Congruency Between Planned and Performed Procedures and Adherence to Recommended Perioperative Practices: A Chart Audit of High-Risk Surgical Patients.

Documentation in an electronic health record system helps ensure that perioperative personnel provide appropriate treatment and care to surgical patients. A retrospective chart review performed with an audit instrument sought to describe the extent to which the documented preoperative plan for a surgery corresponded to the procedure performed. The secondary aim was to describe to what extent perioperative nurses' and physicians' documented care was in accordance with national and international guidelines. Extracted data consisted of physicians' and nurses' documentation of 24 high-risk surgical patients who died within 30 days after a procedure at two hospitals within a single health system. Surgeons documented a planned surgical method for 23 of the 24 patients and the surgical team performed 20 surgeries as planned. Perioperative nurses' and anesthesia professionals' documentation showed a lack of adherence to recommended practices: compliance with guidelines concerning antibiotic prophylaxis and preoperative hygiene preparation were low.

Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: A discursive paper.

Aim: To discuss specialist operating theatre nurses' competence in relation to the general six core competencies and patient safety. Design: A discursive analysis of legal statutes and scientific articles. Methods: Swedish legal statutes and an overview of scientific articles on operating theatre nursing were deductively analysed and classified into healthcare providers' general six core competencies. Results: All healthcare professionals should possess the general core competencies, regardless of their discipline. The specific content within these competencies differs between disciplines. The specialized operating theatre nurse is the only healthcare professional having the competence to be responsible for asepsis, instrumentation, infection and complication, control and management of biological specimens during the surgical procedure. Besides operating theatre nurses, no other healthcare profession has the formal education, competence or skills to perform operating theatre nursing care in the theatre during the surgical procedure. Operating theatre nurse competence is therefore indispensable to ensure patient safety during surgery.

Prerequisites for safe intraoperative nursing care and teamwork-Operating theatre nurses' perspectives: A qualitative interview study.

AIM: To describe operating theatre nurses' experience of preconditions for safe intraoperative nursing care and teamwork. BACKGROUND: Surgical interventions are often needed for patients' well-being and survival from health problems. Adequate information to professionals responsible within the surgical organisation is of importance for patient safety in connection to the surgery. The members in the surgical team need correct information about the patients' health and planned care. The information is mainly transferred by computerised systems that do not necessarily provide all information needed. METHOD: A qualitative descriptive design was chosen. Narrative interviews were carried out with 16 experienced operating theatre nurses in four different hospitals in rural and urban areas in Sweden. The data were analysed using qualitative content analysis. The study complied with criteria to Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULT: Operating theatre nurses strived to get adequate information about the patients' care, the surgical intervention and the equipment to be well prepared for intraoperative nursing care. The information from the computerised systems was described as fragmented and obliged the operating theatre nurses to demand a preoperative dialogue between the members of the surgical team. Professional collegial teamwork and committed leadership were considered to enhance patient safety. CONCLUSION: From the operating theatre nurses' perspective, prerequisites for intraoperative safe nursing care and teamwork depend upon a preoperative dialogue between the members in the surgical team for collegial teamwork, obtaining a reliable preoperative overall picture based on adequate information transfer, and the support of a committed first-line manager. RELEVANCE TO CLINICAL PRACTICE: The operating theatre nurses need a reliable preoperative overall picture in advance, to be able to be well prepared for the patients' surgery. The overall picture should be based on adequate data about the patients' health status and needs, details about the surgical intervention and prescriptions.

Operating theatre nurses' experience of patient-related, intraoperative nursing care.

The way patient-related, intraoperative nursing care is performed by operating theatre nurses' has not been elucidated in any great detail. The aim of this study therefore was to describe theatre nurses' experience of patient-related, intraoperative nursing care. The study draws on qualitative, interpretive description methodology. Sixteen specialists in operating theatre nursing care, working in rural or metropolitan hospitals in Sweden, were included in the study. Data were collected by means of interviews and analysed using an inductive, qualitative, descriptive analysis technique. The data analysis resulted in 15 overarching nursing care procedures and three motives for nursing care procedures in the field of intraoperative nursing care with the goal of achieving the best surgical outcome for the patient. The operating theatre nurses' experience of patient-related, intraoperative nursing care was described as procedures to create a continuous, confidence-based relationship and situation-related well-being; procedures to guarantee patient safety and well-being by keeping a watchful eye; and procedures to create a secure environment that promotes wound healing, recovery and well-being.

The hip and knee replacement operation: an extensive life event.

BACKGROUND: A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation. AIM: The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery. METHOD: A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants' experiences of the hip and knee replacement intervention across the entire perioperative period. FINDINGS: Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted. CONCLUSION: Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.

The lived body and the perioperative period in replacement surgery: older people's experiences.

AIM: This paper is a report of a study to explore older people's experiences of their lived bodies during the perioperative period for a hip or knee replacement. BACKGROUND: Replacement surgery of a major joint for older people suffering from osteoarthritis is an established treatment in developed countries. Scientific knowledge is available on replacement surgery from several perspectives, but not about older people's experiences of the entire perioperative period of a replacement procedure. METHOD: A qualitative longitudinal study was conducted between 2002 and 2004. Audiotaped interviews were carried out with 12 older people, on five different occasions during the perioperative period. The data were analysed using latent qualitative content analysis. FINDINGS: The perioperative period of a hip or knee replacement can be regarded as a process of transition which includes six critical phases. The transition was supported with the dream of becoming as able-bodied as previously in life, by having surgery. In addition, our findings revealed that the care recipients lacked knowledge about the surgical intervention as a whole. CONCLUSION: The meaning of having joint replacement surgery was to overcome the confinement of living with a painful and unreliable body. Furthermore, care recipients struggled to regain a body in charge and control of their lives, yet from a new starting point. The care recipients were not prepared for the transitional changes through the perioperative period. Further research is needed to develop an appropriate programme for patient care during the perioperative period, in order to facilitate the process of transition.