There are a number of factors recognised as significant for nursing staff retention. These include, a lack of organisational care, bullying (commonly referred to as horizontal violence), and high workload acuity. However, there does not appear to be any indication that these factors influence the retention of nurses within the speciality of acute perioperative nursing. A descriptive study using postpositivist methodology and triangulation of methods was designed to answer the question: What are the critical factors that influence staff retention in an acute perioperative environment? Forty-eight (n = 48) perioperative nurses answered a questionnaire in relation to individual needs, provision of nursing care and administration and management. Four (n = 4) nurses subsequently participated in a focus group interview that explored in more depth, the survey data related to the following characteristics: Educational opportunities; Level of workload acuity; Rostering flexibility; Management; Established policies/Quality assurance; Graduate orientation programs and Professional relationships in an acute perioperative setting. Data analysis revealed that > 90% of respondents agreed that these characteristics are important for job satisfaction and influence staff retention in an acute perioperative environment. A sense of belonging appears to be the most important theme that emerged from the qualitative data. Job satisfaction and staff retention are attained when nurses have a sense of belonging in the workplace. To achieve these, nurses need to identify barriers, develop their communication and leadership skills and determine the ideal professional practice model. The themes (Figure 5), "Finding time" and increased "sick leave", in relation to workload acuity are new findings that provide a platform for future research.

This dissertation uses population-based administrative healthcare data to evaluate the outcomes, processes-of-care and practice variation associated with preoperative medical consultation in Ontario, Canada. First, a multicentre cross-sectional study was conducted to develop a novel algorithm for identifying preoperative medical consultations using administrative data. The optimal claims-based algorithm was a physician service claim for a consultation by a cardiologist, general internist, endocrinologist, geriatrician, or nephrologist within 120 days before the index surgery. This algorithm had a sensitivity of 90% (95% confidence interval [CI], 86 to 93) and specificity of 92% (95% CI, 88 to 95). Second, we conducted a population-based cohort study to evaluate the association of preoperative medical consultation with outcomes and processes-of-care. After adjustment for measured confounders using propensity-score methods, consultation was associated with increased preoperative testing, preoperative pharmacological interventions, 30-day mortality [relative risk (RR) 1.16; 95% CI, 1.07 to 1.25], 1-year mortality (RR 1.08; 95% CI, 1.04 to 1.12), and mean hospital stay (difference 0.67 days; 95% CI, 0.59 to 0.76). These findings were stable across subgroups, as well as sensitivity analyses that tested for unmeasured confounding. Third, temporal trends and practice variation in consultation were evaluated within the population-based cohort. The proportion of patients undergoing consultation remained relatively stable over the study period, at approximately 39%. Although patient-level and surgery-level factors did predict consultation use, they explained only 6.8% of variation in consultation rates. By comparison, inter-hospital differences in rates were substantial (range, 1.9% to 86.8%), were not explained by surgical volume or teaching status, and persisted after adjustment for patient-level and surgery-level factors. Overall, this dissertation highlights the need for research to identify interventions for safely decreasing perioperative risk, define mechanisms by which consultation influences outcomes, examine factors that influence practice variation in medical consultation, and identify patients who benefit most from preoperative medical consultation.

Syfte: Att undersöka hur musik som omvårdnadsåtgärd påverkar patienten fysiskt och psykiskt pre-, peri- och postoperativt. Metod: Deskriptiv litteraturstudie. 12 artiklar inkluderades som granskades, analyserades och sammanställdes. Sökningarna utfördes i databaserna PubMed och Cinahl. Huvudresultat: Resultatet visade att musik i samband med operation påverkar patienten både fysiskt och psykiskt på flera olika sätt. Musik lindrar framförallt oro och minskar smärtupplevelsen. Viss påverkan kunde ses på vitala parametrar såsom minskning av puls, blodtryck och andningsfrekvens. Stressreaktionen i kroppen påverkas också till viss del genom att kortisolnivån minskar av musiklyssnande. Musik kan också reducera depression i samband med operation. Slutsats: Musik påverkar faktorerna oro, smärta, stress, vitala parametrar och depression positivt hos patienter pre-, peri- och postoperativt. Musik som omvårdnadsåtgärd i samband med operation kan vara ett bra komplement för sjuksköterskan att använda sig av i omvårdnadsarbetet för att lindra patientens lidande. / Aim: To examine how music as a nursing intervention affects the patient physically and mentally pre-, peri-and postoperatively. Method: Descriptive study. 12 articles were included that were examined, analyzed and summarized. The searches were conducted in PubMed and Cinahl. Results: The results showed that music associated with surgery affects patients both physically and psychologically in various ways. Music soothes especially anxiety and reduces pain. Some effects could be seen on vital parameters such as reduction of heart rate, blood pressure and respiratory rate. The stress response in the body is also affected to some extent by cortisol level decreases when listening to music. Music can also reduce depression associated with surgery. Conclusion: Music have a positive effect on the factors of anxiety, pain, stress, vital parameters and depression in patients pre-, peri-and postoperatively. Music as a nursing intervention associated with surgery can be a good addition for the nurse to use in the nursing process to relieve the patient's suffering.

This dissertation uses population-based administrative healthcare data to evaluate the outcomes, processes-of-care and practice variation associated with preoperative medical consultation in Ontario, Canada. First, a multicentre cross-sectional study was conducted to develop a novel algorithm for identifying preoperative medical consultations using administrative data. The optimal claims-based algorithm was a physician service claim for a consultation by a cardiologist, general internist, endocrinologist, geriatrician, or nephrologist within 120 days before the index surgery. This algorithm had a sensitivity of 90% (95% confidence interval [CI], 86 to 93) and specificity of 92% (95% CI, 88 to 95). Second, we conducted a population-based cohort study to evaluate the association of preoperative medical consultation with outcomes and processes-of-care. After adjustment for measured confounders using propensity-score methods, consultation was associated with increased preoperative testing, preoperative pharmacological interventions, 30-day mortality [relative risk (RR) 1.16; 95% CI, 1.07 to 1.25], 1-year mortality (RR 1.08; 95% CI, 1.04 to 1.12), and mean hospital stay (difference 0.67 days; 95% CI, 0.59 to 0.76). These findings were stable across subgroups, as well as sensitivity analyses that tested for unmeasured confounding. Third, temporal trends and practice variation in consultation were evaluated within the population-based cohort. The proportion of patients undergoing consultation remained relatively stable over the study period, at approximately 39%. Although patient-level and surgery-level factors did predict consultation use, they explained only 6.8% of variation in consultation rates. By comparison, inter-hospital differences in rates were substantial (range, 1.9% to 86.8%), were not explained by surgical volume or teaching status, and persisted after adjustment for patient-level and surgery-level factors. Overall, this dissertation highlights the need for research to identify interventions for safely decreasing perioperative risk, define mechanisms by which consultation influences outcomes, examine factors that influence practice variation in medical consultation, and identify patients who benefit most from preoperative medical consultation.

Objective: The goal of medical care in twenty-first century is to pursue a safe, effective, patient-centered, timely, efficient and equitable service system. The mission of medical professional providers and managers of medical institutions depends on controlling ¡§quality¡¨, i.e. medical essence and existence of medical institute. In order to raise surgical medical service quality in medical centers, the perioperative visit becomes an important index of medical quality in surgery. Therefore, this study investigated the effect of surgical medical quality in one southern medical center carried out the perioperative visit. Method: The samples were from patients undergoing surgery in one medical center. From March 1 to June 30, 2008, we conducted structural questionnaire to gather 505 cases. The contents of the perioperative visit included the visit for patients in the early stage of surgery, the care in the middle stage of surgery, and the visit for patients in the later stage of surgery. Based on the contents of the visits, this study analyzed the influence of demographic characteristics (including sex, age, surgical divisions, anesthesia, marital status, past medical history, surgical experience and blood types, etc.) on medical quality (including the decrease of anxiety, the raise of medical service satisfaction, the loyalty of returning to the original hospital and self health cognition, etc.). The collective data analyzed by descriptive statistics, One-Way ANOVA, independent-sample T test were compared the difference between the groups by Bonferroni correction. Result: The results indicated that the decrease of anxiety was not affected by sex, marital status, past medical history, surgical experience, and blood types, but was dependent on age, divisions and anesthesia. For the age group, the results of 21-40 year-old people were the most significant. For surgical divisions, the results of patients in orthopedic system were the most significant. The increase of medical service satisfaction was not affected by sex, past medical history and surgical experience, but was dependent on age, divisions, anesthesia, martial status and blood types. For the age group, the results of 21-40 year-old people had the highest satisfaction. For surgical divisions, the results of patients in orthopedic system had higher satisfaction than others. The health cognition and loyalty of returning to the original hospital was not affected by sex, age, divisions, anesthesia and past medical history, but was dependent on martial status, surgical experience and blood types. Conclusion: Therefore, the results suggested that medical institutions, professional clinical staffs and researchers should timely correct perioperative contents and make an integral care plan for medical teams to join in order to perfectly provide a personal, familial, whole and integral medical care and then to achieve the essence of medical quality.

Operationssjuksköterskan träffar dagligen patientersom ska genomgå någon form av kirurgi. Många patienter upplever rädsla och oroi den perioperativa perioden där operationssjuksköterskan har som uppgift attskapa en tillitsfull relation och vara ett stöd för patienten. Humor har visatsig ha en positiv inverkan på interaktionen mellan patient och vårdare. Syfte: Att sammanställa kunskap om hur patientenoch sjuksköterskan kan uppleva humor i omvårdnaden och hur humor kan användassom ett kommunikationsredskap. Metod: Metodenvar litteraturstudie. De 14 inkluderade artiklarna syntetiserades med hjälp avNoblit & Hare’s beskrivning av metasyntes med arbetets syfte somutgångspunkt. Resultat: Humor ikommunikationen mellan sjuksköterskan och patienten ger god respons då detanvänds vid rätt tillfälle. Det framkom att humor kunde verka somrelationsskapande och underlätta kommunikationen. Patienten kunde med hjälp avhumor ge uttryck för- och hantera känslor. Slutsats: Ökad kunskap omhumor och dess användning i kommunikationen kan verka som ett välfungeranderedskap i kommunikationen mellan operationssjuksköterskan och patienten

Tanken på att komma till en operationsavdelning kan upplevas som främmande och i visa fall även skrämmande. På en operationsavdelning ska flera operationer genomföras under en dag och flödet av patienter och operationer ska ske effektivt. För att patienten ska uppleva trygghet och få god omvårdnad i den situationen är det av stor vikt att få ta del av patientens tankar och känslor inför generell anestesi. Syftet med studien var just att beskriva patienters tankar och känslor inför generell anestesi. För att bäst kunna besvara syftet har en öppen kvalitativ induktiv intervjustudie med livsvärldsperspektiv använts i den här studien. Åtta intervjuer genomfördes och analyserades med hjälp av en induktiv innehållsanalys. Resultatet visar på en variation av upplevelser. Ett lidande i form av oro och otrygghet förekom hos vissa patienter, som exempelvis att inte veta vad som ska hända, osäkerhetskänsla och att något kan inträffa under sövningen. Även lugn och trygghet var känslor som uttrycktes av patienterna och till grund för det låg bland annat en god vårdrelation till anestesipersonalen baserat på tidigare positiva erfarenheter av generell anestesi. Viktigt för de patienter som intervjuades var att få tillräcklig information och mötas av trygg och erfaren anestesisjuksköterska. Resultatet av studien har bland annat väckt tankar runt hur viktigt det är att som anestesisjuksköterska få reda på om patienten är orolig inför sövningen och utifrån det kunna planera och utforma bemötandet.

In Canada and around the world, there has been an increased focus on the efficiency, cost and access to health care services. One area of particular focus is surgical procedures, often with government funding and policies focused on reducing wait times through pay for performance and volume target initiatives. In Ontario, an expert panel was assembled to evaluate the current state of surgical processes and provide recommendations to improve access, efficiency and quality. This thesis addresses the panel's recommendation for a simulation-based decision tool to help hospitals inform decisions that can lead to improved access and efficiency. A generalised, simulation based perioperative decision tool is presented that can be used to test a variety of tactical decisions. The generic model has been applied to six hospitals of varying sizes, ranging from large academic centres to small rural community hospitals. The model remains in use at some of the hospitals to regularly inform decisions. The model is also being applied to additional hospital sites. During application of the generic model, challenges in design decisions and validation were encountered. As a result, a series of principles are proposed to guide future generic modelling design and achieving user acceptance. These principles add to the generic simulation modelling and healthcare modelling research fields by laying some groundwork for a formalised approach to designing effective generic simulation models and achieving confidence in results. Finally, the research demonstrates two uses of the generic model: as decision tool and as a demonstrative tool. As a decision tool the model is used to compare numerous potential tactical decision options under consideration. As a demonstrative tool, the model is used to quantify the effect of poor practices on hospital performance. The design of the generic model only considers efficient processes and best practices. When model results are compared to historical performance, decision makers are able to quantify the effect of existing poor practices on their performance and decision making. The tool enables users to base their tactical level decisions on the assumption that good practices and procedures are followed.

In Canada and around the world, there has been an increased focus on the efficiency, cost and access to health care services. One area of particular focus is surgical procedures, often with government funding and policies focused on reducing wait times through pay for performance and volume target initiatives. In Ontario, an expert panel was assembled to evaluate the current state of surgical processes and provide recommendations to improve access, efficiency and quality. This thesis addresses the panel's recommendation for a simulation-based decision tool to help hospitals inform decisions that can lead to improved access and efficiency. A generalised, simulation based perioperative decision tool is presented that can be used to test a variety of tactical decisions. The generic model has been applied to six hospitals of varying sizes, ranging from large academic centres to small rural community hospitals. The model remains in use at some of the hospitals to regularly inform decisions. The model is also being applied to additional hospital sites. During application of the generic model, challenges in design decisions and validation were encountered. As a result, a series of principles are proposed to guide future generic modelling design and achieving user acceptance. These principles add to the generic simulation modelling and healthcare modelling research fields by laying some groundwork for a formalised approach to designing effective generic simulation models and achieving confidence in results. Finally, the research demonstrates two uses of the generic model: as decision tool and as a demonstrative tool. As a decision tool the model is used to compare numerous potential tactical decision options under consideration. As a demonstrative tool, the model is used to quantify the effect of poor practices on hospital performance. The design of the generic model only considers efficient processes and best practices. When model results are compared to historical performance, decision makers are able to quantify the effect of existing poor practices on their performance and decision making. The tool enables users to base their tactical level decisions on the assumption that good practices and procedures are followed.

There are a number of factors recognised as significant for nursing staff retention. These include, a lack of organisational care, bullying (commonly referred to as horizontal violence), and high workload acuity. However, there does not appear to be any indication that these factors influence the retention of nurses within the speciality of acute perioperative nursing. A descriptive study using postpositivist methodology and triangulation of methods was designed to answer the question: What are the critical factors that influence staff retention in an acute perioperative environment? Forty-eight (n = 48) perioperative nurses answered a questionnaire in relation to individual needs, provision of nursing care and administration and management. Four (n = 4) nurses subsequently participated in a focus group interview that explored in more depth, the survey data related to the following characteristics: Educational opportunities; Level of workload acuity; Rostering flexibility; Management; Established policies/Quality assurance; Graduate orientation programs and Professional relationships in an acute perioperative setting. Data analysis revealed that > 90% of respondents agreed that these characteristics are important for job satisfaction and influence staff retention in an acute perioperative environment. A sense of belonging appears to be the most important theme that emerged from the qualitative data. Job satisfaction and staff retention are attained when nurses have a sense of belonging in the workplace. To achieve these, nurses need to identify barriers, develop their communication and leadership skills and determine the ideal professional practice model. The themes (Figure 5), "Finding time" and increased "sick leave", in relation to workload acuity are new findings that provide a platform for future research.