title: Elective surgical patients' narratives of hospitalization: the co-construction of safety.
abstract: This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n=72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of 'chaos' and 'suffering' emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient-clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety.
authors: Department of Health Care Management and Policy, Faculty of Business, Economics and Law, University of Surrey, Stagg Hill Campus, Guildford GU2 7XH, United Kingdom. Electronic address: c.doherty@surrey.ac.uk.
authors: Carole
authors: C
authors: Doherty
authors: Surrey Business School, Faculty of Business, Economics and Law, University of Surrey, Stagg Hill Campus, Guildford GU2 7XH, United Kingdom.
authors: Mark N K
authors: MN
authors: Saunders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D017558:Elective Surgical Procedures / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D033262:Narration; D061214:Patient Safety; D010817:Physician-Patient Relations; D036301:Qualitative Research; D035502:Trust; D006113:United Kingdom; D055815:Young Adult
keywords: Hospital; Patient safety; Patients' stories; Sensemaking; Trust; UK