An exploratory study of Maltese patients’ perceptions of their preparation for total joint replacement at the pre-admission clinic

Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study

BACKGROUND

Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively.

OBJECTIVES

To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks.

DESIGN

An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process.

SETTING

Orthopaedic departments in NHS secondary care.

PARTICIPANTS

Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers.

INTERVENTIONS

Occupational advice intervention.

MAIN OUTCOME MEASURES

Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost.

RESULTS

A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff.

LIMITATIONS

Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it.

CONCLUSIONS

The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention.

FUTURE WORK

The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained.

STUDY REGISTRATION

Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.

Who cares? A critical discussion of the value of caring from a patient and healthcare professional perspective

BACKGROUND

This study was undertaken in order to discover and illuminate the essential caring behaviours valued by both patients and staff in an orthopaedic setting within a district general hospital in the United Kingdom.

OBJECTIVES

This descriptive study was undertaken in order to acquire a greater understanding of perceptions of caring from both patient and orthopaedic healthcare professional perspectives.

METHODS

A sample of 30 patients and 53 healthcare professionals consisting of doctors, nurses, physiotherapists and occupational therapists were asked to complete the Caring Behaviours Inventory (CBI) questionnaire (Wolf et al., 1994). Data were analysed using descriptive and inferential statistics.

RESULTS

The findings revealed both similarities and differences relating to the importance of positive caring behaviours exhibited during caring interactions. Healthcare professionals working in the orthopaedic setting acknowledged the value of similar positive caring behaviours to those of the patient group but ranked the importance of these differently.

DISCUSSION

Several important insights into perceptions of caring have been gained. These relate to an overall understanding of the caring behaviours that are considered of importance to patients and healthcare professionals; the differences that exist between the caring perceptions of both groups and the factors which influence these perceptions.

The Importance of Written and Verbal Information on Pain Treatment for Patients Undergoing Surgical Interventions

Patients who undergo a surgical intervention require information in the preoperative phase. Few qualitative studies are available that illuminate the importance of preoperative information for patients' experiences of postoperative pain management. The aim of this study was to examine patients' perceptions of preoperative information about pain treatment as well as its importance for the way pain was managed in the postoperative phase. A descriptive, qualitative study using individual interviews was performed. Content analysis was employed to analyze individual interviews with 18 patients who had undergone total hip or knee joint plastic surgery. Every second participant received verbal information on pain treatment in the standard way at the preoperative discussion, whereas the others were also provided with written information. The interviews took place in a public hospital, on the second or third postoperative day, between September and November 2010. The study revealed that a combination of written and verbal information on pain relief was perceived as valuable by the patients. Four main categories were identified: The form of information; the content of the information; the patients' experience of postoperative pain relief, and factors that influenced the patients' experience of pain relief. The theme "Participation" emerged from the latent content. Preoperative information on pain relief facilitated increased patient participation. Health care professionals often aim to ensure that patients participate in the care, but the latter sometimes lack the desire, strength, or ability to become involved.

Nursing in fast-track total hip and knee arthroplasty: A retrospective study

AIM

To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care.

METHODS

Retrospective, descriptive design. Data collection; from the hospital administrative database, local descriptions of fast-track, personal contact and discussion with staff.

RESULTS

The number of operations increased threefold from 351 operations in 2002 to 1024 operations in 2012. In 2012, THA/TKA patients had a postoperative mean LOS of 2.6/2.8 days. Nurses had gained tasks from surgeons and physiotherapists and thus gained more responsibility, for example, for pain management and mobilisation. Staffing levels in the ward in 2002 and 2012 were almost unchanged; 16.0 and 15.8 respectively. Nurses were undertaking more complicated tasks.

CONCLUSION

Nursing care must still focus on the individual patient. Nurses need to have enough education to manage the complex tasks and increased responsibility. To prevent undesirable outcomes in the future, there is a need to pay attention to the nursing quality in balance with the nursing budget. It may, therefore, be considered a worthwhile investment to employ expert/highly qualified professional nurses in fast-track THA and TKA units.

It's big surgery: preoperative expressions of risk, responsibility, and commitment to treatment after high-risk operations

OBJECTIVE

To identify the processes, surgeons use to establish patient buy-in to postoperative treatments.

BACKGROUND

Surgeons generally believe they confirm the patient's commitment to an operation and all ensuing postoperative care, before surgery. How surgeons get buy-in and whether patients participate in this agreement is unknown.

METHODS

We used purposive sampling to identify 3 surgeons from different subspecialties who routinely perform high-risk operations at each of 3 distinct medical centers (Toronto, Ontario; Boston, Massachusetts; Madison, Wisconsin). We recorded preoperative conversations with 3 to 7 patients facing high-risk surgery with each surgeon (n = 48) and used content analysis to analyze each preoperative conversation inductively.

RESULTS

Surgeons conveyed the gravity of high-risk operations to patients by emphasizing the operation is "big surgery" and that a decision to proceed invoked a serious commitment for both the surgeon and the patient. Surgeons were frank about the potential for serious complications and the need for intensive care. They rarely discussed the use of prolonged life-supporting treatment, and patients' questions were primarily confined to logistic or technical concerns. Surgeons regularly proceeded through the conversation in a manner that suggested they believed buy-in was achieved, but this agreement was rarely forged explicitly.

CONCLUSIONS

Surgeons who perform high-risk operations communicate the risks of surgery and express their commitment to the patient's survival. However, they rarely discuss prolonged life-supporting treatments explicitly and patients do not discuss their preferences. It is not possible to determine patients' desires for prolonged postoperative life support on the basis of these preoperative conversations alone.

A systematic review of qualitative studies: patients' experiences of preoperative communication

AIM

This article reports on a systematic review of qualitative studies on patients' experiences of preoperative communication with healthcare professionals.

BACKGROUND

Communication is critical for providing efficient care to patients. It is especially important for patients waiting for surgery, as they experience a variety of unknowns before the procedure. Through communication with healthcare professionals, patients gain a better understanding of the surgery and the issues related to their life after the surgery. Thus, the preoperative communication between healthcare professionals and patients is a significant topic for review.

DESIGN

Systematic review.

METHODS

Six electronic databases (CINAHL, Cochrane Library, Embase, Medline, PsycINFO and PUBMED) were systematically searched. Qualitative studies of patients' experiences before surgery were purposely selected for synthesis. Key themes and concepts were extracted and synthesised.

RESULTS

Eleven studies on patients' experiences before surgery were identified. Four main themes relating to patients' experiences of preoperative communication with healthcare professionals were identified from all 11 articles. These themes were as follows: need for information, involving relatives, need for control and healthcare professionalism.

CONCLUSIONS

Patients' experience of preoperative communication with healthcare professionals showed different needs and feelings for communication. Healthcare professionals need to have adequate knowledge, skills and positive attitudes to help patients through the journey of this critical life event.

RELEVANCE TO CLINICAL PRACTICE

Patients' sensitivity and their different needs for communication may contribute to future advances in the training of healthcare professionals with regard to their communication knowledge and skills. They may also affect the allocation of resources for patients waiting for surgery and educating related professionals about their knowledge and skills of communication and their attitudes. Adequate space for meeting simultaneously with patients and their relatives and extra human resources and tools for the assessment of individuals' need for communication are also required.

Setting up pre-admission visits for children undergoing day surgery: a practice development initiative

The hospital experience can bring about a range of negative emotions for children. The literature clearly states that children who are prepared for surgery recover faster and have fewer negative effects. Pre-admission programmes seek to prepare children (and their parents) for surgery. This paper describes in detail how a pre-admission programme was established for children and their families who were scheduled for day case surgery.