LIMITACIONES A LA MATRÍCULA EN LOS PLANES RENOVADOS

Early therapeutic interventions aimed at supporting and enhancing the patient’s generalised resistance resources and strengthening their sense of coherence are likely to positively influence their recovery, therefore it follows that nurses, as agents of the clinical gaze have a pivotal role in providing the necessary care. Nurses are

professionally encouraged to provide care with compassion (Nursing Midwifery Council, 2013) and amongst others, Benner (1984) indicated that through a professional, caring partnership with the patient, the establishment of hope, confidence and trust, befitting of compassionate care, enhances the healing process and positively influences a patient’s recovery from illness. In a care collaborative, doctors would also be expected to engage in effective, patient-centred communication across all levels of the medical hierarchy.

During the interviews the informants appeared very clear about the part played by doctors in the context of their recovery experiences, but patients appeared less clear about their experiences of interacting with nurses and other agents of the medical gaze. This may have been consequential to a number of factors, such as over-lapping job roles, a lack of familiarity with the colour coding of uniforms, or simply limited

communication skills when introducing themselves to patients, which has been a focus of a campaign to enhance compassionate care (Hellomynameis.org.uk, 2014). At times it was difficult to ascertain from the participant narratives as to whether they were commenting upon qualified nurses or healthcare assistants. Nevertheless, many of the informants in this study did comment specifically about their positive and negative experiences of how they were nursed and how nursing appeared to be managed during aspects of their care and recovery.

As a subtext to their experiences of recovery, study participants identified that the part played by nursing in the delivery of care aimed at enhancing the recovery of patients incorporated a wide range of qualities. Alongside the traditional nursing role of providing patients supportive care with their activities of daily living that included

intimate care upon the body of the patient (recognised by some as necessary, unpleasant work conducted by more junior or less qualified staff), good nursing care provision was also perceived through the provision of accurate, integrated and

supportive information. However, considerable variability in the quality of nursing care was an experience of many patients which merits attention, at least in terms of providing patients with a voice, through an open forum for disclosure followed by an explanation as to why this may be so.

Good quality, personally directed care was often associated with being comforted, particularly where professional rapport had been developed. In terms of psychological care, many patients welcomed the familiar comforting elements of personal

communication exchanges in the form of polite greetings that occur when people meet and the everyday small-talk that often arises, but they also commented on the beneficial comforting effect that was provided through the sensitive use of language and the

comfort of physical touch. Several participants identified how at a moment of existential personal terror and vulnerability, where their family members were not available or accessible, nursing staff provided them with comfort, care and reassurance. One

participant remarked that the nurses had reassuringly reached out to him at a point he had felt very vulnerable, lonely and tearful.

The lack of continuity of care from particular nursing staff was raised as an issue that negatively affected their care and recovery. The participants were aware that the lack of continuity of care was not limited to medical staff, the day to day changes in nursing staff was identified as a problem for them and whilst they understood the logistical challenge. It was suggested by one patient that better management of the nurses shift allocation pattern and duty rostering would improve the continuity of care, which he felt would better promote the development of a more effective care

relationship between the patient and the nurse, which may then improve the patient experience of recovery.

Participants also recognised that the job role of nurses was important, integral constituent with both the technical and non-technical workings of the medical gaze, this included observations by patients of the activity of the gaze that occurred around focal gathering points, usually where communication hubs were placed. The ward /

departmental nursing stations were visible to mobile patients and in critical care areas centralised heart monitoring screens and x-ray viewers are housed for physiological observation purposes. There were also a number of examples of considerable

communication failure that negatively affected the patients perception of the care of the medical gaze, one such example arose when a blood sample was taken where the patient was offered no explanation whatsoever as to the purpose of the sample and it made him feel as though he was just a number and saw it as a lost opportunity for human interaction. Another patient was aware that he courted a nurse’s displeasure by simply using his call bell to ask for help. Similar issues arose around the timing of nighttime medication. Whilst patients understood that nurses had a job to do, numerous patients recounted the experience of having been woken during the night to receive medication. The provision of oral or inhalational medication appears to be driven by a temporal system entrenched within the medical gaze and at the convenience of the medical gaze, rather than in a negotiated, informed and consensual approach that involves the patient (Jarman et al, 2002). Some patients felt that on occasions nurses waited until they (the patient) dropped off to sleep before being approached to take their medication. However, as recorded in the findings of this research, there were much

more serious failings within nursing and its intended provision of person-centred

compassionate care that indicate a major flaw in the regulation and maintenance of the nursing gaze (chapter 6, section 6.2.2), which included accounts of a lack of attention to the needs of the individual, whereby it could be perceived that nursing was more

concerned with its role in the clinical gaze, rather then being attentive to the needs of its patients. As stated in the findings, it was apparent that (along with medicine) nursing fails to find time to listen to the voice of the patient, accordingly such insights into what patients experienced during their recovery had only been revealed as a consequence of undertaking of this research study, which I found disappointing.

It is clear that the evidence provided by the narrative accounts of the participants in this research has provided a rich seam of material that could be used to better inform the architects of the clinical gaze that there is much to be done to improve the patients experience of recovery from cardiac arrest, much of which will form the basis of the recommendations for practice that have emerged from this dissertation.