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Empowering knowledge and Quality of Recovery after hip or knee replacement
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients and their spouses. Patient education is linked to and promotes the recovery process and can improve the outcome after elective hip or knee replacement. Fulfilment of knowledge expectations is essential for enabling people to become empowered during the period of recovery.

Aim

The overall aim was to explore the association between empowering knowledge and patients’ quality of recovery after elective hip or knee replacement.

Methods

The design of the four papers was descriptive, prospective and comparative. Consecutively included patients and their spouses from Cyprus, Finland, Greece, Iceland and Sweden answered questionnaires before surgery and at discharge from hospital. Data was collected during the years 2009-2012. Relationships and associations between a number of factors and fulfilment of knowledge expectations, and patients’ quality of recovery were investigated. Comparisons between patients undergoing hip or knee replacement and between patients and their spouses were made.

Results

Patients and their spouses had similar knowledge expectations, and these were not fulfilled during the hospital stay. Spouses had less fulfilled knowledge expectations compared with the patients. Swedish patients and spouses had less fulfilled knowledge expectations compared with the Icelandic and Finnish ones. Patients who experienced the hospital stay as meeting their general expectations had more fulfilled knowledge expectations compared with those who did not.

Access to knowledge was the main predictor of the variance in fulfilment of knowledge expectations. Negative emotions, such as depressive state and impatience, were associated with less fulfilled knowledge expectations. For patients undergoing hip replacement, a higher level of professional education was associated with less fulfilled knowledge expectations. For patients undergoing knee replacement, a history of employment in social services or healthcare was associated with less fulfilled knowledge expectations.

Patients’ experience of greater satisfaction with care was associated with better quality of recovery for both kinds of arthroplasty. Patients with fulfilled knowledge expectations experienced better quality of recovery. The spouserelated factors, namely uncertainty and depressive state, were associated with lower quality of recovery. Factors associated with greater quality of recovery among the patients were spouses with a history of employment in social services or health care, and nurses explaining matters concerning the care and treatment for the spouses.

Conclusion

Patients and their spouses had high knowledge expectations that were not fulfilled during the hospital stay. Patients’ emotional state and their access to knowledge were important for their fulfilment of knowledge expectations. Patients’ and spouses’ emotional state also played an important role in determining the patients’ quality of recovery, and greater satisfaction with care among the patients was associated with better quality of recovery.

These results emphasise the need to detect patients and their spouses in need of support in their preparation and recovery process. It is therefore important to assess patients’ and spouses’ personal knowledge expectations, and adapt to their emotional state while fulfilling them.

The content of patient education should be personalised in future care, and informal caregivers should be seriously taken into account during the period of early recovery. The results of this thesis can be used in the development and testing of person-centred educational interventions for patients undergoing elective hip or knee replacements.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1496
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-125237DOI: 10.3384/diss.diva-125237ISBN: 978-91-7685-876-9 (print)OAI: oai:DiVA.org:liu-125237DiVA: diva2:903828
Public defence
2016-03-18, K1, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (English)
Opponent
Supervisors
Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2016-02-17Bibliographically approved
List of papers
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3. The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
Open this publication in new window or tab >>The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement: a European study
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2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 17-18, 2489-2501 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe and compare the quality of recovery (QoR) on discharge from hospital between patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors.

Background. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today’s shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with QoR at discharge from hospital.

Design. A descriptive, comparative study including 12 hospitals in five European countries; Cyprus, Finland, Greece, Iceland and Sweden.

Methods. Consecutively included patients responded on: Health-Related Quality of Life, and emotions before surgery and at hospital discharge; Quality of Recovery, Patient Satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total 865 patients were included (hip n=413, knee n=452).

Results. In the dimension of pain, patients undergoing hip replacement had significantly better QoR compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer QoR. Fulfilment of knowledge expectations has a limited effect on QoR. Greater satisfaction with care predicted better QoR.

Conclusions. Negative preoperative emotions were related to poorer QoR. For both kinds of arthroplasty, greater satisfaction with care was associated with better QoR.

Relevance to clinical practice. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2016
Keyword
Fulfilment of knowledge expectations, health-related quality of life, hip replacement, knee replacement, preoperative emotional state, quality of recovery, satisfaction with care
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-125235 (URN)10.1111/jocn.13278 (DOI)
Note

At the time of thesis presentation publication was in status: Manuscript

Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-04-21Bibliographically approved
4. Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
Open this publication in new window or tab >>Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
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2016 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 23, 32-46 p.Article in journal (Refereed) Published
Abstract [en]

Background: Today’s shorter hospital stays means that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the health care staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be primary caregivers as their relationship with the patient is more interdependent than other family members or caregivers.

Objectives: The aim was to describe spouse-related factors that were associated with patients’ quality of recovery on discharge from hospital after elective hip or knee replacement.

Design: The design was prospective, descriptive and comparative with two measurements; before arthroplasty and on discharge.

Settings: Two Finnish, three Icelandic and two Swedish university or community hospitals.

Participants: The sample consisted of spouses and patients. The inclusion criteria were: age ≥ 18 years, able to complete the questionnaires, and able to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as; wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years, and 54% of them were females.

Methods: Self-reported instruments on; expected and received knowledge, access to knowledge, emotional state and quality of recovery were used.

Results: If the spouses were or had been employed in the social services or healthcare their partner had greater quality of recovery (p=0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p<0.001). Spouses who experienced that nurses had enough time and explained matters concerning their family members’ care and treatment had partners who experienced greater quality of recovery (p=0.011, 0.044).

Conclusions: Spouses’ emotional state played an important role in the patients’ quality of recovery, with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses’ fulfilment of knowledge expectations was not associated with patients’ recovery.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
Access to knowledge, empowering knowledge, emotional state, fulfilment of knowledge expectations, hip replacement, knee replacement, recovery, spousal caregivers
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-125236 (URN)10.1016/j.ijotn.2016.03.001 (DOI)
Note

At the time for thesis presentation publication was in status: Manuscript

Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2017-04-21Bibliographically approved

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