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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. [ABSTRACT FROM AUTHOR]

Aims: To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. Design: A cross‐sectional design. Methods: Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care‐Nurses' Attitudes (FINC‐NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. Results: Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. Conclusion: This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. Impact: Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child‐centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established. [ABSTRACT FROM AUTHOR]

Background: Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality.Methods: Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE.Results: We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L-1 above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds.Conclusions: Perioperative increases in hsTnT ≥14 ng L-1 above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE.Clinical Trial Registration: NCT03436238. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to describe patients' lived experience of warmth and coldness in connection with surgery. Methods: A reflective lifeworld research (RLR) approach founded on phenomenology and the methodological principles of openness, flexibility, and bridling were used. The data consisted of 16 in-depth interviews with patients from four hospitals in Sweden. Results: Warmth and coldness in connection with surgery means an expectation to maintain one´s daily life temperature comfort. When patients' needs of temperature comfort is fulfilled it give a sense of well-being and calmness. Despite the body is covered there are feelings of vulnerability. When patients have the ability to change their own temperature comfort, they feel independent. Conclusion: The individual feeling of temperature comfort could be affected or changed to discomfort during the perioperative context, and an intervention is required to avoid suffering due to the care. An ability to independently influence one´s own temperature comfort can strengthen the patient, whereas the opposite entails suffering in silence. The phenomenon is also related to feelings of confidence about receiving the best care as well as being exposed and vulnerable. When the patient´s need of comfortable temperature is met then feelings of security and sense of well-being emerged. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective of the study: Emergency laparotomy and other high-risk acute abdominal surgery procedures have a high mortality rate. The perioperative management of these patients is complex and poses several challenges. The objective of the study is to implement and evaluate the outcome of protocol-based standardised care for patients in need of acute abdominal surgery in a Swedish setting. NÄL is a large county hospital in Sweden serving a population of approximately 270,000 inhabitants. The study seeks to determine whether standardised protocol-based perioperative management in emergency abdominal surgical procedures leads to a better outcome measured as short- and long-term mortality and postoperative complications compared with the present standard in Swedish routine care. The study is ongoing, and this article describes the methodology used in the study and discusses the benefits and limitations the study design. Results: There are no results so far. The inclusion rate for the first 22 months is as expected; 404 patients have been included and protocols have been followed and reviewed according to the study plan. 25 patients have been missed and demographic data and outcome data for these patients will be collected and analysed. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to compare the effect of preheated (36 °C) and room-temperature (20 °C) skin disinfectant solution on skin temperature and patients' experience of the skin disinfection process. Background To prevent surgical site infections, it is important to disinfect skin prior to invasive surgery. In clinical practice, conscious patients often comment on the coldness of the preoperative skin disinfection solution. Evidence is lacking, as to whether preheated skin disinfectant has any positive effects during preoperative skin disinfection. Design Randomised controlled trial. Methods A total of 220 patients undergoing pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronisation therapy under local anaesthesia were included and randomly allocated to preheated or room-temperature skin disinfection. Skin temperature was assessed before and after skin disinfection at the planned incision site; in addition, three study-specific questions were used to assess how patients experienced the temperature. Results Patients experienced the skin disinfection process with preheated disinfectant as significantly more pleasant. They felt less cold and reported increased satisfaction with the temperature of the solution compared to patients who were disinfected with room-temperature solution. Skin disinfection with preheated solution also yielded a significantly higher mean skin temperature compared to room-temperature solution. Conclusions Preoperative skin disinfection with preheated disinfectant may prevent heat loss and contributes to a more pleasant experience for patients. Relevance to clinical practice Skin disinfection with preheated skin disinfectant is an easy and inexpensive nursing intervention that has a positive impact on heat loss and on patients' experience of the disinfection process. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to describe stress symptoms among adolescents before and after scoliosis surgery and to explore correlations with postoperative pain. Background Scoliosis surgery is a major surgical procedure. Adolescent patients suffer from preoperative stress and severe postoperative pain. Previous studies indicate that there is a risk of traumatisation and psychological complications during the recovery period. Design A prospective quantitative cohort study with consecutive inclusion of participants. Methods A cohort of 37 adolescent patients aged 13-18. To assess the adolescents' experiences before surgery and at six to eight months after surgery, the Trauma Symptom Checklist for Children - Alternative version, Youth Self-Report and Kiddie Schedule for Affective Disorder and Schizophrenia for children 12-18 were used. The Visual Analogue Scale was used for self-report of postoperative pain on day three. Results Rates of anxiety/depression and internalising behaviour were significantly higher before surgery than six months after. Preoperative anger, social problems and attention problems correlated significantly with postoperative pain on day three. At follow-up, postoperative pain correlated significantly with anxiety, social problems and attention problems. Conclusions The results of this study indicate a need for interventions to reduce perioperative stress and postoperative pain to improve the quality of nursing care. Relevance to clinical practice Attention to preoperative stress and implementation of interventions to decrease stress symptoms could ameliorate the perioperative process by reducing levels of postoperative pain, anxiety, social and attention problems in the recovery period. [ABSTRACT FROM AUTHOR]

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., (Copyright © 2018 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)