Dr Clare-Louise Sandell Isle of Wight A Phenomenological Investigation Into The Lived Experience Of Surgical Site Infection Following Total Hip Or Total Knee Replacement Surgery Dr Clare-Louise Sandell Isle of Wight

Phenomenological Investigation Into The Lived Experience Introduction: This study was part of a mixed methods study exploring the incidence and experience of surgical site infection Aim: To gain an understanding of the lived experience of surgical site infection Methodology: Qualitative methodology which involves an interpretive naturalist approach to its subject matter, using a Husserlian descriptive phenomenological approach Interpretative epistemological framework to support data collection

Study Recruitment 23 self-reported SSI 15 identified as willing to be contacted 15 patients sent introductory letter and patient information leaflet Nine agreed to participate Six made no further contact

Data Collection & Analysis Unstructured interviews Development of an interview schedule Consent Audio-taping Verbatim transcription Data analysis using Colaizzi’s Method (Colaizzi, 1979)

Findings Nine interviews 88 significant statements Colaizzi’s stage 1 88 significant statements Colaizzi’s stage 2 67 formulated meanings Colaizzi’s stage 3 Five themes Colaizzi’s stage 4

Themes Vulnerability (seven sub themes) Pendulum of care Lived experience of surgical site infection Vulnerability (seven sub themes) Perception of infection (three sub themes) Yo yoing Significant event Pendulum of care (two sub themes) Seem to have got the themes diagram twice. Should be numbers under 10 in letters.

Theme: Vulnerability Vulnerability (seven sub themes) Pendulum of care Lived experience of surgical site infection Vulnerability (seven sub themes) Perception of infection (three sub themes) Yo yoing Significant event Pendulum of care (two sub themes)

Vulnerability Loss of control- Despair/dread- “trapped” in hospital loss of control of body Physical Psychologically Pain Fear – Fear for the future Despair/dread- Hopelessness about the situation

Vulnerability Benchmarking – Fretting- Isolation- Burden- Used others to compare their progress against Negative experience Fretting- Represented by terms such as : anxiety, worry, nervous Worried about what was happening to them Isolation- Functional Geographical Burden- Represented in terms of how they were at that time Also a representation of how they viewed their potential future

Theme: Perception of infection Lived experience of surgical site infection Vulnerability (seven sub themes) Perception of infection (three sub themes) Yo yoing Significant event Pendulum of care (two sub themes)

Perception of infection Previous Knowledge/experience: Repetition of previous experiences Pattern recognition Symptoms/treatment of infection: Sub theme bipolar in nature: Expectations vs. reality Reality vs. expectations Interaction with healthcare professionals: Labelling by healthcare professionals Used this pattern recognition as a way of ascribing meaning to what was happening to them

Theme: Significant event Lived experience of surgical site infection Vulnerability (seven sub themes) Perception of infection (three sub themes) Yo yoing Significant event Pendulum of care (two sub themes)

Significant Event Legitimate worry: Way of rationalising why they had developed an infection “…only two operations I have had an infection and the only two operations where I have had a catheter fitted.” “ I said to them’ how many bits of stuff have I got hanging out of me now then?’ and um the guy said to me ‘only your catheter’. So I said ‘what happened to the drain then?’ and he said ‘it fell out when they transferred you from the operating table to the trolley’”

Theme: Yo yoing Yo yoing Vulnerability (seven sub themes) Lived experience of surgical site infection Vulnerability (seven sub themes) Perception of infection (three sub themes) Yo yoing Significant event Pendulum of care (two sub themes)

Yo Yoing The movement between healthcare professionals- lack of continuity “.....umm he then said ‘I am not convinced that you had an infection’ so err how you are going to tell me? I said ‘people are telling me I’ve had an infection. You’re saying you’re not convinced. What? Somebody there must be a way of knowing whether or not I’ve got an infection surely?” “....went to see my doctor again because I was getting rather concerned with it. She again rung the hospital (again having previously been told to start antibiotics by the hospital) somebody in the hospital said ‘oh no you shouldn't have treated Mr …., you should have sent him straight up here” Representation of the patient journey Lack of continuity of healthcare professionals and advice received

Theme: Pendulum of care Lived experience of surgical site infection Vulnerability (seven sub themes) Perception of infection (three sub themes) Yo yoing Significant event Pendulum of care (two sub themes)

Pendulum of Care: Caring environment- Not presented as a cause for potential infection Care givers-the experience of care- Initially presented as a positive experience This then ‘swung’ to a negative experience

Interconnectivity Of Themes

Summary Identity - Perception of infection Cause – Significant event Donaldson et al (2007) suggest that patients develop a personal representation of their ‘illness’ Identity - Perception of infection Cause – Significant event Timeline – Vulnerability Consequences –Vulnerability Control care -Vulnerability Two remaining themes are influencing factors (yo- yoing) and the result of how that ‘illness’ is managed (pendulum of care)

Conclusion First phenomenological exploration of “the lived experience of surgical site infection” in THR and TKR Specifically THR and TKR … not general surgery Not just MRSA (not just isolation / psychology) Explored “experience” …..not functional outcome

Conclusion The way the patient was managed and their interaction with healthcare professionals impacted negatively on their lived experience Personal preconceptions: The depth of emotions presented by patients and the extent of their vulnerability not fully appreciated considering this was early in their recovery

Thank you Any Questions?