Table 4.

Influences on comfort within the clinical environment

Influence	Operational definition	Subthemes and supporting evidence*†
Physical facilities and ambience	Patients feel comfortable (at ease, positive and safe) in a clinical environment in which staff are positive, helpful, have time for all patients’ needs and work as a cohesive team (all roles and all ethnicities) to relieve discomfort and distress. Being away from home, feeling confined and sharing personal space can be difficult therefore supporting patients’ personal preferences for privacy, companionship, quiet and sleep is crucial. Additionally, facilities should be clean, well equipped, physically comfortable (temperature, beds, chairs and fresh air) and support self-comforting strategies such as faith-based activity, distraction (TV and Wi-Fi) and a sense that one’s culture is respected. Family’s unique comforting role is facilitated by staff who acknowledge, welcome and keep family informed; family-friendly space and flexible visiting times are essential.	The operational definition for the theme ‘Physical Facilities and Ambience’ summarises the findings from four underlying subthemes: ‘I’ve never once felt I didn’t want to be here’ Contributing to comfort was an ambience of caring, positivity (staff are friendly and encouraging) and support, irrespective of who was on duty. ‘[What makes you feel cared for]… It’s quite subtle, [but] you soon pick it up… really caring you know. I feel comfortable here type of thing… I’ve never once felt I didn’t want to be here, if I had to be somewhere doing what I’m doing you know this will do me’ (NZE7). ‘Even the people that are bringing breakfast for us and the cleaners, they’re all good, good people’ (M5). Being able to rest/sleep without constant interruptions or disturbance from lights and noise was crucial. Also important was observing staff working as a cohesive team. Perceiving that there were enough staff to meet all patients’ care needs (not just their own) was important. Patients did not like seeing busy, overworked staff, or other patients not getting prompt attention. ‘… I get a bit stressed because I think the nurse in there now she’s amazing …[but] she’s the only one and she’s doing the best job she can … I find it a bit hard because everyone’s demanding things off her … she hasn’t had her break and everybody else you know gets on top of her. I find that really hard to watch’ (NZE6). ‘Facilitating family’s comforting role’ Important here was that family felt welcome, supported and able to be involved through staff actions and behaviour that included making an effort to connect with family, acknowledging and validating family’s situation, supporting advocacy, keeping them informed and through flexible visiting hours. ‘… [M]y husband’s come in every day and that’s been good and hard for him. I’ll be pleased to get home to make it easier for him to be quite honest. He’s a bit naughty he sort of sits there beside me over the hour (when ward is closed to visitors)but then he doesn’t talk. He just sits there and holds my hand’ (NZE4). ‘Physical facilities are clean, well equipped and facilitate all other influences on comfort’ Physical facilities that were important for comfort include those that support privacy, rest and sleep (quiet, comfortable beds), are clean and essential equipment is readily available. ‘… [T]he top-up of the hand gloves, the towel, it’s very good. You know they don’t wait until they run out …(How does that make you feel when you see that?) I feel comfortable, yes. Yeah I feel comfortable you know…I get used to seeing the nurses wear the gloves, so I always feel good. That’s hygienic to me wearing the gloves’ (P6). Also important are family-friendly facilities, family space and an environment that sustains spiritual connectedness (place for prayer/ karakia) and cultural connectedness (such as culturally diverse décor). For example, this is what a tapa cloth wall hanging signified to one Pacific patient: ‘… [O]ur island is respected by here, our culture and everything like that’ (P4). ‘Control over personal space’ The inability to control one’s personal space with respect to lights, noise disturbances, roommates and other patients’ visitors could be very distressing. ‘… [W]hen you want to go to sleep their lights are on and they won’t turn the lights off and that’s happened here all this week, which is 100% worse when you’re feeling awful … I like everything to be right and you can’t have it right when you’re in hospital. This is not your place; you’re a guest here. So my tendency is to not sleep because of that’ (NZE2) Patients appreciated staff-initiated efforts to reduce environmental stressors as they were reluctant to ask roommates, family or staff to curtail activities.

*Patient interviews were coded by ethnicity and interview order, that is, M1 is the first Māori interview, P1 for the first Pacific interview and NZE1 is the first New Zealand European (NZE) interview.

†Examples are from stage 2 semistructured interviews of patients undergoing heart surgery.

NZE, New Zealand European.