Surgical perioperative pathways-Patient experiences of unmet needs show that a person-centred approach is needed.

AIM: To explore patients' and healthcare professionals' experiences of patients' surgical pathways in a perioperative setting. BACKGROUND: Elective surgical pathways have improved over the past decades due to fast-track programmes, but patients desire more personalised and coordinated care and treatment. There is little knowledge of how healthcare professionals' collaboration and communication affect patients' pathways. DESIGN: The overall framework was complex intervention method. A phenomenological-hermeneutic approach was used for data analyses. COREQ checklist was used as a guideline to secure accurate and complete reporting of the study. METHODS: Field observations (120 hr) and semi-structured interviews (24 patients) were undertaken during 2016-2017. Healthcare professionals involved in the pathways were interviewed: (a) 13 single interviews and (b) 13 focus group interviews (37 healthcare professionals) were conducted. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS: Patients asked for individualised information adapted to their life and illness experiences. Furthermore, healthcare professionals need access to a quick overview of individual patients and their perioperative pathway in the electronic patient journal (EPJ). Agreements made with patients did not always reach the right receiver, there was poor interpersonal communication and the complex teamwork between many healthcare professionals made pathways incoherent and uncoordinated. Healthcare professionals who had the time to talk about other subjects than the disease with smiles and good humour gave patients a feeling of security. CONCLUSION: Patients wanted to be treated as individuals, but often they received standard treatment. Healthcare professionals had the intention of treating patients individually, but the EPJ and information provided to patients were not easy to access. RELEVANCE TO CLINICAL PRACTICE: Visible information about the patient's whole pathway could improve healthcare professionals' care and treatment. In addition, systematic feedback from patients' could make it possible to adjust information, care and treatment to achieve a more coherent pathway. Particular attention needs to be paid to how electronic healthcare systems can underpin relational coordination in pathways.

Patient participation in postoperative pain assessment after spine surgery in a recovery unit.

AIMS AND OBJECTIVES: To explore how patients undergoing spine surgery participated in postoperative pain assessment in a recovery unit. BACKGROUND: Despite advances in medicine, pharmaceutical and technical knowledge, patients report considerable postoperative pain after spine surgery. Research shows that patients require efficient individual pain treatment and that their participation has a positive effect on pain treatment. DESIGN: This study was based on a phenomenological hermeneutic design. METHODS: Fifteen qualitative interviews were conducted in 2014. Meaning condensation was used to analyse data. RESULTS: Three themes emerged: (1) communication and knowledge; anaesthesia, analgesics and severe pain affected patients' ability to assess and communicate their pain. (2) Pain assessment using a numerical rating scale; this theme was characterised by individual differences in rating perception. Also, new postoperative pain sensations were described as different kinds of pain and variation in the pain intensity during activity. (3) Patient-nurse relationship; this theme was characterised by reports of frequent and direct contact on the part of the nurses about pain assessment. Patients' lack of knowledge about pain treatment resulted in inactivity and uncertainty of when to ask for analgesics. CONCLUSION: This study indicates that nurses and patients would benefit from building a mutual understanding of pain perceptions and numerical rating scale as this would pave the way for a more accurate pain assessment. Patients' ability to participate in pain assessment was affected by anaesthesia, analgesics and severe pain. Patients needed knowledge about complications and needed to understand when they should ask for analgesics. RELEVANCE TO CLINICAL PRACTICE: Results indicate that patient perceptions of numerical rating scale and variation in patients' ability to communicate in the initial postoperative period should be given more attention to underpin patients' pain assessment. This may be a key factor in ensuring patient participation in pain assessment and thereby improving postoperative pain management.