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Patients felt greater personal control and emotional comfort in hospital when they felt secure, informed, and valued

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A M Williams

Dr A M Williams, Curtin University of Technology, Perth, Western Australia, Australia; anne.williams{at}curtin.edu.au

QUESTION

What aspects of the hospital environment affect patients’ feelings of personal control and emotional comfort?

DESIGN

Qualitative study using the grounded theory method.

SETTING

Hospitals in Perth, Western Australia.

PARTICIPANTS

56 patients >18 years of age (median age range 54–64 y, 59% women) who had been admitted to hospital for any episode of illness and could converse in English.

METHODS

Data were collected through 78 hours of field observation and semistructured interviews with patients. Interviews were audiotaped and transcribed verbatim. Data were analysed thematically using the constant comparative method.

MAIN FINDINGS

Patients identified 3 conditions of the hospital environment that affected their feelings of personal control and emotional comfort. (1) Level of security. Patients’ feelings of personal control increased when assistance was available to help them do things they could not do by themselves; they felt insecure and experienced emotional discomfort when assistance was lacking. One patient described being afraid of injury and feeling insecure when he could not get assistance to fix a broken bed. Some patients increased their feelings of security by actively seeking assistance from others, including nurses and family members. (2) Level of knowing. Patients experienced emotional discomfort when they were unsure of what to do in hospital, although previous experience of hospital or illness or availability of information resources increased feelings of personal control and emotional comfort. Patients also obtained information themselves if they were able (eg, from other people, books, the internet). (3) Level of personal value. Patients felt that their personal control and value were reduced and they experienced a loss of dignity when they had to depend on others. Several patients described how their independence was reduced in hospital: “You can’t get out…you can’t go and sit in the sun outside and, you can’t drink your own water and you can’t eat your own food.” They felt that they were more able to do things for themselves at home and that this enhanced their recovery. Hospital environments that felt like home facilitated emotional comfort, and 3 aspects of the environment influenced feelings of personal value. (a) Lack of control over use of equipment and furniture that was physically uncomfortable increased emotional discomfort, and the types of food and drinks available also affected patients’ experiences. Discomfort could sometimes be overcome if family members brought patients other food and equipment. (b) Patients considered their surroundings (eg, access to fresh air, views of nature) to be important and wanted a separate space to interact with family, friends, other patients, and even pets. Some patients liked having a single room: “When you’ve got other people round you, you’d have one over there with a cough that’s terrible and one that talks to themselves half the night and all sorts of things.” Other patients preferred rooms with multiple beds: “I had someone to talk to…I think a lot happier than what you are in a single room.” Some patients were concerned with a lack of cleanliness in the hospital. (c) Facilities and equipment that enabled independence in hospital increased patients’ feelings of personal control (eg, mobile IV lines with battery-powered infusion devices).

CONCLUSION

Patients’ feelings of control and emotional comfort in hospital were greater when they felt secure, informed, and valued.

ABSTRACTED FROM

Williams AM, Dawson S, Kristjanson LJ. Exploring the relationship between personal control and the hospital environment. J Clin Nurs 2008;17:1601–9.

Commentary

The study by Williams et al captures an insightful perspective on the effect of the hospital environment on patients’ sense of personal control and emotional comfort during their admission. By voicing how level of security, knowing, and personal value influence the experience of hospitalisation, the authors foreground areas of possible intervention for nurses and open further debate about the importance of these issues.

The findings highlight the importance for patients of understanding institution rules: Can my family bring me food? Can I use my own blanket? What are the routines and expectations? They show the pivotal role nurses can play to increase patients’ emotional comfort by removing this guess work and communicating what patients need to know about the hospital environment. They suggest that further study of simple interventions to improve emotional comfort is of value. Such interventions include unit-specific information brochures, a means of communicating the positions and responsibilities of members of the staff team, or a list of ward routines.

The findings also illuminate a paradox between patients’ reluctance to accept help and the distress experienced when help is unavailable. Although this paradox will resonate with nurses, more work is needed to better understand how patients and their families may be invited to fully participate in their care without creating expectations that are unrealistic, inappropriate, or discriminate against those who lack social support.

Nurses will be interested to explore how these findings can assist in improving patient outcomes. Although the value of increased privacy, access to outdoor spaces, or more comfortable furniture may not resonate with most healthcare decision makers, nurses will welcome further study of related outcomes, including improved communication among the healthcare team, infection control, and early mobilisation associated with changes to the hospital infrastructure. This study supports expanded involvement by nurses in healthcare environment planning and evaluation to assist in meeting patients’ needs.

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Footnotes

  • Source of funding: National Health and Medical Research Council.

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