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Bakgrund: World Health Organization gör tydligt att patientsäkerhet är av högsta prioritet för att kunna bedriva säker kirurgi. Kirurgi bedrivs i komplexa miljöer och det föreligger alltid risk för vårdskada. Operationssjuksköterskan kan med sin unika kompetens bidra till att säkerställa patientsäkerheten genom att använda ett säkerhetsmedvetet arbetssätt. Checklista för säker kirurgi är ett säkerhetsverktyg som främjar och optimerar samverkan och kommunikation vid kirurgi. Internationell forskning pekar på att det finns brister i användningen av den.

Syftet: Att undersöka följsamheten till checklista för säker kirurgi med avseende på delen kontroll inför op-start med specifikt fokus på operationssjuksköterskans punkter.

Metod: Datainsamling genomfördes på två universitetssjukhus i mellansverige på två operationsverksamheter genom 24 strukturerade icke-deltagande observationer under kontroll inför op-start. Som teoretisk referensram användes Schweizerostmodellen.

Resultat: Visade att kontroll inför op-start genomfördes på alla observationer, att följsamheten för den personal som skulle initiera checklistan var låg och att följsamheten till punkterna varierade mellan operationsverksamheterna. Vidare påvisades att operationssjuksköterskans följsamhet till kontroll inför op-start har brister.

Slutsats: Kontroll inför op-start genomfördes i samtliga fall. Dock påvisades sämre följsamhet till punkterna och utförandet samt att följsamheten till punkterna skiljde sig åt mellan operationsverksamheterna. Dessutom påvisades att operationssjuksköterskan följsamhet till kontroll inför op-start har brister, vilket kan äventyra patientsäkerheten. Att dessa brister synliggörs kan bidra till ytterligare forskning och därmed förhoppningsvis leda till förbättrad patientsäkerhet.

SAMMANFATTNING

Bakgrund: Varje år utförs cirka en miljon ambulansuppdrag i Sverige. Vanliga uppdrag är bröstsmärta, stroke, buksmärta och trauma. Akut prehospitalt omhändertagande innebär ofta lidande som är förknippat med smärta, rädsla, ångest och oro. Att identifiera lidande är en viktig del vid akut omhändertagande och det är av vikt ur ett vårdetiskt perspektiv och ur professionens roll att ambulanssjuksköterskan ser patientens lidande och kan ge den lindring som krävs. Tidigare forskning visar att patienten inte får adekvat lindring vid det akuta omhändertagandet och att det finns en kunskapslucka om hur patientens upplever sitt lidande. Den teoretiska utgångspunkten i detta arbete är lindra lidande utifrån Maria Armans vidareutveckling av Katie Eriksson teori.

Syfte:  Belysa patientens upplevelse av lindrat lidande vid akut omhändertagande i prehospital miljö.

Metod: En litteraturöversikt bestående av 18 artiklar med kvalitativ ansats. Avsikten var att skapa en tydlig bild av aktuell sammanställd forskning inom valt kunskapsområde. Innehållsanalys enligt Friberg (2022) användes för resultatsammanställning. Artiklarnas kvalitét granskades utifrån SBU:s kvalitets mall för artiklar med kvalitativa ansatser. 

Resultat: Resultatanalysen resulterade i två huvudkategorier; beroende omvårdnadsåtgärder vid akut omhändertagande och oberoende omvårdnadsåtgärder vid akut omhändertagande. Faktorer som belystes av vikt för studiens syfte var ambulanssjuksköterskans kompetens och förmågan att ge god omvårdnad. 

Slutsats: Av resultatet framkommer att det är en kombination av kompetens hos ambulanspersonalen och omvårdande åtgärder som leder till att patienten upplever sitt lidande lindrat i det akuta omhändertagandet.

Introduction: The ambulance service has undergone significant changes, from a transport service to treating advanced and life-threatening conditions. This places great demands on the ambulance team responsible for patient care, and the specialist-trained ambulance nurse has a responsibility for ensuring effective teamwork. Previous research has shown that teamwork is strongly related to patient safety, but there is limited research on the ambulance nurses' own experiences of teamwork and how they perceive that teamwork affects patient safety. Aim: The aim of the study was to investigate ambulance nurses' experiences of collaboration in teams and their experiences of how teamwork affects patient safety. Method: Qualitative interview study with an inductive approach was used. Ten interviews were conducted with practicing ambulance nurses. The interviews were transcribed and analyzed according to Graneheim and Lundman's method for qualitative content analysis. Results: The results showed that there were factors that influenced how ambulance nurses experienced collaboration in the team, such as situational awareness, communication, competence and experience were identified. Shortcomings in one or more of these factors negatively affected the team and patient care. The team was positively affected when roles in the team were clear, and communication worked well. When team members had the same level of education, safety increased because they had similar pre-understanding and similar ways to care for the patients. Conclusion: This study has shown that patient care is affected by how teamwork works. The study can, therefore, be used for improving teamwork, which in turn would improve patient safety.

The overall aim of this thesis is to explore how to achieve and measure person-centred pain management (PCPM) for the patient with acute abdominal pain (AAP) in acute surgical care. The Fundamentals of Care (FoC) framework guides all studies.

The methods: In Study I, focused ethnography is used with 92h of participant observations (n=34) at the emergency department (n=1) and surgical wards (n=2), including 261 patient–provider interactions. In Study II, case study is used for secondary analysis of 20 observations from Study I. In Study III, a questionnaire is developed in a systematic process to measure PCPM, performed by combining; a validated questionnaire, theoretical and empirical evidence. The questionnaire is tested by question appraisal, theoretical experts (n=2), patients (n=5) and providers (n=5), and thereafter by patients (n=100) at surgical wards (n=4). In Study IV, a qualitative systematic review is performed with a synthesis by thematic analysis, to test and refine a model for PCPM from Study I. The synthesis includes 15 qualitative studies representing patients (n=495) and/or nurses (n=259) from n= 3 emergency departments and n=17 hospital wards in n=9 countries. The patients are ≥ 18 years old, with AAP (Studies I-IV), or acute pain from surgery (Study IV). The results confirms that the patient still suffer from unmanaged pain in acute surgical care, and presents actions on behalf of the patient and provider, and contextual factors including the organizational culture, to achieve and measure PCPM. The studies presents a model for PCPM from the patient perspective (Study I), patient-provider communications contributing to meeting fundamental care needs (Study II), an initially feasible and valid questionnaire to measure PCPM (Study III), and a tested and refined model for PCPM from the patient and nurse perspective (Study IV). 

Conclusion: This thesis presents scientific evidence providing an in-depth understanding of what is important for successful pain management from the patient’s and nurses’ perspectives, how these parts are interconnected, and how they can be achieved and measured. The results also show the feasible role of communication in meeting the patient’s fundamental care needs. This evidence is suggested to be tested and evaluated in clinical practice to perform PCPM, relieving the patient from pain. 

Aim: To develop and test a questionnaire using the Fundamentals of Care framework to measure person-centred pain management.

Design: Cross-sectional exploratory descriptive design.

Methods: Development in three phases: (a) literature search for questionnaires measuring person-centred pain management, (b) seven-step process developing items using thematic analysis, (c) initial feasibility and validity testing. Theoretical and empirical evidence was used, including the 'Strategic and Clinical Quality Indicators in Postoperative Pain management' questionnaire, the Fundamentals of Care framework and person-centredness principles. Theoretical experts (n = 2) reviewed the questionnaire, further evaluated by providers (n = 5) and patients (n = 5) using a think-aloud process, and by additional questions in the questionnaire answered by n = 100 patients. The questionnaire was tested February to March 2021, at four surgical wards in a university hospital.

Results: The evaluation showed initial support for feasibility and validity, and the questionnaire was found to represent and be sensitive to capture the patients' experiences of person-centred pain management and being easy to answer. The 100 patients with acute abdominal pain who answered the questionnaire (aged 18-89 years, 46 women and 54 men), identified missing elements of fundamental care in their pain management, indicating that the questionnaire is sensitive to capture specific areas for improvement.

Conclusion: This first attempt at transforming the essential components of person-centred pain management into measurable items in a questionnaire was found promising. The questionnaire is suggested to be further tested for psychometric properties and patient benefit to provide clinical guidance in acute surgical care to meet the patient care need of pain management.

Implications for the profession and/or patient care: The developed questionnaire addresses the need of nurses and nursing leaders to evaluate the delivery of person-centred pain management in acute surgical care, to relieve the patient from pain.

Patient or public contribution: Patients and providers were involved in testing the questionnaire.

AimTo explore, through the patient's perspective, how patient–provider communication is linked to missed nursing care vs. meeting patients’ fundamental care needs.BackgroundMissed nursing care causes severe consequences for patients. Person-centred fundamental care, in which communication is central, provides an approach to manage this challenge. However, the specific patient–provider communications linked to care outcomes are unknown.MethodsCase study using secondary analysis of observations and interviews. A purposeful sample of 20 patients with acute abdominal pain collected using ethnographic methodology at one emergency department and two surgical wards. The Fundamentals of Care framework guided the analysis.ResultsCommunications that included the patient as an equal member of the care team were observed to make a difference between adequate and missed nursing care. Four categories were identified: interpersonal respect, humanized context of care, available and accessible communication channels, and mutual holistic understanding of the care needs and care plan.ConclusionCommunication can be an essential tool to avoid missed nursing care and address the critical need for nursing managers to restore the fundamentals of care.Implications for Nursing ManagementNursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.

  Aims

To test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results.

Design

A qualitative systematic review with thematic synthesis using the Fundamentals of Care framework.

Methods and Data Sources

A literature search in February 2021 in six scientific databases: CINAHL, PsycInfo, Pubmed, Scopus, Social Science Premium Collection and Web of Science, reported using ENTREQ and PRISMA. Quality assessment was performed for the individual studies. Thematic analysis and the GRADE-CERQual approach were used in the synthesis including the assessment of confidence in the evidence.

Results

The model was tested against the evidence in 15 studies appraised with moderate or high quality and found represented in the literature but needed to be expanded. A refined model with a moderate/high confidence level of evidence presents elements to be used in a holistic care process; The nurse is guided to establish a trusting relationship with the patient and enable communication to identify and meet pain management needs using pharmacological and non-pharmacological management. Nurse leaders are guided to support this process by providing the right contextual conditions.

Conclusions

The strengths of the confidence level in the refined model, and that it is represented from the nurse and patient perspectives in nursing research across countries and cultures, support our recommendation for empirical evaluation.

Implications for the Profession and/or Patient Care

The model links the knowledge of pain management elements from individual studies together into actions to be performed in clinical practice. It also outlines the organizational support needed to make this happen. Nurses and nursing leaders are suggested to test the model to implement person-centred pain management in clinical practice.

Patient or Public Contribution

No patient or public contribution.

Impact

What Problem Did the Study Address? There is a need to transfer available evidence of person-centred pain management into practice to relieve the patient from pain. What Were the Main Findings? Person-centred pain management is of high priority for patients and nurses around the world and can be performed in a holistic care process including patient–nurse trust and communication, supported by contextual conditions to deliver timely pharmacological and non-pharmacological pain management addressing the patient's physical, psychosocial and relational care needs. Where and on Whom will the Research Have an Impact? The model is to be tested and evaluated in clinical practice to guide the providers to relieve the patient from pain.

Reporting Method

Relevant EQUATOR guidelines were used to report the study: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

Background: Burn wound dressing is associated with great suffering for the patient in the form of pain and anxiety. There is research that investigates strategies to alleviate this suffering, however there is a lack of research compiles these strategies.  

Purpose: The purpose of the essay was to compile and evaluate different strategies, which can be used by specialist nurses in intensive care to relieve pain and anxiety in burn patients during wound dressing.  

Method: The essay was a descriptive literature review that included 20 quantitative articles. Article review was performed using templates from SBU and GRADE. Katie Eriksson’s theory of suffering was the essay’s theoretical outset.  

Results: Different categories for the relief of pain, anxiety and pain-related anxiety during dressing change of burn wounds emerged. These were complementary and medicinal strategies. Complementary strategies was the category that showed the greatest potential to reduce pain, anxiety and pain-related anxiety.  

Conclusion: Complementary and certain medical strategies significantly alleviate suffering in combination with opioids and achieve the greatest possible relief when repeated over several consecutive days. In order to alleviate suffering when performing dressing changes of burn wounds, the specialist nurse in intensive care needs to adapt the care to the patient's needs and wishes. 

Background: Previous research shows that 32–90% of patients who have undergone some sort of surgery develop accidental perioperative hypothermia. Often, patients already have mild hypothermia upon arrival at the operating room. The perioperative specialist nurses have a shared responsibility to prevent and treat unintended cooling of the patient. Despite a lot of research on hypothermia and its consequences, studies show that there are knowledge gaps within the subject in specialist nurses who are part of the surgical team. Furthermore, there are currently no Swedish national guidelines for perioperative heat conservation measures during surgery, but more general recommendations on the importance of maintaining the patient’s temperature.

Aim: To describe how specialist nurses in ambulatory surgery work to maintain normothermia in the patient.

Method: Qualitative interview with inductive approach. Semi-structured interviews with ten specialist nurses at two ambulatory surgery departments. The data were analyzed with manifest content analysis according to Graneheim and Lundman. 

Results: The results revealed three categories: decisions on heat conservation measures, conditions for preventing perioperative hypothermia and a desire to do good. The categories had a total of eight associated subcategories. 

Conclusion: The specialist nurse’s work to maintain normothermia in the patient was complex in which many different factors came into play. There was a good knowledge of perioperative hypothermia and heat conservation measures in the surgical team. However, the results showed that the work in preventing perioperative hypothermia was not always based on evidence and that there was not enough basis for decision for perioperative heat conservation measures.

Background: Transgendered individuals are a growing minority group in society who generally have poor confidence in health care. They experience shortcomings in the contact with health services that affect the experience of their interaction with health care staff. There is currently limited knowledge about how transgendered individuals wants to be encountered and treated in health care. 

Aim: The aim was to study the collective knowledge regarding how transgendered people experience the interaction with health care. 

Method: A literature study with a systematic approach where studies were compiled using content analysis according to Evans with an inductive approach. The theoretical framework Fundamentals of Care (FoC) was used throughout the literature study. 

Results: Three themes emerged: (1) To be addressed with the right pronoun to be met with insensitivity, tactlessness and open dissatisfaction, (2) To bear responsibility for their care due to lack of knowledge on the part of the caregiver, (3) To feel trust or mistrust in the treatment. Five sub-themes were found: (Ia) from correct address to inappropriate questions and the experience of poorer care when the transidentity was announced. (Ib) Unnecessary physical examination to a reluctance to provide care. (IIa) To meet competent or incompetent caregivers. (IIb)To be responsible for training the caregiver. (IIa) from feeling welcome to not wanting to seek care. 

Conclusions: The interaction with health care worries transgender individuals and needs improvement. Normalizing reactions that support rather than condemn are desired in the meeting of health care. The theoretical framework FoC can be used as a guide for person- centered care in the meeting of health care staff with transgendered individuals in the operating room. 

Bakgrund: I Sverige har ca 10% av de nyfödda barnen behov av neonatalvård där vanligaste dödsorsaken är asfyxi, infektioner, underburenhet samt fosterskador. Oavsett ålder ska välbefinnandet främjas till livets slut. Familjecentrerad Vård (FCV) är en arbetsmodell kring ett sjukt barn och dennes familj där vården planeras efter hela familjens behov i samråd med familjen för hela familjens bästa.

Syfte: Undersöka föräldrars upplevelser av vårdtiden då deras barn vårdats i livets slut på en neonatal intensivvårdsavdelning ur ett familjecentrerat perspektiv.

Metod: Kvalitativ litteraturöversikt med systematisk ansats med riktad innehållsanalys.

Resultat: Resultatet visar att det var viktigt att få spendera tid med sitt barn både före och efter döden. Föräldrarna önskade få ge normal omsorg som att hålla om, mata och trösta. Det fanns ett stort behov av information och kommunikation kring barnets situation. I efterhand värdesatte de högt att de fått hjälp att insamla minnessaker. Föräldrarna menade på att vårdtiden var svår men värdefull.

Slutsats: FCV kan vara ett verktyg som får föräldrarna att spendera mer tid med sitt barn vilket kan leda till minskad prevalens av depression efter barnets död. Det är av stor vikt att se varje familjs individuella behov för en så bra vårdtid som möjligt för familjen.

Background

A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development.

Method

This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%.

Results

Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021).

Conclusions

Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions.