What's going on after hospital? – Exploring the transition from hospital to home and patient experiences of nurse‐led follow‐up phone calls

Abstract

Aims and Objectives To explore the transition from hospital to home and patient experiences of nurse‐led post‐operative follow‐up phone calls after thoracic surgery. Background Enhanced Recovery After Surgery protocol places new demands on patients after hospital. Need for a proactive approach to improve the post‐operative follow‐up process in the home is required. Design Qualitative intervention study. Methods Interviews were conducted with patients who had received a post‐operative phone call after hospital discharge (n = 15). The analysis was inspired by Gadamer and Meleis. COREQ guidelines were followed. Results Two overall themes emerged: (1) The follow‐up phone call, which concerns experiences involving the actual call and (2) Transitioning from hospital to home, which through four subthemes illuminates; how patients describe their initial time at home, that patients experience a changed body after surgery, that patients feel alone after returning home and that a call from a nurse can help patients not to feel left out and finally why it is absolutely essential that nurses initiate the phone call. Conclusion Patients are at different stages in their transition process after hospital, making timing of follow‐up tricky. Being part of an Enhanced Recovery After Surgery programme has implications for the initial period after discharge; dominated by fatigue, pain and experiences of a changed body. Patients experience being left alone with their illness, and the phone call helps to relieve this isolation. It is essential that the nurse call the patient since the patients want to avoid disturbing the staff. Relevance to clinical practice Healthcare workers can use the findings to understand how patients experience the transition from hospital to home when enrolled in an Enhanced Recovery After Surgery programme. Need for support from a nurse following discharge is suggested.

Issues in patients’ experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence

“… 51 52 55 56 58 59 They complained that it was difficult to obtain healthcare professionals’ treatments after discharge, and therefore, they felt vulnerable: ‘There was no rehab in the hospital this time, you were just shunted out the door after four days, and so obviously that was cost-cutting.’ 56 This disconnection was regarded by patients as the main barrier to self-care at home: ‘Because I feel that after having such major surgery you need all the care and attention you can get from well trained staff that are there as a back up when you need them.’ 31 Although nearly all patients experienced nutritional problems (such as weight loss), only a few were able to receive guidance at home from clinical dietitians. 31 48 51 52 Furthermore, patients said they would be grateful if healthcare professionals would call at different stages of their recovery at home: ‘…It would have been good to get another one [phone call] at a later stage when I was feeling more on top of things…’ 47 …”

Postoperative Recovery: Experiences of Patients Who Have Undergone Orthopedic Day Surgery

“…Receiving such a call would have reduced their fear of being thought bothersome. Donsel et al 23 highlighted the importance of having a nurse call the patient during postoperative follow-up instead of the patients having to initiate the call. When the patients were contacted, they were able to avoid feeling like they were disturbing the healthcare team, which was seen to be the case if the patient needed to initiate the contact.…”

“…Together with some other reasons, feeling lonely may occur due to isolation during periods of disability. 27 Donsel et al 23 suggested that a phone call from a nurse sometime after discharge could reduce those feelings. The participants emphasized that next of kin could play an important role in the recovery process.…”

“…But at the same time, the participants expressed experiencing loneliness during the recovery process as it is something one must get through alone. Donsel et al 23 argued that family members may have a problem understanding the feelings experienced by a patient who has undergone surgery and is going through the recovery process.…”

Framework, component, and implementation of enhanced recovery pathways

“…Post-discharge surveillance is an important part of the pathway, as patients may have additional care needs once home [ 108 ]. A survey indicated that the post-discharge telephone checkup was valued most highly out of all ERAS components postoperatively [ 109 ], follow-up calls aided in answering unexpected questions patients had post discharge (despite prior attempts to optimize knowledge) [ 110 ] and relieving the isolation faced by patients ‘left alone with their illness’ [ 111 ]. Active post-discharge surveillance programs are cost-effective, as postoperative issues may be resolved in the outpatient setting thereby reducing readmission or emergency department presentation [ 112 ].…”