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Experiences of abandonment and anonymity among arthroplastic surgery patients in the perioperative period: Some issues concerning communication, pain and suffering
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. (Omvårdnad)ORCID iD: 0000-0002-3907-2197
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall objective of the thesis is to describe and illustrate the experience of being an arthroplastic surgery patient during the perioperative period with regard to the issues of communication, pain,suffering and satisfaction with care. While waiting for surgery, the participants in this thesis experience suffering in different ways and mainly experience health care as being unavailable and negative in a faceless system (I). Obtaining information related to their illness is difficult, as it is hard to establish contact with health care providers. The responsibility for establishing contact and obtaining information rests solely with the patients (II). In Paper I, due to poor communication, the respondents express feelings of abandonment, anonymity and being disparaged by the health care system. During the participants' journey through the health care system, the negative experience acquires a more positive nature, as personal contacts are established with health care representatives (I-IV). The findings in the different papers (I-IV) are interpreted in the light of Katie Eriksson and Lennart Fredriksson’s descriptions of suffering and the caring conversation. There are participants in this thesis who have been able to reach a personal understanding of themselves and have found reconciliation in suffering. In this way, they have been able to maintain or obtain meaning in their lifeworld. Through their own power, or with the help of family and friends, individuals may be able to attain confirmation of their suffering, have the time and space to suffer and find reconciliation. However, as long as health care is experienced as a faceless system, there are individuals in this study who are unable to face their suffering. During the patients’ journey through the system, it becomes obvious that the system obtains a face when the individuals are able to establish trustful contact with an actual person within the system. The system does not obtain a face as long as the individuals perceive themselves as being poorly treated by health care representatives. In these cases, the system is actually the cause of additional suffering. In the terms defined by Fredriksson, the system obtains a face when a turning point occurs in the form of a caring conversation. During the waiting time, there are few opportunities for a caring conversation. An opportunity is more likely to occur when the individual is admitted to hospital. This is reflected in the extensive degree of satisfaction with care as expressed in Papers II-IV. High levels of satisfaction are reported, although the participants report having experienced high levels of postoperative pain. In Paper III, 68% (n=40) and, in Paper IV, 83.5% (n=50) of the patients experienced pain of = 4 on the Visual Analogue Scale (VAS). When they have been admitted to hospital, the individuals sense that they are confirmed by and visible in the system. This visibility is mutual, as the individual becomes an actual person to health care representatives. In a caring conversation, a sense of trust is established and, as this occurs, the individual and the care provider dare to communicate in an open way, where both are present in the situation.

Abstract [sv]

Det övergripande syftet med avhandlingsarbetet är att illustrera och belysa upplevelsen av att vara patient med behov av ledprotes, avseende aspekterna kommunikation, smärtupplevelse, lidande och tillfredsställelse med vård och behandling. Under väntetiden för ledprotesoperation upplever deltagarna i studierna lidande i olika former, tillika att vården är otillgänglig och onåbar i ett ansiktslöst system (I). Att få information om sin sjukdom vad man kan/får/ska göra är nästan omöjligt. Kontakten med sjukvården är svår att upprätta och det är mestadels patientens ansvar att söka information om vad som händer (II). Den bristfälliga kommunikationen som deltagarna i delstudie I upplever, leder till att de känner sig missförstådda och nedvärderade av sjukvårdssystemet, och därmed befinner sig i en ständig kamp för att få sitt vårdbehov bekräftat. Under deltagarnas vandring i sjukvårdssystemet förändras deras negativa uppfattning om vården till att bli mer positiv när en reell kommunikation och personlig kontakt etablerats (IIV). Fynden i arbetena (I-IV) tolkas inom ramen för Katie Erikssons och Lennart Fredrikssons beskrivningar av lidande och det vårdande samtalet. En del deltagare i studierna har av egen kraft, eller till följd av personliga egenskaper uppnått insikter om sig själva och försonats med sitt lidande, på så sätt har de kunnat bibehålla eller uppnå mening i sin tillvaro. Av egen kraft, eller med hjälp av anhöriga kan individerna få sitt lidande bekräftat och därmed möjligheten att kunna lida ut och försonas med sig själv och den förändrade tillvaron. Så länge som sjukvården upplevs som ett ansiktslöst system finns det deltagare i avhandlingen som inte klarar av att ta itu med sitt lidande. Under patientens vandring i sjukvårdssystemet blir det uppenbart att systemet får ett ansikte först när deltagarna kan relatera till vården i form av en reell person. Vården får inte ett ansikte så länge som patienten upplever sig dåligt bemött utan detta sker när det med Fredrikssons termer uppstår ett vårdande samtal. Under väntetiden för operation finns det relativt få tillfällen där ett vårdande samtal har möjlighet att uppstå. Möjligheten för detta är dock större när patienten väl är inlagd på sjukhuset för att bli opererad, vilket återspeglas i den höga grad av tillfredsställelse med vården som uttrycks i delstudie II-IV. Patienterna är tillfredsställda med vård och behandling, trots att de har upplevt postoperativ smärta i en hög grad. I delstudie III var det 68% (n=40) och i delstudie IV 83.5% (n=50) som hade upplevt smärtor motsvarande = 4 på Visuell Analog Skala (VAS). Under sjukhusvistelsen upplever sig patienten bekräftad och synlig i systemet. Synligheten är ömsesidig då även vården (systemet) får ett ansikte på patienten. I ett vårdande samtal uppstår en känsla av tillit och när detta sker vågar patienten och vårdaren kommunicera på ett öppet sätt där de båda är närvarande i situationen.

Place, publisher, year, edition, pages
Umeå, 2005. , p. 64
Series
Umeå University medical dissertations,, ISSN 0346-6612 ; 952
Keywords [en]
Advice, communication, information, nursing, orthopaedic care, pain, suffering
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:miun:diva-10567ISBN: 91-7305-844-0 (print)OAI: oai:DiVA.org:miun-10567DiVA, id: diva2:279805
Public defence
2005-05-13, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2009-12-10 Created: 2009-12-07 Last updated: 2009-12-10Bibliographically approved
List of papers
1. What information do patients waiting for and undergoing arthroplastic surgery want? Their side of the story
Open this publication in new window or tab >>What information do patients waiting for and undergoing arthroplastic surgery want? Their side of the story
2006 (English)In: Journal of Orthopaedic Nursing, ISSN 1361-3111, E-ISSN 1873-4839, Vol. 10, no 1, p. 5-14Article in journal (Refereed) Published
Abstract [en]

This nurse-led focus-group study investigated information needs of patients waiting for arthroplastic surgery – how did they obtain the information and advice they needed? The content analysis of the interview transcripts revealed two main categories – ways of obtaining information and advice and what is needed – what patients want. In the picture emerging from the findings, it is evident that the content of the information that is given does not solely determine whether the respondents’ information needs are met. The way the information is given and whether the respondent is confirmed as a human being and taken seriously by the staff, is believed to be more important in the mutual process of communicating information. On a concrete level, respondents ask for information and advice on what they can do to manage their present life situation while waiting for surgery; this includes pain management, advice on self-training and contact with physiotherapists. They want to know “when” surgery will be performed and to be given opportunities to ask questions. This study serves as another piece in the puzzle investigating patients’ information needs. Implications for nursing are discussed, together with suggestions for future areas of research.

Keywords
Patient information; Advice; Expectations; Waiting for surgery; Arthroplastic surgery
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-3887 (URN)10.1016/j.joon.2005.09.014 (DOI)2-s2.0-33344474450 (Scopus ID)4220 (Local ID)4220 (Archive number)4220 (OAI)
Available from: 2008-11-19 Created: 2008-11-19 Last updated: 2017-12-12Bibliographically approved
2. Patient satisfaction with postoperative pain management despite experiencing high levels of pain
Open this publication in new window or tab >>Patient satisfaction with postoperative pain management despite experiencing high levels of pain
1998 (English)In: European Nurse, ISSN 1358-8621, Vol. 3, no 4, p. 264-273Article in journal (Refereed) Published
Abstract [en]

.European Nurse 3(4): 264-273. The survey was conducted at a Swedish county hospital. Fifty-nine patients undergoing orthopaedic surgery (hip and knee arthroplasty) participated. In structured interviews, the patients answered questions about preoperative information, general satisfaction with nursing care and on assessment of their postoperative pain. On the fourth day after surgery, they were asked to estimate their experienced level of postoperative pain on the Visual Analogue Scale (VAS). The results reveal that approximately 70% of the patients undergoing surgery for knee arthroplasty (KA) had experienced pain corresponding to at least >/=4 on the VAS. This was very different from the study hypothesis, which was that fewer than half the patients would experience pain of >/=4 on VAS. Patients undergoing KA experienced significantly more pain postoperatively than patients undergoing hip arthroplasty (HA) (p = 0.001). Of HA patients, 46% experienced pain of 2:4 on the VAS; this was also slightly more than the study hypothesis. Forty-nine percent of patients had received information about pain and pain treatment on admission to hospital. Patients who had received information had a slight tendency to experience higher levels of pain, on movement (p = 0.077). In spite of high levels of experienced pain among a large number of the patients, they were generally satisfied with their pain management and the nursing care and the personal approach of the hospital staff. The ethics committee at the University of Umea approved the study.

Keywords
Patient-Satisfaction-Evaluation, Postoperative-Pain-Drug-Therapy, Postoperative-Pain-Nursing, Postoperative-Care, Orthopedic-Nursing
National Category
Archaeology
Identifiers
urn:nbn:se:miun:diva-1477 (URN)154 (Local ID)154 (Archive number)154 (OAI)
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2010-12-14Bibliographically approved
3. The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management.
Open this publication in new window or tab >>The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management.
2003 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 2, p. 169-176Article in journal (Refereed) Published
Abstract [en]

The primary objective of this study was to test whether specific information given prior to surgery can help patients obtain better pain relief after total knee arthroplasty (TKA). Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care. The study was an intervention study with two groups of equal size (n ¼ 30). The intervention group was given specific information while the control group received routine information. Pain assessments were made preoperatively and every 3 h for the first three postoperative days, using the visual analogue scale (VAS). The results of this study suggest that information does influence the experience of pain after surgery and related psychological factors. The postoperative pain declined more rapidly for patients in the treatment group, the degree of preoperative state anxiety was lower and they were more satisfied with the postoperative pain management.

Keywords
Postoperative pain, Information, Anxiety, Pain assessment
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-1478 (URN)000186527700011 ()14572947 (PubMedID)2-s2.0-0142188632 (Scopus ID)155 (Local ID)155 (Archive number)155 (OAI)
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2017-12-13Bibliographically approved
4. Waiting for surgery; living a life on hold: A continuous struggle against a faceless system
Open this publication in new window or tab >>Waiting for surgery; living a life on hold: A continuous struggle against a faceless system
Show others...
2005 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 42, no 5, p. 539-547Article in journal (Refereed) Published
Abstract [en]

This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip and its impact on daily life. The interviews reveal that respondents experience suffering from different points of view; illness-, caring- and life- suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless - against a faceless enemy - "the system". No one is there to answer their plea or to address the frustration that then arises and, in combination with their present life situation, this may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life may find it easier to accept the waiting times and wait for their turn in the queue. They are able to reformulate their life-world and live a full life, in spite of severe pain and disability.

Keywords
Pain, communication, information, arthritis
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-1258 (URN)10.1016/j.ijnurstu.2004.09.009 (DOI)000230121700006 ()15921985 (PubMedID)828 (Local ID)828 (Archive number)828 (OAI)
Available from: 2008-09-30 Created: 2008-09-30 Last updated: 2017-12-13Bibliographically approved

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