The Experience of Sharing with Strangers: A Phenomenological Study of Patients in an Acute Medicine Unit

Abstract

In undertaking this qualitative study, my aim was to explore the lived experience of patients in the Acute Medicine Unit (AMU) of a UK teaching hospital, to find out how it felt to witness the distress of other patients in that setting. My findings demonstrated that fellow patients do indeed give rise to anxiety, but I did not anticipate the nature of this at the outset.
Background
Although the clinical aims of the Acute Medicine Unit have largely been met, insofar as they have improved mortality rates and quality of care (Royal College of Physicians 2007), there is little evidence to suggest that the patient’s experience of the process has been given enough appraisal (Scott, Vaughan and Bell, 2009). The fact that several patients share a ‘bay’ means that they are likely to be exposed to each other’s situations, giving rise to additional anxiety. This research aimed to establish whether such exposure is psychologically stressful for patients in the AMU.
Study Design
Interpretive phenomenological analysis (IPA), was used to guide the study design. A purposive sample of 4 patients who were admitted to AMU were selected and each consented to an audio-recorded semi-structured interview, which was then transcribed and analysed according to IPA principles (Smith, Flowers and Larkin 2009). I obtained ethical approval from the University, the NHS Research Ethics Committee and Health Research Authority before commencement of the study.
Findings
Unlike other studies, where patients had shared learning and a sense of camaraderie, there was no evidence of any meaningful interaction between patients in AMU. There appear to be several unique features of the AMU, namely the transient nature of patients, the disparate presentations and the underlying anxiety surrounding an unplanned admission, which set the AMU apart from other areas studied to date. There were three main themes relating to fellow patients which arose. The first was individual insecurities, which demonstrated that some participants displayed coping strategies to help them deal with fellow patients, many choosing to avoid others to minimise anxiety. The second was environmental exposure to fellow patients which meant that participants had to cope with exposure to sights sounds and smells resulting from proximity of others. The third and most surprising finding was that some participants viewed fellow patients as being competition for care, which caused anxiety due to their uncertain prognosis. There was minimal evidence that witnessing the distress of fellow patients caused distress to patients in AMU, which was not what I anticipated.
Discussion
The findings differed quite considerably from those anticipated, which meant that I had to extend the scope of the literature search, having failed to identify papers that adequately illuminated the subject area at the outset. This demonstrated that qualitative research findings are not always easy to anticipate. I imagined that, because I had been traumatised by my experiences as a nurse by witnessing patient distress, that patients might also find this exposure difficult. Only one participant demonstrated any concern over something that they witnessed, which I found surprising.
Recommendations
Given that this is a very small study, it would be interesting to conduct further research into the psychological impact of sharing a space with fellow patients in the AMU, and to further explore the notion that fellow patients represent competition for care in this environment, an important finding given the current demand for emergency services and difficulties with recruitment.

Date of Award	Dec 2018
Original language	English
Awarding Institution	Coventry University
Supervisor	Diane Phimister (Supervisor), Laurence Baldwin (Supervisor) & Katherine Brown (Supervisor)