SAMMANFATTNING Bakgrund: Delaktighet och inflytande i samhället är ett målområde som Folkhälsomyndigheten (2015) lyfter fram som förutsättning för folkhälsan. I sjukvården ska patientlagen (SFS 2014:821) stärka patientens ställning och främja patientens delaktighet, integritet och självbestämmande. En intention är att utveckla en säkrare vård tillsammans med patienten. Begreppet patientdelaktighet är inte entydigt definierat enligt tidigare studier och forskare skriver det är bara den enskilda patienten som kan avgöra om delaktighet uppnåtts rörande den egna omvårdnaden.  Syfte: Att beskriva vad patienter upplever påverkar delaktighet i vården vid en thoraxkirurgisk vårdavdelning. Metod: Deskriptiv kvalitativ design med semistrukturerade intervjuer som omfattade sju patienter vilka genomgått öppen hjärtkirurgi. Analysarbetet genomfördes med kvalitativ innehållsanalys. Resultat: Det som påverkar upplevd delaktighet i vården bestod av underlättande och begränsande faktorer. Interaktion med och stöd av personalen samt möjligheten att välja grad av delaktighet underlättade. Begränsande var att inte ha kunskap och de medicinska bedömningarna, det fanns ett kunskapsgap mellan informant och professionen, den sjukvårdspersonal informanterna mötte och hade kontakt med under vårdtiden. För att minska den begränsande faktorn kunskap var skriftlig och muntlig information viktig. De medicinska bedömningarna accepterade informanterna helt och fullt. Professionens kunskap och medicinska bedömningar gav trygghet. Slutsats: Resultatet visar förutsättningar, underlättande och begränsande faktorer, som beskriver hur informanterna upplever vad som påverkade patientdelaktighet i vården i samband med öppen hjärtkirurgi. Stor vikt läggs vid stöd av personal, vid patientinformation och svar på frågor från professionen. / ABSTRACT Background: Participation and influence in society is a target area that Folkhälsomyndigheten (2015) highlighted as vital for public health. In medical care shall Patientlagen (SFS 2014: 821) strengthen the position of patients and promote patient involvement, integrity and self-determination. The intention is to develop safer care together with the patient. The concept of patient participation is not clearly defined in previous studies, and it is only the individual patient, which can determine whether participation is reached regarding their own care. Purpose: To describe what patients experience affects participation in care at a thoracic surgery ward. Method: Descriptive qualitative design with semi-structured interviews involving seven patients who underwent open heart surgery. The analysis was conducted using qualitative content analysis. Results: There affecting perceived participation in the care consisted of facilitating and constraining factors. Interaction and support of the staff and the ability to choose the degree of participation facilitated. Limitation was not to have the knowledge and the medical assessments; there was a knowledge gap between the informant and the profession, the medical staff informants met and had contact with during the hospital stay. To reduce the limiting factor knowledge was written and verbal information important. The medical assessments accepted the informants completely. The profession´s knowledge and medical assessment gave security. Conclusion: The results show potential, facilitating and constraining factors, describing how the informants experience what affected patient participation in care associated with open heart surgery. Emphasis is placed on the support of the staff, the patient information and answers to questions from the profession.

Diss. (sammanfattning) Linköping : Univ., 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Johann Wolfgang Goethe University, 2003. / Includes bibliographical references.

Thesis (Ph. D.)--Johann Wolfgang Goethe University, 2003. / Includes bibliographical references.

Made available in DSpace on 2015-07-22T20:50:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-11-24 / Os exercícios pós-operatórios de cirurgias oncológicas de mama são tidos como essenciais para o restabelecimento da função do membro superior, possibilitando a continuidade do tratamento e retorno às atividades de vida diária. Entretanto, há divergências na literatura quanto ao início, tipo de exercícios e período de acompanhamento. Os objetivos dessa investigação foram: implantar um programa extramuros de exercícios, iniciado precocemente, para mulheres submetidas à cirurgia por câncer de mama; avaliar a efetividade desse programa; verificar o tempo necessário para a recuperação da amplitude de movimento (ADM) do ombro homolateral à cirurgia; verificar a influência das variáveis: tipo de cirurgia, realização de linfonodectomia axilar e idade, na recuperação da ADM; relacionar o início do programa com a incidência de seroma e deiscência e, mensurar a adesão dessas mulheres ao programa. Os resultados mostraram que o programa foi efetivo para a recuperação funcional da ADM, sendo que o tempo mínimo necessário foi de 75 dias para as mulheres submetidas à quadrantectomia, e de 105 dias para as mastectomizadas ou com manipulação axilar. Não houve diferença estatística significativa entre a formação de seroma (p>0,999) ou deiscência (p>0,999) quando comparadas as mulheres que iniciaram o programa no 1º pós-operatório (PO) com as que iniciaram após a retirada do dreno, sendo que o início precoce propiciou um restabelecimento mais rápido da ADM. Concluiu-se que o programa extramuros composto por nove exercícios e iniciado no 1ºPO possibilita que mulheres com dificuldade ao comparecimento ambulatorial semanal obtenham a movimentação funcional do membro superior, num período de 75 a 105 dias de PO, de acordo com o tipo de cirurgia, sem aumentar a incidência das duas complicações pós-operatórias analisadas. / Post-operative exercises of breast cancer are considered essentials for recovery upper limb function, enabling the continuity of treatment and return to activities of daily living. However, there are differences in the literature about the onset, types of exercises and follow-up period. The aim of this research were: to establish an extramural, early exercise program for women in postoperative (PO) of breast cancer; evaluate the effectiveness of this program; verify the time necessary to recovery of range of motion (ROM) of PO homolateral shoulder; determine the influence of the variables: type of surgery, axillary dissection and age in the recovery of ROM; relate the beginning of the program with the incidence of seroma and dehiscence and measure the adherence of these women to the program. The results showed that the program was effective for the functional recovery of ROM, and the minimum time required for recovery was 75 days for women who underwent quadrantectomy, and 105 days for mastectomized women or with axillary dissection. There was no statistically significant difference between the seroma formation (p> 0.999) or dehiscence (p> 0.999) compared women who started the program in the 1st postoperative day (PO) with those that began after the drain removal, and the early start provided a fast recovery of ROM. Concluded that the extramural program, consisting of a set of nine exercise and started in the 1st PO enables that women with difficult to attend weekly in clinical sessions obtain the functional movement of upper limb, in a period of 75 to 105 days of PO, according to the type of surgery, without increase the incidence of the two postoperative complications analyzed. / TEDE / BV UNIFESP: Teses e dissertações

Este estudo teve como objetivos analisar o conceito náusea em pacientes no período pósoperatório imediato; avaliar a validade de conteúdo e clínica do diagnóstico de enfermagem Náusea no período pós-operatório imediato, considerando-se o modelo de Fehring; identificar a incidência do referido diagnóstico em pacientes no período pós-operatório imediato; verificar possíveis associações entre os antecedentes de náusea obtidos na análise de conceito e os identificados nos pacientes com náusea no pós-operatório imediato e verificar a frequência de ocorrência das características definidoras principais e secundárias do diagnóstico Náusea. A pesquisa foi desenvolvida em três etapas: análise de conceito, validação de conteúdo e validação clínica. A análise de conceito seguiu as oito fases propostas por Walker a Avant: selecionar o conceito, definir o objetivo da análise, identificar a utilização do conceito, definir atributos definidores, desenvolver casos-modelos, desenvolver outros casos, identificar antecedentes e consequentes e verificar as referências empíricas. Essa etapa foi fundamental para a realização das etapas posteriores (validação de conteúdo e validação clínica), permitindo a construção de definições operacionais e a elaboração de instrumentos de coleta de dados mais direcionados ao cenário do paciente com náusea no período pós-operatório. Participaram da validação de conteúdo 52 expertos que responderam a um instrumento que continha dados de identificação profissional e de validação do diagnóstico de enfermagem Náusea (enunciado, definição, posição que ocupa na estrutura taxonômica e características definidoras, descritas em uma escala tipo Likert). A maioria dos expertos considerou o domínio 12 (Conforto), a classe 1 (conforto físico) e o enunciado (náusea) adequados ao diagnóstico. Foram sugeridas modificações na definição atual do referido diagnóstico de enfermagem. Quatro características definidoras foram consideradas principais (relato de náusea, salivação aumentada, aversão à comida e sensação de vômito) e oito foram denominadas secundárias (deglutição aumentada, gosto amargo na boca, palidez, taquicardia, diaforese, sensação de calor e frio, alterações da pressão arterial e dilatação pupilar). Na etapa de validação clínica, 106 pacientes foram incluídos na amostra. Para a coleta de dados, foram utilizados o questionário de avaliação pré, intra e pósoperatória e a Escala Hospitalar de Ansiedade e Depressão. A náusea foi avaliada em duas etapas: 1) análise das manifestações objetivas (dois enfermeiros simultaneamente) e 2) subjetivas (um enfermeiro). A incidência de náusea foi de 21,70% e, na maioria das vezes, de moderada intensidade. Os antecedentes associados à presença de náuseas no pós-operatório foram: sexo, idade, tipo de anestesia, presença de dor, movimentação e alimentação pósoperatória e odores nocivos. Na etapa 1, a característica definidora denominada principal foi relato de náusea, e as manifestações secundárias foram sensação de vômito, palidez e deglutição aumentada. O índice de concordância variou de 86,95% a 100,00%. Na etapa 2, as características consideradas principais foram relato de náusea e sensação de vômito, e as características definidoras secundárias identificadas foram salivação aumentada e sensação de calor e frio. Os escores totais do diagnóstico de enfermagem Náusea foram de 0,79 e 0,73 para as validações de conteúdo e clínica respectivamente, considerado válido para a Taxonomia da North American Nursing Diagnosis Association - International (NANDA-I). Concluiu-se que o relato de náusea, sensação de vômito, palidez, salivação aumentada, deglutição aumentada e sensação de calor e frio são fortes indicativos do diagnóstico de enfermagem Náusea. / The aims of this study were to analyze the nausea concept in patients during the immediate postoperative period; to assess the content and clinical validity of the nursing diagnosis nausea in the immediate postoperative period, considering Fehring\'s model; to identify the incidence of this diagnosis in patients during the immediate postoperative period; to check for possible associations between the nausea antecedents obtained in the concept analysis and those identified in patients with immediate postoperative nausea and to verify the frequency of the primary and secondary defining characteristics of the Nausea diagnosis. The research was developed in three phases: concept analysis, content validation and clinical validation. The concept analysis followed the eight phases proposed by Walker and Avant: select the concept, define the aim of the analysis, identify the use of the concept, define defining attributes, develop model cases, develop other cases, identify antecedents and consequences and check empirical references. This phase was fundamental to accomplish further phases (content validation and clinical validation), permitting the construction of operational definitions and the elaboration of data collection instruments that were better directed at the context of postoperative nausea patients. Fifty-two specialists participated in the content validation, who answered an instrument with professional identification data and the validation of the nursing diagnosis nausea (wording, definition, position in taxonomic structure and defining characteristics, described on a Likert scale). Most experts considered domain 12 (Comfort), class 1 (physical comfort) and the wording (nausea) adequate for the diagnosis. Modifications were suggested in the current definition of the referred nursing diagnosis. Four defining characteristics were considered primary (reported nausea, increased salivation, aversion toward food and gagging sensation), while eight were called secondary (increased swallowing, sour taste in the mouth, pallor, tachycardia, excessive sweating, feeling hot and cold, blood pressure alterations and pupil dilation). In the clinical validation phase, 106 patients were included in the sample. For data collection the pre, intra and post-operative assessment questionnaire and the Hospital Anxiety and Depression Scale were used. Nausea was assessed in two phases: 1) analysis of objective manifestations (two nurses simultaneously) and 2) subjective (one nurse). The incidence level of nausea corresponded to 21.70%, in most cases of moderate intensity. The following antecedents were associated with the presence of nausea and vomiting: gender, age, anesthesia type, presence of pain, postoperative movements and meals and harmful smells. In phase 1, the defining characteristic that was considered primary was reported nausea and the secondary manifestations were gagging sensation, pallor and increased swallowing. Agreement levels ranged between 86.95% and 100.00%. In phase 2, reported nausea and gagging sensation were considered primary characteristics, while increased salivation and feeling hot and cold were identified as secondary defining characteristics. The total scores of the nursing diagnosis Nausea corresponded to 0.79 and 0.73 for the content and clinical validations, respectively, which are considered valid for the Taxonomy of the North American Nursing Diagnosis Association - International (NANDA-I). In conclusion, reported nausea, gagging sensation, pallor, increased salivation, increased swallowing and feeling hot and cold are strong signs of the nursing diagnosis Nausea.

Bakgrund: Pankreatikoduodenektomi är den enda kurativa behandlingen av pankreascancer och pankreasanastomosläckage (PAL) är en mycket allvarlig postoperativ komplikation. Metoder för att identifiera detta i ett tidigt skede behöver förbättras. Den postoperativa övervakningen består till stor del av vitalparametrar men sjuksköterskan observerar även andra tecken på försämring. Metod: 32 patienter som genomgått pankreatikoduodenektomi inkluderades i studie. Ett bedömningsformulär innehållande 14 parametrar togs fram och användes för att identifiera vad i sjuksköterskans observationer som kan identifiera tidiga tecken på PAL. Studien hade kvantitativ ansats. Syfte: Att identifiera tidiga tecken på PAL efter pankreatikoduodenektomi med hjälp av ett bedömningsformulär. Resultat: Bedömningsformuläret identifierade normalförloppet efter pankreatikoduodenektomi. Vid jämförelse mellan patienterna som drabbats av PAL och normalförloppet urskildes tre signifikanta skillnader. Patienterna med PAL hade innan det diagnostiserades ökat syrgasbehov, sjuksköterskan bedömde deras allmäntillstånd som dåligt istället för ganska gott och patienternas egenbedömning av allmäntillståndet visade att de mådde sämre för varje dag istället för bättre. Slutsatser: Studien indikerar att ökat syrgasbehov samt sjuksköterskans bedömning och patientens egenbedömning av allmäntillståndet är vägledande för upptäckten av pankreasanastomosläckage. / Background: Pancreaticoduodenectomy is the only curative treatment of pancreaticcancer and postoperative pancreatic fistula (POPF) is a very serious complication. Methods to identify this in an early stage must be improved. The postoperative monitoring is largely composed of vital signs, but the nurse also observes other signs of deterioration. Method: 32 patients how underwent pancreaticoduodenectomy were included in the study. An assessment form containing 14 parameters was used to identify what in the nurse's observation that can identify early signs of POPF. The study had a quantitative approach. Objective: To identify early signs of POPF after pancreaticoduodenectomy using anassessment form. Results: The assessment form identified the normal process after pancreaticoduodenectomy. In the comparison between the patients affected by POPF and the normal process, three significant differences were distinguished. The patients with POPF had before it occurred increased oxygen needs, the nurse assessed the general health as poor rather than pretty good and the patients self-assessed the general health worse by the day instead of better. Conclusions: This study indicates that increased oxygen needs and the nurse's assessment and the patient's self-assessment of general health can be indicative for the discovery of POPF.

Bakgrund: Smärta är en subjektiv känsla där varje individ lär sig betydelsen av ordet genom egna erfarenheter. Smärta är något nästan alla upplever efter ett kirurgiskt ingrepp och där otillräcklig smärtlindring i den akuta fasen kan leda till svåra komplikationer vilket skapar lidande för patienten samt stora samhällsekonomiska kostnader. Syfte: Att beskriva patienters upplevelse av postoperativ smärtbehandling. Metod: Litteraturstudie med deskriptiv design av 11 kvalitativa originalartiklar från databaserna PubMed, CINAHL och PsycINFO vars innehåll analyserades i fem steg. Resultat: Patienter var överlag tillfredsställda trots smärta. Det fanns delade åsikter om nyttan av NRS (numerisk skala). Patienter hade en rad föreställningar om läkemedel som ledde dem till att undvika analgetika. Information ansågs vara huvudsakligen hjälpsamt, framför allt skriftlig, dock upplevde patienter att informationen var bristfällig. Attityd, tillit och kommunikation spelade en viktig roll för relationen mellan personal och patient. Patienter som genomgått dagkirurgi och behandlade sin smärta ensamma i hemmet med mycket begränsad kontakt med vårdpersonal, upplevde svårigheter att ta beslut och följa sin smärtbehandlingsplan. Patienter uppskattade att bli inkluderade och delaktiga i sin vård, även om det kunde upplevas som en börda, och tog många egna initiativ och egna strategier under sin behandling, ofta för att slippa använda analgetika. Tidigare erfarenheter var också något som ofta hjälpte patienter i deras smärtbehandling. Slutsats: Patienter var ofta nöjda med sin smärtbehandling trots att de fortfarande upplevde smärta, viktigast för att uppnå detta var en känsla av trygghet. Viktiga faktorer för detta var utförlig skriftlig och upprepad information om smärta, smärtbehandling och analgetika samt ett gott, professionellt, inkluderande och individanpassat bemötande från vårdpersonalen. Brister inom dessa områden ledde till oro och rädsla för det okända, vilket försvårade smärtupplevelsen. Patienter upplevde sällan fullgod smärtlindring. / Background: Pain is a subjective feeling where each individual learns the meaning of the word through their own experiences. Pain is something almost everyone experiences after a surgical procedure and where insufficient pain relief in the acute phase can lead to severe complications, which creates suffering for the patient and large socio-economic costs. Aim: To describe patients' experience of postoperative pain management. Method: Literature review with descriptive design of 11 qualitative original articles from the databases PubMed, CINAHL and PsycINFO whose contents were analyzed in five steps. Result: Patients were generally satisfied despite pain. There were different opinions about the benefits of the NRS (numeric rating scale). Patients had a number of conceptions about drugs that led them to avoid analgesics. Information was considered to be mainly helpful, especially written, however patients felt that the information was deficient. Attitude, trust and communication played an important role in the relationship between staff and patient. Patients who underwent day surgery and treated their pain alone in the home with very limited contact with health care professionals experienced difficulties in making decisions and following their pain management plan. Patients appreciated being included and involved in their care, although it could be perceived as a burden, and took many own initiatives and strategies during their treatment, often to avoid using analgesics. Previous experience was also something that often helped patients in their pain management. Conclusion: Patients were often satisfied with their pain management even though they were still experiencing pain, most important to achieve this was a peace of mind. Important factors for this were detailed written and repeated information about pain, pain treatment and analgesics as well as a good, professional, inclusive and individualized response from the care staff. Deficiencies in these areas led to worrying and fear of the unknown, which made the pain experience more difficult. Patients rarely experienced adequate pain relief.

Bakgrund: Överrapportering är en kommunikativ process där patientansvaret skiftar från givare till mottagare. Överrapportering uppfattas påverka patientsäkerhet och vårdkvalitet. Syfte: Syftet var att beskriva sjuksköterskors upplevelse av överrapportering från anestesisjuksköterskor i samband med patientöverföring från operationsavdelningen till den postoperativa avdelningen. Metod: En semistrukturerad intervjustudie (n=13) analyserades med hjälp av kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Sjuksköterskornas upplevelser av överrapportering från anestesisjuksköterskor i samband med patientförflyttning från operationsavdelning till postoperativ avdelning genomsyrades av interaktion och rädsla för att missa saker. Förberedelser påverkar upplevelsen av rapporten. Sjuksköterskorna tillägnade sig information, vilket orsakade effekter. Slutsats: Sjuksköterskorna upplevelser av överrapportering genomsyrades av en medvetenhet om patientsäkerhet. / Background: The responsibility of the patient shifts from a sender to a receiver during handover, through a communicative process. Handover is perceived as crucial to patient safety and quality of care.  Objective: The aim of the study was to describe nurses’ perceptions of nurse anesthetists' handover when patients were transferred from the operating room to the postanesthesia unit.  Method: Semi-structured interviews (n=13) were analyzed using qualitative content analysis according to Graneheim and Lundman (2004).  Result: The postanestesia unit nurses’ experiences of handover from nurse anesthetists was influenced by interaction and fear of missing information. Preparation featured the impression of handover. The participants acquired information, which in turn caused effects.  Conclusion: The postanesthesia unit nurses’ experiences of handover was influenced by awareness of patient safety.