Postoperative urinary retention (PUR) is a common problem seen after surgery, particularly after orthopedic surgery. There has been a great deal of research done surrounding the causes of PUR and the optimal treatment for PUR, all with conflicting results. Little research has been done with orthopedic nurses to find out how they actually treat PUR, and on what information they base those treatment decisions. Evidence-based practice has been gaining popularity recently and highlights the need for nurses to make treatment decisions based on sound research, patient preferences, clinical expertise, and taking into consideration health care resources and the clinical setting (DiCenso, Ciliska, & Guyatt, 2005). This study investigated nurses' views on the definition of PUR, how they assessed for PUR, how they treated PUR and what they based their treatment decisions on. Ten nurses who worked on orthopedic units were interviewed using a semi-structured format consisting of four questions. The interviews were recorded and then transcribed verbatim by the student researcher. Qualitative description, as described by Sandelowski (2000), was used to analyze data. All nurses defined PUR fairly similarly. Various contributing factors for PUR were mentioned, some that were studied in the literature, and some that were not. Each nurse had a slightly different way of treating PUR, and 'ward routine' was also described differently. Study results point to a need for more research and education in the area of PUR so that all nurses are treating PUR in the same manner based on the same sound knowledge base.

Bakgrund: En stor del av vårdskadorna som uppstår i vården beror på brister i kommunikation. Rapportering är en del av det dagliga arbetet som sjuksköterska, där målet är att föra vidare information om en patientens tillstånd för att säkerställa den fortsatta vården och patientsäkerheten. Syfte: att beskriva hur anestesisjuksköterskan och vårdavdelningens sjuksköterska ser på rapportering vid överföring av patient från UVA till vårdavdelning. Metod: Kvalitativ studie. Studien har analyserats med hjälp av innehållsanalys där ett tema, två kategorier och nio subkategorier har framkommit. Fokusgruppsintervjuer med sammanlagt tio sjuksköterskor från vårdavdelningar med erfarenhet av att hämta patienter på UVA samt åtta sjuksköterskor från anestesin. Resultat: För att en rapport skall bli bra krävs att rapporten följer en viss procedur och struktur. Det är viktigt att rapporten följer en röd tråd och att informationen inte blir överflödig. Vårdmiljön vid rapporteringen har också stor betydelse. Det blir svårt att lämna en bra rapport då det är mycket stress runtomkring och då det är svårt att hålla sekretessen. Från både anestesin och vårdavdelningarna finns en vilja att ha förståelse för varandra för att skapa en god miljö vid rapporteringen. I rapporteringen är det viktigt att lagom mycket information om patienten lämnas annars finns risk att personen som tar emot rapporten slutar lyssna. Diskussion: Vårdavdelningarnas sjuksköterskor saknar kunskap om de specifika läkemedel som administreras av anestesisjuksköterskan under narkosen. Detta kan få ödesdigna konsekvenser då det finns en risk att drabbas av återfall av läkemedel med andningshämmande effekt, en så kallad recurarisering. / Background: A great deal of the related care injuries that develops in the hospitals often depends on communications failures. Reporting handovers is a great part of nurse’s daily work, the where report handovers purpose is to transfer information related to the patient between staff so that the patient safety can be ensured. Aim: To describe how the anaesthesia nurse and the ward nurse perception in the report handover of an postoperative patient. Method: Qualitative studies where made. Focus group interviews with total of ten nurses from the wards, nurses with experience from giving and taking reports in handover situations from the postoperative anaesthesia care unit (PACU), and eight nurses from the anaesthetic ward. The result where analysed with help from a content analysis, that resulted in one theme, two categories and nine sub categories. Result: Areport requires that the reporter follow a particular procedure and structure. It’s important that the report makes a common line for the listener, and that the information is not redundant. The environment is also important, it becomes difficult to make a good report when it’s stressful around, that also makes it difficult to maintain confidentiality. From both the anaesthesia and ward it’s a willingness to understand each other when it comes to patient handover, regarding to the stressfulness and the lack of care places at the wards. It’s important that the right amount of information about the patient is given, otherwise there’s a risk that the person receiving the report, stop listening. Discussion: The ward nurses lack the knowledge about the specific drugs during anaesthesia that are administrated by the anaesthesia nurse. That can bring a fatal consequence if the patient gets a residual paralysis of the muscle relaxant drug.

Pain is common among women undergoing first trimester surgical abortions. At the postoperative unit, department of gynaecology, University Hospital, Uppsala, the goal is that 80 % of the women should rate pain as £ 3 on a numeric rating scale (NRS), when leaving the unit. The aim of the study was to investigate how rating was performed at the unit and to investigate patient’s perceptions of pain after having undergone first trimester surgical abortion. 20 patients (74%) participated in the study. Ninety percent of the patients rated their pain as NRS £ 3 when leaving the unit. Seven patients (35 %) rated their pain as NRS > 3 directly after operation, and 2 (10 %) patients NRS > 3 when leaving the unit. There were no correlations between patient’s age and ratings of pain. There was no difference in rating of pain between patients with prior vaginal delivery and patients who had no prior vaginal delivery. There were no correlations between ratings of pain and gestational age. Conclusion: It is important that patients undergoing first trimester surgical abortions receive adequate pain treatment. The unit’s goal for postoperative pain treatment is achived, 90 % of the patients rated their pain as NRS £ 3 when leaving the unit.

Bakgrund: Höga ljudnivåer på postoperativa avdelningar har visat sig öka utsöndring av stresshormoner hos patienter. Med insikt om hur musik som omvårdnadsåtgärd påverkar patienten postoperativt, kan omvårdnadspersonalen försöka göra den postoperativa vården så angenäm som möjligt. Syfte: Att belysa musikens inverkan på postoperativa avdelningar – ur ett patientperspektiv. Metod: Litteraturstudie baserat på åtta vetenskapliga artiklar som analyserats systematiskt. Resultat: Det framkom att musik kan användas som omvårdnadsåtgärd för att minska stress, oro och smärtupplevelse postoperativt. Patienterna upplevde att musik kan bidra till ett ökat välbefinnande och reducera upplevelsen av störande ljud. Konklusion: Omvårdnadspersonalen bör få ökad kunskap om musikens betydelse postoperativt ur ett holistiskt synsätt, då musik är en enkel och kostnadseffektiv omvårdnadsåtgärd. Nyckelord: Postoperativ, musik, omvårdnad, litteraturstudie / Background: High noise levels in postoperative departments has shown to increase secretion of stress hormones in patients. With an awareness of how music as a nursing intervention affects the patient postoperatively, the nursing staff can try to make the post-operative care as pleasant as possible. Aim: To illuminate the effect of music on post-operative departments – from a patient´s perspective. Method: Literature study based on eight scientific articles that was systematic analyzed. Results: It was found that music can be used as a nursing intervention to reduce stress, anxiety and pain perception postoperatively. The patients showed that music can contribute to increased well-being and reduce the perception of noise. Conclusion: Nursing staff should enhance the understanding of the importance of music postoperatively from a holistic approach, where music is a simple and cost effective nursing intervention. Keyword: Postoperative, music, nursing, literature

Abstracts: The purpose of the study was to compare the efficacy and cost between intravenous patient-controlled analgesia (PCA) with intramuscular (IM) analgesics for women in the first two days after surgery. The study included 200 patients who were assigned to receive PCA or intramuscular injections opioid during a period of 2 days after surgery. The PCA group included 124 patients and IM group had 76 patients. The data were collected using a structured questionnaires, patient chart review and hospital charge data. The several findings were observed in this study. 1. The pain level in the PCA group was significantly lower than in the IM group (P< 0.01). The PCA group had significantly greater satisfaction with pain control than those in IM group (p< 0.01). The influence of activity by pain in the IM group had significantly greater than those in PCA group (p< 0.05). 2. The incidence of skin itching in PCA group was significantly higher than in the IM group ¡]P< 0.01¡^.3. Cost per patient was higher for PCA group¡]NT$ 420.9¡Ó22.6¡^than IM group¡]NT$228.4¡Ó60.1¡^. In conclusion, PCA produced better pain relief, get better patient¡¦s satisfaction than conventional on-demand IM opioid injections but it was more expensive.

No description available.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成5年10月13日 柴田佳久氏の博士論文として提出された

Thesis (doctoral)--Freie Universität, Berlin, 2000.

Introduction: Patients having total joint replacement often experience moderate to severe pain postoperatively. Postoperative pain can reduce patients’ mobility, affecting their motivation to participate in any rehabilitation activities. For patients having total join replacement, rehabilitation plays an important role in promoting their early recovery. Therefore, it is crucial for healthcare professionals to develop and evaluate intervention that can better control patients’ post-operative pain. In the clinical setting that I am working, pharmacological method is the major means of postoperative pain management. However, many Chinese patients are reluctant to use analgesic to control their post-operative pain because of the side effects and adverse reactions of the drugs. In this dissertation, music therapy, a non-pharmacological method that can be managed by nurses, is adopted for postoperative pain control. It is used to promote rehabilitation for patients who have undergone total joint replacement. Objectives: The objectives of this study are (1) to review the published research articles that investigated the effects of music therapy in reducing the post-operative pain and promoting rehabilitation for patients having total joint replacement; and (2) to establish an evidence-based guideline for the use of music therapy by nurses to control postoperative pain and to facilitate rehabilitation for patients having total joint replacement. Methods: A comprehensive literature search on four electronic databases including CHINAL, Medline (OvidSP), PubMed and the British Nursing Index were conducted. A total of eight RCTs and two non-randomized controlled trials were eventually identified. Results: All the reviewed studies showed that music therapy has a statistically significant effect on reducing postoperative pain. Sedative or relaxation music (music which has no lyrics, sustained melodic quality; rate of 60-80 beats per minutes; absence of strong rhythms or percussion) are recommended in the guideline. The target setting is a total joint replacement centre in a public hospital of Hong Kong. The target clients are adult patients (aged 19 or above) that are referred by the orthopedic out-patient department and are pending for their total knee/ hip replacement in the center. The transferability and feasibility of the literature are high. The guideline is developed based on the evidence in reviewed literature. A pilot testing plan is established to detect the potential barrier and friction of the guideline before the implementation. After that, an evaluation plan for patients, healthcare providers and system outcomes was also proposed. Conclusion: An evidence based guideline is developed for the total joint replacement center. It is anticipated that, with the use of this guideline by nurses, it will not only facilitate better rehabilitation for patients having total joint replacement, but also enhances nurses’ autonomy in their nursing practice. / published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / abstract / toc / Surgery / Master / Master of Philosophy