A challenging journey: The experience of elderly patients and their close family members after major emergency abdominal surgery

Abstract

Rationale Knowledge of how elderly patients undergoing major emergency abdominal surgery and their close family members experience the course of illness is limited. Little is known about how such surgery and hospitalisation affect elderly patients' daily life after discharge. It is well known that such patients have an increased risk of mortality and that their physical functional level often decreases during hospitalisation, which can make them dependent on family or homecare services. Critical illness and caregiving for a close relative can be a stressful experience for families, which are at risk of developing stress‐related symptoms. Aim To explore how elderly patients and their families experience the course of illness during hospitalisation and the first month at home after discharge. Method A phenomenological study was conducted to gain in‐depth descriptions through 15 family interviews with 15 patients who had undergone major emergency abdominal surgery and 20 of their close adult family members. Data were analysed using a phenomenological approach inspired by Giorgi. Findings The essence of the phenomenon is captured in three themes: (1) Being emotionally overwhelmed, (2) Wanting to be cared for and (3) Finding a way back to life. Conclusion Patients and their close family members experienced the course of illness as a challenging journey where they longed for life to become as it was before illness. They experienced illness as a sudden life‐threatening incidence. In this situation, it was crucial to be met with empathy from healthcare professionals. The patients’ experience of fatigue and powerlessness remained intense one month after discharge and affected their and their close family members’ lives.

Being well? A meta-ethnography of older patients and their relatives’ descriptions of suffering and well-being in the transition from hospital to home

“…The relatives also echoed the experiences of the older patients and described those feelings of being seen as an object aligning with being excluded; for example, when they struggled with asking relevant questions due to their fears of being unable to fully comprehend the given information [ 28 ]. Furthermore, information was perceived to be hardly understandable and, when coupled with an abrupt discharge, was experienced as a loss of control and stressful by relatives [ 25 , 31 ]. Additionally, the experience of being excluded was described as a feeling of being co-responsible for care but without being involved in the process by the health care professionals [ 24 , 25 , 28 , 31 ].…”

“…Furthermore, information was perceived to be hardly understandable and, when coupled with an abrupt discharge, was experienced as a loss of control and stressful by relatives [ 25 , 31 ]. Additionally, the experience of being excluded was described as a feeling of being co-responsible for care but without being involved in the process by the health care professionals [ 24 , 25 , 28 , 31 ].…”

“…Not only was this experience important for them to feel prepared for every phase of the transition process, but also for the recovery at home to occur [ 23 , 29 , 30 ]. Hence, a clear, individualized, proactive, and timely discussion during the discharge process, as well as information about how to deal with the home recovery, were pointed out as important factors for older patients and the relatives [ 24 , 31 ]. These particular factors strongly contributed to their experience of well-being.…”

“…Because of his strength of will! And this is an important benefit for me.” Patients and relatives Jensen et al (2017) [ 30 ] “If only I had known”: a qualitative study investigating a treatment of patients with a hip fracture with short time stay in hospital The study aimed to describe the experiences of hip fracture patients with regard to self-care after short time stay in hospital Informants : amongst others ten patients (67–92 years) (2 m / 8 f) and four relatives (2 m / 2 f) Country : Denmark Interviews Observations Descriptive phenomenological approach, Reflective Lifeworld Research (Dahlberg 2010, Dahlberg et al 2008, Kvale 1996) Field observations within wards (Spradley, 1980) Two categories/six themes: Patient perspectives of the pathway: - Preconceived notions - Importance of autonomy - Master in my own house - Will and zest for life Self-care and empowerment: - Preparing for discharge - Cross sectional collaboration “The first week after I came home I actually got better every day.” Petersen et al (2021) [ 31 ] A challenging journey, the experience of elderly patients and their close family members after major emergency abdominal surge ry The study investigated the experience of patients and their caregivers with regard to major emergency abdominal surgery during hospitalisation and in the first month after discharge Informants : Fifteen patients (70–90 years) (6 m / 9 f) and twenty of their family members (8 m / 12 f) Country : Denmark Semi-structured interviews Phenomenological approach (Giorgi 2009) Three themes: - Being emotionally overwhelmed - Wanting to be cared for - Finding a way back to life “I’m sick of being stuck in my apartment on the second floor – walking from the bedroom to the kitchen. That’s how my days go by.…”

Nursing intervention to meet the family members’ needs during the surgery waiting time

“…Surgeries are stressing moments for patients and families due to the death risk implied, as well as to the sequelae after recovery ( 1 ) ; therefore, it is necessary to meet the families’ needs arising in this process.…”