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  • 1.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Laurssen, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Older Patients' Worries in Connection With General Anesthesia and Surgery - A Qualitative Study2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 6, p. 822-833Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine anxiety and what older patients worry about related to anesthesia and colorectal surgery, and their perceptions regarding nurses' ability to ease preoperative worry.

    Design: Qualitative individual face-to-face interviews.

    Methods: The study included 18 patients aged between 62 and 91 years with lower abdominal tumors. The study was conducted in two day-surgery wards in Sweden. Interview data were analyzed with Malterud's systematic text condensation.

    Findings: Four themes were identified: (1) losing control of one's body, leaving one's life in someone else's hands, and the feeling that there is no going back, (2) claustrophobia and anticipated pain in an unknown environment, (3) unknown and frightening vocabulary concerning the surgery, and (4) what can happen if something goes wrong.

    Conclusions: Patients worry about a number of things. If preoperative worry could be identified, actions taken to reduce worry could be personalized and patients' own strategies to reduce worries may be helpful for them.

  • 2.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Nyholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Enblad: Neurosurgery.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    How Anesthesiologists and Nurse Anesthetists Assess and Handle Patients' Perioperative Worries Without a Validated Instrument2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 4, p. 810-819Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study how nurse anesthetists and anesthesiologists assess and handle patients' perioperative anxiety without using a validated instrument.

    DESIGN: Qualitative study.

    METHODS: Individual in-depth face-to-face interviews were conducted with nurse anesthetists (n = 9) and anesthesiologists (n = 5) from a university hospital in Sweden. Data were analyzed with thematic analysis according to Braun and Clark.

    FINDINGS: Two themes were identified: (1) I ask about anxiety, look for visual signs, and observe communication and (2) I handle patients' anxieties individually. In addition to subthemes describing assessment and handling of adults, it appeared that parents played an important role in children's perioperative anxiety.

    CONCLUSIONS: When not using a validated instrument, assessing perioperative anxiety is commonly based on the anesthesiologist's and nurse anesthetist's experience, knowledge, views, and attitudes. The evaluator's capability of using different strategies in the assessment and handling of perioperative anxiety is important.

  • 3.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Rudolfsson, Gudrun
    Univ West, Dept Hlth Sci, Div Nursing, Trollhattan, Sweden; Nord Univ, Fac Nursing & Hlth Sci, Bodo, Norway.
    Rask-Andersen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Runeson, Roma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Wålinder, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    I Stay: Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 3, p. 633-644Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace.

    DESIGN: Qualitative design.

    METHODS: Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud.

    FINDINGS: Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone's equal value and resulting in a feeling of homelikeness. (2) Sustained development in one's own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them.

    CONCLUSIONS: In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.

  • 4. Engström, Åsa
    et al.
    Boström, Jonas
    Karlsson, Ann-Christin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Women's Experiences of Undergoing Total Knee Joint Replacement Surgery2017In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 32, no 2, p. 86-95Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of the study was to describe women's experiences of undergoing total knee joint replacement surgery.DesignA qualitative approach was used.

    Method

    A content analysis of the text from interviews with five women was conducted.

    Findings

    The time before surgery was marked by the experience of constant pain, which affected the women negatively in their everyday lives. During surgery, the information provided by the staff gave each woman a sense of security; the women handed over responsibility to the staff and experienced a sensation of relief. The postoperative period was characterized by a feeling of joy when the surgery was over, although a rough and tedious rehabilitation phase then began. Challenges in everyday life were a factor for motivation and confidence, although postoperative pain was experienced as discouraging.

    Conclusion

    Support from health care staff is an important factor for coping with everyday life during the preoperative, perioperative and postoperative phases of undergoing knee joint replacement.

  • 5.
    Forsberg, Markus
    et al.
    Cty Council Gavleborg, Dept Anaesthesia, Gavleborg, Sweden.
    Björn, Catrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Cty Council Gavleborg, Dept Anaesthesia, Gavleborg, Sweden.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Dept Hlth & Caring Sci, Gavle, Sweden.
    Nilsson, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Univ Gavle, Fac Hlth & Occupat Studies, Dept Hlth & Caring Sci, Gavle, Sweden.
    Nurse Anesthetists' Reflections on Caring for Patients With Previous Substance Dependence: Balancing Between Professionalism and Preconceptions2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 1, p. 69-77Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The study aim was to describe nurse anesthetists' reflections on the provision of perioperative care to patients with previous substance dependence.

    DESIGN: A qualitative approach with a descriptive design.

    METHODS: Semistructured interviews based on clinical vignettes were conducted with 10 nurse anesthetists.

    FINDINGS: The perioperative care provided to patients with previous substance dependence was perceived as balancing between professionalism and preconceptions for this specific patient group. The nurse anesthetists felt that anesthetizing this group of patients constituted a challenge with regard to knowledge, experience, and time. However, the nurses also had feelings of distrust and uncertainty because of lack of knowledge.

    CONCLUSIONS: The nurse anesthetists strove to uphold the principle that patients who are/have been substance dependent have the same right to adequate treatment and care as all patients. If guidelines were developed for this patient group, care could be made safer and nurses' sense of uncertainty minimized.

  • 6.
    Jaensson, Maria
    et al.
    School of Health Sciences, Örebro University, Sweden.
    Falk-Brynhildsen, Karin
    School of Health Sciences, Örebro University.
    Gillespie, Brigid
    Griffith University, Australia.
    Yang Wallentin, Fan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Nilsson, Ulrica
    School of Health Sciences, Örebro University.
    Psychometric Validation of the PerceivedPerioperative Competence Scale-Revised inthe Swedish Context2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 3, no 4, p. 499-511Article in journal (Refereed)
    Abstract [en]

    Purpose: To psychometrically test the Perceived Perioperative Competence Scale-Revised (PPCS-R) in the Swedish context.

    Design: Cross-sectional survey.

    Methods: The 40-item PPCS-R was translated into Swedish using a forward-translation approach. A census of 2,902 registered nurse anesthetists (RNAs) and operating room (OR) nurses was drawn from a database of a national association in Sweden.

    Finding: The response rate was 39% (n = 1,033; 528 RNAs and 505 OR nurses). Cronbach alpha for each factor was 0.78 to 0.89 among OR nurses and 0.79 to 0.88 among RNAs. Confirmatory factor analysis showed good model fit in the six-factor model. Conclusions: Psychometric testing of the Swedish translation of the PPCS-R suggests a good construct validity, and the construct and its six factors are conceptually relevant among the Swedish OR nurses and RNAs.

  • 7.
    Karlsson, Ann-Christin
    et al.
    School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.; School of Health and Caring Sciences, Linnæus University, Växjö, Sweden..
    Ekebergh, Margaretha
    Larsson Mauléon, Annika
    Almerud Österberg, Sofia
    Patient-nurse anesthetist interaction during regional anesthesia and surgery based on video recordings.2013In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 28, no 5Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia.

    DESIGN: Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated.

    METHODS: A hermeneutic analysis was conducted on the data.

    FINDING: The findings of the analysis demonstrated that the NA was in either "present" presence or "absent" presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way.

    CONCLUSIONS: Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.

  • 8.
    Karlsson, Ann-Christin
    et al.
    School of Health Science, Blekinge Institute of Technology, Karlskrona; School of Health and Caring Sciences, Linnæus University, Växjö, Sweden.
    Ekebergh, Margaretha
    School of Health and Caring Sciences, Linnæus University, Växjö; School of Health Sciences, University of Borås, Borås, Sweden.
    Mauléon, Annika Larsson
    School of Health and Caring Sciences, Linnæus University, Växjö, Sweden.
    Almerud Österberg, Sofia
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    "Is that my leg?" patients' experiences of being awake during regional anesthesia and surgery2012In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 27, no 3, p. 155-164Article in journal (Refereed)
    Abstract [en]

    Most knee or hip replacement surgery is performed under regional anesthesia, when patients are awake. Previous research has primarily focused on patients' experiences during general anesthesia. The aim of this study was to uncover the meaning of being awake during regional anesthesia and surgery. Nine interviews with patients undergoing knee or hip replacement surgery comprise the data. The phenomenological analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. Four interrelated constituents further elucidated the patients' experiences: balancing between proximity and distance in the operating theater, balancing between having control and being left out, my partly inaccessible body handled by others, and the significant role of the carer. Anesthesia providers and perioperative nurses need to understand the awake patients' intraoperative experiences to support and confirm them when they can no longer experience or have full access to their body.

  • 9.
    Knudsen, Kati
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Nilsson, Ulrica
    The best method to predict easy intubation: a quasi-experimental pilot study2014In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 29, no 4, p. 292-297Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To facilitate evaluation of the airway before endotracheal intubation, different scores have been developed, mainly to predict difficult airways. However, in anesthesia clinical practice in Sweden, scores would be more useful if they could also predict an easy airway, so that the correct category of anesthesia personnel can be allocated. Therefore, we evaluated whether scoring systems commonly used to predict difficult airways could also predict easy endotracheal intubation.

    DESIGN:

    This prospective observational study included patients who were scheduled for general anesthesia and required endotracheal intubation.

    METHODS:

    Airways were evaluated preoperatively by two independent variables, namely Mallampati classification and thyromental distance. After anesthesia induction, the Cormack and Lehane grade was assessed.

    FINDING:

    Mallampati scores yielded the highest specificity in predicting easy intubation, and Cormack and Lehane grades yielded the highest positive predictive value for predicting easy intubation.

    CONCLUSIONS:

    Mallampati classification is an appropriate screening test for predicting easy intubation.

  • 10.
    Nilsson, Ulrica
    et al.
    School of Health Sciences, Örebro University.
    Göras, Camilla
    School of Health Sciences, Örebro University.
    Yang-Wallentin, Fan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Ehrenberg, Anna
    School of Health Sciences, Örebro University.
    Unbeck, Maria
    School of Health Sciences, Örebro University.
    The Swedish Safety Attitudes Questionnaire—Operating Room Version: Psychometric Properties in the Surgical Team2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 6, p. 935-945Article in journal (Refereed)
    Abstract [en]

    Purpose

    To validate the Swedish Safety Attitudes Questionnaire–operating room (SAQ-OR) version by re-evaluating its psychometric properties for the surgical team.

    Design

    Cross-sectional questionnaire study.

    Methods

    541 surgical team members including perioperative nurses, physicians, and licensed practical nurses at three Swedish hospitals were included.

    Findings

    For the total sample, the Cronbach’s α for the six factors ranged from 0.51 to 0.76. Goodness-of-fit analyses indicated that the six-factor model was acceptable and the factor loadings were statistically significant. The test of the hypothesized relationships among the factors showed a correlation from 0.936 to 0.042.

    Conclusions

    The refined Swedish version of the SAQ-OR is a reasonably reliable and acceptably valid instrument for the measurement of patient safety climate in the surgical team. However, the results related to the different analyses varied among the different professionals and further research, using larger samples, is needed to explore these differences, especially among the physicians.

  • 11.
    Randmaa, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mårtensson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Swennne, Christine Leo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    An observational study of postoperative handover in anesthetic clinics: the content of verbal information and factors influencing receiver memory2015In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 30, no 2, p. 105-115Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim was to examine the handover process in the postanesthesia care unit, how much the receiver remembered, and what factors influenced memory.

    Design

    An observational study with a descriptive and correlational design.

    Methods

    A total of 73 handovers were investigated, and data were collected using observation, audiotape recordings of the handovers, and the patient's anesthetic record.

    Finding

    Interruptions occurred at 56 (77%) handovers and the sender expressed unclear information at 51 (70%) handovers. The mean of the verbally given information remembered by the receivers was 47%; the items mostly likely not to be remembered were the drugs used during anesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with receivers' retention of information were structure and handover duration.

    Conclusion

    Lack of structure and long duration of the verbal handover decrease how much the receiver will remember.

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