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Bakgrund: Arbetsmiljön består av fyra delar: fysiska, psykiska, organisatoriska och psykosociala. Delarna i arbetsmiljön påverkar personalen olika mycket. Den organisatoriska delen är stor på operationsavdelningar, där fokus ligger på planering av operationsprogrammet för att inte behöva stryka patienter och att patienter med mest behov ska få vård först. Det gör att snabba förändringar behöver göras och att operationssjuksköterskan inte alltid hinner med att förbereda sig. Motiv: Föreliggande studie kommer att kunna leda till kunskap om operationssjuksköterskans hantering av förändringar i operationsprogrammet. Den informationen kan vara värdefull för mindre erfarna operationssjuksköterskor. Syfte: Syftet med studien var att beskriva erfarenheter bland operationssjuksköterskor gällande hanteringen av kortsiktiga förändringar i operationsprogrammet. Metod: Studien är kvalitativ där deltagarna var operationssjuksköterskor och arbetade vid ett länssjukhus i Norrland. Semistrukturerade intervjuer användes för att samla in data, med en respondent i taget. Kvalitativ innehållsanalys användes sedan för att analysera materialet. Resultat: För hantering av kortsiktiga förändringar har deltagarna olika sätt att förbereda sig, de beskrev vad som var avgörande för att räcka till och vilket sorts inflytande operationssjuksköterskorna har. Dessa tre delar har delats in i kategorier: att hinna förbereda sig, att räcka till och att ha inflytande. Konklusion: Operationssjuksköterskorna beskrev en förståelse av förändringarna som sker i operationsprogrammet. Irritation och frustration kan däremot uppkomma vid sena ändringar och vid ovana ingrepp. Erfarenhet är en tillgång när det gäller förändringar, då de kan jämföra ingrepp med tidigare operationer. Ovana ingrepp kan annars lösas genom byte med kollega eller förlita sig på övrig personal på salen. Antalet förändringar i operationsprogrammet upplevs ha minskat något över tid. / Background:The work environment consists of four parts: physical, mental, organizational and psychosocial. The parts of the work environment affect the staff differently. The organizational part is large in operating wards, where the focus is on planning the operating program so as not to have to cancel patients and that patients with the most needs should receive care first. This means that rapid changes need to be made and that the operating room nurse sometimes does not have enough time to prepare. Motive: The present study will be able to lead to knowledge about the operating room nurse's handling of changes in the operating program. That information can be valuable for less experienced operating room nurses. Aim: The purpose of this study was to describe experiences among operating room nurses regarding the management of short-term changes in the operating program. Methods: The study has a qualitative approach where the participants were operating room nurses and worked at a county hospital in northern Sweden. Semi-structured interviews were used to collect data, with one respondent at a time. Qualitative content analysis was then used to analyze the material. Result: To manage short-term changes, the participants have different ways of preparing, they described what was crucial to suffice and what kind of influence the operating room nurses have. These three parts have been divided into categories: to have time to prepare, to suffice and to have influence. Conclusion: The operating room nurses described an understanding of the changes that are taking place in the surgical program. Irritation and frustration can, however, occur at late changes and the unfamiliar procedures. Experience is an asset when it comes to changes, as they can compare procedures with previous operations. Unusual interventions can otherwise be solved by changing with a colleague or relying on other staff in the hall. The changes in the operating program are perceived to have decreased.

Operationssjuksköterskan arbetar i en högteknologisk och komplex miljö, där samarbetet sker multiprofessionellt. För att kunna upprätthålla en god och säker vård för patienten, behövs en god kommunikation. Operationssjuksköterskan har ett ansvar att skapa en god atmosfär i operationsrummet och samarbeta med teamet för att upprätthålla ett etiskt förhållningsätt kring patienten. Forskning visar att om kommunikationen brister i operationssalen, finns en ökad risk för att patientens vård äventyras. Syftet var att belysa betydelsen av kommunikation i operationsteamet på operationssal utifrån operationssjuksköterskans perspektiv. En systematisk litteraturöversikt med kvalitativ design genomfördes. Artiklar söktes i databaserna Cinahl och PubMed. 13 vetenskapliga artiklar analyserades enligt Bettany-Saltikov och McSherrys (2016) analysmodell. Resultatet presenteras med hjälp av tre huvudkategorier som har betydelse för kommunikation. Att bli påverkad av arbetsmiljön i operationssalen, att teamrelation påverkas i operationssalen och betydelse för säker vård. En god kunskap och förståelse för hur respektfullt versus respektlöst beteende påverkar kommunikationen, är viktig för att främja en god atmosfär i operationssalen. Detta leder till ett gott samarbete i operationsteamet vilket stärker patientsäkerheten. / The operating room nurse works in a high-tech and complex environment, where collaboration takes place multi-professionally. In order to maintain good and safe care for the patient, good communication is needed. The operating room nurse has a responsibility to create a good atmosphere in the operating room and cooperate with the team to provide an ethical approach to the patient. Research shows if communication is lacking in the operating room, there is an increased risk of care being compromised. The purpose was to highlight the communication in the operation team in the operating theatre from the operating room nurse's perspective. A systematic literature review with a qualitative design was conducted. The search was conducted in the Cinahl and PubMed databases. Thirteen scientific articles were analysed according to Bettany-Saltikov and McSherry's (2016) analysis model. The result is presented in three main categories and are important for communication. being affected by the work environment in the operating room, the team relations are affected in the operating room and importance for safe care. A good knowledge and understanding of how respectful versus disrespectful behaviour affects the communication is important to promote a good atmosphere in the operating theatre. This leads to good cooperation in the operation team and strengthens patient safety.

Introduktion: Det råder brist på operationssjuksköterskor nationellt vilket har lett till stängda operationssalar och långa vårdköer. Med detta examensarbete vill författarna skildra sjuksköterskors perspektiv och ge en djupare kunskap i deras syn på operationssjuksköterskans profession, och vad som skulle kunna öka deras intresse för att söka till specialistsjuksköterskeutbildningen mot operationssjukvård. Syfte: ​​Syftet med studien var att beskriva sjuksköterskors uppfattning om operationssjuksköterskans profession.  Metod: En kvalitativ intervjustudie med semistrukturerade frågor med grundutbildade sjuksköterskor i åtta gruppintervjuer med sammanlagt 17 deltagare. Data analyserade enligt kvalitativ innehållsanalys. Resultat: I resultatet framkom två huvudkategorier, med totalt fyra underkategorier. Den första huvudkategorin blev tvetydig kunskap som råder om operationssjuksköterskans profession med tillhörande underkategorier specifikt ansvar utifrån specialistkompetens samt otydlig kunskap och fysiskt krävande arbete. Den andra huvudkategorin blev öka intresse för specialistsjuksköterskeutbildning inriktning mot operationssjukvård, med underkategorierna bra anställningsvillkor och ha nära till utbildningsort samt synliggöra operationssjuksköterskans profession. Konklusion: Studiens resultat visade att operationssjuksköterskans profession inte är helt känd för alla sjuksköterskor. Det fanns olika uppfattningar som mer eller mindre stämmer in på vad operationssjuksköterskans kompetens innebär. I resultatet framkom även förslag på faktorer som skulle kunna öka sjuksköterskors intresse för operationssjukvård. / Introduction: There is a shortage of surgical nurses nationally, which has led to closed operating theaters and long medical care queues. With this degree project, the researchers want to portray nurses' perspectives and provide a deeper knowledge of their view of the operating theatre nurse's profession and what could increase their interest in applying for specialist nursing training against surgical care. Purpose: The purpose of the study was to describe nurses' perception of the operating theatre nurse's profession.  Method: A qualitative interview study with semi-structured questions with basic nurses in eight group interviews and a total of 17 participants. Data analyzed according to qualitative content analysis. Results: The results revealed two main categories, with a total of four subcategories. The first main category was ambiguous knowledge that prevails about the surgical nurse's profession with associated subcategories of specific responsibilities based on specialist competence as well as unclear knowledge and physically demanding work. The second main category was to increase interest in specialist nursing training focusing on surgical care, with the subcategories of good employment conditions and being close to the place of training and making the surgical nurse's profession visible. Conclusion: The results of the study showed that the profession of operating theatre nurse is not completely known to all nurses. There were different perceptions that are more or less correct in what the surgical nurse's competence entails. The results also revealed suggestions for factors that could increase nurses' interest in surgical care.

Introduktion: Strävandet efter ett gemensamt mål utgör grunden för ett kollaborerat samarbete och bristande kommunikation ger märkbara effekter. Operationssjuksköterskan ansvarar även för samverkan och en god kommunikation med operationsteamet och andra vårdenheter. Detta för att tillgodose kontinuitet för patientens vård. Teamets olika professioner och kompetenser skapar ett gemensamt vårdande till förmån för patienten. Syfte: Syftet är att belysa operationssjuksköterskans erfarenhet av kommunikationen inom den perioperativa vården. Metod: Litteraturstudie med en integrativ översikt. 14 studier valdes ut och systematisk artikelsökning utfördes i relevanta databaser. Resultat: Kommunikationen har påvisats kunna ske verbalt eller icke-verbalt för att förmedla information. Operationssjuksköterskans erfarenheter av beteenden och bemötanden har haft en inverkan på hur kommunikationen har påverkats för patientens vårdande. Missförstånd i kommunikationen medförde otrygghet, kulturella skillnader och frångående av rutiner som hotar patientsäkerheten. Konklusion: Flera olika professioner ska kunna samarbeta, kommunicera och tillsammans ansvara för att vården som ges är patientsäker. Med förbättrad och stödjande kultur för vårdpersonalen på operationssalarna och ökat lärande inom IPC och IPL finns möjlighet till förbättrad kommunikation och patientsäkerhet. / Introduction: The pursuit of a common goal forms the basis of collaborative cooperation and lack of communication produces noticeable effects. The operating room nurse is also responsible for cooperation and good communication with the operating team and other care units so that continuity is ensured for the patient's care. The team's various professions and competencies create joint care for the benefit of the patient. Aim: The purpose is to shed light on the operating room nurse's experience of communication within perioperative care. Method: Literature study with an integrative overview. 14 studies were selected and a systematic article search was performed in relevant databases. Results: Communication has been shown to be able to take place verbally or non-verbally to convey information. The operating room nurse's experiences of behaviors and attitudes have had an impact on how communication has been affected for the patient's care. Misunderstandings in communication led to insecurity, cultural differences and deviations from routines that threatened patient safety. Conclusion: Several different professions must be able to cooperate, communicate and together be responsible for ensuring that the care that is given, is patient safe. With improved and supportive culture for the nursing staff in the operating rooms and increased learning in IPC and IPL, there is an opportunity for improved communication and patient safety.

Surgical procedures that require general anesthesia can be stressful and create needless anxiety for school-age children. Interventions aimed at reducing preoperative anxiety can improve cooperation and enhance postoperative outcomes by lowering anxiety levels prior to induction of general anesthesia. The purpose of this study was to examine the effects of behavioral interventions versus drug therapy in reducing pre-operative anxiety in children. The secondary purpose was to compare methods used to integrate anxiety reduction interventions into pre-operative care and to evaluate the most widely used and effective strategy for clinical practice. A literature review exploring behavioral based stress reduction interventions and drug therapy targeted at reducing preoperative anxiety was conducted from various online databases. Peer reviewed articles, published in the English-language between 2006 and 2015 that focused on postoperative outcomes in which preoperative interventions to reduce anxiety in children age two years and older, as well as the parent’s perspective of the outcome, were included for synthesis. Results from 9 randomized controlled trials that used behavioral based interventions implemented on the day of surgery, prior to anesthesia induction were compared for effectiveness at anxiety reduction versus the use of drug therapy prior to surgery. The studies suggest more successful post-surgical outcomes related to shorter length of stay and post-operative delirium for behavioral interventions to reduce anxiety prior to surgery and demonstrated even greater optimal outcomes for combined behavioral interventions. Drug therapy alone to decrease anxiety prior to anesthesia induction showed mixed results in reduction of physiologic and general outcomes following surgery. No significant difference between behavioral based interventions versus drug therapy was shown in any of the reviewed studies to have a significant effect on post-surgical outcomes. However, potentially promising behavioral based interventions such as clowns, electronic devices, parental presence and music over drug therapy prior to surgery, require further evaluation for their use in decreasing pre-operative anxiety in school-age children and having a positive impact on post-operative outcomes.

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Decision-making in healthcare is a complex and, at times, uncertain process. In the United States Certified Registered Nurse Anesthetists (CRNA) administer the majority of anesthesia. Nurse Anesthetists must draw on their educational background, clinical experience, and cognitive processes to make sound clinical judgments. To avoid errors understanding the relationship between cognitive preference and skill acquisition is critical. This study was designed to describe the cognitive preferences of Student Nurse Anesthetists (SRNAs) and CRNAs in the United States. The 2 cognitive preferences explored are rational (analytical) and experiential (intuitive) decision-making. The researcher used a quantitative, cross-sectional, descriptive correlational design. The researcher administered the Rational Experiential Inventory (REI-40) via electronic survey to enrolled SRNAs and practicing CRNAs. The REI-40 is a validated psychometric tool involving 40 questions. Twenty questions evaluate each decision-making style. Ten questions assess engagement (e.g., enjoyment and reliance), and 10 questions assess the ability (e.g., capability and use) of each style. The demographics (e.g., age, gender, clinical experience, setting, and education) were collected and compared with the cognitive preference. This study revealed that SRNAs’ and CRNAs’ dominant cognitive preference was rational thinking and experiential thinking was greater than mid-scale. There was no statistical difference in how SRNAs and CRNAs scored on the REI-40 Inventory. Furthermore, there were no strong correlations between years of experience and cognitive preferences. However, there was a statistically significant difference in experiential cognitive ability and engagement when compared by gender identity. Ideally how one feels, and thinks should be aligned when making clinical decisions. This is the art and science of the profession. Research has revealed that human factors such as cognitive biases, heuristics, personal experience, and emotions play a role in decision-making. The development and integration of experiential decision-making is essential to aligning clinical judgment and safe patient care. This study describes SRNAs’ and CRNAs’ cognitive preferences and the relationship to the level of skill acquisition. This knowledge contributes to the understanding of CRNAs’ decision-making processes. Furthermore, there are ramifications for developing continuing education and clinical support tools for the profession.

<p>The use of both percutaneous and tunnelled central venous catheters in hospitalized patients has increased markedly over the last decade (Camp-Sorrell, 1990). With this increase, there is a clinical need to have an occlusive central line dressing to maintain a barrier to possible site contamination. This randomized control trial examined the use of the transparent dressing OpSite Wound (Smith and Nephew-Ine.) versus the ransparent dressing LV. 3000 (Smith & Nephew Inc.) in its ability to maintain an occlusive central line dressing. The study took place at Chedoke-McMaster Hospitals McMaster Division from June 1991 to September 1991. Adult medical-surgical patients who had a central line in place for longer than 48 hours were eligible for the study. Twenty five central lines were randomized to either the control group (OpSite Wound) or the experimental group (LV. 3000) An independent assessor saw all study patients daily to document dressing adhesiveness and the number of dressing changes performed. Analysis showed that the LV. 3000 dressing was changed every 5.5 days as opposed to the OpSite Wound dressing that was changed every 2.6 days. This difference was both statistically and clinically significant Analysis also showed that the dressings covering central lines with no intravenous in-line attachment (pigtail) were changed more frequently than the dressings covering central lines with an attached pigtail. This difference was also statistically significant The LV. 3000 dressing therefore, provides an occlusive central line dressing that is changed one-half the number of times that the OpSite Wound dressing is changed, or in other words, the OpSite. Wound dressing is changed twice as often as the I.V. 3000 dressing when used on central lines.</p> / Master of Health Sciences (MSc)