Should patients still be copied into their letters? A rapid review.

OBJECTIVE: To systematically identify, synthesise and evaluate the strength of the international evidence on copy letter practice. METHODS: A systematic search identified original research studies on copy letters. Searches were limited by date and language as permitted in rapid review methods guidance. Article screening, data extraction and strength of evidence assessment were completed independently by multiple authors. RESULTS: Thirty-seven studies were included. There was a lack of information about copy letter content. Many patients report being satisfied with copy letters, understand them and find them useful. However, there is a lack of objective, high quality evidence to suggest that copy letters increased patient understanding or improved physical or psychological health outcomes. Many letters were written at a level which would make them inaccessible to patients with low health literacy. The strength of evidence was either "emerging" or "acceptable" practice for most studies (n = 30). CONCLUSION: There is a lack of objective, high quality evidence to demonstrate the benefits of copy letters as described in health policy. PRACTICE IMPLICATIONS: Personalising letters and using lay rather than medical terms appears to be useful for improving copy letter readability. Further research is required to explore this, especially in people with low health literacy levels.

A qualitative investigation of hospital visitors' experiences using the analytic lens of liminality: Informing nursing practice and policy.

This research aimed to inform nursing practice and policy by identifying satisfying and problematic experiences of hospital visitors during the hospitalisation episode of a significant other. An extensive contextual review revealed that healthcare systems in advanced economies face multiple pressures and that in England, the government leaves the determination of hospital visiting rules to individual trusts. The analytic lens of liminality provides rich interpretations of visitors' accounts and demonstrates the importance to visitors of structure (hospital rules and systems) and communitas (social bonding among liminal personae). Supportive hospital structures reduce the challenges of liminality and increase satisfaction. The data further suggest an extension to current understandings of liminality. Strong structure and successful communitas permit a safe exit from liminality after the hospitalisation episode for visitors with a close emotional bond with the patient.

Hospital visitors' experiences at the nurses' station.

Aim To investigate participants' experiences of visiting hospitalised friends and family members in adult acute medical or surgical wards in NHS hospitals in England, to improve knowledge of hospital visiting practices and to inform future policy-making and professional practice. Method A review of the contextual influences and the literature identified that hospital visitors might experience many of the characteristics of liminality, which is a state of being between two social structures or ways of being. In 2013, a total of 17 semi-structured, recorded and transcribed interviews were conducted with participants who had been hospital visitors in the period 2011-2013. The transcribed interviews underwent a thematic analysis. Liminality was then used as an analytic lens, and was central to the theoretical framework that was constructed to further consider the experiences of hospital visitors. Findings Participants experienced the hospitalisation of their friend or family member and their subsequent role as hospital visitors as a suspension of their everyday lives. Liminality was a predominant and consistent theme of the interviews. Five main themes of liminality were identified in relation to hospital visitors' experiences: total obedience; loss of status; ambiguity and being betwixt and between; uncertainty; and structure and communitas. The findings suggested that nurses consider the area behind the nurses' station as 'back stage'; a place they can use for downtime, socialising and computer work. In contrast, hospital visitors perceive the nurses' station to be a continuation of the ward, where they expect professional 'front stage behaviour' from staff. Conclusion When hospital visitors, already discomfited in their liminal status, encounter nurses' 'back-stage behaviour' at the nurses' station, their feelings of marginalisation, exclusion and mistrust increase. This may lead them to judge that the nurses lack professionalism and care, which can lead them to make complaints. Increased awareness of hospital visitors' perceptions might result in fewer complaints, and enable more NHS resources to be directed at improving patient care.