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  • 1.
    Allvin, R.
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden, Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Berg, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Idvall, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Nilsson, U.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden, Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden, Department of Health Sciences, Örebro University, Örebro, Sweden.
    Postoperative recovery: A concept analysis2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, p. 552-558Article in journal (Refereed)
    Abstract [en]

    Aim. This paper presents a concept analysis of the phenomenon of postoperative recovery. Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. Method. Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.

  • 2.
    Berg, Katarina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Patients’ perspectives on recovery from day surgery2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A large number of elective surgical patients in Sweden and elsewhere have their surgical procedure performed in a day surgery context. The surgical care event, with its postoperative surveillance, is brief at the surgery unit and patients are discharged home with the intention that they should manage postoperative recovery mainly themselves. However, several patients attest to being in an exposed situation when assuming responsibility for recovery at home. The overall aim of this thesis was to attain comprehensive knowledge of postoperative recovery following day surgery from a patient perspective.

    A questionnaire, the Post-discharge Surgical Recovery scale, was translated into Swedish and evaluated regarding its psychometric properties in a Swedish context. A sample of 607 day surgery patients who had undergone orthopaedic, general or gynaecological surgery self-rated their recovery at postoperative Days 1, 7 and 14 using the Post-discharge Surgical Recovery scale and the Quality of Recovery-23. Health-related quality of life was assessed before and 30 days after the surgical procedure, using the EQ-5D. In a second sample, 31 patients were interviewed in their homes regarding their recovery after day surgery. The interviews were conducted on postoperative Days 11-37, and focused on the meaning of recovery, self-care and perceptions of recovery. Data were explored by means of a phenomenographic analysis.

    The Post-discharge Surgical Recovery scale showed satisfactory psychometric properties when used among Swedish day surgery patients. Following discharge, recovery included both physical and emotional perspectives. Recovery varied, and influencing factors were found to be type of surgery, age, perceived health and emotional status on the first postoperative day. Orthopaedic patients had a more protracted recovery process compared to general surgery and gynaecological patients, along with more postoperative pain and lower health-related quality of life. Patients perceived that postoperative recovery comprised different internal and external factors and a large amount of responsibility regarding their recovery and surgical outcome. To be prepared for recovery at home, patients wanted knowledge and understanding about the normal range of recovery following their specific surgical procedure, and needed support from different sources in their surroundings.

    This thesis provides insight into day surgery patients’ postoperative situation. Based on the studies, individualized and well thought-out support appears favourable in order to have confident and well prepared patients at home. In contrast to smooth and easy patient care at the surgery unit, the postoperative phase seems to be a weak link in the day surgical continuity of patient care. Postoperative care needs to be further improved to increase quality and patients’ overall satisfaction with the day surgical experience. Attention should be paid to patients’ physical and emotional resources and needs.

    List of papers
    1. Psychometric evaluation of the post-discharge surgical recovery scale
    Open this publication in new window or tab >>Psychometric evaluation of the post-discharge surgical recovery scale
    Show others...
    2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed) Published
    Abstract [en]

    Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    day surgery; postoperative period; psychometrics; questionnaire; recovery; validation study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-58188 (URN)10.1111/j.1365-2753.2009.01197.x (DOI)000279901700019 ()
    Note

    This is the authors’ version of the following article: Katarina Berg, Ewa Idvall, Ulrica Nilsson, Kristofer Franzén Årestedt and Mitra Unosson, Psychometric evaluation of the post-discharge surgical recovery scale, 2010, Journal of Evaluation In Clinical Practice, (16), 4, 794-801. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01197.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html

    Available from: 2010-08-11 Created: 2010-08-09 Last updated: 2017-12-12Bibliographically approved
    2. Postoperative recovery after different orthopedic day surgical procedures
    Open this publication in new window or tab >>Postoperative recovery after different orthopedic day surgical procedures
    2011 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 15, no 4, p. 165-175Article in journal (Refereed) Published
    Abstract [en]

    Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2 weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2 weeks after surgery compared to the other patient groups (p < 0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

    Place, publisher, year, edition, pages
    Amsterdam: Elsevier, 2011
    Keywords
    Day surgery; Postoperative recovery; Orthopedic nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-71363 (URN)10.1016/j.ijotn.2011.02.003 (DOI)
    Available from: 2011-10-13 Created: 2011-10-13 Last updated: 2017-12-08
    3. Postoperative recovery and its association with health-related quality of life among day surgery patients
    Open this publication in new window or tab >>Postoperative recovery and its association with health-related quality of life among day surgery patients
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge. A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.

    Results: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    Conclusion: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

    Keywords
    Ambulatory surgical procedures, nursing, quality of life, recovery of function
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-85025 (URN)
    Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2016-09-26Bibliographically approved
    4. Postoperative recovery from the perspective of day surgery patients: A phenomenographic study
    Open this publication in new window or tab >>Postoperative recovery from the perspective of day surgery patients: A phenomenographic study
    2013 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1630-1638Article in journal (Refereed) Published
    Abstract [en]

    Background: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patient’s own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.

    Objectives: To explore day surgery patients’ perceptions of postoperative recovery.

    Design: A qualitative design with a phenomenographic approach was used.

    Methods and settings: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face-to-face at the patients’ homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.

    Results: The patients perceived postoperative recovery as comprising internal and external prerequisites and implied changes in ordinary life with varying levels of support. The organization at the day surgery unit, with its advantages and disadvantages, was perceived as having an impact on the subsequent recovery trajectory. The results are demonstrated in three descriptive categories: ‘Conditions for recovery at home’, The rollback to ordinary life’ and ‘Being a cog in a flow of care’.

    Conclusions: Postoperative recovery following day surgery implies, from the patients’ perspective, a migration from being a recipient of care at the day surgery unit to playing an active role, with extensive responsibility at home. To manage self-care confidently, postdischarge patients require knowledge and understanding of what constitutes the normal range in recovery following their specific surgical procedure.

    Place, publisher, year, edition, pages
    Elsevier, 2013
    Keywords
    Ambulatory surgical procedures, nursing, qualitative research, recovery of function, self care
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-85026 (URN)10.1016/j.ijnurstu.2013.05.002 (DOI)000327225300007 ()
    Note

    Funding agencies|ALF||County Council of Ostergotland, Sweden||Linkoping University||

    Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2017-12-07Bibliographically approved
  • 3.
    Berg, Katarina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery in daysurgery: Evaluation of psychometric properties and clinical usefulness of a questionnaire in day surgery2010Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.

    Aims: The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.

    Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.

    Results: In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.

    Conclusions: The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.

    List of papers
    1. Psychometric evaluation of the post-discharge surgical recovery scale
    Open this publication in new window or tab >>Psychometric evaluation of the post-discharge surgical recovery scale
    Show others...
    2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed) Published
    Abstract [en]

    Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    day surgery; postoperative period; psychometrics; questionnaire; recovery; validation study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-58188 (URN)10.1111/j.1365-2753.2009.01197.x (DOI)000279901700019 ()
    Note

    This is the authors’ version of the following article: Katarina Berg, Ewa Idvall, Ulrica Nilsson, Kristofer Franzén Årestedt and Mitra Unosson, Psychometric evaluation of the post-discharge surgical recovery scale, 2010, Journal of Evaluation In Clinical Practice, (16), 4, 794-801. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01197.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html

    Available from: 2010-08-11 Created: 2010-08-09 Last updated: 2017-12-12Bibliographically approved
    2. Postoperativerecovery after different orthopaedic day surgical procedures
    Open this publication in new window or tab >>Postoperativerecovery after different orthopaedic day surgical procedures
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Orthopaedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to two weeks after different orthopaedic day surgical procedures, and tried to identify possible predictors associated with recovery. Three-hundred and fifty-eight patients who had undergone knee arthroscopy or surgery on the hand/arm, foot/leg or shoulder were included. Data were collected preoperatively and on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23, and a general health question. A multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day, and type of surgery. Postoperative recovery after common orthopaedic day surgical procedures differs, and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

    Keywords
    Day surgery, postoperative recovery, orthopaedic nursing
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-59513 (URN)
    Available from: 2010-09-17 Created: 2010-09-17 Last updated: 2010-09-17Bibliographically approved
  • 4.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery from the perspective of day surgery patients: A phenomenographic study2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, p. 1630-1638Article in journal (Refereed)
    Abstract [en]

    Background: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patient’s own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.

    Objectives: To explore day surgery patients’ perceptions of postoperative recovery.

    Design: A qualitative design with a phenomenographic approach was used.

    Methods and settings: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face-to-face at the patients’ homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.

    Results: The patients perceived postoperative recovery as comprising internal and external prerequisites and implied changes in ordinary life with varying levels of support. The organization at the day surgery unit, with its advantages and disadvantages, was perceived as having an impact on the subsequent recovery trajectory. The results are demonstrated in three descriptive categories: ‘Conditions for recovery at home’, The rollback to ordinary life’ and ‘Being a cog in a flow of care’.

    Conclusions: Postoperative recovery following day surgery implies, from the patients’ perspective, a migration from being a recipient of care at the day surgery unit to playing an active role, with extensive responsibility at home. To manage self-care confidently, postdischarge patients require knowledge and understanding of what constitutes the normal range in recovery following their specific surgical procedure.

  • 5.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Ulrica
    Örebro University Hospital.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Psychometric evaluation of the post-discharge surgical recovery scale2010In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, p. 794-801Article in journal (Refereed)
    Abstract [en]

    Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

  • 6.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Faculty of Health and Society, Malmö University.
    Nilsson, Ulrica
    Örebro University Hospital.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Postoperative recovery after different orthopedic day surgical procedures2011In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 15, no 4, p. 165-175Article in journal (Refereed)
    Abstract [en]

    Orthopedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to 2 weeks after different orthopedic day surgical procedures and tried to identify possible predictors associated with recovery. Three-hundred and fifty eight patients who had undergone knee arthroscopy or surgery to the hand/arm, foot/leg or shoulder were included. Data were collected on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23 and a general health question. Multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health 1 and 2 weeks after surgery compared to the other patient groups (p < 0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day and type of surgery. Postoperative recovery after common orthopedic day surgical procedures varies and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

  • 7.
    Berg, Katarina
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Idvall, Ewa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsson, Ulrica
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperativerecovery after different orthopaedic day surgical proceduresManuscript (preprint) (Other academic)
    Abstract [en]

    Orthopaedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to two weeks after different orthopaedic day surgical procedures, and tried to identify possible predictors associated with recovery. Three-hundred and fifty-eight patients who had undergone knee arthroscopy or surgery on the hand/arm, foot/leg or shoulder were included. Data were collected preoperatively and on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23, and a general health question. A multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day, and type of surgery. Postoperative recovery after common orthopaedic day surgical procedures differs, and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

  • 8.
    Berg, Katarina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Idvall, Ewa
    Linköping University, Department of Medicine and Care.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Postoperative recovery for day surgery patients2004In: 12th Biennal Conference of the Workgroup of European Nurse Researchers,2004, 2004, p. 77-77Conference paper (Other academic)
  • 9.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Kaspersen, Rikard
    Sykehuset Osffold HF, Norway .
    Unby, Christina
    Sirius Humanum AB, Sweden .
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    The Interaction Between the Patient and Nurse Anesthetist Immediately Before Elective Coronary Artery Bypass Surgery2013In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 28, no 5, p. 283-290Article in journal (Refereed)
    Abstract [en]

    Purpose: Establishing a purposive interaction with a patient who is in a vulnerable situation before coronary artery bypass graft (CABG) surgery poses a challenge for the nurse anesthetist. The aim of this study was to identify and describe the interaction between the patient and the nurse anesthetist immediately before elective CABG surgery. less thanbrgreater than less thanbrgreater thanDesign: An observational study using a grounded theory design was used. less thanbrgreater than less thanbrgreater thanMethods: A theoretical selection of patients and nurse anesthetists was made. A total of 11 situations of patient/nurse anesthetist interaction were observed. The data were analyzed using the constant comparative method. Findings:A core category of reassurance emerged from other categories of continuity, confirmation, and control. Continuity was characterized by expedient anesthesia nursing of high quality, confirmation was related to communication in a trusting atmosphere, and control was associated with skilled nursing interventions in the thoracic operating theatre. less thanbrgreater than less thanbrgreater thanConclusions: Reassurance can be achieved through a well-structured anesthesia nursing performance in the thoracic operating theatre, and by focusing on the patient and continuously giving him/her information during the preoperative preparation phase.

  • 10.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Postoperative recovery and its association with health-related quality of life among day surgery patientsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge. A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.

    Results: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    Conclusion: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

  • 11.
    Berg, Katarina
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjellgren, Karin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Postoperative recovery and its association with health-related quality of life among day surgery patients2012In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 11, no 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first Postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe Postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between Postoperative recovery and healthrelated quality of life 30 days after discharge.

    METHODS: A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery recovery scale and the quality of recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate Postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between Postoperative recovery and health-related quality of life.

    RESULTS: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower Postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).

    CONCLUSION: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.

  • 12.
    Idvall, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Berg, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Unosson, Mitra
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Brudin, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Differences between nurse and patient assessments on postoperative pain management in two hospitals2005In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 11, no 5, p. 444-451Article in journal (Refereed)
    Abstract [en]

    Rationale: Differences between patient and professional assessments on pain and pain management have been reported, but no further analysis has described the statistical problems of pseudocorrelation concerning the nature of these differences. Aim: The aim of the present study was: (1) to investigate the differences between nurse and patient assessments of post-operative pain management in two hospitals, and (2) to discuss the nature and scope of these differences. Method: The subjects were 209 inpatients and 63 nurses from a central county hospital and 77 inpatients and 34 nurses from a university hospital. The 'Strategic and Clinical Quality Indicators in Postoperative Pain Management' questionnaire was used, comprising 14 items in four sub-scales (communication, action, trust and environment) and two questions concerning the worst pain experienced during the past 24 hours and general satisfaction. Result: Except for the trust sub-scale in one hospital, the correlations between patient and nurse ratings concerning all assessments were significant in both hospitals (r = 0.22 - 0.59). Both groups of patients had significantly higher (better) scores than judged by the nurses on the environment sub-scale and general satisfaction. In contrast, nurses from both hospitals tended to significantly underestimate patients' worst pain during the past 24 hours. Other differences between patient and nurse assessments were either non-significant or inconsistent between hospitals. Using so-called Oldham plots nurses tended to under-estimate severe pain more often than mild pain, as judged by the patients, but this association was weak and statistically significant in one hospital only. Conclusion: Although the effects of pseudocorrelation are minimized by using Oldham plots, they are not cancelled. This issue is discussed, and we conclude that this study does not support the notion that the nurses tend to underestimate severe pain more often than mild pain. © 2005 Blackwell Publishing Ltd.

  • 13.
    Idvall, Ewa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berg, Katarina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Nilsson , U
    Örebro University Hospital.
    Assessment of recovery after day surgery using a modified version of quality of recovery-402009In: ACTA ANAESTHESIOLOGICA SCANDINAVICA, ISSN 0001-5172 , Vol. 53, no 5, p. 673-677Article in journal (Refereed)
  • 14.
    Johansson, Helena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berg, Katarina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Jonasson, Lise-Lotte
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    To live a life with COPD: the consequences of symptom burden2019In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 905-909Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is a prevalent illness that, due to its symptoms and treatment, entails a significant burden for the affected person, and his/her family, health care and private finances. Today, knowledge and understanding are sparse regarding COPD-affected persons’ own lived experiences and about the symptom burden and its effect on their daily life. Due to this knowledge gap the aim of this study was to identify and describe the symptom burden and its effect on daily life in people with COPD, based on their own lived experiences.

    Subject and method: Eleven males and 14 females in GOLD stages III and IV, in an age range of 58–82 years, were interviewed. An interview guide was used to direct the face-to-face interviews. Data was analyzed with thematic analysis following the six steps according to Braun and Clarke.

    Results: The results highlighted one theme: an altered everyday life. The altered everyday life leads to a need for support to handle everyday life and for different strategies to live as desired. Persons with COPD need to take each day as it comes and their life is not easy to plan since it depends on how they feel from day to day. Life is handled with several strategies such as breathing techniques, and ways to take care of the home and garden as well as the emotions. Support from the next of kin, society and the health care service is important.

    Conclusion: This study provides the insight that persons with COPD in stages III and IV have an altered life caused by the symptom burden. They must struggle with strategies to handle everyday life. There is a need of support from the next of kin and society to facilitate daily living, but this support needs to be well-balanced.

  • 15.
    Nilsson, Ulrica
    et al.
    Örebro University Hospital, Sweden.
    Berg, Katarina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Kalmar County Council.
    Idvall, Ewa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Relation between personality and quality of postoperative recovery in day surgery patients2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 8, p. 671-675Article in journal (Refereed)
    Abstract [en]

    Background and objective Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery. Methods Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14. Results We found a positive correlation in changes of physical independence and extroversion (r = 0.20; P = 0.010) and intellect (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between physical interdependence and agreeableness and between physical interdependence and conscientiousness (r = -0.17; P = 0.028-0.030 for both). Conclusion Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.

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