TY - JOUR
T1 - Patient experience in fast-track hip and knee arthroplasty
T2 - a qualitative study
AU - Specht, Kirsten
AU - Kjærsgaard-Andersen, Per
AU - Pedersen, Birthe D.
N1 - "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."
PY - 2016/3
Y1 - 2016/3
N2 - 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.
AB - 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.
KW - Hip/knee replacement
KW - Nurse's responsibilities
KW - Patients' experience
KW - Phenomenological hermeneutics
KW - Qualitative study
KW - Length of Stay
KW - Arthroplasty, Replacement, Knee/nursing
KW - Humans
KW - Middle Aged
KW - Pain Management
KW - Patient Discharge
KW - Male
KW - Arthroplasty, Replacement, Hip/nursing
KW - Patient Satisfaction
KW - Aged, 80 and over
KW - Ambulatory Care Facilities
KW - Denmark
KW - Female
KW - Aged
U2 - 10.1111/jocn.13121
DO - 10.1111/jocn.13121
M3 - Journal article
C2 - 26708610
SN - 0962-1067
VL - 25
SP - 836
EP - 845
JO - Journal of Clinical Nursing
JF - Journal of Clinical Nursing
IS - 5-6
ER -