title: Patient experience in fast-track hip and knee arthroplasty--a qualitative study.
abstract: OBJECTIVE
  To explore the lived experience of patients in fast-track primary unilateral total hip and knee arthroplasty from the first visit at the outpatient clinic until discharge.
  
  
  BACKGROUND
  Fast-track has resulted in increased effectiveness, including faster recovery and shorter length of stay to about two days after hip and knee arthroplasty. However, the patient perspective in fast-track with a median length of stay of less than three days has been less investigated.
  
  
  METHODS
  A qualitative design.
  
  
  METHODS
  A phenomenological-hermeneutic approach was used, inspired by Paul Ricoeur's theory of narrative and interpretation. Eight patients were included. Semi-structured interviews and participant observation were performed.
  
  
  RESULTS
  Three themes emerged: dealing with pain; feelings of confidence or uncertainty - the meaning of information; and readiness for discharge. Generally, the patients were resistant to taking analgesics and found it difficult to find out when to take supplementary analgesics; therefore, nursing staff needed enough expertise to take responsibility. Factors that increased patients' confidence: information about fast-track, meeting staff before admission and involving relatives. In contrast, incorrect or conflicting information and a lack of respect for privacy led to uncertainty. In preparing for early discharge, sufficient pain management, feeling well-rested and optimal use of time during hospitalisation were important.
  
  
  CONCLUSIONS
  The study shows the importance of dealing with pain and getting the right information and support to have confidence in the fast-track programme, to be ready for discharge and to manage postoperatively at home.
  
  
  CONCLUSIONS
  In fast-track focusing on early discharge, there is an increased need for evidence-based nursing practice, including a qualified judgement of what is best for the patient in certain situations. The knowledge should be gleaned from: research; the patients' expertise, understanding and situation; and nurses' knowledge, skills and experience.
authors.affiliation: Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.|Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark.|The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Specht
authors.affiliation: Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark.|The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.|Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Kjaersgaard-Andersen
authors.affiliation: Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
authors.forename: Birthe D
authors.initials: BD
authors.lastname: Pedersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D019644:Arthroplasty, Replacement, Hip / Q000451:nursing / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000451:nursing / Q000523:psychology*; D003718:Denmark; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010351:Patient Discharge; D017060:Patient Satisfaction
keywords: hip/knee replacement; nurse's responsibilities; patients’ experience; phenomenological hermeneutics; qualitative study