The ‘Staff Recognition’ theme relates to the first aim of the study: To explore older patient and informal carer perspectives of the care and treatment received whilst on the AMU. Despite recalling weaknesses around their care delivery, the
participants voiced positive recognition of the staff on the AMU. The analysis revealed that the same participants that voiced dissatisfaction in the earlier theme also praised the staff in this theme. All but two of the patient participants (Beryl and Charles) spoke favourably about the staff on the AMU.
The data in this theme centred on participant praise of the staff on the AMU. The participants spoke about the staff being good, kind and caring. The participants felt they had been looked after on the AMU, felt their basic needs had been met, and were happy with the care they received on the AMU. The analysis revealed that the participants wished to express the positive attributes of the staff, saying that all the staff, from those clearing up the wards to the doctors were lovely, helpful, pleasant, and caring. Participants outlined how attentive the staff were, checking on them regularly and ensuring they had everything they needed.
The following three patient participants successfully illuminate the theme. Doris was admitted to the AMU with extreme lethargy. She repeatedly praised the staff
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on the AMU, stating that they treated her as well as royalty. She stated that the staff were both lovely and attentive:
“Well they couldn’t do enough for you, they was, they were little angels, they was really” (Female patient, age 81, TA).
Norma, like Doris, repeatedly praised the staff on the AMU. This lady was admitted with chest pains. She stated that the staff on the AMU were very pleasant, very kind, very efficient, helpful, highly attentive, and caring. She stated that the staff made her feel comfortable and at ease:
“I don’t think they could have done any more, been any more pleasant than what they were. Everyone was so pleasant, the nurses and the staff” (Female patient, age 80, TA).
Leonard similarly spoke about the positive attributes of the AMU staff. He talked about the staff checking on him regularly and ensuring he had everything needed:
What more do you want?
As I say there was this small fellah [emphasised words], and er he came round every hour,
near enough to check your blood pressure and that, and as I said,
the moment I stood up, he knew I was a bit shaky, and he was there straight away; “Where are you going,
can I help you? Hang on to me”.
So I mean, what more do you want?
I don’t know whether I was one of the lucky ones or not, but er no complaints in that ward whatsoever.
If they treat everybody [emphasized word] that goes in the same as they did me [emphasised word],
79 (Male patient, age 87, NA).
Leonard provided a further scattering of evaluations across a second longer stretch of narrative, where he periodically stepped back to judge the AMU staff, whom he appraised as “good”, “kind” and “brilliant”. He voiced that their level of
attentiveness made him feel safe. These three patient participants, like many of the other participants, voiced that the staff on the AMU could not have done any more for them.
The data in this theme also included comments whereby participants, like Leonard above, singled out individual members of staff for praise. In doing so the attributes of care valued by participants were revealed. An example is provided below by an interwoven narrative given by Kath, and her daughter, Jane. The paramedics were called out when Kath was experiencing severe shortness of breath. Kath was subsequently admitted to the emergency department, where she was prescribed diuretics, and consequently frequently needed a bed pan. Once on the AMU both mother and daughter singled out an individual nurse for praise:
One nurse was excellent C: Well when you,
no when you’ve was first admitted [onto AMU] the nurse was very good,
she went,
when I said that you’d hadn’t had anything to eat she went and made you some hot milk…
Pt : Yer.
C : then you was still in the hospital gown weren’t you? Pt : Yer.
C : Erm, and your sheets were wet… Pt : Yes.
C : and I think that was from the bedpan… Pt : Yer because and they spilt it
I think when they took it away.
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Pt : Yes. And she did change the bed. C : Yes she, she was excellent,
she didn’t go and see to anybody else, she concentrated on you,
you had the bedpan,
then she put you in the chair and changed your sheets
and made you comfortable in bed didn’t she? (Evaluation):
(Female patient, age 88, & carer, daughter, NA).
This narrative, like others, highlighted the attributes of care valued by participants. They particularly valued staff that were attentive and checked on them regularly. This included noticing and removing wet clothing, assisting with toileting, and providing basic toiletries and basic refreshments.
In summary, the data in this theme centred on the positive recognition by both patient and carer participants of the staff on the AMU.
a) Dispersal of blame
The theme of ‘Staff Recognition’ appears on the surface to contradict the earlier theme of ‘Shortfalls in Satisfaction’. The data in this sub-theme however revolved around the participant desire to dispel any blame away from the staff for the shortfalls they experienced in respect of their care delivery. There was a clear pattern whereby participants both praised the staff but also offered excuses for any shortfalls in their care delivery. These shortfalls were considered outside the remit of the AMU staff. Participants instead blamed a host of external factors for any dissatisfaction experienced, and this included governmental cut backs, and a shortage of beds and staff.
David and Albert spoke about the staff being very busy and about shortfalls being attributed to factors outside the remit of the staff. Their quotations have been selected as they reflect the data of other participants in this sub-theme.
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David recognised that the AMU staff were busy looking after other sick patients. He voiced that the staff were overworked, there was a shortage of beds, and
insufficient finances for the service:
“I mean they’re busy all the time, you can’t expect them to … you know if you shout them you can’t expect miracles, they’re looking after people” (Male patient, age 80, TA).
Similarly, Albert spoke about the staff “flying about”, and the number of sick patients in need of care. Albert compared the Unit to Clapham Junction, with staff “dashing all over the place”. He stated that he believed that the staff did the best they could in difficult circumstances:
“You know there, somebody goes and they’re not replacing them which, so you know they’re rushing about a little bit, and people do get to the stage where probably they’re not getting erm things done quite [emphasised word] as quickly as what they were getting before, I never had a problem with them in there” (Male patient, age 78, TA).
Like other participants, Albert was keen to point out that the staff were not to blame for weaknesses in his care delivery. He stated:
“… I mean I don’t blame anybody, you know the nurses rushing about, back and forth” (Male patient, age 78, TA).
The interpretation of the ‘Dispersal of blame’ sub-theme was that staff were perceived to be very busy, and that these staff worked hard and did a good job considering the pressure they were under. As succinctly stated by Ida, who was admitted to the AMU following an accidental fall:
“I mean when you think of the people they have in and out, in and out, all the time, I think they do a remarkable job, don’t you?” (Female patient, age 88. TA).
In summary, the data in this sub-theme centred on the participant attempts to disperse blame away from the AMU staff for the shortfalls that they experienced during their AMU stay.
82 Theme 2 Summary
The findings in this theme highlighted how participants praised the staff on the AMU despite the shortfalls that they experienced in respect of their care delivery. Where such shortfalls existed participants dispersed the blame elsewhere. Hence shortfalls in care delivery were not attributed directly to the staff on the AMU, but rather to external factors.