Professional nursing culture on a trauma unit: experiences of patients and staff

Aim. This paper is a report of a study to explore the day-to-day experiences of patients and staff on a unit dedicated to the care of adult patients who have sustained an injury. Background. With the numbers of people suffering traumatic injury increasing, provision of their acute care and rehabilitation is also of increasing concern. Staff have the potential to optimize recovery but the factors that facilitate or inhibit this in practice are unclear. Method. This ethnographic study took place on a trauma unit in the United Kingdom between November 2004 and January 2006. Sixteen periods of observation, qualitative interviews with 40 patients and 19 staff, and four focus groups with staff were undertaken. Thematic analysis was conducted and data were analysed by sentence. Findings. The dynamic process of patient-centred care was expressed through the themes of closeness, therapeutic care and working as a team. Closeness conveyed the sudden and devastating nature of injury, and the necessity for staff to let go of feelings to maintain a positive momentum. Therapeutic care highlighted the social connection between the staff and the patients, combined with a proactive dynamic approach to care. Working as a team identified the importance of maintaining expertise and making the system work for patients to ensure the best possible care. Conclusion. By identifying the context and processes that facilitate recovery, it becomes possible to provide a framework for individuals and units to develop and improve practice that enhances recovery. These findings may be useful for other similar areas of care.