In this article one of the authors presents her experience of using vignettes in an action research case study, with particular emphasis on their trustworthiness. The research was carried out with a group of health care professionals who were working together to improve preoperative education for patients awaiting a hip replacement in one National Health Service Trust in the United Kingdom. The authors describe the exploration of three types of vignette--napshots, portraits, and composites--as a means of collecting, analyzing, and representing data. They provide an example of each and briefly present their evaluative use by the health care professionals. The vignettes were constructed to provide one account of the truth that was representative of events. Within this representation was the writer, researcher, and reader feature. The vignettes stimulated reflection and analysis within the action research cycle and thus contributed to the improvement of practice.

This study examined some effects of providing preoperative education to patients prior to their hospital admission for a total hip replacement. The preoperative education programmes are organised and presented by an occupational therapist with the assistance of a physiotherapist, an anaesthetist, an orthopaedic nurse and a dietician. The content includes information on preparation for surgery, what to expect of admission, surgery and rehabilitation, and how to prepare for discharge. A quasi-experimental design was used to compare a group of patients who had attended an education programme with, as control, a group of patients who had not. The variables Investigated were length of hospitalisation, morphine usage, mobility independence and discharge preparation. The results showed that the patients in the experimental group had a mean of 4 days' less hospitalisation than the control group, required less postoperative morphine and achieved mobility independence sooner. The control patients' lack of knowledge of what to expect from their surgery was evident from the lack of preparation for their discharge home. Large financial savings were then calculated as a direct consequence.

ObjectivesTo understand the role of preoperative education for patients undergoing colorectal surgery by involving patients, carers and staff in: (1) identifying its perceived value and deficits for enhanced recovery; (2) modifying current education practices to address educational deficits; and (3) evaluating these changes for preparing patients to enhance their recovery.DesignQualitative study of three cycles of action research using mixed methods within a 24-month naturalistic enquiry to identify, implement and evaluate changes through observations, questionnaires, semistructured longitudinal interviews, focus groups and documentation review.SettingA UK 1200-bed National Health Service (NHS) hospital providing colorectal surgery in a small city in a rural county.ParticipantsNinety-sevenpatients having colorectal surgery, 19 carers and 22 clinical staff.ResultsThemes identified were: (1) knowledge and engagement; (2) situated understanding and confidence building; and (3) partnership and proactive involvement in enhancing recovery. All patients articulated needs to prepare mentally and physically to plan for colorectal surgery and rehabilitation. Patients and carers wanted to counter uncertainty about medical procedures: likely bodily changes, recovery timescales and future. They therefore sought as much personalised, relevant information as possible about their disease, planned surgery and recovery. Staff implemented preoperative education to more specifically inform and respond multimodally to individual needs.ConclusionsPatients wanted to be proactively involved in managing their recovery to re-engage with their everyday lives. Preoperative education supported this through developing patients’ situated understanding of hospital and bodily processes related to colorectal surgery. Situated understanding was achieved through educational product to give knowledge and processes promoting engagement. Multimodal, comprehensive and timely preoperative education on the whole patient pathway facilitates active engagement. Situated understanding increased patients’ confidence to work in partnership with healthcare professionals and proactively self-manage recovery.

The Department of Health's introduction of intermediate care recognised the need for rehabilitation following acute hospital care. The importance of rehabilitation was also stressed by a review carried out across England and Wales by District Audit. This article reports a phenomenological study carried out to explore service users' experiences of a 22‐bedded intermediate care service. Face‐to‐face, semi‐structured interviews were conducted with eight service users who were older people, with a further follow‐up interview two weeks later. Data was analysed using an open‐coding and theming approach. One of the six emergent themes is discussed in this article: service users' rehabilitation experiences. Data was themed into a rehabilitation framework of users' understanding, assessment and goal setting, interventions and transfer home. Intermediate care was found to provide support for service users between discharge from acute hospital and return to their own homes, but service users lacked understanding and awareness of the potential of the intermediate care service. They did not feel involved in their assessment and goal setting and so were unable to make individual contributions regarding their own rehabilitation needs. Interventions were subsequently not linked to their needs and transfer home experiences were variable. Users' experiences did not reflect the Department of Health's four principles that underpin the delivery of intermediate care: person‐centred care; whole system working; timely access to specialist care; promoting health and an active life. Recommendations are made to address these and to incorporate the recommendations from District Audit.

Preadmission clinics are seen by healthcare professionals as an important part of patients' preoperative experience. Economic benefits, through reducing length of stay postoperatively, have been realized. Relatively little research exists which informs healthcare professionals of the patients view of such clinics. Such feedback from the patients has the potential to provide important evaluative data which can be used to inform future preadmission clinics. This paper presents the findings from a small qualitative study conducted in a total hip replacement preadmission clinic in an independent hospital. Phenomenological interviews were undertaken with ten patients who attended a preadmission clinic. The findings were used by the multidisciplinary team comprising of senior clinicians within the preadmission clinic, and a number of recommendations were made and implemented to improve the clinic. Further analysis of the data also led to the team appreciating the value of the clinic for boosting patients' confidence so that they could make informed choices about their care.