Hvordan kan sykepleieren fremme pasientmedvirkning i postoperativ smertebehandling?

Bakgrunn: Konseptet Joint Care, et akselerert behandlingsforløp ved hofte- og kneprotesekirurgi, ble for få år siden implementert ved enkelte norske helseforetak. Akselererte pasientforløp inkluderer behandlingsmetoder hvor preoperativ informasjon, teamarbeid, pasientdeltakelse og effektiv smertelindring skal bidra til at pasienten raskt gjenvinner normale funksjoner etter kirurgi. Tidligere studier viser en medisinsk og kostnadsbesparende nytte av denne behandlingsformen, men samhandlingen mellom sykepleiere og pasienter i den postoperative perioden har ikke vært beskrevet. Hensikt: Hensikten med denne studien er å kartlegge hvordan sykepleierne samhandler med pasientene om den postoperative smertebehandlingen ved Joint Care. Metode: Studien har et kvalitativ beskrivende design med semistrukturerte dybdeintervjuer. Fem sykepleiere fra ortopedisk sengepost ved et av landets helseforetak deltok i studien. Det ble gjort en kvalitativ innholdsanalyse av datamaterialet. Resultater: Studien viser at pasientene er tidlig mobilisert etter hofteog kneprotesekirurgi, men at mange rapporterer sterke smerter ved mobilisering andre postoperative dag. Eldre pasienter viser ofte en passiv kommunikasjonsform i smerterapporteringen. Sykepleierne er usikre på om pasientene har tilstrekkelig kunnskap om bruk av «numeric rating scale» som smertekartleggingsverktøy. Konklusjon: Ved implementering av akselererte pasientforløp kreves det ikke bare omorganisering av prosedyrer og rutiner. Det bør også legges vekt på at kunnskap og holdninger knyttet til smertebehandling hos helsepersonell og pasienter får anledning til å endres, slik at optimal smertebehandling blir muli

Interference of Postoperative Pain on Women's daily Life after Early Discharge from Cardiac Surgery

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory–Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important

Hip and knee arthroplasty - patient's experiences of pain and rehabilitation after discharge from hospital

Background Fast-track clinical pathways for hip and knee arthroplasty is being implemented in several western countries. The treatment entails patient involvement, optimal pain management, intensive mobilization and early discharge. Limited research has been carried out on patient's experiences after discharge. Purpose The purpose of the study is to describe how patients experience pain and manage the rehabilitation process the first six weeks after discharge. Method The study followed a qualitative descriptive design. Semi-structured interviews were conducted with 12 participants three months after discharge from hip or knee arthroplasty. Findings Patients experienced varying degrees of pain the first three to five weeks after discharge. Walking-training and sleep were affected by pain or stiffness in joints and muscles, and several needed help from family members to perform activities of daily living (ADL). Several participants would have like more individualized information about pain and exercises before discharge. Some experienced that the municipal care services failed to follow up on issues related to pain. Conclusion The study illuminates that patients may need more individualized and adapted information prior to discharge, as well as more multidisciplinary follow-up by doctors, physiotherapists and possibly home care nurses. We recommend more studies examining how patients experience pain and rehabilitation during the first weeks after completing arthroplasty

Pasientens medvirkning i postoperativ smertebehandling ved hofte-og kneprotesekirurgi

Bakgrunn: Akselererte pasientforløp ved hofte- og kneprotesekirurgi er implementert ved flere norske hel - seforetak. Dette innebærer tilpasset preoperativ informasjon, multimodal smertelindring, minimal bruk av inva - sive teknikker, rask mobilisering og et kortvarig sykehusopphold. Behand - lingen forutsetter et tett tverrfaglig samarbeid og aktiv pasientdeltakelse. Tidligere studier viser gode medisin - ske og kostnadsbesparende resul - tater, men det er gjort få kvalitative studier av pasientenes erfaringer. Hensikt: Hensikten med studien var å beskrive hvordan pasienter erfa - rer å medvirke i den postoperative smertebehandlingen ved hofte- og kneprotesekirurgi. Metode: Studien fulgte et kvalitativ beskrivende design. Ti semistruk - turerte intervjuer ble foretatt tredje postoperative dag av pasienter som hadde gjennomgått hofte- eller kne - protesekirurgi. Det ble videre gjort en kvalitativ innholdsanalyse av datama - terialet. Resultater: Studien viste at flere av deltakerne ikke var optimalt smer - telindret under mobilisering, men at de fleste likevel gjennomførte opp - treningsprogrammet. Deltakerne beskrev ulike oppfatninger og hand - lingsmønstre innenfor egen smerte - rapportering, samt uklare rutiner for bruk av smertekartleggingsverktøy. Konklusjon: Studien belyser aktuelle utfordringer knyttet til akselererte pasientforløp, der det forventes en aktiv deltakelse i postoperativ mobi - lisering og smerterapportering. Siden flere av pasientene erfarte smerter ved mobilisering, anbefales videre kvalitative og kvantitative studier som kartlegger pasientens erfaringer med smerte- og smerterapportering både under og etter sykehusoppholdet

Sykepleielærere sine holdninger og kunnskapsbehov i kunnskapsbasert praksis

Nursing educators’ attitudes and needs for knowledge in evidence-based practice It is required that faculty in nursing education prepares students to work evidence-based (EBP). The purposes of this study are to identify teachers’ beliefs towards EBP and to describe what the faculty identify as their specific learning needs to teach EBP. Data were collected from teachers at a University College in Norway by use of questionnaires and focus group interviews. Descriptive statistics were used to analyze the questionnaires and thematic content analysis for the focus group interviews. The teachers have positive beliefs towards EBP and their central learning needs were searching the literature, critical appraisal and application. They have knowledge in basic methodology, but need more knowledge of epidemiological and summarized research. Teaching and training in all six stages of EBP is important for teachers to develop their knowledge of EBP. Qualitative and quantitative methods in combination, works well to identify teachers’ specific needs for new knowledge

Nursing students’ application of knowledge about pain assessment in surgical practice

Background: The International Association for the Study of Pain (IASP) has developed specific learning objectives for bachelor nursing students’ pain curriculum. Earlier studies emphasise the importance of strengthening knowledge of pain management in nursing programs. Nevertheless, there is little research exploring how nursing students develop and achieve their learning outcomes related to the topic of pain. Aim: The aim of the study was to explore how surgical practice students apply their knowledge about pain assessment, and what might affect their learning outcomes. Methods: The study followed a qualitative research methodology with a descriptive design. Data were collected from two different modules and student groups in the bachelor program. Part 1: Document analysis of theoretical exam answers (N=12). Part 2: Two group interviews was conducted where students in surgical practice participated (N=6). A qualitative content analysis was carried out resulting in descriptive subtopics and findings. Findings: The findings illustrate that participants in surgical practice utilised much of the knowledge described in the exam answers. However, their specific application of knowledge could be limited by the supervision situation and unclear routines in the clinic. Conclusion: The study illuminates the importance of further research both within theoretical and clinical studies to improve student‘s knowledge in pain management

Sykepleielærere sine holdninger og kunnskapsbehov i kunnskapsbasert praksis

Nursing educators’ attitudes and needs for knowledge in evidence-based practice It is required that faculty in nursing education prepares students to work evidence-based (EBP). The purposes of this study are to identify teachers’ beliefs towards EBP and to describe what the faculty identify as their specific learning needs to teach EBP. Data were collected from teachers at a University College in Norway by use of questionnaires and focus group interviews. Descriptive statistics were used to analyze the questionnaires and thematic content analysis for the focus group interviews. The teachers have positive beliefs towards EBP and their central learning needs were searching the literature, critical appraisal and application. They have knowledge in basic methodology, but need more knowledge of epidemiological and summarized research. Teaching and training in all six stages of EBP is important for teachers to develop their knowledge of EBP. Qualitative and quantitative methods in combination, works well to identify teachers’ specific needs for new knowledge

Hvordan kan sykepleieren fremme pasientmedvirkning i postoperativ smertebehandling?

Bakgrunn: Konseptet Joint Care, et akselerert behandlingsforløp ved hofte- og kneprotesekirurgi, ble for få år siden implementert ved enkelte norske helseforetak. Akselererte pasientforløp inkluderer behandlingsmetoder hvor preoperativ informasjon, teamarbeid, pasientdeltakelse og effektiv smertelindring skal bidra til at pasienten raskt gjenvinner normale funksjoner etter kirurgi. Tidligere studier viser en medisinsk og kostnadsbesparende nytte av denne behandlingsformen, men samhandlingen mellom sykepleiere og pasienter i den postoperative perioden har ikke vært beskrevet. Hensikt: Hensikten med denne studien er å kartlegge hvordan sykepleierne samhandler med pasientene om den postoperative smertebehandlingen ved Joint Care. Metode: Studien har et kvalitativ beskrivende design med semistrukturerte dybdeintervjuer. Fem sykepleiere fra ortopedisk sengepost ved et av landets helseforetak deltok i studien. Det ble gjort en kvalitativ innholdsanalyse av datamaterialet. Resultater: Studien viser at pasientene er tidlig mobilisert etter hofteog kneprotesekirurgi, men at mange rapporterer sterke smerter ved mobilisering andre postoperative dag. Eldre pasienter viser ofte en passiv kommunikasjonsform i smerterapporteringen. Sykepleierne er usikre på om pasientene har tilstrekkelig kunnskap om bruk av «numeric rating scale» som smertekartleggingsverktøy. Konklusjon: Ved implementering av akselererte pasientforløp kreves det ikke bare omorganisering av prosedyrer og rutiner. Det bør også legges vekt på at kunnskap og holdninger knyttet til smertebehandling hos helsepersonell og pasienter får anledning til å endres, slik at optimal smertebehandling blir muli

‘I need support in becoming the leader I would like to be’ – A qualitative descriptive study of nurses newly appointed to positions of leadership

Abstract Aim The aim of the study was to understand the experiences of nurses who were newly appointed to a position of leadership including facilitators and barriers to success and what they considered important for the development of their role. Methods We used a qualitative descriptive research design. The study was conducted in Norway with 10 nurses who had been appointed to a leadership position within the last 2 years. Participants were interviewed with individual qualitative interviews which were transcribed and subsequently analysed using thematic analysis. Results The following four main themes were identified from the data: I feel lonely in the leadership position, I am not confident as a leader, I am unsure of the requirements and expectations of me, and I need support and supervision. Conclusion The results underscore the challenges reported by new leaders in nursing and their advocacy for mentorship as a facilitator for success. The qualifications of mentors were emphasised with a need for a comprehensive leadership skill set to address the multifaceted aspects of leadership development