Narrative of women's hospital experiences: the impact of powerlessness on personal identity
Creators: name: Polimeni, Anne-Maree
Publisher: name: Swinburne
Year: 2024

description: Since women dominate the health care system as consumers, it is important to understand how women want to be treated by medical staff, and the factors that contribute to satisfactory hospital experiences. The present research comprised two separate but integrated studies exploring these issues. The first study adopted an atheoretical approach. Qualitative and quantitative methods were used to examine the importance of hospital experiences in the lives of women, and the role of power within those experiences. Closed answer items about hospital experiences were completed by 124 women who had had a hospital stay of at least one night. In addition, ten of the women provided open-ended oral and written comments about their hospital experiences, which were used as the basis of the qualitative data. The majority of the women were satisfied with their hospital stay, but a small group recalled experiences of powerlessness associated with the non-medical aspects of their treatment, such as behaviours on the part of health professionals that influenced participants' sense of control as hospital inpatients. The qualitative data reflected similar issues to the quantitative data and provided 'process' information by demonstrating how health professionals' behaviour could contribute to patients' feelings of powerlessness. The results suggested that hospital experiences were a salient part of these women's lives. The richness of the qualitative data suggested that qualitative methodology would be a productive way to further study this area. The second study was an extension of the first via in-depth interviews with 19 women who perceived their hospital experiences as life-altering. The interview content and the analysis were based on a narrative approach that used the theoretical framework of McAdams' (1993) Life Story Model of Identity. Using McAdams' methodology enabled the researcher to evaluate how women constructed meaning from their hospital experiences, and the main issues they faced. The life story interview also proved a useful way to explore issues of loss and self-growth in the face of traumatic hospital experiences. Transcripts of descriptions of positive and negative experiences were analysed according to McAdams' themes of agency (sense of power and control) and communion (relationships with others), and sequences of redemption and contamination. Redemption sequences involve the storyline moving from a bad, affectively negative life scene, to a good, affectively positive life scene. In a contamination sequence, the narrator describes a change from a good, affectively positive life scene, to a subsequently bad, affectively negative life scene (McAdams &amp; Bowman, 2001). Participants also rated their experiences according to Hermans' (Hermans &amp; Oles, 1999) list of affects. There was strong agreement between McAdams' coding of agency and communion and Hermans' agentic and communal indices: the women's hospital stories strongly emphasised the negative or opposite of McAdams' agentic theme 'Self Mastery through Control', which indicated powerlessness, and Hermans' affects, which involved low self-enhancement. It may be useful for future studies to conceptualise McAdams' themes as bipolar by incorporating currently coded themes and their reverse; in particular, by expanding ideas of agency to incorporate powerlessness, as this theme was pervasive in women's hospital experiences. The rating of affects added to the findings as this showed a latent dimension of communion manifested as isolation. The common agency and communion themes were apparent in the two distinct but related aspects of hospitalisation that affect patients' sense of control: the medical condition and the manner in which patients are treated by medical staff. The findings of the main study built on the pilot study by showing how ideas of control and powerlessness can inform better practice. For example, respectful, dignified and fair treatment by health professionals played a part in determining redemption sequences; women also indicated this was how they wanted to be treated. Due to the vulnerability of the 'sick role' disrespectful or offhand treatment by health professionals had particularly distressing effects evident in contamination sequences, such as negative changes to sense of self and attitudes toward the health care system. In some cases, such treatment led to participants' avoiding subsequent interactions with doctors and to sustained feelings of helplessness. The present thesis demonstrates that doctors, nurses and other health professionals need to allow time to attend to the affective as well as the medical aspects of the encounter. Health professionals need a good bedside manner, compassion, and communication skills, as these characteristics play a part in maintaining female patients' sense of self and their faith in and satisfaction with the health care system.