title: 'Poppets and parcels': the links between staff experience of work and acutely ill older peoples' experience of hospital care.
abstract: BACKGROUND
  Few empirical studies have directly examined the relationship between staff experiences of providing healthcare and patient experience. Present concerns over the care of older people in UK acute hospitals - and the reported attitudes of staff in such settings - highlight an important area of study. AIMS AND OBJECTIVES. To examine the links between staff experience of work and patient experience of care in a 'Medicine for Older People' (MfOP) service in England.
  
  
  METHODS
  A mixed methods case study undertaken over 8 months incorporating a 149-item staff survey (66/192 - 34% response rate), a 48-item patient survey (26/111 - 23%), 18 staff interviews, 18 patient and carer interviews and 41 hours of non-participant observation.
  
  
  RESULTS
  Variation in patient experience is significantly influenced by staff work experiences. A high-demand/low-control work environment, poor staffing, ward leadership and co-worker relationships can each add to the inherent difficulties staff face when caring for acutely ill older people. Staff seek to alleviate the impact of such difficulties by finding personal satisfaction from caring for 'the poppets'; those patients they enjoy caring for and for whom they feel able to 'make a difference'. Other patients - noting dehumanising aspects of their care - felt like 'parcels'. Patients are aware of being seen by staff as 'difficult' or 'demanding' and seek to manage their relationships with nursing staff accordingly.
  
  
  CONCLUSIONS
  The work experiences of staff in a MfOP service impacted directly on patient care experience. Poor ward and patient care climates often lead staff to seek job satisfaction through caring for 'poppets', leaving less favoured - and often more complex patients - to receive less personalised care. Implications for practice. Investment in staff well-being and ward climate is essential for the consistent delivery of high-quality care for older people in acute settings.
authors.affiliation: King's College London, National Nursing Research Unit, Florence Nightingale School of Nursing and Midwifery, London, UK. jill.maben@kcl.ac.uk
authors.forename: Jill
authors.initials: J
authors.lastname: Maben
authors.forename: Mary
authors.initials: M
authors.lastname: Adams
authors.forename: Riccardo
authors.initials: R
authors.lastname: Peccei
authors.forename: Trevor
authors.initials: T
authors.lastname: Murrells
authors.forename: Glenn
authors.initials: G
authors.lastname: Robert
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000592:standards; D004739:England; D005851:Geriatric Nursing / Q000592:standards; D006299:Health Services for the Aged / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D007400:Interprofessional Relations; D009723:Nurse-Patient Relations; D009740:Nursing Staff / Q000523:psychology* / Q000592:standards; D019982:Organizational Case Studies; D015279:Organizational Culture; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010361:Patients / Q000523:psychology*; D028723:Personhood; D057184:Practice Patterns, Nurses'; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014850:Waiting Lists; D000078329:Workforce; D016526:Workload / Q000523:psychology