Las lenguas románicas estandarizadas

Without exception – patients and relatives at baseline – described their experience of care in positive terms: staff were kind and responsive when they needed assistance; and relatives indicated that staff made themselves available to discuss their concerns, kept them informed about what was happening, and involved them in decisions about the future. In the detail, we get a more nuanced picture both of experience in context of what was viewed as ‘good’; and variability in responding to preferences and needs.

Warmth and responsiveness

The characterisation of care delivery on both Seaford wards as ‘warm, sensitive and task-focused’ was mirrored in the case studies. For patients, what was conveyed was not simply being acted upon, but actively engaging with the ward environment. Staff responded quickly when asked for assistance; but people also described ‘seizing the right moment’:

Well, I wait ‘till I think they’re not busy. If they’re rushing, rushing backward and forward, I keep quiet. But if they’re just wandering, I’ll say: ‘nurse’, like that and they come over. But if I see them running then I wouldn’t because I think, well they’re off to do something important.

Rose, Poplar ward

Lily, moved from a bay to one of the single rooms similarly, expressed the same sense of being patient and seeking acknowledgement that she only looked for help when it was ‘important’:

I press my buzzer and if they don’t come there and then, I wait a bit longer and I have another press. Because I must realise they’ve got work elsewhere. So you just sit and wait until they can get to you. But it’s really… important you keep your finger on the buzzer; but I wouldn’t do that if it wasn’t important.

Lily, Poplar ward

Iris had also moved from a bay to a single room – not of her choosing – she had developed an MRSA type infection. Her daughter described her as very upset and agitated with the move but had settled after a while. Now she considered her mother as contented on the ward:

She was very frightened about coming in to hospital. It’s her one dread – being in hospital. I know it's a terrible thing to say but this has actually done her good because it’s taken away her fear of hospitals now.

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John’s daughter-in-law voiced the absence of more staff time spent directly sitting with patients. As a HCA in a residential care home, she acknowledged the importance of spending time with people; but viewed this as requiring more staff on the ward as the nurses were so busy: “they’re always

darting about quite a bit”, although “always they do go out of their way to make sure that the patients’ are comfortable” and “they come and make sure that we’re okay” [relatives].

Other patients: source of disturbance, friendliness and reciprocal help

Being on a ward, meant that close proximity to other patients was a source of conviviality and disturbance. Women interviewed considered that ‘friendliness’ was important. They distinguished between liking to sit and talk with people, ‘being sociable’ and being ‘best friends’: “you get

friendly…it’s not a good thing to try to make friends because it doesn’t last”. Daisy described her

relationship with other patients as “vaguely to talk to”, but she had become good friends with Bessie. Conveyed in her account is a level of understanding and acceptance of others’ disorientation:

Bessie and I are quite good friends now…but I still haven’t found her husband though (Daisy laughs)…She does get in a muddle sometimes looking for Fred. She says: “where’s Fred”?

Daisy, Crane ward

The conversation with Daisy was punctuated with interjections to Bessie: “are you all right, Bessie”;

“Careful Bessie”…she doesn't look safe [to the researcher].

Rose liked to sit with people and talk, ‘getting on’ but not ‘close friends’. She was sanguine about other patients calling out:

You can look around at everything and think, ‘oh I wish they wouldn't do that’. I don't like the way they do that…but that's only your personal opinion. I can’t judge what all these people think…There’s a lady, she does a lot of shouting…I think she’s a very disturbed person…but if you pull the clothes over your head and don’t listen, it’s okay…when they moan and groan there’s a reason for it…they’re unhappy…with myself I’m perfectly happy as things are [Rose laughs good humouredly].

Rose, Poplar ward

Lily had been moved to a single room from a bay because of disturbance from other patients, who she described as “rowdy and grumbly”. She felt better on her own, “it's a rest” (being in bed). Men interviewed appeared less interested in the potential for conviviality and social interchange. John was moved to a single room: he was unable to sleep because another patient was shouting out during the night. His daughter-in-law would have preferred that he stayed in the bay for the company but understood that he preferred to be on his own. He found enjoyment in at the bird

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through the window; enjoyment in nature replicated how he spent time at home. Robert was happy to sit with people in the bay and found comfort in the routine: “I was in the medical corps in the

war…it’s got to be run as a routine”.

Going home

Everyone wanted to resume life as before. Apart from Rose, who was to return to her care home, their destination was uncertain. It was not always clear from patients how much involvement they had with the decision about planning for discharge. In part this reflected memory difficulties. Rose hoped to return to her care home but indicated that she didn't know when this would happen; her daughter reminded her she was being discharged within a couple of days. There was a sense from patients’ talk that there had been discussion but that ultimately the decision was not in their hands; it rested elsewhere – not only with professionals but with close relatives. Thus Robert hoped to go back home, but his relatives had talked to him of going into care:

I know they’ve been thinking of me going into another place where I could talk to other people and that…but…in some ways I would and others I wouldn’t.

Robert, Crane ward

Lily wasn't sure how much longer she would be in hospital except that the doctor had said she would be ready when she could walk a little way, adding: “they know better than me”.

Relatives on the other hand, described how they were very much involved in the decision about discharge; a process perceived as emotional and conflicting in reconciling their relative’s wish to resume life as before with their deteriorating health.