When you are in Accident & Emergency, it is because you are vulnerable and in need of care. I looked at patients in the lying down waiting room of the an A&E department in a public hospital in Paris and made some observations of the patients’ micro behaviours.
I saw a young woman lying in the “car park” (the space where people wait, lying down, after the nurse’s initial assessment and before being seen by the doctor). There were two other people in the space but she couldn’t see them, with her bed completely flat, and her neck inside a brace she could only look up at the ceiling. Every few minutes she lifts her phone up so she can see it, and puts it back down again. Sometimes she unlocks it and refreshes her messages, other times she looks at the time, but the longer she waits the more often she lifts her phone without unlocking it at all. It was as if the action of looking at and holding on to the physical object of her phone was comforting, or a product of her anxiety. I think we can relate to playing with our digital devices out of boredom, but this impulsive, repetitive behaviour could be from a mix of anxiety and boredom, created by both the situation and environment. Her mobile phone acts as her portal to the outside world, it symbolises communication and she subconsciously looks for information there.
Every time a staff member passes her bed, she asks for some information. This could be from boredom, loneliness, or anxiety due to a lack of communication with staff members. The relationship between communication (or the lack of) and feelings of safety are manifested in other behaviours that suggest anxiety throughout les urgences. For example, a behaviour that I saw replicated in many instances was people leaving their designated waiting areas in search of a person who could give them information about how long they would have to wait, or scan results for example.
I also saw behaviours related to anxiety and lack of communication displayed by companions to patients, for example trying to see past barriers that protect the privacy of patients. When the door to the care area (zone de soins) opens a woman enters and looks around slyly, and then tries to look through the frosted glass into the first box. A nurse tells her off, and directs her back to the main waiting room, telling her to ask the people doing their civic service (wearing blue vests) for help.
Encroaching on vulnerable people’s privacy doesn’t seem like something that most people would normally do, but in an unfamiliar environment where they are anxious and don’t know where to find information about the wellbeing or location of the patient they are accompanying it doesn’t seem unreasonable. This behaviour also made me reflect on the interplay between public and private space that is found in Accident & Emergency, and the security and privacy concerns that come with this interplay. One older woman is taken on her bed from the lying down waiting room to the main waiting room and parked in front of the administration reception. People are walking past, and looking directly at her, and she has no privacy at all. Her daughter takes the sheet from the bed, and wraps it over her mother, who rolls over on to her side so that she is facing the wall. The daughter strokes her mother’s hair, comforting her.
In this unfamiliar public/private space it could also be said that there are feelings of mistrust, which are linked to anxieties surrounding the quality of care, which stem from the vulnerable state of the patients and also concern for the safety of belongings. A young woman sits up and edges to the end of her bed. She picks up her handbag and walks to the doctor’s desk to ask a question. This behaviour is common in public libraries or on trains, but suggests that people are not entirely comfortable in the environment. However, as in the first observed behaviour, with the mobile phone, holding on to physical objects, in the form of personal belongings, including bags could also be linked to feelings of security and comfort.
It is standard practice to give patients two plastic bags when they arrive in Accident & Emergency, one for their shoes and one for their jacket and bag. These plastic bags are then hung from the end of the bed, out of the patient’s sight. This is anxiety inducing, “is my bag here ? I can’t see it” since in an unfamiliar public environment we are conditioned to keep our personal belongings close to our body and when we are in a vulnerable state this impulse may be heightened. I observed that many people keep their bags on their bed if they can, when it seems that the actual danger is comparatively small to other public environments.
On a visit to A&E on a Thursday evening there was some time when there were more police officers than patients. In a healthcare setting feelings of security for patients come from a high presence of medical staff, with a high presence of police alerting the vulnerable patients to the presence of potentially agressive or dangerous individuals. This poses a question of how we could manage this police presence in a positive way.
With these observations in mind, we can begin to ask ourselves how we can reduce anxiety and improve the sense of security in order to improve the overall experience of going to Accident and Emergency.