Osteopathic intervention for chronic pain, remaining thoracic stiffness and breathing impairment after thoracoabdominal oesophagus resection: A single subject design study

AbstractBackgroundThoracic surgery can cause negative effects such as chronic pain, impaired thorax movement and/or impaired breathing. There are indications that manual therapies, such as osteopathy, may be beneficial for these conditions.ObjectiveTo investigate effects of osteopathic intervention on chronic pain and remaining limitations to thoracic range of motion and breathing in patients who had undergone thoracoabdominal resection of the oesophagus.DesignIn a single-subject research design (Aa-B-Ab), 8 participants with chronic postoperative thoracic pain, stiffness and/or breathing impairment after standardized oesophagus resection were given 10 sessions of osteopathic treatment of 45 min. Expiratory vital capacity, thorax mobility, pain experience, and subjective perception of treatment were measured on three occasions during each phase. The two-standard deviation band method was used to indicate significant change.ResultsA significantly increased range of motion in the thorax was observed in thoracic excursion and in lateral flexion. A positive change in pain was also noted. The results in expiratory vital capacity were contradictory. The participants were generally positive toward the treatment given.ConclusionOsteopathic intervention may affect thoracic impairment and pain among people with chronic pain and impaired thoracic range of motion after thoracoabdominal resection of the oesophagus

Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals

<p>Abstract</p> <p>Background</p> <p>Previous studies show an increased interest and usage of complementary and alternative medicine (CAM) in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals.</p> <p>Method</p> <p>A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included.</p> <p>Result</p> <p>A total of 737 (42.0%) questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in such research. Half of the participants (55.8%) were positive to learning such therapy. Communication about CAM between patients and the health care professions was found to be rare.</p> <p>Conclusion</p> <p>There is a lack of knowledge about CAM and research about it among registered health care professions in Swedish surgical care. However, in contrast to previous studies the results revealed that the majority perceived it as important to gain knowledge in this field.</p

ICU-nurses need of patient follow-up

Bakgrund Uppföljning av utskrivna patienter inom intensivvård har utvecklats under de senaste decennierna, där fokus varit patienternas återhämtning och upplevelse av intensivvårdstiden. Huruvida sjukvårdspersonal har behov av uppföljning har varit oklart. Därför var syftet med denna studie att undersöka intensivvårdssjuksköterskors behov av uppföljning av utskrivna patienter och behovets relation till känsla av sammanhang (KASAM).   Metod En tvådelad enkät, med fokus på behov av uppföljning och KASAM, delades ut till intensivvårdssjuksköterskor vid sex intensivvårdsavdelningar i Västra Götaland under våren 2011.   Resultat Av 216 distribuerade enkäter returnerades 143 (66,2 %). Drygt 80 % av intensivvårdssjuksköterskorna skattade sig ha ett behov. Det fanns ingen skillnad i personliga faktorer (ålder, kön, erfarenhet, KASAM) mellan de med behovet och de utan. Vanligaste sätten att följa upp på var att besöka patienten, kontakta patientens sjuksköterska och att läsa i patientens journal. De vanligaste orsaker till behovet av uppföljning var feedback på utförda åtgärder samt av empati för patienten. Knappt 12 % såg nackdelar med att följa upp, medan drygt 67 % såg nackdelar med att inte följa upp.   Konklusion Intensivvårdssjuksköterskor har ett behov av att följa upp utskrivna patienter. Detta behov kan vara knutet till sjuksköterskans profession, snarare än till sjuksköterskans personliga egenskaper. Orsaken till behovet kan ses som två huvudsyften; verksamhetens lärande och patientens förståelse.Background Follow-up on discharged patients in intensive care has emerged in the last decades. Focus has been patient recovery and experiences from the intensive care units (ICU). It is however unknown whether health care workers have a need of follow-up on discharged patients. Hence, the aim of this study was to survey ICU-nurses need of follow-up on discharged patients and the correlation to sense of coherence (SOC).   Method A two-parted questionnaire, with focus on the need of follow-up and SOC, was distributed to ICU-nurses at six ICU’s in the west ofSwedenin 2011.   Result A total of 216 questionnaires were distributed, and 143 was returned (66.2%). Approximately 80% of the ICU-nurses indicated that they had a need of following up on discharged patients. No personal attribute (age, gender, working experience, SOC) differed between those with a need and those without a need. The most common way of practically follow-up on patients was by visiting the patient, contacting the patient’s nurse, and by reading the patient’s electronical journal. The general reason for the need of follow-up was to gain feedback on the preformed interventions (nursing and medical), and by empathy for the patient. Almost 12% of the ICU-nurses emphasized disadvantages by following-up on discharged patients. But just over 67% experienced disadvantages with not performing follow-up on discharged patients.   Conclusion There is a need among ICU-nurse to follow-up discharged patients. This need could be connected to the nursing profession, rather than the nurses’ personal attributes. The reason of the need of follow-up could be interpreted as two main objectives; Organizational learning and Patient understanding

Komplementära och alternativa terapier i kirurgisk vård

International and national use of complementary and alternative medicine (CAM) is high in the general population and among patients. The level of knowledge about CAM among health care professions is low, but an interest in receiving education about this field has been observed. Concerning surgical care, previous studies indicate a wide range of CAM use among patients, but the level of knowledge among health care professions is poorly investigated, both internationally and in Sweden. Concerning CAM therapies in the management of signs and symptoms in surgical care, transcutaneous electric nerve stimulation (TENS) was used with a variety of effectiveness and osteopathic medicine was found to be poorly investigated in this context. The overall objective of this thesis was to investigate CAM in the surgical context with a focus on health care professions’ perceptions and understanding and the usefulness of therapy in symptom management in clinical settings. Both inductive (paper I; semi structured interviews, n=16) and deductive (paper II; questionnaire, n=737) methods were used to investigate perceptions and understanding of CAM among Swedish health care professions in surgical care. TENS as a pain relieving complement during the transition from epidural analgesia (EDA) to general analgesia after major abdominal surgery was investigated in a randomized controlled trial design (paper III; n=20). Osteopathic intervention in management of chronic signs and symptoms after thoracotomy was investigated with a single-subject research design (paper IV; n=8). The results reveal that surgical health care professions understand and perceive CAM as a wide range of therapies, remedies and systems. Their self valued level of knowledge was low, both concerning CAM and CAM research, but a desire was found to gain knowledge about CAM. A majority of the participants would consider learning a CAM therapy. Dialog about and referral to CAM occurred, but to a limited extent. Concerning therapy usability, TENS was not found to significantly relieve pain, promote recovery or reduce consumption of analgesics. In addition, comments from nurses and patients indicated that TENS treatment obstructed postoperative care. A significant improvement was observed in the osteopathic intervention in stiffness and benefits for pain, but not in breathing. The comprehensive conclusion of the thesis is that Swedish health care professions recognise the concept of CAM and some of its therapies, but their knowledge is in general low. Concerning therapy usability and the effectiveness of CAM in surgical care, the context is essential; TENS after major abdominal surgery in EDA elimination is questionable as concerns pain and its clinical application, while osteopathy may be beneficial in the management of chronic signs and symptoms after thoracotomy

Diversities in perceived knowledge and practice of preoperative skin preparation in Swedish orthopaedic surgery

Preoperative skin preparations may reduce the risk of hospital-acquired infections. This cross sectional questionnaire study aimed to identify the practice and knowledge of preoperative skin preparation in Swedish orthopaedic surgery departments. One hundred and six respondents (response rate 68%) from 13 Swedish orthopaedic departments reported a diversity of current recommendations and evidence, and good knowledge of skin preparations. This study found variations in practice and deviations from recommendations, despite high levels of knowledge

Undergraduate physical therapy students´ experiences of supervision during bachelor thesis course

Studies evaluating scientific supervision at the undergraduate level are few and heterogeneous. The aim of this study was to further explore undergraduate students´ experiences of and thoughts about scientific supervision. The sample of informants consisted of 13 physical therapy students from two Swedish universities. Data collection was done using semi-structured interviews covering the areas of supervision and collaboration. Data analysis was performed according to qualitative content analysis. Three theme emerged from the interviews- the role of the supervisor, the student's perception of uncertainty and structure of the supervision. Physical therapy students´ experience of their supervision was dependent on the supervisors’ attributes, both favourable and unfavourable, difficulties with communication, being disregarded and affected by the supervisors’ personal views. This was also put in the context of the current form of supervision, as individual and group supervision brought both positive and negative factors to the experience of the process

Nurse job satisfaction at a surgical ward – a comparative study between Sweden and Poland

Background Job satisfaction is a major issue in work psychology among nurses, and in the surgical nursing context, important factors leading to the perception of job satisfaction have been suggested. Two European Union neighboring countries (Sweden and Poland) were chosen for the purpose of this study due to similar nursing education but different health care systems, employment regulations and salaries. Recognition of the factors which are related to nurse job satisfaction may lead to improvements in the nurses’ working conditions. The aim of this study was to explore and compare job satisfaction and various factors among Polish and Swedish nurses in a surgical ward context. Material and Methods The study had a cross-sectional survey design, with questionnaires among Polish and Swedish nurses in surgical care, and was conducted between April and December 2014. The main assessment tool was a Job Satisfaction Survey questionnaire. In total, 408 nurses returned the questionnaire (response rate – 59%). Results Swedish nurses rated job satisfaction significantly higher than Polish nurses. The possibilities for professional development at the current workplace correlated with job satisfaction in both groups. Higher values of exhaustion due to nurses’ working duties were correlated with general job satisfaction. Conclusions Swedish and Polish nurses showed ambivalence towards job satisfaction. Their job satisfaction increased when their exhaustion level was higher. The possibilities for achievements, developing professional skills, and promotion may be important factors affecting job satisfaction. Med Pr. 2019;70(2):155–6

Safety climate and readiness for implementation of evidence and person centered practice - A national study of registered nurses in general surgical care at Swedish university hospitals.

BACKGROUND: The rationale behind this study is the increasing research on relationships between patient safety, evidence based practice and person centered care, and the growing interest in outcomes of surgical patients. The aim of this study was to explore the safety climate and readiness to implement evidence-based and person centered care as perceived by registered nurses in Swedish surgical care. METHODS: The design was an exploratory, cross-sectional survey carried out in a national Swedish context. Data were collected through the Safety Attitudes Questionnaire (SAQ - Short form) and the Context Assessment Index (CAI). RESULTS: In total, 1570 questionnaires were distributed, of which 727 were returned, giving a response rate of 46.3 %. The results revealed that in general, the safety climate in Swedish surgical care is positively related to readiness for evidence-based and person centered care, although specific management and cultural factors may be more sensitive and represent targets for improvement. CONCLUSION: This study presents new knowledge regarding the safety climate and readiness to implement evidence based practice and person centered care in general surgical wards in university hospitals and indicates important associations between these two areas. While RNs generally reported positive job satisfaction and a good team work culture in their units, there were indications that improvements in organizational management are needed

Patients' perceptions of the meaning of good care in surgical care : a grounded theory study.

BACKGROUND: Patients in surgical care have reported a fear of being discharged prior to sufficient recovery and a lack of control of their situation. Establishing the patient-nurse relationship is essential in the context of the care. The Swedish National Board of Health and Welfare has established indicators for good care for comparison, evaluation and improvement of the quality of the health care system. These indicators are knowledge-based, appropriate, safe, effective and equal health care, as well as care within a reasonable time and patient-centred care. Current core competence in nursing education include quality improvement, patient-centred care, teamwork and collaboration, using evidence-based practice, safety and informatics. This study investigates patients' perceptions of the meaning of good care in inpatient surgical care. METHODS: Grounded theory according to Charmaz was chosen as the study design. Interviews were conducted with 13 patients from six surgical wards in the south of Sweden in 2014-2015. RESULTS: The results showed that patients in surgical care perceived good care as being safe, as they were vulnerable and anxious. This could be achieved through accessible care, reliable care, caring attitudes and participating in one's own care. Patient participation was achieved by information and education and the possibility to affect their care. CONCLUSION: Patients need safety to experience good care. Caring attitudes and patient participation can be attained through patient-centred care. Bedside handover can improve patients' perceptions of accessible care and reliable care and can increase patient participation. Continuously maintaining competence and using evidence-based practice are needed to achieve reliable care

Health Is Belonging : Lived Experiences during Recovery after Pancreaticoduodenectomy.

The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants' view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities