Background: In the post-operative phase, the patient's ability to communicate is impaired. The postoperative patient is therefore in great need of that the information given is being individually adapted. Objectives: The aim of this study was to investigate communicative barriers and facilitating factors between the nurse and the patient in postoperative care and to describe areas of improvement. Methods: Literature study consisting of 12 qualitative scientific original articles focusing on communication between the nurse and the patient in postoperative care and the patient's communicative needs and the nurse's approach to this. Findings: The literature study showed that barriers like stressful working conditions led to short or no communication between the nurse and the patient, and that the postoperative care time thereby was prolonged. Different language, dialects, gender, cultural beliefs and socio-economic backgrounds meant that the information from the nurses was not perceived - or interpreted correctly - and that the time spent developing the message increased the workload. Patients who took an interest in their treatment and asked questions, acted as a positive facilitator. In by doing this, the patients increased the likelihood of being helped and communicated with by the nurses. Conclusion: The result of the literature study shows that an established clear communicative interaction between the nurse and the patient, with individualized care, could be perceived by the patient as just as important and desirable as a quick recovery from illness. / Bakgrund: I det postoperativa skedet är patientens förmåga att kommunicera nedsatt. Den postoperativa patienten är därför i stort behov av att informationen som ges är individanpassad. Syfte: Syftet var att undersöka kommunikativa barriärer och underlättande faktorer mellan sjuksköterskan och patienten i postoperativ vård samt beskriva förbättringsområden. Metod: Litteraturstudie bestående av 12 stycken kvalitativa vetenskapliga originalartiklar med fokus på kommunikation mellan sjuksköterskan och patienten i postoperativ vård samt patientens kommunikativa behov och sjuksköterskans förhållningssätt till detta. Resultat: Litteraturstudien visade på att barriärer likt stressiga arbetsförhållanden ledde till kort eller ingen kommunikation mellan sjuksköterskan och patienten samt att den postoperativa vårdtiden därigenom blev förlängd. Olika modersmål, dialekt, kön, kulturell övertygelse och socioekonomisk bakgrund gjorde att informationen från sjuksköterskorna ej uppfattades- eller tolkades korrekt samt att tiden lagd på att få fram budskapet ökade arbetsbördan. Vad som agerade underlättande var patienter som själva var framåt och frågade om sin behandling. Detta resulterade i att dessa patienter fick hjälp samt ökade sannolikheten för kommunikation med sjuksköterskorna. Slutsats: Resultatet av litteraturstudien visade att ett etablerat tydligt kommunikativt samspel mellan sjuksköterskan och patienten, med individanpassad vård, kunde av patienten upplevas som lika viktigt och önskvärt som ett snabbt tillfrisknande från sjukdom.

[Truncated abstract] Cardiac surgery involving cardiopulmonary bypass is a complex procedure that results in significant changes to blood coagulation, fibrinolytic biochemistry, platelet number and function, and the vasculature. These are due to pharmacological agents which are administered, haemodilution and contact of the blood with artificial surfaces. Consequently there are significant risks of thrombosis and haemorrhage associated with this procedure. The research presented in this thesis utilises in vitro, in vivo, and a novel ex vivo model to investigate the nature of the haemostatic defect induced by cardiopulmonary bypass. The components studied include the drugs heparin, protamine sulphate, and aprotinin, different types of bypass circuitry (including heparin bonded circuits) and procedures such as acute normovolaemic haemodilution. Patient variables, such as Factor V Leiden, are also studied. Each of these components is assessed for the effects on a number of laboratory measures of haemostasis including activated partial thromboplastin time, prothrombin time, activated protein C ratio, antithrombin concentration, heparin concentration, thrombin-antithrombin complex formation, prothrombin fragment 1+2 formation, markers of platelet surface activation and secretion, activated clotting time, haemoglobin concentration and coagulation factor assays.

Patients experience some degree of pain accompanying all surgical procedures. If this pain is not adequately treated, it will cause severe physiological and psychological damage. It will even affect patients' postoperative recovery. However, if preemptive analgesia is administered before noxious stimuli arise, rather than afterwards, it is significantly more effective. The purpose of this study is to recognize that reasonable effort and time should be spent to determine a patient's tolerance level towards pain before surgery. Then, the appropriate dosage of analgesia can be given immediately after surgery to alleviate pain. By administering effective pain relief, it will improve patient¡¦s satisfaction with medical services. Using classic experimental design (which consists of an experimental group and a control group), this study focuses on cases of patients who had hemorrhoid surgery in a certain hospital in southern Taiwan. The experimental group and the control group consist of a total of 75 valid samples. The experimental group received customizing analgesic postoperative care, while the control group received conventional analgesic postoperative care. Patient¡¦s satisfaction questionnaires were gathered from patients on the day they were discharged from the hospital. Instruments used in the experiment include VAS, PThM, and patient¡¦s satisfaction questionnaires.To examine the basic characteristics of the samples in both the experimental group and the control group, two statistical methods, Chi-square test and independent T test, were adopted. For patient¡¦s satisfaction questionnaires, Mann-Whitney-Wilcoxon test of nonparametric method was adopted to examine if obvious differences in satisfaction levels existed between the two groups. The result of the experiment shows the analgesic effect from customizing analgesic postoperative care is far better than conventional care. The patient¡¦s satisfaction toward the doctor's professional skill was higher as well. On the other hand, the patient¡¦s satisfaction level toward the whole medical process had no obvious improvement. This study proves that customizing analgesic postoperative care can effectively prevent postoperative pain from occurring. However, to raise patient¡¦s satisfaction towards the whole medical process, better professional medical skill is required as well as improved medical services.

Introduction: Knee osteoarthritis is one of the common causes leading to musculoskeletal disability of the elderly around the world. Total knee replacement (TKR) is an effective and common treatment for end stage knee arthritis. Most papers suggest that early rehabilitation could improve postoperative knee function. However, postoperative pain and local swelling are the complications that diminish range of motion (ROM) and inhibit patients’ recovery. A comprehensive review of the literature reveals that cryotherapy is an effective and safe method to overcome these complications. In this paper, a guideline of using cryotherapy in reducing postoperative pain and knee swelling so as to improve the ROM of patients and promote recovery after TKR has been developed. Objectives: The objectives of this translational research are: (1) to look for relevant papers that related to cryotherapy in reducing postoperative pain and knee swelling so as to improve the ROM of patients after TKR; (2) to gather and criticize the data obtained; (3) to develop a guideline of using cryotherapy in reducing pain, knee swelling and improving ROM of patients after TKR based on the evidence from the reviewed literature; (4) to assess the implementation potential of the newly developed guidelines; and (5) to establish the implementation and evaluation plans for the new innovation. Methods: An empirical literature search published from 2001 to 2011 by several searching engines regarding cryotherapy in reducing postoperative pain and knee swelling with the aim to improve the ROM of patients after TKR has been conducted. After that, the qualities of relevant studies were retrieved and criticized by using the appraisal checklist of the SIGN (2004). The derived evidences were then be summarized and synthesized. An evidence-based guideline was established with reference to the evidence from the reviewed literatures and the results of the quality assessment. Recommendations are graded by SIGN (2004). The implementation potential including transferability, feasibility and cost-benefit ratio of the innovation were assessed as well. Lastly, implementation and evaluation plans have been developed to assess and appraise the effectiveness of the new guideline. Results: Finally, seven studies were chosen as final references after methodological quality assessment. Four main types of comparison were made from these seven reviews including: (1) continuous compressive cryotherapy vs. compressive crepe bandage; (2) comparison in different temperature of cryotherapy; (3) outcome measures; and (4) complications in cryotherapy. After the summary, six main categories of recommendations were synthesized: (1) continuous compression cryotherapy; (2) effective temperature; (3) potential complications; (4) regular assessment; (5) duration; and (6) intermitted ice pack regimen. Based on these syntheses and recommendations, a guideline of using cryotherapy for patients after having TKR was developed. Conclusion: With the implementation of the newly developed evidence-based cryotherapy guidelines for patients after having TKR in local clinical settings, the improvement in the ROM of the knee joint will be anticipated as a result of the reduction in postoperative pain and knee swelling. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Typescript (Photocopy) / Includes two papers co-authored by the author as appendix D. / Bibliography: leaves 397-425 / xvii, 425 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--Dept. of Psychology, University of Adelaide, 1991

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.