Thesis (M.S.)--University of Michigan, 1988.

Thesis (M.S.)--University of Michigan, 1988.

Preoperative psychological state is a major issue in day surgery; especially as patients have a short hospital stay. Except for preoperative anxiety, knowledge is sparse about how patients’ experience mood during waiting for day surgery. The overall aim of this thesis was to describe preoperative moods, persons’ experiences of preoperative mood, and the experiences persons´ describe as having an influence on their preoperative waiting. In study І, mixed methods were used. Data from 163 participants were collected through a study-specific questionnaire. In study ІІ, a qualitative method was used. Data from 20 participants were collected through semi-structured interviews. All participants (n=183) were waiting for small or medium surgery within four different specialties’ (I, II). Data were analysed with descriptive statistics and thematic content analysis (І) and inductive content analysis (ІІ). The main finding was that preoperative patients experience a variety of moods, besides anxiety patients may experience a positive mood. Moodinfluencing factors while waiting for day surgery were found. Patients may experience a shifting mood or to not feel calm, while other patients may feel calm, and experience a harmonious mood. Nearly half of the participants felt calm before surgery, as seventy persons (43 %) stated that they felt calm, whereas 91 persons (57%) stated that they did not feel calm (І). Previous negative experiences from health care were confirmed as a trigger for anxiety. Earlier positive experiences, feelings of trust and expectations contribute to a harmonious mood and to feel calm. Regard-less of mood, patients´ experienced feeling hope about regaining health as a help to balance mood (I-II). The findings contribute to knowledge about different preoperative moods and may have implications in improving preoperative care with support strategies that benefits patients’ during waiting for day surgery regardless of psychological state / <p>Alternativ benämning av serie</p><p>Örebro Studies in Care Sciences</p>

Bakgrund: Illamående, kräkningar, smärta, muntorrhet, törst och hunger är vanliga postoperativa komplikationer som patienter upplever obehagliga och påfrestande vilket leder till lidande och försämrat välbefinnande. Preoperativ fasta är rutin i många verksamheter trots att forskning visar att det inte är nödvändigt. I riktlinjer för nutrition i samband med kirurgi beskrivs att preoperativ kolhydratrik dryck kan användas för att minska katabolism och insulinresistens postoperativt. Syfte: Att beskriva om, och i så fall i vilken utsträckning, preoperativ kolhydratrik dryck kan förbättra välbefinnandet postoperativt hos vuxna efter elektiv kirurgi. Metod: En litteraturöversikt med deskriptiv design som presenterar 13 randomiserade kontrollerade studier.  Resultat: Effekten av interventionen vid postoperativt illamående och kräkningar kunde inte helt klargöras. Muntorrhet, törst och hunger visade sig minska signifikant i flertalet studier bland patienter som intagit en kolhydratrik dryck preoperativt. Inget tydligt resultat kunde påvisas vid smärta eller övriga utfall för välbefinnande som översikten undersökt.  Slutsats: Preoperativ kolhydratrik dryck kan bidra till bättre välbefinnande postoperativt gällande muntorrhet, törst och hunger hos kirurgiska patienter. Däremot kan interventionens effekt på postoperativt illamående, kräkningar och smärta inte helt klargöras då endast en tredjedel av inkluderade studier visar på signifikant minskning i interventionsgruppen. Sammantaget kan det konstateras att preoperativ kolhydratrik dryck bör administreras inför kirurgi då det till viss del kan öka välbefinnandet och minska lidandet postoperativt. / Background: Nausea, vomiting, pain, mouth dryness, and hunger are common postoperative complications that patients experience as unpleasant and testing. These variables are connected to suffering and decreased wellbeing. Standardised fasting routine is commonly used in a large number of areas despite the fact that research has proven this to be an unnecessary practice. Nutritional guidelines in surgery describe that preoperative oral carbohydrate drinks can be used to decrease catabolism and insulin resistance postoperatively. Aim: The purpose of this study aims to investigate whether, and to what extent, preoperative oral carbohydrate drinks can improve postoperative well-being in adults undergoing elective surgery. Method: A descriptive literature review of thirteen randomised control trials. Results: The influence of intervention in postoperative nausea and vomiting could not be determined. The symptoms of mouth dryness, thirst, and hunger were significantly lower in several studies among patients who received preoperative oral carbohydrate drinks. Examination of pain and other potential variables of well-being showed no conclusive results. Conclusion: Preoperative carbohydrate drinks can improve postoperative well-being significantly, particularly in mouth dryness, thirst, and hunger for surgical patients. The influence of intervention on postoperative nausea, vomiting and pain could not be determined since only one-third of the included studies presented a significant decrease in the aforementioned variables. Therefore, preoperative carbohydrate drinks should be administered preoperatively as a procedure in order to increase well-being and reduce suffering postoperatively to some extent.

Introduktion: 50–75% av barn som ska genomgå operation upplever preoperativ oro. Barn har en större sårbarhet för stress och den preoperativa oron kan medföra konsekvenser med onödigt lidande och ett försvårat sövningsmoment preoperativt. Det kan även medföra mer smärta och ökad oro postoperativt. Sederande premedicinering är en av de vanligaste metoderna för att lindra barns oro preoperativt, men till följd av att läkemedelskonsumtionen då ökar kan alternativa lösningar vara av intresse. Syfte: Syftet var att undersöka olika preoperativa icke-farmakologiska metoders effekter för att minska oro hos barn i åldrarna två till tolv år. Metod: Denna allmänna litteraturöversikt granskar och analyserar 13 olika originalartiklar. Originalartiklarnas metod, resultat och diskussion jämfördes mot varandra för att undersöka effekterna av preoperativa icke-farmakologiska metoder som kan förebygga oro hos barn. Resultat: Analysering av de 13 studierna har resulterat i att ett flertal olika metoder funnits effektiva för syftet. Informationsundervisning har varit inriktningen i åtta studiers interventioner där sex av dessa visat på en signifikant lägre orosnivå i interventionsgruppen preoperativt jämfört med kontrollgruppen. Två av dessa åtta studier påvisade ingen signifikant skillnad i orosnivå. De resterande fem studier vars intervention inriktades på distraktion, påvisade två effektiva metoder där orosnivån signifikant minskades preoperativt efter intervention. Två studier påvisade ingen signifikant skillnad i orosnivån efter intervention, och en studie hade motsatt effekt med en ökad oro i interventionsgruppen preoperativt. Slutsats: Alternativ till icke-farmakologiska metoder för att lindra preoperativ oro hos barn har genom denna studie visat sig vara många. Informationsgivande undervisning och distraherande förberedelser kan konstateras effektiva i vissa utföranden inför barnoperationer och sövningsmoment. / Introduction: 50-75% of children undergoing surgery experience preoperative anxiety. Children are more vulnerable to stress, and preoperative anxiety can result in unnecessary suffering and a more complicated anaesthesia procedure. It can also result in more pain and increased anxiety postoperatively. Sedating premedication is one of the most common methods to reduce children’s preoperative anxiety, but alternative methods can be of interest because of the increase in medication consumption.  Aim: This study aimed to investigate different preoperative non-pharmacological methods and their effects on decreasing preoperative anxiety in children ages two to twelve years.  Method: This general literature review studies and analyses 13 original articles. The original article's methods, results and discussion are compared to investigate the effects of preoperative non-pharmacological methods to prevent anxiety in children.  Result: The analysing of the 13 studies have resulted in many different effective methods for the aim of this study. Informative education has been the aim of intervention in eight studies, where six of these have shown a significantly lower level of anxiety in the intervention group preoperatively compared to the control group. Two of the eight studies showed no significant difference in anxiety levels. The remaining five studies in which intervention aimed towards distraction showed two effective methods where anxiety decreased significantly preoperative after the intervention. Two studies showed no significant difference in measured anxiety after the intervention, and one study had the opposite effect with an increase of anxiety after the intervention, preoperatively.  Conclusion: Many alternatives to non-pharmacological methods to reduce preoperative anxiety have, through this study, been found. Informative education and distractive preparation can be established to affect some methods in the preparation of paediatric surgeries and anaesthetic procedures.

No description available.

A multiple baseline study was conducted across five hysterectomy patients between the ages of 30-36. Three patients received a treatment intervention consisting of general and sensory information, muscle relaxation, a cognitive coping technique, and a pre-anesthetic interview. Two yoked, placebo control patients watched a 20-min video· tape about surgery, practiced recovery exercises, and made up stories from TAT cards. Self-report measures taken were the Hospital Stress Rating Scale, a recovery inventory, and postsurgical pain ratings. Physiological measures consisted of pulse, respiration, blood pressure, skin temperature, and blood lactates. Recovery variables were taken on amount of pain medication taken, number ·of days in the hospital, · vomiting, and psychiatric or physical complications. The results indicated that patients in the treatment condition reported less pain and took fewer pain medications after surgery. All other variables indicated little or no change. All patients experienced a decrease in blood lactate levels after the training session. Training time was approximately 1 hour, and thus hospital staff could conduct the training in a reasonable amount of time.

Introduktion: Anestesi på barn ställer anestesisjuksköterskan inför en komplex situation. Barn är oroliga inför det okända som ska hända. För att minska oron behöver anestesisjuksköterskan reducera deras nivå av oro. Föräldrarna tryggar barnen och tillsammans med dem ska anestesisjuksköterskan delge barnen trygghet. Syfte: Beskriva anestesisjuksköterskors erfarenheter i att bemöta och lindra oro hos barn som ska genomgå anestesi. Metod: En kvalitativ intervjustudie, innehåll analyserades utifrån kvalitativ innehållsanalys. Sammanlagt intervjuades 8 anestesisjuksköterskor med varierande ålder och yrkeserfarenhet. Resultat: Anestesisjuksköterskornas erfarenheter visade att skapa trygghet, ha ett avledande tillvägagångsätt och att utgå ifrån den egna professionen var viktigt för att bemöta och lindra oro. Att samarbeta med föräldrarna, skapa en relation till barnet och ha bra preoperativa förberedelser tycktes skapa trygghet hos både barnet och föräldern. De använde sig av avledande strategier för att flytta den negativa oron till något positivt. Den erfarenhet som anestesisjuksköterskorna hade gav dem en trygg grund i de situationer som inte var fullt så optimala. Då det inte fanns några färdiga mallar i hur de ska bemöta och lindra oro hos barn ansåg de flesta att ”fingertoppskänslan” har stor betydelse. Det viktiga var att hela tiden anpassa sig till barnet och ta den tid som behövdes. Slutsats: Studien belyste anestesisjuksköterskans erfarenhet av att bemöta och lindra oro hos barn. I resultatet framkom att anestesisjuksköterskan upplevde svårighet att bemöta oroliga barn samt att det var en svår situation de ställdes inför. Emellanåt kunde samarbetet med oroliga föräldrar vara svårt, dock kunde samarbetet förbättras om anestesisjuksköterskan och föräldern hade samma målbild. Det ställdes höga krav på kompetens och ödmjukhet samtidigt som anestesisjuksköterskan hade en viktig roll i att skapa trygghet hos barnen. / Introduction To prepare a child for anesthesia put the nurses in a complex situation. The child is worried about the unknow that is going to happen and therefore the nurse needs to reduce the child’s level of anxiety and worry. The parents are supposed to comfort the child and together with the nurse they should help the child to manage the difficult situation. Aim: Describe the anesthesia nurses experience in addressing and reducing anxiety in children who are about to undergo anesthesia. Method:A qualitative interview study of 8 nurses with different age and work experience where included and interviewed. Result: Based on the experience of the nurses it showed that the most important thing where to create comfort, use distractions and the ability to use their previous professional experience. To be able to cooperate with the parents, create a relationship with the child as well as excellent preoperative preparation seemed to create comfort in both the child and the parents. The nurses used distracting strategies to transfer the negative anxiety to something more positive.  Since there are no written guidelines of how to comfort children about to undergo anesthesia the nurses had to use and incorporate their previous experience as an anesthesia nurse. The nurses mentioned that it is crucial to be able to sense and evaluate the situation and then act based on the conclusion. The most important thing was to adapt and conform to the need of the child and not rush the process. Conclusion: The study highlighted the experience of the nurse’s preoperative care. The result showed that the nurses experienced difficulty to care for worried children as well as the complex situation they were presented with. Sometimes worried parents made the situation more complex for the anesthesia nurse since they were not able to cooperate and work together. However, the corporation could be improved if the anesthesia nurse and the parent had the same goal and a joint way of handling the situation. The anesthesia nurse were required to have high professional competence, advanced humility as well the ability to make sure that the child  is comfortable and relaxed.

<p>Kranskärlsoperationen är för patienten en stor händelse som leder till många frågor och funderingar. Tidigare forskning har visat att patienter som genomgått en ranskärlsoperation har stort behov av information. Vårt syfte med studien var att beskriva informationen vid en kranskärlsoperation. Studien gjordes som en itteraturstudie. Resultatet av studien utföll i tre kategorier, informationsmetoder, vad informationen innehöll samt olika faktorer som påverkade patientinformationen. Information gavs skriftligt, muntligt, som videofilm, med Internet eller av en patient som tidigare gjort en kranskärlsoperation, ofta i kombination med varandra. Vad patienten ville att informationen skulle innehålla varierade från person till person beroende på i vilken fas patienten befann sig, pre- eller postoperativt. Flera faktorer framkom som var av betydelse. Det var viktigt för patienterna att personalen tog sig tid att lyssna och svara på frågor och funderingar. Patienter med litet socialt nätverk hade större behov av information än andra med stort socialt nätverk. En annan betydelsefull sak var att patienterna lätt skulle kunna komma i kontakt med kompetent personal både innan operationen och efter utskrivningen. Slutsatsen av resultatet var att informationen bör vara individuellt anpassad utifrån varje patients behov. Fortsatt forskning behövs för utveckling av en god patientinformation kring patienternas upplevelse av olika sorters informationssätt, samt att utveckla kontakt med patienter som tidigare gjort en kranskärlsoperation</p> / <p>Coronary artery bypass is for the patient a major event leading to many questions and concerns. Previous research has shown that patients who have undergone coronary artery bypass have great needs of information. Our aim of this study was to describe information before and after a coronary artery bypass. The study was done as a literature review. The results of the study were distributed into three categories, information methods, information content and the various factors that affect patient information. Information was given in writing, orally, by video, by Internet or by a patient previously undergoing a coronary artery surgery, usually in combination with each other. What the patient wanted the information should contain varied from person to person depending on what stage the patient was, pre- or postoperatively. Several factors emerged that were relevant. It was important for the patients that the staff took the time to listen and respond to questions and concerns. Patients with small social networks had a greater need for information than others with larger social network. Another important thing was that patients could easily get in touch with competent personnel both before surgery and after discharge. The conclusion of the result was that the information should be individualized based on each patient's needs. Continued research is needed to develop good patient information on patients' experience of different types of information means, and to develop contact with patients who have previously done a coronary artery bypass.</p>

Kranskärlsoperationen är för patienten en stor händelse som leder till många frågor och funderingar. Tidigare forskning har visat att patienter som genomgått en ranskärlsoperation har stort behov av information. Vårt syfte med studien var att beskriva informationen vid en kranskärlsoperation. Studien gjordes som en itteraturstudie. Resultatet av studien utföll i tre kategorier, informationsmetoder, vad informationen innehöll samt olika faktorer som påverkade patientinformationen. Information gavs skriftligt, muntligt, som videofilm, med Internet eller av en patient som tidigare gjort en kranskärlsoperation, ofta i kombination med varandra. Vad patienten ville att informationen skulle innehålla varierade från person till person beroende på i vilken fas patienten befann sig, pre- eller postoperativt. Flera faktorer framkom som var av betydelse. Det var viktigt för patienterna att personalen tog sig tid att lyssna och svara på frågor och funderingar. Patienter med litet socialt nätverk hade större behov av information än andra med stort socialt nätverk. En annan betydelsefull sak var att patienterna lätt skulle kunna komma i kontakt med kompetent personal både innan operationen och efter utskrivningen. Slutsatsen av resultatet var att informationen bör vara individuellt anpassad utifrån varje patients behov. Fortsatt forskning behövs för utveckling av en god patientinformation kring patienternas upplevelse av olika sorters informationssätt, samt att utveckla kontakt med patienter som tidigare gjort en kranskärlsoperation / Coronary artery bypass is for the patient a major event leading to many questions and concerns. Previous research has shown that patients who have undergone coronary artery bypass have great needs of information. Our aim of this study was to describe information before and after a coronary artery bypass. The study was done as a literature review. The results of the study were distributed into three categories, information methods, information content and the various factors that affect patient information. Information was given in writing, orally, by video, by Internet or by a patient previously undergoing a coronary artery surgery, usually in combination with each other. What the patient wanted the information should contain varied from person to person depending on what stage the patient was, pre- or postoperatively. Several factors emerged that were relevant. It was important for the patients that the staff took the time to listen and respond to questions and concerns. Patients with small social networks had a greater need for information than others with larger social network. Another important thing was that patients could easily get in touch with competent personnel both before surgery and after discharge. The conclusion of the result was that the information should be individualized based on each patient's needs. Continued research is needed to develop good patient information on patients' experience of different types of information means, and to develop contact with patients who have previously done a coronary artery bypass.