Now that the nursing process, along with good-quality nursing documentation, is being introduced into all areas of patient care, the need arises to document work of perioperative nurses in the operating theatre. Perioperative documentation is entirely different from nursing documentation, not only in terms of processing but also in terms of scope.This thesis consists of two parts: Theoretical and Empirical. The Theoretical focuses on the general issue of medical documentation used at the various hospital departments. The aim of the work was to (1) map current situation in the area of perioperative documentation at selected hospitals; (2) ascertain which components perioperative documentation is composed of; (3) find the opinion of nurses on the use of perioperative documentation; and (4) set up perioperative documentation. The research part of the thesis was a combination of quantitative and qualitative survey. For the quantitative survey, questionnaires were prepared and distributed to perioperative nurses working in operating theatres of hospitals throughout the Czech Republic. Two hypotheses were proposed. 1. Perioperative documentation is maintained at operating theatres. 2. Nurses consider perioperative documentation useful. Qualitative examination consisted in comparative analysis of perioperative documentation folders. The research set consisted of six perioperative documentation folders obtained from hospitals throughout the Czech Republic. Answers to the following three questions were sought: (1) Is perioperative documentation used at operating theatres? (2) Which parts is perioperative documentation composed of? (3) Does perioperative documentation comply with applicable legislation? The results were analyzed and processed into tables and graphs. The results show that nurses use perioperative documentation at operating theatres. From the research it follows that the processing of the perioperative folders is not fully compliant with applicable legislation. Although mandatory data are included in the vast majority of perioperative folders, the nursing process, as the information which is most important for nursing care, is missing from all of the perioperative folders analyzed. Despite this, nurses consider perioperative documentation useful, not only from the medical aspect but also from the legal, financial and informative aspects. The results of this research may stimulate creation of a unified model of perioperative documentation. This work may also serve as information material for students of medical disciplines.

The aim of the work: The aim of this thesis is to provide detailed information about organization and operation of today's operating rooms from nurse´s point of view. Operational treatment requires high demands on technical and material equipment, special staff training, perfect adherence to asepse, antisepsis, sterility as well as work organization. The thesis should also introduce the most urgent problems of the current situation of the operating rooms management. The most recent discoveries and proven methods are summarized in a simple and comprehensible form that will serve as a guide for perioperative nurses. Method: Qualitative research methods in the form of a semi-structured interview have been used. This thesis will use the qualitative survey method in the form of a semistructured interview along with snowball sampling. The research consists of respondents with finished specialization in instrumentation for the operating room who are still active in the given field. Current status: The organization and operation room management consists of two functional models. These are so called "sideline sterilization" versus central operating rooms. Both ways have their advantages and disadvantages related to workload, general nursing education, and operating rooms management. However, the least preferred option is a combination of both perioperative operations. Results: The results of the research focused on the centralization and operating rooms management show that "sideline sterilization" is considered an obsolete model of tool sterilization for operating rooms. The results also show that the model of central operating rooms with the combination of central sterilization is more modern and efficient both in terms of expenses and effort, not just for nurses but for all healthcare professionals. Conclusion: In accordance with the aim of this work the issue of centralization of operating rooms is pointed out, considering both the construction with the necessity to follow all known procedures in compliance with aseptic conditions, as well as the need of good management or nurse education. The results can be used for further research and as a further source of information for non-medical fields, mainly perioperative care.

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No. of bitstreams: 2 Dissertação - Lorena Morena Rosa Melchior - 2017.pdf: 2293458 bytes, checksum: 1552ff2a26ec1415f63306425eea8876 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-20 / INTRODUCTION: The anesthetic-surgical procedure is a complex and critical process, a moment that can generate important implications for the patients, and can generate diverse feelings such as anxiety and fear. Preoperative anxiety has affected about 60 to 80% of surgical patients. The patient's emotionally unstable surgery is scary and traumatic and is still predisposed to complications. PURPOSE: To investigate the profile of anxious patients hospitalized in preoperative elective surgery. METHOD: A cross-sectional, analytical study with subsequent cohort formation, performed at a public university hospital in the city of Goiânia-GO, Brazil. The population consisted of preoperative elective surgery patients hospitalized in surgical units, the sample was constituted of 200 patients in the preoperative period, by means of a sample calculation. Four instruments were used, one structured with sociodemographic and clinical-surgical questions; The Hamilton anxiety scale; The numerical scale of pain and the admission card of the surgical center. The study was carried out in total accordance with the Resolution 466/2012 regarding ethical issues. The analysis was expressed in absolute and relative frequencies and the Chi-square test was employed, with a significance level of 5%. The Prevalence Ratio (PR) was evaluated through gross and adjusted Poisson regression. RESULTS: The prevalence of anxiety was 53,0% (n=106) (CI 95% 46,06/59,85), mild anxiety was present in 67,0% (n=71) (CI 95%; 57,6-75,4), and 33,0% (n=35) (CI 95% 24,5/42,3) of the patients presented moderate and severe anxiety. In the multivariate analysis, sex, occupation and fear of anesthesia were significant, configuring as predictors to moderate and severe anxiety. The fear of anesthesia, of something going wrong, or of dying emerged in a predominant part of the sample, and the fear of errors showed significant relation to moderate and severe anxiety. CONCLUSIONS: The prevalence of preoperative anxiety found in the study was high. Most of the anxious patients expressed levels of mild anxiety. The most common factors that led to anxiety were the fear of death and of errors by the surgical team. Sex, occupation and fear of anesthesia configured as predictors to moderate and severe anxiety. / INTRODUÇÃO: O procedimento anestésico-cirúrgico é um processo complexo e crítico, um momento capaz de gerar implicações importantes aos pacientes, podendo gerar diversos sentimentos como o de ansiedade e o medo. A ansiedade pré-operatória tem afetado cerca de 60 a 80% dos pacientes cirúrgicos. O paciente instável emocionalmente a cirurgia é algo assustador e traumático e ainda está predisposto a complicações. OBJETIVO: Investigar o perfil dos pacientes ansiosos hospitalizados em pré-operatório de cirurgia eletiva. MÉTODO: Estudo de delineamento transversal, analítico, com posterior formação de coorte, realizado num hospital universitário público do município de Goiânia-GO, Brasil. A população foi constituída por pacientes em pré-operatório de cirurgia eletiva internados em unidades cirúrgicas, a amostra foi constituída de 200 pacientes em pré-operatório, mediante cálculo amostral. Utilizou-se quatro instrumentos, um estruturado com questões sociodemográficas e clínico-cirúrgicas; a escala de ansiedade de Hamilton; a escala numérica de dor e a ficha de admissão do centro cirúrgico. O desenvolvimento do estudo atendeu integralmente à Resolução 466/2012, quanto às questões éticas. Realizou-se análise expressa em frequências absoluta e relativa e utilizou-se o teste qui-quadrado, considerando nível de significância de 5%. A Razão de Prevalência (RP) foi avaliada por meio da Regressão de Poisson bruta e ajustada. RESULTADOS: A prevalência de ansiedade pré-operatória foi 53,0% (n=106) (IC 95% 46,06/59,85), a ansiedade leve foi de 67,0% (n=71) (IC 95%; 57,6- 75,4), e 33,0% (n=35) (IC 95% 24,5/42,3) dos pacientes apresentaram ansiedade moderada e grave. O perfil dos ansiosos foi formado por pacientes na faixa etária entre 50 a 69 anos, mulheres, baixa escolaridade, casados, moradores do interior do estado de Goiás, em casas cujo provedor era único, trabalhadores informais/desempregados, não tabagistas/etilistas, com menos de 24 horas de internação, com experiência cirúrgica prévia, sem doenças crônicas e sem dor no pré-operatório. Na análise multivariada, o sexo, a ocupação e o medo da anestesia foram significativos, configurando-se em preditores para ansiedade moderada e grave. O medo da anestesia, de algo dar errado, ou de morrer, esteve em parte predominante da amostra e o medo de erros mostrou relação significante com a ansiedade moderada e grave. CONCLUSÕES: A prevalência de ansiedade pré- operatória encontrada foi alta, comparada a estudos semelhantes. A maioria dos pacientes ansiosos demonstrou níveis de ansiedade leve. O sexo, a ocupação e o medo da anestesia configuraram-se em preditores para ansiedade moderada e grave nos pacientes cirúrgicos.

Bakgrund: Informationsöverföring sker kontinuerligt i den perioperativa vården. Det anses vara ett riskmoment när patient och information överförs till ny personal och vårdenhet. Kontinuitet, kvalitet, effektivitet och patientsäkerhet uppnås genom att operationssjuksköterskan initierar och genomför adekvat informationsöverföring i samband med patientens kirurgiska ingrepp. Syfte: Var att belysa den perioperativa sjuksköterskans upplevelser av informationsöverföring, pre- och postoperativt. Metod: En litteraturstudie med systematiskt tillvägagångssätt i enlighet med Bettany-Saltikov och McSherry (2016). Resultatet baseras på analysen av tolv kvalitativa vetenskapliga artiklar. Resultat: Resultatet påvisade att det fanns flertalet brister i den perioperativa informationsöverföringen och att den upplevdes som komplex. Resultatet redovisades i tre huvudkategorier; Utspridd och bristfällig information, Förutsättningar för informationsöverföring samt Människans inverkan på informationsöverföring. Slutsats: Många faktorer påverkar informationsöverföringen pre- och postoperativt utifrån den perioperativa sjuksköterskans upplevelser. Då medlemmar av det kirurgiska teamet inte alltid medverkar vid den postoperativa patientöverlämningen  finns en risk för att kirurgisk information kan gå förlorad. När  informationsöverföringen brister kan det ge upphov till negativa konsekvenser för patienten. / Background: The transfer of information within perioperative care, is a continuous process. When a patient, together with the relevant patient-information is transferred to a new carer and care unit, there is considered to be an element of risk involved. Continuity, quality, efficiency and patient safety will be achieved when the operating theatre nurse initiates and implements an adequate transfer of information, in connection with the patient’s surgical procedure. Aim: To illustrate how perioperative nurses experience the pre and postoperative transfer of information. Method: A systematic literature review in accordance with  Bettany-Saltikov and McSherry (2016).  The result is based on an analysis of twelve qualitative, scientific articles. Results: The study results demonstrate that there are several deficiencies during the transfer of perioperative information, and that it is perceived as complex. The results are presented in three main categories; Scattered and inadequate information, Prerequisites for information transfer and The human influence on information transfer. Conclusion: Based on the experiences of the perioperative nurses, there are many factors which influence the pre and postoperative transfer of information. As members of the surgical team do not always participate in the postoperative patient handover, there is a risk that surgical information may be lost. There can be negative consequences for the patient when the transfer of information is inadequate.

Patienter som genomgår laparoskopiska ingrepp sövs med anestesiläkemedel och behöver administration av intravenösa vätskor och inblåsning av koldioxidgas i bukhålan under operationen. Ju längre anestesitid och ju längre tid det laparoskopiska ingreppet tar desto större är risken att patienter drabbas av perioperativ hypotermi. Icke-invasiva och invasiva uppvärmningsmetoder visar kunna förebygga perioperativ hypotermin och de postoperativa komplikationer som associeras med hypotermiuppkomst vid laparoskopiska ingrepp.Syfte: Syftet är att beskriva omvårdnadsåtgärder som kan förebygga uppkomsten av perioperativ hypotermi och dess postoperativa komplikationer hos patienter som genomgår laparoskopisk kirurgi. Metod: En integrativ litteraturöversikt. Resultat: Studien visar att icke-invasiva och invasiva uppvärmningsåtgärder kan förebygga perioperativ hypotermi och minska de postoperativa komplikationerna associerade med hypotermi vid laparoskopisk kirurgi. Forcerad varmluftsbehandling visar sig vara den mest effektiva metoden för att förebygga perioperativ hypotermi. Andra icke-invasiva och invasiva värmebehandlingar är effektiva när de kombineras med varandra men inte när de administreras enskilt.Uppvärmningsmetoder visar sig förebygga uppkomst av hypotermi, bibehålla intraoperativ normotermi, öka komfort, minska postoperativa komplikationer vilket även leder till bättre återhämtning hos patienter som genomgår laparoskopisk kirurgi. Slutsats: Denna studie belyser att uppvärmnings åtgärder med invasiva och icke-invasiva uppvärmningsmetoder kan behandla och förebygga hypotermiuppkomst under den perioperativa perioden hos patienter som genomgår laparoskopisk kirurgi. Studien även visar att dessa uppvärmningsmetoder förebygger även de postoperativa komplikationer som associeras med perioperativ hypotermin vid laparoskopisk kirurgiuppkomst. / Patients undergoing laparoscopic procedures need anesthetics, intravenous fluids and insufflation of carbon dioxide gas during laparoscopic surgery. The larger the time of the anesthesia and the laparoscopic procedure is, the greater is the risk of the patients being affected by perioperative hypothermia. Non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia during laparoscopic surgery. Purpose: The aim of the study is to describe the nursing interventions that can prevent the onset of perioperative hypothermia and its postoperative complications during laparoscopic surgery. Method: An integrative review. Result: The study indicates that non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia and complications during laparoscopic surgery. Forced air warming turns out to be the most effective treatment to prevent perioperative hypothermia. Invasive and non-invasive warming treatments seem to be more effective in combination with each other to prevent perioperative hypothermia than when administered alone. These treatments prevent intraoperative hypothermia, maintain intraoperative normothermia, increase comfort, decrease postoperative complications and improve patient recovery after laparoscopic surgery. Conclusions: This study illustrates that non-invasive and invasive warming methods can treat and prevent the onset of perioperative hypothermia during laparoscopic surgery. The study even illustrates that these warming methods prevent the postoperative complications associated with perioperative hypothermia during laparoscopic surgery.

Kirurgiska ingrepp, operationer, medför ofta ett personligt trauma för patienten där denne oundvikligen hamnar i en utsatt situation. Inför operation kan patienten uppleva en rad olika tankar och känslor som alla kan ha en inverkan på patientens mående och välbefinnande. Operationer som genomförs under regional anestesi ställer högre krav på operationspersonalens bemötande, då de har en viktig roll för att stötta den vakna patienten.   Syftet med denna studie var därför att undersöka hur patienter som opereras under regional anestesi upplever att de blir bemötta av personalen på operationssalen och hur de upplever att det påverkar deras välbefinnande. Studien utgick från en deskriptiv design med en kvalitativ ansats och baserades på sju intervjuer. Intervjuerna transkriberades och en manifest innehållsanalys gjordes efter Graneheim och Lundmans (2004) metod.   Resultatet visar att samtliga informanter hade upplevt ett gott bemötande av operationspersonalen. Informanterna angav att delaktighet, personalens närvaro och ett gott omhändertagande bidrog till denna upplevelse. Bemötandet visade sig även ha betydelse för hur informanterna upplevde välbefinnandet. Det som informanterna framför allt upplevde hade en positiv påverkan på deras välbefinnande var känslan av att känna sig sedd av operationspersonalen. Samtidigt kunde informanterna inte ange något i personalens bemötande som hade upplevts som negativt eller haft en negativ påverkan på deras välbefinnande. Däremot påpekade vissa informanter att det är viktigt att hänsyn tas till patienternas personligheter och känslouttryck för att patienten ska bemötas på bästa sätt.  Således upplevde samtliga informanter som genomgått höft- eller knäoperation under regional anestesi att de fått ett gott bemötande och eller blivit väl omhändertagna av operationspersonalen. Då studien är begränsad i sitt omfång och då det är ett outforskat område som undersökts behövs ytterligare forskning för att styrka studiens resultat. / Surgical procedures, i.e. operation, often inflicts personal trauma for the patient where the patient unavoidably is put in a vulnerable situation. Before surgery the patient can experience a range of emotions and thought that all can affect the patients well being. Surgery performed under regional anesthesia puts higher demands on the operating staff’s behavior, since they play a key role in offering support to the patient who is awake.  The aim of this study was therefore to investigate how patients undergoing regional anesthesia perceive the treatment from the staff in the operating room and how their treatment affect the patients experience of well being. The study had a descriptive, qualitative design based on seven interviews. The interviews were transcribed and a manifest content analysis was conducted after Graneheim and Lundmans (2004) method. The results showed that all of the informants had had a good experience of the treatment they got from the operating staff. The informants claimed that being included, the staffs’ presence and good care taking all contributed to this experience. How they perceived the treatment from the staff also had an effect on the patients well being.  The informants stated that what had the most influence on contributing to their well being was a notion of being seen by the operating staff.  In conclusion, all informants who had undergone either hip- or knee surgery under regional anesthesia had a positive experience of the treatment they received from the operating staff and stated they had been well taken care of. Due to the limitations of this study in regards to the small sample and due to the fact that this subject is an unexplored area, further research is therefore needed to verify the results of this study.

Introduktion: Trycksår är en vårdskada som kan uppstå i samband med kirurgiska ingrepp. Det medför ett stort lidande för patienten men även en kostnad för samhället. Alla patienter som opereras har en ökad risk att utveckla trycksår på grund av unika riskfaktorer som en operation medför. Därför har operationsteamet en särskild utmaning i att förebygga denna vårdskada.   Syfte: Syftet med studien var att undersöka vilka trycksårspreventiva åtgärder som operationsteamet använder.   Metod: Studien genomfördes som en observationsstudie med kvantitativ ansats. Operationsteam vid ett medelstort sjukhus i södra Sverige observerades.  Ett observationsprotokoll konstruerades för att fånga de åtgärder som operationsteamet använde. Totalt genomfördes 20 observationer.   Resultat: Operationsteamet tryckavlastade patientens hälar och bakhuvud. Patienten värmdes intraoperativt, personalen såg till att patienten inte låg med benen i kors eller låg på varmt underlag och anpassade  operationsbordet efter patientens behov. Flera möjliga trycksårsförebyggande metoder genomfördes inte alls eller i liten utsträckning. Operationsteamet repositionerade inte patienten varannan timme, instrument, personal och utrustning tilläts trycka på patienten och material fanns mellan patienten och den tryckavlastande madrassen.   Konklusion: Operationsteamet utnyttjade trycksårspreventiva åtgärder för att förhindra trycksår hos patienten. Dock fanns ett flertal trycksårsförebyggande åtgärder som sällan användes eller inte alls. / Introduction: Pressure ulcers are a common health problem that can be a complication in surgical procedures. It means a great suffering for the patient, but also a cost to society. The surgical team has a special challenge to prevent pressure ulcers that occur in the operating room. It´s because all patients who undergo surgery have an increased risk of developing pressure ulcers because of the unique risk factors that an operation means for the patient.   Aim: The purpose of this study was to investigate the methods that the surgical team use to prevent pressure ulcer in patients during surgery.   Method: The study was conducted as an observational study with quantitative approach. The study included 20 observations of surcial teams on a hospital in south Sweden. An observation protocol was created to capture the preventive methods the surgical team used.   Results: The surgical team depressurized the patients heels and occiput with pillows. The surgical team was warming the patient intraoperatively, made sure that the patient was not lying with legs crossed or laid on a warm surface. The staff adjusted the operating table to the patient's needs. Several possible methods to prevent pressure ulcers that was not used or rarely used, was also observed. The surgical team did not reposition the patient every two hours, equipment and staff were allowed to press against the patient and layers of material laid between the patient and the pressure ulcer preventing mattress.   Conclusion: The surgical team used pressure ulcer preventive methods to decrease the risks of pressure ulcer in the patients. However, there were a number of pressure ulcers prevention methods that were rarely used.

Att upprätthålla patientens integritet är en utmaning för anestesisjuksköterskan i hens dagliga arbete. Orsakerna är den fysiska miljön på den postoperativa enheten, patient- tätheten, den sederade patienten samt vikten av att säkerställa god och säker vård efter överlämnandet. Anestesisjuksköterskan kan aldrig förutse hur och i vilken grad patien- ten uppfattar stimuli strax efter uppvaknandet och därför blir behovet att skydda integri- teten särskilt viktigt. Forskningsläget är oklart då inga artiklar som gäller bevarandet av patientens integritet i samband med överlämning till den postoperativa enheten har kun- nat identifieras. Överlämningen och överrapporteringen sker i ett vårdrum där obehö- riga  och eventuellt deras närstående befinner sig. Anestesisjuksköterskans tystnadsplikt utmanas och patienten som överlämnas är inte helt vaken vilket begränsar patientens möjlighet att värja sig för utlämnande situationer. Studiens syfte var att undersöka vilka tillvägagångssätt som anestesisjuksköterskan använder för att skydda patientens integri- tet i samband med överlämning till den postoperativa enheten. Kvalitativ observations- studie som kombinerades med kortare intervjuer valdes som metod. Studien utfördes på två mindre operationsenheter i västra Sverige. Totalt genomfördes 26 observationer och 12 intervjuer. Dataanalysen utfördes med tematisk analys enligt Braun och  Clarke (2006). Resultatet presenteras i tre huvudteman som utkristalliserades under analysen: Skapa trygghet och tillfredställelse, Skapa skyddande revir och Skapa lämpliga tillvä- gagångssätt.  Det framkom att medvetenheten om komplexiteten i situationen hos anes- tesisjuksköterskan var stor och att hen använde olika strategier för att skydda patientens integritet i samband med överlämningen. Forskning inom andra kontext bekräftar delar av studiens resultat. Den postoperativa miljön med ständiga avbrott,  närvaro av obehö- riga samt patientens halvvakna tillstånd och hens utsatthet försatte anestesisjuksköters- kan och patienten i situationer där integritetsskyddet brast. Anestesisjuksköterskan var till viss del medveten om risker som kunde utgöra en integritetskränkning. Hen använde tillvägagångssätt för att skapa skydd både genom fysiska medel samt genom att avstå eller begränsa verbal kommunikation. En ökad medvetenhet kräver tid för en aktiv dis- kussion om patientens integritet och hur den skyddas. Det bör vara ett gemensamt an- svar för all personal som på något sätt är delaktig i överlämningssituationen eller befin- ner sig på den postoperativa enheten.

Approximately 65% of all surgeries are conducted in the outpatient surgery setting involving more than 35 million patients. Thirty-five to fifty percent of these outpatients will experience post discharge nausea and vomiting (PDNV), nausea and vomiting that occurs after discharge from the health care facility after surgery. A dearth of literature details the problems associated with nausea and vomiting experienced by patients after discharge home from outpatient surgery. The purposes of this dissertation were to (1) review the current knowledge in the area of post discharge nausea and vomiting; (2) present results of an integrative review of the research literature to determine best evidence for prevention of PDNV in adults or rescue of patients who suffer from post discharge nausea and vomiting (PDNV); (3) present a critical review and analysis of measurement of nausea and vomiting after discharge from outpatient surgery, and (4) present findings of a prospective research study. The purposes of the research study were to: 1) describe the incidence and severity of PDNV over a 7-day period in a sample of adult surgical patients undergoing outpatient surgeries under general anesthesia, 2) describe the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, 3) compare the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and 4) determine outcomes associated with PDNV. This study was part of a multi-site study that had as a primary objective development of a simplified risk model for predicting patients most likely to suffer PDNV. In this research study we described the incidence and severity of PDNV in adult outpatients after ambulatory surgery, described the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, compared the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and determined outcomes associated with PDNV.

Vårdpersonal och allmänheten uttrycker ofta negativa attityder till patienter som är överviktiga. Antalet patienter som genomgår en operation för sin övervikt ökar för varje år. Det är en omvälvande operation för patienten och patienter söker mycket information innan operationen. Den perioperativa dialogen, en ideal arbetsmodell har tidigare prövats på andra patientgrupper men inte på patienter som skall genomgå en operation för sin övervikt.  Syfte med studien var att beskriva patienters upplevelse av sin övervikt och hur kontinuiteten i den perioperativa dialogen kan ge lindrat lidande i samband med operation för övervikt. Studien har en hermeneutisk design. Data samlades in med hjälp av den perioperativa dialogen som dokumenterats vid sjuksköterskans möte med 26 patienter. Data tolkades genom hermeneutisk texttolkning. Resultatet beskrivs i två huvudteman Att leva i en överviktig kropp och Kontinuiteten i den perioperativa dialogen skapar möjligheter för lindrat lidande. Övervikten hindrar patienter i det dagliga livet både fysiskt och psykiskt, vilket tär på krafter och erfars som en lidande kropp. Genom den perioperativa dialogens kontinuitet lindras oro och tryggheten ökar, patienter upplever att de får vara med och planera, påverka och genomföra sin vård. Delaktighet minskar oron och därmed lidandet för patienten. Den perioperativa dialogen borde vara en självklarhet eftersom förtroende och trygghet skapas genom kontinuitet och patienten får möjlighet att bevara sin autonomi.  Utan kontinuiteten i den perioperativa vården försvinner patientens möjlighet till delaktighet i sin vård. / Health professionals and the public often have negative attitudes towards patients who are overweight. The number of patients undergoing surgery for their obesity is increasing every year. A surgery for obesity is a major change for the patient and patients seek a lot of information before surgery. The perioperative dialogues have been tried in other patient groups before but not in patients with overweight. The overall aim of the study was to describe how anesthesia and theatre nurses through the continuity of the perioperative dialogue can alleviate suffering of the patient during a surgery for obesity. The study has a hermeneutic design. Data were collected with the help of the perioperative dialogue as documented on the nurse's meeting with 26 patients. Data were interpreted through a hermeneutic text interpretation.The results are described in two main themes To live in an overweight body and Continuity in the perioperative dialogue creates opportunities for the alleviation of suffering. Obesity hinders patients in daily life both mentally and physically, which is putting a strain on their forces, and is experienced as a suffering body. Through the perioperative dialogue continuity reduces anxiety and increases safety. Patients feel that they may be involved in planning, influencing and implementing their care. This participation reduces anxiety and therefore the suffering for the patient. The perioperative dialogue should be obvious as the confidence and safety created by the continuity and patients should be able to maintain its autonomy. Without continuity in the perioperative care disappear the patient's ability to participate in their care. / Den perioperativa dialogen - ett applicationsmoment som skapar kontinuitet