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Arakelian, Erebouni
Publications (10 of 13) Show all publications
Lögde, A., Rudolfsson, G., Runeson, R., Rask-Andersen, A., Wålinder, R. & Arakelian, E. (2018). I am quitting my job: Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job. International Journal for Quality in Health Care, 30(4), 313-320
Open this publication in new window or tab >>I am quitting my job: Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job
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2018 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, no 4, p. 313-320Article in journal (Refereed) Published
Abstract [en]

The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university-and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
Keywords
quitting job, specialist nurse, qualitative, interviews
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-356800 (URN)10.1093/intqhc/mzy023 (DOI)000432295500012 ()29518200 (PubMedID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-17Bibliographically approved
Leo Swenne, C., Hjelte, L., Härdne, E., Friberg, C. & Arakelian, E. (2018). Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay. Nordic journal of nursing research
Open this publication in new window or tab >>Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay
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2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Article in journal (Refereed) Epub ahead of print
Abstract [en]

The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.

Place, publisher, year, edition, pages
SAGE Publications Ltd, 2018
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-342785 (URN)10.1177/2057158518754785 (DOI)
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-02-23Bibliographically approved
Swenne, C. L., Jangland, E. & Arakelian, E. (2017). Patients' experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a qualitative follow-up study. Scandinavian Journal of Caring Sciences, 31(4), 904-913
Open this publication in new window or tab >>Patients' experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a qualitative follow-up study
2017 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 904-913Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have a long recovery process.

AIM: To describe patients' experiences of their everyday lives after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

METHOD: A follow-up study with a qualitative, descriptive design. Data were collected by individual, in-depth telephone interviews with 16 patients who had been treated for peritoneal carcinomatosis 14 months earlier at a university hospital in Sweden. The interviews were performed between May and June 2013 and analysed using systematic text condensation.

RESULTS: Five themes were identified: (i) finding one's new self and relating to the new situation; (ii) the disease making its presence felt through bodily complications or mental fatigue; (iii) worrying about the return of the disease and passing it on to one's children; (iv) experiencing difficulties contacting various care facilities, not having a clear plan for ongoing rehabilitation; and (v) the need for online support through the Internet and counselling for both patients and their family members.

CONCLUSIONS: Despite bodily complications, mental fatigue and worries about the return of the disease, the patient's everyday life was focused on finding his/her new self and adapting to the new circumstances. Difficulties in contacting care facilities and the lack of an ongoing medical and nursing rehabilitation plan called for a need for network support for patients and their families.

CLINICAL RELEVANCE: After advanced surgery, patients require a continuous medical and nursing rehabilitation plan, and a platform of support such as meetings via social media and Internet which would connect former patients and their families with future patients and their family members. A contact nurse with specific expertise should design an individual rehabilitation plan and continuously identify the individual needs for long-term support.

Keywords
cancer, everyday life, need for support, patients’ experiences, peritoneal carcinomatosis, rehabilitation plan
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-319014 (URN)10.1111/scs.12412 (DOI)000416413000029 ()28124449 (PubMedID)
Available from: 2017-03-30 Created: 2017-03-30 Last updated: 2018-02-05Bibliographically approved
Arakelian, E., Swenne, C. L., Lindberg, S., Rudolfsson, G. & von Vogelsang, A.-C. (2017). The meaning of person-centred care in the perioperative nursing context from the patient's perspective: an integrative review. Journal of Clinical Nursing, 26(17-18), 2527-2544
Open this publication in new window or tab >>The meaning of person-centred care in the perioperative nursing context from the patient's perspective: an integrative review
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2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 17-18, p. 2527-2544Article, review/survey (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing.

BACKGROUND: Person-centred care is used, but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts.

DESIGN: Integrative Review.

METHODS: A two-part search strategy was employed: first, a computerised database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004-2014, was performed, and second, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected, and an integrative review was conducted.

RESULTS: Four themes were discovered: 'being recognised as a unique entity and being allowed to be the person you are', 'being considered important by having one's personal wishes taken into account', 'the presence of a perioperative nurse is calming, prevents feelings of loneliness and promotes well-being, which may speed up recovery' and 'being close to and being touched by the perioperative nurse during surgery'.

CONCLUSIONS: Person-centred care means respecting the patient as a unique individual, considering the patient's particularities and wishes and involving the patient in their own care. Person-centred care also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone.

RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of person-centred care, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient, resulting in personalisation of care rather than simply defining the concept.

Keywords
integrative review, nursing, patient perspective, perioperative, person-centred care
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-319489 (URN)10.1111/jocn.13639 (DOI)000408919200003 ()27862496 (PubMedID)
Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2018-03-19Bibliographically approved
Jangland, E., Yngman Uhlin, P. & Arakelian, E. (2016). Between two roles - Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews. Nurse Education in Practice, 21, 93-99
Open this publication in new window or tab >>Between two roles - Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews
2016 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 21, p. 93-99Article in journal (Refereed) Published
Abstract [en]

The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-311127 (URN)10.1016/j.nepr.2016.10.005 (DOI)000389159100013 ()27769020 (PubMedID)
Available from: 2016-12-21 Created: 2016-12-21 Last updated: 2017-11-29Bibliographically approved
Swenne, C. L., Cederholm, K., Gustafsson, M. & Arakelian, E. (2015). Postoperative health and patients' experiences of efficiency and quality of care after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, two to six months after surgery. European Journal of Oncology Nursing, 19(2), 191-197
Open this publication in new window or tab >>Postoperative health and patients' experiences of efficiency and quality of care after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, two to six months after surgery
2015 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 19, no 2, p. 191-197Article in journal (Refereed) Published
Abstract [en]

Purpose: To study post-discharge health after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and to. analyse patients' experiences of in-hospital efficiency and quality of care. Methods: In-depth individual telephone interviews using an interview guide with open-ended questions were performed with 19 patients with peritoneal carcinomatosis between April and October, 2012. Data were analysed with systematic text condensation. Results: Four themes were identified: 1) Coming home was an essential step in the recovery process and the focus was on getting well physically despite mental stress, uncertainty about the medical rehabilitation plan and the future. 2) Health was affected negatively by postoperative chemotherapy and its side effects. 3) Stoma - a necessary evil affecting the patient's social life. 4) Quality of care and efficiency were defined in patient-centred terms and inter-personal care from the patient's perspectives on Micro level. Despite all, 32% of the patients described being fully recovered and had started to study or work two months after surgery. Conclusions: The study gives insights into some real-life experiences described by patients. The study results can be used to prepare written information, to design a postoperative rehabilitation plan for future patients with Peritoneal Carcinomatosis (PC) and to create a home-page through which patients can receive support from both health care professionals and other fellow patients.

Keywords
Postoperative health, Perception, Efficiency, Quality of care, Peritoneal carcinomatosis
National Category
Nursing Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-253263 (URN)10.1016/j.ejon.2014.05.007 (DOI)000353748700014 ()
Available from: 2015-05-26 Created: 2015-05-25 Last updated: 2017-12-04Bibliographically approved
Eriksson, H., Haglund, K., Leo Swenne, C. & Arakelian, E. (2014). Patients' experiences of postoperative health related to cytoreductive surgery and hyperthermic intraoperative chemotherapy. Journal of Clinical Nursing, 23(1-2), 201-210
Open this publication in new window or tab >>Patients' experiences of postoperative health related to cytoreductive surgery and hyperthermic intraoperative chemotherapy
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 1-2, p. 201-210Article in journal (Refereed) Published
Abstract [en]

Aims and objectives.To study patients’ descriptions of their health after cytoreductive surgery (CRS) before discharge.

Background. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) affects the patient’s recovery. The hospital stay is long, and it is important to study how patients experience their health postoperatively.

Design. Qualitative descriptive design.

Methods. Between January–May 2012, individual interviews were conducted with 20 patients in a university hospital in cen- tral Sweden using a semi-structured interview guide. Data were analysed using qualitative content analysis.

Results. Three themes (a process, body and mind, and support) and nine categories emerged. The surgery was described as a turning point, followed by a period of hope and thankfulness. Nevertheless, patients had difficulty taking in their positive feelings because they were overwhelmed by their bodily ailments. Despite the patients’ descriptions of being on an emotional roller coaster, thinking about death and an uncertain future, or being in a state somewhere between sleep and wakefulness, they described them- selves as being in good mental health. Continuous individualised information and support from the surgeon and staff members were described as being important for the recovery process, and none of the patients asked for counselling before discharge.

Conclusion. Surgery was described as a turning point followed by an uncertain future. Despite the overwhelming nature of their bodily ailments and being on an emotional roller coaster postoperatively, patients described themselves as being in good psychological health and not needing any professional counselling. Continuous individualised information from the surgeon and staff members played an important role in the recovery process.

Relevance to clinical practice. Both staff and future patients may benefit from the patients’ experiences after CRS and HIPEC described in this study. The knowledge gained from this study could be used in designing a care plan for future patients undergoing CRS and HIPEC.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-212662 (URN)10.1111/jocn.12360 (DOI)000327883400021 ()
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2017-12-06Bibliographically approved
Arakelian, E., Torkzad, M. R., Bergman, A., Rubertsson, S. & Mahteme, H. (2012). Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment: a retrospective study. World Journal of Surgical Oncology, 10, 258
Open this publication in new window or tab >>Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment: a retrospective study
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2012 (English)In: World Journal of Surgical Oncology, ISSN 1477-7819, E-ISSN 1477-7819, Vol. 10, p. 258-Article in journal (Refereed) Published
Abstract [en]

Background: The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment option for peritoneal carcinomatosis (PC). There have been few studies on the pulmonary adverse events (AEs) affecting patient recovery after this treatment, thus this study investigated these factors. Methods: Between January 2005 and December 2006, clinical data on all pulmonary AEs and the recovery progress were reviewed for 76 patients with after CRS and HIPEC. Patients with pulmonary interventions (thoracocenthesis and chest tubes) were compared with the non-intervention patients. Two senior radiologists, blinded to the post-operative clinical course, separately graded the occurrence of pulmonary AEs. Results: Of the 76 patients, 6 had needed thoracocentesis and another 6 needed chest tubes. There were no differences in post-operative recovery between the intervention and non-intervention groups. The total number of days on mechanical ventilation, the length of stay in the intensive care unit, total length of hospital stay, tumor burden, and an American Society of Anesthesiologists (ASA) grade of greater than 2 were correlated with the occurrence of atelectasis and pleural effusion. Extensive atelectasis (grade 3 or higher) was seen in six patients, major pleural effusion (grade 3) in seven patients, and signs of heart failure (grade 1-2) in nine patients. Conclusions: Clinical and radiological post-operative pulmonary AEs are common after CRS and HIPEC. However, most of the pulmonary AEs did not affect post-operative recovery.

Keywords
Peritoneal carcinomatosis, CRS, HIPEC, Post-operative recovery, Pulmonary influences, Radiological assessment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-193642 (URN)10.1186/1477-7819-10-258 (DOI)000313158500001 ()
Available from: 2013-02-05 Created: 2013-02-05 Last updated: 2017-12-06Bibliographically approved
Arakelian, E., Gunningberg, L., Larsson, J., Norlén, K. & Mahteme, H. (2011). Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. European Journal of Surgical Oncology, 37(10), 897-903
Open this publication in new window or tab >>Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
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2011 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 37, no 10, p. 897-903Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can prolong survival in selected patients with peritoneal carcinomatosis (PC). However, there is little data on patients' recovery process after this complex treatment. This study aimed to describe the in-hospital postoperative recovery and factors related to the recovery of patients who undergo CRS and HIPEC.

METHOD:

A retrospective audit of the electronic health record (EHR) was undertaken for 76 PC patients (42 women, 34 men) treated primarily with CRS and HIPEC between 2005 and 2006 in Sweden.

RESULTS:

Oral intake, regaining bowel functions and mobilisation usually occurred between 7 and 11 days postoperatively. Patients experienced nausea for up to 13 days postoperatively. Forty-two patients were satisfied with their pain management, which usually took the form of epidural anaesthesia and which continued for about one week post-surgery. Sleep disturbance was observed in 51 patients and psychological problems in 49 patients during the first three postoperative weeks. Tumour burden, stoma formation, use of CPAP, primary diagnosis, and the length of stay in the ICU were factors related to an early recovery process.

CONCLUSION:

Drinking, eating, regaining bowel functions and mobilisation were re-established within 11 days of CRS and HIPEC. Tumour burden, stoma formation, use of CPAP, primary diagnosis and the length of stay in the ICU all had an impact on postoperative recovery, and should be discussed with the patients preoperatively and taken into consideration in designing an individualised patient care plan, in order to attain a more efficient recovery.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-159496 (URN)10.1016/j.ejso.2011.06.003 (DOI)000295894900010 ()21783337 (PubMedID)
Available from: 2011-10-03 Created: 2011-10-03 Last updated: 2017-12-08Bibliographically approved
Arakelian, E., Gunningberg, L. & Larsson, J. (2011). How operating room efficiency is understood in a surgical team: a qualitative study. International Journal for Quality in Health Care, 23(1), 100-106
Open this publication in new window or tab >>How operating room efficiency is understood in a surgical team: a qualitative study
2011 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, no 1, p. 100-106Article in journal (Refereed) Published
Abstract [en]

Objective. Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency'understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency.

Design. Qualitative study.

Settings. A 1100-bed Swedish university hospital.

Participants. Eleven participants, nine team members from the same team and their two leaders were interviewed.

Methods. The analysis was performed according to phenomenography, a research approach that aims to discover variationsin peoples' understanding of a henomenon.

Results. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites,enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders.

Conclusions. The seven ways of understanding operating room efficiency appear to represent both organization-oriented andindividual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.

Keywords
Leadership, quality management, qualitative methods, general methodology, teamwork, human resources
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-138784 (URN)10.1093/intqhc/mzq063 (DOI)000286474000012 ()21098628 (PubMedID)
Available from: 2010-12-20 Created: 2010-12-20 Last updated: 2017-12-11Bibliographically approved
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