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  • 1.
    Hellman, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sirviö Lager, Mirjam
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Wikberg, Marlene
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Den stora utmaningen: anestesisjksköterskors erfarenheter av barninduktion2011Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Nurse Anesthetists in Sweden have a unique role due to the responsibilities required of the profession and due to the fact that NA´s often work alone. There are many challenges a nurse anesthetist meets when performing a child induction, both from a physiological and a psychological aspect. There are only a few studies conducted concerning nurse anesthetists´ experiences of child induction.

    Aim: The aim of this study was to describe nurse anesthetists´ experiences of child induction.

    Method: The study was conducted in a hospital in Norrland in the spring of 2011. A qualitative interview method was used with a content analysis of the material. A total of 14 NA´s were interviewed, with a varied amount of years in the profession.

    Result: All interviewees thought that it was a challenge to perform a child induction. With increasing experience, the NA´s became more comfortable in their professional role and could cope with the small margins that a child´s physiology brings. They all emphasized the importance of a good communication with the child and its family. NA´s sometimes found themselves in situations wherein ethical dilemmas arose.

    Discussion: The study showed that NA´s evolved from being a novice to becoming an expert in their field. A clear sense of pride of the profession could be read between the lines during the interviews. The NA´s could be found in a continuum between being relationship-oriented and being task-oriented.

     

    Key words: Child induction, experience, interaction,  Nurse anesthetist, Nursing

  • 2.
    Schandl, Anna
    et al.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden .
    Bottai, Matteo
    Unit of Biostatistics, Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden .
    Hellgren, Elisabeth
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden .
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Sackey, Peter V.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden .
    Developing an early screening instrument for predicting psychological morbidity after critical illness2013In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. Art. no. R210-Article in journal (Refereed)
    Abstract [en]

    Introduction: Guidelines recommend follow-up for patients after an intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU follow-up of ICU survivors. The aim of the study was to develop a predictive screening instrument, for use at ICU discharge, to identify patients at risk for post-traumatic stress, anxiety or depression. Methods: Twenty-one potential risk factors for psychological problems - patient characteristics and ICU-related variables - were prospectively collected at ICU discharge. Two months after ICU discharge 252 ICU survivors received the questionnaires Post-Traumatic Stress Symptom scale -10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) to estimate the degree of post-traumatic stress, anxiety and depression. Results: Of the 150 responders, 46 patients (31%) had adverse psychological outcome, defined as PTSS-10 >35 and/or HADS subscales >= 8. After analysis, six predictors were included in the screening instrument: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, in-ICU agitation, being unemployed or on sick-leave at ICU admission and appearing depressed in the ICU. The total risk score was related to the probability for adverse psychological outcome in the individual patient. The predictive accuracy of the screening instrument, as assessed with area under the receiver operating characteristic curve, was 0.77. When categorizing patients in three risk probability groups - low (0 to 29%), moderate (30 to 59%) high risk (60 to 100%), the actual prevalence of adverse psychological outcome in respective groups was 12%, 50% and 63%. Conclusion: The screening instrument developed in this study may aid ICU clinicians in identifying patients at risk for adverse psychological outcome two months after critical illness. Prior to wider clinical use, external validation is needed.

  • 3.
    Sjöling, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Experiences of abandonment and anonymity among arthroplastic surgery patients in the perioperative period: Some issues concerning communication, pain and suffering2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall objective of the thesis is to describe and illustrate the experience of being an arthroplastic surgery patient during the perioperative period with regard to the issues of communication, pain,suffering and satisfaction with care. While waiting for surgery, the participants in this thesis experience suffering in different ways and mainly experience health care as being unavailable and negative in a faceless system (I). Obtaining information related to their illness is difficult, as it is hard to establish contact with health care providers. The responsibility for establishing contact and obtaining information rests solely with the patients (II). In Paper I, due to poor communication, the respondents express feelings of abandonment, anonymity and being disparaged by the health care system. During the participants' journey through the health care system, the negative experience acquires a more positive nature, as personal contacts are established with health care representatives (I-IV). The findings in the different papers (I-IV) are interpreted in the light of Katie Eriksson and Lennart Fredriksson’s descriptions of suffering and the caring conversation. There are participants in this thesis who have been able to reach a personal understanding of themselves and have found reconciliation in suffering. In this way, they have been able to maintain or obtain meaning in their lifeworld. Through their own power, or with the help of family and friends, individuals may be able to attain confirmation of their suffering, have the time and space to suffer and find reconciliation. However, as long as health care is experienced as a faceless system, there are individuals in this study who are unable to face their suffering. During the patients’ journey through the system, it becomes obvious that the system obtains a face when the individuals are able to establish trustful contact with an actual person within the system. The system does not obtain a face as long as the individuals perceive themselves as being poorly treated by health care representatives. In these cases, the system is actually the cause of additional suffering. In the terms defined by Fredriksson, the system obtains a face when a turning point occurs in the form of a caring conversation. During the waiting time, there are few opportunities for a caring conversation. An opportunity is more likely to occur when the individual is admitted to hospital. This is reflected in the extensive degree of satisfaction with care as expressed in Papers II-IV. High levels of satisfaction are reported, although the participants report having experienced high levels of postoperative pain. In Paper III, 68% (n=40) and, in Paper IV, 83.5% (n=50) of the patients experienced pain of = 4 on the Visual Analogue Scale (VAS). When they have been admitted to hospital, the individuals sense that they are confirmed by and visible in the system. This visibility is mutual, as the individual becomes an actual person to health care representatives. In a caring conversation, a sense of trust is established and, as this occurs, the individual and the care provider dare to communicate in an open way, where both are present in the situation.

  • 4.
    Sjöling, Mats
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Westman, Anton
    Umeå University.
    Saveman, Britt-Inger
    Umeå University.
    Skydiving culture and its relation to injury risks and injury reporting2010Conference paper (Refereed)
    Abstract [en]

    This article explores some aspects of the Swedish skydiving culture and its relation to injury risks and injury reporting. The reference frame emerging from the analyses encompasses experiences of joy, passion and playfulness; and of injury, suffering and death. For the individual the risk of injury is viewed as an integrated element of the recreational activity, counterbalanced by its recreational value. From the findings we suggest that Swedish skydiving culture on an organisational level is carried by the local club; not the national association. Though the association has far-reaching powers over the clubs, skydiving culture at the local drop zone and formal and informal hierarchical structures among skydivers are what really decide how rules are enforced, and if incidents and injuries are reported.

  • 5.
    Åberg, Viktor
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jeffrey, Wall
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Oavsiktlig vakenhet under operation - Hur kan riskerna minskas?2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Awareness defines as when a patient undergoing surgery in general anaesthesia can remember events or have sensations allthough he or she should have been uncouncious. It is a very serious complication of anesthesiology that can lead to posttraumatic stress syndrome. Approximately 0,1 – 0,2 % of all patients undergoing surgery in general anesthesia is suffering from intraoperative awareness. The most common reason is light anesthesia which, especially on patients at risk, sometimes can be hard to prevent with only the traditional monitoring at hand. Thereby further interventions are also available. Aim: The aim of this literature review was to examine if the risk for intraoperative awareness can be decreased with the use of certain drugs, measurements or other interventions. Method: This study was performed through search of literature in databases PubMed, Cinahl and SveMED+. After analyze and evaluation regarding quality, 20 articles was included in the study. Results: The included articles were divided into four categories for a better overview. These were drugs- and anesthesiology methods, EEG-methods, EEG-methods compared with traditional monitoring and other methods. The results showed that there are many methods available and that there are mixed opinions of their efficiency. Conclusion: The used methods have a margin of error and none of them are so effective that they can be used as a single method to prevent awareness. EEG-measurements can however be an effective add to the traditional monitoring.

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