Anestesisjuksköterskan kan arbeta över flera områden där arbete vid en anestesiklinik är det vanligaste. I arbetet på en anestesiklinik ingår även uppgiften att medverka vid patienttransporter mellan sjukhus, interhospitala transporter. Tidigare studier har visat att många specialistsjuksköterskor är oroliga och bekymrade över dessa uppdrag. De upplevde otrygghet, osäkerhet och brist på tydliga riktlinjer. Ansvaret är stort och ibland är det långt mellan sjukhusen. Studiens syfte var att undersöka hur samtliga anestesisjuksköterskor på en anestesiklinik i sydvästra Sverige upplever att medverka vid patienttransporter mellan sjukhus. Studien genomfördes med en kvantitativ ansats och empirisk data samlades in med hjälp av ett frågeformulär. Deskriptiv statistik användes för att redovisa resultat. Resultatet av studien visar att anestesisjuksköterskornas erfarenheter av interhospitala patienttransporter är varierande. Flera svarade att de tyckte att det fanns svårigheter att utföra god omvårdnad under transporterna. Spridningen bland anestesisjuksköterskornas svar var stor på frågan om de kände sig stressade eller obekymrade över dessa uppdrag, de flesta befann sig kring mitten av skalan. Samarbetet med ambulanssjuksköterskorna var något som överlag fungerade mycket väl, och de hade stort förtroende för deras kompetens. Att helt avstå från att medverka vid interhospitala patienttransporter var något en fjärdedel av anestesisjuksköterskorna önskade. Behovet av mer forskning inom detta område är stort. / Nurse anesthetist work in several areas but working at an anesthetic clinic is the most common. Working at a clinic involves overseeing patients during interhospital patienttransports. Earlier studies have shown that many specialist nurses are worried and concerned over transporting patients. They experience feelings of insecurity, vulnerability, and a lack of clear guidelines. The responsibility is major and sometimes there are long distances between the hospitals. The aim of the study was to evaluate how the nurse anesthetists experience their participation during the transport of patients. The study was conducted using a quantitative approach and empirical data was collected using a questionair. Descriptive statistics were used to present the results. The results showed that the nurse anesthetists experiences of transporting patients varied greatly. Several responded that they found it difficult to give good care during the transport. There was also a large range of the answers to the question about whether they felt stressed or unconcerned during these assignments, but most were in the middle of the scale. Cooperation between the nurse anesthetists and the ambulance nurses generally worked well, they even had a strong confidence in their competence. One fourth of the nurse anesthetists reported they would prefer not to be involved in interhospital patienttransports. More research is needed in this area is great.

Sammanfattning Bakgrund: Anestesisjuksköterskan har omvårdnadsansvaret för patienter under sekundärtransport i Sverige och har därför en viktig roll. Nuvarande forskning beskriver att anestesisjuksköterskor upplever bristande kommunikation och svårigheter med att vårda i ambulans. Forskning som belyser just anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport är sparsam och därmed önskvärd. Syfte: Syftet med studien var att beskriva anestesisjuksköterskors upplevelser av att vårda patienter under sekundärtransport. Metod: Studien genomfördes med en beskrivande design och kvalitativ ansats. Data samlades in genom semistrukturerade intervjuer med tio anestesisjuksköterskor på två sjukhus i Mellansverige. En kvalitativ innehållsanalys tillämpades för att transkribera och analysera intervjuerna. Resultat: Studiens resultat delades in i fyra olika kategorier, Att vara steget före, Yrkesroll och ansvarsförhållanden, Att vårda under specifika omständigheter och Teamarbete samt åtta underkategorier. Dessa underkategorier var; Att ha en handlingsplan, Att vara förberedd, Ansvar och personlig utveckling, Yrkeserfarenhet och kompetens, Att vårda unga patienter, Att vårda i ambulans, Stöd från kollegor samt Kommunikation och information. Slutsats: Att ha en handlingsplan, tidigare yrkeserfarenhet, kommunikation samt stöd från kollegor var faktorer som påverkade anestesisjuksköterskornas upplevelser av att vårda patienter under sekundärtransport. Dessa faktorer var avgörande för om anestesisjuksköterskorna upplevde vårdandet som positivt eller negativt. Studiens resultat tyder på behov av tydliga rutiner samt gemensamma utbildningstillfällen för alla involverade yrkesgrupper. Nyckelord: anestesisjuksköterska, sekundärtransport, upplevelser / Abstract Background: The nurse anesthetist is responsible for the patient care during interhospital transport in Sweden and therefore has an important role. Current research describes how nurse anesthetists’ often experience difficulties in their work, in the forms of inadequate communication and the challenges of out-of-hospital patient care. When it comes to nurse anesthetists’ experiences of patient care, however, there is a lack of research in the area of interhospital transport, which thus deserves further attention. Purpose: The purpose of the study was to describe nurse anesthetists’ experiences of caring for patients during interhospital transports. Method: The study was conducted according to a descriptive design using a qualitative approach. Semi-structured interviews were conducted with ten nurse anesthetists’ at two hospitals located in the middle part of Sweden to collect data. A qualitative content analysis was used to transcribe and analyze the interviews. Result: The study results were divided into four categories: To be one step ahead, Profession and responsibility, Patient care during specific circumstances and Teamwork with eight subcategories. These subcategories were; To have a plan of action, To be prepared, Responsibility and personal development, Work experience and competence, To care for young patients, Patient care in ambulance, Support from colleagues and Communication and information. Conclusion: To have a plan of action, previous work experience, communication and support from colleagues were factors that affected the nurse anesthetists’ experiences of caring for patients during interhospital transport. These factors were decisive for whether the nurse anesthetists’ experienced caring as positive or negative. The study results indicate that there is a need for clear routines as well as team-based training sessions for every professional involved within interhospital transport. Keywords: experiences, interhospital transport, nurse anesthetist

The purpose of this study is using Analytic Hierarchy Process (AHP) to inspect the evaluative criteria of performance and weighted model that are suit for nurse anesthetists. AHP not only can provide the supervisor a more effective, justifiable, and objective method in evaluation but also can indicate the personal achievement and development to nurse anesthetists themselves. To reinforce the employees¡¦ core abilities and assist the management of organization, AHP is anticipated to substitute for the traditional subjective impression-based evaluative method. The research method includes consulting the references and industrial practices, by which performance appraisal criteria for nurse anesthetists were drafted. Furthermore, expert survey on the evaluation system in use was carried out among managers of the department of anesthesiology of 17 medical centers. Based on the data gathered from the questionnaire survey, analysis of importance and the AHP approach were applied to construct the structure and weights of the Performance Appraisal Criteria for nurse anesthetists. Also, verification was made in the department of anesthesiology of a chosen medical center. The result of empirical examination supports the practicality and fitness of the structure of this Performance Evaluation System. Findings of this research are as follows: I. Performance Appraisal constructs and weights The Performance Appraisal Criteria includes the following three constructs: 1. Work achievement (Weight: 0.352) ; 2. Professional capacity and character (Weight: 0.246); 3. Work behavior and attitude (Weight: 0.402). II. Performance Appraisal Criteria and weights 1. ¡§Work achievement¡¨ construct includes the following seven items: (1) Crisis management (Weight: 0.085); (2) Particular contribution (Weight: 0.018); (3) Time arrangement (Weight: 0.0402); (4) Work efficiency (Weight: 0.056); (5) Maintenance of equipment (Weight: 0.046); (6) Cost control (Weight: 0.035);¡]7¡^Work quality (Weight: 0.069) 2. ¡§Professional capacity and character¡¨ construct includes five items: (1) Professional knowledge and skills (Weight: 0.029); (2) Executive skills (Weight: 0.043); (3) Responsive ability (Weight: 0.082); (4) Judgment (Weight: 0.064); (5) Confidence (Weight: 0.028). 3. ¡§Work behavior and attitude¡¨ construct has seven items: (1) Responsibility (Weight 0.061); (2) Devotion (Weight 0.047); (3) Teamwork and cooperation (Weight 0.042); (4) Attendance and Diligence (Weight 0.025); (5) Proactively (Weight 0.072); (6) Co-operation (Weight 0.084); (7) Pressure management (Weight 0.070).

Background: Bullying is a form of violence and is described as unwelcome aggressive behavior(s) by unrelated individuals. The prevalence of bullying in the nursing profession has been reported to be as high as 31% in the United States, and has been studied extensively in undergraduate nursing, midwifery, medical school residencies, and Certified Registered Nurse Anesthesia (CRNA) professional roles. There is a significant gap in the literature and paucity of evidence about the extent of Student Registered Nurse Anesthesia (SRNA) bullying underscored that this topic required further investigation. Purpose: To investigate whether bullying behaviors occur among anesthesia preceptors, and if so, how SRNAs perceive bullying has affected their educational experience. Methods: The American Association of Nurse Anesthetists (AANA) disseminated an online survey based on an existing tool to SRNAs for this study. The study used a quantitative descriptive methodology consisting of a survey of nine demographic questions, eight 5-point Likert scale questions, and two multiple-choice questions. Setting and sample: A nationwide online survey sent to 1500 SRNAs yielded (N=133) participants, who were predominantly female (67.67%), in front-loaded programs (52.63%) with an average age of 24-29 years old. Results: Results revealed SRNAs entering clinical rotations in 2015 and 2016 were bullied more than those entering in 2017. The majority of the respondents (89.26%) reported that they couldn't think clearly when they were bullied. More than half of SRNAs agreed (74.62%) that bullying impedes learning. Overall, CRNA preceptors (85.48%) were reported as the most frequent bullies, with MD/DO anesthesiologists reported as the second most frequent (68.55%) followed by non-CRNA nursing staff (41.94%).

The development of anesthesia has greatly contributed to the safety of surgeries, reduced the level of invasiveness of many procedures, and provided increased comfort for patients. The delivery of anesthetics has been primarily provided by one of two unique health care providers: a trained physician who has specialized in anesthesia, or an advanced practice nurse—the certified registered nurse anesthetist (CRNA). Both providers have a similar scope of practice, are nationally certified, and often work side-by-side. However, in recent years there has been some controversy between the two providers regarding autonomy, safety, and quality of services. The purpose of this study was to utilize current research comparing the two professions to determine if there is a difference in the quality of care and cost effectiveness between these two providers. This research was focused on studies performed in the United States after 1985. Results indicated no significant differences in quality of care between providers; however, a cost difference does exist. CRNA's provide a high quality of care equivalent to their physician counterparts, but at a reduced price. They additionally offer access to care in rural areas that lack anesthesiologists. Limitations include an inability to assess the impact of doctoral level programs for nurse anesthetists (required for entry into practice beginning in 2025) and how this may affect the main components of patient care assessed in this study (quality of care and cost). Future studies should look at ways to improve the relationship between the two providers and to remove barriers to nurse anesthetists’ scope of practice in order to increase overall access to care.

Bakgrund: Tidigare forskning visar att det finns flera faktorer som bidrar till preoperativ oro, vilket är ett tillstånd som kan orsaka flera negativa konsekvensen både i direkt anslutning till operation som långt senare efter operation. Ett av målen vid ett preoperativt möte mellan anestesisjuksköterskan och patienten är att anestesisjuksköterskan ska minska patientens stress. Därmed är det av värde att göra en översikt avseende aktuell forskning kring omvårdnadsåtgärder som kan vidtas av anestesisjuksköterskor för att lindra preoperativ oro. Syfte: Studiens syfte var att beskriva vilka omvårdnadsåtgärder som kan att vidtas av anestesisjuksköterskor för att lindra preoperativ oro hos patienten. Metod: Metod var integrerad litteraturöversikt bestående av 20 vetenskapliga artiklar, varav 14 kvantitativa och sex kvalitativa. Vid litteratursökning användes databaserna CINAHL och PubMed. Resultat: Analysen resulterade i fyra kategorier som beskriver omvårdnadsåtgärder som anestesisjuksköterskor kan vidta för att lindra preoperativ oro: Individanpassa den preoperativa informationen, Skapa en bekväm miljö, Bemöta individanpassat och empatiskt och Ha en lugnande närvaro och kommunikation. Slutsats: Analysen resulterade i fyra distinkta kategorier gällande omvårdnadsåtgärder mot preoperativ oro. Utifrån komfortteorin är det möjligt att anföra att om anestesisjuksköterskor kombinerar omvårdnadsåtgärder från de fyra kategorierna för att lindra patienters preoperativa oro har patienter större möjlighet att nå total komfort. Framtida forskning behövs avseende effekten av omvårdnadsåtgärder som utförs av just anestesisjuksköterskor samt effekten av patientens egna strategier för att lindra preoperativ oro. / Background: Previous research has identified several factors contributing to patients experiencing preoperative anxiety, which is a condition that can cause several negative consequences both directly in connection with the surgery, as well as long after the surgical procedure. One of the aims during a preoperative meeting between the nurse anesthetist and the patient is for the nurse anesthetist to ease the patient’s stress. Thus, it is of value to conduct and overview of current research regarding nursing interventions that can be conducted by nurse anesthetists to alleviate preoperative anxiety. Aim: The aim of the study was to describe what nursing interventions that nurse anesthetists can conduct to alleviate a patient’s preoperative anxiety. Method: Integrative literature review consisting of 20 scientific articles, of which 14 were quantitative and six qualitative. The literature search was conducted in the databases CINAHL and PubMed. Result: The analysis resulted in four categories describing nursing interventions that nurse anesthetists can conduct to alleviate a patient’s preoperative anxiety: Individualize the preoperative information, Create a comfortable environment, Treat individually and empathically and Have a soothing presence and communication. Conclusion: The integrative literature review with data from the 20 scientific articles resulted in four categories describing nursing interventions to alleviate preoperative anxiety. It is possible to say, based on the theory of comfort, that the patient has a greater chance to reach total comfort if nurse anesthetists combine multiple nursing interventions from the four categories to alleviate the patient’s preoperative anxiety. Future research is suggested to focus on the effect of nursing interventions performed by nurse anesthetists and the effect of the patient’s own strategies to alleviate preoperative anxiety.

Background: The majority of the children who undergo surgery experience severe anxiety prior to surgery. Preoperative anxiety should be avoided to reduce the psychological trauma. The nurse anesthetist should create a good contact and help the family cope with the frightening situation. There are both pharmacological and non-pharmacological ways to reduce anxiety. Aims: The purpose of the study is to describe the anesthetic nurses' experiences of anesthetizing children. Method: The study is based on interviews with twelve nurse anesthetists, operating at three of the sections on surgery center at one of Sweden's regional hospital. The interviews were based on semi-structured questions and analyzed using qualitative content analysis. Findings: Six categories emerged: parents, profession and compliance to different situations, the important meeting, premedication and external factors. Conclusion: An optimized premedication was highlighted as the most important factor for a successful anesthetic induction of children. If the child already had an intravenous line upon arrival at the surgical department it simplified the induction significantly. How well the parents handled the situation was also important for how the situation turned out. / Bakgrund: Att ett barn ska genomgå en operation är en händelse som påverkar hela familjen. En stor del av de barn som ska opereras upplever ångest och oro inför operationen. Preoperativ oro bör förebyggas för att minska det psykiska traumat. Anestesisjuksköterskan måste skapa en god kontakt och hjälpa familjen bemästra situationen. Det finns både farmakologiska och icke farmakologiska vägar för att minska oro och ångest. Syfte: Syftet med studien är att beskriva anestesisjuksköterskors erfarenheter av att söva barn. Metod: Studien är baserad på intervjuer med tolv anestesisjuksköterskor, verksamma vid tre av sektionerna på operationscentrum vid ett av Sveriges regionsjukhus. Intervjuerna byggde på semistrukturerade frågor som analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Sex kategorier framkom: föräldrar, yrkesutövandet, följsamhet till unika situationer, det viktiga mötet, premedicinering och yttre faktorer. Slutsats: En optimerad premedicinering framhölls som allra viktigast för en lyckad barnanestesi. Att barnet redan hade en intravenös infart vid ankomst till operationsavdelningen förenklade induktionen betydligt. Hur väl föräldrarna hanterade situationen hade även det stor betydelse för hur situationen föll ut, en nervös förälder kunde förvärra barnets oro medan en trygg förälder kunde hjälpa till att lugna barnet.

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.

SAMMANFATTNING Bakgrund: Under den intraoperativa perioden, det vill säga från att patienter anländer till operationsavdelningen tills att de överlämnas till postoperativ vård, upplever de vanligen oro och ångest. Detta kan minimeras genom att anestesisjuksköterskan tillämpar ett personcentrerat förhållningssätt. Studier inom vården visar att genom ett gott kommunikativt samspel kan personcentrering uppnås, men också attvälbefinnandet ökar både hos patienter och sjuksköterskor. Orlando (1990) har utarbetat en omvårdnadsteori, som beskriver hur sjuksköterskor kan uppnå ett gott kommunikativt samspel och därmed personcentrerad vård. Syfte: Syftet var att beskriva det kommunikativa samspelet mellan patient och anestesisjuksköterska från det initiala mötet tills patienten sövts. Metod: En icke-deltagande observationsstudie genomfördes på två olika operationsavdelningar på ett universitetssjukhus i Mellansverige. Tjugo parvisa observationstillfällen analyserades med en kvalitativ-deduktiv innehållsanalys. Ett analysprotokoll baserat på Orlando’s teori användes. Resultat: Intraoperativt präglades det kommunikativa samspelet antingen av: 1) ömsesidig interaktion, där både patient och anestesisjuksköterska uppmärksammade varandras verbala och icke-verbala signaler, eller 2) förbisedda behov, som en konsekvens av bristande kommunikativt samspel där patienternas signaler feltolkades eller inte uppfattades. En ömsesidig interaktion och därmed ett gott kommunikativt samspel uppnåddes på flera sätt. Orlando’s reflekterande omvårdnadsprocess var inte nödvändig för att skapa ett gott kommunikativt samspel. Däremot, om omvårdnadsprocessen inte följdes, blev vården och det kommunikativa samspelet inte alltid personcentrerat och det hände att patientens behov förbisågs helt. Slutsats: Anestesisjuksköterskor måste bemästra konsten att personcentrera både kommunikation och vård. Resultatet i denna studie beskriver det kommunikativa samspelet intraoperativt och kan därmed skapa medvetenhet hos anestesisjuksköterskorna om hur de kommunicerar. Examensarbetet bidrar till ökad förståelse av det kommunikativa samspelet med en mer personcentrerad, bättre och säkrare vård som följd. / ABSTRACT Background: Patients commonly experience anxiety and distress intraoperatively, which is the period from patient arrival at the theatre department till they are discharged to a postoperative unit. This can be eased, if a person-centered approach is applied by the nurse anesthetist. Studies show that good nurse-patient interactions lead to person-centered care and increases well-being for both patients and nurses. Orlando’s (1990) nursing theory, describes how to achieve good nurse-patient interaction and consequently person-centered care. Objective: The objective was to describe nurse-patient interactions, from the initial encounter until the patient was under sedation. Method: Non-participating observations were performed at two separate theatre departments at a university hospital in central Sweden. Twenty paired observations were analysed using qualitative-deductive content analysis. A protocol based on Orlando’s theory was used. Result: Intraoperative nurse-patient interaction was characterised by either: 1) mutuality, where both patient and nurse were attentive to each other’s verbal and non-verbal signals. This resulted in good nurse-patient interaction, or 2) unmet needs, a consequence of insufficient nurse-patient interactions where the patient’s signals were being misinterpreted or not perceived. This study shows that good nurse-patient interactions can be achieved in different ways. Implementing the reflective nursing process was not necessary to engender good nurse-patient interactions. Although, if not implemented, then a good nurse-patient interaction and person-centered care could not be guaranteed, even to the point where the patients’ needs were completely missed.  Conclusion: It is crucial for the nurse anesthetist to master the ability to apply person-centered care and communication intraoperatively. The result of this study describes the intraoperative nurse-patient interaction and can therefore bring enlightenment to the nurse anesthetist about how the communicate. This thesis contributes to an increased understanding regarding the nurse-patient interaction with a augmented person-centered care and therefore leading to higher quality and safety in care provided.

Hurricane Katrina devastated New Orleans in 2005. Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) were impacted by the storm. CRNAs were required to be on duty during the storm and SRNAs’ education was disrupted by the storm. This dissertation is a compilation of three papers that represent the initial exploratory research into the impact of natural disasters on CRNAs and future CRNAs. The first article was a focused ethnography utilizing focus groups and described the shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina and the psychosocial impact the storm had on them. Ten CRNAs participated in focus groups that were audio-recorded, transcribed and analyzed. Six major themes emerged from the study and represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted in short-term sleep disturbances and a temporary increase in alcohol consumption. The second article was also a focused ethnography that utilized focus groups to describe the shared experiences of SRNAs whose senior year was disrupted by Hurricane Katrina and the psychosocial impact the storm had on them. Ten former SRNAs participated in focus groups that were audio-recorded, transcribed, and analyzed. Three major themes emerged from the study and represented how the SRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the SRNAs resulted in temporary increased alcohol consumption and anxiety. The third article discussed the results of an observational study regarding the impact of Hurricane Katrina on the outcome of the Self-Evaluation Exam (SEE) taken by senior-level students in the Louisiana State University Health Sciences Center Nurse Anesthesia Program. A convenience sample consisted of 174 former students. Regression analysis revealed the relationship between the overall percentile score of the SEE and the year the test was taken (prior to or after Hurricane Katrina) while adjusting for potential confounding variables. The findings suggest that Hurricane Katrina did not have an impact on the outcome of the SEE taken by these individuals.