Received: 30 September 2016 Revised: 19 January 2018 Accepted: 16 February 2018

DOI: 10.1111/ijn.12648

ORIGINAL RESEARCH PAPER

Effectiveness of a telephone follow‐up nursing intervention in

postsurgical patients
Rosimere Ferreira Santana RN, MS, PhD, Associate Professor1 |

Shimmenes Kamacael Pereira RN, MS2 |

Thalita Gomes do Carmo RN, MS, PhD Student, Assistant Professor3 |

Vanessa Emille Carvalho de Sousa Freire RN, MS, PhD, Visiting Professor4 |

Thais da Silva Soares RN, Health Care Science Master Student5 |

Dayana Medeiros do Amaral RN, Health Care Science Master Student6 |

Raquel Dantas Vaqueiro Student Nursing, CNPq fellow3

1
Medical‐Surgical Nursing Department,
Federal Fluminense University, Rio de Janeiro, Abstract
Brazil
Background: Surgical recovery can be defined as the days required to initiate activities that
2
Medical‐Surgical, Rio de Janeiro, Brazil
maintain life, health, and well‐being.
3
Federal Fluminense University, Rio de
Janeiro, Brazil Aim: The main study objective was to compare the effectiveness of telephone versus conven-
4
Health Sciences Institute, University of tional follow‐up in postsurgical older adult patients.
International Integration of the Afro‐Brazilian Methods: This is a quasi‐experimental study with random sampling. Postsurgical patients
Lusofony, Acarape, Brazil
5
over 60 years old who had undergone gastrectomy and colectomy were selected from 2 hospitals
Gerontology Nursing, Rio de Janeiro, Brazil
6
and randomly divided into intervention group (22 patients) and control group (21 patients). Data
Oncology Nursing, Rio de Janeiro, Brazil
collection was performed from January to September 2014. The differences in surgical recovery
Correspondence
Thalita Gomes do Carmo, Federal Fluminense between the control and intervention groups were measured at 48 hours, 4 weeks, and 8 weeks
University, Rua Dr. Celestino, 74, 6° andar, after surgery.
Niterói, Rio de Janeiro, CEP: 24020‐091, Rio
de Janeiro, Brazil.
Results: Patients in the control group took significantly longer duration in the length of
Email: thalitado@gmail.com surgical recovery from the first to the second (P = .007) and to the third evaluation time points
Funding information (P = .013). Patients in the intervention group had significant less impaired mobility (P = .003), need
National Council for Scientific and Technolog- for assistance for self‐care (P = .009), fatigue (P = .048), and time required for recuperation
ical Development (CNPq), Grant/Award Num- (P = .048).
bers: 134354/2014‐2015 and IT‐134354/
2014‐2015; Foundation for Research Support Conclusion: Telephone follow‐up reduced the occurrence of delayed surgical recovery.
of the State of Rio de Janeiro—FAPERJ, Grant/
Award Number: E‐26/103.269/2012
KEY W ORDS

geriatric, nursing, nursing diagnosis, perioperative, perioperative care, telenursing

S U M M A R Y ST A T E M E N T • Guidance and telephone follow‐up calls for postsurgical patients are

important to provide a better outcome.
What is already known about this topic? What this paper adds?
• Increasing numbers of adverse perioperative events in patients who • Telephone follow‐up calls were associated with significantly
undergo surgical procedures have influenced and increased the rate decreased length of postsurgical recovery in days.
of delayed surgical recovery.
• Compared with patients who received follow‐up calls, patients
• Although telemonitoring is recognized as a useful intervention to who received conventional follow‐up only had poorer surgical
achieve better postsurgical outcomes, it is not consistently used. recovery outcomes, such as impaired mobility, need for

Int J Nurs Pract. 2018;24:e12648. wileyonlinelibrary.com/journal/ijn © 2018 John Wiley & Sons Australia, Ltd 1 of 8
https://doi.org/10.1111/ijn.12648
2 of 8
assistance for self‐care, fatigue, and increased time required for
recuperation.
• The continuity of postoperative care at home should be systema-
tized by telephone consultation.
The implications of this paper:
• Telephone follow‐up calls represent an effective intervention
expanding perioperative nursing care through the use of high acces-
sibility and low‐cost information technology.
• New studies are required to evaluate the cost‐effectiveness of tele-
phone follow‐up calls as an intervention.
• Continuity of postoperative care by telephone follow‐up calls
should be included in the professional training of nurses.
1 | I N T RO D U CT I O N
The aging process causes changes that can affect response to surgical
procedures. Considering this, older adult patients have higher rates of
postsurgical complications than younger patients when experiencing
gastric resection, gastrostomy, or colectomy (Oliveira et al., 2011; Su
et al., 2016). Thus, interventions aimed at reducing postsurgical compli-
cations in elderly patients are justifiable. Worldwide, the incidence of
adverse events following surgical procedures ranges from 3% to 16%,
with a 0.5% mortality rate, with than half of these events deemed pre-
ventable. Additionally, about 7 million surgical patients suffer significant
complications each year (World Health Organization, 2009). At the same
time, advances in surgical techniques make it possible to reduce surgery
time and create consistent methods to reduce hospital length of stay,
such as the use of anaesthetics with minimal side effects and minimal
disruption in daily living (Carvalho, Matsuda, Stuchi, & Coimbra, 2008).
Gastrectomy consists of partial or total gastric resection. It is a
complex surgical procedure and the main treatment for gastric cancer.
Patients undergoing this type of surgery require adjustments before
returning to social, work, and leisure activities (Mello, Lucena, Echer,
& Luzia, 2010). Recovery following gastrectomy can take as long as
3 months, and evidence from studies has shown that it can take 6 to
12 months for patients to reach their preoperative levels of physical
health (Shan, Shan, Morris, Golani, & Saxena, 2015). Nursing interven-
tions are essential for effective surgical recovery and prevention of
adverse events. Nurses provide instructions on self‐care after surgery,
promote patients' autonomy and independence, and raise patients'
self‐esteem, self‐worth, and self‐efficacy. Education about how to
adapt to health conditions, the temporary or permanent sequelae of
surgery, should always be given before discharge (Mello et al., 2010).
The adoption of telecommunication in nursing care allows profes-
sionals to monitor patients' health condition, so that, if needed, their
homecare plans can be modified early (Broens, van Halteren, van
Sinderen, & Wac, 2007).
According to the Nursing Interventions Classification (NIC) sys-
tem, telephone follow‐up is defined as “providing results of testing or
evaluating a patient's response and determining potential for problems
as a result of previous treatment, examination, or testing, over the tele-
phone” (McCloskey & Bulechek, 2014). Some steps of the nursing pro-
cess can be done via telephone calls, including diagnosis, planning,
SANTANA ET AL.
interventions, and evaluation. Telephone calls allow nurses to provide
systematic care and to complement the nursing process (Inman,
Maxson, Johnson, Myers, & Holland, 2011). In this study, we used tele-
phone calls as a postoperative intervention. The hypothesis was that
this intervention, compared to standard care, would improve patients'
autonomy for self‐care and surgical recovery. The main study objective
was to compare the effectiveness of telephone versus conventional
follow‐up in postsurgical older adult patients.
2 | METHODS
2.1 | Study design
This was a quasi‐experimental study, with 2 randomly selected groups.
2.2 | Setting
The study was conducted in 2 hospitals located in Niteroi, Rio de
Janeiro State, Brazil. The first hospital is the largest teaching univer-
sity‐affiliated hospital of the region, with 91 beds and 3 surgical cen-
tres (1 for general surgeries, 1 for specialized surgeries, and 1 for
gynaecological surgeries). The second hospital is a large urban hospital
with 514 beds, comprising intensive care units, outpatient clinic, and
homecare service. It includes a centre for general surgery, a centre
for minor surgery with 9 surgical rooms, and a diagnostic centre with
15 consultation rooms. The hospital is structured to provide surgical
treatment in different specialties. From 58 services offered in this hos-
pital, 18 are surgical procedures. Both hospitals have outpatient clinics
in which the data collection team, comprising 3 registered nurses who
were also perioperative specialists, evaluated the participants of the
study after they were discharged. Data collection was performed from
January to September 2014.
2.3 | Participants and sampling
Forty‐three patients admitted for gastrostomy or colectomy surgeries
were recruited for the study. Patients were eligible for the study if they
were aged over 60 years and if they were submitted to gastrostomy or
colectomy 24 hours to 7 days before recruitment. Patients who
answered less than 75% of the telephone calls, who had cognitive
impairment or hearing loss without a companion who could answer
the phone, who had postoperative complications during hospitaliza-
tion, and those who had been readmitted to the hospital before the
first telephone call were excluded from the study.
The following parameters were considered for sample size calcu-
lation: 5% significance level (α), 80% statistical testing power (1‐β),
and an expected decrease of 25% in the incidence of delayed surgi-
cal recovery, based from previous studies (Schulz, 2013). According
to Schlesselman (1982), 21 participants per group, 42 participants
in total, were adequate for study. The intervention group consisted
of participants who received the telemonitoring intervention, and
the control group consisted of participants who received conven-
tional follow‐up only. Simple randomization was undertaken using
the Statistical Package for the Social Sciences (SPSS) program (SPSS,
Chicago, IL, USA).
SANTANA ET AL.
2.4 | Blinding
The investigators who collected data before randomization were
unaware of which patients would receive the intervention or conven-
tional follow‐up consultations. The nurse who was responsible for call-
ing the patients was the only person who was aware of which patients
were in the control group and which were in the intervention group.
2.5 | Intervention protocol
Patients in the intervention group received telephone calls at 48 hours,
4 weeks, and 8 weeks after surgery. Figure 1 shows how the patients'
monitoring was performed. To avoid bias, 3 members of the team were
chosen to collect data, another investigator was responsible for the
randomization procedure, and a fifth person was in charge of calling
the patients in the control group to schedule consultations in the out-
patient clinics. The calls were made by a gerontology and perioperative
nursing specialist.
During the calls, the nurse used a script with questions and recom-
mended interventions to be delivered over the phone, depending on
the patient's answer to each question. Recommendations were made
to minimize the following problems: pain, urinary incontinence, incision
or ostomy‐related complications, risk for infection, physical health or
self‐care limitations, nutritional problems, and health maintenance
issues. Medical staffs from the hospital were contacted whenever
the nurse concluded that a patient needed in‐person reassessment or
procedures.
Participants in the control group received conventional follow‐up.
They were contacted by telephone to schedule medical appointments
at the outpatient clinics, which is the routine follow‐up approach used
at the 2 hospitals. During these appointments, patients usually receive
a standardized discharge plan.
The data collection team was trained to identify the nursing diag-
nosis “delayed surgical recovery” as defined by the NANDA Interna-
tional taxonomy as “the extension of days required to initiate
activities that maintain life, health, and well‐being” (Herdman &
Kamitsuru, 2014). Defining characteristics of delayed surgical recov-
ery, such as impaired mobility, needing assistance for self‐care, fatigue,
and time required for recuperation, and related factors (eg, pain, post-
operative infection), were the study variables of interest, while the
presence or the absence of this nursing diagnosis was the main out-
come measure. Patients in both groups were assessed at 3 different
times:
FIGURE 1 Monitoring of the intervention group
3 of 8
• Time 1 (D1)—from 24 to 48 hours after surgery, while the patient
was still in the hospital.
• Time 2 (D2)—4 weeks after surgery, during the patient's follow‐up
consultation with a physician.
• Time 3 (D3)—8 weeks after surgery, during the patient's follow‐up
consultation with a physician and probable surgical discharge.
2.6 | Statistical analysis
Descriptive analysis was performed using frequencies, percentages,
ranges, means, and standard deviations. The following tests were per-
formed for inferential analysis, at a significance level of 0.05 or less:
• For categorical data analysis, a Fisher's exact test or a chi‐squared
test was used, in the presence of significant differences in social
and demographic variables.
• For numeric data, a Student's t‐test or a Mann‐Whitney test was
used, based on normality assumptions.
• For repeated measures of categorical data, an analysis of variance
(ANOVA) was used, in the presence of significant variation in the
ratio of categorical data over time (time effect), using the categor-
ical modelling data procedure of the SAS® software (SAS Institute
Inc., Cary, NC, USA).
2.7 | Ethical considerations
Ethical approval was obtained from hospital 1 (Certificate for Ethical
Appreciation number: 221.674) and hospital 2 (Certificate for Ethical
Appreciation number: 000.499). All participants signed an informed
consent form.
3 | RESULTS
3.1 | Participants
A total of 83 participants were assessed for eligibility. Forty were not
eligible for the study for the following reasons: refusal to participate
(n = 10), delayed surgical recovery before hospital discharge (n = 10),
readmission (n = 2), presence of complications before the surgical pro-
cedure (n = 4), died before or after the surgery (n = 4), and
4 of 8 SANTANA ET AL.

hospitalization for diagnostic investigation (n = 10). The remaining 43
participants were randomized into 2 groups: 21 were allocated to the
control group and 22 to the intervention group. All continued to partic-
ipate until the end of the study. Figure 2 presents the CONSORT flow
diagram of participants throughout the study.
3.2 | Base data
Table 1 provides the frequency (n) and percentage (%) of social and
demographic characteristics based on group (intervention and control)
and the corresponding chi‐squared or Fisher's exact tests (P value).

FIGURE 2 CONSORT flow diagram

TABLE 1 Social and demographic variables (n = 43)

Experiment (n = 22) Control (n = 21)
Variables n % n % P Valuea

Gender
Male 14 63.6 11 52.4 .46
Female 8 36.4 10 47.6
Ageb 66.9 (60‐82) 70.7 (60‐89) .10
Surgery/diagnosis
Colectomy 16 72.7 16 76.2 .80
Gastrectomy 6 27.3 5 23.8 .80
Diabetes 4 18.2 5 23.8 .47
Dyslipidaemia 2 9.1 1 4.8 .52
Cancer 17 77.3 18 85.7 .38
Subarachnoid haemorrhage 7 31.8 9 42.9 .45
Anaemia 2 9.1 5 23.8 .19
Respiratory failures 0 0 0 0 1
HIV 0 0 0 0 1

χ or Fisher's exact test.

a 2

b
Average ± standard deviation (minimum‐maximum) compared through Student's t‐test for independent samples.
SANTANA ET AL. 5 of 8

Table 2 shows the frequency (n) and percentage (%) of the defin-
ing characteristics according to group and the corresponding chi‐
squared or Fisher's exact tests from the 3 time point evaluations, to
identify delayed surgical recovery. The existence of a homogeneous
sample was verified through seeking significant differences in the
social and demographic characteristics between the intervention and
control groups. However, no significant differences at the 5% level
were seen in the social and demographic variables between the 2
treatment groups; therefore, groups are homogeneous.
to receive instructions, especially about surgical incision care and ther-
apeutic regimen directions.
Table 3 shows interventions required over the follow‐up period.
The lowest number of requirements occurred in the fourth week (22
demands), and the highest at the first week (135 needs). The need
for interventions such as bowel control and therapeutic regimen main-
tenance was the same over time, while return to daily activities
decreased in the first weeks and increased after the fourth week.
There were no complaints about postoperative nausea, and all partici-
pants in the intervention group reported positive expectations.

3.3 | Intervention uptake

All participants from the intervention group interacted with the nurse
3.4 | Outcomes and estimates
on the phone during the study follow‐up days. Sometimes, study par- There was a significant increase in delayed surgical recovery from D1
ticipants passed the phone to a person from the family or a caregiver to D2 (P = .007) and from D1 to D3 (P = .013) in the control group.

TABLE 2 Distribution of defining characteristics, related factors, and the nursing diagnosis delayed surgical recovery during the 3 assessments (D1,
D2, D3) (n = 43)

D1 D2 D3
Case Control Case Control Case Control
(n = 22) (n = 21) (n = 22) (n = 21) (n = 22) (n = 21)
Variables n % n % P Valuea N % n % P Valuea n % n % P Valuea
Defining characteristics
Postpones resumption of work 6 27.3 4 19.1 .39 3 13.6 3 14.3 .65 3 13.6 2 9.5 .52
Impaired mobility 1 4.6 9 42.9 .003 1 4.6 9 42.9 .003 0 0.0 5 23.8 .021
Requires assistance for self‐care 5 22.7 7 33.3 .44 0 0.0 6 28.6 .009 0 0.0 4 19.1 .049
Fatigue 9 40.9 13 61.9 .17 0 0.0 4 19.1 .048 1 4.6 3 14.3 .28
Excessive time required for recuperation 0 0.0 5 23.8 .021 0 0.0 4 19.1 .048 0 0.0 2 9.5 .23
Evidence of interrupted healing 1 4.6 1 4.8 .74 0 0.0 1 4.8 .49 0 0.0 0 0.0 NA
of surgical area
Loss of appetite with nausea 3 13.6 2 9.5 .52 0 0.0 1 4.8 .49 1 4.6 0 0.0 .51
Loss of appetite without nausea 1 4.6 3 14.3 .29 0 0.0 1 4.8 .49 0 0.0 1 4.8 .49
Related factors
Pain 7 31.8 8 38.1 .67 2 9.1 4 19.1 .31 1 4.6 2 9.5 .48
Postoperative emotional response 9 40.9 6 28.6 .40 4 18.2 4 19.1 .62 7 31.8 6 28.6 .82
Perioperative surgical site infection 0 0.0 1 4.8 .49 3 13.6 4 19.1 .47 0 0.0 1 4.8 .49
Obesity 3 13.6 2 9.5 .52 3 13.6 2 9.5 .52 3 13.6 2 9.5 .52
Extensive surgical procedure 22 100 21 100 NA 21 95 21 100 .51 21 95 21 100 .51
Prolonged surgical procedure 2 9.1 1 4.8 .52 2 9.1 1 4.8 .52 2 9.1 1 4.8 .52
Delayed surgical recovery 0 0 0 0 NA 3 13.6 9 42.9 .033 3 13.6 8 38.1 .067

NA, not applicable.

χ or Fisher's exact test.
a 2

TABLE 3 Nursing interventions during follow‐up (n = 22)

Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8,
Interventions n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)

Surgical wound care 22 (100) 22 (100) 5 (22.7) 1 (4.5) 1 (4.5) ‐ ‐ ‐

Pain 22 (100) 6 (27.3) 1 (4.5) ‐ ‐ ‐ ‐ ‐
Nausea 22 (100) ‐ ‐ ‐ ‐ ‐ 1 (4.5) 1 (4.5)
Anxiety reduction 22 (100) ‐ ‐ ‐ ‐ ‐ ‐ ‐
Diet planning 22 (100) 17 (77.3) 5 (22.7) ‐ ‐ ‐ ‐ ‐
Energy control 22 (100) 5 (22.7) ‐ ‐ ‐ ‐ 1 (4.5) 1 (4.5)
Bowel control 22 (100) 2 (9.0) 2 (9.0) 2 (9.0) 2 (9.0) 2 (9.0) 2 (9.0) 2 (9.0)
Return to daily activities 22 (100) 17 (77.3) 6 (27.3) 6 (27.3) 15 (68.2) 15 (68.2) 13 (59) 15 (68.2)
Therapeutic regimen maintenance 22 (100) 22 (100) 22 (100) 22 (100) 22 (100) 22 (100) 22 (100) 22 (100)
6 of 8
On the other hand, there was a significant decrease in “fatigue” from
D1 to D2 (P = .007; P = .015) and from D1 to D3 (P = .013; P = .004)
in the intervention and control groups, respectively.
The other defining characteristics showed no significant variations
at the 5% level over the 3 assessments within the groups, and findings
indicated a downward trend in the need for assistance for self‐care
from D1 to D2 (P = .073) and from D1 to D3 (P = .073) in the interven-
tion group.
About the assessment of related factors, it was observed that pain
decreased from D1 to D3 in both groups (P = .041), while the other
related factors did not have significant variation at the 5% level over
the 3 assessments.
The intervention group had a lower frequency of delayed surgical
recovery (P = .033), impaired mobility (P = .003), need for assistance for
self‐care (P = .009), fatigue (P = .048), and time required for recupera-
tion (P = .048) at D2. Other defining characteristics and factors showed
no significant differences in this time point.
4 | DISCUSSION
Over the course of the study, it was observed that the frequency of
delayed surgical recovery increased significantly in the control group.
Studies consider that older adults have an increased chance of compli-
cations in the postoperative period, with rates ranging between 24.0%
and 67.7% (Abrahamsen, Haugland, & Ranhoff, 2016). Our findings
confirm estimates from the National Cancer Institute, which describe
a higher incidence of colorectal cancer (the leading cause of colectomy)
and gastric cancer (the leading cause of gastrostomy) in patients over
60 years (World Health Organization, 2002).
Initially, participants were dependent on a caregiver to perform
self‐care, which was overcome by interventions for assistance with
pain, reduction of anxiety, and difficulty in performance of daily activ-
ities recommended to patients and caregivers in successive telephone
calls. Including caregivers in the telephone follow‐up program was
shown to be effective in providing patient independence by teaching
caregivers, rather than the patients, how to help the patient to do
things by themselves. This provided self‐confidence and independence
for patients. This could be a major contribution of perioperative nurses,
in providing continuity of operative care in the home by telephone,
delivering teaching and support for the return of activities of daily
living.
The average length of hospital stay was 15.5 days, which
exceeded that described in the medical literature (McClelland & Smith,
2016), which indicates an estimate of 6 to 8 days to discharge. Factors
such as hospitalization with no date set for a surgical procedure, clini-
cal research during hospitalization, cancellation of surgery, and
increased postoperative days all contribute to extension of hospital
length of stay. Although we have not investigated these factors exten-
sively, it is likely that they all occurred in this study.
The occurrence of fatigue decreased in the intervention group
from D1 to D2. The presence of postoperative fatigue is more com-
mon in patients who have comorbidities, and its frequency can range
from 30% to 95% in older adults (Pereira et al., 2014). We believe that
the telemonitoring intervention was effective in minimizing fatigue in
SANTANA ET AL.
our sample, because participants who received the intervention
reported less episodes of energy exhaustion and frustration when
returning to their daily activities. Telephone instructions included rec-
ommendations of time necessary for rest and progressive initiation of
daily activities, such as self‐care, short walks, going to the market, par-
ticipating in family reunions, and driving.
Regarding nutritional status, at assessment, the average nutritional
status remained close to the normal range, and improved over time.
Gastrostomy and colectomy are surgeries that potentially impair nutri-
tional health; however, the preoperative nutritional status of the
patients directly affects the recovery of bodily functions after surgery.
We observed that 50% of those who were excluded as their surgical
recovery predischarge was delayed had malnutrition, while the other
half was at risk of malnutrition. Improvements in nutritional status over
the postoperative days were noticed in the assessments of defining
characteristics such as loss of appetite and nausea. Patients from both
groups had decreasing reports of these symptoms, but the intervention
group improved slightly better than the control group. Authors of a
study with 141 patients undergoing various types of surgery observed
that nausea and vomiting were the most frequent symptoms, from a
total of 169 symptoms, reported by the patients via telephone calls.
Similarly, most symptoms began after surgery and decreased later
(Hundt et al., 2005).
Pain was another symptom that decreased over time in this study.
Studies show that pain is a frequent complaint in patients over
60 years, particularly when they experience general surgeries such as
gastrostomy, colectomy, and exploratory laparotomy (Barbosa et al.,
2014; Couceiro, Valença, Lima, de Menezes, & Raposo, 2009). Nurses
must be aware of this symptom and its management because uncon-
trolled pain is related to postoperative complications and readmissions
(Wilson & Low, 2017).
Another important factor that was assessed in this study was sur-
gical site infection, which can be identified within 30 days after gastro-
intestinal surgery (Pivoto, Lunardi Filho, Santos, Almeida, & Silveira,
2010). Although we did not identify significant increase or decrease
of this complication at the 5% level of significance, we noticed that
some patients in both groups reported surgical site infections, particu-
larly at D2. This type of infection can be prevented in most cases by
adhering to proper sterile techniques, but host defence plays a very
important role in minimizing colonization of surgical wounds during
the postoperative period (Sessler, 2006).
Complete healing and suture removal occurred in 93.4% of the
cases by the fourth week. Secondary intention healing occurred in only
1 case, in a patient following colectomy. Authors of another study have
reported that 76% of surgical wound infections present by the seventh
day after discharge, with the remaining 23% presenting during the sec-
ond week after discharge (Sasaki et al., 2011).
Telemonitoring is an effective strategy to prevent and minimize
problems, especially when patients are far from clinics or when access
to healthcare is difficult. The Global Guidelines for the Prevention of
Surgical Site Infection include 16 recommendations for preventing
infections during and after surgery, and many of those recommenda-
tions can be taught to patients (World Health Organization, 2016).
Regarding therapeutic regimen management, we noticed that all
patients from the intervention group needed some recommendations,
SANTANA ET AL.
although they reported that they were feeling well at the first tele-
phone call. Instructions included wound care; administration of analge-
sics, anti‐inflammatories, and antibiotics; and reminders about the
importance of monitoring and controlling chronic diseases. This indi-
cates that it is important to invest time in clarifying postoperative
patients' understanding of instructions given at discharge.
Comparisons between the 2 groups showed that patients in the
intervention group had significantly less problems, such as impaired
mobility, need for assistance for self‐care, fatigue, and time required
for recuperation. Those problems are related to the surgical proce-
dures themselves, which often result in impaired ability to move and
to promote self‐care because of surgery‐related pain and fatigue
(Santana, do Amaral, Pereira, Delphino, & Cassiano, 2014). Patients
from the intervention group were instructed not only about how to
deal with those limitations but also about how to return to their daily
life activities such as shopping, going to the bank, performing house-
hold activities, and driving (Duarte, Andrade, & Lebrão, 2007). We
believed that the instructions on this topic were essential to interven-
tion group autonomy and better recovery compared to the control
group. Therefore, the relevance of this study lies in the fact that
telemonitoring is a low‐cost and effective nursing intervention, and
further study is warranted.
4.1 | LIMITATIONS
The limitations of this study are associated with the need for a
larger sample that could result in identification of other statistically
significant differences. There were difficulties during recruitment,
such as cultural barriers and the hospitalization itself, making
some participants feel that that was not a good time to participate
in a study.
5 | C O N CL U S I O N
Systematic nursing practice involves the use of strategies to support
implementation of nursing activities and to improve patients' health
state efficiently and effectively. Telemonitoring was used in this study
to provide postoperative recommendations for older adults after
discharge and resulted in improved health status and better
postsurgical recovery compared with conventional, in‐person follow‐
up. Telemonitoring is especially recommended in the presence of bar-
riers that can hinder access to a hospital or clinic, which is a common
problem in developing countries.
The adoption of telemonitoring during postsurgical follow‐up of
older adults has implications for nursing practice, such as improvement
of the quality of nursing care, use of a standardized nursing
language, and contribution to knowledge development. In addition,
telemonitoring makes it possible to target nursing interventions and
to promote an expanded view of nursing care. Thus, researchers and
policy makers should coordinate efforts to make technology‐related
nursing activities, such as telephone interventions and telemonitoring,
more accessible to patients, and should use economic analysis to bet-
ter understand its contribution.
7 of 8
ACKNOWLEDGEMENTS
Research entitled “Effectiveness of monitoring by phone the surgical
recovery of surgical patients” was conducted with financial support
from the Foundation for Research Support of the State of Rio de
Janeiro—FAPERJ, process E‐26/103.269/2012, and the Institutional
Program for Scientific Initiation Scholarships (AGIR/PROPPi/UFF) of
the National Council for Scientific and Technological Development
(CNPq), process IT‐134354/2014‐2015. The complete protocol of
clinical study does not appear in any database.
CONFLIC T OF IN TE RE ST S TAT EME NT
No conflict of interest.
AUTHORSHIP STATEMENT
Rosimere Ferreira Santana: Made contribution to analysis and interpre-
tation of data, revising it critically for important intellectual content
and submitting it. Gave final approval of the version to be published.
Shimmenes Kamacael Pereira: Made contributions to conception,
design, and acquisition of data. Gave final approval of the version to
be published.
Thalita Gomes do Carmo: Made contribution providing language
help, drafting the version to be published, revising it critically for
important intellectual content and submitting it. Gave final approval
of the version to be published.
Vanessa Emille Carvalho de Sousa Freire: Made contribution pro-
viding language help, revising the version to be published, and gave
final approval of the version to be published.
Thais da Silva Soares: Made contribution to analysis and interpre-
tation of data. Gave final approval of the version to be published.
Dayana Medeiros do Amaral: Made contribution to analysis and
interpretation of data. Gave final approval of the version to be
published.
Raquel Dantas Vaqueiro: Made contribution to analysis and inter-
pretation of data. Gave final approval of the version to be published.
ORCID
Rosimere Ferreira Santana http://orcid.org/0000-0002-4593-3715
Thalita Gomes do Carmo http://orcid.org/0000-0002-5868-667X
Vanessa Emille Carvalho de Sousa Freire http://orcid.org/0000-0003-
3571-0267
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How to cite this article: Santana RF, Pereira SK, do Carmo TG,
et al. Effectiveness of a telephone follow‐up nursing interven-
tion in postsurgical patients. Int J Nurs Pract. 2018;24:
e12648. https://doi.org/10.1111/ijn.12648