Spinal fusion surgery: From relief to insecurity.
BACKGROUND
During their decision-making process patients perceive surgery as a voluntary yet necessary choice. Surgery initiates hope for a life with less pain but also creates a feeling of existential insecurity in terms of fear, isolation and uncertainty.


OBJECTIVE
The aim of this study was to explore how patients experience their situation from the point of making the decision to undergo spinal fusion surgery to living their everyday life after surgery.


METHODS
A phenomenological-hermeneutic study design was applied based on the French philosopher Paul Ricoeur's theory of interpretation. Data were collected through observations and semi-structured interviews.


RESULTS
The recommendation and decision to undergo spinal fusion surgery felt like a turning point for the patients and brought hope of regaining their normal lives, of being a more resourceful parent, partner, friend and colleague with no or less pain. Thus, deciding to undergo surgery created a brief feeling of relief. However, life with back pain had changed the patients' understanding of themselves. Consequently, some patients postoperatively experienced insecurity and a weakened self-image with difficulties creating meaning in their lives.


CONCLUSIONS
Being recommended and undergoing spinal fusion surgery initiates hope for a life with less pain and altered life conditions. At the same time, paradoxically, this creates a feeling of existential insecurity in terms of facing the surgery and the future to come. It is, therefore, important to recognise and include the patients' everyday life experiences concerning how they give (or may not give) meaning to their illness, i.e. their understanding of how it is affecting them. These aspects are essential for the patients' definition and re-definition of themselves and thus crucial to draw upon in the relationship and communication between patient and healthcare professional.
Section for Nursing Science, Department of Public Health, Aarhus University, Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Denmark. Electronic address: jannedamsgaard@webspeed.dk.
Janne B
JB
Damsgaard
Aarhus University, Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Denmark.
Lene B
LB
Jørgensen
Section for Nursing Science, Department of Public Health, Aarhus University/VIA University College, Aarhus, Denmark.
Annelise
A
Norlyk
University of Southern Denmark and Vejle Hospital, Denmark.
Regner
R
Birkelund
D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001416:Back Pain / Q000523:psychology / Q000601:surgery*; D003657:Decision Making; D005260:Female; D065026:Hope; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D013123:Spinal Fusion / Q000523:psychology*
Change; Communication; Decision; Disconnectedness; Identity; Insecurity; Meaning; Pain; Powerlessness; Relief; Spinal fusion surgery