The experience of patients undergoing knee surgery with local or regional anesthesia: an ethography

This ethnographic study is concerned with the surgical experience of patients within the social context in which it occurs: the operating theatre. Traditionally, the focus of the operating theatre has been on conducting safe, efficient surgery with unconscious patients. However, as the volume of surgery performed under local or regional anaesthesia increases, this focus is shifting. Care of awake patients in the operating theatre is now a prominent feature of modern perioperative practise, and support for the conscious patient has become a major responsibility for all perioperative staff. The aim of this thesis is to understand the experience of being a conscious patient during regional anaesthesia and knee surgery in the perioperative environment. Through such an understanding the nature of the relationship between the conscious patient and the rest of the perioperative team can be established and the most important factors that influence the perioperative experience of this patient group clarified.

An ethnographic approach has been used to gather data which enables an understanding of the relationship between the conscious patient in an operating theatre and the rest of the perioperative team. Data was gathered through preoperative and postoperative interviews with seven adult patients scheduled for knee arthroplasty or knee arthroscopy under local or regional anaesthesia. One other patient was interviewed preoperatively but not postoperatively. In addition to the patients, three surgeons, one anaesthetist, one anaesthetic practitioner, one scrub practitioner and a recovery practitioner were also interviewed, making a total of 22 interviews. Participant observation was also conducted in four locations in the hospital; day surgery theatres and main theatres during surgery, the preoperative clinic referred to as ‘joint school’ (where seven consultations were observed) and the fracture clinic where a further seven consultations were observed. Collectively, these areas reflect those visited by patient participants during their surgical journey.

The study generates an authentic ethnographic account of the patients’ experiences of knee surgery with local or regional anaesthesia. A thick description, drawn from the views of patients and perioperative staff, has been produced which supports theoretical interpretations of the behaviour and relationships enacted in the context of everyday life in an operating theatre setting. Data analysis was through a constant comparative approach which followed the six steps of grounded theory methodology (Glaser and Strauss, 1967). Perioperative staff caring for the patient during this time typically adopt a medical or scientific perspective towards the patient’s body, whereas patients view this experience from a lived perspective. Four themes identified as trust, capital, embodiment and the clinical gaze were identified through the data analysis. These themes relate to the strategies patients and staff utilise to bridge the gap between their different perspectives. An understanding of which can contribute to ways of interacting with and caring for surgical patients in the perioperative environment.