title: Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies.
abstract: OBJECTIVE
  To aggregate, interpret and synthesise findings from qualitative studies to further our knowledge regarding patients' pre- and postoperative experiences when participating in an enhanced recovery after surgery.
  
  
  BACKGROUND
  Numerous quantitative studies have documented benefits of participation in enhanced recovery after surgery programmes. Randomised control trials show that enhanced recovery after surgery reduce patient morbidity and shorten hospital length of stay. However, we presently have only sparse knowledge regarding patients' experiences of participating in these programmes.
  
  
  METHODS
  A qualitative systematic review and meta-synthesis.
  
  
  METHODS
  A systematic literature search of databases (Cinahl, Medline, PsycINFO, Ovid Nursing, and EMBASE) for qualitative studies published between 2000-2014 were undertaken. The identified studies were critically evaluated using the Critical Appraisal Skills Program, and patient experiences were synthesised into new themes by a team of researchers, using qualitative content analysis.
  
  
  RESULTS
  Eleven studies were included. Upon analysis, four main themes emerged: information transfer, individualised treatment vs. standardised care, balancing burdensome symptoms and expectations for rapid recovery, and sense of security at discharge. Information helped patients feel secure and prepared for surgery. Patients reported being motivated to participate in their recovery process. However, this became challenging when they faced symptoms such as pain, nausea, and weakness. Professional support fostered a feeling of security that was important in helping patients continue their regimen, recover, and be discharged as early as planned.
  
  
  CONCLUSIONS
  Patients in enhanced recovery after surgery programmes desired more consistency between pre- and postoperative information. Important opportunities exist to improve symptom management and help patients feel more secure about recovery postoperatively.
  
  
  CONCLUSIONS
  Nurses are in a unique position to improve communication of standardised regimens and enhance symptom management across the perioperative period. Clinical outreach, such as follow-up visits or phone calls, could target older adults who need additional assistance to meet enhanced recovery after surgery programme goals and derive benefit.
authors.affiliation: Diakonhjemmet University College, Institute of Nursing and Health, Oslo, Norway.
authors.forename: Tonje
authors.initials: T
authors.lastname: Sibbern
authors.affiliation: Lovisenberg Diaconal University College, Oslo, Norway.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Bull Sellevold
authors.affiliation: Diakonhjemmet University College, Institute of Nursing and Health, Oslo, Norway.|Lovisenberg Diaconal University College, Oslo, Norway.
authors.forename: Simen A
authors.initials: SA
authors.lastname: Steindal
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Dale
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Watt-Watson
authors.affiliation: Diakonhjemmet University College, Institute of Nursing and Health, Oslo, Norway.|Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
authors.forename: Alfhild
authors.initials: A
authors.lastname: Dihle
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D006801:Humans; D059408:Pain Management / Q000451:nursing / Q000523:psychology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000451:nursing / Q000517:prevention & control*; D017060:Patient Satisfaction; D011184:Postoperative Period; D036301:Qualitative Research
keywords: enhanced recovery after surgery; information; meta-synthesis; pain; patients’ experiences; qualitative systematic review; symptom management