Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-09T17:07:23Z No. of bitstreams: 1 Renata da Silva Schulz.pdf: 1769123 bytes, checksum: 9d3c4de0e502584c8e773a4bf8ca9627 (MD5) / Made available in DSpace on 2015-12-09T17:07:23Z (GMT). No. of bitstreams: 1 Renata da Silva Schulz.pdf: 1769123 bytes, checksum: 9d3c4de0e502584c8e773a4bf8ca9627 (MD5) Previous issue date: 2013 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este estudo teve como objetivos avaliar a efetividade da intervenção acompanhamento por telefone comparado ao tratamento convencional em pacientes idosos de pós-operatório das cirurgias de colecistectomia e herniorrafia e o de analisar a evolução do diagnóstico de enfermagem Recuperação Cirúrgica Retardada (RCR) ao longo de quatro semanas nos grupos envolvidos. Método: Trata-se de um ensaio clínico controlado e randomizado, com abordagem quantitativa, realizado em dois hospitais de ensino do Rio de Janeiro. A amostra foi composta por 43 pacientes, acompanhados por 4 semanas. Para randomização da amostra utilizou-se o Programa Statistical Package for the Social Sciences (SPSS) e como intervenção de enfermagem o acompanhamento por telefone para os pacientes do grupo experimento. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina, sob o protocolo nº 327/2010 e CAAE: 09911212.0.0000.5243. A coleta de dados foi realizada durante seis meses, pela enfermeira pesquisadora e por cinco examinadoras que passaram por treinamento diagnóstico. Resultados: Não houve diferença significativa, em nível de 5%, nas variáveis sociais e demográficas modificadas entre os dois grupos de tratamento. Observou-se queda significativa da primeira avaliação para a última avaliação para a característica definidora “perda do apetite com náuseas” do grupo experimento (p = 0,013). Entre a primeira e a última avaliação a característica definidora “precisa de ajuda para completar o autocuidado” no grupo controle apresentou tendência de queda (p = 0,041). Para os fatores relacionados houve queda significativa da “dor” no grupo experimento (p = 0,041) assim como o “sentimento pós-operatório” (p = 0,023). Conclusão: Houve baixa prevalência do diagnóstico de RCR nos grupos para as cirurgias estudadas. Apesar de não ter havido diferença estatística entre os grupos, observou-se maior tendência de queda no grupo experimento. O acompanhamento por telefone é um recurso de baixo custo, acessível por grande parte da população, com altas taxas de adesão e, por isto estendida ao atendimento em saúde pública e privada. Durante o contato telefônico as principais dúvidas foram em relação ao uso de medicações, a ferida operatória e a alimentação. Estudos com maior casuística são necessários para que se possa afirmar que há superioridade estatística quanto à incidência de Recuperação Cirúrgica Retardada quando comparada ao tratamento convencional. / This study aimed to evaluate the effectiveness of the intervention telephone follow-up compared with conventional treatment in elderly patients after cholecystectomy and hernia surgery and to analyze the evolution of nursing diagnosis Delayed Surgical Recovery (DSR) over four weeks, in the groups involved. Methodology: This was a randomized controlled trial with a quantitative approach, performed in two teaching hospitals in Rio de Janeiro. The sample consisted of 43 patients followed for 4 weeks. For randomization of the sample was used the program Statistical Package for Social Sciences (SPSS) and as a nursing intervention, the follow-up by phone for patients in the experimental group. This study was approved by the Ethics Committee of the Faculty of Medicine, under protocol number 327/2010 and CAAE: CAAE: 09911212.0.0000.5243. Data collection was carried out over six months by the research nurse and five examiners who were trained for the diagnois. Results: No significant difference at 5% level, in the social and demographic variables, between the two treatment groups, was found. We observed a significant decrease of the first assessment to last assessment for the defining characteristic "loss of appetite with nausea" in the experimental group (p = 0.013). Between the first and last assessment the defining characteristic "need help to complete self-care" in the control group tended to decrease (p = 0.041). Factors related to significant falls in the "pain" in the experimental group (p = 0.041) as well as "feeling after surgery" (p = 0.023). Conclusion: There was a low prevalence of the diagnosis of DSR in groups for the surgeries studied. Although there was no statistical difference between the groups, there was a greater tendency to fall in the experimental group. Telephone follow-up is a low-cost resource, accessible by most of the population, with high rates of adherence and may be used for health care in public health system. During the telephone contact were the main questions regarding the use of medications, and the power to wound. Studies with larger samples are needed so that one can say that there are statistical superiority regarding the incidence of Delayed Surgical Recovery when compared to conventional treatment.

Introduktion: Förebyggande och korrekt utförda omvårdnadsåtgärder är en del av operationssjuksköterskans arbete. Operationssjuksköterskan arbetar utifrån den perioperativa vårdprocessen med att planera, genomföra och utvärdera omvårdnadsåtgärder. Återkoppling har visat sig förbättra omvårdnad och utveckla professionen. I litteraturen finns få studier om hur operationssjuksköterskor upplever återkoppling under den perioperativa vårdprocessen. Syfte: Studiens syfte var att beskriva operationssjuksköterskors upplevelse av återkoppling och upplevelse av återkopplingens betydelse för utveckling av professionen. Metod: En kvalitativ intervjustudie med semistrukturerade frågor har analyserats med kvalitativ innehållsanalys. 11 operationssjuksköterskor i åldern 26-60 år och med erfarenhet som operationssjuksköterska mellan 7 månader och 36 år inkluderades, alla var kvinnor. Resultat: Operationssjuksköterskorna önskade mer återkoppling både för professionens utveckling i stort och för förbättrad utvärdering av egna utförda omvårdnadsåtgärder. All återkoppling upplevdes positivt. Avsaknad av samarbete mellan vårdenheter påverkade möjligheten till återkoppling negativt. Brist på återkoppling ledde till eget sökande av återkoppling på utförda omvårdnadsåtgärder. Konklusion: Genom återkoppling kan operationssjuksköterskorna få svar på sina utförda omvårdnadsåtgärder. Återkoppling till operationssjuksköterskan behöver implementeras och utvecklas i det dagliga arbetet. / Introduction: Preventive and correctly taken nursing measures is part of the operating theatre nurse´s work. The operating theatre nurse´s work with the perioperative process by planning and implementing the nursing measures and evaluating them. Feedback has been shown to improve the care and develop the profession. There are few studies in the literature about the operating theatre nurses experience of feedback during the perioperative process. Aim: The aim of this study was to describe the operating theatre nurse´s experience of feedback and the importance of the feedback for the development of the profession. Method: A qualitative study with semi-structured questions has been analyzed with a qualitative content analysis. 11 operating theatre nurses in the age 26-60 years with the experiences an operating theatre nurse from 7 month to 36 years participated, all were women. Results: The operating theatre nurses experienced that it would be significant with more feedback, both for the development of the profession and to improve the evaluation of taken nursing measures. All feedback was positive. Lack of cooperation between care units affected the possibility of feedback negatively. The lack of feedback led them to seeking feedback of nursing measures by themselves. Conclusion: Through feedback the operating theatre nurses can get answer of their taken nursing measures. The feedback to the operating theatre nurses need to be implemented and develop in the daily work.

Bakgrund: I litteraturen finns evidens att använda dubbla lager av operationshandskar vid all kirurgi för att förebygga smittspridning mellan patient och personal samt för att förebygga vårdrelaterade infektioner. Operationshandskar kan ha olika tjocklek och taktil känsla beroende på latex eller latexfritt material. Trots att evidens finns att använda dubbla lager operationshandskar förekommer variation i användandet. Syfte: Syftet med studien var att undersöka om operationssjuksköterskor och kirurger väljer enkla eller dubbla handskar vid operationer, samt hur de motiverar sitt val. Metod: Operationssjuksköterskor och kirurger från två operationsavdelningar i Mellansverige undersöktes i en tvärsnittsdesign med intervjustödda enkäter. Flera deltagare intervjuades flera gånger. Resultat: Totalt inkluderades 66 deltagare i studien och 137 intervjuer genomfördes. Nästan hälften av deltagarna motiverade sitt val av handskar med rutin eller vana. Vid samtliga ortopediska operationer användes dubbla handskar. Enkelt lager av handskar användes i högre grad då endast latexfria handskar fanns att tillgå, och den dominerande motiveringen var då att det var mer svårarbetat med dubbla handskar. Slutsats och klinisk betydelse: Användandet av enkla respektive dubbla handskar skiljer sig mellan verksamheterna och mellan yrkeskategorierna. Dubbla handskar användes av samtliga deltagare på den avdelning där skriftliga riktlinjer angående dubbla handskar fanns formulerade. Enkla handskar användes i högre grad då endast latexfria handskar fanns att tillgå. Resultatet i föreliggande studie indikerar att riktlinjer angående dubbla handskar, samt latexfria handskars sämre taktila förmåga kan ha betydelse för hur operationspersonal väljer operationshandskar. / Background: In the literature, there is evidence of the usage of double layered surgical gloves during all surgical procedures in order to prevent the spread of infection between the patient and medical personnel, as well as, to prevent clinical infections. Double layered surgical gloves can have different thickness and tactile feeling depending on latex or latex-free material. Aim: To investigate if operating room nurses and surgeons choose single or double gloving for operations, as well as, how they motivate their choices. Method: Operating room nurses and surgeons from two different operation departments in the middle of Sweden were examined in a cross-sectional design with interview-supported questionnaires. Some participants were interviewed several times. Results: In total, 66 participants were included in the study and 137 interviews were conducted. Almost half of the participants motivated their choice of gloves routinely or habitually. In all orthopedic operations, double gloves were used. Conclusion and clinical implications: The usage of single as opposed to double-gloving differs between departments and between different categories of profession. The majority of participants chose to use double gloves. Double gloves were more frequently used on the ward where written guidelines regarding double gloves were formulated. Single gloves were more commonly used in the pediatric surgery department, where only latex-free gloves were available for use. The result in the present study indicates that guidelines regarding double gloves can be significant for how operation personnel choose surgical gloves.

Bakgrund: Under det perioperativa vårdförloppet föreligger många riskfaktorer för patienten att utveckla oavsiktlig hypotermi. Detta kan leda till flertalet operativa och postoperativa komplikationer vilket kan skapa obehag och lidande för patienten, förlänga vårdtider och generera ökade kostnader för samhället. Den perioperativa specialistsjuksköterskans omvårdnadsansvar innefattar ett flertal värmebevarande omvårdnadsåtgärder för att förebygga och behandla hypotermi hos patienten. Syfte: Syftet med studien var att beskriva anestesi-, operations- och intensivvårdssjuksköterskors värmebevarande omvårdnadsåtgärder i det perioperativa vårdförloppet. Metod: En studie med deskriptiv analys utfördes. Data samlades in genom en strukturerad intervjuguide. Sammanlagt deltog 36 specialistsjuksköterskor i studien. Resultat: Specialistsjuksköterskornas värmebevarande omvårdnadsåtgärder bestod utav både passiva och aktiva åtgärder varav tre var utmärkande; att använda luftvärmetäcke, att ge varma infusions- och spolvätskor samt att undvika onödig exponering av patienten. Rutinmässig temperaturmätning av patienten saknades i det perioperativa vårdförloppet. Dokumentering av värmebevarande omvårdnadsåtgärder utfördes i hög grad inom det perioperativa specialistsjukskötersketeamet. Slutsats: Flertalet aktiva och passiva värmebevarande omvårdnadsåtgärder utfördes perioperativt trots avsaknad av skriftliga lokala arbetsrutiner och nationella riktlinjer. Förvärmning av patienten eller operationsbädden förekom däremot inte som aktiva förebyggande omvårdnadsåtgärder. Klinisk betydelse: Studien önskar lyfta fram ett viktigt omvårdnadsområde för specialistsjuksköterskor verksamma inom perioperativ vård. Studieresultatet skulle kunna ligga till grund för utbildningsinsatser och utformandet av lokala arbetsrutiner gällande värmebevarande omvårdnadsåtgärder. / Background: During perioperative care multiple risks exist for the patient to develop accidental hypothermia. This can cause increased morbidity, unnecessary patient suffering, prolonged recovery time and subsequently increased costs for the society. Perioperative nursing care involves several warmth preserving interventions to prevent inadvertent hypothermia. Objective: The aim of this study was to describe the perioperative specialist nurses warmth preserving nursing interventions in perioperative care. Method: A study with descriptive analyses has been performed. Data was collected through a structured interview guide. A total of 36 specialist nurses participated in the study. Result: The specialist nurses’ warmth preserving interventions consisted of both passive and active interventions where three were more distinctive; to use forced air warming blankets, to give warm intravenous and/or irrigation fluid and to avoid unnecessary exposure of the patient. Warmth preserving nursing interventions was well documented within the perioperative nursing team. Temperature monitoring was not routinely performed. Conclusion:. Several active and passive warmth preserving interventions were carried out, even though local and national guidelines regarding warmth preserving interentions were missing. Prewarming of patient or operating table was not implemented as active preventative measures. Clinical significance: This study wishes to aid in the ongoing work of improving perioperative care by giving focus to an important area within nursing. The study result will hopefully encourage to further education and to the development of local guidelines regarding warmth preserving interventions.

Bakgrund: Anestesi- och operationssjuksköterskor arbetar i en komplex miljö. För att öka effektiviteten infördes ett effektivitetssalskoncept på en klinik. Flera sätt att öka effektiviteten beskrivs i litteraturen, få studier har dock berört sjuksköterskornas upplevelser av att arbeta enligt liknande koncept. Syftet: Var att undersöka hur anestesi- och operationssjuksköterskor upplevde det perioperativa omvårdnadsarbetet när det sker inom effektivitetssalskonceptets ramar. Metod: En kvalitativ induktiv pilotstudie genomfördes, ett ändamålsenligt urval användes och fyra stycken specialistsjuksköterskor deltog i studien. Enskilda intervjuer genomfördes med öppna frågor. Data analyserades med kvalitativ innehållsanalys. Resultat: Upplevelsen av omvårdnadsarbetet när det skedde enligt effektivitetssalskonceptet var behäftat med känslor av tillfredsställelse och glädje, bland annat över att operationsköerna kortades av. Vikten av kommunikation, samordning och samarbete framträdde tydligt. Bristande kommunikation kunde leda till ineffektivitet och förvirring. Arbetssättet krävde och främjade samarbete inom operationslaget. Ökad kontinuitet beskrevs både i kontakt med kollegor och med patienter. Vissa nackdelar som rörde tidsdisponering och de fysiska lokalerna beskrevs. Slutsats: Arbete enligt effektivtetssalskonceptet var i hög grad beroende av kommunikation, samarbete och samordning. Fungerade detta kunde det leda till ökad arbetstillfredsställelse och kontinuitet i den perioperativa omvårdnaden. Kommunikationsbrister inverkade negativt på effektiviteten. Klinisk betydelse: Pilotstudien utgjorde en del i ett underlag för utveckling av effektivitetssalskonceptet på den aktuella kliniken. Med kunskap om hur omvårdnadsarbetet påverkades kunde förbättringsarbetet underlättas. / Background: Anesthesia and operating room nurses are working in a complex environment. To reduce surgical queues and increase efficiency, an efficiency model was introduced at a clinic. Several ways to increase efficiency are described in the literature, few studies have concerned nurses' experiences of working according to similar concepts. The aim: Was to examine how the anesthesia and operating room nurses experienced the perioperative nursing care when it took place within the frames of an efficiency model. Method: A qualitative inductive pilot study was conducted. An appropriate selection were used and four specialist nurses participated in the study. Interviews were conducted with open questions. Content analysis was carried out. Results: The experience of nursing care when it is done according to the efficiency model was beset with feelings of satisfaction and joy, among other things that the surgery waiting lists could be shortened. The importance of communication, coordination and cooperation was clearly apparent. Lack of communication could lead to inefficiency and confusion. The approach required and promoted collaboration within the surgical team. Increased continuity was described both in contact with colleagues and patients. Some drawbacks concerning time disposition and the physical premises was described. Conclusion: Work according to the efficiency model was to a large extent dependent on communication, cooperation and coordination. Did this work it might have lead to increased job satisfaction and continuity of the perioperative nursing care. Communication shortcomings adversely affected efficiency. Clinical significance: The pilot study may be part of a basis for developing the efficiency model at the current clinic. With knowledge of how nursing care is affected, the improvement work is facilitated.

Anualmente são realizadas mais de 234 milhões de cirurgias no mundo com taxas de morbi e mortalidade relativamente elevadas. Os dados nacionais disponíveis de registros de operações não cardíacas são escassos e deficientes. O objetivo do nosso estudo foi avaliar o perfil epidemiológico dos pacientes submetidos a operações não cardíacas e a sua evolução nos últimos anos no Brasil. Selecionamos a partir do banco de dados de DATASUS, as informações de sistema público de saúde em caráter nacional para descrição epidemiológica de operações não cardíacas realizadas no país. As variáveis estudadas foram: número total de internações, gasto total por internação, gasto com transfusões sanguíneas, número de óbitos e tempo de internação hospitalar. O período estudado compreendeu os anos de 1995 a 2007. No período de 13 anos, foram realizadas 32.659.513 operações não cardíacas no país e houve um incremento de 20,42% no número de procedimentos realizados. De forma semelhante, os gastos hospitalares relacionados a estas cirurgias apresentaram aumento importante neste período (~ 200%), com gasto anual superior a 2 bilhões de reais. As despesas relacionadas às transfusões sanguíneas no perioperatório tiveram um aumento superior a 100%, com um gasto anual acima de 17 milhões de reais ao ano. A mortalidade hospitalar encontrada é bastante elevada no nosso país, com média de 1,77% e o aumento registrado foi mais de 30% no período. A única variável que apresentou redução ao longo dos últimos anos foi o tempo de internação hospitalar, com a média de permanência de 3,83 dias. Concluímos que há uma tendência no aumento de intervenções cirúrgicas no país. Apesar do aumento dos gastos hospitalares relacionados a estas cirurgias, a taxa de mortalidade encontrada ainda é bastante elevada. Estudos futuros são necessários para maior investigação e elaboração de estratégias complementares para melhorar os resultados cirúrgicos / Worldwide, there were performed about 234 millions of surgeries annually with a relatively high surgical morbidity and mortality. Registry and information about non-cardiac operations in Brazil are scarce and deficient. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. This is a retrospective cohort study that investigated the time-window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The variables studied were: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. There were 32.659.513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200% and the yearly cost of surgical procedures to public health system was superior to 1.2 billions of dollars (2 billions of reais). The cost of blood transfusion had an increment superior to 100% and annually approximately 10 millions of dollars (17 millions of reais) were spent in perioperative transfusion. Actually, in 2007, the surgical mortality in Brazil was 1.77% and it had an increment of 31.11% in the period of 1995 to 2007. The length of stay was the unique variable which had a reduction of its numbers in the period. In average, the mean time of surgical hospitalization was 3.83 days. We concluded that the volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil

Bakgrund: Enligt Socialstyrelsens drabbas ca 110 000 patienter eller 8% av alla i den somatiska sjukhusvården av en vårdskada. En vårdskada är en undvikbar skada och patientsäkerhet är då att skydda patienten mot denna skada. En operationsavdelning är en komplex enhet med högteknologisk utrustning där många specialiteter och yrkeskategorier ska samordnas och arbeta i team för att patienten ska få en säker vård. Operationssjuksköterskan ska arbeta för en god och patientsäker perioperativ omvårdnad. Kärnan i operationssjuksköterskans omvårdnadsarbete är att säkerställa patientens säkerhet under operation och att arbeta förebyggande genom att tänka på allt som kan gå fel under en operation. Men vad som tillhör operationssjuksköterskans ansvarsområde och hur vederbörande kan säkerställa patientsäkerhet inom perioperativ omvårdnad behöver belysas och analyseras bättre.Syfte: Att belysa operationssjuksköterskans uppfattning om patientsäkerhet inom perioperativ omvårdnad i en svensk kontext.Metod: Kvalitativa semistrukturerade intervjuer genomfördes med 14 operationssjuksköterskor på ett mellanstort sjukhus i Södra Sverige. Intervjuernas innehåll analyserades med innehållsanalys.Resultat: Följande kategorier framkom i resultatet; Klinisk kompetens, Kommunikation, Vårdmiljö och Kompetensutveckling med elva underkategorier. Dessa kategorier reflekterade hur operationssjuksköterskorna uppfattade patientsäkerhet i förhållande till sin roll och ansvarsområden inom den perioperativa omvårdnaden.Slutsats: Resultatet indikerar att operationssjuksköterskan uppfattar att det huvudsakliga ansvarsområdet inom perioperativ omvårdnad är hygien och att bevara steriliteten och inom detta område försöker arbeta för att förhindra vårdskador och ge patienten en säker vård. Det finns dock omständigheter i organisationen på operationsavdelningen, i teamet och bristande respekt för operationssjuksköterskans kompetens som försvårar det arbetet. / Background: The National Board of Health and Welfare estimates that 110 000 patients or 8% of all patients in the somatic hospital care are affected by health care errors. A health care error is an avoidable damage and patient safety are defined to protect patient against damage. An operation theatre is a complex environment with advanced technical equipment. Interdisciplinary groups of health professionals work together in teams to deliver safe care for the patients. The operating theatre nurse shall work to give the patient safe perioperative nursing. The core of their work is to ensure patient safety during surgery, managing risks and preventing harm. However, to analyze and illuminate the responsibility of the operating theatre nurses work to secure patient safety during perioperative nursing seems to be scarcely investigated.Aim: The aim of this study was to illuminate the operating theatre nurses perceptions of patient safety in perioperative nursing in a Swedish context.Method: Qualitative semi structured interviews were conducted with 14 operating theatre nurses in a hospital in the South of Sweden. The data was analyzed using content analysis.Results: These categories were identified in the results; clinical competence, communication, care environment and skills development with eleven subcategories. These categories reflected how the operating theatre nurses perceived patient safety related to their role and responsibility in perioperative nursing.Conclusion: The result indicates that these operating theatre nurse perceive that the main responsibility in perioperative nursing is hygiene and to preserve sterility. Furthermore, work to prevent health care error and to give the patient safe care. There are circumstances in the organization of the operation theatre, in the team and lack of respect for the operating theatre nurses competence that complicates that work.

Orientador: Marla Andréia Garcia de Avila / Resumo: Introdução – Em geral, as crianças com hidrocefalia são submetidas a várias cirurgias e requerem cuidados diários, principalmente devido ao uso de derivação ventrículo peritoneal. Embora toda a família seja afetada, um de seus membros, denominado cuidador informal, assume a responsabilidade pelo cuidado, nem sempre com preparo técnico e emocional. Cabe aos profissionais de saúde a realização do processo educativo, tendo como foco o conhecimento e como objetivos a promoção de saúde e a prevenção de complicações. Artigo 1: Objetivo –Avaliar o conhecimento, a atitude e a prática de cuidadores informais de crianças com hidrocefalia antes e após intervenção com material educativo previamente desenvolvido. Método –Trata-se de um estudo quase-experimental, do tipo antes e depois, realizado com 32 cuidadores informais de crianças com hidrocefalia de um hospital universitário do interior de São Paulo. A coleta de dados ocorreu em três etapas: pré-teste, intervenção educativa através do material educativo e pós-teste. Foi utilizado o inquérito conhecimento, atitude e prática como instrumento de avaliação pré e pós-teste. Para análise da comparação pré-teste e pós-teste foi utilizado o teste t pareado e Teoria Clássica dos Testes. Resultados –Após a leitura do material educativo, os domínios conhecimento e prática obtiveram um aumento na taxa de acertos de 17% e 21,4%, respectivamente, e valor p<0,01. Artigo 2: Objetivo - Compreender se o material educativo “Diário de Laura: conhecendo ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction - In general, children with hydrocephalus are submitted to many surgeries and require daily care, mainly due to the use of peritoneal ventricle shunt. Although the whole family is affected, one of its members, called informal caregiver, assumes responsibility for care, not always with technical and emotional preparation. It is up to health professionals to carry out the educational process, focusing on knowledge and the objectives of health promotion and prevention of complications. Article 1: Objective - To assess the knowledge, attitude and practice of informal caregivers of children with hydrocephalus before and after intervention with previously developed educational material. Method - This is a quasiexperimental before and after study conducted with 32 informal caregivers of children with hydrocephalus from a university hospital in the inland of São Paulo State. Data collection took place in three stages: pre-test, educational intervention through educational material and posttest. The knowledge, attitude and practice survey was used as a pre- and post-test assessment tool. For analysis of pre-test and post-test comparison, the paired t-test and Classical Test Theory were used. Results – After caregivers read the educational material, the correct answer rate increased by 17% in the knowledge domain and 21.4% in the practice domain, with pvalues of < 0.01. Article 2: Objective - To understand if the educational material “Laura's Diary: Knowing Hydrocephalus a... (Complete abstract click electronic access below) / Mestre

Sammanfattning Bakgrund: Perioperativ omvårdnad omfattar den vård patienten får både pre-, intra- och postoperativt. Sjuksköterskor har ett brett ansvar gentemot sina patienter som är i behov av vård, det är sjuksköterskans ansvar att samarbeta med andra professioner för att kunna bemöta patientens behov och lindra dess lidande. Under den perioperativa omvårdnaden är det väsentligt att arbeta utifrån ett patientsäkert perspektiv, det är sjuksköterskans ansvar att förse patienter med en god- och säker vård.  Syfte: Beskriva sjuksköterskors erfarenheter av perioperativ omvårdnad.  Metod: Inför den här litteraturöversikten valdes en kvalitativ metod med en induktiv ansats, nio stycken artiklar granskades och analyserades utifrån Fribergs femstegsanalys.   Resultat: Under den perioperativa omvårdnaden är kommunikation med patienter och annan vårdpersonal viktigast. Dock fann många sjuksköterskor att det inte fanns tillräckligt med tid att förmedla all information till patienterna. Hade patienter någon form att kognitiv diagnos blev det oftast svårare att förmedla informationen, mer tidskrävande och de var inte alltid säkert att patienten hade förstått det som har sagts. Slutsats: Sjuksköterskor ansåg även att det krävs ett gott samarbete både med patienten och annan vårdpersonal. Omvårdnaden brister om samarbetet inte fungerar, det skapar ineffektivitet, minskad patientsäkerhet och utformar hierarkier. / Summary Background: Perioperative nursing includes the care the patient receives both pre-, intra- and post-operatively. Nurses have a wide responsibility towards their patients that are in need of care. It’s the nurse's responsibility for collaborating with other professionals to be able to respond to the patient's needs and ease the patients suffering. During perioperative nursing it is essential to work from a patient-safe perspective, it is the nurse's responsibility to provide patients with good and safe care. Aim: Describe nurses' experiences of perioperative nursing. Method: For this literature review, a qualitative method with an inductive approach was selected, 9 articles were reviewed and analyzed based on Friberg's five-step analysis. Outcome: During perioperative nursing, communication with patients and others health professionals is most important. However, many nurses found that there was not enough time to convey all information to the patients. If patients had any form of cognitive diagnosis, it was often more difficult to convey information, more time-consuming and they were not always sure that the patient had understood the information. Conclusion: Nurses also felt that good collaboration is required both with the patient and other staff. Nursing fails if the collaboration does not work, it creates inefficiency, reduces patient safety and creates hierarchies.

Introduktion: I samband med röntgen vid operation föreligger en risk att patienten drabbas av vårdskada. Det ställer krav på att operationssjuksköterskan är välinformerad och har den kompetens som behövs för att optimera röntgenanvändning vid operation. Syfte: Att belysa operationssjuksköterskans omvårdnadsansvar av patienten i samband med röntgenanvändning vid operation. Metod: En litteraturstudie där vetenskapliga forskningsartiklar utgjorde informationskällan. Informationen har sedan analyserats, och kategorier och underkategorier har skapats. Resultat: Baseras på tio vetenskapliga artiklar och presenteras i form av två kategorier och sju underkategorier som arbetades fram under analysprocessen. Den första kategorin; ”Skapa välmående för patienten” byggs upp av underkategorierna ”Medvetenhet om patientens utsatthet”, ”Lugn och trygg vårdmiljö” och ”Information till patienten”. Den andra kategorin; ”Minska risken för vårdskada” innehåller underkategorierna ”Skydda patienten”, ”Möjlighet att förbereda arbetet”, ”Skapa en helhetsbild av patienten” och ”Minska stråldosen”. Konklusion: Operationssjuksköterskan har möjlighet att påverka vården av patienten när röntgen används vid operation, men för att kunna ha möjlighet att påverka vården och nå goda resultat behöver operationssjuksköterskorna ha kunskap om det omvårdnadsansvar som åligger dem. / Introduction: When using X-ray in the operating room the patient is at risk of health care injury. It is required for the operating theatre nurse to be well informed and has the necessary skills to optimize X-ray use. Purpose: To highlight operating theatre nurses responsibility when using x-ray in surgery. Method: A literature study where scientific research articles was the source of information. The information has then been analyzed and categories and subcategories have been created. Result: Based on ten studies and presented in the form of two main categories and seven subcategories. The first main category ”Creating wellbeing for the patient” consists of the subcategories ”Awareness of the patients vulnerability”, ”Calm and secure environment” and ”Patient information”. The other main category ”Reduce risk of healthcare injury” consists of the subcategories ”Protect the patient”, ”Prepare the work”, ”Patients overall picture” and ”Reduce radiation”. Conclusion: The operating theatre nurse has the ability to influence the care when X-ray is used in surgery, but knowledge and insight about the responsibility is essential.