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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 SANTANA ET AL.

assistance for self‐care, fatigue, and increased time required for interventions, and evaluation. Telephone calls allow nurses to provide
recuperation. systematic care and to complement the nursing process (Inman,
• The continuity of postoperative care at home should be systema- Maxson, Johnson, Myers, & Holland, 2011). In this study, we used tele-
tized by telephone consultation. phone calls as a postoperative intervention. The hypothesis was that
this intervention, compared to standard care, would improve patients'
The implications of this paper:
autonomy for self‐care and surgical recovery. The main study objective
• Telephone follow‐up calls represent an effective intervention was to compare the effectiveness of telephone versus conventional
expanding perioperative nursing care through the use of high acces-
follow‐up in postsurgical older adult patients.
sibility and low‐cost information technology.

• New studies are required to evaluate the cost‐effectiveness of tele-


phone follow‐up calls as an intervention. 2 | METHODS
• Continuity of postoperative care by telephone follow‐up calls
should be included in the professional training of nurses. 2.1 | Study design
This was a quasi‐experimental study, with 2 randomly selected groups.

1 | I N T RO D U CT I O N
2.2 | Setting
The aging process causes changes that can affect response to surgical The study was conducted in 2 hospitals located in Niteroi, Rio de
procedures. Considering this, older adult patients have higher rates of Janeiro State, Brazil. The first hospital is the largest teaching univer-
postsurgical complications than younger patients when experiencing sity‐affiliated hospital of the region, with 91 beds and 3 surgical cen-
gastric resection, gastrostomy, or colectomy (Oliveira et al., 2011; Su tres (1 for general surgeries, 1 for specialized surgeries, and 1 for
et al., 2016). Thus, interventions aimed at reducing postsurgical compli- gynaecological surgeries). The second hospital is a large urban hospital
cations in elderly patients are justifiable. Worldwide, the incidence of with 514 beds, comprising intensive care units, outpatient clinic, and
adverse events following surgical procedures ranges from 3% to 16%, homecare service. It includes a centre for general surgery, a centre
with a 0.5% mortality rate, with than half of these events deemed pre- for minor surgery with 9 surgical rooms, and a diagnostic centre with
ventable. Additionally, about 7 million surgical patients suffer significant 15 consultation rooms. The hospital is structured to provide surgical
complications each year (World Health Organization, 2009). At the same treatment in different specialties. From 58 services offered in this hos-
time, advances in surgical techniques make it possible to reduce surgery pital, 18 are surgical procedures. Both hospitals have outpatient clinics
time and create consistent methods to reduce hospital length of stay, in which the data collection team, comprising 3 registered nurses who
such as the use of anaesthetics with minimal side effects and minimal were also perioperative specialists, evaluated the participants of the
disruption in daily living (Carvalho, Matsuda, Stuchi, & Coimbra, 2008). study after they were discharged. Data collection was performed from
Gastrectomy consists of partial or total gastric resection. It is a January to September 2014.
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,
2.3 | Participants and sampling
& Luzia, 2010). Recovery following gastrectomy can take as long as Forty‐three patients admitted for gastrostomy or colectomy surgeries
3 months, and evidence from studies has shown that it can take 6 to were recruited for the study. Patients were eligible for the study if they
12 months for patients to reach their preoperative levels of physical were aged over 60 years and if they were submitted to gastrostomy or
health (Shan, Shan, Morris, Golani, & Saxena, 2015). Nursing interven- colectomy 24 hours to 7 days before recruitment. Patients who
tions are essential for effective surgical recovery and prevention of answered less than 75% of the telephone calls, who had cognitive
adverse events. Nurses provide instructions on self‐care after surgery, impairment or hearing loss without a companion who could answer
promote patients' autonomy and independence, and raise patients' the phone, who had postoperative complications during hospitaliza-
self‐esteem, self‐worth, and self‐efficacy. Education about how to tion, and those who had been readmitted to the hospital before the
adapt to health conditions, the temporary or permanent sequelae of first telephone call were excluded from the study.
surgery, should always be given before discharge (Mello et al., 2010). The following parameters were considered for sample size calcu-
The adoption of telecommunication in nursing care allows profes- lation: 5% significance level (α), 80% statistical testing power (1‐β),
sionals to monitor patients' health condition, so that, if needed, their and an expected decrease of 25% in the incidence of delayed surgi-
homecare plans can be modified early (Broens, van Halteren, van cal recovery, based from previous studies (Schulz, 2013). According
Sinderen, & Wac, 2007). to Schlesselman (1982), 21 participants per group, 42 participants
According to the Nursing Interventions Classification (NIC) sys- in total, were adequate for study. The intervention group consisted
tem, telephone follow‐up is defined as “providing results of testing or of participants who received the telemonitoring intervention, and
evaluating a patient's response and determining potential for problems the control group consisted of participants who received conven-
as a result of previous treatment, examination, or testing, over the tele- tional follow‐up only. Simple randomization was undertaken using
phone” (McCloskey & Bulechek, 2014). Some steps of the nursing pro- the Statistical Package for the Social Sciences (SPSS) program (SPSS,
cess can be done via telephone calls, including diagnosis, planning, Chicago, IL, USA).
SANTANA ET AL. 3 of 8

2.4 | Blinding • Time 1 (D1)—from 24 to 48 hours after surgery, while the patient
was still in the hospital.
The investigators who collected data before randomization were
unaware of which patients would receive the intervention or conven- • Time 2 (D2)—4 weeks after surgery, during the patient's follow‐up

tional follow‐up consultations. The nurse who was responsible for call- consultation with a physician.

ing the patients was the only person who was aware of which patients • Time 3 (D3)—8 weeks after surgery, during the patient's follow‐up
were in the control group and which were in the intervention group. consultation with a physician and probable surgical discharge.

2.5 | Intervention protocol 2.6 | Statistical analysis


Patients in the intervention group received telephone calls at 48 hours, Descriptive analysis was performed using frequencies, percentages,
4 weeks, and 8 weeks after surgery. Figure 1 shows how the patients' ranges, means, and standard deviations. The following tests were per-
monitoring was performed. To avoid bias, 3 members of the team were formed for inferential analysis, at a significance level of 0.05 or less:
chosen to collect data, another investigator was responsible for the
randomization procedure, and a fifth person was in charge of calling • For categorical data analysis, a Fisher's exact test or a chi‐squared
the patients in the control group to schedule consultations in the out- test was used, in the presence of significant differences in social
patient clinics. The calls were made by a gerontology and perioperative and demographic variables.
nursing specialist.
• For numeric data, a Student's t‐test or a Mann‐Whitney test was
During the calls, the nurse used a script with questions and recom-
used, based on normality assumptions.
mended interventions to be delivered over the phone, depending on
the patient's answer to each question. Recommendations were made • For repeated measures of categorical data, an analysis of variance

to minimize the following problems: pain, urinary incontinence, incision (ANOVA) was used, in the presence of significant variation in the

or ostomy‐related complications, risk for infection, physical health or ratio of categorical data over time (time effect), using the categor-

self‐care limitations, nutritional problems, and health maintenance ical modelling data procedure of the SAS® software (SAS Institute

issues. Medical staffs from the hospital were contacted whenever Inc., Cary, NC, USA).

the nurse concluded that a patient needed in‐person reassessment or


procedures.
Participants in the control group received conventional follow‐up. 2.7 | Ethical considerations
They were contacted by telephone to schedule medical appointments
Ethical approval was obtained from hospital 1 (Certificate for Ethical
at the outpatient clinics, which is the routine follow‐up approach used
Appreciation number: 221.674) and hospital 2 (Certificate for Ethical
at the 2 hospitals. During these appointments, patients usually receive
Appreciation number: 000.499). All participants signed an informed
a standardized discharge plan.
consent form.
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
3 | RESULTS
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,
3.1 | Participants
and time required for recuperation, and related factors (eg, pain, post- A total of 83 participants were assessed for eligibility. Forty were not
operative infection), were the study variables of interest, while the eligible for the study for the following reasons: refusal to participate
presence or the absence of this nursing diagnosis was the main out- (n = 10), delayed surgical recovery before hospital discharge (n = 10),
come measure. Patients in both groups were assessed at 3 different readmission (n = 2), presence of complications before the surgical pro-
times: cedure (n = 4), died before or after the surgery (n = 4), and

FIGURE 1 Monitoring of the intervention group


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hospitalization for diagnostic investigation (n = 10). The remaining 43 3.2 | Base data
participants were randomized into 2 groups: 21 were allocated to the
control group and 22 to the intervention group. All continued to partic- Table 1 provides the frequency (n) and percentage (%) of social and
ipate until the end of the study. Figure 2 presents the CONSORT flow demographic characteristics based on group (intervention and control)
diagram of participants throughout the study. 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- to receive instructions, especially about surgical incision care and ther-
ing characteristics according to group and the corresponding chi‐ apeutic regimen directions.
squared or Fisher's exact tests from the 3 time point evaluations, to Table 3 shows interventions required over the follow‐up period.
identify delayed surgical recovery. The existence of a homogeneous The lowest number of requirements occurred in the fourth week (22
sample was verified through seeking significant differences in the demands), and the highest at the first week (135 needs). The need
social and demographic characteristics between the intervention and for interventions such as bowel control and therapeutic regimen main-
control groups. However, no significant differences at the 5% level tenance was the same over time, while return to daily activities
were seen in the social and demographic variables between the 2 decreased in the first weeks and increased after the fourth week.
treatment groups; therefore, groups are homogeneous. 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)
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On the other hand, there was a significant decrease in “fatigue” from our sample, because participants who received the intervention
D1 to D2 (P = .007; P = .015) and from D1 to D3 (P = .013; P = .004) reported less episodes of energy exhaustion and frustration when
in the intervention and control groups, respectively. returning to their daily activities. Telephone instructions included rec-
The other defining characteristics showed no significant variations ommendations of time necessary for rest and progressive initiation of
at the 5% level over the 3 assessments within the groups, and findings daily activities, such as self‐care, short walks, going to the market, par-
indicated a downward trend in the need for assistance for self‐care ticipating in family reunions, and driving.
from D1 to D2 (P = .073) and from D1 to D3 (P = .073) in the interven- Regarding nutritional status, at assessment, the average nutritional
tion group. status remained close to the normal range, and improved over time.
About the assessment of related factors, it was observed that pain Gastrostomy and colectomy are surgeries that potentially impair nutri-
decreased from D1 to D3 in both groups (P = .041), while the other tional health; however, the preoperative nutritional status of the
related factors did not have significant variation at the 5% level over patients directly affects the recovery of bodily functions after surgery.
the 3 assessments. We observed that 50% of those who were excluded as their surgical
The intervention group had a lower frequency of delayed surgical recovery predischarge was delayed had malnutrition, while the other
recovery (P = .033), impaired mobility (P = .003), need for assistance for half was at risk of malnutrition. Improvements in nutritional status over
self‐care (P = .009), fatigue (P = .048), and time required for recupera- the postoperative days were noticed in the assessments of defining
tion (P = .048) at D2. Other defining characteristics and factors showed characteristics such as loss of appetite and nausea. Patients from both
no significant differences in this time point. 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
4 | DISCUSSION that nausea and vomiting were the most frequent symptoms, from a
total of 169 symptoms, reported by the patients via telephone calls.
Over the course of the study, it was observed that the frequency of Similarly, most symptoms began after surgery and decreased later
delayed surgical recovery increased significantly in the control group. (Hundt et al., 2005).
Studies consider that older adults have an increased chance of compli- Pain was another symptom that decreased over time in this study.
cations in the postoperative period, with rates ranging between 24.0% Studies show that pain is a frequent complaint in patients over
and 67.7% (Abrahamsen, Haugland, & Ranhoff, 2016). Our findings 60 years, particularly when they experience general surgeries such as
confirm estimates from the National Cancer Institute, which describe gastrostomy, colectomy, and exploratory laparotomy (Barbosa et al.,
a higher incidence of colorectal cancer (the leading cause of colectomy) 2014; Couceiro, Valença, Lima, de Menezes, & Raposo, 2009). Nurses
and gastric cancer (the leading cause of gastrostomy) in patients over must be aware of this symptom and its management because uncon-
60 years (World Health Organization, 2002). trolled pain is related to postoperative complications and readmissions
Initially, participants were dependent on a caregiver to perform (Wilson & Low, 2017).
self‐care, which was overcome by interventions for assistance with Another important factor that was assessed in this study was sur-
pain, reduction of anxiety, and difficulty in performance of daily activ- gical site infection, which can be identified within 30 days after gastro-
ities recommended to patients and caregivers in successive telephone intestinal surgery (Pivoto, Lunardi Filho, Santos, Almeida, & Silveira,
calls. Including caregivers in the telephone follow‐up program was 2010). Although we did not identify significant increase or decrease
shown to be effective in providing patient independence by teaching of this complication at the 5% level of significance, we noticed that
caregivers, rather than the patients, how to help the patient to do some patients in both groups reported surgical site infections, particu-
things by themselves. This provided self‐confidence and independence larly at D2. This type of infection can be prevented in most cases by
for patients. This could be a major contribution of perioperative nurses, adhering to proper sterile techniques, but host defence plays a very
in providing continuity of operative care in the home by telephone, important role in minimizing colonization of surgical wounds during
delivering teaching and support for the return of activities of daily the postoperative period (Sessler, 2006).
living. Complete healing and suture removal occurred in 93.4% of the
The average length of hospital stay was 15.5 days, which cases by the fourth week. Secondary intention healing occurred in only
exceeded that described in the medical literature (McClelland & Smith, 1 case, in a patient following colectomy. Authors of another study have
2016), which indicates an estimate of 6 to 8 days to discharge. Factors reported that 76% of surgical wound infections present by the seventh
such as hospitalization with no date set for a surgical procedure, clini- day after discharge, with the remaining 23% presenting during the sec-
cal research during hospitalization, cancellation of surgery, and ond week after discharge (Sasaki et al., 2011).
increased postoperative days all contribute to extension of hospital Telemonitoring is an effective strategy to prevent and minimize
length of stay. Although we have not investigated these factors exten- problems, especially when patients are far from clinics or when access
sively, it is likely that they all occurred in this study. to healthcare is difficult. The Global Guidelines for the Prevention of
The occurrence of fatigue decreased in the intervention group Surgical Site Infection include 16 recommendations for preventing
from D1 to D2. The presence of postoperative fatigue is more com- infections during and after surgery, and many of those recommenda-
mon in patients who have comorbidities, and its frequency can range tions can be taught to patients (World Health Organization, 2016).
from 30% to 95% in older adults (Pereira et al., 2014). We believe that Regarding therapeutic regimen management, we noticed that all
the telemonitoring intervention was effective in minimizing fatigue in patients from the intervention group needed some recommendations,
SANTANA ET AL. 7 of 8

although they reported that they were feeling well at the first tele- ACKNOWLEDGEMENTS
phone call. Instructions included wound care; administration of analge- Research entitled “Effectiveness of monitoring by phone the surgical
sics, anti‐inflammatories, and antibiotics; and reminders about the recovery of surgical patients” was conducted with financial support
importance of monitoring and controlling chronic diseases. This indi- from the Foundation for Research Support of the State of Rio de
cates that it is important to invest time in clarifying postoperative Janeiro—FAPERJ, process E‐26/103.269/2012, and the Institutional
patients' understanding of instructions given at discharge. Program for Scientific Initiation Scholarships (AGIR/PROPPi/UFF) of
Comparisons between the 2 groups showed that patients in the the National Council for Scientific and Technological Development
intervention group had significantly less problems, such as impaired (CNPq), process IT‐134354/2014‐2015. The complete protocol of
mobility, need for assistance for self‐care, fatigue, and time required clinical study does not appear in any database.
for recuperation. Those problems are related to the surgical proce-
dures themselves, which often result in impaired ability to move and CONFLIC T OF IN TE RE ST S TAT EME NT
to promote self‐care because of surgery‐related pain and fatigue
No conflict of interest.
(Santana, do Amaral, Pereira, Delphino, & Cassiano, 2014). Patients
from the intervention group were instructed not only about how to
AUTHORSHIP STATEMENT
deal with those limitations but also about how to return to their daily
life activities such as shopping, going to the bank, performing house- Rosimere Ferreira Santana: Made contribution to analysis and interpre-

hold activities, and driving (Duarte, Andrade, & Lebrão, 2007). We tation of data, revising it critically for important intellectual content
and submitting it. Gave final approval of the version to be published.
believed that the instructions on this topic were essential to interven-
Shimmenes Kamacael Pereira: Made contributions to conception,
tion group autonomy and better recovery compared to the control
group. Therefore, the relevance of this study lies in the fact that design, and acquisition of data. Gave final approval of the version to
be published.
telemonitoring is a low‐cost and effective nursing intervention, and
Thalita Gomes do Carmo: Made contribution providing language
further study is warranted.
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.
4.1 | LIMITATIONS Vanessa Emille Carvalho de Sousa Freire: Made contribution pro-
The limitations of this study are associated with the need for a viding language help, revising the version to be published, and gave
larger sample that could result in identification of other statistically final approval of the version to be published.
significant differences. There were difficulties during recruitment, Thais da Silva Soares: Made contribution to analysis and interpre-
such as cultural barriers and the hospitalization itself, making tation of data. Gave final approval of the version to be published.
some participants feel that that was not a good time to participate Dayana Medeiros do Amaral: Made contribution to analysis and
in a study. 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.
5 | C O N CL U S I O N

ORCID
Systematic nursing practice involves the use of strategies to support
implementation of nursing activities and to improve patients' health Rosimere Ferreira Santana http://orcid.org/0000-0002-4593-3715
state efficiently and effectively. Telemonitoring was used in this study Thalita Gomes do Carmo http://orcid.org/0000-0002-5868-667X
to provide postoperative recommendations for older adults after Vanessa Emille Carvalho de Sousa Freire http://orcid.org/0000-0003-
discharge and resulted in improved health status and better 3571-0267
postsurgical recovery compared with conventional, in‐person follow‐
up. Telemonitoring is especially recommended in the presence of bar- RE FE RE NC ES
riers that can hinder access to a hospital or clinic, which is a common
Abrahamsen, J. F., Haugland, C., & Ranhoff, A. H. (2016). Assessment of
problem in developing countries. recovery in older patients hospitalized with different diagnoses and
The adoption of telemonitoring during postsurgical follow‐up of functional levels, evaluated with and without geriatric assessment.
European Review of Aging and Physical Activity, 13(5), 1–7. https://doi.
older adults has implications for nursing practice, such as improvement
org/10.1186/s11556‐016‐0166‐y
of the quality of nursing care, use of a standardized nursing
language, and contribution to knowledge development. In addition, Barbosa, M.H., de Araújo, N.F., da Silva, J.A., Corrêa, T.B., Moreira, T.M., &
Andrade, E.V. (2014). Pain assessment intensity and pain relief in
telemonitoring makes it possible to target nursing interventions and
patients post‐operative orthopedic surgery. Escola Anna Nery
to promote an expanded view of nursing care. Thus, researchers and Revista de Enfermagem, 18(1), 143–147. doi:https://doi.org/10.5935/
policy makers should coordinate efforts to make technology‐related 1414‐8145.20140021.
nursing activities, such as telephone interventions and telemonitoring,
Broens, T., van Halteren, A., van Sinderen, M., & Wac, K. (2007). Towards
more accessible to patients, and should use economic analysis to bet- an application framework for context‐aware m‐health applications.
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