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Patienters upplevelser av omhändertagandet på akutrum i samband med trauma: en intervjustudie
Sophiahemmet University.
2015 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesisAlternative title
Patients' experiences of care received in the emergency room after trauma : an interview study (English)
Abstract [sv]

SAMMANFATTNING

I Sverige är trauma den vanligaste dödsorsaken bland personer under 45 år. Fler än 4500 människor avlider i Sverige varje år på grund av yttre skador. På samhällsnivå genomförs förebyggande åtgärder för att minska morbiditet och mortalitet orsakad av trauma. Under 2005 uppgick kostaderna till 21 miljarder kronor, i denna siffra ingår enbart vägtrafikolyckor. I Stockholms läns landsting finns ett traumacenter, situerat på Karolinska Universitetssjukhuset i Solna. Omhändertagande av trauma- ett och trauma- två sker där. Resterande sjukhus i länet tar hand om och vårdar trauma- tre patienter. Då patienter vårdas i samband med trauma sker omhändertagandet strukturerat oftast utefter ABCDE konceptet. ABCDE är en del av ATLS som används för att snabbt kunna göra en bedömning och hantering av eventuella skador, ett välstrukturerat arbetssätt som ger snabba och effektiva åtgärder och insatser. Teamet inne på akutrummet vet vilka roller och uppgifter alla har vilket medför en säkerhet i teamarbetet. Sammansättningen av teamet skiljer sig åt mellan olika sjukhus. Kommunikationen såväl inom teamet som gentemot patienten är viktig. Detta belyses dels av sjuksköterskans kärnkompetenser som består bland annat av personcentrerad omvårdnad och säker vård. Då patienten sätts i centrum i omhändertagandet och att personalen drar nytta av dess kunskap bidrar till säker vård både för patienten och personalen.

Syftet med studien var att beskriva patienters upplevelser av omhändertagandet på akutrum i samband med trauma.

Det är en kvalitativ deskriptiv intervjustudie där semistrukturerade intervjuer utfördes. Totalt utfördes sex intervjuer. Intervjuerna ljudupptogs och transkriberades innan analysen genomfördes. Data analyserades med innehållsanalys. Meningsenheter kondenserades, kodades och delades in i subtema, tema och övergripande tema.

I resultatet framkom ett övergripande tema, två teman med fem subteman. Övergripande tema blev Patienters upplevelser av omhändertagandet på akutrum i samband med trauma. Teman var Att vara patient på akutrum och Att vara delaktig och upplevelser av bemötande. Det framkom blandade upplevelser kring kommunikationen och hur information gavs. Som patient uppleva att vara i centrum av omhändertagandet men utan att få ögonkontakt med personalen. Känslor såsom trygghet och oro tillsammans med lugn uppstod. Allvaret i situationen förstärks av att det var ett stort antal personal som var inblandad i omhändertagandet. Olika utrustningar och undersökningar utmärker sig mer än andra, dessa var nackkragen och stockvändning. Patienter upplevde att nackkragen kunde orsakade obehag samt att stockvändningen utfördes på ett rutinmässigt, inövat och säkert sätt.

Studiens resultat tyder på att bemötande, kommunikation och grad av delaktighet är tre viktiga aspekter gällande patienters upplevelser vid omhändertagande på akutrum i samband med trauma. Dessa tre aspekter formuleras som att patienten upplever sig vara i centrum, får information kring vad som sker och vad som planeras samt att beredas möjlighet att vara delaktig i situationen.

Abstract [en]

ABSTRACT

In Sweden trauma is the most common cause of death in people under the age of 45.

More than 4500 people each year die as a result of external injuries. On a demographic level preventive measures are being taken to reduce morbidity and mortality caused by trauma.

During the year of 2005 the costs added up to 21 billion Swedish crowns, and this figure only covers the costs of traffic accidents. In Stockholm County there's one main trauma center which is situated at Karolinska University hospital. This hospital handles the treatment of the most severe traumas, called trauma- one and trauma- two. Remaining hospitals in the county are capable of treating minor trauma, so called trauma- three. The care and treatment plan of a patient injured by trauma is built on the structure called ABCDE (Airway-Breathing-Circulation-Disability-Exposure) which is a part of ATLS. This structure is used to quickly discover, estimate and treat possible injuries. It also provides a way for the entire traumateam to work together from concise guidelines. With all personnel using the same tool/structure for examination and prioritizing the treatment of the patient it not only secures that each profession acts their part, but also increases patient safety. Each hospital relies on their own traumateam, however the constitution of the professions included in the team may differ between hospitals. Within the team communication is of the essence, both within the team and with the patient. In this team the nurse's competence of person-centered care and patient safety comes well to use. When the care provided is person-centered the traumateam can use the patient’s own knowledge and recourses which increases safety for both patient and personnel.

The aim of the study was to describe the experience of patients receiving nursing care in the emergency room after injury by trauma.

This study is a qualitative descriptive interview study where semi structured interviews were conducted. In total there were six interviews. The interviews were audio recorded and transcribed before they were analyzed. Content analysis was performed in which meaning units were condensed, coded and divided into subthemes, themes and general theme.

The result showed one general theme, two themes and five subthemes. The general theme was Patient´s experiences of the nursing care in the emergency room after trauma. The themes were Being a patient in an emergency room and To feel included and experiences of personal treatment. The experiences of communication and the way information was given were mixed. Patients experienced being in focus but not receiving eye contact from the personnel. Emotions that emerged were such as safety and anxiety along with tranquility. The severity of the situation was amplified by the large number of personnel present in the emergency room during nursing care. Some equipment’s and examinations were experienced as more emotional, these were the stiff neck collar and the log-roll. The stiff neck collar for some, felt uncomfortable and unpleasant. The log-roll though was pursued in a very secure and well-practiced manner which resulted in a feeling of routine and safety.

The result showed in this study indicates that personal treatment, communication and a high degree of inclusion are the three most important aspects regarding patients experiences of nursing care in the emergency room after trauma. These three aspects are formulated in that the patients experiences being in focus, receiving information about present and future actions and examinations and also given the opportunity to feel included in the situation.

Place, publisher, year, edition, pages
2015. , 32 p.
Keyword [en]
Trauma, Experience, Nursing care, Communication, Content analysis
Keyword [sv]
Trauma, Upplevelse, Omhändertagande, Kommunikation, Kvalitativ innehållsanalys
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-1893OAI: oai:DiVA.org:shh-1893DiVA: diva2:821542
Educational program
Specialistsjuksköterskeprogrammet : inriktning akutsjukvård
Supervisors
Examiners
Available from: 2015-06-16 Created: 2015-06-15 Last updated: 2015-06-16Bibliographically approved

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