1. Project: The Perioperative Period for acute and planned Orthopaedic Surgery The hip and knee replacement – a thorough life event Birgitta Åkesdotter Gustafsson April 2009 Sweden

2. The study The aim for the study was to illuminate the meaning of contemplations related to hip or a knee replacement surgery. The design for the study was longitudinal with a Phenomenological Hermeneutic approach Data collection; interviews with 12 participants (16) (6 women and 6 men) at five different occasions over a specific period of time. The data analysis was based on 60 interview transcripts

3. The interviews; place, time and key question The interviews took place in the participants home (43) and at a clinic (17) and were carried out no 1 shortly after being admitted on the waiting list no 2 the day before the operation no 3 in 2 weeks after the operation no 4after six months no 5after 12 months The Key question starting up every interview session was please tell me How are you today when being on the waiting list for your operation, - the day before your operation, 2 weeks after your....

4. Background A worn out hip or knee generate disability, pain, worry, confinement Joint replacement surgery is evident treatment for arthritis in a major joint as a hip or knee to reduce disability and pain

5. A place on the waiting list Acquiring a place on the waiting list a hard work for some and a self-evident cause for some Having achieved a place on the waiting list for surgery a great success and joy

6. Choosing the challenge Getting ready for the operation (after entrance to the waiting list) preoperative ambivalence inner negotiations about having surgery or not The operation generates hope the operation “a knight in shining armour” postoperatively, g ratitude was expressed for having survived the operation.

7. Choosing the challenge The operation generates fear th e operation “the face of death” preparing the last will, the funeral putting economy and important papers in order Postoperatively,fear and misgivings about how to manage on the road to recovery

8. Choosing the challenge The operation generates past memories re-tie to the current situation recollections of former days from the childhood, the youth and various parts of life valuation of the good and the bad parts in former life reliving horrifying memories from former treatment of an injury 50–60 years ago in the hip or the knee now again actual for surgery

9. Moving from thankfulness to ordinary every day life Thankfulness for having survived the operation A transition from the good times grow towards ordinary every day life

10. Moving from despair towards reluctant acceptance of unexpected bad conditions for every day life Adjusting to disillusionment trying to accept unexpected bad outcome of surgery trying to accept unexpected bad conditions for future every day life

11. The operation for a hip or knee replacement The operation was an extremely thorough life event involving contemplations about life and death and about hope and fear. It caused reminiscence of former days and led patients to settle important private matters in case the operation meant death. There were serious private negotiations about going for the challenge of having surgery or not. Gratitude was expressed for having survived the operation.

12. The operation for a hip or knee replacement Fears soon appeared about how to endure on the road to recovery. The outcome of surgery generated thankfulness and transition towards everyday life or a transition from despair towards reluctant acceptance of unexpected new bad conditions for future life. A perioperative period starting at the entrance to the waiting list for and ended when no more care was needed related to the actual operation

13. The meaning of contemplations The meaning of contemplations is about the operation being a thorough life event, where earlier and current life is experienced to be at risk, but the hope of a better future makes the challenge worthwhile. The inner negotiations about having surgery or not and existential anxiety reminded people that life cannot be taken for granted.

14. Original sourses for researchproject The research project The Perioperative Period for acute and planned Orthopaedic Surgery encopass four articles from the patients points of views on care and nursing care. The point of departure for the project was the original source for Perioperative Nursing by Tollerud et al Tollerud L, Botsford J, Hoglan MA., Price JL, Sawyer M (1985) A Model for Perioperative Nursing Practice. AORN Journal, 41: 188 -196., AORN Journal 1985 and the Paradigm of Humanistic Nursing, including the nursing dialogue according to Paterson & Zderad, the National League for Nursing, Jones and Bartlett 1976. Paterson & Zderad also used a Lifeworld Perspective originated from Husserl idea of phenomenology (Der Ph ä nomenogie. Kluwer Academic Publishers 1950). The Swedish Nursing Lifeworld perspcetive by Dahlberg K, Drew N (1997) A Lifeworld paradigm for nursing research. Holistic nursing 15, Segesten K, Nystr ö m M, Suserud BO, Fagerberg I (2003) Att f ö rst å v å rdvetenskap (Understand Nursing Scinece) Lund, Studentlitteratur was also used. Please, also see the references in the Congress book for this presentation about The hip and knee replacement – a thorough life event. Bets of luck to all of you Operating room nurses/Theatre nurses to enlarge and develope our scientific and professional knowledge on Operating Room/Theatre Nursing for the best nursing care for our fellow Human Beings. Birgitta