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Introduktion: Operationssjuksköterskor i den perioperativa vården möter ofta barn som ska genomgå en operation. Krav på produktion och rutiner styr att det första mötet sker med anestesisjuksköterskan och därmed blir operationssjuksköterskans möte med barnet mer begränsat. Detta kan medföra svårigheter att skapa en vårdrelation med barnet och att planera omvårdnaden utifrån barnets behov. Syfte: Studien syftade till att beskriva hur operationssjuksköterskor kunde uppleva omvårdnad riktat till barn i relation till den perioperativa vården. Metod: En kvalitativ deskriptiv studie genomfördes utifrån ett bekvämlighetsurval och 13 verksamma operationssjuksköterskor intervjuades. Intervjumaterialet analyserades med kvalitativ innehållsanalys enligt Graneheim & Lundman (2004). Resultat: Analysen av intervjumaterialet resulterade i tre kategorier: Vikten av att anpassa vården utifrån krav på produktion, vikten av kommunikation och vikten av erfarenhet och kompetens. Kategorierna beskrev operationssjuksköterskors olika upplevelser av deras omvårdnad av barn i förhållande till rutiner anpassat till barns behov, samarbeten och erfarenheter inom perioperativ vård. Konklusion: Studien visade att operationssjuksköterskor upplevde att omvårdnaden styrdes av produktion, tid och resurser, vilket kunde leda till att barnets bästa och säkerhet äventyrades. De använde sig av kreativa lösningar, medmänsklighet, kompetens, samarbete och föräldrars stöd. De upplevde behov av utbildning och förbättringsarbeten. / Introduction: Theatre nurses in perioperative care often meet children who are to undergo surgery. Requirements for production and routines govern that the first meeting takes place with the anesthesia nurse and thus the theatre nurse meeting with the child becomes more limited. This can lead to difficulties in creating a care relationship with the child and in planning the care based on the child's needs. Aim: To describe theatre nurses experiences of nursing directed to children in relation to perioperative care. Method: A qualitative descriptive study was conducted based on a convenience sample and 13 active theatre nurses were interviewed. The interview material was analyzed with a qualitative content analysis according to Graneheim & Lundman (2004). Results: The analysis of the interview material resulted in three categories: The importance of adapting care based on production requirements, the importance of communication and the importance of experience and competence. The categories described the theatre nurse´s different experiences of their care for children in relation to routines adapted to children's needs, collaborations and experiences in perioperative care. Conclusion: The study showed that theatre nurses felt that nursing was governed by production, time and resources, which could lead to the child's best interests and safety being jeopardized. They used creative solutions, compassion, competence, cooperation and parental support. They experienced a need for education and improvement work.

Introduktion: Trycksår är en vårdskada som orsakar lidande för patienten och är kostsam för både patienten och samhället. Trots tillgång till evidensbaserade riktlinjer för trycksårsprevention uppkommer trycksår i samband med operationer. Det saknas en sammanställning av perioperativa sjuksköterskors kunskap, attityder och hur de utövar trycksårsprevention. Syfte: Syftet var att sammanställa perioperativa sjuksköterskors kunskaper, attityder och omvårdnadshandlingar relaterat till trycksårsprevention. Metod: En litteraturstudie genomfördes med systematisk sökning i databaserna CINAHL och PubMed. Studier publicerade mellan 2010–2020 inkluderades. Åtta kvantitativa studier inkluderades i litteraturstudien och presenterades som en narrativ sammanställning. Resultat: Resultatet visade att perioperativa sjuksköterskor hade en positiv attityd till trycksårsprevention men det fanns kunskapsluckor inom området, bland annat gällande riskbedömning och förebyggande åtgärder. Mängden utförda adekvata omvårdnadshandlingar varierade. Riskbedömning utfördes inte i stor utsträckning medan dokumentation angående postoperativ hudstatus utfördes ofta. Tidsbrist och problematisk dokumentation upplevdes hindra det preventiva trycksårsarbetet. Konklusion: Perioperativa sjuksköterskor var positivt inställda till trycksårsförebyggande åtgärder, men adekvata omvårdnadshandlingar för att förebygga trycksår utfördes inte i tillräckligt stor utsträckning. Tidsbrist och problematiska dokumentationssystem ansågs utgöra hinder förtrycksårsförebyggande åtgärder. Perioperativa sjuksköterskor kunskap angående trycksårsprevention behöver förbättras. / Introduction: A pressure ulcer is a hospital acquired condition that causes suffering for the patient and are expensive for the patient as well as the community. Despite access to evidence-based pressure ulcer prevention guidelines, pressure ulcers occur during surgery. There is a lack of compilation of perioperative nurses' knowledge, attitudes and how they practice pressure ulcer prevention. Aim: The aim was to compile perioperative nurses' knowledge, attitudes and nursing actions related to pressure ulcer prevention. Method: A literature review was conducted and the databases CINAHL and PubMed were searched for studies. Studies published between 2010–2020 were included. Eight quantitative studies were included in the literature review and narrative synthesis was used to compile the data. Results: The results showed that perioperative nurses had a positive attitude towards pressure ulcer prevention, but there were knowledge gaps in the area, for example regarding risk assessment and preventive measures. The amount of adequate nursing actions performed varied. Risk assessment was not performed to a large extent, while documentation regarding postoperative skin status often was done. Lack of time and problematic documentation were perceived to hinder pressure ulcer prevention. Conclusion: Perioperative nurses were positive about pressure ulcer prevention measures, but adequate nursing actions to prevent pressure ulcers were not performed to a sufficient extent. Lack of time and problematic documentation systems were considered to constitute obstacles to pressure ulcer prevention. Perioperative nurses' knowledge regarding pressure ulcer prevention needs to be improved.

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>Worldwide, more than 2 million patients die within 30 days after noncardiac surgery anually. Postoperative ischemic myocardial injury is frequent, however, no consensus exists about its definition.</p> <p><strong>Objective: </strong>to develop a term Myocardial Injury after Noncardiac Surgery (MINS) caused by myocardial ischemia, requiring at least, troponin T (TnT) elevation, and with prognostic relevance at 30 days after surgery.</p> <p><strong>Methods: </strong>we performed a prospective study including 15,167 patients ³45 years-old undergoing noncardiac surgery, who had fourth-generation TnT measurements during the first 3 postoperative days. We undertook Cox regression analyses with 30-day mortality after surgery as the dependent variable, using different TnT thresholds, clinical features and several perioperative variables. Non-ischemic etiologies were excluded. Furthermore, we developed a scoring system to predict risk in MINS patients.</p> <p><strong>Results:</strong> MINS was defined as TnT ≥0.03 ng/mL with or without clinical features, and it was an independent predictor of 30-day mortality (adjusted HR 3.82, CI 95% 2.84-5.10). We determined that MINS incidence was 8%, its population attributable risk 33.7%, and 30-days mortality rate 9.6%. Patients did not experience ischemic symptoms in 84% of MINS cases. Additionally, we developed a scoring system in patients suffering MINS with 3 independent predictors of death (age ≥75 years, new ST elevation or left bundle branch block, and anterior location of ECG changes),</p> <p><strong>Conclusion: </strong>Among patients undergoing noncardiac surgery, we defined MINS based on a TnT threshold ≥0.03 ng/mL. Mostly, MINS patients were asymptomatic. Therefore, this strongly suggests the importance of a troponin monitoring during the first few days after surgery.</p> / Master of Health Sciences (MSc)

<p><strong>Background: </strong>Myocardial injury after noncardiac surgery (MINS) increases the risk of 30-day mortality. Intraoperative hemodynamic events (i.e., tachycardia, bradycardia, hypotension, and hypertension) may contribute to developing MINS.</p> <p><strong>Objectives: </strong>To determine if the addition of the duration spent within predefined intraoperative systolic blood pressure (BP; mmHg) (i.e.,160-199 and ≥200) and heart rate (HR; bpm) (i.e.,100-140 and >140) hemodynamic bands improved the prediction of Day 1 MINS (i.e., postoperative troponin T elevation ≥0.03 ng/ml within the first day after surgery) beyond preoperative risk model prediction.</p> <p><strong>Methods: </strong> Prospective observational data was used to developed a baseline risk model to predict Day 1 MINS. Preoperative HR, systolic BP, and hemoglobin as well as intraoperative duration spent within each predefined hemodynamic band were explored to identify optimal thresholds for the prediction of Day-1 MINS. Preoperative variables were added to the baseline risk model to create a preoperative model. Intraoperative variables were then added to the preoperative risk model to create the final model. Models were compared using discrimination (c-statistic) and net reclassification index (NRI).</p> <p><strong>Results: </strong>Adding preoperative hemoglobin ≤105 g/dL, systolic BP110 improved baseline model discrimination (0.783 to 0.792, p5min; HR >100 for >147min; systolic BP59min and systolic BP >160 for >42min further improved discrimination (0.8; p</p> <p><strong>Conclusion:</strong> Adding intraoperative hemodynamic durations significantly improved Day-1 MINS model discrimination and risk stratification compared to the baseline risk model.</p> / Master of Health Sciences (MSc)

<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)

Bakgrund: Alla patienter som opereras i generell anestesi löper risk för perioperativ hypotermi. Obehandlad hypotermi kan leda till fysiologiska komplikationer och orsaka lidande för patienten och utgör en risk för patientens säkerhet samt ökade vårdkostnader. Enligt den teoretiska modellen Perioperative Patient Focused Model ansvarar operationssjuksköterskan för säker vård och behöver förebygga och behandla perioperativ hypotermi. Det finns olika metoder för att förhindra hypotermi, det saknas dock tillräcklig kunskap om dessa bland vårdpersonal och därför finns ett behov av att sammanställa och utvärdera den aktuella evidensen av perioperativ hypotermiprevention. Syfte: Sammanställa olika metoder och deras effektivitet för förebyggande av perioperativ hypotermi hos vuxna patienter i generell anestesi. Metod: Deskriptiv litteraturstudie med systematisk ansats baserad på 22 kvantitativa randomiserade kontrollstudier analyserade med hjälp av narrativ syntes. Resultat: Aktiva metoder för hypotermiprevention är effektivare än passiva metoder, där varmluftstäcke var den effektivaste metoden. Andra effektiva metoder, speciellt när överkroppen inte kan täckas intraoperativt, är värmemadrass samt värmda infusionsvätskor. Samtidigt pekar resultatet på att flera olika metoder bör användas tillsammans, varav minst en aktiv metod, och alla patienter oavsett ingrepp har nytta av att få preoperativ uppvärmning. Slutsats: Även om det är svårt att helt förhindra perioperativ hypotermi hos alla patienter är det möjligt att förebygga och begränsa dess omfattning genom att kombinera olika befintliga metoder baserat på operationssjuksköterskans perioperativa bedömning av patienten. / Background: All patients who undergo surgery under general anesthesia are at risk of perioperative hypothermia. Untreated hypothermia can lead to physiological complications and cause suffering for the patient, thereby posing a risk to the patient's safety, as well as increased healthcare costs. According to the Perioperative Patient Focus Model the operating room (OR) nurse must provide safe care and thereby prevent and treat perioperative hypothermia. There are various methods to prevent hypothermia, however, there is a lack of sufficient knowledge about these among healthcare personnel and therefore there is a need to compile and evaluate the current evidence of perioperative hypothermia prevention. Aim: To compile different methods and their effectiveness for the prevention of perioperative hypothermia in adult patients under general anesthesia.  Method: Descriptive literature study with a systematic approach based on 22 quantitative randomized control trials analyzed using narrative synthesis. Results: Active methods of hypothermia prevention are more effective than passive methods, forced air blanket being the most effective method. Other effective methods, especially when the upper body cannot be covered intraoperatively, are heating mattresses and warmed infusion fluids. At the same time, the results indicate that several different methods should be used together, of which at least one active method, and all patients, regardless of surgery intervention, benefit from preoperative warming. Conclusion: Although it is difficult to completely prevent perioperative hypothermia in all patients, it is possible to prevent and limit the extent by combining different existing methods based on the operating nurse's perioperative assessment of the patient.