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Spouse-related factors associated with Quality of Recovery of patients after hip or knee replacement: a Nordic perspective
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland.
School of Health Sciences, University of Akureyri, Iceland .
University of Turku, Department of nursing Science, Turku, Finland and Dean Lahti University of Applied Sciences, Lahti Finland.
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2016 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292Article in journal (Refereed) In press
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 [en]
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: urn:nbn:se:liu:diva-125236DOI: 10.1016/j.ijotn.2016.03.001OAI: oai:DiVA.org:liu-125236DiVA: diva2:903821
Note

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

Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2016-06-15Bibliographically approved
In thesis
1. Empowering knowledge and Quality of Recovery after hip or knee replacement
Open this publication in new window or tab >>Empowering knowledge and Quality of Recovery after hip or knee replacement
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:nbn:se:liu:diva-125237 (URN)10.3384/diss.diva-125237 (DOI)978-91-7685-876-9 (Print) (ISBN)
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

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