The Nurse Anesthetists' Adherence to Swedish National Recommendations to Maintain Normothermia in Patients During Surgery.

PURPOSE: The aim of this study was to determine if nurse anesthetists (NAs) have access, knowledge, and adhere to recommended guidelines to maintain normal body temperature during the perioperative period. DESIGN: A descriptive survey design. METHODS: Questionnaires were sent to heads of the department (n = 56) and NAs in the operating departments in Sweden. FINDING: The level of access to the recommendations is high, but only one third of the operating departments have included the recommendations in their own local guidelines. The NAs' adherence was low, between 5% and 67%, and their knowledge levels were 57% to 60%. CONCLUSIONS: A high level of knowledge, access, and adherence are important for the organization of operating departments to prevent barriers against implementation of new recommendations or guidelines. There are needs for education about patients' heat loss due to redistribution and clear recommendations.

Emotional responses of family members of a critically ill patient: a hermeneutic analysis.

This study used an exploratory design with a hermeneutic approach. The aim was to increase the understanding of the emotional responses of family members during the patient's critical care. Interviews from the main researcher's previous study about relatives of patients in an intensive care unit (ICU) were used. Two of these interviews were chosen, one with the mother and one with the father of an adult young patient, who became critically ill and admitted to a general ICU in south-west Sweden. The present study identified six feelings describing the emotional responses of the family members. The family members experienced feelings of uncertainty, feelings of abandonment, feelings of desertion from the loved one, feelings of being close to the deathbed, feelings of being in a no-man's-land and feelings of attachment. The experienced feelings described in this article can contribute to expanding healthcare professionals understanding of the family members' emotional responses during the patient's critical care.

Effects of process-oriented group supervision - a comparison of three groups of student nurses.

AIM: To evaluate student nurses' perceptions of the effects of process-oriented group supervision provided during their undergraduate education. BACKGROUND: Supervision is an important ability and part of a nurse's leadership role. Student nurses need to learn competence in clinical practice. METHOD: A descriptive-correlational study comparing three groups of student nurses (n = 151) who attended process-oriented group supervision during their education. FINDINGS: The effects of process-oriented group supervision were increased awareness of interpersonal, professional and communication skills. There was a moderate relation between the three factors. The strongest correlation was found between the factors professional and communication skills (r = 0.81). The correlations between the factors in group 3, the mandatory group, were identical. CONCLUSIONS: By correlating the factors, we concluded that the student nurses' perceptions of the effects of process-oriented group supervision strengthened their professional identity, which may have a bearing on patient safety, nursing leadership and collaboration with the patient, her/his family members and other professionals. IMPLICATION FOR NURSING LEADERSHIP: There is potential for improving the links between nursing leadership, supervision and patient safety.

Evaluation of process-oriented supervision of student nurses: a Swedish case study.

The value of supervision that is provided to student nurses during their education is high. The aim of this study was to evaluate the organizational changes in an educational program for Swedish student nurses, focusing on the content and quality of process-oriented supervision. The research question was: Do the organizational changes pertaining to the student nurses' supervision (its reduced frequency and mandatory nature) influence its content and quality and, if so, in which ways? The data were collected by focus group discussions and were analyzed by a qualitative content analysis. Three themes emerged: difficulties with the new organization, the content and learning outcomes of supervision, and the nurse supervisors' intentions. Supervision is recommended in order to achieve the goal of nursing education and to ensure that student nurses gain an understanding of their experiences, thus equipping them with the professional skills and competence that are required to meet patients' needs.

Parents' experiences of their child's first anaesthetic in day surgery.

BACKGROUND: Parents play an important part in their child's anaesthesia. When a child has to receive anaesthesia, it is of great importance that parents are there by his/her side as children depend on them for support. Many parents worry and experience fear before their child's anaesthesia and studies show that there is a correlation between a worried parent and a worried child. AIM: The purpose of this study was to illustrate the meaning of being a parent at one's child's first anaesthesia in day surgery. METHOD: Six parents were interviewed and data were analysed using a descriptive qualitative approach inspired by phenomenology. RESULT: The phenomenon, 'a child's first anaesthesia in day surgery as experienced by parents' is based on the following components: ambivalence between worry and relief, a feeling of losing control, needing to be prepared, being able to be present and a need of emotional support. CONCLUSION: Specific individually-adapted information with a compulsory preoperative visit, presence and participation from, if possible, both parents at their child's anaesthesia but also designated staff from the anaesthetic team to focus solely on supporting the parents at their child's anaesthesia induction can improve the conditions for security.

Fungal DNA and pet allergen levels in Swedish day care centers and associations with building characteristics.

Pet allergens and mold growth related to damp are common phenomena in day care centers in Sweden but exposure measurements of these factors are lacking. The aim of this study was to investigate the relationship between building construction and indoor environment quality in Swedish day care centers and the potential for exposure to fungi (analyzed by quantitative PCR) and animal allergens (analyzed by ELISA). Measurements were performed in 21 day care centers (103 rooms) from one municipality in Sweden, which were identified as constructions at risk of dampness (85% of the buildings) and with visible damage and mold growth (54% of the buildings). Dust samples were collected using cotton swab and Petri dishes. Total fungal DNA was detected in 99% and 100%, Aspergillus/Penicillium DNA in 54% and 68%, and Stachybotrys chartarum DNA in 4% and 9% of the investigated rooms in cotton swab and Petri dish samples, respectively. The total fungal DNA levels (Geometric Mean, GM) were 4.2 × 10(6) cell equivalents per m(2) and 2.9 × 10(5) cell equivalents per m(2) per day in the swab and Petri dish samples, respectively. The concentrations (GM) of cat (Fel d1), dog (Can f1), and horse (Equ cx) allergens were 9.4, 7.2 ng m(-2) day(-1), and 5.0 unit per m(2) per day, respectively. Total fungal DNA levels were higher in risk construction buildings (p = 0.01), in rooms with linoleum flooring material (p = 0.003), and in buildings with rotating heat exchangers (p = 0.02). There were associations between total fungal DNA levels and cat (p = 0.02), dog (p < 0.001), and horse (p = 0.001) allergens. In conclusion, risk constructions, damp constructions, mould growth, fungal DNA, and animal allergens were common exposure factors in Swedish day care centers. Building constructions that represent a high risk for internal dampness should be avoided in the future, and measures to reduce allergen levels should be considered to protect pet-allergic children from asthmatic problems.

Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness.

The trend within the Swedish healthcare system is to reduce the duration of hospital care. This means that a patient who is discharged to their home after critical illness is highly likely to be functionally impaired, and therefore, requires care-giving assistance from a family member. The aim of this study was to generate a theoretical model with regard to relatives' coping when faced with the situation of having an adult next-of-kin recovering at home after critical illness. The design incorporated grounded theory methodology. Four coping strategies exhibiting different characteristics were identified: volunteering, accepting, modulating and sacrificing. Factors determining the choice of coping strategy were the physical and psychological status of the relative, previous experience of ICU-care and the psychological status of the patient. The theoretical model described in this article can contribute to expanding healthcare professionals' understanding of the coping strategies of relatives during recovery, but also provide inspiration for social action to be taken.

Coping strategies when an adult next-of-kin/close friend is in critical care: a grounded theory analysis.

The aim of the study was to generate a theoretical model of how relatives/close friends cope when faced with having an adult next-of-kin/close friend admitted to critical care. Using interviews, data were collected from 18 relatives/close friends of adult patients in thoracic surgical, neurosurgical, coronary, and general ICUs in south-west Sweden. The design incorporated grounded theory methodology. The results indicate the relatives/close friends tried to make the experience of their situation easier, but that the approaches used differed in accordance with the individual's internal and external resources. Four coping strategies exhibiting different characteristics were identified: the relatives/close friends alleviated, recycled, mastered, or excluded their feelings. Factors determining the choice of coping strategy were social background, previous experience of ICU-care and how the situation was apprehended. The theoretical model described in this article can contribute to expanding nurses' understanding of the coping strategies of relatives/close friends in critical care.

One-year outcomes using ranibizumab for neovascular age-related macular degeneration: results of a prospective and retrospective observational multicentre study.

The Swedish Lucentis Quality Registry is a 12-month, open-label, observational, prospective, and retrospective study of ranibizumab administration for wet AMD. Visual acuity (VA) was measured with Snellen or ETDRS chart in 370 patients (66.8% women; age range 46-93 years). In total, a mean of 4.7 ± 1.6 injections per patient (range 1-10) was given to month 12. Mean VA score was 58.3 ± 12.2 letters before treatment, 63.3 ± 12.5 after 3 injections (Δ4.9 ± 10.1 letters from baseline), and 59.3 ± 16.2 at 12 months (Δ1.0 ± 13.6). VA score from baseline to month 12 was stable in 74.4% of patients, improved by 15 letters/3 lines or more in 14.7%, and decreased by ≥15 letters/3 lines in 10.9% of patients. With a mean of 4.7 ranibizumab injections per patient per year, mean VA was stabilised but not increased. To maintain the initial gain seen after the first three injections, an average of 1.8 ± 1.5 additional injections does not appear to be adequate.

Theoretical model of coping among relatives of patients in intensive care units: a simultaneous concept analysis.

UNLABELLED: This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area. BACKGROUND: When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery. METHOD: Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home. FINDINGS: The theoretical model was developed in 2004-2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated. CONCLUSION: This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used.

The value of caring in nursing supervision.

AIM: The aim of this study was to explore and describe nurse supervisors' views of the value of caring in nursing supervision and how they strive to make this value visible. BACKGROUND: The academic part of nursing education presupposes scientifically based nursing knowledge. Several strategies have been suggested for ensuring high-quality clinical nursing education, including nursing supervision, as it facilitates the fusion and integration of theory and practice. To achieve high-quality nursing supervision it is important to describe the supervisors' interventions. METHOD: Data were collected by means of focus group interviews and analysed by qualitative content analysis. FINDINGS: Four themes emerged: genuine encounter, consciousness of one's own value base, confirmation and a relationship characterized by learning and consolation. The supervisors' description of how they strived to make the value of caring in nursing supervision visible can be expressed as follows: the value of caring is inherent in all aspects of nursing supervision; in the narratives of the patients' situations; in relation to the professional role; and in the benefits of participating in group supervision. CONCLUSIONS: The value of caring in nursing supervision was described as a genuine encounter, consciousness of one's own value base, confirmation and a relationship characterized by learning in addition to providing consolation. The role of the supervisor is characterized by three dimensions: willingness, knowledge and courage.

What is supportive when an adult next-of-kin is in critical care?

There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented.