Perioperative Dialogue Research Articles

Empowerment in the perioperative dialog.

AimTo describe how the nurse anaesthetist empowers the patient in the perioperative dialogue.DesignA qualitative descriptive design with interviews with 12 nurse anaesthetist (NA).MethodA hermeneutic text interpretation with a foundation in Gibson's empowerment model.ResultThe results highlight Gibson's nursing domain: Helper, Supporter, Counsellor, Educator, Resource Consultant, Resource Mobilizer, Facilitator, Enabler and Advocate. The overall understanding is revealed as a relationship can be built through closeness between the patient and the NA. The NA helps the patient master the situation by talking to and touching the patient. The patient is helped to find their own strengths and to cope with their fears. The patients decide over their own bodies. When the patients do not want to or cope with protecting themselves, the NA protects and represents the patient.

The nurse anesthetist perioperative dialog

BackgroundIn the perioperative dialogue, pre-, intra- and postoperatively, the patient shares their history. In the dialogue, the nurse anesthetist (NA) gets to witness the patient’s experiences and can alleviate the patients’ suffering while waiting for, or undergoing surgery. The aim of this study was to describe the nurse anesthetist’s experiences of the perioperative dialogue.MethodsThe study had a qualitative design. Interviews were conducted with 12 NA and analyzed with interpretive content analysis. The methods were conducted in accordance with the COREQ guidelines.ResultsIn the result, three categories emerge: A mutual meeting (the preoperative dialogue) where the patient and the NA through contact create a relationship. The NA is present and listens to the patient, to give the patient confidence in the NA. In the category, On the basis of the patient’s needs and wishes (the intraoperative dialogue), the body language of the NA, as well as the ability to read the body language of the patient, is described as important. In the category, To create a safe situation (the postoperative dialogue) the NA ensures that the patient has knowledge of what has happened and of future care in order to restore the control to the patient.ConclusionThe patient is met as a person with their own needs and wishes. It includes both a physical and a mental meeting. In a genuine relationship, the NA can confirm and unreservedly talk with the patient. When the patients leave their body and life in the hands of the NA, they can help the patients to find their inherent powers, which allows for participation in their care. Understanding the patient is possible when entering in a genuine relationship with the patient and confirm the patient. The perioperative dialogue forms a safety for the patients in the operating environment.

Anästhesie bei Kindern und Jugendlichen mit Behinderung

Children and adolescents with disabilities have the right of full and effective participation and inclusion in society. Disability includes a wide range of long-term physical, mental, intellectual and sensory impairments for various reasons. In addition to the basic illness many children with disabilities have concomitant diseases. These diseases are decisive for the perioperative risk. Information from parents regarding their child's behavioural patterns and needs, signs of escalating anxiety and pain are important. Perioperative dialog with the parents is helpful and has positive effects also from parental point of view. Pharmacologic premedication is recommended. Induction of anaesthesia can be challenging and sometimes requires unconventional methods. Pain behaviour may be unusual. There are suitable scales that incorporate such behaviours.

Pre-intra-post-operative nursing care pathway: Fragments to fusion, isolation to integration

Perioperative care refers to the care rendered during pre-operative, intra-operative and post-operative (PIP) care of patients undergoing surgery. A patient undergoes these three phases in different environments and also experiences much stress and anxiety. The relationship between patient and nurse during these phases significantly improves the outcome. Although the operating room (OR) nurses play a pivotal role in patient care, they are often unseen. With the view of linking alleviation of stress and anxiety of the patient and the visibility of OR nurses and also the fragmented and isolated care provision, the PIP nursing care pathway was developed based on the perioperative dialogue model. This pathway helps in connecting the three phases of transition, which ensures the fusion and integration of care. Based on this model, the OR nurse makes a pre-operative visit and explains about the OR environment. The same nurse receives the patient in the OR and assists in surgery. The post-operative visit is also made by the same nurse. Adapting this pathway influences patient and OR nurse satisfaction to a great extent. It also empowers the OR nurses to facilitate managed care. Visibility of OR nurses is improved by this pathway because of their interaction and involvement in all the phases. With the support of management, this pathway can be successful in order to provide effective perioperative care, which is fused instead of fragmented and integrated instead of isolated.

Perioperative dialogue on postoperative recovery measured by the use of pain medication, psychopharmaceutical agents and length of hospital stay

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.

Patients' experiences with at-home preoperative skin disinfection before elective hip replacement surgery.

The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.

The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

Hermeneutics and Human Interplay: A Clinical Caring Science Research Method

The aim of this article was to explore, exemplify, and discuss how a participatory hermeneutic method designed for children with special needs can be developed in a caring context. Examples from a clinical study are presented to illustrate how play, as both a methodological concept in hermeneutics and the substance of caring, was applied in research by means of the perioperative dialogue. In participatory research, an ethical approach based on subtle human interplay can be triggered by means of dialogue with parents. Thus, truth can emerge via continuity of care, while the substance of caring can be directed toward the child. Such a clinical method is worth adding to the child research repertoire.

The experiences of parents of children with severe autism in connection with their children’s anaesthetics, in the presence and absence of the perioperative dialogue: a hermeneutic study

The aim of this study was to obtain an understanding of what parents of children with severe autism experience in connection with their child's anaesthetics, in the presence and absence of the perioperative dialogue. Twelve parents who had experience of their child receiving anaesthetics on one or more occasions took part in this study, in which anaesthesia care was organized as a perioperative dialogue. Data were collected by means of conversational interviews, and the text was interpreted using a hermeneutic approach. The hermeneutic text interpretation led to a new understanding based on the knowledge that in the absence of the perioperative dialogue, previous anaesthetics had meant the suffering of care by the following: a hopeless struggle, unspeakable suffering and a disgraceful scenario. However, continuity in the perioperative dialogue provided to be a way out of the suffering by being received by warm hands, being received by a known face and a subtle interplay between the child and nurse. Although health and well-being may be unobtainable goals in this special context of care, the findings provided ample descriptions of the positive effects of the perioperative dialogue, which is all the more valuable when dealing with children who will need repeated anaesthetics in the future.

The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol

To evaluate the efficacy of 'the perioperative dialogue (PD)' by analyzing salivary cortisol, in 5- to 11-year-old children undergoing day surgery. To deal with anxiety prior to investigations and/or procedures, children need to be confident and informed about what is going to happen. Therefore, intervention strategies should be initiated before admission to hospital. Children (n = 93), 79 boys and 14 girls, scheduled for elective day surgery requiring general anesthesia were randomly recruited into three groups: (i) standard perioperative care (n = 31), (ii) standard perioperative care including preoperative information (n = 31), and (iii) the PD (n = 31). Saliva was sampled for cortisol analysis at specific time points during the pre- and perioperative procedures. The children who received the PD had significantly lower (P = 0.003) salivary cortisol concentrations postoperatively. Moreover, it continuously decreased during the day of surgery compared with the other two groups (P < 0.01). Among the children who received analgesics, the PD group received significantly less morphine (P = 0.014) related to bodyweight: the mean dose was 0.1 mg·kg(-1) (n = 9) in the control group vs 0.04 mg·kg(-1) (n = 6) in the PD group. Irrespective of group, there was a positive correlation between the children's morphine consumption and salivary cortisol concentration (r = 0.56; P = 0.038). The W-B scale score was higher in the group that received morphine (median = 3 vs median=1; P = 0.001). The PD's caring, continuity, and on-going dialogues were associated with low concentrations of salivary cortisol postoperatively and reduced morphine consumption and thus appears to be a valuable complement to standard perioperative care in children undergoing day surgery.

Clinical Research with a Hermenutical Design and an Element of Application

In 2008 two researchers completed a 2-year study in collaboration with nurse anesthetists and operating room nurses from three operating theaters in western Sweden. In this paper, with focus on methodology and the ethical approach to research, the aim was to describe a hermeneutical design with an element of application used in a perioperative clinical study. The element of application was chosen to involve clinical nurses to participate as coresearchers. This research was inspired by Lindholm's (2006) method for application research developed to bring new knowledge, to create change as well as to unite theory in dialogues with clinical nurses. Through the perioperative dialogue, the coreseacher not only became one who collected data but also the older patients' nurse, who cared for them. A hermeneutical text interpretation with five readings was used to gain new understanding. Perioperative care becomes evident and is dedicated to the patient in perioperative.

Older Patients and the Perioperative Dialogue - A Hermeneutical Study

This study described who the older patient undergoing surgery is as part of the perioperative dialogue and in order to understand their needs. The study used a hermeneutical design. Data were 54 transcribed stories from perioperative dialogues. The findings show that older patients undergoing surgery were persons: (a) with memories of the life they had lived, (b) whose body had betrayed them, (c) who were worried and afraid before the operation, and (d) who will need help from family and friends. The older patient is a unique human being, a wholeness with a past of their own and a life they have lived: the present – a time of change and the future – a time for recovery.

The Common World–A Model of the Perioperative Dialog, Its Ethos, and Characteristic Structural Caring Principles

The purpose for this paper was to explore, on the basis of a previous research program, the foundations of caring associated with the ethos in the common world of the perioperative dialog. A hermeneutic approach grounded in caring science was employed, in which ethos represents the ultimate meaning of caring. This approach resulted in a model comprising the caring properties and characteristic structural caring principles. As a guiding principle of the common world, ethos revealed a deeper principle of order, the responsibility of the face—“Here I am.”

Continuity created by nurses in the perioperative dialogue – a literature review

This literature review analyses eight research reports dealing with perioperative dialogues conducted between patients and nurses. The aim of this study was to summarise studies concerned with the perioperative dialogue as an organisation model for bringing safe operative practices and caring into perioperative nursing, by creating continuity for both patients and nurses in perioperative praxis and its research. How do patients and perioperative nurses experience the perioperative dialogue as a model? Perioperative nursing should be perceived as a caring profession emphasising that the focus is on perioperative caring. The perioperative dialogue has a humanistic and caring perspective and presents an ideal model on which to base perioperative nursing. There is general acceptance of the value of the perioperative dialogue for both patients and nurses as means of alleviating suffering and creating a safety nursing, with continuity in the process provided by nursing staff. This study suggests further research and that a means of measuring caring in the perioperative dialogue should be more developed.

Use of perioperative dialogues with children undergoing day surgery

This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. A grounded theory study was carried out during 2005-2006 with 15 boys and five girls (aged 6-9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. A conceptual model was generated on the basis of the core category 'enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category 'facing an unknown reality'. Additional categories show that they perceive a 'breaking away from daily routines' and that they are 'trying to gain control' over the situation. During the perioperative period, the categories 'losing control' and 'co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories 'breathing a sigh of relief' and 'regaining normality in life' emerged. The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the 'unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having 'traditional' anaesthetic care.

The Perioperative Dialogue

This article is a synthesis of 2 qualitative studies focusing on patients', anesthetists', and operating-room nurses' experiences of the perioperative dialogue and employing grounded theory as the method of analysis. The aim of the synthesis was to achieve a new holistic understanding of health in the perioperative dialogue. The synthesis highlights the importance of being in communion in a continuous whole due to continuity of care for the creation of health in both patients and nurses.

Creating new meaning or massaging old texts? Commentary on Rudolfsson et al. (2007), “The expression of caring within the perioperative dialogue: a hermeneutic study”

Editor’s Note It is not unusual for peer reviewers to provide contrasting recommendations over whether a paper meets the standard required for publication in the IJNS. This Commentary arises from such a case where two reviewers recommended publication whereas the third (Niels Buus) recommended that the paper be rejected on the grounds that the material had been published previously, a charge the authors (Rudolfsson and colleagues) denied. The issue here is whether secondary analysis of qualitative data published in two previous papers is legitimate and adds to knowledge, or is simply ‘a reworking of old texts’. On balance the editorial team decided to publish the paper and so raise qualitative secondary analysis as an issue for debate. Here, Buus argues the case against.

The expression of caring within the perioperative dialogue: A hermeneutic study

Background and aim This article, which is based on a study conducted in a perioperative context in Sweden, focuses on nurse anaesthetists’ and theatre nurses’ descriptions of caring and how caring becomes visible to patients in the perioperative dialogue. The perioperative dialogue is the pre-, intra- and postoperative meeting between the nurse and patient in connection with the latter's surgery. Methods Semi-structured interviews were conducted with 18 patients and 20 nurses, in which they described their experiences of perioperative dialogues. The interpretation process was based on Gadamer's philosophy of hermeneutics. Findings The findings indicate that, as a caring act, the vow involves: promising to allow the patient to be him/herself, promising to safeguard the welfare of the patient and promising to guide the patient through the operation as well as taking responsibility for that which I have promised. From the patient's perspective, the nurse was someone who: cares about me, takes me seriously, creates a calm atmosphere and to whom I can hand over responsibility. Conclusions Four empirical assumptions were formulated in relation to the nurse's vow and how the nurse's caring became visible to the patients.

Coronary bypass surgery patients' experiences with treatment and perioperative care - a qualitative interview-based study

The purpose of this study was to examine how coronary bypass surgery patients experienced their care. In many hospitals, including the study hospital, perioperative care is still organized in such a manner that theatre nurses have little contact with patients prior to and after surgery. Little is known about how patients experience this type of perioperative care. Nine patients were interviewed approximately a year after their operations. The interviews were qualitative and were analysed by drawing on the phenomenological method. The patients were generally satisfied with the quality of the staff-patient interactions and the information that was given prior to surgery, but some patients expressed a need for a closer postoperative followup by staff directly involved in the surgery. Most patients believed that information and support given by fellow patients was even more important to them than the support and information that was given by staff. The findings suggest that the quality of care and patients' satisfaction can be further enhanced by implementing principles from the perioperative dialogue model. For instance, by allowing for a postoperative meeting between the patient and a theatre nurse, continuity of care can be further enhanced.

Den perioperativa dialogen -- mojligheter och hinder for nya vanor i praxis

Since the beginning of 1990 the education of the Swedish perioperative nurse (anaesthesia nurses and operating room nurses) has stressed the philosophy of perioperative care, including a recent presented model of the perioperative dialogue. The aim of this study was to map managers and perioperativ nurses experiences of possibilities and obstacles for the perioperativ dialogue. A questionnaire was sent to 495 Swedish perioperative nurses and their managers. The response rate was 63% (n=314), consisting of 271 nurses and 43 managers. All open ended questions were interpreted by hermeneutics. As a result of the interpretation two major categories «new habits may be created by praxis» and «new ways of thinking may be banned», emerged. The first category describes the possibilities as; a new way of thinking is developing; managers conceive themselves as fiery spirits'; teamwork expands and routines for perioperative care is developing in praxis. The second category describes the obstacles as; unwillingness to changes; lack of fiery spirits' among nurses; lack of right to make decisions; being understaffed; and the present organisation. The study shows possibilities for launching the perioperative model and the perioperative dialogue into praxis. The dominant obstacle seems to be attitudes to changes by the staff.