Voiceless and Vulnerable: an existential phenomenology of the patient experience in twenty-first century British hospitals

Abstract

Patient experience is a major focus for the NHS, based on current health policy, high profile failures and increased media scrutiny. A Background chapter considers the rationale behind research into patient experience including links with health outcomes, education, clinical effectiveness and quality improvement. The Literature Review found intrinsic factors affecting patient experience to include demographics, expectations and proclivity to complain along with extrinsic factors such as staffing levels and nursing care. The problem to be addressed in this work is the disconnect between information gathered through inpatient experience surveys and the aspects of the inpatient experience which are most meaningful to patients. In order to support a deeper understanding of the patient experience, the research question is therefore ‘what aspects of patient experience may not be captured by inpatient experience surveys yet are discoverable through existential phenomenology?’ The study aimed to support a better understanding of the patient experience and patients’ expression of it, while critiquing the concept of patient satisfaction and the idea that we can capture it. Several topics were deemed to be worthy of further investigation, such as a potential link between illness narrative and inpatient experience. A lack of research into the effect of exposure to negative media coverage of the NHS on patient expectations and subsequent inpatient experience was identified. It was also felt that a qualitative exploration of the effect of nursing attitudes or behaviours on patient experience would be useful to elucidate those values which positively or negatively affect patient experience. A final topic felt to be worthy of investigation was patient experience of standardised NHS feedback mechanisms. After consideration of alternatives, existential phenomenology was determined to be the most appropriate methodology for the study. Data collection involved in-depth interviews with 12 participants, with analysis by means of hermeneutics. Several themes emerged from the data, including vulnerability, voicelessness and assault on personhood. The findings of this study provide useful insight into the patient experience on NHS wards, and the value of an existential-phenomenological approach is demonstrated.

Date of Award	31 Dec 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Christine Hallett (Supervisor) & Jane Brooks (Supervisor)