Purpose: To explore how educators in postgraduate nursing programs in anesthesia care, operating room care, and intensive care nursing-both in academic and clinical settings-experience teaching digital documentation in theory and practice.

Design: Qualitative descriptive study using thematic analysis by Braun and Clarke.

Methods: Individual interviews were conducted between April and August 2023 with 12 participants, including faculty members at the universities and clinical supervisors (10 women, 2 men). The participants were between 37 and 72 years of age (mean, 52 years) and had between 1 and 15 years (mean, 6 years) of work experience.

Findings: Two themes were identified: (1) "Faculty members' contradictory attitudes and opinions regarding the content, importance, and need for documentation in patients' electronic medical records in perioperative care" and (2) "The relationship between universities, healthcare providers, and individuals." Subthemes included the lack of consensus on teaching digital documentation, factors influencing successful teaching, prioritizing patient-oriented competencies and tasks, and viewing documentation as a potential obstacle to care.

Conclusions: The topic of documentation is often a low priority. Higher education and clinical practice lack a consensus on the purpose, content, and methods for teaching documentation. Thus, greater attention is needed to clarify the purpose of documentation, particularly digital documentation, and to define relevant teaching content. Digital competence can better prepare students for future work and reduce technostress. The goal should be to narrow the gap between "work as imagined" and "work as done."

The integration of artificial intelligence (AI) into healthcare, particularly through generative AI models like ChatGPT, presents both transformative opportunities and significant challenges. This discussion article explores the systemic impacts of generative AI, highlighting the ethical concerns, particularly around biases, and the shifts in patient-provider dynamics that could disrupt traditional healthcare. Democratising medical knowledge through ChatGPT tools offers new avenues for patient engagement, yet it may affect existing health disparities and erode trust if not responsibly implemented. As generative AI increasingly influences healthcare, it is critical to recognise the intricate feedback loops and dependencies within these complex adaptive systems so that innovations augment rather than destabilise the overall structure. This article advocates an ‘embrace with caution’ stance, calling for reflexive governance, heightened ethical oversight, and a nuanced appreciation of systemic complexity to harness generative AI’s benefits while preserving the integrity of healthcare delivery.

Background: Digital documentation in patients' electronic medical records (EMRs) places new demands on perioperative nurses, increasing workload and cognitive strain, with subsequent technostress. While new EMR systems are implemented, they are not always adapted to users' needs.

Aim: This study aimed to explore how perioperative nurses and nursing assistants describe their experiences with electronic documentation during surgery and its impact on their work environment. Additionally, it examined the emotional reactions these experiences triggered, and the adaptive strategies used to manage their effects.

Methods: DESIGN: A qualitative study was conducted. Data were analysed using Braun and Clarke's thematic analysis.

Settings: Two university hospitals and one county hospital in Sweden were included.

Participants: 15 women and 5 men, including 9 specialist nurses in anaesthesia care, 9 nurses in operating room (OR) care and 2 nursing assistants in OR care in Sweden participated.

Results: Two main themes emerged: A-Introducing digital systems without a clear aim undermines work performance and B-Digital systems were embraced when automation and comfort were present. Subthemes included leadership and management, possibilities to develop and influence digital systems and EMRs not adapted to clinical needs. Automation from digital systems made work easier, and digital systems within one's comfort zone were appreciated. However, frustration and stress arose when aforementioned preconditions were not fulfilled, leading to adjustments to manage these challenges.

Conclusions: Digital documentation is appreciated when fundamental conditions are met. A lack of clarity on how, what and why to document, along with insufficient training and limited ability to have an influence, triggers negative emotional reactions and unhealthy coping strategies. To enhance digital literacy, a standardised process of digital systems including digital documentation through educational efforts in which knowledge control in educational purposes is included could be tested as a potential solution.

The COVID-19 pandemic put pressure on healthcare organizations, making them dependent on sufficient resources and employees’ performance. Recovery is a key factor in maintaining safe operations, employee health, and retention. However, during the pandemic, working hours became more demanding, which limited time for recovery between shifts. The responsibility to ensure employee recovery in relation to working hours lies at the organizational level. The aim of this study was to examine how working hours, staffing, and recovery were managed at the organizational level during the COVID-19 pandemic in Swedish health care, studied from the perspective of HR representatives. Qualitative interview data based on 19 HR representatives from 16 Swedish regions was analyzed using thematic analysis. The results showed that during the COVID-19 pandemic, organizations maximized working hours and reorganized employees, care, and HR. Actions were taken to buffer job demands, including providing support and identifying employees who were not feeling well. Inadequate staffing and skill mix influenced the management of working hours, staffing, and recovery. Our findings highlight the use of short-term solutions to manage the situation at hand, which could lead to exhaustion of human capital long-term and subsequent effects on safety, performance, and employee retention. We term this phenomenon the organizational recovery paradox. 

Introduction

Good relations are important at work, leading to well-being among coworkers. Since the latest research in nursing is mostly about bullying, and lateral violence, it was important to study what healthy relations mean.

Objectives

The aim was to identify and synthesize qualitative studies that describe healthy relations, creating health and well-being between colleagues at work.

Methods

A meta-synthesis approach, inspired by Sherwood's steps of analysis, was chosen for this study. Ten articles from three continents, comprising 230 participants, were included.

Results

Two themes were identified as follows: (a) creating a mutual bond on a personal level and a permissive atmosphere through the human warmth; and (b) sharing togetherness in a greater whole, offering unconditional help and devoting themselves to taking care of each other. An overarching metaphor implicating the home/homeness was abstracted from the two themes: “Healthy relations between colleagues at work constitute the community as a common world, containing feelings of being at home, implying acting in an expression of the ethos and dignity, a culture created that makes the ideal form of healthy relations visible.”

Conclusion

Nurses find their meaning when they work in a permissive environment, and when they are allowed to be themselves. Such meaning can be found through their engagement with one another, by offering each other unconditional help. Good relationships lead to a place they call their home, where there is trust and friendship.

Aim The study aimed to investigate how departments in a Swedish hospital worked with a structured support model between the sessions and what they identified as success factors. Background To improve the work environment in a Swedish hospital, a structured support model for systematic work environment management was implemented in operating departments. The structured work starts with sending a web-based, open-ended, anonymous questionnaire to all employees. In response, employees describe how they perceive their work environment 'right now'. Next, a session is held where employees' viewpoints are discussed, and areas of improvement are agreed upon. Action plans are created between the sessions, and the employees start working with their plans with support from their managers. Implementing new models takes time and requires efforts from employees and managers. Method A case study was conducted, including three operating departments within a perioperative organization in a university hospital in Sweden. The participating departments had used the model without interruption during the Covid-19 pandemic 2 years after implementation, and they had created a customized working method. Three first-line managers were interviewed, and 22 action plans, 21 workplace meeting notes and two presentations were analysed using thematic analysis. Results The results are sorted under three main thematic headings: Experience of results and benefits, Marketing and cheering on and Making adjustments and making the model one's own. The results from the action plans and workplace meetings indicated that the employees had discussed problems with cooperation, work organization and how to treat each other. Conclusion Human factors, such as support, encouragement, seeing the benefits, allowing for time and respecting each other can facilitate and contribute to the implementation and success of a new model. Implications for Nursing Management The main finding of the study indicates that with a structured way of working, and with the participation of the employees in the systematic work environment work, the employees contributed with constructive suggestions for improvement. This, in turn, contributed to reducing the workload for first-line managers. In addition, when working with a structured model, deficiencies in the workplace were identified, which triggered an improvement process in the participating hospital departments.

To facilitate systematic work environment management, which should be a natural part of business development, a structured support model was developed. The Stamina model has previously been used in Swedish municipalities, showing positive results. The aim was to study how the Human Resources Index (HRI), relational justice, short-term recovery and perceived productivity changed in a recently reorganised perioperative setting in a hospital in Sweden that uses a structured support model for systematic work environment management. A longitudinal design that took measurements at four time points was used in a sample of 500 employees in a perioperative hospital department. The results for the overall sample indicated a positive trend in the HRI (Mt1 = 48.5, SDt1 = 22.5; Mt3 = 56.7, SDt1 = 21.2; p < 0.001). Perceived health-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 3; p < 0.001) and perceived work environment-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 4; p < 0.001) showed major improvements. Short-term recovery showed a minor improvement (Mt1 = 2.61, SDt1 = 1.33; Mt3 = 2.65, SDt3 = 1.22; p = 0.872). In conclusion, the implementation of the Stamina model, of which the HRI constitutes an important part, seems to be a helpful tool to follow-up on work environment processes, and minimise production losses due to health and work environment-related issues.

Background: Nurse managers need to create cultures that are worthy, not only of the commitment of everyone who comes to work but also of the trust of everyone who comes to be served. The aim of our study was to describe the challenges faced by Swedish nurse managers in a perioperative setting.

Methods: A qualitative study was conducted. The participants were chosen by convenience sampling, and individual in-depth interviews were conducted. Data were analysed by Systematic Text Condensation. The COREQ checklist was consulted throughout the study to optimise the quality.

Results: Nineteen nurse managers (all women) participated. Six themes were identified: "striving to treat employees with consideration and solicitude"; "the obligation to take care of each employee's individual needs"; "convincing others was an uphill battle", "finding solutions when things seem impossible"; "staff recruitment, allocation, and management"; "working with constantly changing planning".

Conclusions: The nurse managers faced challenges because of the overwhelming amount of work tasks, with almost no time for reflection. Having carefully chosen tasks and a realistic time schedule for each work task, plus time to find one's own path to inner peace, are essential for nurse managers. Organisations that provide these prerequisites show that they care about their nurse managers. The results of this study indicate the need for time to reflect, as well as support from superior managers and from the human resources department.

Aim To describe reasons why nurse managers in perioperative settings decide to leave their employment. Background Current literature has shown that perioperative nurse managers' reasons to leave their positions are formed through an interaction of factors. Methods Individual in-depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using systematic text condensation. Results Five key themes were identified: (a) to end where I started, as a frontline nurse; (b) I wanted to develop further to the next level in my career; (c) I ran out of ideas; (d) I lost trust in my head manager and did not believe in the new organisation and (e) I had had enough of being offended by my superior manager and my employees. Conclusion Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organisation together with time for discussions. Implications in Nursing Management The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect and appreciation.

BACKGROUND AND OBJECTIVES: Extensive abdominal surgery is associated with the risk of postoperative pulmonary complications. This study aims to explore the incidence and risk factors for developing postoperative pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and to analyze how these complications affect overall survival.

METHODS: Data were collected on 417 patients undergoing surgery between 2007 and2017 at Uppsala University Hospital, Sweden. Postoperative pulmonary complications were graded according to the Clavien-Dindo classification system where Grade ≥ 3 was considered a severe complication. A logistic regression analysis was used to analyze risk factors for postoperative pulmonary complications and a Cox proportional hazards model to assess impact on survival.

RESULTS: Seventy-two patients (17%) developed severe postoperative pulmonary complications. Risk factors were full thickness diaphragmatic injury and/or diaphragmatic resection [OR 5.393, 95% CI 2.924-9.948, p = < 0.001]. Severe postoperative pulmonary complications, in combination with non-pulmonary complications, contributed to decreased overall survival [HR 2.285, 95% CI 1.232-4.241, p = 0.009].

CONCLUSIONS: Severe postoperative pulmonary complications were common and contributed to decreased overall survival. Full thickness diaphragmatic injury and/or diaphragmatic resection were the main risk factors. This finding emphasizes the need for further research on the mechanisms behind pulmonary complications and their association with mortality.