Author: Christine Helen McCloud
McCloud, Christine Helen, 2013 People's Experience of Vitreo-Retinal Day Surgery: A Gadamerian Guided Study Embedded within and Evidence Based Nursing Practice Framework, Flinders University, School of Nursing & Midwifery
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Background: Over the previous three decades, the ophthalmic community has witnessed significant practice changes in both management and performance of vitreo-retinal surgery. Nurses working in the field of ophthalmology have observed the transformation of vitreo-retinal interventional care, from inpatient to day-case care. During this period, a progression from the dominant use of general anaesthesia to regional anaesthesia as standard practice has also been recognised. Day surgery has proven successful for the care of patients requiring cataract surgery. However, the needs of patients following interventions for complex vitreo-retinal disease, now routinely performed as day surgery, remained unknown. Aim: This study aims to understand participants' experience of vitreo-retinal day surgery as guided by the philosophy of Hans-Georg Gadamer. This knowledge development activity is embedded within the structural framework of an Evidence-Based Nursing Practice. At first glance, these two philosophically disparate activities may be considered mutually exclusive. However, such juxtaposition within this study facilitates a synergistic merging of experiential knowledge with nursing practice in the clinical context of vitreo-retinal day surgery care. Research design: Gadamer's Philosophical Hermeneutics proscribes a methodological process; instead, the dictates of Gadamer establish the conditions in which understanding occurs. The present study's structural framework is situated in research-in-practice and includes a modified five-step evidence-based nursing practice model. The use of this model provides a systematic pathway that defines the clinical problem (step one), explores current knowledge and identifies knowledge gaps (step two). The model's intrinsic component is a knowledge-generating research activity (step three), guided by Gadamer's philosophical hermeneutic perspective. Step three presents a qualitative exploration of the experience of vitreo-retinal day surgery and the thematically analyses of the findings. An emerging understanding of this experience forms the basis for developing new nursing interventions (step four) that are implemented and evaluated (step five) within a clinical setting. The evaluation utilises both quantitative and qualitative methods, thus providing in-depth knowledge. Findings: The qualitative evidence of this study leads to understanding the participants' needs that include the following aspects of self within a lived experience: physical, psychological, historically located and within the community. This understanding is combined with expert clinician knowledge, as well as information and theory from established professional literature. This broadly based evidence provides the foundation for the development of new nursing interventions. These interventions aim to improve patient experiences of vitreo-retinal day surgery and are implemented and evaluated in the subsequent steps of this Evidenced Based Nursing Practice activity. The new interventions address the following issues: post-operative pain management, pre-operative preparation, anaesthetic options, isolation following discharge, and information needs. Following the implementation of interventions, evaluation was firstly sought through a 100 consecutive patient audit, followed by in-depth unstructured interviews with nine participants. These evaluation activities found an improvement in patients' experiences of vitreo-retinal day surgery. Conclusions: The present study develops a qualitative knowledge of the V-R day surgery experience and successfully embeds this knowledge within a modified Evidence-Based Nursing Practice framework. The modified framework is utilised in this study and effectively facilitates the following: new knowledge of the vitreo-retinal day surgery experience, the development of new interventions meeting the complex needs of patients undergoing vitreo-retinal day surgery, and the transformation of future care of people requiring vitreo-retinal day surgery. The value of this study exists in bridging the research-practice gap between knowledge generation and clinical care, with a clearly demonstrated outcome of improved patient care.
Keywords: Vitreo-retinal,day surgery,philosophical hermeneutics,evidence based nursing practice
Subject: Ophthalmology thesis
Thesis type: Doctor of Philosophy
School: School of Nursing & Midwifery
Supervisor: Associate Professor Dr Ann Harrington