title: Understanding major trauma patients’ perspectives of healthcare experiences and clinical communication within a Major Trauma Centre
Creators: name: Tanti, Ruth
Publisher: name: University of Liverpool Repository
Year: 2023

description: Chapter 1 Review Abstract: Major trauma patients (MTP) experience many physical and psychological difficulties post-injury. These healthcare needs are treated by specialist multi-disciplinary teams within various inpatient settings; including major trauma centres (MTC). This review explored MTP healthcare experiences and what these experiences tells us about their needs post-injury. Four electronic databases (PsycInfo, Medline, CINAHL and PsychArticles) were searched in May 2023 for studies that were in English, peer-reviewed primary qualitative research and recruited MTP participants. From this search 11 key studies incorporating perspectives of 305 MTP were included and analysed using qualitative evidence synthesis. Four themes were conceptualised from the data; “My health post-injury” outlines how physical pain, psychological difficulties, vulnerability and powerlessness influence MTP healthcare experiences; “How staff made me feel” describes the positive and negative experiences of staff interactions; “My experiences of communication” highlights the integral role of communication and examples of good and bad practice and; “What I was focused on next” encompasses needs for follow-up care, rehabilitation and acknowledges barriers to regaining independence and normality. The varying needs of MTP post-injury impact on their healthcare experiences and their expectations from services. Future research into MTP experiences of social stigma would provide services with information to address barriers to regaining independence. Further understanding perceived power dynamics between staff and MTP and gaps in rehabilitation service provision, would enable services to pro-actively tackle these issues. Finally, it is imperative to gain a further understanding of MTP communication needs as this is an integral part of MTP healthcare experiences. Chapter 2 Empirical Abstract: Major trauma patients (MTP) experience a range of physical and psychological difficulties post-injury. These healthcare needs are treated by specialist multi-disciplinary teams (MDT) in various settings; including major trauma centres (MTC). Several complex conversations occur between staff and MTP following admission. The aim of this study was to understand MTP perspectives of clinical communication within a MTC. A qualitative study involving semi-structured interviews was designed to gain MTP perspectives. Twenty participants were purposively sampled from the outpatient fracture clinic at Aintree Site MTC, Liverpool, UK, over an eight-month period (July 2022 – February 2023). Interviews were analysed using a pluralistic qualitative approach. Three themes were conceptualised from the data; “Challenges to speaking up” occurred as patients were vulnerable, confused, had mixed experiences of navigating medical terminology and did not want to burden staff; “Conversations left me feeling” highlighted the positive (feel reassured, cared for, human again) and negative (feeling like an object, angry, confused and dependent) emotional impact of staff communication; “Strategies need to be clinical but tailored” described the benefits of providing written information, clear explanations of injuries and person-centred communication. There is a need to further explore MTP perceptions of being a burden and the role of family members in patient-staff communication. Staff training on the emotional impact of conversations and skills development to enhance responsiveness to psychological distress is required, as is communication guidance to address MTP challenges to speaking up. MTP require multiple options to communicate and address psychological difficulties.