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Att vara vaken under operation i regional anestesi: Från patienters upplevelser till en vårdande modell
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the thesis was to describe the experiences of awake patients during surgery under regional anesthesia. In addition, the aim was to develop a model for intraoperative care that can support and enhance patients’ well-being during the intraoperative period.

 

Methods: Study I was a patient interview study guided by a reflective lifeworld approach. In study II a philosophical reflection of the findings from study I was carried out. In study III a hermeneutic approach inspired by Ricoeur and Gadamer was used in order to interpret video recorded material. In study IV a hermeneutic approach inspired by Gadamer was used to synthesize the findings in studies I-III transformed into an intraoperative caring model. 

Overall main findings: The analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. The proximity and presence of the nurse anesthetist (NA) anchors the patient in the present and strengthens the patient’s feeling of trust. The temporary disruption in the relationship between the body and the world due to regional anesthesia means that the patient’s being in the world is exposed to revolutionary experiences. Gaps between the patient’s experiences and the situation can be bridged over when the NA acts as the patient’s bodily extension and links the patient as a subject to the world in the intraoperative situation. From the patient’s perspective this calls for the NA’s proximity and genuine presence in the ‘intraoperative caring space’. When the NA’s performance of his/her professional duties clashes with the patient’s existential being in the intraoperative situation the need of present presence from the NA is crucial.

Conclusions: The findings contribute to knowledge development about intraoperative care and raise awareness that care for the awake patient cannot be performed on formal routines that might disregard the uniqueness of each patient’s situation. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behavior in the delivery of intraoperative nursing care.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2013.
Series
Linnaeus University Dissertations ; 157/2013
Keyword [en]
anesthesia care, hermeneutics, intraoperative caring model, patient’s experiences, patient-nurse interaction, phenomenology, philosophy, reflective lifeworld research, regional anesthesia, video recording
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-30684ISBN: 978-91-87427-65-7 (print)OAI: oai:DiVA.org:lnu-30684DiVA, id: diva2:666612
Public defence
2013-12-13, Myrdal, Hus K, Växjö, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2013-11-25 Created: 2013-11-23 Last updated: 2014-05-09Bibliographically approved
List of papers
1. Patient-Nurse Anesthetist Interaction During Regional Anesthesia and Surgery Based on Video Recordings
Open this publication in new window or tab >>Patient-Nurse Anesthetist Interaction During Regional Anesthesia and Surgery Based on Video Recordings
2013 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 28, no 5, p. 260-270Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia. Design: Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated. Methods: A hermeneutic analysis was conducted on the data. Finding: The findings of the analysis demonstrated that the NA was in either "present" presence or "absent" presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way. Conclusions: Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.

Keyword
anesthesia care, patient-nurse interaction, regional anesthesia, video recording, research
National Category
Health Sciences
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-30650 (URN)10.1016/j.jopan.2012.11.009 (DOI)000325838600004 ()2-s2.0-84884413096 (Scopus ID)
Available from: 2013-11-22 Created: 2013-11-22 Last updated: 2017-12-06Bibliographically approved
2. An intraoperative caring model: the 'awake' patient's need for a genuine caring encounter
Open this publication in new window or tab >>An intraoperative caring model: the 'awake' patient's need for a genuine caring encounter
2013 (English)In: Clinical Nursing Studies, ISSN 2324-7940, Vol. 1, no 4, p. 23-35Article in journal (Refereed) Published
Abstract [en]

Anaesthesia nursing care during regional anaesthesia is characterized by the encounter between the ‘awake’ patient’s own lifeworld and the nurse anaesthetist’s knowledge in theory and in practice. This study aims to present an intraoperative caring model from the patient’s perspective that will facilitate nurse anaesthetists’ (NA) practice to enhance and support the ‘awake’ patient’s intraoperative well-being during surgery under regional anaesthesia. The model is underpinned by a synthesis based on interviews with patients, a philosophical reflection using Merleau-Ponty’s philosophy, and video recordings from orthopaedic surgeries under regional anaesthesia. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behaviour in the delivery of intraoperative nursing care. The model can help NAs to access, understand and learn through lived experiences, thereby deepening their professional caring skills. The model is a way to get research knowledge ready for use by NAs to reflect on what gaps need to be filled between what nurses know (research) and do (practice).

Keyword
Anaesthesia care, Caring science, Intraoperative caring model, Regional anaesthesia
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-30683 (URN)10.5430/cns.v1n4p23 (DOI)
Available from: 2013-11-23 Created: 2013-11-23 Last updated: 2016-11-18Bibliographically approved
3. Only a whisper away. A philosophical view of the awake patient's situation during regional anaesthetics and surgery
Open this publication in new window or tab >>Only a whisper away. A philosophical view of the awake patient's situation during regional anaesthetics and surgery
2012 (English)In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 13, no 4, p. 257-265Article in journal (Refereed) Published
Abstract [en]

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau-Ponty. Merleau-Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine-based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mindbodyworld continuum. The core of intraoperative care is to provide support and promote well-being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience.

Keyword
case, intraoperative experiences, Merleau-Ponty, nursing science, phenomenology, philosophy
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-22290 (URN)10.1111/j.1466-769X.2012.00538.x (DOI)000308395300004 ()2-s2.0-84865847680 (Scopus ID)
Available from: 2012-11-06 Created: 2012-11-06 Last updated: 2017-12-07Bibliographically approved
4. "Is that my leg?" patients' experiences of being awake during regional anesthesia and surgery.
Open this publication in new window or tab >>"Is that my leg?" patients' experiences of being awake during regional anesthesia and surgery.
2012 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 27, no 3, p. 155-164Article in journal (Refereed) Published
Abstract [en]

Most knee or hip replacement surgery is performed under regional anesthesia, when patients are awake. Previous research has primarily focused on patients' experiences during general anesthesia. The aim of this study was to uncover the meaning of being awake during regional anesthesia and surgery. Nine interviews with patients undergoing knee or hip replacement surgery comprise the data. The phenomenological analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. Four interrelated constituents further elucidated the patients' experiences: balancing between proximity and distance in the operating theater, balancing between having control and being left out, my partly inaccessible body handled by others, and the significant role of the carer. Anesthesia providers and perioperative nurses need to understand the awake patients' intraoperative experiences to support and confirm them when they can no longer experience or have full access to their body.

National Category
Anesthesiology and Intensive Care Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-22770 (URN)10.1016/j.jopan.2012.02.005 (DOI)22612885 (PubMedID)2-s2.0-84862084739 (Scopus ID)
Available from: 2012-12-10 Created: 2012-12-10 Last updated: 2017-12-07Bibliographically approved

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