1. 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

2. 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

3. 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

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

5. 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

6. 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.

7. 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)

8. 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

9. 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

10. 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)

11. 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

12. 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)

13. 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’”

14. 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)

15. 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

16. 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)

17. 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

18. Interconnectivity Of Themes

19. 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)

20. 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

21. 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

22. Thank you
Any Questions?