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Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse: A Grounded Theory
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.ORCID iD: 0000-0002-1614-7379
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
2017 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 7, no 9, p. 1086-1099Article in journal (Refereed) Published
Abstract [en]

Introduction: Intraoperative care includes a unique knowledge of how to

perform a safe and effective surgery procedure. Surgery performed under regional

or local anaesthesia allows the patient to remain conscious during the

procedure and is rather common in Swedish healthcare today. Aim: The aim

was to obtain a deeper understanding of the main concerns of operating theatre

nurses (OTN) when caring for conscious patients during the intraoperative

phase. Methods: Interviews were conducted with 23 OTNs from five different

hospitals in Sweden and analysed according to grounded theory. Findings:

The main concern among the OTNs was to take the patient in consideration.

The core category “achieve and maintain ethical treatment of patients”

in the operating theatre (OT) was a strategy used throughout the intraoperative

process. Ethical treatment was described as moral behaviour at

different levels and included the team’s behaviour, respectful and individualised

patientcare, and the working-morale of the professionals. Being vigilant

and being flexible were the categories related to the core category. The OTNs

constantly assessed where to pay most attention as they balanced between the

needs of the patient, the team, and the surgery procedure. Conclusion: It is

important that every patient is taken into consideration and that ethical principles

are held to the highest standards in the OT. A familiar team can facilitate

that. The complex skills that operating theatre nurses develop can be

added to explain important competencies within the profession.

Place, publisher, year, edition, pages
2017. Vol. 7, no 9, p. 1086-1099
Keywords [en]
Conscious Patient, Grounded Theory, Intraoperative Care, Nursing
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-32241DOI: 10.4236/ojn.2017.79079OAI: oai:DiVA.org:miun-32241DiVA, id: diva2:1162521
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-09-13Bibliographically approved
In thesis
1. Den vakna patienten: En kvalitativ studie om intraoperativ omvårdnad
Open this publication in new window or tab >>Den vakna patienten: En kvalitativ studie om intraoperativ omvårdnad
2018 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [sv]

Inledning: Som ett resultat av utvecklingen inom anestesi och kirurgi kan allt mer komplexa operationer utföras i lokala eller regionala anestesier. Detta innebär att den kirurgiska patienten kan förbli mer eller mindre vaken genom hela den intraoperativa fasen.

Syfte: Syftet med denna avhandling var att få en djupare förståelse för den intraoperativa omvårdnaden när patienten är vaken. Avhandlingen består av två delstudier [I-II] vilka har, beroende på delstudiens syfte, utgått från operationssjuksköterskans perspektiv [I] och patientens perspektiv [II].

Metod: Utifrån syftet valdes kvalitativa metoder för båda delstudierna. Data samlades in genom fokusgruppintervjuer [I] och individuella intervjuer [I,II]. Insamlad data analyserades i enlighet med Grundad teori [I] och kvalitativ innehållsanalys [II].

Resultat: Studie I visade att det som ansågs vara operationssjuksköterskans huvudangelägenhet var att ta den vakna patienten i beaktande vilket de försökte åstadkomma genom att uppnå och bibehålla en hög moral på sal genom hela processen. För att uppnå hög moral var det tre aspekter som operationssjuksköterskan tog hänsyn till; patienten, teamet och den professionella yrkesrollen. För att uppnå hög moral på sal var operationssjuksköterskorna vaksamma och flexibla. De balanserade mellan patientens behov, teamets behov de behov som var förknippade med säker kirurgi. Moralen beskrevs vara en helhet med målet att ge patienten en positiv upplevelse. Resultatet i studie II visade att patienterna upplevde att de var i en situation de inte hade kontroll över och de var uppmärksamma och reflekterande för att skapa mening och trygghet åt situationen. Det övergripande temat ”att söka efter förtroende i en utsatt och beroende situation” illustrerar hur patienterna tenderade att i första hand tolka det som skedde omkring dem på så sätt att det bringade känslan av att vara trygga. De fyra kategorierna; att erfara stämningen på sal, att möta[o]väntade känselförnimmelser, att uppfatta bevis på säkerhet och att använda individuella strategier, beskriver patienternas upplevelser om vad som påverkade förtroendet samt hur de hanterade dessa upplevelser. Huvudfynden berörde de intraoperativa behoven samt hanteringen och balanseringen mellan dess.

Slutsats: Operationssjuksköterskans intraoperativa omvårdnad kan bidra till positiva upplevelser för patienten som är vaken under ett kirurgiskt ingrepp. Operationssjuksköterskans förmåga att tolka och agera på olika intraoperativa behov samt patientens personlighet och egna förmåga att hantera situationen är av stor betydelse för upplevelsen av den intraoperativa fasen.

Abstract [en]

Introduction: As a result of unaesthetic and surgical development, more complex procedures are performed under local or regional anaesthesia, which allows for a patient to be conscious throughout the intraoperative phase.

Aim: The aim of this thesis was to gain a deeper understanding of the intraoperative nursing care when the patient remains conscious during surgery. The thesis comprises two studies [I-II] and has, depending on the purposes, focused on the perspective of the operating theatre nurses [I] and the patients [II].

Method: based on the aim, a qualitative approach was used for both studies[I, II]. Data were collected through focus group interviews [I] and individual interviews [I, II]. Collected data were analysed in accordance with grounded theory [I] and by using qualitative content analysis [II].

Result: Study I showed that the main concern among the operating theatre nurses was to take the conscious patient into consideration by achieving and maintaining high ethical standards in the operating theatre throughout the process. In order to achieve high ethical standards, there were three aspects that the operating theatre nurses took into consideration: the patient, the team and the morale of the professional role. In order to achieve high morale, the nurses were vigilant and flexible and balanced between patient needs, team needs, and the needs associated with safe surgery. The ethical standards was described as a whole, with the goal of giving the patient a positive experience. Results in Study II showed that the patients felt that they were in a situation they could not control and they were attentive and reflective to make sense and feel trust in the situation. The overarching theme “to seek for trust in a sensitive and dependent situation”, illustrates how the patients tended to assess the events that occurred around them in such a way that it brought the feeling of being in safety in the first place. The four categories; to experience the OT setting, to meet (un)expected sensations, to perceive evidence of safety, and to use individual strategies describes their experiences of what could affect the trust and how they handled this experiences. Main findings concerned the intraoperative needs and the handling and balancing between them.

Conclusion: The operating theatre nurse´s intraoperative nursing care contributes to positive experiences for the patient who are conscious during surgery. The operating theatre nurse´s ability to interpret and to act on different intraoperative needs and the patient´s personality and ability to handle the situation are of great importance in the experience of the intraoperative phase.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2018. p. 66
Series
Mid Sweden University licentiate thesis, ISSN 1652-8948 ; 142
Keywords
Conscious patient, intraoperative nursing, operating theatre nurse, qualitative method, surgical patient, intraoperativ omvårdnad, kirurgisk patient, kvalitativ metod, operationssjuksköterska, vaken patient
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34401 (URN)978-91-88527-60-8 (ISBN)
Presentation
2018-09-27, Sundsvall, 10:30 (Swedish)
Supervisors
Note

Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 2 manuskript.

At the time of the defence the following paper was unpublished: paper 2 manuscript.

Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-09-13Bibliographically approved

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