Introduktion: Hypotermi är ett tillstånd med en kroppstemperatur ≤ 36°C som uppstår hos ca 70% av alla som opereras och ger en ökad risk för flertalet komplikationer. Enligt rekommendationer skall monitorering ske vid alla operationer längre än 30 minuter, och kroppstemperaturen bör därför alltid monitoreras perioperativt i samverkan med förebyggande interventioner. Syfte: Syftet med studien var att studera perioperativ hypotermi med följande två frågeställningar; förekomsten av hypotermi hos patienter som genomgår ett operativt ingrepp kortare än tre timmar och sjuksköterskor specialiserade inom operation-, och anestesisjukvårds kliniska resonemang kring temperaturmätning och hypotermiförebyggande omvårdnadsåtgärder. Metod: En kvantitativ tvärsnittsstudie, där datainsamlingen utfördes med hjälp av ett studieprotokoll och en webbkonstruerad enkät bestående av egenformulerade frågor. Svarsfrekvensen var 17,2% (n=12) respektive 70% (n=16). Data sammanställdes i programmet Microsoft Excel och analyserades deskriptivt, samt analyserades med hjälp av manifest innehållsanalys. Resultat: Kroppstemperaturen hos samtliga deltagare sjönk någon gång under det perioperativa förloppet och hypotermi förekom hos 66,7%. Nära hälften av specialistsjuksköterskorna uppgav att de saknar kunskap om rekommendationerna och det framkom en skillnad gällande mätning beroende på operationens längd. De ansåg att den främsta orsaken till skillnaden gällande mätning av kroppstemperaturen var en ökad exponeringstid och en ökad medvetenhet om hypotermi vid längre operationer. Bristande förutsättningar ansågs även det vara en orsak till att rekommendationerna inte efterföljs. Slutsats: Hypotermi kan förekomma även vid kortare operativa ingrepp, och specialistsjuksköterskor upplever en skillnad gällande monitorering av kroppstemperaturen beroende på längden av det operativa ingreppet. Denna studie synliggör att det finns bristande kunskap om hypotermi och en bristande följsamhet till rekommendationer gällande monitorering av kroppstemperaturen perioperativt.

Bakgrund: Perioperativ oro hos barn förekommer hos upp uppemot sextio procent av alla barn som genomgår anestesi. Oron kan påverkas utifrån livssituation, fantasier, tankar och tidigare upplevelser i samband med sjukhusvård. Genom att kartlägga omvårdnadsinterventioner som minskar perioperativ oro hos barn, kan det förhoppningsvis bidra till en reflektion kring vård av barn i perioperativ miljö. Syfte: Att kartlägga omvårdnadsinterventioner som anestesisjuksköterskan kan använda sig av för att minska barns upplevelser av oro i samband med perioperativ vård. Metod: Deskriptiv litteraturstudie med induktiv ansats. Tjugofem artiklar analyserades med hjälp av Whittemore & Knafls (2005) analysmetod. Resultat: Att i den perioperativa vården använda omvårdnadsinterventioner för att minska barns oro är av stor vikt. Genom att låta barn bekanta sig med vårdmiljön eller låta dem distraheras med spel eller musik gav förutsättningar för att minska deras oro. Slutsats: Ett flertal omvårdnadsinterventioner har identifierats kunna minska barns upplevelse av perioperativ oro. Barn är individer och omvårdnadsinterventionerna behöver anpassas utifrån barnets aktuella behov och situation. / Background: Perioperative anxiety in children occurs in sixty percent of all children who undergoes anaesthesia. Anxiety can be affected by lives situations, fantasies, thoughts and earlier experiences from hospital care. By mapping nursing interventions that reduce perioperative anxiety in children, it can hopefully contribute to a reflection on he care of children in perioperative environments. Purpose: To map nursing interventions that the anaesthetic nurse can use to contribute to children's experience of reduced anxiety associated with perioperative care. Method: Descriptive literature study with an inductive approach. Twenty five articles were analysed using Whittemore & Knafl`s (2005) method of analysis. Results: Using nursing interventions in perioperative care to reduce children's concerns is of great importance. By letting children get acquainted with the care environment or letting them be distracted by games or music provided conditions to reduce their worries. Conclusion: A number of nursing interventions have been identified to reduce children's experience of perioperative anxiety. Children are individuals and nursing interventions need to be adapted based on the child's current needs and situation.

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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.

In den letzten Jahren haben sich die Empfehlungen für eine Antibiotikaprophylaxe in der Herzchirurgie bezüglich Antibiotikawahl und Applikationsdauer verändert und gehen nicht speziell auf die Kinderherzchirurgie ein. Im Deutschen Herzzentrum Berlin wurde seit 1988 bei Operationen aufgrund angeborener Herzfehler die Kombinationsprophylaxe mit Piperacillin und Cefotaxim angewandt. Neue internationale Empfehlungen schlagen jedoch ein Cephalosporin der I. oder II. Generation vor. Fragestellung dieser prospektiven Beobachtungsstudie ist deshalb, ob eine Umstellung der im DHZB üblichen Kombinationsprophylaxe auf eine Monoprophylaxe mit Cefotiam gerechtfertigt ist. Vom 1.3. - 31.8. 1995 wurden 180 Patienten mit Operationen am offenen Herzen in die Studie eingeschlossen. 99 Patienten erhielten die bisher im DHZB etablierte Kombinationsprophylaxe mit Cefotaxim und Piperacillin (Cx/P-Gruppe). 81 Patienten bekamen eine Monoprophylaxe mit Cefotiam (Ct-Gruppe). Die postoperative Infektionsrate betrug in der Ct-Gruppe 14,8 % und in der Cx/P-Gruppe 17,2 %. Die Prophylaxe erfolgte für beide Gruppen durchschnittlich 103 Stunden bzw. 110 Stunden. Die Studie konnte aufgrund geringer Patientenanzahl aus statistischer Sicht keinen Beweis für einen Unterschied erbringen. Dafür zeigte die Metaanalyse, daß auch bei einer großen Patientenanzahl (n=4177) kein statistischer Unterschied zwischen einer Schmalspektrum- und einer Breitspektrumprophylaxe besteht. Es wurde ferner gezeigt, daß Cefotiam den Anforderungen einer effektiven Prophylaxe gerecht wird und Vorteile gegenüber der Kombinationsprophylaxe aufweist. Die Studie hat dazu beigetragen, daß seit 1996 in der Kinderherzchirurgie im DHZB eine Monoprophylaxe mit einem Cephalosporin der I. Generation - Cefazolin - durchgeführt wird und hat weiterhin eine Verkürzung der Prophylaxedauer bewirkt. / Perioperative antibiotic prophylaxis for patients with congenital heart diseases Recommendations for antimicrobial prophylaxis regarding the choice of antibiotics and the application time have changed and do not include cardiac surgery for infants. A combination of piperacillin and cefotaxim has been used since 1988 in the German Heart Institute of Berlin. Updated recommendation now propose the use of a I. or II. generation cephalosporin. The purpose of this prospective study was to evaluate whether a change from the so long used combined prophylaxis towards a monoprophylaxis with cefotiam is justified. From 1st of March until 31st of August 1995 a total number of 180 patients with an open heart surgery were included into the study. 99 patients received a combination with cefotaxim and piperacillin (cx/p-group), which was the standard combination in the German Heart Institute of Berlin. 81 patients received a monoprophylaxis with cefotiam (ct-group). The postoperative rate of infections was 14,8 % in the ct-group and 17,2 % in the cx/p-group. For both groups the duration of prophylaxis was on average 103 respectively 110 hours. Due to a relatively small number of patients the study could not show a statistically significant difference between both prophylactic regimes. The performed meta-analysis comparing the postoperative infections in small spectrum and broad spectrum prophylaxis in the open heart surgery did not find a significant difference in a large group of patients (n=4177). Our study supports the fact, that cefotiam meets the criteria of an effective antibiotic prophylaxis and has additional benefits compared to the combined prophylaxis scheme. The results of this study have led to a replacement of the old perioperative prophylaxis regime by cefotiam for open heart surgery for infants in the German Heart Institute of Berlin since 1996 and have led to a reduction of the application time during the prophylaxis.

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Orientador: Paula Schmidt Azevedo Gaiolla / Resumo: Introdução: A atual mudança no perfil epidemiológico, com aumento da expectativa de vida mundial e no Brasil, contribui para o crescimento da população de idosos e consequentemente de ampliação do espectro das comorbidades destes. Adicionalmente, independentemente da idade, existe aumento de doenças crônicas associadas principalmente aos hábitos modernos. Esses fatores elevam os riscos de complicações durante e após as cirurgias. Por outro lado, nota-se ainda avanço no que diz respeito às propostas e técnicas anestésicas e cirúrgicas, cada vez menos invasivas e mais resolutivas, permitindo aos idosos e portadores de doenças crônicas, serem submetidos a diferentes procedimentos. Portanto, é crucial que seja realizada criteriosa avaliação perioperatória individualizada, visando prever, intervir e minimizar efeitos indesejados associados aos procedimentos cirúrgicos e aos fatores de risco individuais de cada paciente. Objetivo: O presente trabalho propõe a criação de protocolo, de ficha de atendimento e de Manual para guiar a avaliação e manejo perioperatório dos pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Metodologia: O método utilizado na pesquisa foi a busca avançada em inglês no banco de dados da Pubmed, Cochrane, Lilacs e Scielo dos termos: “Preoperative risk screening”; “Preoperative Cardiovascular risk stratification”, “Preoperative pulmonary risk stratification”, “perioperative management of the cirrhotic patient”, “perioperative renal care”,... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The current change in the epidemiological profile, with an increase in life expectancy worldwide and in Brazil, contributes to the growth of the elderly population and, consequently, to a broader spectrum of their comorbidities. In addition, regardless of age, there is an increase in chronic diseases associated with modern habits. These factors raise the risk of complications during and after surgeries. On the other hand, there is still progress in regard to proposals and anesthetic and surgical techniques, which are becoming less invasive and more resolutive, allowing the elderly and patients with chronic diseases to undergo different procedures. Therefore, it is crucial that a careful individualized perioperative evaluation is performed, in order to predict, intervene and minimize unwanted effects associated with surgical procedures and individual risk factors of each patient. Objective: This paper proposes the creation of a protocol, an information sheet and a manual to guide the evaluation and perioperative management of patients at the Hospital das Clínicas, Botucatu Medical School. Methodology: The method used in the research was the advanced search in English in the database of Pubmed, Cochrane, Lilacs and Scielo of the terms: "Preoperative risk screening"; "Preoperative Cardiovascular risk stratification", "Preoperative pulmonary risk stratification", "perioperative management of the cirrhotic patient", "perioperative renal care", arranged in isolation a... (Complete abstract click electronic access below) / Mestre

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.