Table 4

Quotes from patients

1. Information transfer1.1. “Well you know it’s a good thing but there’s simply too much information out there. So I said to myself ok just let the doctors and nurses tell me what to do next. I’ll follow the instructions as long as I know they mean good.” (Patient 6)
1.2. “They spent quite some time to explain the document point by point. It sounds great. Everybody wants a better outcome. Then they asked me if I had any questions. Well I could not think of any right away. They said I would keep one copy of the documents and I’m welcomed to ask questions at any time. But later on the nurses came for the pre-op stuff, then the barber, then the anesthetist, and the OR nurses. I was preoccupied with the surgery I didn’t even give them a second look. It would be better if they gave me the documents some time earlier rather than only two days before surgery.” (Patient 9)
2. Professional support2.1. “They gave me a patient-controlled analgesia pump for the first couple of days after surgery and it really helped a lot. I didn’t feel much pain at that time. But things changed the third day when they switched the pump to oral painkillers. It seemed to me that the oral painkillers helped little. I didn’t expect that I’d suffered from surgical pain starting on POD3. Of course I asked for help. Then came this very patient and intellectual nurse. She spent some time to explain to my family and me about the necessity of switching the pump to oral pills. She also told us that the drug used in the pump was the similar type as the oral ones. She mentioned in the end that she could ask the doctors to refill my pump if I really need that. Then I thought well, if I want to go home early I can not rely on the pump. I didn’t refill the pump and the pain did subside as time went by. Also, she checked on me later that day before the shift of duty and the next morning the first thing she came to the ward. I was able to be discharged a couple of days later, going home with oral painkillers. I was very thankful to her.” (Patient 29)
2.2. “I knew it was natural to have pain because of the surgery but it was intense. I expected the doctor to do something but he just told me ‘It is not uncommon. If I were you I’d have the pain too.’ It was not helping.” (Patient 26)
2.3. “The smell of food made me really nauseous and I didn’t want to eat at all. I called the nurse and then she called in a doctor. He checked my order of drugs and said they already give me drugs for the nausea and it was natural because there’s certainly some swelling in my brain due to the surgery.” (Patient 5)
2.4. “It felt like that they really wanted me to join the program and they really wanted to make sure that I met the milestones. Removal of urinary drain, oral liquid and then solid food intake, off-bed activity… I thought I did everything great. I was proud of myself and grateful to the healthcare team. But after that I felt like I was abandoned. They were probably busy helping others who were not doing great as I did…” (Patient 40)
2.5. “In the beginning when the nurses had their shifts in front of my bed they would remind each other ‘this is an ERAS patient’ and I know it means something different. I can tell that they paid more attention to me than to other patients… Later on they were talking like ‘this is an ERAS patient and he already got off bed yesterday’ Then I became the one who doesn’t deserve their attention.” (Patient 13)
3. Shared responsibility and active participation3.1. “You signed the consent and you made a commitment. You are obliged to stay strong and comply with the rules. It is a sort of pressure.” (Patient 40)
3.2. “The second afternoon after I had my surgery the nurse came in to remind me that it was time for me to get off bed and try to walk according to the schedule. Yes I could fetch my meals and they had removed the drip. But I was not feeling well enough. I had some faintness. I asked ‘maybe we can try tomorrow morning?’ but she kept telling me that how other managed to walk on the second day after surgery and that ‘nobody was ready enough for that’. I didn’t want to annoy her so I tried. I could not recall what happened next because I passed out. She was scared of course. She came to apologize to me the next day. I don’t blame her personally but they should have a mechanism to adjust the goal and not to take them as fixed rules.” (Patient 25)
3.3. “A nurse came in and she shouted ‘how come you’re still in bed? You don’t have any IV fluids today and now try to walk’. But I already walked and I even walked two rounds in the corridor earlier that morning. She did not come early enough to see that… I’m not a soldier to follow the rigid instructions as when to do what.” (Patient 15)
4. Readiness for discharge4.1. “When he [resident] reported to the senior doctor that ‘she’s going to be discharged today’ I thought what’s going on, he must be insane. I was not well enough. I’m stilling having this right facial paralysis. I still can’t close my right eye tightly.” (Patient 20)
4.2. “I was happy to go home only 3 days after surgery, but I wasn’t totally pain free at that time. I couldn’t help thinking maybe I should stay for another couple of days and then go home in a better condition?” (Patient 9)
4.3. “Here in the hospital my son and daughter are around. They are using their annual leave for my hospitalization. But once I go home they’ll have their own family and children to look after… They live quite far away… My husband, he has never done any housework at home. If I don’t cook, he will starve. How can you expect him to take care of me?” (Patient 7)
4.4. “My daughter really devoted herself to helping me recover from the surgery and I know that she wanted me home. But she is not a nurse anyway. I simply believe that it is safer to stay in the hospital. You are surrounded by medical staff so if there’s anything going wrong they will find it out and deal with it quickly.” (Patient 23)
4.5. “I don’t trust the community hospitals and I will certainly go back to the hospital where I had my surgery if anything is wrong. I’m not living close to the hospital. And I know that it’s a busy center and there is a huge number of patients to be admitted. What if they can’t guarantee a bed if I need readmission?” (Patient 40)
5. Follow-up5.1. “This cell phone app works way much better than phone calls. I never called the ward even though I had the number. You nerve know whether the people answers the phone really know whom you are. But it is the doctor who did my surgery and took care of me that is now interacting with me on this app. He knows my condition.” (Patient 20)
5.2. “I know that the doctors are always busy doing the surgeries and dealing with new patients so you don’t want to bother them in the middle of their work. I just left a message to my doctor and whenever he got time he would reply or call back. In this way my questions are answered and I don’t feel myself as a burden to him.” (Patient 9)
5.3. “The third day after I went home I had a funny feeling around the wound. There was a small lump next to the wound which felt soft. My son took a picture of that with his cell phone and sent it to the doctors. They called me to go to the clinic. It turned out that I developed some water under the scalp and they fixed it easily. That was unimaginably convenient.” (Patient 21)
  • POD, postoperative day.