Att genomleva den perioperativa perioden vid akut och planerad ortopedisk kirurgi

Detta är en avhandling från Stockholm : Karolinska Institutet, Department of Neurobiology, Care Sciences and Society

Sammanfattning: The overall aim of the present thesis is to illuminate the meaning of the patients experiences of acute or planned orthopaedic surgery. The thesis comprises four studies (I-IV) which are all based on data collected from interviews with participants living through acute (I) or planned surgery within an urban region of Sweden (II-IV). The first study (I) The role of interactive affirmation in psychosocial rehabilitation following orthopaedic injuries was conducted in order to conceptualize the process of recovering from injuries. A constant comparative analysis of the transcribed interviews (16) revealed that confirmation of self-identity was important for taking an active role in recovery and rehabilitation. The second study (II) explored older people s experiences of their lived bodies during the perioperative period for hip or a knee replacement. A qualitative longitudinal study was conducted. Audio taped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data was analysed using a latent qualitative content analysis. The perioperative period of a hip or knee replacement can be regarded as a process of transition, which includes six critical phases. Although the recipients of care were at a new starting point, they struggled to regain a physical state where they were in charge and control of their lives. The third (III) study, In the hands of formal carers: older patients experiences of care across the perioperative period for hip and knee replacement was aimed to highlight the meaning of care provided by formal carers in relation to a replacement intervention of the hip or knee. A phenomenological hermeneutical approach was selected to capture the patients experiences (12) from the time they were placed on the waiting list until one year after the operation (5 interviews/person). Initially, the operation itself was regarded as the key for reaching the goal of a good self-ruling every-day life. The findings indicate that provision of care characterized by continuous guidance from formal carers with expert knowledge of care and replacement interventions across the entire perioperative period was desired. The fourth study (IV) focuses on twelve patients contemplations related to the hip or the knee replacement operation. A phenomenological hermeneutical approach was chosen in order to illuminate the meaning of contemplations related to the hip and knee replacement intervention (5 interviews/person). The findings indicate that the operation was a thorough life event including contemplations about life and death and about hope and fear. The overall conclusions of the thesis were living through the perioperative period for an acute or planned orthopaedic surgical intervention as a transition in life including different phases. Across the period the need of autonomy, continuity and mutual relationship with formal carers emerged within the phenomenon living through the perioperative period for acute or planned orthopaedic surgery. To support individuals across this period a perioperative education for the patients could be of importance. To know what the operation realistically will bring about, and about the care offered for support across the perioperative period with accessible guidance by competent formal carers appears to be significant information for the patients.

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