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Introduktion: Sepsis och septisk chock är ett livshotande tillstånd som drabbar cirka 49 miljoner människor varje år. Intensivvårdssjuksköterskan har en central roll i överlevnaden hos patienten och använder evidensbaserade omvårdnadsåtgärder för att främja patientens hälsa. Nuvarande forskning visar att både beroende respektive oberoende specifika omvårdnadsåtgärder är nödvändiga för att patienten ska överleva. Syfte: Att belysa intensivvårdssjuksköterskans omvårdnadsåtgärder vid vård av patienter med sepsis och septisk chock. Metod: En integrativ litteraturstudie har genomförts. Litteratursökning har skett i databaserna CINAHL och PubMed. Totalt inkluderades 10 vetenskapliga artiklar som svarade på studiens syfte. Resultat: Utifrån inkluderade artiklar sammanställdes tre huvudteman: 1. “Att arbeta strukturerat” 2. “Övervakning och bedömningar". 3. "Specifika omvårdnadsåtgärder”. Konklusion: Intensivvårdssjuksköterskan utför flera omvårdnadsåtgärder för att främja patientens hälsa vid sepsis och septisk chock både på intensivvårdsavdelningen och på andra vårdavdelningar. Ofta samlas omvårdnadsåtgärderna i ett protokoll som intensivvårdssjuksköterskan har till hjälp för att på ett säkert sätt effektivisera vården. En förutsättning för att uppnå en strukturerad vård är att intensivvårdssjuksköterskan samordnar vården och kommunicerar med andra professioner.

Abstract  Background: The operating team consists of various professions that possess unique skills and knowledge that are needed for patient-safe care. The anesthesia nurse and anesthesiologist have an important role in the team, they need to work together and use their knowledge and skills to maintain patient safety. Work environment, sense of community, effective communication and hierarchical structures were considered to be the factors that had the greatest impact on this international collaboration. Aim: The purpose of the study is to investigate the anesthesia nurse's experience of collaboration with anesthesiologist in the intraoperative stage. Methods: The study was conducted as a qualitative interview study with semi-structured questions. The data collection took place in two operating departments in Stockholm, where 10 anesthesia nurses were interviewed. The analysis was carried out according to Lindgren et al. (2020) description for qualitative content analysis. Results: Four categories were identified. The categories were: Sense of security in the professional role facilitates with subcategories the importance of professional experience and feeling trust in collaboration. When cooperation fails with subcategories of not being listened to and lack of trust. The effect of interpersonal relationships with subcategories personal chemistry in collaboration and handling conflicts. The impact of clarity on the working process with subcategories clear dialogue facilitates and having a clear division of labor. Conclusions: The cooperation in the team is important as the intraoperative environment is complicated. The results shows that good communication, planning, trust and respect for each other’s professional competencies promotes teamwork and thereby increases patient safety.

Bakgrund: Alla patienter är oroliga inför anestesi då de förlorar kontrollen över sin kropp. De önskar ha en bra kontakt med anestesisjuksköterskan för att kunna förmedla sina behov. Informationsbehovet är dock olika för alla patienter, vissa vill veta allt medan andra vill få sparsamt med information. Syfte: Syftet är att beskriva anestesisjuksköterskors erfarenheter av att möta patienter inför och under anestesi. Metod: Kvalitativ systematisk litteraturstudie av bearbetat material. Resultat: Anestesisjuksköterskorna ansåg att det var viktigt att se patientens behov för att kunna skapa trygghet, likväl som att ha en bra kommunikation. Tidsbrist var dock vanligt förekommande vilket skapade hinder i mötet med patienten. Slutsats: Anestesisjuksköterskorna vill utföra ett bra arbete, men då patienterna och verksamheten ofta ställer motstridiga krav krävs en ständig avvägning för att avgöra vad som är bäst här och nu. / Background: All the patients are apprehensive prior to anesthesia, due to the fact that they lose control of their bodies. The patients desire good contact with the nurse anesthetist, in order to convey their needs. The need for information vairy for all the patients. Some require detailed information, while others only sparingly need information. Aim: The aim of the study is to describe nurse anesthetists experience in meeting the patients prior and during anesthesia. Method: A systematic qualitative literature study of published materials was conducted. Results: The nurse anesthetists believe that it is important to see the patients needs, in order to be able to build a sense of security, in addition to good communication. The common obstacle is shortage of time, which affects contact with the patient. Conclusion: The nurse anesthetists feel a need to perform good work. But the patienten och the administration often make conflicting demands, which means that a constant consideration is needed to decide what’s best here and now.

Propofol is an intravenously administered, hypnotic and short- acting pharmaceutical. One common sideeffect (>1:10) and therefore a disadvantage with propofol is the local pain that arise when the initial injection is given. Why the pain arise is not clearly understood. A majority of different pharmacological treatments, different doses and combinations, alternative administrations methods and physical interventions have been tried to reduce the pain when injection of propofol is given. One important task for the nurse is to relieve pain for patients. It is important for all patients to be painless and not experience discomfort caused by procedure in health care. The purpose of this study was to examine if administration of lidocaine and/ or remifentanil could in connection with injection of propofol reduce pain incidence and intensity at the injection. A literature study based on twenty-eight scientific articles was conducted. The result shows that a combination of lidocaine andremifentanil give the best pain relief. Howewer there is no difference in propofolinduced injection pain when lidocaine or remifentanil alone is compared. Other factors that could affect injection pain are use of a tourniquet which enhances the pain reduction, but the time that the tourniquet is applied is not decisive. The placement of the iv-catheter should be in the largest vein possible. By using this knowledge the incidence and intensity of pain could be reduced with drugs commonly used in Swedish aneasthetic care. Thereby patients' suffering could also be reduced.

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Forty to sixty percent of all children having surgery experience preoperative anxiety. Preoperative anxiety is a risk factor for negative behavioural changes postoperative. It is of importance to find strategies in the interaction with the child to reduce anxiety. The overall aim was to describe CRNA's interaction with the child in relation to anxiety during anaesthesia induction and to describe the translation process of m-YPAS into Swedish and the testing of the psychometric properties in a Swedish context. In paper I an explorative qualitative approach with CIT was used and 32 CRNAs were interviewed. Experiences described were about the organisation which included effect of information, teamwork and time. Other experiences were grouped around interrelations such as, communication, meeting both anxious and calm children and experiences of use of physical restraint. Actions taken to reduce anxiety were optimizing the situation, as acting according to the situation, it could mean altering routines, though always without jeopardizing the safety of the child, preparing ahead and using distraction. Creating interpersonal interaction such as, creating contact, participation and using collaboration with the child, parents and colleagues. In paper II m-YPAS was translated into Swedish using cross cultural back translation. The psychometric properties of m-YPAS were tested in two phases. In phase I 52 children were assessed in real time by two SRNAs and one CRNA using m-YPAS and NAS. In phase II 98 video films of children were assessed by experienced CRNAs in the same way as in phase I. The psychometric properties of m-YPAS were good. Conclusion: In the interaction between CRNAs and the child, being flexible and sensitive to the child, taking the role of the child, and acting according to the need of the child were cornerstones in reducing preoperative anxiety and avoiding use of physical restraint. The m-YPAS can be used as an educational tool to enhance the anaesthetist's ability to interpret the child's anxiety. The m-YPAS is a valid and reliable assessment instrument to examine the efficiency of interventions and compare the result of research between cultures.

Sammanfattning Bakgrund: Det är känt att musik kan påverka personer och kan användas i syfte att främja läkning. Musik används bland annat för patienter med demens och för patienter som är vakna under operation. Regional anestesi i samband med operation medför flera fördelar för patienten som skall opereras. Det finns flera studier som visar musikens positiva effekt för patientens välbefinnande både innan och efter operation. Syfte: Syftet med litteraturstudien var att sammanställa forskning avseende musikens inverkan på patienten vid regional anestesi under operation. Metod: Metoden var en systematisk litteraturöversikt. I resultatet inkluderades 13 stycken artiklar, både kvalitativa och kvantitativa. Analysmetod som användes var integrerad dataanalys och resultatet redovisades i form av kategorier och underkategorier. Resultat: Patienters oro och ångest minskade när de fick lyssna på musik under regional anestesi. Patienter beskrev att de upplevde en känsla av välmående och var mer tillfredsställda efter operation om de fått lyssna på musik. Vitalparametrar som blodtryck och pulsfrekvens visade sig minska vid användning av musik. En del patienter upplevde att smärtan minskade. Det fanns dock inkluderande studier som inte påvisade någon signifikant skillnad på respektive kategori. Diskussion: Musik kan ha en positiv inverkan under operation med regional anestesi. Det används olika instrument för att mäta ångest, vilket kan påverka resultatet. Vid vissa studier fick patienterna välja musik själva. Musiken spelades upp i varierande former, till exempel i hörlurar eller i operationssalen. Dessa faktorer gör att de blir svårt att dra ett generaliserbart resultat. Slutsats: Resultatet visar att musik kan ha en positiv inverkan både fysiskt och psykiskt på patienterna som fick lyssna på musik under operation. Anestesisjuksköterskor bör erbjuda musik vid regional anestesi och patienterna kan med fördel få välja musik själva då det visat sig ha bra effekt. / Abstract Background: Music is well known to affect people and has been used to promote healing. Music is used, for example, for patients with dementia and for patients waking up during surgery. Regional anesthesia associated with surgery brings several benefits to the patient to be operated. There are several studies showing the positive impact of music on patient wellbeing before and after surgery. Aim: The purpose of the literature study was to compile research into the impact of music on the patient in regional anesthesia during surgery. Method: The method was a literature review. In the result 13 articles were included, both qualitative and quantitative. The analysis method used was integrated data analysis and the results were presented in the form of categories and undercategories. Result: Patients' anxiety decreased when they listened to music under regional anesthesia. Patients described that they experienced a sense of well-being and were more satisfied after surgery if they had listened to music. Vital parameters such as blood pressure and pulse rate were found to decrease when using music. Some patients felt that the pain decreased. However, there were included studies that did not show any significant difference in the respective categories. Discussion: Music may have a positive effect during surgery with regional anesthesia. Different instruments are used to measure anxiety, which can affect the outcome. In some studies, patients were given the choice of music themselves. The music was recorded in various forms, such as headphones or in the operating room. These factors make it difficult to draw a generalizable result. Conclusion: The result shows that music can have a positive impact both physically and mentally on patients who listened to music during surgery. Nurse anesthetists should offer music at regional anesthesia and patients can benefit from choosing music themselves as it proved to be of good effect.

The rupture of an aneurysm in subarachnoid hemorrhage (SAH) is a dramatic event causing a severe impact on the brain and a transient or permanent ischemic condition. Several types of responses to meet the challenges of SAH have been found in the acute phase, including activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, elevated levels of brain natriuretic peptide (BNP), and disturbances in cerebral and systemic metabolism. Cerebral metabolism and the endocrine stress response in the ultra-early phase was investigated in a novel porcine model of SAH in which autologous blood was injected to the anterior skull base. Early activation of the HPA axis was found with rapid elevation of adrenocorticotrophic hormone, cortisol and aldosterone. The peak values of these hormones were early and may be impossible to catch in patients. There were indications of a sympathetic nervous response with excretion of catecholamines in urine as well as plasma chromogranin-A elevation. Cerebral microdialysis suggested immediate substrate failure followed by hypermetabolism of glucose. The animal model seems suited for further studies of aneurysmal SAH. NT-proBNP was investigated in 156 patients with SAH, there was a dynamic course with increasing levels during the first 4 days of the disease. Factors predicting high NT-proBNP load included female sex, high age, high Troponin-I at admission, angiographic finding of an aneurysm and worse clinical condition at admission. High levels of NT-proBNP were correlated to factors indicating a more severe disease, suggesting the initial injury in aneurysmal SAH is an important factor in predicting high NT-proBNP during the acute stage of the disease. Measurements with indirect calorimetry were performed daily during the first week after SAH on 32 patients with SAH. There was a dynamic course with increasing energy expenditure (EE) the first week after SAH. Comparisons with three predictive equations indicated that measured EE generally is higher than predicted, but considerable variation exists within and between patients, indicating that prediction of EE in SAH is difficult. Altogether, the studies demonstrate a complicated response in acute SAH that needs to be further studied to increase possibility of good outcome in SAH patients.