Spotlight on Research
Thursday, October 2, 2014
What was it like for you?This qualitative study was undertaken in Sweden and explores patients' experiences of their encounters with pre-hospital staff, with a particular focus on the meanings they attribute to their relationships with ambulance clinicians.In total, 20 people (13 males; 7 females) aged between 25 and 88 years were interviewed. They met the following criteria: aged over 18 years, conscious during their time with ambulance staff, and able to give informed consent.Interviews were conducted either at home (n=18) or at work (n=2) according to the participants' preferences. They were audio recorded and transcribed verbatim in preparation for analysis. Three main areas were addressed, including the actual incident/experience itself, the early stages of the therapeutic relationship, and how the relationship developed during the clinical encounter.The authors outline that the process of analysis involved three steps: naïve reading, structural analysis, and comprehensive understanding. The paper gives useful examples illustrating this approach to analysis which was informed by a phenomenological hermeneutic method, enabling the researchers to move back and forth between understanding and explanation of the content.It was in the structural analysis that the main theme ‘To surrender in dependence of another’ emerged. Overall this incorporated both negative and positive experiences, sometimes including relief at being able to relinquish responsibility to the expert healthcare professional and being able to trust their judgement and competence as clinicians but, sometimes, it was an altogether less positive experience, where participants felt powerless and disregarded in decisions relating to their own treatment and management.This overall theme was divided into four sub-themes. First, they outline ‘being in the hands of another’—this was viewed as positive, with participants describing having trust and confidence in the ambulance staff and their clinical decision-making. The patients felt safe but still engaged in the decisions relating to their care.The second sub-theme—‘being in a caring temporary presence’—reflected the relief that patients expressed that they were no longer on their own, that help had arrived. This relief started even before the physical presence of staff e.g. from the point that the patient could hear the ambulance's siren in the distance. Patients talked about the development of an empathetic, relaxed and intimate relationship that was terminated once they arrived at ED. The one-to-one relationship no longer existed in ED with frequent reports of patients feeling ‘lonely’ even though they were under hospital care.The third sub-theme—‘being important while involved’—again reflects positive experiences, where participants reported that they felt the ambulance staff involved them in care decisions and listened to what they were saying. The patients believed the clinicians respected their requests and kept them informed as to the next steps.This was in stark contrast to the fourth sub-theme: ‘being powerless while insignificant’. Here participants identified that the clinicians did not listen to them and, on occasion, they were not allowed to do things they felt capable of doing for themselves. They reported feeling disrespected, insignificant and, sometimes, humiliated.The discussion section in the paper effectively pulls all of these themes together and contextualises the findings against other existing literature. Overall, the authors recognise that there are both strengths and limitations within the study and caution against trying to generalise these findings as, clearly, the paper reflects the experiences of these 20 individuals.Nonetheless, this paper highlights areas of complexity within the patient/clinician relationship that may contribute to our understanding of this phenomenon from a patient's point of view. The authors conclude that future research should involve ambulance staff and family/friends' perspectives in order to give a well-rounded view of this phenomenon.
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