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Operationssjuksköterskans vårdande och kompetens inom perioperativ vård
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0002-6291-0654
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
The operating theatre nurses' caring and competence within perioperative nursing : (English)
Abstract [en]

The overall aim was to describe and deepen the understanding of what operating theatre nurses experience as caring and responsibility as well as ethical problems in perioperative practice. The aim was also to investigate how operating theatre nurses perceive clinical competence in perioperative nursing.

Methods: This research has a hermeneutic design. Qualitative, quantitative and mixed method was used. In the study (I), data were collected through interviews and analysed with phenomenographic method. In studies (II-III) the interview texts from the study (I) was reused. Secondary analysis were performed with hermeneutic text interpretation. In the study (IV), data were collected through a modified questionnaire PROFFSNurse SAS I, which was supplemented with an open question. These data were analysed using statistics and qualitative conventional content analysis.

Results: Operating theatre nurses have the will to meet the patient, be involved and created continuity in the perioperative nursing process (I). Operating theatre nurses experience that they have a formal responsibility to ensure that patients are not at risk and maintain patient integrity and dignity based on personal ethical values (II). Ethical problems and value conflicts can occur if routines and habits prevent operating theatre nurses from caring and when their clinical competence are not utilized in perioperative practice (III). The operating theatre nurses’ self-assessment of clinical competence showed that academic degree, professional experience and interprofessional learning were important for the development of clinical competence. On the other hand, existing routines and habits, as well as inadequate resources, were an obstacle (IV).

Conclusion: Perioperative nursing care includes a nursing process and the operating theatre nurses have responsibility based on ethical values. When the operating theatre nurses are prevented from being a caregiver or that their clinical competence is not utilized, stress of conscience can be caused. Important for the development of clinical competence is an academic degree, professional experience and interprofessional learning.

Abstract [sv]

Operationssjuksköterskans vårdande omfattar patientens pre-, intra- och postoperativ vård. Det perioperativa vårdarbetet ställer krav på att kunna integrera vårdandet med medicinsk teknik för att skapa en god och säker vård i en högteknologisk miljö. 

Genom att ge tid och möjlighet för operationssjuksköterskorna att möta patienter före, under och efter operationen kan deras vårdande bli till för patienten som skall genomgå en operation. Det finns en vilja att vara delaktiga och skapa kontinuitet i den perioperativa vårdprocessen. I det perioperativa vårdarbete tar de ansvar för att skydda patienten i en utsatt och sårbar situation och utifrån inre personliga etiska värderingar upprätthålls integritet och värdighet. Etiska problem uppstår i det perioperativa vårdarbete när vården styrs av rutiner och vanor som kan skapa värdekonflikter vilket hindrar operationssjuksköterskorna från att vara vårdande.

När operationssköterskorna självskattat sin kompetens framkom att akademisk examen och lång yrkeserfarenhet är av betydelse för att kunna hantera komplexa situationer och ta ansvar för de beslut som fattas i vårdandet av patienten.  Vetenskaplig kunskap, medicinsk teknik, omvårdnad/vårdande och interprofessionellt utveckling av lärande är av betydelse för klinisk kompetens.

Utifrån denna avhandlings resultat framkom ny fördjupad förståelse för vad operationssjuksköterskorna uppfattar som att vara en professionell vårdande operationssjuksköterska och behov av utveckling av klinisk kompetens.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2019. , p. 83
Series
Karlstad University Studies, ISSN 1403-8099 ; 2019:6
Keywords [en]
operating theatre nurse, perioperative nursing, responsibility, competence, hermeneutics, mixed methods
Keywords [sv]
ansvar, hermeneutik, klinisk kompetens, mixad metod, operationssjuksköterska, perioperativ vård, PROFFNurse SAS
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-70022ISBN: 978-91-7063-893-0 (print)ISBN: 978-91-7063-988-3 (electronic)OAI: oai:DiVA.org:kau-70022DiVA, id: diva2:1260195
Public defence
2018-04-05, Nyquistsalen, 9C 203, Universitetsgatan 2, 651 87 Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Note

Artikel 4 ingick som manuskript i avhandlingen, nu publicerad.

Available from: 2019-03-15 Created: 2018-11-01 Last updated: 2019-08-29Bibliographically approved
List of papers
1. Making the invisible visible: Operating theatre nurses’ perceptions of caring in perioperative practice
Open this publication in new window or tab >>Making the invisible visible: Operating theatre nurses’ perceptions of caring in perioperative practice
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 361-368Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
care, operating theatre nurse, perioperative nursing
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-30605 (URN)10.1111/scs.12172 (DOI)000354260700019 ()25250842 (PubMedID)
Available from: 2013-12-04 Created: 2013-12-04 Last updated: 2019-07-11Bibliographically approved
2. Responsibility for patient care in perioperative practice
Open this publication in new window or tab >>Responsibility for patient care in perioperative practice
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 3, p. 414-421Article in journal (Refereed) Published
Abstract [en]

Aim: To obtain an understanding of operating theatre nurses' experiences of responsibility for patient care and safety in perioperative practice. Design: A hermeneutic design were used. Method: Data were collected during 2012 from 15 operating theatre nurses who participated in individual interviews. The text was analyzed by hermeneutical text interpretation. Findings: The texts revealed two main themes: A formal external responsibility and personal ethical value. Responsibility that the patient was not exposed to risks, protecting the patient's body, systematically planning and organizing work in the surgical team. The personal ethical value meant confirming the patient as a person, caring for the patient and preserving the patient's dignity. A new understanding emerged that the operating theatre nurse always have the patient in mind.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
ethic, hermeneutic text interpretation, operating theatre nurse, perioperative nursing, responsibility
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-68748 (URN)10.1002/nop2.153 (DOI)000439858900022 ()30062035 (PubMedID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2019-07-09
3. Value conflicts in perioperative practice
Open this publication in new window or tab >>Value conflicts in perioperative practice
2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 7-8, p. 2213-2224, article id 969733018798169Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:: The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves.

OBJECTIVES:: This study describes operating theatre nurses' experiences of ethical value conflicts in perioperative practice.

RESEARCH DESIGN:: Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation.

ETHICAL CONSIDERATION:: The study followed ethical principles in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee.

FINDINGS:: The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient's care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient's best. This occurred when operating theatre nurses' competence was not taken seriously and was ignored in patient care.

CONCLUSION:: Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Care ethics, perioperative practice, theatre nurses, value conflicts
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-70021 (URN)10.1177/0969733018798169 (DOI)000486024000029 ()30345880 (PubMedID)
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2019-10-10Bibliographically approved
4. Operating theatre nurses' self-reported clinical competence in perioperative practice: A mixed method study
Open this publication in new window or tab >>Operating theatre nurses' self-reported clinical competence in perioperative practice: A mixed method study
2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 4, p. 1510-1516Article in journal (Refereed) Published
Abstract [en]

Background: During many years the operating theatre nurse's clinical competence has been describing in relation to patient safety, but the nursing care of the patient remains unclear. Therefore, we want in this study to investigate the relationship between background factors of operating theatre nurses self-rated clinical competence and describe factors of importance for development of clinical competence in perioperative nursing.Methods: A cross-sectional study with a mixed method approach was chosen. The instrument Professional Nurse Self-Assessment Scale of Clinical Core Competence was used for self-rating operating theatre nurses' clinical competence in perioperative nursing, and an open-ended question was added to describe factors of importance for development of clinical competence. In total, 1057 operating theatre nurses in Sweden were asked to participate, and 303 responded (28 %). They had different educational backgrounds and professional experiences, and were employed in universities or central/regional and district hospitals.Results: Academic degree, professional experience and place of employment were significant for the development of the operating theatre nurses' clinical competence. Academic degree appeared to affect operating theatre nurse leadership and cooperation, as well as how consultations took place with other professions about patient care. Being employed at a university hospital had a positive effect on professional development and critical thinking.Conclusions:  An academic degree influenced the operating theatre nurses' ability to act in complex situations, and along with professional experience strengthened the nurses' ability to use different problem-solving strategies and face the consequences of decisions made. Scientific knowledge and interprofessional learning and competence development in medical technologies should supplement nursing care for the development of clinical competence.

Place, publisher, year, edition, pages
Hoboken: , 2019
Keywords
mixed method, operating theatre nurse, perioperative nursing, clinical competence
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-69842 (URN)10.1002/nop2.352 (DOI)000480822100001 ()
Note

Artikeln ingick som manuskript i Blombergs doktorsavhandling.

Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2019-11-22Bibliographically approved

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