Smartphone-Based Telemonitoring for Postoperative Nursing Care and Recovery

Thesis Abstract

Postoperative care after surgical discharge presents a critical window for complication detection, patient engagement, and adherence to recovery protocols; gaps in timely monitoring often lead to delayed intervention, readmissions, and suboptimal functional outcomes. This study investigates the effectiveness of smartphone-based telemonitoring to support nursing care and optimize postoperative recovery by enabling real-time symptom tracking, remote vital sign monitoring, adherence reinforcement, and rapid clinician-patient communication. The aim is to evaluate whether integrating a smartphone telemonitoring system improves recovery trajectories, reduces preventable readmissions, and enhances patient satisfaction compared with standard postoperative care.Specific objectives are (1) to determine the impact of telemonitoring on 30-day postoperative readmission rates; (2) to assess changes in wound healing progression, pain management, and functional recovery using validated scales; (3) to examine patient engagement, data completeness, and adherence to postoperative instructions; (4) to identify clinical workflows, nurse workload, and responsiveness associated with telemonitoring; and (5) to explore patients’ and nurses’ experiences to illuminate facilitators and barriers to sustained use. A mixed-methods design was employed, combining a multicenter randomized controlled trial (n = 320 patients across three tertiary hospitals) with an embedded qualitative study (n = 40 interviews of patients and 15 focus groups with nursing staff). Participants were adults undergoing elective abdominal or orthopedic surgery, discharged within 72 hours postoperatively, and possessing smartphone access. The intervention group used a smartphone app that (a) prompted daily symptom questionnaires (pain, fever, wound status, signs of infection), (b) integrated wireless wearable sensors for heart rate and activity, (c) allowed asynchronous image sharing of wounds, and (d) provided clinician-initiated alerts for predefined thresholds. Standard postoperative care served as the control. Data collection instruments included validated measures the Enhanced Recovery After Surgery (ERAS) recovery score, PROMIS Pain Interference, Mobile App Usability Scale, and the Client Satisfaction Questionnaire. Clinical data were complemented by hospital readmission records and objective postoperative functional assessments at weeks 1, 2, and 4. Quantitative analyses employed intention-to-treat principles. Primary analysis used logistic regression to compare 30-day readmission between groups, adjusting for age, comorbidities, and surgery type. Secondary analyses included repeated-measures ANOVA to evaluate trajectories of pain, activity, and wound healing, and Cox proportional hazards models for time-to-event recovery milestones. Mediation analyses explored whether adherence and timely reporting mediated the relationship between telemonitoring and outcomes. The qualitative component was analyzed using reflexive thematic analysis guided by the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology (UTAUT), with steps of familiarization, coding, theme development, and triangulation to illuminate implementation dynamics. Expected findings include a statistically significant reduction in 30-day readmissions in the telemonitoring arm (anticipated odds ratio ? 0.65, p < 0.05), accelerated recovery trajectories reflected in higher ERAS scores and faster return to baseline activity, and improved patient-reported satisfaction with care coordination. It is hypothesized that higher adherence to daily reporting and rapid nurse responsiveness will mediate improved outcomes. The study also anticipates enhanced patient empowerment and perceived safety, balanced against challenges such as digital literacy needs, data privacy concerns, and nursing workload implications. The study contributes to knowledge by providing robust evidence on how smartphone-based telemonitoring can be integrated into postoperative nursing practice to improve clinical outcomes and experiential quality, identify optimal alert thresholds, and delineate workflow modifications necessary for sustainable adoption. It advances theory by integrating Telehealth Acceptance constructs with nursing workflow models to explain adoption and sustained use in postoperative care. Practical implications include guidance for policy development, standard operating procedures for remote monitoring, data governance frameworks, and design principles for scalable mobile perioperative care solutions. In conclusion, smartphone-based telemonitoring has the potential to transform postoperative nursing care by enabling proactive symptom management, timely interventions, and patient-centered recovery pathways. Recommendations include tailoring alert sensitivity to reduce alarm fatigue, investing in digital literacy training for patients, implementing standardized nurse response protocols, and conducting longer-term follow-up studies to assess cost-effectiveness and impact on chronic postoperative outcomes.