Abstract
Purpose
Day surgery is a common phenomenon and is associated with several benefits including cost-effectiveness. However, patients are required to manage their postoperative recovery at home. Patients undergoing orthopedic surgery are a particularly vulnerable group, and their postoperative recovery requires further investigation. This study aimed to describe the experiences of postoperative recovery of patients who had undergone orthopedic day surgery.
Design
A qualitative and descriptive study design was used
Methods
Participants were selected purposefully and included 18 orthopedic day-surgery patients who underwent surgery in October and November 2020. Semi-structured interviews were conducted from December 2020 to February 2021. All interviews were recorded and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis with an inductive approach. The process of analysis was done in several steps and resulted in four categories
Findings
Four categories that described the postoperative recovery experiences of patients who underwent orthopedic day surgery were developed: (1) Questions arose when I got home; (2) I wanted confirmation that I was on the right path; (3) I felt lonely and dependent on others; and (4) I strove to find a balance between activity and rest
Conclusions
For most patients, there was no follow-up after day surgery. However, patients expressed a desire for confirmation that their recovery process was within the normal trajectory. Most of the recovery takes place at home, leading to feelings of loneliness and highlighting the need for support from healthcare providers and close relatives. A phone call from a nurse after surgery might offer support, reduce feelings of loneliness, and promote a sense of safety. This study highlights the importance of systematic follow-up following orthopedic day surgery.
Keywords
Background
Day surgery is becoming increasingly common worldwide. In many European countries and in North America, more than half of all elective surgeries are performed as day surgery. In Sweden, 80 percent of elective surgeries are performed in a day-surgery context.
2
, 3
, 4
One commonly used definition of day surgery is that the patient is admitted and discharged from hospital the same day or within 24 hours of surgery.5
, 6
, 7
Day surgery has several benefits compared to inpatient surgery: many patients prefer to recover at home; patients are mobilized earlier, reducing the risk of venous thromboembolism; the risk of nosocomial infection is reduced.8
Cost-effectiveness benefits are also accrued since the patient is not occupying a hospital bed and, thus, surgical waiting lists can be decreased.3
,8
However, day-surgery patients are required to manage their postoperative recovery at home on their own.9
,10
To ensure a proper recovery, patients undergoing day surgery need information about the normal trajectory of recovery and about self-care.7
Therefore, to promote recovery in patients who have undergone day surgery, all information provided as part of the perioperative process must be thorough as well as understandable to the patient and their immediate family.Postoperative recovery is a commonly used concept, but it lacks a clear definition. It is seen as a process and as a subjective experience.
10
,12
,13
One definition is the following:Postoperative recovery is an energy-requiring process of returning to normality and wholeness as defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions which results in returning to preoperative levels of independence/dependence in activities of daily living and an optimum level of psychological well-being.10(p. 557)
The process of postoperative recovery begins preoperatively when the decision to undergo surgery is made with the patient and they begin to prepare for the procedure.
14
A further development of Allvin et al's definition of postoperative recovery10
in a day-surgery context was made by Nilsson et al They defined postoperative recovery as an individual process that is affected by physical, psychological, social, and habitual dimensions. Recovery may be considered complete when the patient has reached a “new stable state.” However, this new stable state does not mean that the patient has returned to their preoperative state of health.Patients undergoing orthopedic surgery report a lower degree of postoperative recovery compared to patients undergoing general surgery early in the recovery process as well as one month after surgery.
7
,15
When comparing health-related quality of life postoperatively between patients undergoing orthopedic, general, or gynecological day surgery, patients who have had orthopedic day surgery report a lower rate of health-related quality of life both before and 30 days after surgery. One reason for the slow recovery is many orthopedic patients experience pain and impaired mobility preoperatively, which may affect postoperative recovery time.7
As day surgery continues to become more common and as patients who undergo orthopedic surgery have been shown to be vulnerable as a group, their postoperative recovery requires further investigation. The trajectory of recovery for patients undergoing day surgery differs from patients having inpatient surgery. Even with this knowledge, further studies are needed to get a deeper understanding about what it is like to try to recover at home following day surgery. This study was designed to fill that knowledge gap.
Aim
The aim for this study was to describe the experiences of postoperative recovery for patients who have undergone orthopedic day surgery.
Methods
Design
The study design was qualitative, nonexperimental, and descriptive. The data analysis followed a qualitative content analysis as described by Graneheim and Lundman
16
and Graneheim, Lindgren, and Lundman.17
Ethics
The Ethical Review Board in Sweden (Dnr 2020-04703) approved the study. Before any data were collected, approval for implementing the study was obtained from the unit manager and the head of the surgical ward. All patients chosen for the study received written and oral information about the aim of the study and were granted confidentiality. Furthermore, they were informed that participation was voluntary and that they could withdraw from the study at any time without providing a reason and with no repercussions. All transcriptions were coded and stored in a locked folder in the first author's computer.
Participants and Setting
The study participants were selected purposefully. Patients (N = 35) who underwent day surgery under general or regional anesthesia in the fall of 2020 and met the inclusion criteria were approached and invited to participate approximately two months postoperatively. Inclusion criteria were having had orthopedic day surgery, being classified as I–III according to the physical status classification system of the American Society of Anesthesiologists, were aged 18 or older, and were able to understand and speak Swedish. Out of the invited participants, 18 patients agreed to participate in the study. The 18 study participants ranged in age from 18 to 81 years. Additional characteristics are shown in Table 1.
Table 1Characteristics of Participants (N = 18)
| N | ||
|---|---|---|
| Sex | Male | 4 |
| Female | 14 | |
| Surgery | Foot | 12 |
| Shoulder | 3 | |
| Knee | 3 | |
| Housing | House | 9 |
| Apartment | 9 | |
| Marital status | Single | 10 |
| Married/partner | 8 | |
| Employment | Student | 2 |
| Working | 8 | |
| Retired | 8 |
Approximately 20 to 30 elective orthopedic day surgeries together with 20 to 30 elective orthopedic inpatient surgeries are performed each week at the hospital ward where participant selection took place. Because of reductions in elective surgery caused by COVID-19, between five and ten orthopedic day surgeries were performed each week during the interview period. Typically, all patients meet with an orthopedist at an appointment before the surgery; and they then meet their operating surgeon before being discharged from the Postanesthesia Care Unit (PACU). On the day of the surgery, the patients again meet the same staff prior to surgery. The staff in the PACU are nurse anesthetists and licensed practical nurses; some rotate between the PACU and the surgical ward, and some work only at the PACU. At the PACU, the patients stay for phases I and II of their recovery. For most of the patients, there is no follow-up after they are discharged. Only in special cases or when a patient asks for it is there a follow-up with an orthopedist after surgery.
Data Collection
The first author received permission from the head of the surgical ward and the Review Board of the region to collect the addresses of patients whose characteristics aligned with the inclusion criteria from the surgical planning document. A letter of invitation and an informed consent form was sent to their home addresses approximately two months postoperatively. Patients willing to participate completed the informed consent form, which was returned to the first author who then contacted them to set up a date and time for an interview. All interviews were conducted between late December 2020 and February 2021.
In all, 18 semi-structured interviews (N = 18) were held between two and three months postoperatively. Because of restrictions related to the COVID-19 pandemic, all interviews were conducted by telephone. A pilot interview, which is included in the analysis, was conducted, as the answers to the pilot contributed with valuable input. The pilot interview did however result in minor changes in the phrasing of the questions asked. During the interviews, the participants were asked questions designed to help them describe their experiences of their postoperative recovery. Specific as well as more general questions were used, such as “Can you describe your recovery so far?”, “Can you describe your health today compared to your health prior to your surgery?”, and “What did the information regarding the recovery process consist of?” Each interview lasted between 30 and 60 minutes, and all were audio-recorded and then transcribed verbatim by the first author. Field notes were taken during the interviews to help the interviewer remember specific events during the transcription, but field notes were not included int the analysis of data. The participants were not asked to comment on or review the transcribed interviews.
All interviews were conducted by the first author, who has previous experience conducting interviews at a master's degree level. All coauthors are experienced researchers and specialist nurses. No participants had prior relationships with any of the researchers, and all were informed about the aim of the study and that participating was voluntary and had no bearing on the care they received from their healthcare professionals.
Data Analysis
The collected data were analyzed using qualitative content analysis with an inductive approach according to Graneheim and Lundman
16
and Graneheim et al17
Following the inductive approach, the goal was to acquire an understanding of the participants’ experiences of their postoperative recovery by finding patterns in the collected data. To obtain a sense of the whole, the unit of analysis was read several times. From the unit of analysis, meaning units were identified that provided information directed toward the aim of the study. The units were then condensed, labeled with a code, and sorted into categories. The process of categorization was performed in several steps by merging categories with similar content to form new, broader categories. In qualitative content analysis, a category describes the data on a manifest level with little interpretation.17
The data analysis resulted in four categories. All authors took part in the data analysis and formulation of the final categories. During the process of analysis, different categories were tested until all the authors reached consensus about the categories that corresponded to the data in the best way. Examples of the process of analysis are provided in Table 2.Table 2Example of the Process of Analysis to Describe the Experience of Postoperative Recovery
| Meaning unit | Condensed Meaning Unit | Code | Categorization | Final Category |
|---|---|---|---|---|
| “I wish they had clarified more about the time after the surgery. (…) Because now I do not know, should I exercise? Or should I rest?” (Participant 1) | To wish more information regarding how to behave postoperatively | How to behave postoperatively | ||
| “There was no information about the recovery process, only about the preoperative preparations” (Participant 18) | Only information regarding the time before the operation. | Only preoperative information | The information does not refer to the recovery and causes feelings of unsafety and insecurity. The questions occurred at home, | Questions arose when I got home. |
| “The information was not enough! At the hospital everything was fine, but when I got home, I felt insecure. And I did not know how to behave” (Participant 13) | The information was insufficient which led to feelings of insecurity | The information is insufficient which causes feelings of insecurity at home. |
Results
Four categories that described the postoperative recovery experiences of patients who underwent orthopedic day surgery were developed: (1) Questions arose when I got home; (2) I wanted confirmation that I was on the right path; (3) I felt lonely and dependent on others; and (4) I strove to find a balance between activity and rest.
Questions Arose When I Got Home
The participants emphasized that what they were told during the perioperative process did not include enough information about the recovery process. The PACU staff and the orthopedist sometimes appeared stressed, and there was little time for the participants to ask questions or raise concerns before being discharged. In those cases where participants experienced felt the information was sufficient, the PACU nurses played an important role in promoting patients’ feelings of safety before discharge by giving them thorough, individualized information.
For me, one of the problems was that I did not have enough time to ask all my questions. So, I did not perceive the information to be sufficient. They [the staff at the PACU] were so stressed that I did not feel I had the time to think if I had any questions. (Participant 14)
Hence, a number of participants lacked information about what was required for self-care after surgery to facilitate their recovery when they got home, and this led to feelings of fear and insecurity. As the information provided during the perioperative process was perceived to focus too little on the recovery process, some participants became frightened about compromising the result of the surgery and because of that, many did not exercise at all.
The information regarding preoperative preparations was sufficient. But the information about the time after was not enough. When I got home, I did not know what to do. Was I supposed to exercise my foot or was I supposed to be totally still? I was afraid to destroy something in my foot, so I ended up doing nothing for several weeks. (Participant 2)
Questions about their recovery arose after discharge, and sometimes the participants did not understand or remember the information they had been given. When questions arose, they did not know where to turn; some did not want to call the treating clinic as they did not want to be considered a nuisance. An important factor in regard to feeling safe during the recovery process was a sense of being acknowledged and taken seriously. When several participants took the initiative to raise concerns or ask questions, they described feeling neglected and as though their concerns were not taken seriously. This experience led to feelings of doubt, and the participants started to question their own experiences regarding their recovery.
I do have a lot of questions, but I do not know where I would call in order to get proper answers. Am I supposed to call directly to the orthopedist or am I supposed to call my family doctor? I wished that somebody had told me: Call this number if you have any questions. But nobody did. (Participant 11)
I Wanted Confirmation That I Was on the Right Path
During the recovery process following discharge, the feeling of being on the right path and that their recovery was proceeding satisfactorily was described as important. As most of the participants had no follow-up after day surgery, they expressed a feeling of being abandoned. A follow-up visits with an orthopedist or a physiotherapist or a nurse, either as a regular appointment or by telephone or videoconferencing, was something participants would have liked to have had. Some participants wondered if nobody wanted to know how the surgery and recovery went, while others wished to have confirmation that the recovery process was continuing as expected.
I wished that someone had called me after six to eight weeks just to see how things are going. And, from that call maybe they could have assessed if a follow-up visit at the clinic was necessary. Even if not, everybody needs a follow-up visit, I think a phone call would be of importance. An opportunity to raise questions. (Participant 5)
Participants experienced feelings of being unsafe when they did not know if their recovery trajectory was proceeding as expected. In cases where the recovery was perceived as longer than expected or where participants did not know what to do to recover properly, feelings of both frustration and insecurity occurred. Even when the recovery was proceeding better than expected, many of the participants expressed a desire for a follow-up visit, partly as a confirmation since it can be difficult to assess one's own recovery because how it should be going is not something the average person knows.
I still have pain and my knee is still swollen. This worries me a little. I would have wanted to know why that is. I really would have wanted a follow-up with the orthopedist. After all, even though my knee is pretty much recovered now, I still have some troubles and I want to know if this is within the normal trajectory. (Participant 15)
I Felt Lonely and Dependent on Others
When participants came home after surgery, they described feelings of isolation and loneliness because the recovery process is something one must get through by oneself. It is a new experience for many, and it is difficult to know how to handle it. The ongoing COVID-19 pandemic reinforced those feelings when restrictions made it even harder to meet with relatives and other important people who normally could have been supportive. However, at the same time, the restrictions caused by the pandemic made it possible for some of the participants to find time to rest and focus on their recovery.
With this pandemic, sure I have felt lonely. You are not able to meet people and to have visitors at home like before. But I read, and I take walks in order to recover. (Participant 12)
The presence of relatives and close friends was described not only as an asset but also as a cause of feeling dependent. When participants felt support or encountered understanding from relatives or friends, their feelings of loneliness could be decreased. In addition, when workplaces made modifications to facilitate the possibility of returning to work, those participants who were employed felt less lonely and enjoyed a sense of belonging and normality. However, feeling dependent on others could be a burden to those who were accustomed to being independent and fending for themselves.
Just to take a shower was so hard in the beginning. I needed help from my husband to deal with my personal hygiene: to take showers and to wash my hair, things that are hard to do with only one arm available. It has been hard accepting that. I am used to fending for myself. (Participant 13)
Participants emphasized the importance of having someone to talk to and having someone nearby. This might be family members who could offer emotional support as well as other people who had undergone similar procedures. An acknowledgment of the participant and their process of recovery seemed to be important for several of the participants and promoted feelings of safety.
I really hesitated to undergo this surgery. My dad had the same surgery in the 1970s and it did not go well. But my wife and my kids, they have really helped me to feel safe while recovering. Also, I have talked with people with similar experiences, and they really supported me. (Participant 9)
I Strove to Find a Balance Between Activity and Rest
Almost every participant highlighted the importance of movement and exercise as part of recovering properly. Just to go outside, take a walk around one's house, and get some fresh airs were described as key factors for promoting recovery. Participants emphasized that they could promote their recovery by being in good shape before the surgery and starting to exercise as soon as possible after surgery.
My recovery has been really good. Even though I have had multiple sclerosis and rheumatism for some time, I was in really good shape before my surgery. I ride my bike to my allotment and do gardening every day. That really has helped me recover. And now, after my surgery, I take walks every day, longer and longer each day. (Participant 4)
Nevertheless, having a balance between exercise and rest was described as necessary. Some participants struggled with the fact that they needed to rest and that recovery sometimes took longer than they wanted. They described that an important factor for their being able to accept their situation was to be mentally prepared for not being as active as they used to be. Most of the participants described the importance of striving toward a goal for their recovery independently, with the starting point being how active they were before surgery. The goal varied and could be to return to one's preoperative condition or to be able to go back to a specific type of exercise or to go back to work without pain.
My goal was to get back to work. I have worked half-time for several weeks already. In order to recover I take time to rest every day and I put my foot in a high position. Apart from that I have been taking walks. Initially I used a crutch, but I just wanted to get outside and be able to get some fresh air. Now I also have started some weightlifting to promote my recovery. (Participant 8)
Discussion
This study describes the postoperative recovery experiences of patients who have undergone orthopedic day surgery. One finding was that the information patients were given during the perioperative process focused too little on the recovery process, and questions regarding recovery did not arise until after discharge. The nurses in the PACU seemed to play an important role in creating feelings of safety before discharge by giving thorough, individualized information. Fagermoen and Hamilton
18
found that satisfaction improved following urological surgery when patients were given a booklet with information in addition to verbal information at discharge which led to improved self-management after discharge. In a transition process, the healthcare professionals seem to be a key component. A transition process takes place when an individual experiences changes in health or illness, and during this process, the person is likely to be more vulnerable to risks that can affect their health.19
As the participants in this study had all undergone surgery, it can be assumed that their recovery is a transition process. Hence, healthcare professionals play an important role in facilitating that transition and helping patients feel safe during their recovery. This is in line with Szöts et al20
who concluded that one way of helping patients in their transition process is to provide a structured follow-up via telephone after discharge.There were no established routines for follow-up after surgery for the patients in this study, a result that was also found by Dahlberg et al
9
and Gilmartin.3
Yet all participants emphasized a desire for some kind of follow-up to receive confirmation that their process of recovery was following the expected trajectory. When patients are expected to manage their self-care at home, it is crucial that they be provided with individualized information and some form of follow-up.21
If questions arose after discharge, the participants sometimes avoided contacting the treating clinic as they did not want to be considered a nuisance. Engström et al22
who studied women who had undergone total knee joint replacement surgery would have liked healthcare professionals to contact them after surgery instead of their having to call the surgery unit. Receiving such a call would have reduced their fear of being thought bothersome. Donsel et al23
highlighted the importance of having a nurse call the patient during postoperative follow-up instead of the patients having to initiate the call. When the patients were contacted, they were able to avoid feeling like they were disturbing the healthcare team, which was seen to be the case if the patient needed to initiate the contact. Clari et al24
concluded that with a nurse lead follow-up telephone call, for patients undergoing orthopedic surgery, both postoperative health problems as well as being an unnecessary burden on the community health system may be reduced. By contrast, Dahlberg et al25
concluded that when patients were given the opportunity to decide if and when to contact the day surgery themselves via a phone app instead of being contacted by a healthcare professional, this was considered a way of implementing a person-centered approach to postoperative care for day-surgery patients9
Kennedy et al26
suggest that a multi-modal delivery of postoperative information, such as using traditional forms together with new technology such as internet and mobile technology, could satisfy patients’ postoperative needs and help deliver care tailored to the individual patients’ own preferences. Those participants in the present study who sought contact with the treating clinic emphasized the importance of having their concerns and questions taken seriously during the process of recovery.The results of this study indicate that, during the process of recovery, feelings of loneliness may occur because the process is something the patient must go through alone. Loneliness may be considered a subjective experience in which the individual cannot attain a desired quality or quantity of relationships. Together with some other reasons, feeling lonely may occur due to isolation during periods of disability.
27
Donsel et al23
suggested that a phone call from a nurse sometime after discharge could reduce those feelings. The participants emphasized that next of kin could play an important role in the recovery process. But at the same time, the participants expressed experiencing loneliness during the recovery process as it is something one must get through alone. Donsel et al23
argued that family members may have a problem understanding the feelings experienced by a patient who has undergone surgery and is going through the recovery process.Strengths and Limitations
In qualitative content analysis, the concept of trustworthiness during the entire process is significant. Enough participants should be included so that the data address variations and demonstrate diversity.
17
For this study, there were 18 participants. As many interviews (N = 18) were conducted, they were informative, and they had richness and depth, the sample size is considered sufficient. According to Sandelowski,28
a sample size should be large enough to provide variations in the experiences but small enough to allow a deep analysis of the data. For qualitative research there are no fixed rules for sample size. However, one tenet that can help guide the authors is the principle of data saturation. Data saturation declares that sampling should continue up to the point where redundancy is achieved.29
For this study, the authors all discussed the matter of data saturation and agreed that saturation was achieved with the 18 interviews.A known problem in the nursing sciences is the tendency for gender bias, which may lead to problems with generalizability.
30
For this study, 14 of 18 participants were women, although invitations were sent to an equal number of men and women. The predominance of female participants in this study may create questions regarding its credibility; however, the age range of the participants may increase the different angles of the concept of postoperative recovery. Graneheim and Lundman16
use the word transferability in regard to qualitative research. To help the reader decide whether the results from this study are transferable to another setting or not, the participants and the setting for this study have been described. To achieve credibility, it is important to choose meaning units of importance for the concept being studied.17
During the data analysis process, all coauthors took an active part when seeking consensus. Quotes from the transcribed text have been included to increase the study's credibility.The participants were invited to participate approximately two months postoperatively. That increases the risk for recall bias. However, as the aim was to describe the participants experience of their postoperative recovery, the participants needed to have some time to recover before they could answer completely and properly.
Conclusion
When undergoing day surgery, patients have limited time to ask questions, and even when information about postoperative recovery is provided, many patients do not remember what was said in the PACU. Furthermore, when they arrive home and later during the recovery process, additional questions frequently arise, and patients do not know where to turn to seek answers. For most, there is no regular follow-up visit after day surgery. Nevertheless, patients strive to find a balance between activity and rest and want a confirmation that the process of recovery is within the normal trajectory. Most of the recovery takes place at home with limited support from others. This leads to feelings of loneliness and highlights the need for support both from healthcare providers and close relatives during the recovery process. A phone call from a nurse after surgery might support the patient, reduce feelings of loneliness, and promote feelings of security. Even though there might be a cost for making such follow-up phone calls, the burden on community health care could decrease and the transition process and the postoperative recovery for the patients could be facilitated. Hence, the total cost may be decreased. In conclusion, this study highlights the importance of a systematic follow-up after orthopedic day surgery. For the future, an intervention study with some kind of systematic follow-up, such as a phone call from a nurse two to five days after surgery, may help the recovery and reduce some feeling of loneliness.
Data Accessibility Statement
The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Acknowledgments
The authors would like to thank the participants for sharing their experiences.
References
- Day surgery development.Ambul Surg. 2009; 15: 4-9
- Postoperative recovery from the perspective of day surgery patients: a phenomenographic study.Int J Nurs Stud. 2013; 50: 1630-1638
- Contemporary day surgery: Patients' experience of discharge and recovery.J Clin Nurs. 2007; 16: 1109-1117
- Patient satisfaction following day surgery.J Clin Anesth. 2009; 21: 200-205
- Postoperative recovery after general and regional anesthesia in patients undergoing day surgery: A mixed methods study.J PeriAnesth Nurs. 2019; 34: 517-528
- The quality of patient education in day surgery by adult patients.J PeriAnesth Nurs. 2018; 33: 177-187
- Postoperative recovery and its association with health-related quality of life among day surgery patients.BMC Nurs. 2012; 11: 24-33
- Patient selection for day surgery.Anaesth Intenstive Care Med. 2016; 17: 151-154
- “Let the patient decide” – person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: Secondary analysis of a randomized controlled trial.Int J Surg. 2019; 61: 33-37
- Postoperative recovery: a concept analysis.J Adv Nurs. 2007; 57: 552-558
- BMJ Open. 2020;
- Postoperative recovery after different orthopedic day surgical procedures.Int J Orthop Trauma Nurs. 2011; 15: 165-175
- Discharge criteria and complications after ambulatory surgery.Anesth Analg. 1999; 88: 508-517
- Holding it together—patients' perspectives on postoperative recovery when using an e-assessed follow-up: qualitative study.JMIR mHealth uHealth. 2018; 6
- Patterns of changes in patients' postoperative recovery from a short-term perspective.J PeriAnesth Nurs. 2018; 33: 188-199
- Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.Nurse Educ Today. 2004; 24: 105-112
- Methodological challenges in qualitative content analysis: a discussion paper.Nurse Educ Today. 2017; 56: 29-34
- Patient information at discharge—a study of a combined approach.Patient Educ Couns. 2006; 63: 169-176
- Experiencing transitions: an emerging middle-range theory.Adv Nurs Sci. 2000; 23: 12-28
- Nurse-led telephone follow-up after total knee arthroplasty - content and the patients' views.J Clin Nurs. 2015; 24: 2890-2899
- Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery.J Clin Nurs. 2019; 28 (9–10): 1546-1554
- Women's experiences of undergoing total knee joint replacement surgery.J PeriAnesth Nurs. 2017; 32: 86-95
- What's going on after hospital? – Exploring the transition from hospital to home and patient experiences of nurse-led follow-up phone calls.J Clin Nurs. 2021; 30: 1694-1705
- Follow-up telephone calls to patients discharged after undergoing orthopaedic surgery: Double-blind, randomised controlled trial of efficacy.J Clin Nurs. 2015; 24: 2736-2744
- Let the patient decide” – Person-centered postoperative follow-up contacts, initiated via a phone app after day surgery: Secondary analysis of a randomized controlled trial.Int J Surg. 2019; 61: 33-37
- A qualitative study of patient education needs for hip and knee replacement.BMC Musculoskelet Disord. 2017; 18: 413
- Concept analysis of loneliness with implications for nursing diagnosis.Int J Nurs Terminol Classif. 2009; 20: 25-33
- Sample size in qualitative research.Research in nursing & health. 1995; 18: 179-183
- Nursing research: Generating and assessing evidence for nursing practice.10th ed. Wolters Kluwer, Philadelphia2017
- Is there still gender bias in nursing research? an update.Research in nursing & health. 2013; 36: 75-83
Article info
Publication history
Published online: March 10, 2022
Footnotes
Conflict of Interest: There is no conflict of interest to report.
Identification
Copyright
© 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc.
User license
Creative Commons Attribution (CC BY 4.0) | How you can reuse 
Elsevier's open access license policy
Creative Commons Attribution (CC BY 4.0)
Permitted
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article
- Reuse portions or extracts from the article in other works
- Sell or re-use for commercial purposes
Elsevier's open access license policy
