an opportunity to explore recovery within diverse states of remission. The analysis presented here draws on an ESRC funded study of recovery (ES/K006037/1) involving secondary analysis of qualitative interview data from four datasets. The current paper focuses on the experiences of adults diagnosed with leukaemia (n=39) interviewed about their experiences by the Health Experiences Research Group, University of Oxford. The paper argues for the usefulness of exploring recovery in terms of the lived and located experiences of leukaemia patients on exiting - completely or partially - from the sick role and associated status. Analysis identified that recovery is multi-dimensional involving both ‘recovery from’ (…the disease, treatment, being seriously ill) and ‘recovery of’ (…previous routines, responsibilities and pleasures). Patients’ expectations and experiences of recovery were located in relation to particular dimensions of identity and played out in diverse arena that included employment, physical activity, relationships and roles, (in)dependence and responsibility

The social relations of recovery following admission to intensive care

There is an extensive literature addressing patients’ experiences of becoming ill, seeking help, of the illness itself and treatment offered. A notable absence, with few exceptions, within this canon is the patient’s experience of recovery. A further group of patients whose experience has been overlooked are those who have spent time in an intensive care unit (ICU). Rier’s (2000) exploration of his own experience remains one of the few papers to look at this group. This paper presents a secondary analysis of interview data collected by the Health Experiences Research Group, University of Oxford. A total of 37 former patients who had each spent time in an ICU in the UK were interviewed in depth about their recollections and subsequent recovery. A notable feature of the accounts was the role played by family and friends both during and after hospital stay. This paper explores the social relations of recovery especially the role of family and friends throughout the trajectory of illness and recovery