The operating theatre nurses' caring and competence within perioperative nursing :

The overall aim was to describe and deepen the understanding of what operating theatre nurses experience as caring and responsibility as well as ethical problems in perioperative practice. The aim was also to investigate how operating theatre nurses perceive clinical competence in perioperative nursing. Methods: This research has a hermeneutic design. Qualitative, quantitative and mixed method was used. In the study (I), data were collected through interviews and analysed with phenomenographic method. In studies (II-III) the interview texts from the study (I) was reused. Secondary analysis were performed with hermeneutic text interpretation. In the study (IV), data were collected through a modified questionnaire PROFFSNurse SAS I, which was supplemented with an open question. These data were analysed using statistics and qualitative conventional content analysis. Results: Operating theatre nurses have the will to meet the patient, be involved and created continuity in the perioperative nursing process (I). Operating theatre nurses experience that they have a formal responsibility to ensure that patients are not at risk and maintain patient integrity and dignity based on personal ethical values (II). Ethical problems and value conflicts can occur if routines and habits prevent operating theatre nurses from caring and when their clinical competence are not utilized in perioperative practice (III). The operating theatre nurses’ self-assessment of clinical competence showed that academic degree, professional experience and interprofessional learning were important for the development of clinical competence. On the other hand, existing routines and habits, as well as inadequate resources, were an obstacle (IV). Conclusion: Perioperative nursing care includes a nursing process and the operating theatre nurses have responsibility based on ethical values. When the operating theatre nurses are prevented from being a caregiver or that their clinical competence is not utilized, stress of conscience can be caused. Important for the development of clinical competence is an academic degree, professional experience and interprofessional learning.Operationssjuksköterskans vårdande omfattar patientens pre-, intra- och postoperativ vård. Det perioperativa vårdarbetet ställer krav på att kunna integrera vårdandet med medicinsk teknik för att skapa en god och säker vård i en högteknologisk miljö.  Genom att ge tid och möjlighet för operationssjuksköterskorna att möta patienter före, under och efter operationen kan deras vårdande bli till för patienten som skall genomgå en operation. Det finns en vilja att vara delaktiga och skapa kontinuitet i den perioperativa vårdprocessen. I det perioperativa vårdarbete tar de ansvar för att skydda patienten i en utsatt och sårbar situation och utifrån inre personliga etiska värderingar upprätthålls integritet och värdighet. Etiska problem uppstår i det perioperativa vårdarbete när vården styrs av rutiner och vanor som kan skapa värdekonflikter vilket hindrar operationssjuksköterskorna från att vara vårdande. När operationssköterskorna självskattat sin kompetens framkom att akademisk examen och lång yrkeserfarenhet är av betydelse för att kunna hantera komplexa situationer och ta ansvar för de beslut som fattas i vårdandet av patienten.  Vetenskaplig kunskap, medicinsk teknik, omvårdnad/vårdande och interprofessionellt utveckling av lärande är av betydelse för klinisk kompetens. Utifrån denna avhandlings resultat framkom ny fördjupad förståelse för vad operationssjuksköterskorna uppfattar som att vara en professionell vårdande operationssjuksköterska och behov av utveckling av klinisk kompetens.Artikel 4 ingick som manuskript i avhandlingen, nu publicerad.</p

Att vårda patienten inom operationssjukvård : en fenomenografisk studie

Syfte: Det övergripande syftet med avhandlingen var att beskriva uppfattningar av operationssjuksköterskans vårdande inom operationssjukvård och perioperativ vård Metod: En kvalitativ beskrivande design med en fenomenografisk metod valdes i båda studierna (I och II). I studie I samlades data in genom intervjuer med 16 strategiskt utvalda legitimerade sjuksköterskor och studenter i sista terminen av grundutbildningen till sjuksköterska. I studie II samlades data in genom intervjuer med 15 kliniskt verksamma operationssjuksköterskor. Båda studierna analyserades enligt fenomenografisk metod. Resultat: Resultatet av studie I visade att operationssjuksköterskans yrkesfunktion uppfattades som osjälvständig men ändå med ansvar för patientens vård utifrån specifika kunskaper i hygien och operationsmetodik. Omvårdnaden i yrkesfunktionen var otydlig och uppfattades som fragmentarisk eftersom operationssjuksköterskor enbart var delaktiga i en del av patientens vårdprocess och hade få möjligheter att skapa en vårdrelation med patienten. Resultatet i studie II visade att operationssjuksköterskor ville följa patienten hela vägen. Det innebar att lära känna patienten både före och efter operationen och därigenom bli ansvariga för att säkerställa patientens kontinuitet och säkerhet i vården. Genom att hålla ett vakande öga skyddade de patientens kropp och bevarade patientens värdighet. Konklusioner: Operationssjuksköterskans yrkesfunktion ansågs som fragmenterad och uppfattades vara medicinskt och tekniskt inriktad. Det framkom att vårdandet inom operationssjukvård och perioperativ vård var otydlig. Det fanns en vilja att bli mer delaktig i patientens vård och att vårdandet blev tydligare för andra yrkeskategorier inom vård

Operating theatre nurses' with managerial responsibility : Self-reported clinical competence and need of competence development in perioperative nursing

AIM: The aim of this study was to investigate operating theatre nurses (OTNs) with managerial responsibility, and their self-rated clinical competence and need for competence development in perioperative nursing. DESIGN: A cross-sectional study was applied using a modified version of Professional Nurse Self-Assessment Scale of Clinical Core Competence I. METHOD: Data were collected from 303 OTNs in Sweden, 80 of whom indicated that they had managerial responsibility. Statistics analysis was used to identify the relationships between background variables to compare OTNs with and without managerial responsibility and their need for competence development. RESULTS: OTNs with an academic degree and managerial responsibility self-rated their clinical competence higher compared with OTNs without an academic degree. It also turned out that OTNs with RN education and 1-year advanced nursing in theatre care, and master's 60 credits had a lower need for competence development in cooperation and consultation, professional development and critical thinking

Student nurses' experiences of undignified caring in perioperative practice - Part II

Background: In recent years, operating theatre nurse students’ education focused on ethics, basic values and protecting and promoting the patients’ dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient’s care during surgery. Objective: The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice. Research design: The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan’s critical incident technique. Participants and research context: Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. Ethical considerations: The study was approved by the Karlstad University’s Research Ethics Committee. Findings: The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient’s worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient’s body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient’s dignity in perioperative practice. Discussion: In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. Conclusion: The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed