Voiceless and vulnerable: An existential phenomenology of the patient experience in 21st century British hospitals.

Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated.

Corporatising compassion? A contemporary history study of English NHS Trusts' nursing strategy documents.

The purpose of this contemporary history study is to analyse nursing strategy documents produced by NHS Trusts in England in the period 2009-2013, through a process of discourse analysis. In 2013 the Francis Report on the Mid-Staffordshire NHS Foundation Trust was published. The Report highlighted the full range of organisational failures in a Trust that valued financial efficiency over patient care. The analysis that followed, however, dwelt heavily on the failings of the nurses. Nursing strategy documents at that time served to set the future direction for NHS Trusts, prescribing specific value frameworks for each nursing workforce. However, the values chosen frequently conflicted with each other pitting nursing values against a managerial trope. It is argued that documents provided a response to wider NHS concerns and high-profile failures in care, particularly the Francis Report, paying lip service to staff engagement whilst maintaining a corporate focus. Nursing values were placed firmly within a managerialist discourse, one that has needed to be re-evaluated in the current Covid-19 pandemic. Wider implications of the research suggest discussion of value conflict may be beneficial within nursing education and a truly local approach to strategy creation would potentially promote staff buy-in to strategy documents.

The Norwegian Mobile Army Surgical Hospital in the Korean War (1951-1954): Military Hospital or Humanitarian "Sanctuary?"

During the Korean War (1950-1953) the Norwegian government sent a mobile army surgical hospital (MASH) to support the efforts of the United Nations (UN) Army. From the first, its status was ambiguous. The US-led military medical services believed that the "Norwegian Mobile Army Surgical Hospital" (NORMASH) was no different from any other MASH; but both its originators and its staff regarded it as a vehicle for humanitarian aid. Members of the hospital soon recognized that their status in the war zone was primarily that of a military field hospital. Yet they insisted on providing essential medical care to the local civilian population as well as trauma care to UN soldiers and prisoners of war. The ambiguities that arose from the dual mission of NORMASH are explored in this article, which pays particular attention to the experiences of nurses, as expressed in three types of source: their contemporary letters to their Matron-in-Chief; a report written by one nurse shortly after the war; and a series of oral history interviews conducted approximately 60 years later. The article concludes that the nurses of NORMASH experienced no real role-conflict. They viewed it as natural that they should offer their services to both military and civilian casualties according to need, and they experienced a sense of satisfaction from their work with both types of patient. Ultimately, the experience of Norwegian nurses in Korea illustrates the powerful sense of personal agency that could be experienced by nurses in forward field hospitals, where political decision-making did not impinge too forcefully on their clinical and ethical judgment as clinicians.

International nurses to the rescue: The role and contribution of the nurses of the International Brigades during the Spanish Civil War.

AIM: To describe the life and work of the international nurses of the International Brigades during the Spanish Civil War and to examine their role in relation to their contribution to Spanish nursing in this period. METHODS: This historical study is based primarily on the memoirs of the international nurses who joined the war health services of the International Brigades during the Spanish Civil War. The evidence that was elicited from these sources was compared and contrasted with other contemporary documents in order to compare their perspectives with those of other contemporaries. RESULTS: The nurses of the International Brigades joined the front line health services as part of the mobile medical and surgical teams that were attached to the fighting units. They lived and worked under extreme conditions, often under fire. Their work while in Spain was not limited to care delivery but also included managerial and educational aspects. The international nurses' observations of Spanish nursing at the time were not always accurate, which might be explained by a lack of contact with qualified Spanish nursing staff due to a shortage of fully qualified nurses. CONCLUSION: In the absence of the voices of the Spanish nurses themselves, the written records of the international nurses were invaluable in analyzing Spanish nursing in this period. Their testimonies are, in essence, the international nurses' legacy to the Spanish nurses who stayed behind after the departure of the International Brigadists in 1938.

Crisis at Guy's Hospital (1880) and the nature of nursing work.

This historical study aims to refine understanding of the nature of nursing work. The study focuses on the 1880 crisis at Guy's Hospital in London to examine the nature and meaning of nursing work, particularly the concept of nursing work as many 'little things.' In this paper, an examination of Margaret Lonsdale's writing offers an original contribution to our understanding of the ways in which nursing work differs from medical practice. In this way, we use the late-nineteenth-century controversy at Guy's Hospital as a prism through which to examine the contested nature of nursing work. Lonsdale's ideas are corroborated by examination of writings by nurse leaders Florence Nightingale and Eva Luckes. Luckes, in particular, elaborated what was meant by nursing as the performance of a thousand little things, which are specific to nursing work. While physicians had been performing much of what was considered to be nursing work, nurses developed some of these and other interventions into a unique body of work characterized by meticulous attention to significant details. Some implications regarding current nursing practice are discussed.

Physical restraint: experiences, attitudes and opinions of adult intensive care unit nurses.

BACKGROUND: Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours. AIM: To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint. DESIGN: Questionnaire survey. METHODS: A postal questionnaire was distributed to all nurses (n = 192) within two purposefully selected large adult intensive care units in the UK. RESULTS: Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% (n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process. CONCLUSION: Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor. RELEVANCE TO CLINICAL PRACTICE: Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal.

Stoicism and care in the face of carnage.

Nursing Standard interviews nurse historian Christine Hallett about the nursing contribution to the first world war effort. Professor Hallett, author of Veiled Warriors, explains the incredible demands placed on nurses who found themselves treating vast numbers of casualties with wounds of unprecedented severity. Patriotism, a culturally ingrained stoicism and camaraderie between nurses helped them get through it.

'A very valuable fusion of classes': British professional and volunteer nurses of the First World War.

Public perceptions of the work of nurses and VAD-volunteers in the First World War have been heavily influenced by a small number of VAD-writings. The work of trained, professional nurses in supporting and supervised the work of VADs has been largely overlooked. This paper examines several of the writings of both volunteers and professionals, and emphasises the overlooked supervisory, managerial and clinical work of trained nurses. In this centenary year of the First World War's opening months, the paper also explores the ways in which the British mass-media--notably the BBC--have chosen to cling to a romantic image of the untrained nurse, whilst at the same time acknowledging the significance of trained, professional nursing.

Nurses and subordination: a historical study of mental nurses' perceptions on administering aversion therapy for 'sexual deviations'.

This study aimed to examine the meanings that nurses attached to the 'treatments' administered to cure 'sexual deviation' (SD) in the UK, 1935-1974. In the UK, homosexuality was considered a classifiable mental illness that could be 'cured' until 1992. Nurses were involved in administering painful and distressing treatments. The study is based on oral history interviews with fifteen nurses who had administered treatments to cure individuals of their SD. The interviews were transcribed for historical interpretation. Some nurses believed that their role was to passively follow any orders they had been given. Other nurses limited their culpability concerning administering these treatments by adopting dehumanising and objectifying language and by focussing on administrative tasks, rather than the human beings in need of their care. Meanwhile, some nurses genuinely believed that they were acting beneficently by administering these distinctly unpleasant treatments. It is envisaged that this study might act to reiterate the need for nurses to ensure their interventions have a sound evidence base and that they constantly reflect on the moral and value base of their practice and the influence that science and societal norms can have on changing views of what is considered 'acceptable practice'.

'Queer' treatments: giving a voice to former patients who received treatments for their 'sexual deviations'.

AIMS AND OBJECTIVES: The study aimed to examine the experiences of patients and meanings attached to 'treatments' of sexual deviations, which included homosexuality and transvestism, in the UK (1949-1992), exploring reasons for such treatments, experiences and how individual lives were affected. BACKGROUND: Male homosexuality remained illegal in England until 1967 and, along with transvestism, was considered an antisocial sexual deviation that could be cured. Homosexuality remained classifiable as a mental illness until 1992. Nurses were involved in administering treatments to cure these individuals; however, there is a paucity of information about this now-discredited mental health nursing practice. DESIGN: A nationwide study based on oral history interviews. METHODS: Purposeful and snowball sampling was utilised when selecting participants for the study. Participants were recruited via adverts in gay establishments/media. All participants gave signed informed consent. Face-to-face oral history interviews were conducted and transcribed for historical interpretation. RESULTS: Seven former male patients made contact, aged 65-97 years at interview. All reported that the treatments had been unsuccessful in altering their sexual desires or behaviour. Most sought treatment owing to unsupportive and negative attitudes from friends, family and wider society. Others selected treatments instead of imprisonment. Most eventually found happiness in same-sex relationships. However, all were left feeling emotionally troubled by the treatments they received. CONCLUSION: Defining homosexuality and transvestism as mental illnesses and implementing what could be argued to be inefficient treatments to eradicate them appears to have had a lasting negative impact on the patients who received them. RELEVANCE TO CLINICAL PRACTICE: Nurses who care for older gay, lesbian, bisexual and transgender patients need to be mindful of their potential past treatment by healthcare services and ensure that they are non-judgmental and accepting of their sexual orientation and current gender.

"Time enough! Or not enough time!" An oral history investigation of some British and Australian community nurses' responses to demands for "efficiency" in health care, 1960-2000.

Oral history methodology was used to investigate the perspectives of retired British district nurses and Australian domiciliary nurses who had practiced between 1960 and 2000. Interviews yielded insights into the dramatic changes in community nursing practice during the last four decades of the 20th century. Massive changes in health care and government-led drives for greater efficiency meant moving from practice governed by "experiential time" (in which perception of time depends on the quality of experience) to practice governed by "measured time" (in which experience itself is molded by the measurement of time). Nurses recognized that the quality of their working lives and their relationships with families had been altered by the social, cultural, and political changes, including the drive for professional recognition in nursing itself, soaring economic costs of health care and push for deinstitutionalization of care. Community nurses faced several dilemmas as they grappled with the demands for efficiency created by these changes.

Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970-2003.

Promoting the health of Europeans in a rapidly changing world: a historical study of the implementation of World Health Organisation policies by the Nursing and Midwifery Unit, European Regional Office, 1970-2003 The World Health Organisation (WHO) was inaugurated in 1948. Formed in a period of post-war devastation, WHO aimed to develop and meet goals that would rebuild the health of shattered populations. The historical study reported here examined the work of the Nursing and Midwifery Unit (NMU) of WHO's European Regional Office during the later part of the twentieth century. The study examined archive sources lodged at the NMU archive. The sources included manuscripts relating to important NMU initiatives, reports and papers published by WHO, and a range of secondary sources. The study identified three main driving forces in the work of the NMU of the European Regional Office of WHO. One of the strongest of these was a drive to develop and promote the nursing profession within the countries of the European Region. The second was the promulgation and implementation of the positive public health strategies of WHO, particularly its '38 Targets for Health for All by the Year 2000'. The third focussed on securing equity across the European continent and on promoting the development of the nursing professions in poorer and less-developed countries. The study concludes that the nursing professions in European states grew in strength and influence, and that the health of populations improved throughout the continent between 1970 and 2003. It discusses the extent to which the role of the NMU in these advances may have been significant.

In my day II: Reflecting on the transformative potential of incorporating celebrations into the nursing curriculum.

Understanding one's history is a powerful way to build a sense of belonging, identity and connection. Similarly, history learning can be a powerful component in the core curriculum for undergraduate nursing. History learning develops thinking skills transferable to and necessary in nursing practice. Additionally, awareness about the profession's struggles, achievements and enduring concerns is raised and belief that an individual or group can have influence is affirmed. Perseverance, commitment and seeing the big picture gives a nurse's career meaning and purpose. All of these factors can produce a transformed perspective in today's learners, who are often present-focused, isolated and disconnected from the past and the profession. This paper reports an evaluation of a second interactive learning experience held at the University of the Sunshine Coast to celebrate International Nurses Day 2010. In a previous paper, we shared our initial insights after the success of the first event, and now build upon those insights by examining the transformative learning provoked by the experience, from the points of view of students and staff.

Portrayals of suffering: perceptions of trauma in the writings of First World War nurses and volunteers.

The trauma-writings of World War I nurses have been identified as an important and influential corpus of early 20th-century works. Not only did the rediscovery of these writings in the later 20th century serve to recognize the importance of women's writings as part of the historical record, and identify certain female writers as some of the most important thinkers of the modernist movement; they also demonstrated the importance of the nursing perspective as one element of wartime experience. This paper considers a number of influential works written by both nurses and members of the Voluntary Aid Detachments (VAD) who assisted with nursing work during the war. The paper identifies how nurses and VADs presented their experiences of war trauma. It also considers how some writers strove to attach meaning to (or in some, cases expressed their sense of the meaninglessness of) the suffering caused by the war. The paper considers further how some nurses themselves experienced trauma as a result of their exposure to wartime work, and how some writers developed what are referred to as "philosophies of suffering," in which they struggled to understand suffering as an element of human experience.

Russian romances: emotionalism and spirituality in the writings of "Eastern Front" nurses, 1914-1918.

The nursing work of the First World War is usually associated with the trench warfare of the Western Front. Nurses were based within fairly permanent casualty clearing stations and field hospitals, and patients were moved "down the line" to base hospitals, and then to convalescent hospitals "at home." The nurses and volunteers who worked on the Eastern Front and offered their services to the letuchka or "flying columns" of the Russian medical services had a very different experience. They worked with highly mobile units, following a rapidly moving "front line." The diaries of three British (one Anglo-Russian) nurses who worked alongside Russian nursing sisterhoods in three different flying columns-Violetta Thurstan (Field Hospital and Flying Column), Florence Farmborough (With the Armies of the Tsar) and Mary Britnieva (One Woman's Story)--stand as an important corpus of nursing writing. Written in a highly romantic style, they take up similar themes around their work on the Eastern Front as a heroic journey through a dreamlike landscape. Each nurse offers a portrayal of the Russian character as fine and noble. The most important themes deal with the romance of nursing itself, in which nursing work is portrayed as both character-testing and a highly spiritual pursuit.

Colin Fraser Brockington (1903-2004) and the revolution in nurse-education.

Colin Fraser Brockington was Professor of Social and Preventive Medicine at the University of Manchester from 1952 to 1965. During that time he developed the Diploma in Community Nursing, the first pre-registration training course for nurses at a British University. This paper traces Brockington's education and career and explores his commitment to university-based nursing education which appears to have stemmed from his desire to enhance and broaden the role of the health visitor. It also considers the implications of the innovative course at Manchester and evaluates the way in which it influenced the gradual movement of nursing education into the university sector throughout the UK.

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer.

BACKGROUND: Life course research methodologies are used extensively in historical and social science research. In 1998 the life course paradigm was introduced to provide a way of tracing the interplay of person and setting. The method has had a very limited use in nursing research, but in this study it was utilized as a way of capturing dynamic change by placing the individual within a context of four domains; location in time and place, linked lives, human agency and timing of lives. OBJECTIVE: To describe the paradigm, review its use in healthcare research and provide a specific example of its use in healthcare. DESIGN: This paper discusses a novel method of creating life course charts for a qualitative study exploring the differing experiences of women referred from primary care to specialist services due to a family history of breast cancer. SETTING: A nurse-led breast cancer family history clinic in the UK. PARTICIPANTS: Twenty-two women. METHODS: Life charts were used in conjunction with a grounded theory approach to analyse data collected from semi-structured interviews. FINDINGS: Twenty-two life charts were created and the ability to layer the charts of multiple women to visualise similarities and differences aided the analysis. The life charts were a useful tool in the development of theoretical understandings and the psychosocial process of realisation of risk emerged as central to the initiation of referral. This was often apparent when approaching the age of an affected relative (anticipated onset) or when current circumstances emulate past experience (generational transference). CONCLUSIONS: This approach to charting complex psychological, social and contextual factors throughout the life course was methodologically beneficial and could have a wider utility in nursing and healthcare research. As a research tool it enhanced a holistic approach to patient care issues and was helpful as an aid to understanding health behaviours linked to familial risk.