Voiceless and vulnerable: An existential phenomenology of the patient experience in 21st century British hospitals.

Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated.

Corporatising compassion? A contemporary history study of English NHS Trusts' nursing strategy documents.

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009-2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents.

The Norwegian Mobile Army Surgical Hospital in the Korean War (1951-1954): Military Hospital or Humanitarian "Sanctuary?"

During the Korean War (1950-1953) the Norwegian government sent a mobile army surgical hospital (MASH) to support the efforts of the United Nations (UN) Army. From the first, its status was ambiguous. The US-led military medical services believed that the "Norwegian Mobile Army Surgical Hospital" (NORMASH) was no different from any other MASH; but both its originators and its staff regarded it as a vehicle for humanitarian aid. Members of the hospital soon recognized that their status in the war zone was primarily that of a military field hospital. Yet they insisted on providing essential medical care to the local civilian population as well as trauma care to UN soldiers and prisoners of war. The ambiguities that arose from the dual mission of NORMASH are explored in this article, which pays particular attention to the experiences of nurses, as expressed in three types of source: their contemporary letters to their Matron-in-Chief; a report written by one nurse shortly after the war; and a series of oral history interviews conducted approximately 60 years later. The article concludes that the nurses of NORMASH experienced no real role-conflict. They viewed it as natural that they should offer their services to both military and civilian casualties according to need, and they experienced a sense of satisfaction from their work with both types of patient. Ultimately, the experience of Norwegian nurses in Korea illustrates the powerful sense of personal agency that could be experienced by nurses in forward field hospitals, where political decision-making did not impinge too forcefully on their clinical and ethical judgment as clinicians.

International nurses to the rescue: The role and contribution of the nurses of the International Brigades during the Spanish Civil War.

AIM: To describe the life and work of the international nurses of the International Brigades during the Spanish Civil War and to examine their role in relation to their contribution to Spanish nursing in this period. METHODS: This historical study is based primarily on the memoirs of the international nurses who joined the war health services of the International Brigades during the Spanish Civil War. The evidence that was elicited from these sources was compared and contrasted with other contemporary documents in order to compare their perspectives with those of other contemporaries. RESULTS: The nurses of the International Brigades joined the front line health services as part of the mobile medical and surgical teams that were attached to the fighting units. They lived and worked under extreme conditions, often under fire. Their work while in Spain was not limited to care delivery but also included managerial and educational aspects. The international nurses' observations of Spanish nursing at the time were not always accurate, which might be explained by a lack of contact with qualified Spanish nursing staff due to a shortage of fully qualified nurses. CONCLUSION: In the absence of the voices of the Spanish nurses themselves, the written records of the international nurses were invaluable in analyzing Spanish nursing in this period. Their testimonies are, in essence, the international nurses' legacy to the Spanish nurses who stayed behind after the departure of the International Brigadists in 1938.

'A very valuable fusion of classes': British professional and volunteer nurses of the First World War.

Public perceptions of the work of nurses and VAD-volunteers in the First World War have been heavily influenced by a small number of VAD-writings. The work of trained, professional nurses in supporting and supervised the work of VADs has been largely overlooked. This paper examines several of the writings of both volunteers and professionals, and emphasises the overlooked supervisory, managerial and clinical work of trained nurses. In this centenary year of the First World War's opening months, the paper also explores the ways in which the British mass-media--notably the BBC--have chosen to cling to a romantic image of the untrained nurse, whilst at the same time acknowledging the significance of trained, professional nursing.

"Time enough! Or not enough time!" An oral history investigation of some British and Australian community nurses' responses to demands for "efficiency" in health care, 1960-2000.

Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by "experiential time" (in which perception of time depends on the quality of experience) to practice governed by "measured time" (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

Portrayals of suffering: perceptions of trauma in the writings of First World War nurses and volunteers.

The trauma-writings of World War I nurses have been identified as an important and influential corpus of early 20th-century works. Not only did the rediscovery of these writings in the later 20th century serve to recognize the importance of women's writings as part of the historical record, and identify certain female writers as some of the most important thinkers of the modernist movement; they also demonstrated the importance of the nursing perspective as one element of wartime experience. This paper considers a number of influential works written by both nurses and members of the Voluntary Aid Detachments (VAD) who assisted with nursing work during the war. The paper identifies how nurses and VADs presented their experiences of war trauma. It also considers how some writers strove to attach meaning to (or in some, cases expressed their sense of the meaninglessness of) the suffering caused by the war. The paper considers further how some nurses themselves experienced trauma as a result of their exposure to wartime work, and how some writers developed what are referred to as "philosophies of suffering," in which they struggled to understand suffering as an element of human experience.

Colin Fraser Brockington (1903-2004) and the revolution in nurse-education.

Colin Fraser Brockington was Professor of Social and Preventive Medicine at the University of Manchester from 1952 to 1965. During that time he developed the Diploma in Community Nursing, the first pre-registration training course for nurses at a British University. This paper traces Brockington's education and career and explores his commitment to university-based nursing education which appears to have stemmed from his desire to enhance and broaden the role of the health visitor. It also considers the implications of the innovative course at Manchester and evaluates the way in which it influenced the gradual movement of nursing education into the university sector throughout the UK.

The personal writings of First World War nurses: a study of the interplay of authorial intention and scholarly interpretation.

The personal writings of First World War nurses and VADs (volunteers) provide the historian with a range of insights into the war and women's nursing roles within it. This paper offers a number of methodological perspectives on these writings. In particular, it emphasises two elements of engagement with texts that can act as important influences on subsequent historical writings: authorial intention and scholarly interpretation. In considering the interplay of these two elements, the paper emphasises the motivations both of those who produced primary sources and of those who later used them to 'serve' particular historical interpretations. The paper examines letters, diaries and semi-fictional writings, considering the influences of gender, class and professional background on the ways in which their authors wrote. It then briefly considers the uses to which historians have put these original writings. The paper offers insights into the ways in which complex personal writings can be interpreted and concludes that the writings of First World War nurses and volunteers offer a rich and varied set of perspectives on both the war itself and the nature of wartime nursing work.

Living with dying: a hermeneutic phenomenological study of the work of hospice nurses.

AIMS: (i) Explore the meaning of comfort care for hospice nurses. (ii) Provide an understanding of how this work is pursued in the hospice setting. (iii) Examine the means by which hospice nurses provide comfort to hospice patients. BACKGROUND: The concepts of 'comfort' and 'comfort care' have long been a subject for examination by nurse researchers. The paper provides an overview of selected, relevant literature in this area. The methods used by nurse researchers have almost always been qualitative, and have focused on the meaning of nursing care for dying patients, from both nurses' and patients' perspectives. DESIGN AND METHODS: The paper reports a hermeneutic phenomenological study of the work of 15 hospice nurses based in one hospice in the north of England. Sampling was purposive, and data were collected by means of semi-structured interviews. A reflective diary was also kept. The interpretation of data was guided by phenomenological and hermeneutic methodology. RESULTS: The nurses interviewed spoke openly about their experiences of working with hospice patients. They saw the relief of suffering through 'comfort care' as an important element of their work. The findings are presented under three thematic headings: 'Comfort and relief', 'Peace and ease' and 'Spirituality and meaning'. CONCLUSION: Hermeneutic phenomenology is an important method for uncovering the complex realities of nursing work. The nurses' perspectives on 'comfort care' they offer to patients were revealed by the data presented here, which were interpreted to offer a unique perspective on this type of nursing work. RELEVANCE TO CLINICAL PRACTICE: These findings offer insights to nurses in both hospice and other settings; they give a number of perspectives on the nature of 'comfort care' and the meanings attached to it by experienced hospice nurses'.

Everyday death: how do nurses cope with caring for dying people in hospital?

In the UK, policies on health recognise the importance of supporting healthcare professionals if they are to realise their potential for delivering quality services. Little is known about how nurses working in hospitals cope with caring for dying people and, hence how they might be best supported in this work. This paper reports a qualitative study informed by phenomenological philosophy, which developed a theory of how newly qualified nurses cope with caring for dying people in acute hospital medical wards. On the basis of the theory, interventions are proposed that could help support nurses in their work with dying people.

The struggle for sanitary reform in the Lancashire cotton mills, 1920-1970.

AIM: This paper reports one aspect of a larger study. The aim of this aspect was to explore the role of the "welfare officer" in promoting the health of cotton mill workers during this period. BACKGROUND: The paper considers one element of a broad exploratory study of the health of women cotton mill workers in the North West of England. The original purpose of the study, which was conducted in 2002 in two towns, Oldham and Ashton-under-Lyne, was to explore the women's own perceptions of the impact of their work on their health, and to find out what, if any, help and support they obtained. During the course of the study it was discovered that "welfare officers", some of whom were trained nurses, had an important role in promoting the health of these workers. The study was therefore expanded to incorporate data obtained directly from interviews with a small sample of welfare officers. The present paper focuses on the issue of sanitary reform and considers the role of the "welfare officer" in promoting public health in the workplace. METHODS: The study employed a combination of archive searches and oral history interviewing. In total, 31 interviews were undertaken between June 2001 and October 2002. The interpretive process focussed both on the ideological power structures which influenced the perspectives of participants, and on evidence for those aspects of participants' experiences which impacted on their health. FINDINGS: In considering their health, female cotton-mill workers recalled that the poor sanitary conditions in their workplaces during the middle years of the 20th century had been a source of some concern to them. They also observed that mill welfare officers took a hand in promoting improvement in available facilities. Welfare officers themselves recounted their own concern regarding the poor sanitary conditions in the mills, and their efforts to improve conditions for the mill workers. CONCLUSIONS: The paper demonstrates the role of a little-known group of health workers in the middle years of the 20th century, and demonstrates the importance of oral history work in re-capturing elements of nursing work and experience, which do not appear extensively in the written record. The study's relevance to contemporary practice lies in the insight it offers into the autonomy with which these occupational health workers defined their roles and performed their work.

Caring for dying people in hospital.

BACKGROUND: Fifty-four per cent of people who die in England and Wales do so in hospital. Evidence suggests that care delivered to dying people in hospital does not match up to the ideal of a good death. These studies have provided organizational and structural explanations of nurses' behaviour that support argument for change at the macro level, in order to improve the quality of care delivered to dying people. There has been little study of the perceptions of nurses working in acute medical settings in relation to their experience of caring for dying people. Therefore, there is little evidence on which to base supportive strategies at the level of individual nurses. AIM: In this study we set out to develop an understanding of care for dying people in hospital, from the perspective of newly qualified staff nurses in the UK. The purpose was to build a theory of how nurses might be helped to deliver quality care to dying people in hospital. METHODS: This paper is based on an exploratory study underpinned by phenomenological philosophy. In-depth interviews were conducted with 28 newly qualified nurses, focusing on their experiences of caring for dying people on medical wards in two acute hospitals in England in 1999. The interview transcripts were interpreted using a phenomenological approach. FINDINGS: The findings presented in this paper relate to commonalities found to underlie study participants' perceptions of their experiences. All the nurses' stories were found to be built around six essences - the personal ideal, the actual, the unknown, the alone, tension and anti-tension. These essences, and the relationships between them, were used to build a model of the experience of caring for dying people in hospital. LIMITATIONS: This descriptive study of the experience of individual nurses does not examine the wider social context. It attempts to complement existing sociological theory of death and dying. CONCLUSION: The study revealed how a group of newly qualified nurses experienced caring for dying people. We theorize that the model developed has utility as a tool for gaining understanding of the experience of caring for dying people. It is assumed that nurses, through using this model to find explanations for their emotions and behaviours, may gain emotional support that might have a positive impact on the quality of care delivered to dying people in hospital.