The survey was sent to the first 655 consecutive patients' discharged home from Barts and The London NHS Trust between the 2-4 April 2001. The sample included both daycase and inpatients. The questionnaire was made up of nine statements as close as possible to the wording of the Nursing Philosophy statements. Using a visual analogue scale, patients were requested to state to what extent (strongly agree to strongly disagree) the goals of each statement were achieved based on their recent hospital stay. To address any problems in understanding the statements, a 'not understood' box was added. A comment section was added after each statement if patients wanted to give a more detailed response. A pilot was carried out in December 2000. Of 200 surveys posted, there was a 30% response rate. There were no incomplete questionnaires and the comment section of each statement was widely used. The main recommendation was that demographic details should be recorded for the main study. The results of the pilot study were presented to the Nursing Policy Board in February 2001.

The survey provided important feedback considering the Nursing Philosophy was not accessed while the patients were in hospital (67% had not seen a copy on the ward). The respondents were representative of the total sample surveyed in terms of clinical group, site, specialty and ethnicity, although the respondents were significantly older than the non-respondents were. The median age was 54 with patients responding ranging from 16-94 years old. The majority of respondents in the sample were white 143(49%), however ethnicity was not asked for/unknown for 99(34%) of the respondents. The second largest known ethnic group was Bangladeshi with 13(6%). There were patients from all three hospitals with 125(43%) from the Royal London, 139(47%) from Bart's and 28(10%) from the London Chest.

A total of 315(48%) patients returned the survey and 303(46%) were included in the data analysis. The majority of respondents agreed with the philosophy statements (range 54% to 89%) with 'physical needs met' scoring the highest level of agreement (89%). Please find below the list of statements and the patients' responses.

1.  Each patient is treated as an individual with varying needs. The following needs are met:

• Physical needs - 89% agree/strongly agree
• Psychological needs - 77% agree /strongly agree
• Social needs - 74% agree/strongly agree
• Religious needs - 54% agree/strongly agree
• Cultural needs - 58% agree/strongly agree
• Equality for patients - 82% agree/strongly agree

2.  Patients and carers are provided with information that will enable them to make informed choices about their treatment and care - 81% agree/strongly agree

3.  There are opportunities to discuss and question all aspects of patient care with members of the nursing team - 84% agree/strongly agree

4.  Each patient is allocated a 'named nurse who co-ordinates assessment, planning, implementation and evaluation of their nursing care - 78% agree/strongly agree

5.  The patient's self-care and rehabilitation is promoted whilst acknowledging each patient's individual needs and limitations -78% agree/strongly agree

6.  The patient's dignity is reflected at all times - 84% agree/strongly agree

7.  A supportive environment is promoted and maintained for the education of all patients and their carers - 72% agree/strongly agree

8.  There is effective communication between all hospital teams, patients and carers -70% agree/strongly agree

9.  A safe environment is maintained for all staff and their patients - 82% agree /strongly agree

10.  While you were an inpatient, did you see a copy of the Trust's nursing philosophy - 33% said yes.

The most enlightening part of the survey was what patients wrote after each statement. There were over 450 written responses with 178 (40%) positive and 269 (60%) highlighting concerns. Some of the comments did not relate to nursing specifically, but were a great resource for identifying service user priorities. All the comments were categorised into key themes, which are outlined below, a sample of both positive and negative comments included.

Care/treatment

'At every opportunity I was encouraged to go forward.'

'Help not available for bathing'

Communication

'Very good. Good hand over and patient knowledge.'

'Appeared to be a lack of strategy between medical and nursing staff, about follow-up care.

'I am always treated with respect.'

'Need more help in Bengali interpreter'

Environment/facilities

'The floor, beds and toilets are regularly maintained'

'The male patients were wandering in and around the female section, which was very unnerving in the evenings.'

Organisation/resources

'Pressure/demand on nursing staff is sometimes almost overwhelming especially during staff shortages. Their resilience and determination to overcome all such obstacles cannot be overstated-marvelous'.

'...My only criticism is that in general, in the NHS, there is a lack of co-ordination when making appointments for tests, etc. It seems that each test treats you as a separate patient whereas I believe tests should be co-ordinated and booked together in blocks for each patient.'

'You need to give of yourself too so that everyone knows where you are coming from.'

'I felt that often, just because I was physically able to do things, psychologically I was also regarded as doing fine.'

The results of the survey were presented to the Nursing Policy Board, November 2002. It was agreed that the results would be disseminated to the Benchmarking Resource Groups, Nursing Facilities Partnership Board, the Clinical Governance Unit, the Patient Advocacy and Liaison Service, Clinical Groups, Complaints Leads within Directorates and above all the patients who contributed to this survey.

Although it was unusual to ask patients to give feedback on a nursing philosophy, the framework of the survey provided the opportunity for patients to voice their opinion about issues of importance to them. In respect of the difficulties inherent in conducting a project of this kind, in an inner-city, multi-cultural society, the project was deemed a great success in terms of user involvement.