Am I safe? An Interpretative Phenomenological Analysis of Vulnerability as Experienced by Patients With Complications Following Surgery

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study

BACKGROUND

The management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND).

METHODS

The research used ethnographic methods, including over 100 hours of observations on surgical units in three English hospitals in order to understand the everyday context of care. Observations focused on the coordination of activities such as handovers and how rescue featured as part of this. We also conducted 27 interviews with a range of clinical and managerial staff and patients. We employed a thematic analysis approach, combined with a theoretically focused implementation coding framework, based on Normalisation Process Theory.

RESULTS

We found that organisational infrastructural support in the form of a leadership support and clinical care outreach teams with capacity were enablers in implementing the patient-led escalation system. Barriers to implementation included making changes to professional practice without discussing the value and legitimacy of operationalising patient concerns, and ensuring equity of use. We found that organisational work is needed to overcome patient fears about disrupting social and cultural norms.

CONCLUSIONS

This paper reveals the need for infrastructural support to facilitate the implementation of a patient-led escalation system, and leadership support to normalise the everyday process of involving patients and families in escalation. This type of system may not achieve its goals without properly understanding and addressing the concerns of both nurses and patients.

A Qualitative Study on How Younger Women Experience Living with an Ostomy

There is a growing demand that ostomy patients receive more systematic and individualised follow-up by ostomy nurses. The purpose of the study was to explore how younger women experience everyday life after an ostomy and to map what healthcare personnel can do to ensure that the patient group can feel safe and looked after. This qualitative study included four younger women who had a stoma fitted. Individual in-depth interviews were conducted, and two participants were interviewed twice. The findings resulted in three main themes: (1) The importance of follow-up and information from healthcare personnel, (2) Experience with illness and freedom in everyday life and (3) Self-image and social relationships. We found that time to prepare before surgery and learning to live with the stoma provide a good basis for handling the new everyday life with a stoma. We conclude that ostomy nurses provide support and security to those undergoing ostomy operations. Healthcare professionals should focus on providing individually tailored information to ensure that patients are receptive to the information being shared with them. Having parts of a bowel removed can be experienced as relief, especially when the disease has previously contributed to poor self-image and social isolation.