Patients' experiences and social relations in geriatric wards
This thesis is based on research which aimed to describe and account for patients' experiences in eight unexceptional examples of predominantly long-stay geriatric wards, each in a different hospital. Observational methods were used to document the experiences of 86 patients. Other data on ward work processes were drawn from interviews with Ward Sisters and Consultants, written records and informal conversations with ward participants. Data analysis was based on the type and amount of inhumane treatment which patients suffered. In focussing on inhumane treatment and developing a systematic and non-emotive analysis of its origins, the research breaks new ground. Patients in all the wards experienced inhumane treatment, but this varied in kind and quantity. It is shown that poor staffing levels and heavy workload cannot by themselves account for the inhumane treatment of patients which was observed. Instead, the beliefs, work practices and interrelationships between Consultants and Ward Sisters emerged as important. Where the work of long-term care was viewed as a valuable and important task, there was evidence of attempts to offer personalised care to patients. Where long-term care was viewed as low-status work, an outcome of 'failure' of the medical cure system, there was scant evidence of personal attention to patients' needs. The nature of inhumane treatment which was observed enables a new perspective to be offered on what constitutes humane treatment and how this might be reliably secured in practice. Eight practical recommendations are made on the basis of research findings. Consideration is also given to ways in which the innovatory social research approach of documenting inhumane treatment might be further developed and applied in practice by professionals seeking to monitor and improve patients' experiences in geriatric wards.