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1.	Arakelian, Erebouni, et al. (författare) Defining operating room efficiency from the perspective of the staff member and the supervisor 2011 Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 23:3, s. 220-221 Tidskriftsartikel (refereegranskat)
2.	Arakelian, Erebouni, 1973-, et al. (författare) Experiences of the Initial Phase Implementation of the STAMINA-Model in Perioperative Context Addressing Environmental Issues Systematically : A Qualitative Study 2020 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:9 Tidskriftsartikel (refereegranskat)abstract (1) Background: Challenges in perioperative settings put demands on staff working with systematic work environment management. A support model, STAMINA (Structured and Time-effective Approach through Methods for an Inclusive and Active working life), was implemented in a hospital in Sweden, to help staff address environmental issues systematically. The aim was to describe the experiences of the initial phase of implementation of the adapted STAMINA model in perioperative context. (2) Methods: Qualitative individual interviews were held with 14 managers and employees (three men and 11 women). Data were analysed by systematic text condensation. (3) Results: Five themes were identified: Limited knowledge of the model and the implementation process; scepticism, lack of confidence in the model and a passive attitude; the model offered increased participation; the culture in the organization-to understand one's role as employees and managers; and endurance and feedback are key factors for success in the implementation process. (4) Conclusions: Scepticism turned to positive attitude by recognising that the STAMINA model offered increased participation. In order to have successful implementation, the organisational culture must be taken into consideration by giving the employees increased responsibilities and timely feedbacks. Role description, goal definition, feedback, and sticking to one model are key factors for success.
3.	Arakelian, Erebouni, 1973-, et al. (författare) Factors influencing early postoperative recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy 2011 Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 37:10, s. 897-903 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can prolong survival in selected patients with peritoneal carcinomatosis (PC). However, there is little data on patients' recovery process after this complex treatment. This study aimed to describe the in-hospital postoperative recovery and factors related to the recovery of patients who undergo CRS and HIPEC. METHOD: A retrospective audit of the electronic health record (EHR) was undertaken for 76 PC patients (42 women, 34 men) treated primarily with CRS and HIPEC between 2005 and 2006 in Sweden. RESULTS: Oral intake, regaining bowel functions and mobilisation usually occurred between 7 and 11 days postoperatively. Patients experienced nausea for up to 13 days postoperatively. Forty-two patients were satisfied with their pain management, which usually took the form of epidural anaesthesia and which continued for about one week post-surgery. Sleep disturbance was observed in 51 patients and psychological problems in 49 patients during the first three postoperative weeks. Tumour burden, stoma formation, use of CPAP, primary diagnosis, and the length of stay in the ICU were factors related to an early recovery process. CONCLUSION: Drinking, eating, regaining bowel functions and mobilisation were re-established within 11 days of CRS and HIPEC. Tumour burden, stoma formation, use of CPAP, primary diagnosis and the length of stay in the ICU all had an impact on postoperative recovery, and should be discussed with the patients preoperatively and taken into consideration in designing an individualised patient care plan, in order to attain a more efficient recovery.
4.	Arakelian, Erebouni, 1973-, et al. (författare) How Anesthesiologists and Nurse Anesthetists Assess and Handle Patients' Perioperative Worries Without a Validated Instrument 2019 Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1089-9472 .- 1532-8473. ; 34:4, s. 810-819 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To study how nurse anesthetists and anesthesiologists assess and handle patients' perioperative anxiety without using a validated instrument.DESIGN: Qualitative study.METHODS: Individual in-depth face-to-face interviews were conducted with nurse anesthetists (n = 9) and anesthesiologists (n = 5) from a university hospital in Sweden. Data were analyzed with thematic analysis according to Braun and Clark.FINDINGS: Two themes were identified: (1) I ask about anxiety, look for visual signs, and observe communication and (2) I handle patients' anxieties individually. In addition to subthemes describing assessment and handling of adults, it appeared that parents played an important role in children's perioperative anxiety.CONCLUSIONS: When not using a validated instrument, assessing perioperative anxiety is commonly based on the anesthesiologist's and nurse anesthetist's experience, knowledge, views, and attitudes. The evaluator's capability of using different strategies in the assessment and handling of perioperative anxiety is important.
5.	Arakelian, Erebouni, 1973-, et al. (författare) How Human Resources Index, Relational Justice, and Perceived Productivity Change after Reorganization at a Hospital in Sweden That Uses a Structured Support Model for Systematic Work Environment Management 2021 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:21 Tidskriftsartikel (refereegranskat)abstract To facilitate systematic work environment management, which should be a natural part of business development, a structured support model was developed. The Stamina model has previously been used in Swedish municipalities, showing positive results. The aim was to study how the Human Resources Index (HRI), relational justice, short-term recovery and perceived productivity changed in a recently reorganised perioperative setting in a hospital in Sweden that uses a structured support model for systematic work environment management. A longitudinal design that took measurements at four time points was used in a sample of 500 employees in a perioperative hospital department. The results for the overall sample indicated a positive trend in the HRI (Mt1 = 48.5, SDt1 = 22.5; Mt3 = 56.7, SDt1 = 21.2; p < 0.001). Perceived health-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 3; p < 0.001) and perceived work environment-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 4; p < 0.001) showed major improvements. Short-term recovery showed a minor improvement (Mt1 = 2.61, SDt1 = 1.33; Mt3 = 2.65, SDt3 = 1.22; p = 0.872). In conclusion, the implementation of the Stamina model, of which the HRI constitutes an important part, seems to be a helpful tool to follow-up on work environment processes, and minimise production losses due to health and work environment-related issues.
6.	Arakelian, Erebouni, et al. (författare) How operating room efficiency is understood in a surgical team : a qualitative study 2011 Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 23:1, s. 100-106 Tidskriftsartikel (refereegranskat)abstract Objective. Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency'understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency. Design. Qualitative study. Settings. A 1100-bed Swedish university hospital. Participants. Eleven participants, nine team members from the same team and their two leaders were interviewed. Methods. The analysis was performed according to phenomenography, a research approach that aims to discover variationsin peoples' understanding of a henomenon. Results. Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites,enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders. Conclusions. The seven ways of understanding operating room efficiency appear to represent both organization-oriented andindividual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.
7.	Arakelian, Erebouni, 1973-, et al. (författare) I Stay : Swedish Specialist Nurses in the Perioperative Context and Their Reasons to Stay at Their Workplace 2019 Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1089-9472 .- 1532-8473. ; 34:3, s. 633-644 Tidskriftsartikel (refereegranskat)abstract Purpose To investigate why nurse anesthetists and operating room nurses choose to stay in the same workplace.Design Qualitative design.Methods Individual interviews were conducted with 15 nurse specialists from four hospitals in Sweden. Two men and 13 women aged between 43 and 63 participated. Data were analyzed with systematic text condensation according to Malterud.Findings Three themes were identified. (1) Organizational stability contributed to low staff turnover, with good spirits between colleagues, representing everyone’s equal value and resulting in a feeling of homelikeness. (2) Sustained development in one’s own profession. (3) A humane head nurse who was at hand, who was a facilitator, who knew staff members, and eliminated obstacles for them.Conclusions In a nonhierarchical and stable organization with a head nurse with caritative leadership skills, a welcoming working environment with opportunities for professional development is created. Thus, nurse specialists choose to stay, contributing to organizational development.
8.	Arakelian, Erebouni, et al. (författare) Job satisfaction or production? How staff and leadership understand operating room efficiency : a qualitative study 2008 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 52:10, s. 1423-1428 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: How to increase efficiency in operating departments has been widely studied. However, there is no overall definition of efficiency. Supervisors urging staff to work efficiently may meet strong reactions due to staff believing that demands for efficiency means just stress at work. Differences in how efficiency is understood may constitute an obstacle to supervisors' efforts to promote it. This study aimed to explore how staff and leadership understand operating room efficiency. METHODS: Twenty-one members of staff and supervisors in an operating department in a Swedish county hospital were interviewed. The analysis was performed with a phenomenographic approach that aims to discover the variations in how a phenomenon is understood by a group of people. RESULTS: Six categories were found in the understanding of operation room efficiency: (A) having the right qualifications; (B) enjoying work; (C) planning and having good control and overview; (D) each professional performing the correct tasks; (E) completing a work assignment; and (F) producing as much as possible per time unit. The most significant finding was that most of the nurses and assistant nurses understood efficiency as individual knowledge and experience emphasizing the importance of the work process, whereas the supervisors and physicians understood efficiency in terms of production per time unit or completing an assignment. CONCLUSIONS: The concept 'operating room efficiency' is understood in different ways by leadership and staff members. Supervisors who are aware of this variation will have better prerequisites for defining the concept and for creating a common platform towards becoming efficient.
9.	Arakelian, Erebouni, 1973-, et al. (författare) Managerial challenges faced by Swedish nurse managers in perioperative settings : a qualitative study 2021 Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 20:1, s. 1-10 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Nurse managers need to create cultures that are worthy, not only of the commitment of everyone who comes to work but also of the trust of everyone who comes to be served. The aim of our study was to describe the challenges faced by Swedish nurse managers in a perioperative setting.METHODS: A qualitative study was conducted. The participants were chosen by convenience sampling, and individual in-depth interviews were conducted. Data were analysed by Systematic Text Condensation. The COREQ checklist was consulted throughout the study to optimise the quality.RESULTS: Nineteen nurse managers (all women) participated. Six themes were identified: "striving to treat employees with consideration and solicitude"; "the obligation to take care of each employee's individual needs"; "convincing others was an uphill battle", "finding solutions when things seem impossible"; "staff recruitment, allocation, and management"; "working with constantly changing planning".CONCLUSIONS: The nurse managers faced challenges because of the overwhelming amount of work tasks, with almost no time for reflection. Having carefully chosen tasks and a realistic time schedule for each work task, plus time to find one's own path to inner peace, are essential for nurse managers. Organisations that provide these prerequisites show that they care about their nurse managers. The results of this study indicate the need for time to reflect, as well as support from superior managers and from the human resources department.
10.	Arakelian, Erebouni, 1973-, et al. (författare) Nurse managers in perioperative settings and their reasons for remaining in their jobs : A qualitative study 2020 Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 28:6, s. 1191-1198 Tidskriftsartikel (refereegranskat)abstract AIM: The study describes what helps nurse managers maintain the strength to keep going as leaders.BACKGROUND: Good leadership is important for the quality of patient care, patient satisfaction in care and efficiency. Many nurse managers stay on despite challenges at work.METHODS: Twelve nurse managers were interviewed. Data were analysed by systematic text condensation according to Malterud.RESULTS: The results were as follows: A-Walking side by side with my employees; B-Knowing that I mean something to my employees; C-Talking to myself-asking myself tough questions; D-Having someone to talk to, to decrease the feeling of being alone; E-Leading and managing in my own way-the fear of not succeeding is my motivation.CONCLUSION: The nurse managers built their own strategies to get through and get on when difficult situations arose. In order to succeed in leading their employees, the nurse managers gathered their inner strength through moving caritatively back and forth between the 'secret room' and the 'staff room' in the house of leadership.IMPLICATIONS IN NURSING MANAGEMENT: The manuscript gives insights into where nurse managers found sources of strengths in their everyday work. To realize their employees' strengths and motivation made a difference for nurse managers as a driving force. By having someone to talk to and by asking themselves tough questions, they were prepared for the challenges that came.
11.	Arakelian, Erebouni, 1973-, et al. (författare) Nurses anaesthetists' versus patients' assessment of anxieties in an ambulatory surgery setting. 2019 Ingår i: Journal of perioperative practice. - : Sage. - 2515-7949 .- 1750-4589. ; 29:12, s. 387-415 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Failure to assess patients' anxiety perioperatively by means of a validated instrument makes the assessment arbitrary. Studies are lacking about how well nurse anaesthetists estimate patients' preoperative worries.PURPOSE: To compare the nurse anaesthetists' estimations of patients' preoperative anxieties with the patients' own assessment of their anxieties.DESIGN: Quantitative prospective design.METHODS: Eighty-five pairs of patients and nurse anaesthetists in two ambulatory surgery units in a university hospital in Sweden were included. Patients' perioperative anxieties were graded using the Numeric Visual Analogue Anxiety Scale.RESULTS: The nurse anaesthetist overestimated the patients' level of preoperative anxiety in 53% of patients and underestimated patients' anxieties in 31% of the patients. Consensus was seen in 16% of the pairs. In fifty-six pairs (65%), the difference between the estimation of level of patients' anxiety according to Numeric Visual Analogue Anxiety Scale was between -3 (overestimation) and +3 levels (underestimation). Median levels of anxiety were estimated as 3 within the patient group and 4 among the nurse anaesthetists.CONCLUSIONS: Systematic assessment of patients' level of anxiety could lead to identifying patients with severe anxiety levels and to offer more individualised treatment. The patients' own estimation must form the basis for the discussion and treatment.
12.	Arakelian, Erebouni, 1973-, et al. (författare) Older Patients' Worries in Connection With General Anesthesia and Surgery - A Qualitative Study 2018 Ingår i: Journal of Perianesthesia Nursing. - : ELSEVIER SCIENCE INC. - 1089-9472 .- 1532-8473. ; 33:6, s. 822-833 Tidskriftsartikel (refereegranskat)abstract Purpose: To examine anxiety and what older patients worry about related to anesthesia and colorectal surgery, and their perceptions regarding nurses' ability to ease preoperative worry.Design: Qualitative individual face-to-face interviews.Methods: The study included 18 patients aged between 62 and 91 years with lower abdominal tumors. The study was conducted in two day-surgery wards in Sweden. Interview data were analyzed with Malterud's systematic text condensation.Findings: Four themes were identified: (1) losing control of one's body, leaving one's life in someone else's hands, and the feeling that there is no going back, (2) claustrophobia and anticipated pain in an unknown environment, (3) unknown and frightening vocabulary concerning the surgery, and (4) what can happen if something goes wrong.Conclusions: Patients worry about a number of things. If preoperative worry could be identified, actions taken to reduce worry could be personalized and patients' own strategies to reduce worries may be helpful for them.
13.	Arakelian, Erebouni, 1973- (författare) Operating Room Efficiency and Postoperative Recovery after Major Abdominal Surgery : The Surgical Team’s Efficiency and the Early Postoperative Recovery of Patients with Peritoneal Carcinomatosis 2011 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract In selected patients, surgical treatments such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have enabled curative treatment options for previously incurable diseases, such as peritoneal carcinomatosis (PC). The introduction of resource demanding surgery could affect the work process, efficiency, and productivity within a surgical department and factors influencing patient postoperative recovery processes may have an impact on the efficiency of patient care after major surgery.The aim of this thesis was to investigate operating room efficiency from the perspective of both staff and leaders’ in two different settings (Papers I and II) and the early postoperative recovery of patients with peritoneal carcinomatosis (Papers III and IV).Interviews were held with 21 people in a county hospital and 11 members of the PC team in a university hospital, and a phenomenographic approach was used to analysis the data (Papers I and II). The patients’ postoperative recovery and pulmonary adverse events (AE) were determined from data retrieved from the electronic health records of 76 patients (Papers III and IV).The concept of efficiency was understood in different ways by staff members and their leaders (Paper I). However, when working in a team, the team members had both organisation-oriented and individual-oriented understanding of efficiency at work that focused on the patients and the quality of care (Paper II).The patients with PC regained gastrointestinal functions and could be mobilised during early postoperative recovery phase, although many patients suffered from psychological disturbances, sleep deprivation, and nausea (Paper III). Postoperative clinical and radiological pulmonary AE were common, but did not affect the early recovery process (Paper IV).In conclusion, leaders who are aware of the variation in understanding the concept of efficiency are better able to create the same platform for staff members by defining the concept of efficiency within the organisation. In a team organisation, the team members have a wider understanding of the concept of efficiency with more focus on the patients. The factors affecting postoperative recovery and pulmonary AE should be considered when designing individualised patient care plans in order to attain a more efficient recovery.
14.	Arakelian, Erebouni, et al. (författare) Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment : a retrospective study 2012 Ingår i: World Journal of Surgical Oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 10, s. 258- Tidskriftsartikel (refereegranskat)abstract Background: The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment option for peritoneal carcinomatosis (PC). There have been few studies on the pulmonary adverse events (AEs) affecting patient recovery after this treatment, thus this study investigated these factors. Methods: Between January 2005 and December 2006, clinical data on all pulmonary AEs and the recovery progress were reviewed for 76 patients with after CRS and HIPEC. Patients with pulmonary interventions (thoracocenthesis and chest tubes) were compared with the non-intervention patients. Two senior radiologists, blinded to the post-operative clinical course, separately graded the occurrence of pulmonary AEs. Results: Of the 76 patients, 6 had needed thoracocentesis and another 6 needed chest tubes. There were no differences in post-operative recovery between the intervention and non-intervention groups. The total number of days on mechanical ventilation, the length of stay in the intensive care unit, total length of hospital stay, tumor burden, and an American Society of Anesthesiologists (ASA) grade of greater than 2 were correlated with the occurrence of atelectasis and pleural effusion. Extensive atelectasis (grade 3 or higher) was seen in six patients, major pleural effusion (grade 3) in seven patients, and signs of heart failure (grade 1-2) in nine patients. Conclusions: Clinical and radiological post-operative pulmonary AEs are common after CRS and HIPEC. However, most of the pulmonary AEs did not affect post-operative recovery.
15.	Arakelian, Erebouni, 1973-, et al. (författare) Reaching a tipping point : perioperative nurse managers' narratives about reasons for leaving their employment - a qualitative study. 2021 Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 29:4, s. 664-671 Tidskriftsartikel (refereegranskat)abstract AIM: To describe reasons why nurse managers in perioperative settings decide to leave their employment.BACKGROUND: Current literature has shown that perioperative nurse managers' reasons to leave their positions are formed through an interaction of factors.METHODS: Individual in-depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using Systematic Text Condensation.RESULTS: Five key themes were identified: a- To end where I started, as a front-line nurse; b- I wanted to develop further to the next level in my career; c- I ran out of ideas; d- I lost trust in my head manager and did not believe in the new organization, and e- I had had enough of being offended by my superior manager and my employees.CONCLUSION: Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organization together with time for discussions.IMPLICATIONS IN NURSING MANAGEMENTS: The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect, and appreciation.
16.	Arakelian, Erebouni, 1973-, et al. (författare) Sharing the Same Reality, Healthy Relations Between Colleagues at Work : A Meta-Synthesis 2023 Ingår i: Sage Open Nursing. - : Sage Publications. - 2377-9608. ; 9 Tidskriftsartikel (refereegranskat)abstract Introduction: Good relations are important at work, leading to well-being among coworkers. Since the latest research in nursing is mostly about bullying, and lateral violence, it was important to study what healthy relations mean.Objectives: The aim was to identify and synthesize qualitative studies that describe healthy relations, creating health and well-being between colleagues at work.Methods: A meta-synthesis approach, inspired by Sherwood's steps of analysis, was chosen for this study. Ten articles from three continents, comprising 230 participants, were included.Results: Two themes were identified as follows: (a) creating a mutual bond on a personal level and a permissive atmosphere through the human warmth; and (b) sharing togetherness in a greater whole, offering unconditional help and devoting themselves to taking care of each other. An overarching metaphor implicating the home/homeness was abstracted from the two themes: "Healthy relations between colleagues at work constitute the community as a common world, containing feelings of being at home, implying acting in an expression of the ethos and dignity, a culture created that makes the ideal form of healthy relations visible."Conclusion: Nurses find their meaning when they work in a permissive environment, and when they are allowed to be themselves. Such meaning can be found through their engagement with one another, by offering each other unconditional help. Good relationships lead to a place they call their home, where there is trust and friendship.
17.	Arakelian, Erebouni, 1973-, et al. (författare) Success factors when implementing a structured support model for systematic work environment management in operating departments : A case study from Sweden 2022 Ingår i: Journal of Nursing Management. - : John Wiley & Sons. - 0966-0429 .- 1365-2834. ; 30:7, s. 3618-3627 Tidskriftsartikel (refereegranskat)abstract Aim The study aimed to investigate how departments in a Swedish hospital worked with a structured support model between the sessions and what they identified as success factors. Background To improve the work environment in a Swedish hospital, a structured support model for systematic work environment management was implemented in operating departments. The structured work starts with sending a web-based, open-ended, anonymous questionnaire to all employees. In response, employees describe how they perceive their work environment 'right now'. Next, a session is held where employees' viewpoints are discussed, and areas of improvement are agreed upon. Action plans are created between the sessions, and the employees start working with their plans with support from their managers. Implementing new models takes time and requires efforts from employees and managers. Method A case study was conducted, including three operating departments within a perioperative organization in a university hospital in Sweden. The participating departments had used the model without interruption during the Covid-19 pandemic 2 years after implementation, and they had created a customized working method. Three first-line managers were interviewed, and 22 action plans, 21 workplace meeting notes and two presentations were analysed using thematic analysis. Results The results are sorted under three main thematic headings: Experience of results and benefits, Marketing and cheering on and Making adjustments and making the model one's own. The results from the action plans and workplace meetings indicated that the employees had discussed problems with cooperation, work organization and how to treat each other. Conclusion Human factors, such as support, encouragement, seeing the benefits, allowing for time and respecting each other can facilitate and contribute to the implementation and success of a new model. Implications for Nursing Management The main finding of the study indicates that with a structured way of working, and with the participation of the employees in the systematic work environment work, the employees contributed with constructive suggestions for improvement. This, in turn, contributed to reducing the workload for first-line managers. In addition, when working with a structured model, deficiencies in the workplace were identified, which triggered an improvement process in the participating hospital departments.
18.	Arakelian, Erebouni, 1973-, et al. (författare) The meaning of person-centred care in the perioperative nursing context from the patient's perspective : an integrative review 2017 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 26:17-18, s. 2527-2544 Tidskriftsartikel (refereegranskat)abstract AIMS AND OBJECTIVES: To determine the meaning of person-centred care from the patient's perspective and in the context of perioperative nursing. BACKGROUND: Person-centred care (PCC) is used but not defined in the perioperative context. The concept indicates an interest in the patient's own experience of health, illness, needs and preferences. As with many terms that are frequently used, there is a tendency for person-centred care to mean different things to different people in different contexts. METHODS: A two-part search strategy was employed; firstly, a computerized database search of PubMed and CINAHL, using Medical Subject Headings and free terms to search articles dating from 2004 to 2014, and secondly, a hand-search of those articles' reference lists was performed. Twenty-three articles were selected and an integrative review was conducted. RESULTS: Four themes were discovered: 'Being recognized as a unique entity and being allowed to be the person you are', 'Being considered important by having one's personal wishes taken into account', 'The presence of a perioperative nurse is calming; prevents feelings of loneliness and promotes wellbeing, which may speed up recovery', and 'Being close to and being touched by the perioperative nurse during surgery'. CONCLUSIONS: PCC means respecting the patient as a unique individual, considering the patient's particularities and wishes, and involving the patient in their own care. PCC also implies having access to one's own nurse who is present both physically and emotionally through the entire perioperative process and who guides the patient and follows up postoperatively, guaranteeing that the patient is not alone. RELEVANCE TO CLINICAL PRACTICE: By having a common understanding of the concept of PCC, the nurse anaesthetists' and theatre nurses' caring actions or concerns will be directed towards the patient', resulting in personalization of care rather than simply defining the concept. This article is protected by copyright. All rights reserved.
19.	Birkestam, Anderz Mw, et al. (författare) An observational study of ad-hoc anaesthesia teams 2020 Ingår i: Journal of perioperative practice. - : Sage Publications. - 2515-7949 .- 1750-4589. ; 30:4, s. 102-106 Tidskriftsartikel (refereegranskat)abstract Background: Anaesthesia teams are temporarily assembled to cooperate with teams in emergency departments in the immediate management of events compromising patients' airway, ventilation and circulation. Purpose: The aim was to describe a temporary ad-hoc anaesthesia team's performance. Design: An observational study was conducted. Methods: Data, collected with 12 non-participatory observations, were analysed using both an thematic method, and a validated assessment tool, the Team Emergency Assessment Measure. Results: Three themes were identified: (1) flexibility in assuming varying roles, (2) expertise in verbal and non-verbal communication and (3) skills dealing with the challenges of working in unfamiliar dynamic environments. Ninety per cent of anaesthesia teams scored 7.6 (0-10) on the overall assessment according to the Team Emergency Assessment Measure rating. Conclusion: Ad-hoc anaesthesia team members communicated in various ways and the anaesthesia team adapted well to the unpredictable environment in the emergency department.
20.	Epstein, Majken, et al. (författare) Managing Sustainable Working Hours within Participatory Working Time Scheduling for Nurses and Assistant Nurses : A Qualitative Interview Study with Managers and Staffing Assistants 2023 Ingår i: Journal of Nursing Management. - : Hindawi Publishing Corporation. - 0966-0429 .- 1365-2834. ; 2023 Tidskriftsartikel (refereegranskat)abstract Aim. To bring insights into how healthcare managers and staffing assistants work to achieve sustainable working hours within a participatory scheduling system. Background. Hospital nurses and assistant nurses often work on rotating shifts, which affects their opportunities for sleep, recovery, and work-life balance. In Sweden, a participatory scheduling approach is commonly used, where working hours are planned in collaboration between employees, managers, and staffing assistants. Influence over working hours is related to positive outcomes among shift workers. However, it also places responsibility on the employee to schedule working hours that promote health and patient safety, i.e., sustainable working hours. Accordingly, the organisation has responsibilities to support the employee in this regard. Methods. Semistructured individual interviews were conducted with 11 managers and 9 staffing assistants from four Swedish regions and analysed using thematic analysis. Results. Several key factors for achieving sustainable working hours within the context of participatory scheduling were described: distribution and clarity of responsibilities, allocating time for scheduling, establishing shared responsibility, considering fairness, fostering an individual relationship with the employee, managing dissatisfaction, providing support, clarifying guidelines for sustainable scheduling, managing inconsistencies between employee requests and sustainable working hours, and considering recovery opportunities and the competence mix on shifts. Additionally, contextual factors, such as staffing levels, working procedures, working time arrangements for night work, and technological support, were highlighted as important. Conclusion. Achieving sustainable working hours within participatory scheduling involves considering the interactions between factors at the levels of the organisation, the individual, and the technological systems. Implication for Nursing Management. Nurse managers and staffing assistants must work closely with their employees during participatory scheduling to ensure sustainable working hours. Key goals in this regard include establishing a shared responsibility, clarifying responsibilities and guidelines for sustainable scheduling, and allocating time for the scheduling process.
21.	Eriksson, Hanna, et al. (författare) Patients' experiences of postoperative health related to cytoreductive surgery and hyperthermic intraoperative chemotherapy 2014 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 23:1-2, s. 201-210 Tidskriftsartikel (refereegranskat)abstract Aims and objectives.To study patients’ descriptions of their health after cytoreductive surgery (CRS) before discharge.Background. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) affects the patient’s recovery. The hospital stay is long, and it is important to study how patients experience their health postoperatively.Design. Qualitative descriptive design.Methods. Between January–May 2012, individual interviews were conducted with 20 patients in a university hospital in cen- tral Sweden using a semi-structured interview guide. Data were analysed using qualitative content analysis.Results. Three themes (a process, body and mind, and support) and nine categories emerged. The surgery was described as a turning point, followed by a period of hope and thankfulness. Nevertheless, patients had difficulty taking in their positive feelings because they were overwhelmed by their bodily ailments. Despite the patients’ descriptions of being on an emotional roller coaster, thinking about death and an uncertain future, or being in a state somewhere between sleep and wakefulness, they described them- selves as being in good mental health. Continuous individualised information and support from the surgeon and staff members were described as being important for the recovery process, and none of the patients asked for counselling before discharge.Conclusion. Surgery was described as a turning point followed by an uncertain future. Despite the overwhelming nature of their bodily ailments and being on an emotional roller coaster postoperatively, patients described themselves as being in good psychological health and not needing any professional counselling. Continuous individualised information from the surgeon and staff members played an important role in the recovery process.Relevance to clinical practice. Both staff and future patients may benefit from the patients’ experiences after CRS and HIPEC described in this study. The knowledge gained from this study could be used in designing a care plan for future patients undergoing CRS and HIPEC.
22.	Jangland, Eva, et al. (författare) Between two roles - Experiences of newly trained nurse practitioners in surgical care in Sweden : A qualitative study using repeated interviews 2016 Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 21, s. 93-99 Tidskriftsartikel (refereegranskat)abstract The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team.
23.	Leo Swenne, Christine, 1958-, et al. (författare) Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay 2018 Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 38:4, s. 212-219 Tidskriftsartikel (refereegranskat)abstract The effects of perioperative dialogue have been studied using qualitative methods, describing patient satisfaction with their care. However, they have not been studied in patients with peritoneal carcinomatosis who undergo major surgery, nor with quantitative variables. The aim was to study the use of pain medication and length of hospital stay following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients who received, versus those who did not receive, perioperative dialogue. The study had a quantitative, retrospective and comparative design including 89 audits. Of these, 37 patients received perioperative dialogues, and 52 patients did not (the control group). The result showed that by postoperative day six, patients who received a perioperative dialogue experienced pain less frequently than patients in the control group. However, no differences between the groups were noted with regard to pain medication consumption and length of hospital stay. To ease their worries, all patients in both groups used benzodiazepines. The perioperative dialogue may be studied quantitatively, but it must involve the patient, who is an equal partner in the dialogue. Structured validated self-reporting measures may be used systematically before and after surgery in order to evaluate the perioperative dialogue using quantitative measures.
24.	Lögde, Ann, et al. (författare) I am quitting my job : Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job 2018 Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 30:4, s. 313-320 Tidskriftsartikel (refereegranskat)abstract The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university- and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.
25.	Nilsson, Ulrica, et al. (författare) A journey to a new stable state-further development of the postoperative recovery concept from day surgical perspective : a qualitative study 2020 Ingår i: BMJ Open. - : BMJ PUBLISHING GROUP. - 2044-6055. ; 10:9 Tidskriftsartikel (refereegranskat)abstract Objective: This study aims to further develop the concept analysis by Allvinet alin 2007 and Lundmarket alin 2016 from the perspective of day-surgery patients. Also, to describe how patients experience postoperative recovery in relation to the identified dimensions and subdimensions and to interpret the findings in order to get a deeper understanding of the concept postoperative recovery.Design: Descriptive qualitative design with a theoretical thematic analysis.Setting: Six day-surgery departments in Sweden.Participants: Thirty-eight adult participants who had undergone day surgery in Sweden. Participants were purposively selected.Results: Four dimensions-physical, psychological, social and habitual-were confirmed. A total of eight subdimensions were also confirmed, two from Allvinet al's study and six from Lundmarket al's study. Recovery included physical symptoms and challenges coping with and regaining control over symptoms and bodily functions. Both positive and negative emotions were present, and strategies on how to handle emotions and achieve well-being were established. Patients became dependent on others. They coped with and adapted to the recovery process and gradually stabilised, reaching a new stable state.Conclusion: Postoperative recovery was described as a process with a clear starting point, and as a dynamic and individual process leading to an experience of a new stable state. The recovery process included physical symptoms, emotions and social and habitual consequences that challenges them. To follow-up and measure all four dimensions of postoperative recovery in order to support and understand the process of postoperative recovery is, therefore, recommended.
26.	Sand, Olivia, et al. (författare) Severe pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are common and contribute to decreased overall survival 2021 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:12 Tidskriftsartikel (refereegranskat)abstract BACKGROUND AND OBJECTIVES: Extensive abdominal surgery is associated with the risk of postoperative pulmonary complications. This study aims to explore the incidence and risk factors for developing postoperative pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and to analyze how these complications affect overall survival.METHODS: Data were collected on 417 patients undergoing surgery between 2007 and2017 at Uppsala University Hospital, Sweden. Postoperative pulmonary complications were graded according to the Clavien-Dindo classification system where Grade ≥ 3 was considered a severe complication. A logistic regression analysis was used to analyze risk factors for postoperative pulmonary complications and a Cox proportional hazards model to assess impact on survival.RESULTS: Seventy-two patients (17%) developed severe postoperative pulmonary complications. Risk factors were full thickness diaphragmatic injury and/or diaphragmatic resection [OR 5.393, 95% CI 2.924-9.948, p = < 0.001]. Severe postoperative pulmonary complications, in combination with non-pulmonary complications, contributed to decreased overall survival [HR 2.285, 95% CI 1.232-4.241, p = 0.009].CONCLUSIONS: Severe postoperative pulmonary complications were common and contributed to decreased overall survival. Full thickness diaphragmatic injury and/or diaphragmatic resection were the main risk factors. This finding emphasizes the need for further research on the mechanisms behind pulmonary complications and their association with mortality.
27.	Swenne, Christine Leo, 1958-, et al. (författare) Patients' experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy : a qualitative follow-up study 2017 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:4, s. 904-913 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Patients with peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have a long recovery process.AIM: To describe patients' experiences of their everyday lives after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.METHOD: A follow-up study with a qualitative, descriptive design. Data were collected by individual, in-depth telephone interviews with 16 patients who had been treated for peritoneal carcinomatosis 14 months earlier at a university hospital in Sweden. The interviews were performed between May and June 2013 and analysed using systematic text condensation.RESULTS: Five themes were identified: (i) finding one's new self and relating to the new situation; (ii) the disease making its presence felt through bodily complications or mental fatigue; (iii) worrying about the return of the disease and passing it on to one's children; (iv) experiencing difficulties contacting various care facilities, not having a clear plan for ongoing rehabilitation; and (v) the need for online support through the Internet and counselling for both patients and their family members.CONCLUSIONS: Despite bodily complications, mental fatigue and worries about the return of the disease, the patient's everyday life was focused on finding his/her new self and adapting to the new circumstances. Difficulties in contacting care facilities and the lack of an ongoing medical and nursing rehabilitation plan called for a need for network support for patients and their families.CLINICAL RELEVANCE: After advanced surgery, patients require a continuous medical and nursing rehabilitation plan, and a platform of support such as meetings via social media and Internet which would connect former patients and their families with future patients and their family members. A contact nurse with specific expertise should design an individual rehabilitation plan and continuously identify the individual needs for long-term support.
28.	Swenne, Christine Leo, et al. (författare) Postoperative health and patients' experiences of efficiency and quality of care after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, two to six months after surgery 2015 Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 19:2, s. 191-197 Tidskriftsartikel (refereegranskat)abstract Purpose: To study post-discharge health after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and to. analyse patients' experiences of in-hospital efficiency and quality of care. Methods: In-depth individual telephone interviews using an interview guide with open-ended questions were performed with 19 patients with peritoneal carcinomatosis between April and October, 2012. Data were analysed with systematic text condensation. Results: Four themes were identified: 1) Coming home was an essential step in the recovery process and the focus was on getting well physically despite mental stress, uncertainty about the medical rehabilitation plan and the future. 2) Health was affected negatively by postoperative chemotherapy and its side effects. 3) Stoma - a necessary evil affecting the patient's social life. 4) Quality of care and efficiency were defined in patient-centred terms and inter-personal care from the patient's perspectives on Micro level. Despite all, 32% of the patients described being fully recovered and had started to study or work two months after surgery. Conclusions: The study gives insights into some real-life experiences described by patients. The study results can be used to prepare written information, to design a postoperative rehabilitation plan for future patients with Peritoneal Carcinomatosis (PC) and to create a home-page through which patients can receive support from both health care professionals and other fellow patients.
29.	Wålinder, Robert, et al. (författare) A supportive climate and low strain promote well-being and sustainable working life in the operation theatre. 2018 Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 123:3, s. 183-190 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Shortage of health-care workers e.g. in operating theatres is a global problem. A shortage of staff negatively affects patient outcomes, making it important to keep the employees from quitting. The aim of this survey was to study if well-being, zest for work, and thoughts about leaving work in an operating theatre can be related to the psychosocial work environment, as described by the job demand-control-support (JDCS) model.METHODS: A questionnaire was provided to personnel in operating theatres of seven Swedish hospitals (n = 1405, with a response rate of 68%) that included the JDCS model, personal factors, work ability, well-being, zest for work, and thoughts about leaving their position. Ordinal scale regression was used for analyses.RESULTS: A majority reported moderate to high zest for work (76%). A minority (30%) had sometimes thought during at least one month in the last year of leaving their position. Lower social support scores and high demands together with low control (high-strain) scores were related to lower well-being, lower zest for work, and more thoughts about leaving the position. Anaesthetists scored in the low-strain field, nurse anaesthetists and assistant nurses in the passive field, and operating nurses in the active field, in comparison to all personnel.CONCLUSION: According to the JDCS model, both lower social support and high strain were related to lower well-being and negative thoughts about the position. Social support scores were about the same for different occupational groups in the operating theatre, and no occupation scored on average in the high-strain field.

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