Patients' experiences of in-hospital care when nursing staff were engaged in a practice development programme to promote person-centredness: A narrative analysis study.

BACKGROUND: The drive towards person-centred approaches to care delivery has been increasingly promoted. This is in response to the significant challenges within health and social care organisations, which impact on the care experience for patients and their families.

OBJECTIVE: The aim of this paper is to illuminate the experiences of patients of care received in hospital wards during the intervention phase of a programme to develop person-centred practice.

DESIGN: A narrative enquiry study was conducted which is a particular way of exploring complex cultural or social patterns. Structural narrative analysis was used to generate explanation and interpretation of in-hospital patients' care experience.

SETTING: Recruitment was from four different hospital sites in one health care organisation, focussing on patients who were admitted to the nine wards/units where the nursing teams were participating in a practice development programme that had the intention of promoting person-centredness.

PARTICIPANTS: Participants were people aged over 18 and receiving care and treatment in the identified wards/units. Twenty-six patients were recruited.

METHODS: Narrative interviews were audio-recorded at four month intervals and transcribed. The records were subjected to a process of structural analysis.

RESULTS: The findings offer insight into patients' experiences of care in a range of clinical settings in which an explicit intervention to promote person-centred practice was underway. There was one overriding theme formulated: Vulnerability at the junctures of systems, care processes and nurses' responses. From this main theme, we derived four sub-themes: (1) confronting vulnerability, (2) experiencing exemplary care, (3) experiencing misalignments in systems, care processes and nurses' responses, and (4) sharing in a sense of belonging with ward nurses.

CONCLUSIONS: In-hospital patients are exposed to vulnerability in the care experience. They placed value on exemplary care. Experiences of misalignments in systems, care processes and nurses' responses disempower patients and heighten a sense of vulnerability. The ward nursing teams were generating a family like atmosphere. Patients responded by sharing a sense of belonging with ward nurses. These findings confirm components that have influenced the development of person-centred practice, such as the importance of the context and culture of care. They also offer new insights that may contribute to on-going practice development work.