Everyday challenges following hospital discharge. A multi‐method study identifying and describing areas of concern for patients during the first month after colorectal cancer surgery

Abstract Aim Identify and describe areas of concern focusing on day‐to‐day variations during the first month after surgery for patients recovering from colorectal cancer surgery. Design A multi‐method design was applied using diaries and interviews. Method Data was collected using semi‐structured diaries kept 1 month after surgery by seven patients recovering from colorectal cancer surgery. Also, face‐to‐face interviews were conducted 1 month after surgery. Data from the diaries constituted a framework for the following directed content analysis of interviews. Findings Low levels of pain were experienced but caused reduced mobility and tiredness. Practical matters in daily living were restricted, while social life could be hampered by a frequent need to defecate. Appetite and consequently the ability to eat and drink was the most prominent concern, due to changes in taste and ability to tolerate food. Worries were mainly related to changes in bowel movements. No Patient or Public Contribution

Everyday challenges following hospital discharge. A multi-method study identifying and describing areas of concern for patients during the first month after colorectal cancer surgery

AIM: Identify and describe areas of concern focusing on day-to-day variations during the first month after surgery for patients recovering from colorectal cancer surgery. DESIGN: A multi-method design was applied using diaries and interviews. METHOD: Data was collected using semi-structured diaries kept 1 month after surgery by seven patients recovering from colorectal cancer surgery. Also, face-to-face interviews were conducted 1 month after surgery. Data from the diaries constituted a framework for the following directed content analysis of interviews. FINDINGS: Low levels of pain were experienced but caused reduced mobility and tiredness. Practical matters in daily living were restricted, while social life could be hampered by a frequent need to defecate. Appetite and consequently the ability to eat and drink was the most prominent concern, due to changes in taste and ability to tolerate food. Worries were mainly related to changes in bowel movements. No Patient or Public Contribution

The lived experience of recovery during the first 6 months after colorectal cancer surgery

AIMS AND OBJECTIVES: To describe the lived experience of recovery during the first 6 months after colorectal cancer surgery. BACKGROUND: Colorectal cancer is the third most common cancer diagnosis worldwide. Early discharge places demands on healthcare professionals to prepare patients for their return home and to provide them with appropriate support throughout the recovery process. This requires knowledge of what it is like to recover from colorectal cancer surgery. DESIGN: A qualitative phenomenological design was used to describe the structure of recovery after colorectal cancer surgery. METHODS: Ten patients recovering from colorectal cancer surgery were interviewed at one month and six months after surgery. The descriptive phenomenological method by Giorgi was used throughout the study. RESULTS: Postoperative recovery was described as a progressive process. This process was accompanied by experiences of physical powerlessness, difficulties with food intake, altered bowel function and dependency on others. The experiences were most intense at the beginning of the recovery but disappeared as time went by and normality in life returned. CONCLUSION: While recovering from colorectal cancer surgery, patients experience obstacles that impede their ability to live life as normal. Six months after surgery, those experiences disappear or become adjusted to being part of normal life. RELEVANCE TO CLINICAL PRACTICE: Patients should be provided with information about the expected postoperative recovery before discharge from hospital. The need for professional support appears to be most frequently needed in early recovery, but it should be considered on an individual basis

Patient characteristics and surgery-related factors associated with patient-reported recovery at 1 and 6 months after colorectal cancer surgery

Predictors for postoperative recovery after colorectal cancer surgery are usually investigated in relation to length of stay (LoS), readmission, or 30-day morbidity. This study describes patient characteristics and surgery-related factors associated with patient-reported recovery 1 and 6 months after surgery. In total, 153 consecutively included patients who were recovering from colorectal cancer surgery reported their level of recovery using the Postoperative Recovery Profile. Multiple logistic regression analysis was used to calculate associations with recovery, defined as good or poor, divided into five recovery dimensions: physical symptoms, physical functions, psychological, social and activity. Better preoperative health predicted good recovery regarding three dimensions 1 month after surgery. Regarding all dimensions 1 month after surgery, poor recovery was predicted by a poor recovery on the day of discharge within corresponding dimensions. Higher age was associated with good recovery 6 months after surgery, while chemotherapy showed negative associations. Overall, a majority of factors had a negative impact on recovery, but without any obvious relation to one specific dimension or point in time. Those factors were: high Body Mass Index, comorbidity, abdominoperineal resection, loop ileostomy, colostomy and LoS. This study illustrates the complexity of postoperative recovery and a need for individualised follow-up strategies

Patients' Experiences During Carotid Endarterectomy Performed Under Local Anesthesia

Purpose: To describe patients' experiences undergoing a carotid endarterectomy (CEA) under local anesthesia. Design: Explorative qualitative design. Methods: Semistructured interviews with 15 participants who had undergone CEA under local anesthesia, analyzed by content analysis. Findings: Undergoing CEA under local anesthesia entails enduring stress with no possibility of withdrawal. Patients' lack of understanding of local anesthesia and experiencing pain and discomfort caused feelings of stress. The surgery resulted in a loss of control; patients had to surrender their autonomy to someone else. The nurse anesthetist was the link to the world outside the operating room (OR), and that nurse conveyed feelings of safety and security during the surgery. Conclusions: Patients' experiences ranged from being pleased with the surgical procedure and local anesthesia to vowing never to undergo such a procedure again. It is important to focus on the patients' experiences and feelings when choosing a method of anesthesia

Patients experience of negative pressure wound therapy at home for treatment of deep perivascular groin infection after vascular surgery

Aims and objectives To explore experiences of negative pressure wound therapy at home, in patients with deep perivascular groin infection after vascular surgery and management in daily life. Background Deep surgical site infection after vascular surgery with exposed vessels often requires long-term treatment with negative pressure wound therapy, and continued therapy at home has become routine. Design An explorative qualitative study. Methods Nine men and six women with a deep surgical site infection in the groin after vascular surgery, treated in their home with negative pressure wound therapy, were interviewed. The interviews were analysed using manifest and latent content analysis. Results Undergoing negative pressure wound therapy at home meant a transition from being a dependent patient to a person who must have self-care competence and be involved in their own care. A need to feel prepared for this before discharge from hospital was expressed. Lack of information and feelings of uncertainty prolonged the time before feeling confident in managing the treatment. The informants gradually accepted the need to be tied up to a machine, became competent in its management and found solutions to perform everyday tasks. Overall, it was a relief to be treated at home. Conclusions Several benefits of negative pressure wound therapy at home were expressed. However, unnecessary stress and anxiety were experienced due to a lack of information on the treatment and instruction concerning the equipment. Adequate information and education must therefore be provided to facilitate the transition from a patient to a person with self-care competence and ability to manage this treatment at home. Relevance to clinical practice The findings revealed a need for more support and knowledge in their transition from hospital care to home care with negative pressure wound therapy. Routines must be established that ensure patient safety and security in treatment at home

Service managers' experiences of how the participation of people with intellectual disabilities can be promoted in Swedish group homes

BACKGROUND: People with intellectual disabilities in staffed group homes often need lifelong support and dependency on others. Thereby, special demands are placed on staff and service managers to ensure opportunities for participation in everyday life. This study aims to explore how service managers promote participation in Swedish group homes for adults with intellectual disabilities. METHOD: A qualitative research design involving individual interviews with 14 service managers was used to gain an understanding of how the participation of adults with intellectual disabilities can be promoted in Swedish group homes. RESULTS: The results comprise two main themes; Creating preconditions for participation and Barriers for promotion of participation. CONCLUSIONS: Service managers experienced that promoting service user participation in group homes was an important part of their responsibility. The findings indicate that structural strategies such as coaching, supervision and reflection are important and should be further developed