Background: As a nurse specialist in anesthesia and intensive care, a part of the work is to assist the emergency alarms within the hospital. Participating in an emergency alarm team means for the nurse specialist, having to move from the safe sphere of the regular workplace This means that they are faced with new challenges that can affect the experience of participating in the emergency team. Internationally, research in the field was scarce and no studies focusing on intra-hospital emergency alarms were found in Sweden. Aim: The purpose of the study was to describe the specialist nurse's perceived challenges in participating before, during and after intra-hospital emergency alarms. Method: In this study, a qualitative approach with a descriptive design was used. Semi-structured interviews were conducted with five anesthesia nurses and five intensive care nurses. The analysis was carried out with inductive qualitative content analysis. Findings: Four categories emerged in the analysis process; Organizational challenges; Challenges in the work environment; Challenges in the team as well as Emotional and mental challenges. The nurse specialists experienced challenges with the anesthesiologist's on-call routines, which meant delayed intubation on occasions where there was a need. Practical challenges with a lot of equipment to be transported to the emergency call were described by the participants. On site at the emergency call, the cooperation between the emergency alarm team and department staff was perceived as a challenge. There was a feeling of high expectations among the nurse specialists. Conclusion: The nurse specialists experienced the emergency alarm as a work task with many challenges. High expectations, great responsibility for patient safety and cooperation were described in the participants' perceived challenges. Together with continued research, the results of the study could lead to improvement measures and business development for the healthcare staff who participate in intra-hospital emergency alarms.

BakgrundPostoperativt illamående (PONV) och smärta är vanligt förekommande efter operation igenerell anestesi. Sedan en lång tid tillbaka används opioider i samband med anestesi och kirurgiska ingrepp som smärtlindring. Detta trots att opioider har många biverkningar, som kan orsaka lidande för patienten samt medföra längre sjukhusvistelse.Opioidfri anestesi är en framväxande metod baserad på idén att undvika opioider för bättre postoperativ återhämtning.Syfte Syftet med systematiska litteraturstudien var att beskriva vilken effekt opioidfri anestesi har på PONV och postoperativ smärta hos patienter som genomgår operation undergenerell anestesi.Metod En systematisk litteraturstudie med deskriptiv design valdes för att systematiskt sammanställa publicerade forskningsresultat från tidigare studier inom området. Sökningarna av artiklar gjordes i Medline via PubMed. Nio artiklar inkluderades i studiens resultat och kvalitetsgranskades utifrån Joanna Briggs Checklist for Randomized Control Trials.ResultatFlera av de inkluderade artiklarna visade att opioidfri anestesi hade signifikanta effekter på både PONV och postoperativ smärta. I de opioidfria grupperna var både PONV och postoperativ smärta mindre förekommande, och de krävde mindre mängd analgetika och antiemetika.SlutsatserResultatet i denna studie visar att opiodfri anestesi har positiva effekter på PONV och postoperativ smärta. Artikelsökningen för denna studie visar på begränsad forskning inom området, men ett flertal större studier pågår vilket visar på ett intresse för att utvärdera och utveckla opioidfri anestesi. Med ökad kunskap och medvetenhet kan onödigt lidande undvikas, speciellt där en ökad risk för PONV och smärta föreligger.

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.

Background: Anaesthesia teams are temporarily assembled to cooperate with teams in emergency departments in the immediate management of events compromising patients' airway, ventilation and circulation. Purpose: The aim was to describe a temporary ad-hoc anaesthesia team's performance. Design: An observational study was conducted. Methods: Data, collected with 12 non-participatory observations, were analysed using both an thematic method, and a validated assessment tool, the Team Emergency Assessment Measure. Results: Three themes were identified: (1) flexibility in assuming varying roles, (2) expertise in verbal and non-verbal communication and (3) skills dealing with the challenges of working in unfamiliar dynamic environments. Ninety per cent of anaesthesia teams scored 7.6 (0-10) on the overall assessment according to the Team Emergency Assessment Measure rating. Conclusion: Ad-hoc anaesthesia team members communicated in various ways and the anaesthesia team adapted well to the unpredictable environment in the emergency department.

Bakgrund: Människan tillbringar en tredjedel av sitt liv i sömn det är ett behov vilket hon inte kan vara utan. Patienter som vårdas på IVA drabbas frekvent av sömnstörningar och därmed sömnbrist. Tidigare gjorda studier tyder på att IVA patienter upplever sömnstörningar som ett stort problem. Syfte: Att beskriva sömnförändringar, sömnpåverkande faktorer och sömnförbättrande omvårdnadsåtgärder för IVA-patienter. Metod: Databassökning gjordes och nyckelord har identifierats. Studier som inkluderar vuxna patienter som vårdats på en IVA har valts för denna beskrivande litteraturstudie. Resultat: IVA-patienter drabbas av fragmenterad sömn uppdelad i korta abnorma perioder. Sömnen påverkas av mänsklig intervention, diagnostiska tester samt miljöbetingad ljus och ljud. Minskning av ljud- och ljusnivån samt sammanhängande vilotid utan intervention var de främst undersökta sömnfrämjande omvårdnadsåtgärder i de granskande artiklarna. Slutsats: Alla IVA-patienter upplevde störd sömnrytm. I vilken utsträckning sömnrytm stördes berodde på ålder, sjukdom, erfarenhet av IVA-vård och respiratorvård. Omvårdnadsåtgärder som planerad vilotid, sänkningar av ljud och ljus förbättrade sömnmönstret och skapade möjlighet till förbättrad sömn.

Background: Suicide is a global health problem, according to WHO 800 000 people worldwide commit suicide every year and the suicide attempts are far more. Aim: To describe intensive care nurses’ (ICU nurse) experiences of taking care of patients, at an intensive care unit, who has committed a suicide attempt. Method: A descriptive design with a qualitative approach was used. Semi structured interviews with ten ICU nurses were conducted and analyzed using qualitative content analysis. Results: Five categories were found; To meet patients who has committed a suicide attempt is complicated, To meet relatives of patients who has committed a suicide attempt, To patients who has committed a suicide attempt, psychiatry has meaning, To care for patients who has committed a suicide attempt brings up a lot of emotions, and To experience limitations and possibilities when taking care of patients who has committed a suicide attempt. ICU nurses described the complexity of nursing, communicating and treating patients who have committed a suicide attempt. These patients were described as a recurrent group, who often had an earlier experience of psychiatric care. They described a variety of reactions from relatives and the relatives need for support. ICU nurses experienced a long wait for the psychiatric consultation which contributed to slowing down the planning of the patients’ continued care. ICU nurses referred to suicide as tragic and that it brings up a lot of emotions among them. They also described that they experienced differences in severity of the suicide attempt depending on the use of suicide method and that prejudices existed among colleagues. ICU nurses described they lacked knowledge about mental illness and wished for better cooperation with psychiatric care. Conclusion: ICU nurses described the complexity of nursing, communicating and treating this group of patients due to lack of knowledge and that cooperation with psychiatric care could be improved.

Abstract

The aim of this study was to describe the anesthesia nurses experiences of pediatric anesthesia in two surgical wards, a general surgery department and a day surgery surgical department at two hospitals in central Sweden. The study had a descriptive design with a qualitative approach, in which ten anesthetic nurses with more or less experience in children's anesthesia participated. Data were collected using semi-structured interview questions and were analyzed using qualitative content analysis. The results were reported based on a theme, three sub themes and nine categories. The theme When skills, tactfulness and interpersonal skills come to a head, with three sub themes Being prepared and ready, Interacts and open for participation   and Emotional tension. The anesthesia nurses who were interviewed described the experiences of children anesthesia as complex and varied situations. They needed to prepare themselves thoroughly, both mentally and practically. Good interactions with the child, parents and health professionals were described as important components for a successful pediatric anesthesia. A successful anesthesia gave a feeling of great satisfaction, while a less successful anesthesia gave a feeling of frustration and failure of the anesthetic nurses. Despite the emotional tension, they felt that pediatric anesthesia was the most fun and challenging they could be involved in their profession.

Keywords: anesthesia nurses, experiences, children's anesthesia, experience, preparation, parents' presence.

Bakgrund: Specialistsjuksköterskor inom anestesi- och intensivvård kommer möta patienter med substansberoende i den perioperativa vården. Att smärtlindra patienter med substansberoende kan vara en utmaning då särskild farmakologisk hänsyn behöver tas till dessa patienter. Patienter med substansberoende får ofta otillräcklig perioperativ smärtlindring. Kliniska, evidensbaserade riktlinjer spelar en grundläggande roll för att förbättra vården för patienter med substansberoende genom att hjälpa specialistsjuksköterskor att fatta de bästa omvårdnadsbesluten för dessa patienter. Syfte: Syftet med studien var att beskriva i vilken omfattning det förekommer riktlinjer för perioperativ smärtlindring till vuxna personer med substansberoende, samt att beskriva hur innehållet i olika riktlinjer inom området överensstämmer med varandra. Metod: Studien har genomförts som en kvalitativ studie med beskrivande design. Riktlinjerna har granskats med en manifest innehållsanalys. Huvudresultat: Åtta regioner hade riktlinjer för perioperativ smärtlindring för patienter med substansberoende medan fem regioner saknade fastställda riktlinjer gällande patientgruppen. Tre huvudkategorier identifierades i granskningen: Preoperativ bedömning, Perioperativ smärtlindring och Perioperativt omhändertagande. Patienter med substansberoende bör identifieras och en individanpassad smärtplan bör göras i samråd med en smärtspecialist. Multimodal smärtlindring, inklusive regional anestesi och perifera blockader, är att föredra för patientgruppen. God omvårdnad, tydlig information och ett gott bemötande är viktigt för att smärtlindringen ska fungera. Slutsats: Det förekommer både regionala och lokala riktlinjer avseende den perioperativa smärtlindringen till patienter med substansberoende. Tydliga riktlinjer kan leda till bättre omvårdnad och ökad kvalitet på den perioperativa vården för dessa patienter. Multimodal smärtlindring är viktigt och leder till ökad komfort.

Background Medical gases are cold and dry, therefore the need for adding humid and heat is highly important, otherwise they can cause damage at the lungs in patients undergoing mechanical ventilation. The most common methods are active and passive humidification so called heated humidification (HH) and heat and moisture exchanger (HME). Aim Summarize existing research on advantages, drawbacks and differences that have emerged with active and passive humidification in respiratory care in the intensive care unit. Method A systematic conducted literature review with a narrative summary to compile the results. Searches were made on the databases CINAHL, PubMed and Cochrane. Nine scientific articles with a quantitative approach between 2012-2022 were included based on PICO. Quality review was performed with validated review templates from Joanna Briggs Institute. Results HH provided less mechanical dead space for intubated patients which provided better PaCO2 values, specifically beneficial for patients with acidosis. However, this method is more expensive and does not work as effectively with increasing room temperature and direct sunlight on the equipment. It therefore requires more controls and supervision in presence of these conditions. In patients undergoing non-invasive mechanical ventilation and in patients with tracheostomy who are mechanically ventilated, HME filters do not give higher PaCO2 values. ​​The increased mechanical dead space it adds does not have the same negative effect in these treatments and conditions. The incremental cost is better for HME filters, but whether it gives rise to more incidences of tube occlusion is not clear. Conclusion Both humidification methods have clear advantages and drawbacks, hence it is advantageous to have access to both methods at intensive care units together with a clear routine about when the methods should be used.

Introduction To prepare a child for anesthesia put the nurses in a complex situation. The child is worried about the unknow that is going to happen and therefore the nurse needs to reduce the child’s level of anxiety and worry. The parents are supposed to comfort the child and together with the nurse they should help the child to manage the difficult situation. Aim: Describe the anesthesia nurses experience in addressing and reducing anxiety in children who are about to undergo anesthesia. Method:A qualitative interview study of 8 nurses with different age and work experience where included and interviewed. Result: Based on the experience of the nurses it showed that the most important thing where to create comfort, use distractions and the ability to use their previous professional experience. To be able to cooperate with the parents, create a relationship with the child as well as excellent preoperative preparation seemed to create comfort in both the child and the parents. The nurses used distracting strategies to transfer the negative anxiety to something more positive.  Since there are no written guidelines of how to comfort children about to undergo anesthesia the nurses had to use and incorporate their previous experience as an anesthesia nurse. The nurses mentioned that it is crucial to be able to sense and evaluate the situation and then act based on the conclusion. The most important thing was to adapt and conform to the need of the child and not rush the process. Conclusion: The study highlighted the experience of the nurse’s preoperative care. The result showed that the nurses experienced difficulty to care for worried children as well as the complex situation they were presented with. Sometimes worried parents made the situation more complex for the anesthesia nurse since they were not able to cooperate and work together. However, the corporation could be improved if the anesthesia nurse and the parent had the same goal and a joint way of handling the situation. The anesthesia nurse were required to have high professional competence, advanced humility as well the ability to make sure that the child  is comfortable and relaxed.

Background. Specialist nurses in intensive care unit and nurse anesthetist take part in trauma life support care in the emergency service. They have an important role of the trauma team. Specialist nurses face challenges that may produce feelings which affect their experiences of participating in trauma life support care.

Aim. The aim was to describe the experiences of specialist nurses in intensive care unit and nurse anesthetist, in trauma life support care at first-level trauma. Method. A descriptive design with a qualitative approach was used. Seven specialist nurses in an intensive care unit and five nurse anesthetists worked with trauma life support care at mid-sized hospitals in middle of Sweden were included. Data were collected with semi-structured interviews and analysed with qualitative content analysis. Result. One theme emerged: The Significance of Trauma Life Support Care. Four main categories: Systematic Care, Being Part of the Trauma Team, Importance of Hospital Environment, and Feelings and Strategies Experienced in the Course of Trauma Life Support Care. Specialist nurses described that structures provided feeling of being secure. Communication improved cooperation and patient safety. Limited workspace, excessive personnel of trauma team complicated the trauma life support care. Trauma life support care was described meaningful under positive stress. Feelings of about what they would meet were experienced encounters. Experiences, clinical practice, and education increased feelings of safety. Debriefing made processing easier. Conclusion. Specialist nurses have an important role in the trauma team. The importance of clinical practice, experiences, and education are significant. Identifying experiences of specialist nurses enables to improve trauma life support care in emergency service.

Bakgrund: Operationsavdelningen klassas som en högriskmiljö, fel eller kommunikationsmisstag kan få allvarliga konsekvenser för patienten. Teamarbete, effektiv och frekvent kommunikation mellan personalen leder till minskade risker för patienten.

Syfte: Syftet med studien var att beskriva anestesisjuksköterskors upplevelse av kommunikationen med operationsteamet under operation

Metod: Kvalitativ intervjustudie. Åtta semistrukturerade intervjuer med anestesisjuksköterskor med olika bakgrund och erfarenhet. Innehållet har analyserats utifrån kvalitativ innehållsanalys.

Huvudresultat: Resultatet resulterade i tre kategorier; perioperativt samarbete, betydelsen av WHO´s checklista och klimatet på operationssalen. Anestesisjuksköterskorna upplevde förbättrad kommunikation när det hade ett fungerade teamarbete och alla strävade åt samma håll och arbetade för patienten. En tydlig och ömsesidig dialog var helt avgörande för att optimera förutsättningarna för anestesisjuksköterskan att göra det bästa för patienten. Sedan införandet av WHO´s checklista upplevde anestesisjuksköterskorna förbättrad kommunikation och ökad delaktighet. De visade sig också att klimatet på operationssalen spelade en avgörande roll för kommunikationen. Tillåtande klimat skapade möjligheter för god kommunikation medan andra faktorer försämrade och försvårade kommunikationen med operationsteamet. 

Slutsats: Det framkom i studien att kommunikationen förbättrades av teamarbete och att alla strävade åt samma håll och arbetade för patienten. En tydlig dialog mellan alla i operationsteamet var avgörande för att optimera anestesisjuksköterskornas förutsättningar att göra det bästa för patienten. Införandet av WHO´s checklista hade förbättrat kommunikation och klimatet på operationssalen spelade en avgörande roll för kommunikationen. Det framkom också att bristande kommunikation skapade frustration och försämrade anestesisjuksköterskornas förutsättningar att göra det så bra som möjligt för patienten. Att belysa vikten av god kommunikation mellan yrkeskategorierna på operation kan förbättra omvårdnaden och patientsäkerheten.

Background: Careful airway management, including tracheal intubation, is important when performing anaesthesia in order to achieve safe tracheal intubation. Aim: To study airway management in anaesthesia care from both the professional and patient perspectives. Methods: 11 RNAs performed three airway tests in 87 patients, monitored in a study-specific questionnaire. The tests usefulness for predicting an easy intubation was analysed (Study I). 68 of 74 anaesthesia departments in Sweden answered a self-reported questionnaire about the presence of airway guidelines (Study II). 20 anaesthesiologists were interviewed; a phenomenographic analysis was performed to describe how anaesthesiologists' understand algorithms for management of the difficult airway (Study III). 13 patients were interviewed; content analysis was performed to describe patients' experiences of being awake fiberoptic intubated (Study IV). Results: The Mallampati classification is a good screening test for predicting easy intubation and intubation can be safely performed by RNAs (Study I). The presence of airway guidelines in Swedish anaesthesia departments is poorly implemented (Study II). Algorithms can be understood as law-like rules, a succinct plan to follow in difficult airway situations, an action plan kept in the back of one's mind while creating flexible and versatile personal algorithms, or as consensus guidelines based on expert opinion in order to be followed in clinical practice (Study III). One theme emerged describing experiences of being awake intubated; feelings of being in a vulnerable situation but cared for in safe hands, described in five categories: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation (Study IV). Conclusions: The Mallampati classification is a good screening test for predicting easy intubation, when the airway assessment is performed in a structured manner by RNAs. The presence of airway guidelines in Swedish anaesthesia departments was poorly implemented and should receive higher priority. Algorithms need to be simple and easy to follow and based on the best available scientific evidence. Tailored information about what to expect, ensuring eye contact, and giving breathing instructions during the procedure may reduce patients' feeling distress.

Background

Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure.

Methods

A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories.

Results

From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself.

Conclusions

Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

Background

In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

Methods

A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

Results

In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.

Conclusions

Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

Background: In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms.

Methods: A qualitative phenomenographic design was chosen to explore anaesthesiologists’ views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted.

Results: Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts’ consensus, a set of scientifically based guidelines for handling the difficult airway.

Conclusions: The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently.

INTRODUCTION

The aim was to describe the relatives need for support and information during the acute phase when a next of kin has survived cardiac arrest treated with hypothermia at the intensive care unit (ICU). The aim was also to describe how everyday life is affected.

OBJECTIVES

Twenty relatives were interviewed at the time the person who had suffered acardiac arrest was discharged from hospital, 1.5–6 weeks after the cardiac arrest.

METHODS

The interviews were recorded and transcribed verbatim and were analyzed with qualitative content analysis.

RESULTS

Support and information.The relatives emphasized the importance of support from the family but they could also feel loneliness in difficult moments. The staff’s presence in the ICU was supportive but how much of support the relatives experienced varied among the groups of relatives. Several of them experienced that the contact with other relatives and friends was a requirement and that all telephone calls to other relatives and friends took a lot of time and also that they could not cope with it. The relatives described that the information received at the ICU was adequate and correct. They felt, however, difficulties to assimilate the information because of difficulties in concentration and language confusion affecting the interpretation of the information. They appreciated the opportunity to ask questions but felt that the answers they sought for was not available. In comparison with ICU, the relatives experienced less information and contact with the staff in the medical ward. The relatives wished more written information and were missing information about prevention. Impact on daily life. The relatives experienced that every day life was affected through increased responsibility for the home. They also experienced that they had to support other relatives and had difficulty to take care of other relatives’ worries. The injured person’s disease resulted in a lot of practical things to take care of, like certificate, absence from work and travels to the hospital. They felt worry for the injured person and how the disease had affected them, mostly they were concerned about personality changes. They felt responsible for the injured person and were also concerned about how to cope with daily life after the person being discharged from the hospital. The relatives felt uncertainty about the future but hopeful. The interviews also revealed that many of the relatives had not discussed with the person stricken by the disease what really had happened.

CONCLUSIONS

The most important support when a next of kin had suffered a cardiac arrest was from other family members. The relatives wished repeated and more written information. Increased responsibility for the home and for the person stricken by the disease was the experience by the relatives on how everyday life was affected

Bakgrund: Verbal kommunikation är ett av flera sätt att förmedla smärta genom. Patienter som är påverkade av läkemedel med sederande effekt har en försvårad situation att förmedla smärtan. Sjuksköterskor behöver kunna bedöma smärta hos patienter som är påverkade av sedering. Smärtbedömning hos sederade patienter kräver kunskap och förståelse, så att adekvat smärthantering ska kunna sättas in och att konsekvenser av obehandlad smärta undviks. Obehandlad smärta kan leda till akut och långvarigt lidande för patienten. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskors erfarenheter och upplevelser av att bedöma smärta hos sederade patienter på anestesi- och intensivvårdsavdelning. Metod: En litteraturstudie med systematisk ansats baserad på tio vetenskapliga artiklar var av sju kvalitativa och tre kvantitativa, publicerade mellan 2015–2022. Databaserna som användes var PubMed och CINAHL. Data som extraherats analyserades genom en innehållsanalys. Resultat: Arbetserfarenhet identifierades som en viktig del i smärtbedömningen. I bedömningen av smärta värderades förändringar i stigande vitalparametrar, kroppsliga tecken som grimaser och oroligt beteende vilket var starkt förknippat med smärta. Kunskap om smärta, förståelse för patientens individuella behov och förutsättningar var viktiga områden för en individanpassad smärthantering. Sedering försvårade kommunikationen för patienten, därav prioriterade sjuksköterskorna smärtlindring. Slutsats: Sjuksköterskor belyste att arbetserfarenhet var betydelsefull för deras smärtbedömning samt att det fanns tecken hos patienten som kunde tolkas som smärta. Förändringar i vitalparametrar användes som en faktor som vägdes in i smärtbedömningen. Det var för sjuksköterskorna högt prioriterat att smärtlindra patienter som var sederade och det framkom att det kunde vara en balans mellan smärtlindring och sedering.

Abstract

The aim of the study was to describe factors of nurse’s experiences when they give NIV treatment to patients with acute respiratory failure in a lung department. Semi structured interview questions about how nurses experience to give NIV treatment on a ordinary lung department was done on 10 nurses, who work in a lung department were NIV treatment is given. Data were analyzed with content analysis. In the result there was shown two themes. The two themes were knowledge and cooperation during NIV treatment and time and support accomplish NIV treatment easier to give. The first themes were knowledge and cooperation during NIV treatment. The theme was created by four categories: “specific knowledge about NIV treatment”, “cooperation with doctors” ”documentation about the treatment”, and ”teamwork between nurses”.  The theme time and support accomplish NIV treatment easier to give, was also created by four categories:” support for next of kin” satisfaction when the treatment is helping, “the patients need of support” and “time for the patient”. NIV treatment is a treatment that is god but in need of development, according to the nurses on the lung department, but there is a lot around the treatment that could be better. For example: getting more time with the patient and further educate doctors and nurses, so that NIV treatment can be given under assured requirements and to more patients.

Key words: nurses, experiences, NIV treatment, COPD patients, technological equipment

Sammanfattning

Bakgrund

Multiresistenta bakterier ökar över hela världen och är enligt WHO ett av de 10 största globala hoten för mänsklig överlevnad. Från att ha varit ett mindre förekommande problem i Sverige förekommer nu multiresistenta bakterier allt oftare inom vården. Ett viktigt arbete som intensivvårdssjuksköterskan har är att motverka smittspridning och förebygga vårdskador.

Syfte

Syftet var att beskriva intensivvårdssjuksköterskors upplevelser av att vårda patienter med multiresistenta bakterier. 

Metod

I studien har kvalitativ ansats med deskriptiv design använts. Data samlades in via semistrukturerade intervjuer, 10 intensivvårdssjuksköterskor deltog. Materialet analyserades med kvalitativ innehållsanalys enligt Graneheim och Lundman.

Huvudresultat

Resultatet av intervjuerna med intensivvårdssjuksköterskorna och deras upplevelse av att vårda patienter med multiresistenta bakterier resulterade i tre olika kategorier: Eftertanke och noggrannhet, Upplevelsen av okunskap och Risken att sprida smitta. Två subkategorier identifierades, Utmaningar i att skydda patienterna vid samvård och Svårigheter att vårda patienter på grund av brister i vårdmiljön. Temat Osäkerhet bildades som var övergripande för kategorierna.

Slutsats

Intensivvårdssjuksköterskor behöver mer kunskap om multiresistenta bakterier för att känna sig säkra i vården av patienter som är bärare av multiresistenta bakterier. Intensivvårdssjuksköterskorna behöver få kunskap genom utbildning och förståelse över vad som väntar om bakterierna får fortsätta utveckla resistens mot antibiotika. Vårdmiljön har betydelse för upplevelsen av vården kring patienter med multiresistenta bakterier. 

The aim of the study was to describe how anaesthetic nurses, within both advanced beginner and expert levels, experience their professional role as they perform a general anaesthetic.

The study had a descriptive design with a qualitative approach in which ten advanced beginners- and ten expert anaesthetic nurses from an operating theatre and an ambulatory surgical ward at a hospital located in the middle of Sweden, participated. All data was collected in an interview with semi-structured questions which focused on how the anaesthetic nurses experience their work. The data were analysed with qualitative content analysis. The results are presented in categories and themes. The themes were formed from the categories. Themes for the advanced beginners were: support develops self confidence that gives the feeling of satisfaction and lack of support impedes further development of independency and gives the feeling of insecurity. Themes for the experts were: experience and new challenges in a supported environment give satisfaction and lack of support and own insecurity give dissatisfaction. The advanced beginners described their experiences in a more descriptive way, while the experts had more difficult to describe what they experienced. The advanced beginners wanted more support from their colleagues while the experts wanted to be more independent and were also more confident in their professional role.

Communication errors are frequent during the perioperative period and cause clinical incidents and adverse events. The overall aim of the thesis was to study communication – the transfer of information, especially the postoperative handover – between healthcare personnel in an anaesthetic clinic and the effects of using the communication tool SBAR (Situation-Background-Assessment-Recommendation) from a patient safety perspective.

The thesis is based on studies using a correlational (Paper I), quasi-experimental (Paper II and III) and descriptive (Paper IV) design. Data were collected using digitally recorded and structured observations of handovers, anaesthetic records, questionnaires, incident reports and focus group interviews.

The results from baseline data showed that lack of structure and long duration of the verbal postoperative handover decreased how much the receiver of postoperative handover remembered; the item most likely not to be remembered by the receiver was anaesthetic drugs. The variation in remembered information showed that there were room for improvement (Paper I). Implementing the communication tool SBAR increased memorized information among receivers following postoperative handover. Interruptions were frequent during postoperative handover, which negatively affected memorized information (Paper III). Furthermore, after implementation of SBAR, the personnel’s perception of communication between professionals and the safety climate improved, and the proportion of incident reports related to communication errors decreased in the intervention group (Paper II). The results of the focus group interviews revealed that the nurse anaesthetists, anaesthesiologists and post-anaesthesia care unit nurses had somewhat different focuses and views of the postoperative handover, but all professional groups were uncertain about having all information needed to secure the quality of postoperative care (Paper IV).

The findings indicate that using a predictable structure during postoperative handover may improve the information memorized by the receiver, perception of communication between professionals and perception of safety climate. Incidents related to communication errors may also decrease. Long duration of the handover and interruptions may negatively affect the information memorized by receiver. To ensure high quality and safe care, there is a need to achieve a shared understanding across professionals of their work in its entirety.  

BACKGROUND: Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking.

OBJECTIVE: The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover.

DESIGN: A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention.

SETTING: The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012.

PARTICIPANTS: Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital.

INTERVENTION: Implementation of the communication tool SBAR in one hospital.

MAIN OUTCOME MEASURES: The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form.

RESULTS: Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear regression generalised estimating equation model was used to account for confounding influences, we were unable to show a significant difference in the information recalled between the intervention group and the nonintervention group over time.

CONCLUSION: Compared with the comparison group with no intervention, when SBAR was implemented in an anaesthetic clinic, we were unable to show any improvement in recalled information among receivers following postoperative handover.

TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Identifier: ISRCTN37251313.

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.

Purpose The aim was to examine the handover process at the post-anaesthesia care unit, how much the receiver remembers and what factors influence memory.

Design An observational study with a descriptive and correlational design.

Methods Seventy-three handovers were investigated, and data were collected using observation, audio-tape recordings of the handovers and the patient´s anaesthetic 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 anaesthesia. A linear generalized estimating equation was used and identified variables that were significantly associated with in 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.

Abstract

Background: Work in an operating room requires effective collaboration among various professional groups. The nurse anesthetist and the anesthesiologist work closely together, but challenges often arise due to differences in professional roles, hierarchical structures, and overlapping responsibilities. Nurse anesthetists generally have more positive attitudes towards collaboration than anesthesiologists. The relationship between these two professional groups is also the primary source of stress for nurse anesthetists, which can negatively affect both the work environment and patient safety.

Purpose: To describe nurse anesthetists’ experiences of collaborating with anesthesiologists in an anesthesia department.

Method: A descriptive interview study with a qualitative approach was conducted. Semi-structured interviews were carried out with five nurse anesthetists in an operating department in central Sweden. A qualitative content analysis was used to transcribe and analyze the interviews.

Result: The nurse anesthetist’s experience of collaborating with the anesthesiologist during anesthesia was presented in three categories: "Perceptions of collaboration", "Prerequisites for functional collaboration", "Challenges for functional collaboration", and nine subcategories: "Positive view of collaboration", "Importance of collaboration", "Clear communication", "Planning for anesthesia", "'Influence in the decision-making process", "A good working relationship", "Variation in anesthesiologists’ preoperative assessments ", "Impact of work experience" and "Impact of stress".

Conclusion: The collaboration between nurse anesthetists and anesthesiologists was mostly positive. Emphasis was placed on communication, planning, shared decision-making, and work relationships. To enhance collaboration, training in communication skills and encouraging participation in decision-making are recommended. Implementing consensus decision guidelines and providing mentorship support to new residents can improve efficiency. Offering stress management strategies and personal support can assist nurse anesthetists and anesthesiologists in coping with stress.

Background: Hypotension is a common side effect during general anesthesia. During the year 2018, 318 cases were registered as a complication caused by hypotension during general anesthesia in Sweden. Mean artery pressure (MAP) can be computed by using the diastolic and systolic blood pressure. Studies shows that there is a sharp connection between low MAP-values, and the duration of the low MAP-value towards organ failure and mortality. The nurse Anesthetist has a responsibility to be one step ahead in order to avoid anesthesia related complications such as hypotension. 

Purpose/aim: To describe the nurse anesthetist experiences and strategies when handling a MAP below 55mmHg among patients during general anesthesia. 

Method: A qualitative study with descriptive design. Individual interviews were conducted with nine nurse anesthetists at an operation unit. Data were collected between January and March in year 2022.  

 Result: The nurse anesthetists experiences and strategies are presented in two categories, together with under categories which are “It is happening on a daily basis”,

 “To feel safety and to work together with colleagues”, “To work out of guidelines” and ” To read and be prepared”, ”Adjust the anesthesia based on the individual” and ”Strategies to avoid a low MAP". 

 Conclusion: Low MAP- Values were common during induction of anesthesia according to the nurse anesthetist. To be prepared and read beforehand were important. Furthermore, it was important to have colleagues nearby to help which gave a feeling of safety. This study showed also that there is a need for guidelines in how to act with a low MAP-occurred. 

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

Introduction: Depth of anesthesia is an expression of how deeply a patient is sedated during general anesthesia. The assessment of depth of anesthesia is primarily a subjective clinical assessment and an important task for the anesthesia nurse. Anesthesia depth monitoring consist of technical equipment that can be used as support in the assessment of depth of anesthesia. Bispectral Index and Entropy are two methods for depth of anesthesia monitoring where brain activity is read to assess depth of anesthesia. Aim: The aim was to compile and describe current research on the use of depth of anesthesia monitoring with Bispectral Index and Entropy in general anesthesia. Method: A scoping review based on 26 scientific articles was carried out with the support of Arksey and O'Malley's methodological framework for scoping reviews. Main results: Bispectral Index and Entropy are significantly consistent in general anesthesia. The use of BIS-monitored anesthesia when compared with standard care resulted in lower anesthetic doses. Those with BIS-monitored anesthesia had fewer blood pressure drops perioperatively, woken up faster, and experienced less long-term negative consequences of anesthesia. Conclusion: The conclusion is that BIS and Entropy perform equally in general anesthesia. If you can implement depth of anesthesia monitoring with BIS as part of the assessment of depth of anesthesia, you can provide safer and better care with less risk of negative peri- and postoperative effects and side effects. More research is needed on Entropy to be able to draw the same conclusions as for the use of BIS.

INTRODUCTION

The aim was to describe relatives’ need of support and information whena significant other has survived cardiac arrest and the impact on everyday life 6 months after theevent.OBJECTIVES.Interviews with 20 relatives were conducted 6 months after a significantother’s cardiac arrest.

METHODS

The interviews were recorded and transcribed verbatim and were analyzed withqualitative content analysis.

RESULTS

The result illustrated various experiences by relatives. Six months after the sig-nificant other’s cardiac arrest relatives experienced support mainly from other family membersand friends. Relatives stated that the care, support and information in the intensive care unit hadbeen good but that they felt abandoned by the health care when the significant other wasdischarged from the intensive care unit. There were various requests to get more support fromthe health care mainly around issues concerning prognosis, rehabilitation and follow-up care.There were also requests to meet others in same situation, like family groups where they couldshare experiences. They experienced that the everyday life was affected especially withincreased responsibilities and requirements at home, restrictions in social life, a sense ofabandoned and a lack of understanding from the surroundings and a constant concern for thesignificant other.

CONCLUSIONS

Relatives’ everyday life was still affected 6 months after the event withincreased responsibilities at home and a constant concern for the person stricken by a cardiacarrest. The study illustrates that health care personnel need to offer relatives follow-upappointments to clarify issues concerning support and information.

INTRODUCTION

The purpose of resuscitation and subsequent hypothermia treatment isto regain the health the patient had before the cardiac arrest. The effect can be classified indifferent ways: survival, time of survival and quality of life (QoL) (1). The life after cardiacarrest survival are affected and described as severe fatigue, feelings of anxiety and/ordepression, increased dependency in activity of daily life (ADL) and decreased QoL. (2)The aim of the study was to describe differences over time regarding functional outcome,physical and cognitive function of survivors after cardiac arrest treated with hypothermiaand also to examine survivors’ life satisfaction 6 months after cardiac arrest and genderdifferences.

OBJECTIVES

A prospective study including 40 cardiac arrest survivors admitted to threeSwedish hospitals between 2008 and 2012.

METHODS

Participants were studied from intensive care unit discharge to one and6 months after cardiac arrest. In addition to cerebral performance category (CPC), partic-ipants were asked to answer questionnaires regarding activities in daily life (Barthel Index),cognitive function (Mini Mental State Examination) and life satisfaction (LiSat-11).

RESULTS

At discharge from intensive care unit 9 (22.5 %) participants were defined withbad functional outcome (CPC 3–4). CPC improved over time and at 6 month all participantswere estimated with good functional outcome (CPC 1–2). At 1 month participants wereimpaired but they improved over time in their activities in daily life and cognitive function.Satisfaction with ‘‘life as a whole’’ was seen in 72.5 %.

CONCLUSIONS

Cardiac arrest survivors are satisfied with life as a whole despite a severeillness which has impaired their physical and cognitive function but seemed to improve overtime. To predict patients’ functional outcome in early stages is difficult and cerebral per-formance category alone is not sufficient to assess patients function. The healthcare teamneeds to work interdisciplinary and furthermore get a consensus of the instruments that bestcan reflect physical and cognitive function to specify the rehabilitation.

REFERENCE(S)1: Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W,Kramer E, et al. Recommended guidelines for reviewing, reporting, and conducting researchon in-hospital resuscitation: the in-hospital ‘Utstein style’. American Heart Association.Circulation. 1997;95(8):2213–39. PubMed PMID: 9133537. 2. Moulaert VR, WachelderEM, Verbunt JA, Wade DT, van Heugten CM. Determinants of quality of life in survivors ofcardiac arrest. J Rehabil Med. 2010;42(6):553–8. PubMed PMID: 20549160.

BACKGROUND:

Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

METHODS:

A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

RESULTS:

Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

CONCLUSIONS:

Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

BACKGROUND:

Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied.

METHOD:

Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

RESULTS:

Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

CONCLUSIONS:

Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.

Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patientstreated with TH.

Results: MRI of the brain was obtained at a median of 4 days (3–13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24–30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p= 0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical, and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600×10−6mm2/s in any region survived to 6months.

Conclusions: In visual analyses of acute MRI, extensive acutelesions were found in the cortical regions and deep gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.