| 1. |
- Hassel, Karin, et al.
(författare)
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Postoperative wound infections after a proctectomy Patient
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 18:11
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61-87 years, median age 71 years) were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: ‘‘Managing postoperative complications,’’ ‘‘Being independent,’’ ‘‘Feeling safe,’’ and ‘‘Accepting the situation.’’ A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery
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| 2. |
- Lindberg, Susan, et al.
(författare)
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Facing an unexpected reality - oscillating between health and suffering 4-6 years after bariatric surgery
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 36:4, s. 1074-1082
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obesity is a significant public health problem that is on the increase worldwide, and treatment with bariatric surgery is becoming more and more common. This type of surgery has proved to be good for weight reduction and for preventing complications, but few studies have investigated patients' long-term experiences of health and suffering.AIM: To explore people's experiences of health after bariatric surgery. What are their thoughts about their life, body and sexuality?METHODS: This study is based on semi-structured interviews with eight women and eight men, 4-6 years after bariatric surgery. The data were analysed using qualitative content analysis and resulted in 5 main themes and 14 subthemes.RESULTS: The new body enabled a healthy life due to better treatment in society, enhanced self-esteem, the pleasure of purchasing clothes and the courage to become more sexually active. At the same time, the body could be experienced as so unfamiliar that their life was dominated by despondency, a lack of freedom and a feeling of being lost, which made them wish to return to their old body.CONCLUSION AND IMPLICATIONS: The participants received extensive information before as well as follow-up conversations up to one year after surgery. Nevertheless, they all experienced that changing from life as an obese person to a radically reduced body often meant a confrontation with an unexpected reality that oscillated between health and suffering. This indicates that preparedness for the life changes that bariatric surgery may entail is inadequate and that moving towards health and suffering takes its own time. Therefore, more time should be allocated to talking about how life is and can become in the long term, which may facilitate a dialogical, person-centred approach to the setbacks and situations each person needs to manage in order to improve her/his health.
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| 3. |
- Wennström, Berith, et al.
(författare)
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Being Caught in a Vicious Circle : An Interview Study of Individuals Suffering From Grade II–IV Hiatal Hernia
- 2023
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Ingår i: Gastroenterology Nursing. - : Wolters Kluwer. - 1042-895X .- 1538-9766. ; 46:6, s. 489-496
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Tidskriftsartikel (refereegranskat)abstract
- Large paraesophageal hernias are related to life-threatening complications that warrant immediate surgery. Whether the long-standing chronic symptoms related to the disease in individuals without hernia incarceration motivate surgical treatment is still a subject for discussion. The aim of this study was to explore how individuals suffering from Grade II–IV hiatal hernia describe their symptoms and health, as well as how the disease affects their life. Semistructured interviews were performed with 22 individuals planning to undergo surgery for a large paraesophageal hernia. The data were analyzed using qualitative content analysis and resulted in one main theme “Being caught in a vicious circle” and six subthemes “Distressing and uncertain times,” “The symptoms have seized control over my health,” “Loss of energy and strength,” “Strategies for managing daily life,” “Loss of social life,” and “Moments of hope despite failing health.” Central to the participants’ descriptions is their commitment to strategies for managing the ever-present and unpredictable symptoms that have seized control over their health. They were trapped in a hopeless and isolated existence, that is, a vicious circle, from which they were unable to escape. Despite the low incidence of volvulus and incarceration, the symptom burden and effect on general health motivate treatment in these individuals.
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| 4. |
- Wennström, Berith, et al.
(författare)
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Bodily and verbal expressions of postoperative symptoms in 3- to 6-year-old boys.
- 2008
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Ingår i: Journal of pediatric nursing. - : Elsevier BV. - 0882-5963 .- 1532-8449. ; 23:1, s. 65-76
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate how small boys between 3 and 6 years of age describe bodily and verbal expressions of postoperative symptoms. The data collection was carried out at a large general hospital in Sweden and included both participant observations and semistructured interviews. The results provided a description of how 3- to 6-year-old boys bodily and verbally express postoperative symptoms. The results also showed that small children have difficulties in distinguishing pain, nausea, and anxiety and that postoperative discomfort was experienced in many different ways.
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| 5. |
- Wennström, Berith, et al.
(författare)
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Child drawings and salivary cortisol in children undergoing preoperative procedures associated with day surgery
- 2013
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 28:6, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPerioperative procedures in children can impair their emotional status negatively with stress and/or anxiety. Cortisol concentrations and drawings could be helpful in gaining information about a child's levels of stress and/or anxiety when attending the hospital for surgery.PurposeThe purpose of this study was to determine the degree of anxiety and stress as well as to explore the association between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children's drawings) as interpreted by the Swedish version of the Child Drawing: Hospital manual.MethodsA total of 93 children scheduled for day surgery were included. Salivary cortisol was sampled preoperatively on the day of surgery at which time the children were also requested to make a drawing of a person at the hospital.ResultsResults showed no association between salivary cortisol concentration and the CD:H score.ConclusionThe drawings and salivary cortisol concentration preoperatively on the day of surgery reflect different components of the conditions of fear, anxiety, or stress emerging in the situation.
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| 6. |
- Wennström, Berith, et al.
(författare)
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Evaluation of the Swedish version of the Child Drawing : Hospital Manual
- 2011
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 67:5, s. 1118-1128
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of psychometric testing of the Swedish version of the Child Drawing: Hospital Manual.Background. Drawings have shown to be useful in assessing emotional status and anxiety in children because they generally speak to us more clearly and openly through their drawings than they are willing or able to verbally.Method. The Child Drawing: Hospital Manual was translated into Swedish according to World Health Organization guidelines (a routine procedure for translation of English instruments) in order to assess anxiety by analysing the drawings of 59 children (5–11 years), of whom nine were girls and 50 boys undergoing day surgery during 2007–2009.Results. Inter-rater reliability (five independent scorers) was high and internal consistency reliability was good (coefficient alpha = 0.77). Parts A and C, as well as the total scale score of the Child Drawing: Hospital Manual, discriminated anxiety significantly between the group of children undergoing day surgery and a comparison group of school children, indicating adequate construct validity.Conclusion. For the Swedish version of the Child Drawing: Hospital Manual, our study demonstrates evidence for adequate construct validity in Parts A and C (and total scale score), high inter-rater reliability and acceptable internal consistency reliability. However, some improvements are needed before the instrument will be a clinically useful assessment of anxiety in children undergoing day surgery.
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| 7. |
- Wennström, Berith
(författare)
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Experiences, symptoms and signs in 3-11 year old children undergoing day surgery within the context of the perioperative dialogue
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgical interventions create real, imagined, or potential fear or anxiety in many children, thus highlighting a need for the health professionals who work with them to increasingly act as facilitators. The overall aim of the present thesis was to gain a deeper understanding of 3-11 year-old children’s perioperative symptoms, signs, experiences and main concerns when attending hospital for day surgery and of how they manage this situation. Paper I explores bodily and verbal expressions of postoperative symptoms using a qualitative and descriptive methodology. Fourteen boys between 3-6 years of age were interviewed and observed. The participant observation method was the primary source of data and the domains and subdomains together showed how bodily and verbal expressions could be intertwined. For boys of this age, distinguishing pain, nausea and distress is diffi cult, and they also have different ways of communicating the ‘correct’ words in clarifying a symptom. For paper II, a grounded theory (GT) study was carried out based on data from 15 boys and 5 girls (aged 6-9 years) scheduled for day surgery. The aim was to explore what it means for children to attend hospital for day surgery. Data were collected using tape-recorded interviews, participant observations and pre- and postoperative drawings. The analysis showed that the main concern for children undergoing day surgery was that they were forced into an unpredictable and distressful situation.They perceived a “breaking away from daily routines” and were “facing an unknown reality”. A conceptual model was generated, including a core category, “enduring infl icted hospital stress”, which explains how the situation was handled. Initially, the children tried to “gain control” over the situation. However, during the perioperative period they experienced a “loss of control” and “cooperated despite fear and pain”. Post-operatively they “breathed a sigh of relief” and tried to “regain normality in life” again. Paper III presents a psychometric test of the Swedish version of the Child Drawing: Hospital Manual (CD:H), which intends to assess hospital anxiety in children. Drawings from 59 children (aged 5-11) undergoing day surgery were analyzed and compared to drawings from 71 school children (aged 5–11) in a comparison group. The results showed that the Swedish version of the CD:H has adequate construct validity (Parts A, C and total scale score), high inter-rater reliability and acceptable internal consistency reliability. In paper IV, the effi cacy of the perioperative dialogue was investigated by analysing salivary cortisol in 5-11 year old children undergoing day surgery. Seventy-nine boys and 14 girls (n=93) scheduled for day surgery were randomly recruited into three groups with different types of perioperative care: Standard perioperative care (control group) (n=31), Standard perioperative care including preoperative information (n=31), and the Perioperative Dialogue (PD) (n=31). Postoperatively, the PD group had signifi cantly lower saliva cortisol concentrations than the other two groups and these levels continuously decreased during the day of surgery. Among the children who received analgesics, the PD group received signifi cantly less morphine related to bodyweight. Irrespective of group, there was a positive correlation between morphine consumption and salivary cortisol concentration. In paper V, associations between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children’s drawings) are investigated. The sample included 93 children (79 boys and 14 girls) scheduled for elective day surgery requiring general anaesthesia. The results showed no signifi cant associations between children’s saliva cortisol concentration (stress) and their drawings (anxiety) in any of the parts of the CD:H or individual items. In conclusion, the studies contribute to a deeper understanding of how 3-11 year-old children undergoing day surgery experience and express their situation, symptoms and physiological stress in the context of the PD. Keywords; anxiety, children, cortisol, day surgery, drawings, nursing, perioperative dialogue, stress, symptoms
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| 8. |
- Wennström, Berith, et al.
(författare)
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Patient experience of health and care when undergoing colorectal surgery within the ERAS program
- 2020
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Ingår i: Perioperative Medicine. - : Springer. - 2047-0525. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSeveral studies show that the enhanced recovery after surgery (ERAS) program reduces complications postoperatively and leads to faster recovery and shorter hospital stays. However, little is known about patients’ self-reported health in an enhanced recovery context. The aim of this study was firstly to describe patient experiences of health within the concept of ERAS after colorectal (CR) surgery during a hospital stay and within 2 weeks of discharge. Secondly, to explore whether the ASA classification/co-morbidity, sex, and surgical method affect the patient’s experience of health.MethodsData were collected through the ERAS-HEALTH questionnaire, including two open-ended questions, and through telephone interviews postoperatively. Qualitative and quantitative analysis was used. Patients undergoing CR surgery (n = 80) were included from October 2016 to June 2018.ResultsThe patients had mainly positive experiences of their hospital stay as well as most of them felt comfortable coming home. However, experienced state of health is affected by factors like surgical method and co-morbidity. Improvements were desired concerning information, food/food intake, pain management, and environment. At home, the patients experienced a lack of information about food/food intake and ostomy care. Decreased appetite and difficulties with micturition were also described. The most troublesome symptom was postoperative fatigue (POF). Analysis of the ERAS-HEALTH questionnaire showed that patients with higher co-morbidity and those who underwent open surgery have a significantly worse experience of their health compared with patients who underwent laparoscopy. However, it seems that the surgical method affects postoperative health to a greater extent than co-morbidity.ConclusionsThe patients reported many positive aspects and challenges when being cared for within the ERAS program. However, several improvements are needed to satisfy patient wishes regarding their care both in hospital and at home. Laparoscopic surgery affects patient state of health positively in several respects compared with open surgery.
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| 9. |
- Wennström, Berith, et al.
(författare)
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Patient symptoms after colonic surgery in the era of enhanced recovery--a long-term follow-up.
- 2010
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 19:5-6, s. 666-672
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The main purpose of this study was to analyse, prospectively, patient symptoms during the first four weeks following elective colon surgery. A secondary aim was to find areas to improve inpatient information and postoperative care. BACKGROUND: Fast-track recovery following colon surgery has been proven beneficial to patients in the early postoperative phase. Less is known about the continuous recovery at home. DESIGN: A prospective follow-up survey. METHODS: Consecutive patients (n = 32) planned for elective colon surgery were evaluated. Both open and laparoscopic operations were included. All followed a fast-track protocol in hospital. Patient symptoms were recorded by validated quality of life questionnaires (EORTC QLQ-C 30, EORTC QLQ-CR 38 and Brief Pain Inventory). An interview was conducted five weeks and one year after surgery. RESULTS: The hospital stay was six days, and 10% of patients were readmitted. The fast-track concept worked well. The main problems after discharge were fatigue, nausea and bowel disturbances. Pain was not a significant issue. Most symptoms had disappeared after four weeks. CONCLUSIONS: The first period at home is troublesome, and better information about common symptoms is needed. A direct telephone line has been set up to answer questions and to lower patient anxiety. RELEVANCE TO CLINICAL PRACTICE: Clinical guidelines for patient's discharge planning can be performed based on the results from this study. Further improvement regarding the epidural anaesthesia is needed to reduce minor side effects.
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| 10. |
- Wennström, Berith, et al.
(författare)
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Rectally administered diclofenac (Voltaren) reduces vomiting compared with opioid (morphine) after strabismus surgery in children.
- 2002
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Ingår i: Acta anaesthesiologica Scandinavica. - 0001-5172. ; 46:4, s. 430-4
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Tidskriftsartikel (refereegranskat)abstract
- Nausea, vomiting and pain are common complications after strabismus surgery in children. Diclofenac, a non-steroid anti-inflammatory drug, is widely used to treat acute and chronic pain but there are few reports of its use given rectally in children undergoing strabismus surgery. This open randomised study was designed to investigate the analgesic and anti-emetic properties of rectally administered diclofenac compared with opioid (morphine) given i.v. in connection with strabismus surgery in children.
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