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Nurse anaesthetists' experiences with pre-operative anxiety
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
Division of nursing science, Department of medical and health sciences, Linköping University, Sweden.
Division of child and adolescent psychiatry, department of clinical and experimental medicine, Linköping University.
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
2013 (English)In: Nursing Children and Young People, ISSN 2046-2336, Vol. 25, no 1, p. 28-34Article in journal (Refereed) Published
Abstract [en]

Aims To explore nurse anaesthetists’ experiences and actions when administering and caring for children requiring anaesthesia.

Method A qualitative design employing critical incident technique was used. Interviews were carried out with a purposeful sample of nurse anaesthetists (n=32). The nurse anaesthetists’ experiences were grouped into two main areas: organisation focused and interrelational focused. Actions were grouped into two main areas: optimising the situation and creating interpersonal interaction.

Findings The categories and subcategories of the nurses’ experiences appeared to influence the outcome for the child. The nurse anaesthetists’ first priority was to create an optimal environment and increase sensitivity in their interactions with the child.

Conclusion Sensitivity to the child and flexibility in altering actions are key strategies to avoid physical restraint.

Place, publisher, year, edition, pages
2013. Vol. 25, no 1, p. 28-34
Keywords [en]
Anaesthesia, children’s surgery, nurse anaesthetists, pre-operative anxiety, peri-operative nursing
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-22671DOI: 10.7748/ncyp2013.02.25.1.28.s9537PubMedID: 23520951Scopus ID: 2-s2.0-84879189317OAI: oai:DiVA.org:hj-22671DiVA, id: diva2:678599
Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2018-03-16Bibliographically approved
In thesis
1. Nurse anaesthetist's interactions and assessment of children's anxiety
Open this publication in new window or tab >>Nurse anaesthetist's interactions and assessment of children's anxiety
2012 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Forty to sixty percent of all children having surgery experience preoperative anxiety. Preoperative anxiety is a risk factor for negative behavioural changes postoperative. It is of importance to find strategies in the interaction with the child to reduce anxiety. The overall aim was to describe CRNA's interaction with the child in relation to anxiety during anaesthesia induction and to describe the translation process of m-YPAS into Swedish and the testing of the psychometric properties in a Swedish context. In paper I an explorative qualitative approach with CIT was used and 32 CRNAs were interviewed. Experiences described were about the organisation which included effect of information, teamwork and time. Other experiences were grouped around interrelations such as, communication, meeting both anxious and calm children and experiences of use of physical restraint. Actions taken to reduce anxiety were optimizing the situation, as acting according to the situation, it could mean altering routines, though always without jeopardizing the safety of the child, preparing ahead and using distraction. Creating interpersonal interaction such as, creating contact, participation and using collaboration with the child, parents and colleagues. In paper II m-YPAS was translated into Swedish using cross cultural back translation. The psychometric properties of m-YPAS were tested in two phases. In phase I 52 children were assessed in real time by two SRNAs and one CRNA using m-YPAS and NAS. In phase II 98 video films of children were assessed by experienced CRNAs in the same way as in phase I. The psychometric properties of m-YPAS were good. Conclusion: In the interaction between CRNAs and the child, being flexible and sensitive to the child, taking the role of the child, and acting according to the need of the child were cornerstones in reducing preoperative anxiety and avoiding use of physical restraint. The m-YPAS can be used as an educational tool to enhance the anaesthetist's ability to interpret the child's anxiety. The m-YPAS is a valid and reliable assessment instrument to examine the efficiency of interventions and compare the result of research between cultures.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences, 2012. p. 72
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 32
Keywords
Preoperative anxiety, child, nurse anaesthetist, anxiety assessment
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:hj:diva-19527 (URN)9789185835317 (ISBN)
Available from: 2012-09-25 Created: 2012-09-25 Last updated: 2013-12-16Bibliographically approved
2. Developing guidelines in nursing care of children with Autism Spectrum Disorder in high technology health care settings
Open this publication in new window or tab >>Developing guidelines in nursing care of children with Autism Spectrum Disorder in high technology health care settings
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction. The high technology environment such as a radiology and anaesthesia department in a typical health care setting can many times be a frightening environment for children. Children with neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), have problems with communication and social interaction. They are dependent on routines and can have higher sensitivity to sensory stimuli than other children. These children are one group who constitutes special challenges in reducing anxiety and creating participation in a high technology environment. This can make them prone to frightening encounters in health care settings if not cared for with special consideration.

Aim: The overall aim of this thesis was to audit and enhance the care of children in a high technology environment in the health care system with a focus on children with Autism Spectrum Disorder.

Methods: A descriptive design was used with both qualitative and quantitative methods. In Study I, 32 nurse anaesthetists were interviewed to explore the actions and experiences of caring for children in a high technology environment using a qualitative method, known as the Critical Incident Technique (CIT). In the two following studies (Study II, III) a cross-sectional design was used and two national surveys were performed to obtain knowledge on the status in Sweden regarding the care of children with ASD in high technology environments. Sixty-eight anaesthesia departments, 38 paediatric departments and 86 radiology departments responded to the survey. Descriptive statistic was used for the answers apart from the comments part of the questionnaire where qualitative content analysis was used. Due to the limited existence of guidelines in these environments, the creation ofevidence-based guidelines was performed in Study IV, using a Delphi method. The Delphi study was based on information gleaned from the previous studies and from the literature, and 21 experts identified in Study II and III were the expert panel developing the guidelines.

Result: Nurses identified children with special needs such as children with ASD as a vulnerable group in a high technology environment (Study I). Seven departments in the anaesthesia context had guidelines for caring for children with ASD in the perioperative context. In the other departments, the care of children with ASD was dependent on the knowledge of the nurse presently working there (Study II). None of the radiology departments in Sweden had guidelines on how to care for children with ASD going through a radiographic examination without anaesthesia (Study III). As a result of Study I, II and III, the need for structured guidelines for caring for children with ASD in a high technology context was identified and a set of guidelines and a checklist was created. The guidelines relate to the organisational structure for the care of children with deficits in social interaction, communication, sensory sensitivity and dependence on routines. The checklist relates to gleaning information about the specific child to be able to give person-centred care based on the specific characteristic of the child (Study IV).

Conclusion: Nurses working in a high technology environment in health care have diverse experiences of preventing anxiety in children with ASD coming for a challenging procedure. There are a limited number of evidence-based guidelines to decrease anxiety and to create participation in this group ofchildren. Evidence-based guidelines were created as a tool for enhancing person-centred care in a high technology environment for this group of children. The fact that several problems are assembled under one disorder makes ASD a useful condition to have as a basis for formulating national guidelines. Guidelines that cater for the care of children with ASD in a high technology environment using a person-centred approach may also extend to the care for children with other neurodevelopmental disorders that exhibit some of the same problems as children with ASD.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2017. p. 98
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 079
Keywords
Anaesthesia, autism, children, guidelines, nurses, participation, radiology
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-35268 (URN)978-91-85835-78-2 (ISBN)
Public defence
2017-04-28, Forum Humanum, Hälsohögskolan i Jönköping, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-04-06 Created: 2017-03-28 Last updated: 2017-04-10Bibliographically approved

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Gimbler Berglund, IngalillEricsson, ElisabethFridlund, Bengt

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