Patient experience in fast-track hip and knee arthroplasty: a qualitative study

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Abstrakt

Aims and objectives: To explore the lived experience of patients in fast-track primary unilateral total hip and knee arthroplasty from the first visit at the outpatient clinic until discharge. Background: Fast-track has resulted in increased effectiveness, including faster recovery and shorter length of stay to about two days after hip and knee arthroplasty. However, the patient perspective in fast-track with a median length of stay of less than three days has been less investigated. Design: A qualitative design. Methods: A phenomenological-hermeneutic approach was used, inspired by Paul Ricoeur's theory of narrative and interpretation. Eight patients were included. Semi-structured interviews and participant observation were performed. Results: Three themes emerged: dealing with pain; feelings of confidence or uncertainty - the meaning of information; and readiness for discharge. Generally, the patients were resistant to taking analgesics and found it difficult to find out when to take supplementary analgesics; therefore, nursing staff needed enough expertise to take responsibility. Factors that increased patients' confidence: information about fast-track, meeting staff before admission and involving relatives. In contrast, incorrect or conflicting information and a lack of respect for privacy led to uncertainty. In preparing for early discharge, sufficient pain management, feeling well-rested and optimal use of time during hospitalisation were important. Conclusion: The study shows the importance of dealing with pain and getting the right information and support to have confidence in the fast-track programme, to be ready for discharge and to manage postoperatively at home. Relevance to clinical practice: In fast-track focusing on early discharge, there is an increased need for evidence-based nursing practice, including a qualified judgement of what is best for the patient in certain situations. The knowledge should be gleaned from: research; the patients' expertise, understanding and situation; and nurses' knowledge, skills and experience.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Nursing
Vol/bind25
Udgave nummer5-6
Sider (fra-til)836–845
ISSN0962-1067
DOI
StatusUdgivet - mar. 2016

Bibliografisk note

"This is the peer reviewed version of the following article: Specht, K., Kjaersgaard-Andersen, P. and Pedersen, B. D. (2016), Patient experience in fast-track hip and knee arthroplasty – a qualitative study. J Clin Nurs, 25: 836–845. doi:10.1111/jocn.13121, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jocn.13121/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."

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