Introduktion: Den perioperativa sjuksköterskan har en viktig roll i den perioperativa miljön, där hon med rätt fingertoppskänsla ska förhålla sig empatisk och se patienten som en individ genom att bevara patientens värdighet, autonomi och integritet. Som blivande operationssjuksköterskor har vi blivit medvetna om att arbetet i den perioperativa vården bedrivs med hög produktion och kostnadseffektivt tänkande. Vi har därför intresserat oss för att undersöka hur den perioperativa sjuksköterskan bevarar patientens värdighet i den högteknologiska miljön. Syftet: Att få en ökad förståelse om hur den perioperativa sjuksköterskan bevarar värdigheten hos patienten i den perioperativa vården. Metod: En kvalitativ induktiv empirisk forskningsmetod. Öppna frågor ställdes enskilt till 14 frivilliga perioperativa sjuksköterskor vid tre olika sjukhus i Sverige. Resultat: Efter en kvalitativ innehållsanalys blev två kategorier synliga i resultatet: Perioperativa sjuksköterskans handlande för att bevara värdigheten för patienten och När patienten inte sätts i fokus. För de två kategorierna blev dessutom åtta subkategorier synliga.  Den perioperativa sjuksköterskans egenskaper och professionella förhållningssätt är av stor betydelse för att värdigheten ska bevaras i den perioperativa miljön. Genom att föra en dialog med patienten skapas trygghet och förtroende. Teamet arbetar för att vården ska bli värdig och patientsäker. Om en oetisk handling uppkommer är det av vikt att den perioperativa sjuksköterskan står upp för sin patient och vågar konfrontera. Konklusion: Via intervjuer i denna studie framkom hur den perioperativa sjuksköterskans handlande bevarar patientens värdighet i den perioperativa vården samt hur hon använder sitt professionella förhållningssätt då patienten inte sätts i fokus. / Introduction: The perioperative nurse has an important role in the perioperative environment, where she with the right sensitivity should act empathetic and see the patient as an individual by keeping the patient's dignity, autonomy and integrity. As future theatre nurses we have become aware of that the work in the perioperative care is conducted with high production and a cost effective way of thinking. Therefore, we found it interesting to investigate how the perioperative nurse keeps the patient's dignity in the high technology environment. Aim: To achieve an increased understanding of how the perioperative nurse keeps the dignity of the patient in the perioperative care. Method: A qualitative inductive empirical research method. Open questions were asked individually to 14 voluntary perioperative nurses at three different hospitals in Sweden. Results: After a qualitative analysis of the content, two categories became visible in the results: The act of the perioperative nurse to keep the dignity of the patient and When the focus is not on the patient. For the two categories, also eight subcategories became visible. The characteristics and professional way to act of the perioperative nurse are of great importance for keeping the dignity in the perioperative environment. By having a dialouge with the patient a sense of safety and confidence is created. The team work towards a dignified and secure care for the patient. If an unethical act occurs it is of great importance that the perioperative nurse stands up for the patient and dares to take the confrontation. Conclusion: Interviews in this study showed how the acts of the perioperative nurse keep the dignity of the patient in the perioperative care and how she uses her professional approach when the focus is not on the patient.

Vid den perioperativa dialogen möter den perioperativa sjuksköterskan patienten vid tre tillfällen i samband med operation. Detta har visat sig komma både patienter och sjuksköterskor till godo. För att införa perioperativ dialog krävs förändringar i organisationen. Syftet med arbetet var att undersöka vilka förutsättningar som krävs för att införa och arbeta med perioperativ dialog på operationsavdelning. Arbetet är en pilotstudie med kvalitativ ansats, där chefssjuksköterskor intervjuats. I resultatet framkom kategorierna förutsättningar och hinder med sub- och sub-subkategorier. Chefssjuksköterskorna i undersökningen hade svårt att se hur perioperativ dialog skulle kunna införas i deras operationsverksamhet. De pekade på personalbrist, och genom det svårigheter för operationssjuksköterskan att få tid att följa patienten. Vidare framkom det att det måste finnas ett behov hos patienter och personal av att använda perioperativ dialog. De såg också möjligheter att införa det i elektiv verksamhet och att det finns behov av en drivande person som kan starta upp införandet genom projekt. / Perioperative dialogue is a way of working where the perioperative nurse meets the patient at three occasions, which has proved to be beneficial for both patients and nurses. To implement the perioperative dialogue, organization changes are needed. The aim of the study was to investigate what is required to implement and work with perioperative dialogue. A pilot study has been performed, with a qualitative approach, where head-nurses were interviewed. The result presented two main categories, opportunities and hindrances with sub- and sub-subcategories. The interviewed head-nurses had difficulties to see how to implement perioperative dialogue in their organization. Shortage of staff, and therefore difficulties for the theater nurse to have the time to follow the patient was emphasized. Perioperative dialogue demands a need from patients and staff. In daily work the participating head nurses did see the possibility for easier implementation in elective surgery and also the need for a special person to head the project.

Bakgrund: På en operationssal är teamarbetet viktigt, dels för att arbetet ska fungera men också för att säkerställa patientsäkerheten. En viktig aspekt i teamarbetet är att de perioperativa sjuksköterskorna känner att de andra i teamet har förståelse för deras arbetsuppgifter. Syfte: Syftet med studien var att belysa perioperativa sjuksköterskors upplevelser av teamarbetet utifrån förståelse för deras arbetsuppgifter. Metod: En kvalitativ induktiv intervjustudie genomfördes med 16 perioperativa sjuksköterskor från tre små till mellanstora sjukhus i södra Sverige. Datamaterialet analyserades utifrån en kvalitativ latent innehållsanalys. Resultat: Studien visar att det finns flera saker som påverkar teamarbetet och sjuksköterskorna upplever att även om förståelsen för deras arbete från andra teammedlemmar oftast är bra, finns det möjligheter till förbättring. Ur resultatet framträdde det övergripande temat självständighet förutsätter delaktighet, med kategorierna yrkesroll, samverkan, arbetsmiljö och patientsäkerhet och därtill hörande underkategorier. Slutsats: Nyttan är att ge perioperativ personal en insikt i vad som kan underlätta teamarbetet. Det behövs fortsatt forskning inom ämnet, men det är också viktigt att utbildningar och arbetsplatser satsar på att träna teamarbete för att öka kunskapen och förståelsen mellan professionerna. / Background: In an operating theatre teamwork is important, partly to get the job done, but also to ensure patient safety. An important aspect of teamwork is that perioperative nurses feel that the other members of the team understand their work assignments. Aim: The aim of this study was to highlight perioperative nurses' experiences of teamwork based on an understanding of their work assignments. Method: A qualitative inductive interview study was conducted with 16 perioperative nurses from three small to medium-sized hospitals in southern Sweden. The data were analyzed based on a qualitative latent content analysis. Results: The study shows that there are several aspects that affect teamwork and nurses feel that although understanding of their work assignments from other team members usually are good, there are possibilities for improvement. The overall theme independence requires participation emerged from the result, as well as the categories profession, collaboration, work environment and patient safety with related subcategories. Conclusion: To give perioperative personnel an insight into what might facilitate teamwork can be beneficial.  Further research on the topic is required, but it is also important that schools and workplaces practice teamwork to increase knowledge and understanding between different professions.

Transplant medicine has been developing fast, bringing about also development of nursing care in this field. The purpose of this thesis was to examine the experience of perioperative nurses with organ procurement at the IKEM Transplant Centre and to obtain information on the procurement of different organs, organ storage, the organisation of perioperative nurses' work and on how the nurses perceive their work. This thesis applied a qualitative method, using semi-structured interviews divided into several parts, and the results were subsequently categorized. Meister's questionnaire was used to assess the mental workload of perioperative nurses. A total of 8 perioperative nurses working in full-time positions at the IKEM Transplant Centre and 8 perioperative nurses working in surgery units, all of them chosen by non-probability sampling, participated in the survey. Perioperative nurses perceive differences in the procurement of different organs from cadaver donors and know the possible modification of the procedure. What matters to them is the organ that is procured - kidney procurement or multiple organ procurement in cooperation with multiple surgeon teams, split-liver or reduction-liver transplantation or the donor's age. The nurses emphasize that their job requires responsibility, is demanding and causes stress. More experienced nurses participate in organ procurement in donor hospitals, bearing their own responsibility, but at the same time working in a well-functioning transplant team that includes also the coordinator and procurement surgeon. These nurses work on-call and are responsible for organising the work in the surgery room. They know that their job is demanding and are proud of where they work; however, they very often point out the stressfulness of their work. They know it is necessary to take time to relax and regenerate. Transplant centre perioperative nurses can be assessed as the second category of Meister's questionnaire, while perioperative nurses in surgery units as Meister's first category. This thesis may be used as study material and was used for a presentation at a medical conference.

Bakgrund: Organdonation är en komplex operation som ställer höga krav på operationssjuksköterskan. I Sverige styrs donationsprocessen av lagar och regler och ett ställningstagande från patienten eller närstående är avgörande för processen att påbörjas. På operationssalen innebär det ett teamarbete från flera olika sjukhus med olika professioner närvarande och operationssjuksköterskans roll är att delta och assistera under ingreppet. Operationssjuksköterskans huvudansvar är omvårdnad av donatorn med fokus på värdighet, integritet och respekt. Det finns få studier om hur operationssjuksköterskan upplever ingreppet och det är viktigt att sammanställa befintlig forskning för att få en helhetsbild.  Syfte: Syftet var att beskriva operationssjuksköterskans upplevelse av att delta under en organdonation där livsuppehållande åtgärder avslutas.  Metod: En kvalitativ systematisk litteraturstudie med induktiv ansats. Insamlade data kvalitetsgranskades enligt Critical Appraisal Skills Programme [CASP] (2018) och en tematisk analys gjordes enligt Braun och Clarke (2006).  Etiska övervägande inför litteraturstudien fanns och det sågs ingen risk för skada hos tredje part. Alla inkluderade artiklar skulle redovisa etiskt godkännande.  Resultat: 11 artiklar inkluderades i studien, resultatet formades under tre huvudteman, att stå inför en surrealistisk situation, att hantera en svår situation och att finna mening i situationen.Slutsats: Operationssjuksköterskan upplevde ingreppet som psykiskt utmanande och brist på stöd från kollegor. Kränkande behandling av kirurger och brist på erfarenhet och kunskap om ingreppet påverkade hur operationssjuksköterskan hanterade situationen. Operationssjuksköterskorna såg det som sitt ansvar att bevara donatorns värdighet genom hela förloppet och fann därmed mening i en svår situation.

A projected deficit in the perioperative workforce of 32,000 perioperative nurses retiring by 2024, creates an inability to meet the nursing needs of the United States population. The need for experienced perioperative nurses has been increasing while the availability of nurses with perioperative education has been decreasing. The purpose of this phenomenological study was to explore the lived experience of post-licensure nurses who participated in a perioperative clinical rotation within their baccalaureate nursing program and did that experiential experience affect the recruitment and employment for perioperative nursing to halt the impending shortage. The integrations of Kolb’s experiential learning theory and Bandura’s theory of self-efficacy model was the framework that supported the study. Thirteen interviews were conducted using van Manen’s (1990) method for researching the lived experience. The two themes emerging from the data were value and attitude. Subthemes under value are gaining knowledge and skill set and a different type of nursing. Subthemes under attitude are (a) communication with the medical team and advocacy for families and patients. The experiential perioperative clinical rotation affected the study participants’ interest for working in the operating room (OR). Most had a highlighted interest in the specialty, and those participants’ not choosing the OR as their choice of employment expressed that the experience positively affected the type of nurse they are today. Experiential learning can build the fundamental knowledge necessary to understand the novice perioperative nurse’s role as a career choice.

Introduktion: Långa väntetider har varit ett problem inom svensk hälso- och sjukvård under lång tid. Pandemin, orsakad av COVID-19, har inte underlättat situationen. Det har bidragit till ett ökat krav på effektivitet och produktion, vilket även har medfört ett ökat arbetstempo inom den perioperativa vården. Syfte: Syftet var att beskriva operationssjuksköterskors upplevelser av hur krav på ökad produktion kan ha påverkat patientsäkerheten.  Metod: En kvalitativ metod med induktiv ansats har använts för att analysera, tolka och beskriva operationssjuksköterskors upplevelser av hur krav på ökad produktion kan påverka patientsäkerheten inom perioperativ vård. Resultat: Kategorin “Arbete under tidspress” beskrev operationssjuksköterskors upplevelser av krav på effektivitet i den dagliga arbetsmiljön samt hur det påverkat deras fysiska och psykiska välmående. Vidare beskrev kategorin “Förhindra att patienten utsätts för skada” upplevelser av att ej vara förberedd, känslan av ett utökat ansvar och bristande möjligheter till kompetensutveckling. Vilket kunde få konsekvenser för patientsäkerheten. Konklusion: Kravet på ökad produktion leder till minskad möjlighet till preoperativa förberedelser vilket i sin tur leder till bristande patientsäkerhet. Kravet på produktion gav även mindre möjlighet till kompetensutveckling och återhämtning för operationssjuksköterskor. Vilket inte bidrog till en hållbar arbetsmiljö. / Introduction: Long waiting times have been an issue in the Swedish healthcare for a long time. The pandemic, caused by COVID-19, haven’t facilitated the situation. This led to a higher demand for efficiency, production and a faster pace of work in perioperative care. Aim: The aim the study was to describe surgical nurses' experiences of how demands for increased production can affect patient safety. Method: A qualitative method with an inductive approach has been used to analyze, interpret and describe surgical nurses' experiences of how demands for increased production can affect patient safety in perioperative care. Results: The category "Work during time pressure" describes surgical nurses' experiences of demands for efficiency in the daily work environment and how it affects their physical and mental well-being. Furthermore, the category "Prevent the patient from being exposed to harm" describes experiences of not being prepared and being subjected to increased responsibility but lack of competence development. Conclusion: The demand for increased production led to reduced opportunities for preoperative preparations, which led to a lack of patient safety. The requirement for production also provided less opportunity for skills development and recovery for the surgical nurses. Which did not contribute to a sustainable work environment.

A manutenção da integridade cutânea é um cuidado a ser prestado individualmente a cada paciente de forma integralizada com outros cuidados do intra-operatório, aplicando o conhecimento técnico e científico. Os cuidados de enfermagem promovidos ao paciente no período intra-operatório refletirão no pós-operatório3. Muitas lesões de pele têm seu início na sala de operação e segue se agravando no pós-operatório cirúrgico22. Esta pesquisa justifica-se pela escassez de estudos referentes às lesões de pele de pacientes desenvolvidas e observadas no período intra-operatório. Neste estudo exploratório, descritivo e de coorte o objetivo principal é verificar a incidência de pacientes submetidos à cirurgia cardíaca que desenvolveram lesões de pele no período intra-operatório, caracterizar as lesões e identificar os fatores de risco. A coleta de dados foi realizada no Centro Cirúrgico (CC) de um hospital público de ensino, de atenção terciária à saúde, predominantemente cirúrgico, especializado em cardiologia no município de São Paulo, a amostra do estudo foi de 182 pacientes. O estudo foi feito com um p significativo ( 0,05) frente aos testes estatísticos não-paramétricos. A maioria dos pacientes estudados foi do sexo feminino (67%), com idade mediana de 63 (53 70) anos. A raça branca foi predominante (63,2%). Os pacientes obtiveram a mediana do IMC de 26,15 (23,3 29) e os dias de internação apresentaram mediana de 6 (2 11). Quanto ao perfil clínico dos pacientes 49,5% apresentavam insuficiência coronariana, 18,7% insuficiência da valava mitral; 83,5% dos pacientes apresentavam hipertensão arterial, 22,5% tinham diabete insulino não dependente e 9,3% diabete insulino dependente; 20,9 faziam uso de álcool e 13,2 faziam uso de tabaco. Com relação à avaliação clínica da pele houve predominância da pele de coloração rósea claro com 76,4%, textura normal 56%, turgor normal 67% e 61,5% dos pacientes tinham umidade normal. Quanto à incidência de pacientes submetidos à cirurgia cardíaca que desenvolveram lesões de pele em decorrência do período intra-operatório obteve-se incidência de 20,9% (38). Tivemos que 35 (19,2%) lesões apresentaram-se como UP no estágio I, 02 (1,1%) lesões caracterizaram-se como abrasão, 02 (1,1%) feridas incisas, 01 (0,5%) laceração, 01(0,5%) queimadura elétrica superficial e 01(0,5%) UP no estágio II. Quanto aos fatores de risco para lesão de pele no período intra-operatório de cirurgia cardíaca, na análise estatística, considerando p< 0,05 apresentou-se com estatisticamente significante: a idade elevada (63 anos) p= 0,053; pele pálida apresentou p= 0,015; umidade normal da pele revelou p= 0,042; o tempo total de procedimento anestésico cirúrgico apresentou p= 0,035. Os pacientes que utilizaram o equipamento Eco Trans Esofágico teve significância estatística com p= 0,031 e para os que utilizaram o equipamento Desfibrilador Externo p= 0,01. Muito se tem estudado sobre a integridade da pele, relacionando a prevenção de UPs, porem ainda são escassos os trabalhos referentes sobre lesões de pele. O paciente cirúrgico traz consigo fatores de risco que colaboram com o desenvolvimento de lesões, portanto a enfermagem perioperatória deve estar atenta a todos os riscos para realizar um planejamento de assistência e cuidado individualizado para os pacientes / The maintenance of skin integrity is an individual care given to each patient that is integrated to other intraoperative cares, applying both technical and scientific knowledge. Nursing care provided to the patient in the intraoperative stage will reflect in the post-operative one3. Many skin lesions start in the operating room and worsen in the post-operative stage22. This research is justified by the scarceness of studies referring to skin lesions on patients that developed and were observed during the intraoperative stage. In this exploratory, descriptive and cohort study, the main objective was to verify the incidence of patients that underwent heart surgery who developed skin lesion in the intraoperative stage, to characterize lesions and to identify risk factors. The collection of data occurred in an Operating Room (OR) of a public teaching hospital, with tertiary health care, predominantly surgical, and specialized in cardiology in the Municipality of São Paulo, and the study sample was taken from 182 patients. The study was performed with a significant p ( 0,05) compared to the non-parametric statistics tests. Most of the patients studied were females (67%), with an average age of 63 year (53 70). Caucasians were predominant (63,2%). Patients had a BMI medium of 26,15 (23,3 29) and the average of hospitalization days was 6 (2 11). As for the patients clinical profile 49,5% presented heart failure, 18,7% mitral valve failure; 83,5% of the patients presented high blood pressure, 22,5% had non-insulin dependent diabetes and 9,3% had insulin dependent diabetes; 20,9 used alcoholic beverages and 13,2 were smokers. Concerning the clinical skin evaluation, we found a predominance of light pink skin coloration in 76,4%, 56% normal texture, 67% normal turgor, and 61,5% of the patients had normal skin moister. As for the incidence of patients that underwent heart surgery, which developed skin lesions due to the intraoperative stage, an incidence of 20,9% was obtained.(38). We found that 35 (19,2%) lesions presented Stage I PU, 02 (1,1%), lesions were characterized as abrasions, 02 (1,1%) incise wounds, 01 (0,5%) laceration, 01(0,5%) superficial electric burn and 01(0,5%) Stage II PU. As for risk factors for skin lesions in the intraoperative stage of heart surgery, during the statistics analysis, considering p< 0,05, showed as statistically significant: the increased age (63 years) p= 0,053; the presentation of pale skin p= 0,015; normal skin moister of p= 0,042; the total time of the anesthesia procedure with p= 0,035. Patients that used Esophagic Trans Echo equipment had statistical significance with p= 0,031, e the ones that used the External Defibrillator equipment p= 0,01. The integrity of the skin referring to PUs prevention has been well studied however there are still few works about skin lesions. The surgery patient is followed by risk factors that co-operate with the development of lesions; hence perioperative nursing must be aware of all risks to elaborate an individual care and assistance plan for patients

The basic theoretical background: It is known that the profession of nurses is very physically and mentally challenging. Otherwise, it is not even for nurses in the operating room. The work of nurses in operating rooms is highly specialized and demanding profession that requires specific skills and knowledge primarily because the operating rooms is very specific and puts high demands on the technical and material equipment, flawless organization work and to perfect the principles of antisepsis and asepsis. It's about challenging, diverse activities, including the preparation of operating material, devices, apparatus, instruments and sterilization. The correct execution of all these activities, the profession ranks between occupation with time pressure, physical stress and irregular rhythm of life and professions, in which psychological and physical depletion of reserves means not only a danger to themselves, but also the health of the patient. The objectives of the work: To meet the main intent of the work were established two objectives. The first goal is to find out what type of workload for nurses in perioperative care predominates. The second goal is to compare the differences of the workload for novice and long - term working nurses in perioperative care. Hypothesis: Depending on the set objectives have been identified four hypotheses. H1: the incidence of psychological burden for nurses in perioperative care predominates over the occurrence of physical exertion. H2: for nurses working less than three years in perioperative care is the presence of psychic load higher than for senior sisters. H3: for nurses working for more than three years in perioperative care is the presence of physical load higher than the sisters with less length of practice. H4: the workload of nurses in perioperative care does not differ from the standard, based on the Meister´s method of assessing workload. Methodology: Research method of quantitative inquiry of research using the techniques of a standardised questionnaire, supplemented by their own questions. The questionnaire was completely anonymous and respondents ' participation in the research was voluntary. Were used two standardized questionnaires. The first questionnaire was elected from Maister, which assesses the impact of work on the psyche of the individual. The second questionnaire was used as a working activity from Baecky, which is used to measure physical activity. The target group were the nurses working in the perioperative care. In total, were interviewed across nine hospitals of the Czech Republic. All selected Hospital have agreed to perform the research investigation to this thesis. The results obtained were statistically processed. Conclusion: The work provides information about what type of workload predominate for nurses in perioperative care and about the differences of the workload for starting and working nurses in perioperative care. The results of the thesis can be used by medical facilities to identify the workload for nurses in perioperative care and by the perioperative nurses. From the above results, it is clear that the issue of mental and physical loads primarily nurses in the operating room is a very current topic, and it is important to deal with manifestations of this load. In addition to this thesis was created, information material on the prevention of the workload and the methods of its elimination.

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.