N IVELES DE LENGUAJE NATURAL

An initial period of non-participant observations was conducted for three-four weeks of data collection at each site. At this stage I located myself in communal areas such as dining rooms, staff rooms, receptions, in-between spaces such as corridors and stairwells or shared ward spaces, in offices such as nurses’ stations, therapy offices or managerial and administration offices. I attended meetings with managerial staff, therapists and nurses, some of which I was invited to, some I stumbled across or learned about as part of being, listening and seeing in the setting. These meetings consisted of multidisciplinary team meetings, patient review or discharge meetings, morning or afternoon handovers or project meetings.

152 At each site, I was enabled and allowed to freely roam. Following an initial ‘tour’ of the building and a discussion with my ‘gatekeeper’ at each site, I was left to move around the buildings as I wished, without evident restriction. I was able to come and go as I pleased. I was not asked to ‘report’ on when I would be in the building or where I would be, other than to sign in and out as I entered and exited the buildings. At Bracken Lodge, my gatekeeper requested that I place a sign which read ‘Researcher in the House’ (which had been made for me by my gatekeeper) on a board in reception when I arrived, so that any visitors would know I was on-site and could avoid me or find me as they wished.

At Goodleigh Hall, the doors both to enter, exit and to move within required the use of an electronic fob which had to be tapped onto a panel by the door to release it. Each ‘fob’ was individually programmed to allow the entrance to certain areas of the building. I was provided with a fob on my first day as soon as I arrived, which enabled me access to almost every area of the building. My access included management offices but excluded any areas where financial or human resource information was stored/conducted. I kept this fob throughout the length of my data collection period and in-between visits.

At Bracken Lodge entrance and exit doors and internal doors near stairwells and separate patient/staff areas required the punching in of a code to unlock the door. On my first day, I was taken on a tour of the building and given the codes to all the internal doors and the door between units. I was not given the code to the front door but the entry of all through the front door was managed by a receptionist who let people in by the pressing of a panel by her desk.

As I got to know people within the settings and they began to recognise and interact with me, as I sat observing, staff at Goodleigh Hall especially would regularly come and sit alongside me and begin a conversation with me. These conversations often began with a question for me, and developed into deeply reflective conversations around their work, the happenings of that particular day and how they felt about what was going on around them and what they were a part of. It was during these

153 conversations where staff members would reflect specifically on the highs on lows of their jobs and express how seeing successful rehabilitation processes made them feel.

As I began to get to know people at Goodleigh Hall and Bracken Lodge and they became used to seeing me - I slowly negotiated access into different spaces such as laundries and kitchens, therapy gyms and relaxation groups. The building of relationships with a wider range of staff types and this broadening of access to ‘non- clinical’ operational areas of the building proved critical in understanding how patient futures are shaped. [See findings chapter 6]

At the outset, the research had been designed with a view of conducting broad observations, close observations and then interviews in order to allow a sequential and deeper understanding of individuals before interview. However, interviews were conducted within a few weeks and were run alongside observations. This happened for a number of reasons. First, some staff participants who were part of an allied health professional group (and therefore small in number within the setting) were either leaving their jobs or going on holiday. This meant therefore that for them to be involved in the research they had to be interviewed earlier than the research design originally planned.

This however did not seem to be a problem for participants as in practice it seemed that an interview is far less intrusive than observations. While an interview requires trust, interview volunteering was fed by participant intrigue and gave a sense of importance (interview invites therefore had to broaden to all). To watch however required a much greater relationship to be built, and to be built slowly and over time.

Close observations (especially those of a particularly intimate nature such as personal care or therapy sessions) therefore were often conducted towards the end of the data collection period in both settings as were interviews with patients. In practice, a great deal of trust from patients had to be built to Interview them and an even greater trust required with patients and with staff, to access and get behind bedroom

154 doors to witness personal care. While staff and family interviews could be conducted at a much earlier stage than imagined, close observations took time and the privilege of their viewing an outcome of relational success.

I was warmly welcomed at both sites and interacted with frequently, so much so, writing up notes was often challenging as I would be talked to, questioned, involved almost everywhere I inhabited. It is however the highly interactive and friendly environment which encapsulates these places of care and captivated me both during data collection and during my own clinical career where I worked in such a place myself. My fondness of these environments and my will to understand them better has driven this PhD. Inhabiting these places and being taken in and ‘owned’ as ‘our Julie’ mirrored my own experience of working in such places as a clinician and later therapy team lead and eventually ‘matron’. While this PhD largely focuses on the troubling reality of the now extraordinary lives of those with severe brain injury and the subsequent constraining of lives, these places are full of warmth, dynamism and care between staff, families and residents.