PATIENT PERSPECTIVES

Day surgery: patients felt abandoned during the preoperative wait

Jo Gilmartin and Kerrie Wright

Background. The rapid expansion in day surgery has facilitated a shift in surgical nursing intervention. The evolving evidence
base has a major part to play in influencing nurse-led preassessment, information provision, pain management and postoperative intervention. However, the literature is characterised by a number of deficits: poor attention to patient experience from
admission to discharge, anxieties evoked and the potential needs of patients are not well articulated.
Aim. The purpose of this paper is to describe and interpret patients experiences of contemporary day surgery.
Method. This hermeneutic phenomenological approach focused on the experience of 20 adult patients. Data was collected by
using unstructured interviews. The transcripts were interpreted through the identification of four prevalent themes using the
phenomenological method.
Findings. The themes that emerged from the data are emphasised, ranging from the feeling of empowerment during preparation,
through apprehensions encountered and the feeling of abandonment in the preoperative waiting area, to recovery dynamics.
Conclusion. The study demonstrates that the majority of the patients felt abandoned in the preoperative stage and nurses did not
recognise the importance of ongoing psychological support. Therefore, it is crucial to strengthen the provision of emotional
support and person-centred care in a day surgery context. There is also a need to be aware that environmental factors can
impact on patient anxiety, promoting the use of music preoperatively can reduce anxiety and increase well-being.
Relevance for clinical practice. Crucially health professionals need to facilitate person-centred and continuity of care throughout
the day surgery experience. Using dynamic interpersonal skills, such as active listening holding containment and attunement
to reduce anxiety and feelings of abandonment in the preoperative period. Moreover, being alert to verbal utterances, paralanguage and non-verbal cues demonstrated by the patient. Specific information about delays regarding the timing of procedures
needs to be carefully explained.
Key words: apprehensions, day surgery, empowerment, health communication, nurses, nursing
Accepted for publication: 9 February 2008

Introduction
Responding to an increasing need for surgical intervention
within the population has resulted in the dramatic growth of
day surgery (Henderson & Zernike 2001). Prolonged hospital stays for certain procedures, such as hernia repairs and
cholecystectomies, are becoming a thing of the past (Mitchell
2005). The economic benefits of day surgery include reduced
costs and more effective use of theatre time, therefore, its
growth is likely to continue (Lemos et al. 2003, Cheng et al.
Authors: Jo Gilmartin, PhD, Med, RN, SCM, Lecturer in Health &
Psychology, School of Healthcare Studies, Baines Wing, University of
Leeds, Leeds UK; Kerrie Wright, BSc (Hons), Msc, RNT, RGN,
Lecturer in Nursing, School of Healthcare Studies, Baines Wing,
University of Leeds, Leeds, UK

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2004, Skattum et al. 2004). Expanding day surgery is number

one in the 10 High Impact Changes suggested as part of the
NHS moderntion Agenda (N.H.S. Modernisation Agency
2004). The NHS plan (Department of Health 2000) anticipates facilitating three-quarters by 2010 the Department of
Health (2000) is aiming for three-quarters of all operations
being performed on a day surgical basis.
Same day discharge has prompted a shift in patient needs
compared to individuals who have a longer inpatient stay;
psychological preparation, the dissemination of information
Correspondence: Jo Gilmartin, School of Healthcare Studies, Baines
Wing, University of Leeds, Leeds LS2 9UT, UK. Telephone: 0113
3431254.
E-mail: j.gilmartin@leeds.ac.uk

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doi: 10.1111/j.1365-2702.2008.02374.x

Patient perspectives

and symptom management must be appropriately managed if

patients are to meet the criteria for discharge (Mitchell 2001,
Pfisterer et al. 2001). These are also essential requirements for
patients and their relatives/carers as they predominantly take
responsibility for aftercare when back in the community (Cox
& OConnell 2003).
Various studies have sought to ascertain the opinion of
patients having undergone day surgery to identify what
service improvements may be necessary (Mitchell 2005). In
some studies, patients have reported satisfaction with elements of the day surgery process (Yellen & Davis 2001,
Barthelsson et al. 2003, Sharma et al. 2004). However, some
concerns have been identified and according to Costa (2001)
it is important in this ever-expanding area to incorporate
patient views as part of service improvement. What follows is
a discussion of issues raised by day surgical patients regarding
their experiences, in particular preparation for surgery, the
day of surgery itself and postoperative care.
Preparation for surgery starts with the patients preassessment visit. Preassessment serves a dual purpose; it is
important to identify patients general fitness for day surgery
and is the prime venue for initial patient preparation
(Gilmartin 2004). This is crucial to prevent cancellations, to
ensure that co-morbidities are recognised, treated and
patients are well informed and prepared for day surgery
(Smith 2007). Clark et al. (2000) investigated 178 patients
experiences of oral day case surgery using a questionnaire
design. Eighty per cent of the sample identified that preassessment clinic attendance reduced their anxiety, eased
worries and improved confidence in relation to their forthcoming admission.
In contrast a qualitative study using semi-structured
interviews with 30 patients undergoing gynaecology, urology
and general surgery by Gilmartin (2004) identified elements
of dissatisfaction with their experience of this service. Eighty
per cent of the sample felt there was insufficient information
provision regarding their forthcoming procedure. The negativity associated with inadequate information provision prior
to day surgery was also a significant finding in the systematic
review undertaken by Pearson et al. (2004). Moreover,
deficits in information provision have also been revealed in a
recent systematic review undertaken by Rhodes et al. (2006).
Specific information deficits identified by Bradshaw et al.
(1999) involved the management of pain and in general the
use of appropriate terminology. A study by Cox and
OConnell (2003) of 80-day surgery gynaecology patients
identified from patient diaries and telephone interviews
information regarding potential postoperative symptoms
was lacking. Bradshaw et al. (1999) identified that information could be variable depending upon individual surgeons. A

Patients felt abandoned

phenomenological study of 16-day surgical patients experiences of ambulatory surgery by Costa (2001) identified three
common themes, one of which was fear arising from
information giving, specifically anaesthesia and fear of dying.
According to Costa (2001) appropriate and timely provision of preoperative information is essential. Mitchell (2005)
proposes that the level of information people need and how
they retain it varies and so information provision should be
more appropriately tailored to individual need. Certain
authors have identified that reinforcement of information
(Gilmartin & Wright 2007) could prove more successful
either via ensuring carers/relatives are present (Barthelsson
et al. 2003) or by offering postoperative telephone calls
(Thompson et al. 2003).
The experience of the day of surgery has highlighted
certain flaws. Six patients in Gilmartins (2004) reported that
surgical admission dates and times were changed at short
notice and cancellations ensued, provoking anxiety. Alternatively, a qualitative study by Barthelsson et al. (2003) of seven
patients experiences of undergoing laparoscopic fundoplication all identified that their anxiety reduced as they were the
first to be operated on. Waits associated with day surgery
resulted in a second theme being identified by Costa (2001)
where patients felt as though they were not treated as
individuals whilst waiting for surgery; they reflected that they
would have found it beneficial to have carers/relatives in the
prewait area with them. Maintaining a degree of control was
also important to these patients, such as being able to walk
independently to the operating room.
Same day discharge requires patients and carers to manage
postoperative symptoms in their own home. As a consequence, Jacquet et al. (2006) identified that there can be levels
of apprehension the first night being at home following
surgery. Thompson et al. (2003) used questionnaires among
100 oral surgery patients to explore their experiences and
found that between 45% and 92% of patients experienced
some form of postoperative sequelae which was difficult to
manage, such as nausea, vomiting and drowsiness. Pfisterer
et al. (2001) identified that some experiences of nausea and
vomiting have been noted by patients up to the 5th
postoperative day. A review of the literature by OdomForren and Moser (2005) identified that the results of
unrelieved nausea can impact upon the patients ability to
resume daily activities and acquire sleep which can result in
prolonged time off work, which can also impact upon
relatives/carers. A total of 825% of the sample in Cox and
OConnells (2003) required a carer beyond the initial 24hour postdischarge.
Managing adequate pain control is an essential part of
recuperation (Coll et al. 2004). A study by Limb et al. (2000)

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J Gilmartin and K Wright

of 62 patients posthaemorrhoidectomy reported 95% satisfaction with a multi-modal approach suggesting that testing
new approaches may bring patients benefits postoperatively.
Postdischarge reports are not always as favourable. Thompson et al. (2003) uncovered as part of their follow-up phone
calls that 11 patients were exceeding recommended doses of
analgesics caused by problematic pain levels experienced at
home. In addition 388% of the sample in Cox and
OConnells study still experienced pain between 5 and 10day postoperatively. A literature review by Coll et al. (2004)
was critical of a lack of realistic expectation of the intensity
of pain following day surgery, suggesting patients be advised
about comfortable levels as opposed to being pain free. In
light of day surgical expansion, a more in-depth exploration
of the patient experience is required as a platform from which
to respond more effectively to the challenges encountered.

comfortable with. Active listening, non-verbal cues and

probing were used to encourage responses. The interviews
were carried out in the participants homes.
Holloway and Wheeler (2002) indicate that unstructured
interview generates rich data but also has a dross rate,
which contains a certain amount of irrelevant material. In
some instances, it was necessary to re-focus the participants
during the interview. The interviews lasted approximately
1 hour and were drawn to a close 67 minutes before the
end, thus allowing time for the participants to make final
disclosures. On completion debriefing took place to facilitate
closure. The individual interviews were audio-taped and
transcribed verbatim. Brief notations were taken by the
researcher at the time of data collection to strengthen the
recorded data and allow for memo-ing.

Sample

The study
Study aim
The aim of this study was to describe and interpret patients
experiences of contemporary day surgery.

Methods
This qualitative study used a hermeneutic phenomenological
approach (van Manen 1990, Crotty 1996) to explore the
experiences of 20 patients who had undergone day surgery.
Central to hermeneutic phenomenology is the individuals
understanding, focusing on the lived experience of a particular phenomenon. van Manen (1990) emphasises subjectivity, discovery and the value of perceptions of the world in all
its variegated aspects, which gives phenomenology its distinctive character. Phenomenology illuminates the diverse
range of human experience, the context and a careful
description of that experience. The central idea is understanding experience rather than providing causal explanation
of that experience (Van der Zalm & Bergum 2000). This
paradigm was suited to discovering patients experiences in a
day surgery context to gain a deeper understanding of the
lived experience.

Data collection
The data was collected by means of unstructured interviews,
with one key question encouraging the participant to talk
about their experience of the day of surgery itself. Questions
were then asked to clarify and understand patients statements. They were encouraged to disclose only what they felt
2420

The 20 participants, consisting of gynaecology, urology and

general surgery patients, were purposively selected at the
preassessment clinic in one large teaching hospital in the
North of England. This process was supported by discussions
with key people from the preassessment clinic and day
surgery unit including the lead clinician for day surgery, the
surgeons and the preassessment and day surgery nurses.
Purposeful sampling was undertaken on the basis that
participants had experience of the phenomena being studied
and could articulate this experience (Holloway & Wheeler
2002). The sample selection targeted a more heterogeneous
group including diversity of procedures and characteristics,
such as gender and age, than would have occurred in a
consecutive sample of one group of surgical patients. This
increased the rigour of this study by seeking a deeper and
fuller meaning of the experience from different groups of day
surgery patients. Thus, opening up possibilities of a completely different, although complementary, perspective from
that of one surgical group contributing to a richer description. The sample consisted of men and women from 19
85 years of age, the majority being white with only two
participants from minority ethnic groups. The patients were
English speaking, had a contact phone number, were having a
general anaesthetic and had attended the preassessment
clinic. To preserve confidentially, each participant was given
a pseudonym which was the only identification used on any
documentation related to the study.

Ethics
The research proposal was submitted to the local NHS
Trusts ethics committee and approval was gained before

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Patient perspectives

Patients felt abandoned

the study began. The participants were furnished with

detailed information about the nature and purpose of the
project and their function within the study. The interview
method for gathering data was explained, including time
commitment and risks involved. The participants written
consent was recorded before each interview began; they
were informed that they could withdraw from the study at
any stage without jeopardising their treatment in any way.
Participant anonymity and confidentiality were also considered; they were informed that they would be given a
pseudonym attached to the data from the point of collection and that audio tapes would be erased on completion of
the project.

review was also employed to detect bias or inappropriate

subjectivity.
When the draft of the themes was completed, it was
submitted to three participants who volunteered to be of
further assistance at the end of the interview, and to one
critical reader who had considerable experience of qualitative research, as an independent review to support the
credibility of the data analysis. They were satisfied with the
data analysis and the independent reviewer made some
suggestions to strengthen the representation of the themes.
The literature was used to discuss the findings and
demonstrate its fittingness into similar contexts outside the
study.

Data analysis

Findings

Data analysis was informed by a number of techniques

described by van Manen (1990). To interpret the text, the
patients experience was read carefully and reread several
times. Three approaches were taken to identify thematic
aspects of the phenomena. Firstly, a holistic approach was
used, the text was read as a whole, and the salient question
was which statement showed the fundamental meaning of the
text as a whole. Secondly, a selected meaning approach was
employed; the text was reread posing a question regarding
which statements appeared vital or revealing about the
phenomenon being described. This was followed on by the
detailed meaning approach, every sentence or sentence cluster
was examined carefully and the question posed was what did
this sentence or cluster reveal about the experience being
described. The analysis entailed comparisons of significant
statements to identify similarities and differences between the
diverse groups of participants and was coded according to
common characteristics. These resulted in the emergence of
four major themes.

Four main themes relating to aspects of the patients

experience of day surgery emerged from the data.

The feeling of empowerment during preparation

Patients described their personal experiences prior to having
surgery in terms of receiving reassuring explanations from
health professionals. The majority said they felt frightened
about having a general anaesthetic in case they did not
recover:
I saw the anaesthetist and she asked me about my previous
operations. I told her about my concerns and the problems with
anaesthetics and sickness afterwards. She was very understanding
and said she could help, telling me about anti-sickness medication.
(Serena)

Others described the interaction with the surgeon:

The exchange with the surgeon was extremely helpful because she
drew a very detailed sketch of what the haemorrhoidectomy would
entail as she talked to me. I also asked her questions about

Rigour
Establishing validity involved determining the extent to
which conclusion effectively represents empirical reality
and, as Hansen (1979) indicated, whether constructs devised
by researchers represent the categories of human experience
that occurred. Trustworthiness was established through
member checking and peer review (Holloway & Wheeler
2002). This means that participants were given the opportunity to read the findings and indicate, if they were compatible
with their perspective. Throughout the interviews, the
researcher paraphrased the participants words to avoid
misinterpretation or misunderstanding. This process is often
known as member validation (Lincoln & Guba 1985). Peer

postoperative pain, which was a concern, and she gave me detailed

information. (Jules)

The apprehensions encountered

In contrast, some women focused more on the potential
threats associated with having a general anaesthetic and
undergoing surgical procedures:
I felt very worried for a week before I came in. I was frightened of not
waking up after the anaesthetic. Yesa nervous wreck on the
morning of the procedure in case I would not see my children again. I
expressed my fears to the gynaecologist but he just acknowledged
them briefly and moved on to the next patient. (Jaffa)

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For others it related to the side-effects of the anaesthetic:

I was frightened of waking up during the procedure or dying whilst
under the anaesthetic. The night before coming in for day surgery, I
couldnt sleep. It was daunting and terrifying and I did not feel
confident to tell the nurse. (Grace)

Many of the men and women also described the challenges of

a mixed sex preoperative waiting area:
I felt self-conscious and became bright red in the presence of young

delay. They do not seem to tell you what is happening. I felt

abandoned and spent many miserable hours with myself and no one
expressed concern. (Rowan)
I couldnt walk very far, because of my arthritis and the long wait
was distressing. I was getting pains in my knees, in my back, and in
my neck. The nurses were reluctant to listen to my concerns. I
couldnt read or relax. I would never do it again because of the
abandonmentit was terrifying. (Calypso)

menvulnerable, embarrassed. (Kiera)

The dynamics of recovery

I found that I had to sit with my legs togetheralthough I was
wearing surgical underwear, a surgical gown and a dressing gown, it
didnt hide very much in my opinion. I was feeling quite nervous in
the presence of several women who were chatting. So I just got up
and sat on my own and read a magazine. (Talcot)

Dealing with emotional challenges was described as daunting

by the majority:

Patients also described a range of experience relating to the

recovery phase:
I woke up at ten past ten and I had a lot of pain in my legs and felt
very sickbut I was so pleased to be awake. The nurses were lovely
and asked how I felt. I had a bit of toast and some teathen I began
to vomit. They gave me an anti-sickness injectionthen I started to
feel better. (Fife)

Failing to provide a urine sample was a huge ordeal which activated

strong feelings of nervousness and despair in me. I felt upset all the

I was feeling sleepy after the anaesthetic, however, I was beginning to

time in case the cystoscopy got cancelled. The nurse was supportive

wake up after the operation (haemorrhoidectomy) and the doctor

but I used breathing techniques that helped calm down disturbing

came to see me. I appreciated his open, attentive and sensitive

emotions and eventually managed to produce a sample. (Saffron)

approach. He reassured me that the operation went well. Then the

pain zapped me and I did ask for painkillers. (Jules)

I was worried about the possibility of urinary incontinence and

frequency occurring after the cystoscopyyou get that feeling that
you might smell of urinefilthy. The urologist already mentioned
that the patch of nerves that control my bladder seemed very small
indicating that some were probably removed when I had my
prostatectomy. (Rupert)

Others described symptoms, such as nausea, high or low

blood pressure, difficulty with breathing, drowsiness, abdominal pain and distension or vaginal bleeding, which seemed to
be a major symptom for the gynaecology patients:
I felt a bit zonked and wobbly when I stood up with blood running
down my legsI hadnt been expecting it. Then I realized that I had

The feeling of abandonment in the preoperative waiting

area
Several participants described how they felt miserable,
abandoned and upset during the preoperative wait:
Bella asserted: I was very busy with the consultations on admissionthen I sat down and felt totally abandoned. The wait became a
bit of an overwhelming ordeal and the nursing staff made little
attempt to interact with me. I tried to calm down a patient who was

been sitting on a pad and there was a lot of blood and iodine on that
too. I shouted to the nurses for wipes and a pad and I wished they had
anticipated my needs because I felt embarrassed. (Petunia)
When I came round from the anaesthetic I just couldnt breathe. It
was as though I were chokingthe nurse was in there holding my
hand and encouraging me to breathebreathe, but no air was getting
into meSuddenly I had an oxygen mask on my face. Oh my God I
had a right panic attack (Solange)

nurse.

One particular male patient who underwent a hernia repair

described some side-effects: Masud, aged 46 years, asserted
that:

Many described how upset they were during the long wait:

I felt really wet down my legs when I woke up. I discovered later that

threatening to run away. Again, the nursing staff did not support this
distressed patient. I never told anyone that I was a day surgery staff

As a patient you are at a huge disadvantage when you hear whispers

that the anaesthetist hasnt turned up and we were not given direct
information by the nurses and doctors about the long, unexpected

2422

there was quite a bit of blood everywhere because my femoral artery

was accidentally nicked during surgery. The surgeon told me when I
started to wake up but I took nothing in, because I was sleepy. I asked

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Patient perspectives
the nurse what had happened. The pain besieged me and it felt worse
than the bleeding but the painkillers were helpful.

And some felt they were unprepared for the swift discharge:
Noticeably, Talcot, aged 22 years, who underwent a left
hydrocele repair,
I was drowsy, incoherent, and very disorientated following the
procedure and would have liked more time to recover. The nurses
hurried me and I could hardly walk at all.

Discussion
What stands out in the accounts is the psychological effects
resulting from long periods of preoperative waiting were
worsened by increased nervous tension and boredom. This
variable has also been recognised by Malsters et al. (1998)
and Williams et al. (2003). The unexpected long wait
highlighted in this study, six hours in some cases, left patients
feeling vulnerable and angry. The results also show that some
were frightened of waking up during the procedure or dying
whilst under the anaesthetic. Similar findings have been have
been noted by Costa (2001).
One important distinction concerned some patients
experiences of being abandoned during the preoperative
wait. This particular finding has not been previously
addressed or examined in the day surgery literature. For
the patients the critical moments of the journey are
punctuated by waiting time variables, lack of information
about delays, lack of emotional support and psychological
disengagement by health professionals. These findings in
relation to information deficits in day surgery concord with
much previous research on (Pearson et al. 2004, Mitchell
2005 & Rhodes et al. 2006). The dangers of psychological
disengagement are emphasised too by Kitwood (1997)
pointing to the construction of a culture that is associated
with alienation. The most obvious hindrance is that patients
feeling states are ignored. Corner (2002) also considers the
drawbacks of treating patients as objects and the meaning
of messages portrayed by efficiency disparate from humanistic intervention.
Therefore, it is crucial that health professionals recognise
that variations of continuity in the preoperative dialogue
can pose difficulties for the patients. Continuity implies that
practitioners are visible and use empathy (Reynolds et al.
2000), intuition (McCutcheon & Pincombe 2001) and a
series of high quality interactions validation, recognition,
attunement (Cortina & Marrone 2003), facilitation, relaxation and reflection (Rolfe 2002). The ability to respond
sensitively is essential and to provide enough containment
to enable the patient to work through significant emotional

Patients felt abandoned

experiences. Of course it is crucial to be alert to the

message that is being conveyed non-verbally; in some
instances the words being more of an adornment. Effective
care occurs when a person-centred approach has been
applied consistently and then the psychological needs begin
to be met.
The embarrassment highlighted in the mixed-sex preoperative waiting area was troublesome for some patients. Kent
(2002) suggested that anxiety is likely to increase when a
trigger confronts the individual. There is a danger that
dealing with interactions from others in a mixed-sex environment could trigger appearance-related stressors. Practitioners need to be aware of factors that exacerbate
appearance-related concerns and promote positive coping
(Rumsey & Harcourt 2005). Ameliorating distress might
involve looking at creative and practical ways of developing a
safe environment. Spatial layout, seating arrangements and
interior design features such as the effects of natural murals
and nature sounds could have positive effects on promoting
privacy and calmness.
The description of postoperative side-effects following day
surgery was variable. The most common side-effect for the
gynaecology patients appeared to be vaginal bleeding.
Bleeding was a major problem too for one male patient
who underwent a hernia repair. This patient stated that his
femoral artery was accidentally nicked during day surgery.
However, medical interventions were successful in relieving
this symptom. One interesting strength of this study was the
reported low incidence of nausea and vomiting following a
general anaesthetic. Accounts of postoperative pain were
significantly low and were markedly reduced with analgesia.
These findings show contrast to previous research, for
instance, Pfisterer et al. (2001) noted that nausea and
vomiting can be problematic up to the 5th postoperative
day. In addition, Coll et al. (2004) suggested that pain
thresholds are variable following day surgery with diverse
responses to analgesia.
Noteworthy, encounters with doctors were conflicting in
postoperative care. Some appreciated the rapid recovery
from anaesthesia, the personal visit and conversation with
the surgeon. The so-called unsatisfactory encounters focused on hurried interactions, moments of drowsiness and
difficulty with information absorption. This is also supported by the work of Oberle et al. (1994) which
demonstrated that postoperative information-giving and
patient education had been compromised by timing variables. Barthelsson et al. (2003) reported amnesia as a
common and frustrating experience following general
anaesthesia. They go on to suggest that reinforcing information and ensuring that relatives/carers are present during

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J Gilmartin and K Wright

discharge planning could positively influence this significant

challenge.

(N.H.S. Modernisation Agency 2004, Smith et al. 2006) with

a far reaching agenda.

Study limitations

Acknowledgements

One limitation in this study stems from the number of

participants. Although 20 patients were involved there
proved to be a smaller number of eligible general surgery
patients than was originally intended. Sampling was limited,
focusing on gynaecology, urology and general surgery
patients, excluding other groups who undergo day surgery,
such as orthopaedic patients or patients undergoing cholecystectomy.
This particular study was only able to provide limited
insights into what this experience may be like. Nonetheless,
the chosen philosophy helped to compensate for this by
supporting the notion of reflection, allowing a description of
emotion and thought to emerge, rather than a solely
contextual interpretation of the experience.
Another limitation arises from the fact that patients were
selected from one day surgery unit in the same region.
However, it might be useful in future studies to sample a
group of patients from another region to see if any
significant differences emerge. This might be a revealing
annexation.

I would like to express my sincere thanks to all those who

have given me help with this project: to the patients who
willingly participated, to the medical and nursing staff of a
day unit of the local Trust in Leeds.

Conclusion
Phenomenology was the methodology chosen to find a deeper
understanding of the patients experience of day surgery and
open up new meanings. It was felt that its inductive and
descriptive nature acknowledged the subjectiveness of experience and facilitated the generation of a vast amount of data.
Of the four themes identified in the data on the day of
surgery, two themes entitled The apprehensions encountered and The feeling of abandonment in the preoperative
waiting area presented most detail about patient concerns.
These themes addressed emotional vulnerability and difficulties in communicating for the patient.
To conclude, it is crucial to acknowledge that a number of
troublesome issues were expressed by the patients in this
study. This finding has clear implications for health professionals and will be useful to the development of day surgery
care encouraging practitioners to be more alert to the
potential needs of patients.
Therefore, it is essential to facilitate a stronger degree of
empowerment (Henderson 2003) to ensure greater continuity
of care throughout the day surgery experience. The time is
ripe for such innovation given that the health service
modernisation plan is currently promoting clinical excellence
2424

Contributions
Study design: JG, KW; data analysis: JG, SL, AS, JW and
manuscript preparation: JG, KW, JW.

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