Patients' experiences of undergoing surgery From vulnerability towards recovery -including a new, altered life

Sammanfattning: The overall aim of this thesis was to explore patients’ experiences of undergoing surgery, including their perceptions of quality of care and recovery. A mixed methods design was used, and studies with qualitative methods (I, II) and quantitative methods (III, IV, V) were performed. Data were collected through interviews with ten patients after gastric bypass surgery (I) and nine patients after lower limb fracture surgery (II) and were subjected to qualitative content analysis. Data were also collected using two standardized questionnaires; The Quality from Patient’s Perspective (III) and Postoperative Recovery Profile (IV, V). A total of 170 orthopedic and general surgery patients participated in study III. In study IV and V, 180 patients participated. Accordingly, 170 of patients were the same in study III, IV and V. Data were analyzed by descriptive statistics (III, IV, V) and a manifest content analysis of the free-text answers (III) as well as with analytical statistics (IV, V). Prior to surgery, patients undergoing gastric bypass surgery (I) described a sense of inferiority related to their obesity. In the post-anesthesia care unit, patients felt both omitted and safe in the unknown environment and expressed needs to have the staff close by. Despite the information provided prior to surgery it was difficult to imagine one’s situation after homecoming, thus it was worth it so far and visions of a new life were described. Patients undergoing lower limb surgery (II) described feelings of helplessness when realizing the seriousness of their injury. The wait prior to surgery was strain, and patients needed orientation for the future. They remained awake during surgery and expressed feelings of vulnerability during this procedure. In the post-anesthesia care unit, patients expressed a need to have control and to feel safe in their new environment. Mobilizing and regaining their autonomy were struggles, and patients stated that their recovery was extended. The quality of the perioperative care was assessedas quite good (III). While undergoing a surgical procedure (III), the areas identified for improvement were information and participation. Patients preferred to hand over the decisionmaking to staff and indicated that having personalized information about their surgery was important. However, too detailed information before surgery could cause increased anxiety (III). After surgery, orthopedic patients were substantially less recovered than general surgery patients (IV, V). Approximately two-thirds of orthopedic patients and half of general surgery patients perceived severe or moderate pain in the first occasion (day 1-4 after surgery) (IV). Both the orthopedic and general surgery group showed a significant systematic change at a group level towards higher levels of recovery after one month compared with day 1-4 after surgery. The same patterns occurred regarding acute and elective surgery (V). Patients overall recovered better (IV, V) after a gastric bypass, than after other surgeries. Compared with the period prior to surgery; certain Gastric bypass patients felt after one month that they had improved (IV). The orthopedic groups assessed their psychological function as being impaired after one month compared with the first occasion (IV, V). The overall view of patients’ experiences of undergoing surgery (I-V) can be understood as a trajectory, from vulnerability towards recovery, including a new, altered life. Patients’ experiences and perceptions of the care given (I, II, III) are embedded within this trajectory. As a thread in this thesis, through all studies, patients expressed vulnerability in numerous ways. A progress towards recovery with regards to regaining preoperative levels of dependence/independence could be concluded. Thus, for patients undergoing gastric bypass surgery, a view of a new, altered life after surgery was also discernible. While undergoing surgery, satisfaction with the provision of information not necessarily include receiving as much and the most detailed information as possible; nevertheless, the need for information to a great extent is personal. The recovery-period for orthopedic patients is strain, and the support must be improved. In conclusion, the perioperative support may contain a standardized part, made-to-order to the general procedure commonly for all patients, such as information about the stay in the post anesthesia care unit. Moreover, the support should be person-centered, accounting for the patients’ expectations about the future but also tailored to the specific surgical procedure; with its limitations and possibilities. Then, patients in a realistic way would be strengthened towards recovery, including a new, altered life.