The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

This diploma thesis focuses on information awareness among mothers of children hospitalized at surgical intensive care units. Four research questions were formulated on the basis of literature review. The theoretical part of this thesis gives an overview of basic facts concerning information awareness and care of children at surgical ICUs. Furthermore, it describes the way information is passed on in praktice. A part of the theoretical section also comprises of the list enumerating the most common diagnoses with which children found themselves to be placed at surgical ICUs and it contains, as well, the description of admittance of children for a surgical intervention, pre-surgical care, post-surgical care and discharge of children from hospital to homecare. Collection of data for the practical part of the diploma thesis was conducted at two intensive care units in the University Hospital in Motol, Prague, and UH Brno in the CR. Five respondents were intentionally selected from each ICU with whom semi-structured interviews were conducted, which are summarized in sub-chapter 4.2. The results of interviews with individual respondents were further subjected to analysis and summarized in summary tables. The Diploma thesis had two objectives. The first objective was to ascertain subjective information awareness of mothers about their children´s illnesses and possible complications or consequences related to these illnesses. We wanted to find out whether mothers were subjectively satisfied with information provided about thein children´s illnesses and possible complications or consequences related to these illnesses. We also wanted to discover whether they experienced any information deficit in this area and what were their most frequent questions to the medical personnel. It was ascertained through interviews that the majority of respondents was not satisfied with information provided. The second objective was to discover subjective information awareness pertaining to the period of hospitalization at surgical ICU and child´s subsequent homecare. We wanted to know whether mothers felt that they were kept informed enough about pre-surgical and post-surgical care of their child and whether or not they were satisfied with information pertaining to child´s subsequent homecare. We were also interested in whether or not they experienced any deficit of information received and what were their most frequent questions to the medical personnel. It was discovered through an analysis that the majority of respondents was not satisfied with information pertaining to pre-surgical care and complications which might have arised during the surgical intervention. As for information centred on the date of operation and possible duration of hospitalization most respondents were satisfied with it. Furthermore, the majority of respondents were satisfied with information provided about child´s subsequent homecare. We discovered that respondents were not informed satisfactorily by medical personnel about other contacts such as for clubs for parents, stoma clubs and centres of early intervention. It was possible to ascertain from the results that each respondent saw deficits in different areas of information provision as well. In the list of such information deficit areas are information about the character of surgical intervention, the ward rules, and the fact that doctors and nurses do not have enough time. Moreover, the respondents also perceived the deficit in sharing of information among medical personnel. On the basis of final results which point to experience of unsatisfactory information awareness among mothers about pre-surgical care for the child we developed in a written form the Information for parents about pre-surgical and post-surgical care brochure. We also prepared due to the fact that mothers sensed the lack of written information about the ward the Information for parents about the ward brochure.

The overall aim of the thesis was to describe caregivers’ experiences of caring for women with breast cancer on a surgical ward. The study was based on interviews with narrative parts and tape-recorded clinical supervision sessions. The interviews and clinical supervision sessions were transcribed verbatim, and analysed by content analysis. Nurses (n=10) described life for women with breast cancer as either having freedom or not having freedom, with both physical and existential suffering. Dying occurred either naturally in patients’ own home or unnaturally in hospital. The nurses felt that it is possible to alleviate suffering during dying through providing adequate pain relief but also, through listening, providing information and changing the caring atmosphere (I). Breast cancer as an illness was described from a dark point of view by caregivers (n=37). The descriptions focused on loss of breasts and control, progression of the illness and annihilation. The illness seemed, in the caregivers’ mind, to often end with a painful death. Caregivers who had the opportunity to follow the total care process described a lighter viewpoint (II). According to nurses (=31) the most important needs among women, their relatives and nurses themselves were the needs to talk and receive information. There was a discrepancy between what was described as important needs and the descriptions of how these needs were provided for. Nurses, whose own needs for support were sometimes unsatisfactorily met (III), seemed almost to be unaware of the needs among women and their relatives. In the clinical supervision sessions caregivers reflected on difficult care situations related to women’s, relatives’, and most often caregivers’ feelings (n=38). The care situations were described as evoking feelings of discomfort, powerlessness and reduced self-esteem. These feelings were described by caregivers as arising in connection with caring for especially women with advanced breast cancer in a changing organisation (IV). Caregivers’ descriptions of caring for women with breast cancer show a lot of negative experiences of powerlessness and frustration. They met women and their relatives who suffered in various ways and had considerable need for support. Caregivers often found themselves unable to meet these needs due to organisational obstacles e.g. lack of time and lack of knowledge about other caregivers’ responsibility in the care.

Introduction: Balance between the essential nutritive substances is important for a person to maintain health. The surgical patient can be stricken with conditions, which have a negative impact on this balance and can lead to malnutrition. Working as a nurse it is important to identify patients that are malnourished or is in the risk zone of malnourishment since 30 % of all patients in hospitals are malnourished. Aim: The aim of this study was to examine the compliance to the guidelines for nutritional assessment and parenteral nutrition on a surgical ward. Also whether the nutritional treatment/-support was reported to the next caregivers if the patient was malnourished or was in the risk zone of malnourishment at the time of discharge. Method: 80 patients enrolled on the ward in the beginning of year 2011 were included. Audit of patient records was made according to the hospital guidelines for nutrition and parenteral nutrition and followed a study specific protocol. Results: The examination of the case records showed that the guidelines for nutrition were partly complied with. Nutritional treatment/-support was reported to the next caregivers when needed. Compliance to the guidelines for parenteral nutrition was deficient. Conclusion: The guidelines for nutritional assessment and parenteral nutrition are not used adequately. / Introduktion: En stadig balans mellan de livsviktiga näringsämnena krävs för att en person ska kunna hålla sig frisk och för att kroppen ska fungera. Den kirurgiska patienten kan drabbas av tillstånd som har en negativ inverkan på denna balans och kan riskera att drabbas av malnutrition. Det är viktigt att som sjuksköterska identifiera de patienter som är malnutrierade eller är i riskzonen för att drabbas av malnutrition då 30 % av alla patienter som vårdas på sjukhus är malnutrierade. Syfte: Syftet med denna studie var att undersöka om de riktlinjer som finns för nutritionsbedömning och parenteral nutrition följs på en kirurgisk vårdavdelning samt om nutritionsbehandlingen/-stödet rapporteras vidare till nästa vårdform då en malnutrierad patient/riskpatient för malnutrition skrivs ut. Metod: 70 patienter som var inskrivna på den aktuella avdelningen i början av år 2011 inkluderades i studien. En journalgranskning gjordes utifrån ett journalgranskningsprotokoll, där innehållet utgick från de nutritionsriktlinjer som finns för verksamhetsområdet för kirurgi samt riktlinjerna för parenteral nutrition. Resultat: Journalgranskningen visade att de riktlinjer som finns för nutrition följs till viss del. Vad gäller rapportering av nutritionsbehandling/-stöd till nästa vårdgivarform görs detta då det är aktuellt. Följsamheten till riktlinjerna för parenteral nutrition var det som var mest bristfälligt. Slutsats: Riktlinjerna för nutritionsbedömning och parenteral nutrition följs inte i den utsträckning som det borde.

Mobile technologies have the potential to improve patient monitoring, medical decision making and in general the efficiency and quality of health delivery. They also pose new security and privacy challenges. The objectives of this work are to (i) Explore and define security and privacy requirements on the example of a post-surgical care application, and (ii) Develop and test a pilot implementation Post-Surgical Care Studies of surgical out- comes indicate that timely treatment of the most common complications in compliance with established post-surgical regiments greatly improve success rates. The goal of our pilot application is to enable physician to optimally synthesize and apply patient directed best medical practices to prevent post-operative complications in an individualized patient/procedure specific fashion. We propose a framework for a secure protocol to enable doctors to check most common complications for their patient during in-hospital post- surgical care. We also implemented our construction and cryptographic protocols as an iPhone application on the iOS using existing cryptographic services and libraries.

No description available.

Bakgrund: Patienter på kirurgisk vårdavdelning uttrycker ett stort informationsbehov vid utskrivning och upplever att väsentlig information saknas. Enligt patientlagen har patienter rätt till individanpassad information och delaktighet i sin vård. Högt flöde av patienter på kirurgiska vårdavdelningar och förkortade vårdtider kan medföra att patienter behöver klara av många delar av sin egenvård i hemmet efter en operation Syfte: Att undersöka hur patienter som skrivits ut från kirurgisk vårdavdelning upplever att deras informationsbehov har tillgodosetts för att klara av den första tiden i hemmet. Metod: Kvalitativ intervjustudie med ett bekvämlighetsurval. Åtta patienter som vårdats på kirurgisk vårdavdelning inkluderades. Intervjuerna analyserades med systematisk textkondensering. Resultat: Det framkom tre teman som beskriver patienternas upplevelser av hur deras informationsbehov blev tillgodosett. Patienterna beskrev upplevelser av oro och rädsla på grund av bristande information om kroppens återhämtning efter kirurgi. En kunskapsbrist hos patienter efter utskrivning bidrog till upplevelser av osäkerhet kring egenvård. Anpassad information och möjlighet att ställa frågor ansågs vara viktigt. Slutsats: Trots att patienter på kirurgisk vårdavdelning upplever att de får välanpassad och användbar information inför hemgång är det inte tillräckligt för att de ska känna sig trygga i hemmet. Avsaknad av viktig information och kunskap skapade känslor av oro och rädsla. Det är viktigt att utforma utskrivningssamtalet med fokus på patientdelaktighet och patientens individuella behov. Här finns ett område för specialistsjuksköterskan inom kirurgisk vård med sin kompetens att förbättra. / Background: Patients treated in surgical wards require self-care information at discharge. They demand information that suits their needs and express a lack of essential information. Swedish regulation states that patients have the right to get individualized information and to be able to participate in their care. Due to the large volume of patients in surgical wards and shortened length of stay, patients may be required to handle more aspects of self-care at home. Aim: The aim is to understand how surgical patients feel their information needs have been met, in order for them to confidently take care of themselves after discharge. Method: Qualitative interview study with a convenience sample of eight patients treated in surgical wards, analyzed using systematic text condensation. Findings: Three themes emerged which explained how patients felt their information needs were met. Patients describe a sense of anxiety and fear at home due to lack of information concerning recovery after surgery. A lack of knowledge after discharge led to insecurities related to self-care. Adapted information and possibilities to ask questions were perceived as important. Conclusion: Patients treated in surgical wards perceive discharge information as well-adapted and useful. However, it is perceived as not being extensive enough. A lack of essential information, coupled with a lack of knowledge led to feelings of anxiety and fear. With these results in mind, it is important to individualize the information given to patients at discharge, and to improve the patient participation during this process. This is an area that registered nurses, specialized in surgical care, have potential to improve.

SAMMANFATTNING Bakgrund: Tidigare studier visar att patienter upplever att de inte får tillräckligt med information vid utskrivning från kirurgisk vårdavdelning vilket påverkar patientens återhämtning i hemmet. Bristande utskrivningsinformation leder till otrygghet och ger upphov till onödigt lidande. Sjuksköterskan upplever sin roll vid utskrivningen som oklar, och patienterna uttrycker behov av personcentrerad utskrivning.  Syfte: Studiens syfte är att undersöka hur patienter beskriver sin utskrivning från kirurgisk vårdavdelning och sin upplevelse av hur fysiska, psykosociala och relationella omvårdnadsbehov blev tillgodosedda.  Metod: Kvalitativ intervjustudie med deduktiv ansats, med utgångspunkt i ramverket Fundamentals of Care’s andra dimension. Tio patienter som vårdats på kirurgisk vårdavdelning deltog.  Resultat: Informanterna beskrev merparten av sina fysiska, psykosociala och relationella behov som tillgodosedda. De berättade också om upplevelser av icke tillgodosedda behov. Icke tillgodosedda fysiska behov handlade ofta om smärta och trötthet samt osäkerhet kring egenvård. Planerad uppföljning förknippades med trygghet och att träffa fysioterapeut och dietist bidrog till tillgodosedda fysiska behov. Inom de psykosociala behoven framkom ett tillgodosett informationsbehov, trots att mängden information varierade. Skriftlig information uppskattades. Informanterna beskrev personalen som närvarande, engagerade och empatiska, vilket bidrog till tillgodosedda relationella behov. Slutsats: Resultatet av denna studie visar att patienter som skrivs ut från kirurgisk vårdavdelning har i huvudsak fått sina behov tillgodosedda. Det framkom dock också brister i de fysiska, psykosociala och relationella behoven. Tydliga och förbättrade rutiner kring utskrivning behövs. Specialistsjuksköterskan i kirurgisk vård ska leda förbättringsarbete och har ansvar för att vården av patienterna är evidensbaserad och är således lämpad att arbeta fram rutiner kring utskrivning.

Bakgrund: Var sjätte barn föds idag med hjälp av kejsarsnitt i Sverige. Ett urakut kejsarsnitt genomförs när situationen är mycket kritisk och barnet måste ut så fort som möjligt för att rädda barnets eller mammans hälsa och liv. Det finns många risker med kejsarsnitt, men vid ett urakut kejsarsnitt övervägs dess fördelar. Patientsäkerhet såsom sterilitet är operationssjuksköterskans främsta kompetensområde under ett operativt ingrepp. Det höga arbetstempot som förekommer under mycket akuta operationer gör att omständigheter och prioriteringar ändras vilket påverkar rutinerna och patientsäkerheten. Att arbeta under dessa förhållanden påverkar även operationspersonalen. Motiv: Få studier tar upp operationssjuksköterskans perspektiv av ett urakut kejsarsnitt. Operationssjuksköterskans upplevelser, tankar och känslor är viktiga då dessa faktorer kan drabba patientsäkerheten under operation. Kunskap om faktorerna kan hjälpa till att utveckla strategier för att förebygga och hantera komplikationer som dessa kan medföra. Syfte: Syftet med studien är att beskriva operationssjuksköterskans erfarenhet vid urakut kejsarsnitt.   Metod: Semistrukturerade individuella intervjuer genomfördes med operationssjuksköterskor (n=12) som har erfarenhet av urakut kejsarsnitt. Intervjuerna analyserades med kvalitativ innehållsanalys.  Resultat: Majoriteten av de intervjuade operationssjuksköterskorna hade liknande erfarenheter i relation till urakut kejsarsnitt. Fyra kategorier identifierades: tidspress, teamarbete, egen erfarenhet och förbättringsarbete. Kategorierna hade ett gemensamt övergripande tema där livet prioriteras. Konklusion: Studien ger ökad kunskap om operationssjuksköterskans erfarenheter vid ett urakut kejsarsnitt där både svårigheter och möjligheter lyfts. Tid, teamarbete och kompetens identifieras som faktorer som påverkar upplevelsen. Utbildning och postoperativt stöd lyftes som möjliga förbättringar men vidare forskning inom ämnet är nödvändigt för att hitta fungerande strategier. / Background: Every sixth child is born with a caesarean section today in Sweden. An emergency caesarean section is performed as the situation is very critical and the child has to be born as soon as possible to save the child’s or the mother’s health and life. There are many risks with a caesarean section, but in care of an emergency caesarean section, the benefits are greater. During an operation, patient security such as sterility is the operating room nurse’s main area of competence. The high pace of work that occurs during an emergency surgery means that the circumstances and the priorities change, which affect the routines and the patient safety. Working during these conditions also affect the surgical team.  Motive: There are few studies that address the operating room nurse’s perspective of an emergency caesarean section. The operating room nurse’s experiences, thoughts and feelings are important as these factors can affect the patient safety during surgery. This knowledge can help to develop strategies to prevent and manage complications that these can cause. Aim: The aim of this study is to describe the operating room nurse’s experience in emergency caesarean section.  Methods: Semi-structured individual interviews have been conducted with operating room nurses (n=12) with experience in emergency caesarean section. The interviews were analyzed with qualitative content analysis. Result: The majority of the interviewed operating room nurses had similar experiences and opinions in relation to emergency caesarean section.  Four categories were identified: time pressure, teamwork, individual experience and improvements. The categories had a theme in common: life is a priority. Conclusion: The study provides increased knowledge about the operating room nurse’s experiences in an emergency caesarean section where both difficulties and opportunities are highlighted. Time, teamwork and competence are identified as factors that affect the experience. Education and postoperative support were highlighted as possible improvements but futher reseach in the subject is necessary to find useful strategies.